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CC BY-NC-ND 4.0 · Appl Clin Inform 2024; 15(05): 898-913
DOI: 10.1055/a-2385-1654
Review Article

Defining Documentation Burden (DocBurden) and Excessive DocBurden for All Health Professionals: A Scoping Review

Deborah R. Levy   *
1   Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education Center, VA-CT, West Haven, Connecticut, United States
2   Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States
,
Jennifer B. Withall   *
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Rebecca G. Mishuris
4   Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Victoria Tiase
5   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Courtney Diamond
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Brian Douthit
6   Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
7   Department of Veterans Affairs, Tennessee Valley Health System, Nashville, Tennessee, United States
,
Monika Grabowska
6   Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
,
Rachel Y. Lee
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Amanda J. Moy
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Patricia Sengstack
6   Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
8   Vanderbilt University Medical Center, School of Nursing, Nashville, Tennessee, United States
,
Julia Adler-Milstein
9   Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, California, United States
,
Don Eugene Detmer
10   Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Kevin B. Johnson
11   Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine; University of Pennsylvania, United States
12   Applied Informatics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
James J. Cimino
13   Department of Biomedical Informatics and Data Science, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Sarah Corley
14   MITRE Corporation, Center for Government Effectiveness and Modernization, McLean, Virginia, United States
,
Judy Murphy
15   Indepdendent, Minneapolis, Minnesota, United States
,
S. Trent Rosenbloom
6   Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
,
Kenrick Cato
16   Children's Hospital of Philadelphia and University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
,
Sarah C. Rossetti
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
17   Columbia University School of Nursing, New York, New York, United States
› Author Affiliations Funding This work was supported by American Medical Informatics Association (AMIA)'s 25 × 5 Task Force and the Agency for Healthcare Research and Quality (AHRQ 1HS028454-01A1 Essential Nurse Documentation: Studying EHR Burden during COVID-19 [ENDBurden]). Funding not specific to this work: D.R.L. is supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations, Office of Research and Development, and has access to facilities at the VA Connecticut Healthcare System, West Haven, CT (CIN-13-407). C.D. receives support from U.S. National Library of Medicine t15 Grant 5T15LM007079.
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Abstract

Objectives Efforts to reduce documentation burden (DocBurden) for all health professionals (HP) are aligned with national initiatives to improve clinician wellness and patient safety. Yet DocBurden has not been precisely defined, limiting national conversations and rigorous, reproducible, and meaningful measures. Increasing attention to DocBurden motivated this work to establish a standard definition of DocBurden, with the emergence of excessive DocBurden as a term.

Methods We conducted a scoping review of DocBurden definitions and descriptions, searching six databases for scholarly, peer-reviewed, and gray literature sources, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review guidance. For the concept clarification phase of work, we used the American Nursing Informatics Association's Six Domains of Burden Framework.

Results A total of 153 articles were included based on a priori criteria. Most articles described a focus on DocBurden, but only 18% (n = 28) provided a definition. We define excessive DocBurden as the stress and unnecessarily heavy work an HP or health care team experiences when usability of documentation systems and documentation activities (i.e., generation, review, analysis, and synthesis of patient data) are not aligned in support of care delivery. A negative connotation was attached to burden without a neutral state in included sources, which does not align with dictionary definitions of burden.

Conclusion Existing literature does not distinguish between a baseline or required task load to conduct patient care resulting from usability issues (DocBurden), and the unnecessarily heavy tasks and requirements that contribute to excessive DocBurden. Our definition of excessive DocBurden explicitly acknowledges this distinction, to support development of meaningful measures for understanding and intervening on excessive DocBurden locally, nationally, and internationally.

Keywords

electronic health records and systems - documentation burden - excessive documentation burden - clinician documentation - burden - usability - informatics - health informatics - health care

After Reading this Work

Readers will understand the concept of DocBurden and excessive DocBurden, the origins of the current domains of DocBurden and be able to articulate a singular standardized definition of excessive DocBurden that can be applied to all HPs.


Research Question

What is a standardized definition of excessive DocBurden to guide and align efforts to reduce burden across a variety of domains, settings, and from various stakeholder perspectives?


Protection of Human Subjects

No human subjects were involved in the project.


Authors' Contribution

D.R.L., J.B.W., S.C.R., and K.C. conceptualized the project. D.R.L., J.B.W. designed the search strategies. B.D., C.D., M.G., D.R.L., R.L., or J.B.W. independently evaluated the titles and abstracts for inclusion and exclusion criteria. Data were extracted by one reviewer (C.D., M.G., R.L., or J.B.W.) and verified by another (D.R.L. or J.B.W.). All authors contributed to the concept clarification phase. The manuscript was drafted by D.R.L. and J.B.W., with detailed feedback from S.C.R., B.D., and K.C. The manuscript and standardized definitions were reviewed in detail by expert coauthors (P.S., K.J., J.A.M., D.E.D., J.J.C., S.C., J.M., A.J.M., S.T.R.). The complete manuscript (drafts and final version) was reviewed in detail by all coauthors.


Data Availability Statement

The data underlying this article are available in the article and in its online [Supplementary Appendix Materials].


Disclaimer

The contents of this manuscript represent the view of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. Government. A.J.M. reports employment by JP Morgan Chase, that her views are hers alone, and do not represent those of JP Morgan Chase, and this work was performed on her own time.


* Co-primary authors.


Supplementary Material



Publication History

Received: 29 May 2024

Accepted: 06 August 2024

Accepted Manuscript online:
13 August 2024

Article published online:
30 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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