CC BY 4.0 · Appl Clin Inform 2021; 12(05): 1061-1073
DOI: 10.1055/s-0041-1739518
Research Article

Clinician and Health Care Leaders' Experiences with—and Perceptions of—COVID-19 Documentation Reduction Policies and Practices

Amanda J. Moy
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Jessica M. Schwartz
2  Columbia University School of Nursing, New York, New York, United States
,
Jennifer Withall
2  Columbia University School of Nursing, New York, New York, United States
,
Eugene Lucas
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
3  NewYork-Presbyterian Hospital, New York, New York, United States
,
Kenrick D. Cato
2  Columbia University School of Nursing, New York, New York, United States
3  NewYork-Presbyterian Hospital, New York, New York, United States
4  Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, United States
,
S. Trent Rosenbloom
5  Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
,
Kevin Johnson
5  Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
,
Judy Murphy
6  Twin Cities, Minnesota, United States
,
Don E. Detmer
7  Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States
,
Sarah Collins Rossetti
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
2  Columbia University School of Nursing, New York, New York, United States
› Author Affiliations
Funding The 25 × 5 Symposium was supported through the U.S. National Library of Medicine (NLM) grant 1R13LM013581-01 and co-sponsored by AMIA. The co-authors are also supported through training grants from the NLM 5T15LM007079 and the National Institute for Nursing Research (NINR) 5T32NR007969.

Abstract

Background Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States.

Objectives The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic.

Methods We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed.

Results Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1–61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), changing compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7–63.7%).

Conclusion The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.

Author Contributions

A. J. M., S. C. R., and J. M. S. initiated the project, methods, and analysis plan. A. J. M. drafted the manuscript and conducted the quantitative analysis. A. J. M. and J. W. conducted the qualitative analysis. J. M. S. and A. J. M. led the survey development and distribution. J. M. S., E. L., K. D. C., J. W., J. M., S. T. R., and S. C. R. contributed to edits. All members of the 25 × 5 Steering Committee contributed as authors, tested the survey instrument, provided conceptual feedback, and approved the final manuscript.


Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Columbia University Irving Medical Center Institutional Review Board.


Supplementary Material



Publication History

Received: 20 July 2021

Accepted: 30 September 2021

Publication Date:
24 November 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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