• The Reducing Clinician Burden (RCB) Project is a formal activity of the Health Level Seven (HL7) Electronic Health Record Work Group (EHR WG). The project is open, transparent and collaborative, includes a diverse array of contributors from the health/healthcare community (US and International) and is not limited to HL7 members (although HL7 membership is encouraged – see http://www.hl7.org for additional details). Contributors represent a wide variety of training and backgrounds and include front line clinicians, clinical informaticians, software developers, standards developers, providers, payers and policy makers.  (Note that there are also other HL7 activities addressing burden reduction including several within the HL7 Da Vinci FHIR Accelerator Project which focuses on provider/payer communications.)

  • A primary objective of the RCB Project is to understand the substance, extent and impact of clinician burden – particularly with regard to front-line clinicians and their role in clinical practice, patient health and well-being, diagnosis and treatment of diseases, clinical decision making, clinical documentation, and patient safety. Our ongoing goals are to better understand the root causes of clinician burden, to share success stories regarding the use of information technology (IT) to mitigate burden, and to support novel and disruptively innovative advances that will allow healthcare IT to reduce burden and improve care quality by better supporting clinical workflow.

  • Given that the RCB Project is a function of the HL7 EHR WG, we are particularly focused on clinician burden(s) such as increased cognitive load, decreased efficiency, and data quality burdens associated with:
    1. implementation and use of EHR/HIT systems in clinical practice;
    2. capture, exchange and use of health data/records.

Please subscribe to the HL7 EHR WG listserver for meeting announcements, agendas and updates regarding current work.

NOTE: DRAFT documents may be incomplete and are posted for Team review and discourse. Please take care to note their draft (tentative) status if referencing or sharing with others.

NOTE: Some document links will take you to an intermediate page with another link to the actual document (a click on that 2nd link should give you access).  We are working to resolve this issue.

Table of Contents - click on the desired topic or section.

BREAKING NEWS - February 2023 - US Physician Burnout increased by 6% since 2021, 26% since 2018...

Please review these recently published articles.  First is the Medscape Report/Survey on US Physician Burnout and Depression 2023, followed by another perspective - commentary from the New York Times Opinion Section:

           Medscape - Physician burnout and depression continue to climb, Article by Mariah Taylor, published 27 Jan 2023

            Medscape - 29 physician specialties ranked by 2022 burnout rates, Article by Erica Carbajal, published 1 Feb 2023

            Medscape - "I Cry but No One Cares” - US Physician Burnout and Depression Report 2023, Slide Set by Leslie Kane MA, published 6 Feb 2023

           NY Times - Another Opinion - Doctors Aren’t Burned Out From Overwork - We’re Demoralized by Our Health System, Eric Reinhart MD, published 5 Feb 2023

HL7 EHR WG/Reducing Clinician Burden Related Meeting Schedule

Special thanks to Dr. Michael Brody for the GoToMeeting facilities.

NEW!  Reducing Clinician Burden - How to Get Involved and Contribute

New!  Burden Reduction Initiatives and Activities YOU can Join - HL7 + Others 

HL7 RCB Project - Presentations and Reports

Additional presentations are included in the "Success Stories" section below.

HL7 RCB Project - Analysis, Derivations and Worksheets

  • DRAFT Reducing Clinician Burden Analysis Worksheet, dated 11 Apr 2022
    All reference sources up through #135 have been reviewed and are incorporated in this version. See "References" Tab.
  • Burden Impact Statement, updated 19 Mar 2021
    The HL7 Burden Impact Statement (BIS) targets HL7 Projects – to assess potential impact on clinician burden and identify possible benefits toward burden reduction. Intended for inclusion as part of HL7 Project Scope Statements (new projects) and within HL7 Standards and Implementation Guides. The BIS is a collaboration with, and has been endorsed upon submission by, the American Medical Association.
  • UPDATED!  DRAFT Data Usability Characteristics/Qualities, Gary Dickinson, updated 28 Feb 2023
    These comments were submitted to the Sequoia Project, Data Usability Workgroup, as part of their consideration of characteristics/qualities of health data that make it usable - for particular end uses/end users (e.g., clinicians in clinical practice) and are derived from analysis of the RCB Project.
  • UPDATED!  DRAFT Requirements Statements Applicable to USCDI, Candidate Standards and Systems, Gary Dickinson, updated 28 Feb 2023
    Additional comments submitted to the Sequoia Project, Data Usability Workgroup.  EXAMPLES of requirements statements that might be derived from Data Provenance Use Cases.  This update reflects audit log detail consistent with ASTM E2147-18 - as required for ONC EHR/HIT system certification in Dec 2022.
  • Response to US Office of National Coordinator - 2030 Health Interoperability Outcomes, Gary Dickinson, submitted 30 Jul 2021
    These comments were developed and submitted in response to the ONC Request for Comments - partially based on HL7 EHR Work Group/RCB Project Team analysis.
  • DRAFT Reducing Clinician Burden - Cause Matrix, updated 12 Apr 2021
    This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.
  • Reducing Clinician Burden Comments on ISO DIS 27269 - International Patient Summary, dated 30 Mar 2020
    These comments on the DRAFT International Patient Summary were prepared in correspondence with findings of the HL7 RCB Project and clinician burdens associated with patient summary creation, exchange and use, particularly with regard to aspects of information overload, data integrity, patient/provider identity matching, preservation of clinical data context, reconciliation of medications, medication allergies, all allergies, problems/diagnoses and more.
  • UPDATED!  DRAFT Clinical Documentation - Collect, Share, Use - Information Flow and Lifecycle Example - including Intersections with Clinician Burden and Safety Concerns, updated 23 Feb 2023, .pdf version.xlsx version (Command-Click to download directly)
    This worksheet shows a typical end-to-end information flow for clinical documentation, starting at the point of origination (authorship) of a health record entry - following with points of update, verification, attestation, exchange (transmit and receipt) - ending at the point where record entry content is accessed/used for subsequent patient care, interventions and decision making.
  • UPDATED!  DRAFT Clinical Documentation - Ensuring End-to-End Fidelity, dated 2 Apr 2023
    This graphic asks the question "How Might We Ensure End-to-End Fidelity as We Collect, Share and Use Clinical Documentation?", considering what the author sees/intends and how that corresponds to what the end user sees.
  • UPDATED!  DRAFT Clinical Documentation - Collect, Share, Use - Data Segmentation for Clinical Integrity, dated 2 Apr 2023
    This graphic shows a Clinical Documentation Instance and subsequent clinical and non-clinical flow based on its segments: •provenance, •clinical facts, findings and observations, •order detail, •prior authorization detail, •billing/claims detail, •quality/performance data, •public health data, •administrative data, •finance/cost data, •registry data... Each segment represents a purpose of collection and a corresponding purpose of use, based on stakeholder needs.
  • UPDATED!  “A Perspective on the History and Progression of EHR System Functionality Standards, Certification and Adoption”, Gary Dickinson, updated 8 May 2023
    This document offers a timeline of HL7 and ISO TC215 EHR system functionality standards development activities from 2000 to the present.
  • "Re-Envisioning HL7", Gary Dickinson, submitted 30 Nov 2020
    These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.

