A recent scoping review titled "Defining Documentation Burden (DocBurden) and Excess DocBurden for All Health Professionals," published in Applied Clinical Informatics, presents standardized definitions of documentation burden as applied in healthcare. Led by Deborah Levy, MD MPH MS, a 3rd-Year Postdoctoral Research Fellow in Advanced Informatics at the Department of Veterans Affairs at VA-Connecticut and a Lecturer at Yale School of Medicine in BIDS, and Jennifer Withall, RN PhD, from Columbia University Department of Biomedical Informatics (DBMI), the work addresses the lack of a widely accepted definition of DocBurden and introduces an emergent term of Excessive DocBurden. DocBurden is a well-established issue associated with stress and decreased health professional well-being, contributing to reduced patient safety. The new standardized definition can serve as a foundation for future research and policy development aimed at alleviating documentation burden.
Key findings from the review include:
- Standardized Definitions: The study introduces a clear definition of "documentation burden" (DocBurden) and a new term, "Excessive DocBurden," which describes the overload experienced by health professionals when EHR system usability fails to align with the needs health professionals in care delivery.
- Literature Gap: An analysis of 153 sources revealed that while 82% discussed documentation burden, only 18% provided explicit definitions, highlighting a significant gap in existing literature.
- Opportunities for Mitigation: The research supports development of strategies to reduce both DocBurden and Excessive DocBurden, with the future potential to improve clinician well-being and patient safety.
This work was performed with an awareness of ongoing initiatives including the AMIA 25x5 Task Force and the National Burden Reduction Collaborative, which aim to improve the experience of healthcare for health professionals and patients through coordinated action. Dr. Levy has served on the AMIA 25x5 Task Force since it’s inception and is a current member of the Impact Workstream. Expert co-authors were included from within AMIA and the AMIA 25x5 Task Force community.
Dr. Levy shared that this is exactly the type of high impact work and contribution to national efforts to mitigate DocBurden that drew her to pursue a career as a physician informatician.
I hope to improve the experience of healthcare for patients and health professionals through the adept use of technology. Co-leading this work was an immense honor and directly supports this mission. My positive experiences guiding the engagement of the esteemed interprofessional co-author team, with each member bringing a depth of expertise, are reflected in the clarity and wide applicability of the definition.” Dr. Levy continues, “I was particularly impressed by the concept clarification phase of work, as we iteratively refined the definition and identified the emergent term of Excessive DocBurden. Differentiating the burden from necessary tasks to carry out healthcare (DocBurden) from the EHR tasks that are low value and potentially more stress-inducing (Excessive DocBurden) has the potential to advance the thus far elusive task of measurement in this domain.
Deborah R Levy, MD, MPH, MS