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 implications 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. Unfortunately, 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, including cumbersome design, decisions made at implementation (e.g., whether a nurse or medical assistant can document within fields

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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/.

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 requirements 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 requirements 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 associated 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 tracing in public health (Alotaibi and Federico, 2017; O’Shea, 2020). There are many opportunities to reorient health IT systems to reduce workplace 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.

Goal 5.5.	The use of technology is understood and established as an enabler to streamline care.
Actors		Academic Institutions, Clinical Training Programs, and Accreditation Bodies
		Health Information Technology (IT) Companies
		Health Systems
		Health Workers
		Insurers and Payers
		Patients
Actions	5.5.A. 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).
	5.5.B. Use EHR audit-log data to characterize the work environment and assess whether interventions to improve the environment were effective.
	5.5.C. Create publicly available accountability measures.
	5.5.D. Examine the benefits and drawbacks to using technology, 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.

RELATED RESOURCES^{2 1}

Enhance Workplace Efficiency

• Calculator/Guide: Team Documentation: Improve Efficiency of EHR Documentation (Sinsky, 2014)
• Guide: Taming the Electronic Health Record Playbook (Jin et al., 2022)
• Case Study: HCA Healthcare’s Program to Streamline Documentation 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 Information Technology)

Strengthen Leadership Behaviors

• Webinar: Integrating Patient Safety and Clinician Wellbeing (Privitera and MacNamee, 2021)

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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/.