HL7 RCB Project Project Team - Problem-Oriented Health Record (POHR)

The RCB Problem-Oriented Health Record Project Team has developed their initial standard - focused on functionality for Problem List Management - and addition work is underway.  Co-Leads:  Lincoln Weed JD (ldweed424@gmail.com), Charles Burger MD (Cburger710@gmail.com), Ryan McMullins MD, Joel Buchanan MD (jbuchanan@uwhealth.org)

See the POHR Meeting schedule above - with GoToMeeting link.  If you have experience and/or an interest in this topic, please join us.

POHR is now an active HL7 Project with its own Confluence page.  Please follow this link:  Problem Oriented Health Record (POHR)

HL7 RCB Project Focus Team - Medication List Management and Reconciliation

The RCB Medication Reconciliation Burden Reduction Focus Team is underway.  Co-Leads:  Reed Gelzer MD (r.gelzer@trustworthyehr.com), James Tcheng MD (james.tcheng@duke.edu)

The Focus Team meets first Wednesday monthly at 5PM ET (US) using the Zoom Link noted above.  If you are a clinician with medication reconciliation experience, please join us.

HL7 RCB Project Focus Team - Artificial Intelligence (AI)

Recently the HL7 EHR WG/Reducing Clinician Burden Project Team received several reports/presentations regarding the substantial potential of Artificial Intelligence/Machine Learning in burden reduction and would like to start a dialogue within the HL7 Community in this regard.
•  How might we best assess this topic?
•  What might we identify as drivers of our interest and potential outcomes/results of related endeavors?
•  What standards development projects/products should be the first priority and most immediately advantageous/beneficial to the health/healthcare community?  
•  Who should be part of any AI/ML collaboration (both internal and external to HL7)?

Please follow this link for additional details:  Artificial Intelligence (AI)

HL7 RCB Project - Reducing Burden - Success Stories

The HL7 EHR WG/Reducing Clinician Burden Project Team has invited a number of healthcare provider and other organizations to share their positive experience(s) in reducing clinician burden and burnout.  Their success stories are outlined in the following presentations.  Please contact the authors directly for further information on their projects.  (Most represent work still in progress).

HL7 EHR WG - Electronic Health Record System Functional Model (EHR-S FM)

  • HL7 EHR-S FM Release 2.1
    Current HL7 EHR System Functional Model, balloted and published by HL7 in 2020;  Anticipated adoption by ISO in 2022 as ISO/HL7 10781.
  • NEW!!  HL7 EHR System Usability Functional Profile Release 1, published 2 Jan 2023
  • UPDATED!!  EHR-S FM Based Functional Profiles, dated 8 May 2023
    Current Set of Functional Profiles (FPs), based on EHR-S FM (various releases), defined for specific requirements of care settings, services, specialties and other domains.  These were developed by the HL7 EHR and other WGs.  Additional FPs (not listed) have been developed by EHR system developers, healthcare providers, certification bodies, government agencies and others.
  • UPDATED!!  EHR-S FM Known National Initiatives, dated 8 May 2023
    National initiatives known to have used the EHR-S FM for EHR development programs, certification and accreditation purposes.

HL7 RCB Project - Our Conversations with US Centers for Medicare and Medicaid Services (CMS), Office of Burden Reduction and Health Informatics (OBRHI)

We are engaged in a continuing conversation with the US CMS OBRHI.  Following are OBRHI presentations and teleconference recordings for your reference.

HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot

This ballot closed on 14 September 2020.

HL7 RCB Project - White Paper

This White Paper has been released for Project Team review and comment.

Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic

"See What We Mean"

HL7 RCB Project - Survey and Responses

HL7 RCB Project - Focus Team Drafts

US Office of National Coordinator for Health Information Technology (ONC)

ONC Strategy for Reducing Burden

US National Academy of Medicine

US Department of Health and Human Services (HHS) Patients over Paperwork Initiative

More RCB Perspectives and Resources

HL7 RCB Project - Reference Sources