Paper Seeks to Standardize Definition of Documentation Burden

A new paper in the journal Applied Clinical Informatics seeks to clarify and standardize the concept of documentation burden across health professions. 

The review was authored by AMIA 25x5 Task Force members Deborah Levy, M.D., M.P.H., M.S., Jennifer Withall, Ph.D., and colleagues. 

The AMIA 25x5 Task Force is charged with reducing excessive documentation burden to 25 percent of the current state. In addition to standardizing the necessary definitions, the task force uses data collected through surveys to measure and trend perceived documentation burden among all health professionals documenting patient care in the EHR. The TrendBurden open dataset is available for academic and clinical research. 

The authors note that documentation burden has lacked a precise, universally accepted definition—until now. They say that a clear standardized definition is crucial for aligning efforts aimed at reducing both “DocBurden" and excessive DocBurden, as well as tracking progress towards this goal. This scoping review introduces an inclusive, interprofessional standardized definition of DocBurden, providing a foundation for future research, initiatives, and policies. Additionally, it enhances clarity on the evolving discourse surrounding excessive DocBurden within the U.S. healthcare system. 

The objective of the study was to align efforts to reduce DocBurden, such as the AMIA 25x5 Task Force Initiative and the National Burden Reduction Collaborative, with other national initiatives targeting clinician wellness and patient safety by providing a necessary standardized definition of documentation burden for health professionals.

“While there is an abundance of peer-reviewed and gray literature, not all stakeholders talk consistently about documentation burden,” said Sarah Rossetti, R.N., Ph.D., chair of the AMIA 25x5 Task Force, in a statement. "It’s hard to move the needle and impactfully reduce documentation burden when all stakeholders are not universally approaching the problem. The goal of the 25x5 Task Force from the beginning was to facilitate a standard definition for more effective conversation around mitigating and reducing documentation burden."