National Plan for Health Workforce Well-Being (2022)

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5 Priority Area: Engage Effective Technology Tools Optimize and expand the use of health information technologies that support health workers in providing high-quality patient care and serving population health, and minimize technologies that inhibit clinical decision-making or add to administrative burden. “The best redesign would be to really incorporate those who are working on the frontline in the decisions that are being made. Often the administration, who do not know what it's like to be swamped in the trenches of illness and disease, are the ones making the decisions.” - Frontline Health Worker1 Well-designed health information technology (IT) can support the delivery and management of care and disease prevention, but poorly designed health IT can introduce frustration and errors into the care process, making it more difficult (NASEM, 2019). The im- plications can be pronounced in health care, where the ubiquity of electronic health records (EHRs) has significantly increased access to useful data for patient care and health care research. Unfortu- nately, EHRs are also among the most highly cited causes of health worker frustration and burnout (NASEM, 2019). Health workers report frustration stemming from several aspects of EHRs, includ- ing cumbersome design, decisions made at implementation (e.g., whether a nurse or medical assistant can document within fields 1 For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/ clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/. 43 

44 | National Plan for Health Workforce Well-Being outside of the chief complaint, what actions require an order, etc.), and unclear requirements from regulating bodies. EHRs also serve as the dataset for billing by health entities, with varying require- ments and processes for reimbursement. Often, there are different data needs for what information must be recorded for the patient’s health needs and what should be recorded for enhanced billing. In many instances, the lack of integration of administrative require- ments in EHRs means the same note is duplicated by different team members, contributing to unnecessarily lengthy and unclear records. This tension can add to health worker stress and burnout (NASEM, 2019). Inefficient workflows can be as or more problematic than the EHR for health workers. Interruptions and distractions “are asso- ciated with lower-quality and less safe care” (NASEM, 2019). They also “add to cognitive burden, delay task completion, and increase the risk of forgetting tasks” (NASEM, 2019). Health workers have suggested ways to deploy technologies—including but not limited to EHRs—to enable more efficient work and care and contact trac- ing in public health (Alotaibai et al., 2017; O’Shea, 2020). There are many opportunities to reorient health IT systems to reduce work- place stress and enhance professional well-being in the domains of design, implementation, and regulation. Health IT companies, via the EHR and other digital platforms, can have a tremendous effect on well-being if the private sector develops greater will to invest resources in well-designed health IT to serve all users, especially health workers. PREPUBLICATION COPY - Uncorrected Proofs 

Engage Effective Technology Tools | 45 Priority Area: Engage effective technology tools. Health IT is user friendly and affordable, and meets Goal 1 standards co-designed with users. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Health Systems Actors Health Workers Insurers and Payers Patients Private and Non-Profit Organizations 1A. Promote necessary interactions of stakeholders to design and improve documentation systems and leverage better technology solutions that are health-oriented and human- centered. 1B. Conduct research on how to develop and apply health IT that supports health workers in care delivery, including pre- vention services and contact tracing. Actions 1C. Define standards for all health technologies to be clini- cally useful and accurate. Include standards for the follow- ing domains: usability/user experience before and after implementation of technology, degree of cognitive load, and degree of clinical decision-making support. 1D. Create market advantages for producing technologies that are human-centered and highly user friendly. PREPUBLICATION COPY - Uncorrected Proofs 

46 | National Plan for Health Workforce Well-Being Health IT is interoperable across disciplines and Goal 2 platforms to enhance team-based care and continuity of care. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Actors Health Systems Health Workers Patients 2A. Encourage the adoption of existing interoperability standards and the development of enhanced interoperability standards. Actions 2B. Discourage proprietary solutions that are not interoper- able. PREPUBLICATION COPY - Uncorrected Proofs 

Engage Effective Technology Tools | 47 Technology innovations improve both patient care and Goal 3 workload of health workers. Federal, State, and Local Governments Health Information Technology (IT) Companies Health Systems Actors Health Workers Patients Professional and Specialty Societies 3A. Deploy health IT using human-centered design and hu- man factors and systems engineering approaches to ensure the effectiveness, efficiency, usability, and safety of the technology. 3B. Develop widgets that focus on documenting individual services. Actions 3C. Establish a joint public-private fund for technology and EHR optimization to improve workloads and workflows. 3D. Establish partnerships with social service agencies to connect patients to services and ensure their pertinent health information can be shared in a meaningful way. PREPUBLICATION COPY - Uncorrected Proofs 

48 | National Plan for Health Workforce Well-Being Technologies facilitate increased personal connections Goal 4 with patients. Health Information Technology (IT) Companies Health Systems Actors Health Workers Patients 4A. Automate processes to streamline the health care team’s workflow (e.g., ambient artificial intelligence, virtual scribes, or voice assistants) to allow health workers to focus on lis- tening to patients, rather than manually documenting notes at the computer, and increase patient safety. Actions 4B. Offload and/or automate the administrative tracking tasks associated with preventive care (e.g., natural language processing technologies for inbox management), so health workers can focus on more complex care needs and commu- nicating information to the patient. PREPUBLICATION COPY - Uncorrected Proofs 

Engage Effective Technology Tools | 49 The use of technology is understood and established as Goal 5 an enabler to streamline care. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Health Information Technology (IT) Companies Health Systems Actors Health Workers Insurers and Payers Patients 5A. Employ technology tools to maintain personal safety (e.g., ability to videoconference into a patient’s room when appropriate) when treating communicable diseases or while calling on other experts and members of the care team (e.g., virtual reality headsets). 5B. Use EHR audit-log data to characterize the work envi- Actions ronment and assess whether interventions to improve the environment were effective. 5C. Create publicly available accountability measures. 5D. Examine the benefits and drawbacks to using technol- ogy, video, and phone consultations in addressing workforce burnout and patient health. NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being. PREPUBLICATION COPY - Uncorrected Proofs 

50 | National Plan for Health Workforce Well-Being RELATED RESOURCES2 1 Enhance Workplace Efficiency • Calculator/Guide: Team Documentation: Improve Efficiency, Workflow, and Patient Care (American Medical Association) • Webinar: Taming the EHR (American Medical Association) • Case Study: HCA Healthcare’s Program to Streamline Docu- mentation for Nursing (American Hospital Association) • Case Study: Just in Time: EHR Training at Atlantic Medical Group (American Hospital Association) • Commentary: Evaluating and Reducing Cognitive Load Should Be a Priority for Machine Learning (Ehrmann, et al., 2022) • Framework: Trusted Exchange Framework and Common Agreement (Office of the National Coordinator for Health IT) Strengthen Leadership Behaviors • Webinar: Reframing Burnout through Human Factors: In- tegrating Well-Being and Patient Safety (American Hospital Association) 2 For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/. PREPUBLICATION COPY - Uncorrected Proofs