25 By 5: Symposium to Reduce Documentation Burden
on U.S. Clinicians by 75% by 2025

The overall symposium goal is to establish strategies and approaches to reduce clinician documentation burden on US clinicians to 25% by 2025.

Specific meeting goals include: 1) Engage a diverse group of key stakeholders and leaders focused on reducing documentation burden 2) Assess the likely potential for burden reduction within categories of documentation burden, including identifying ‘low hanging fruit’ for ‘quick wins’ without adversely impacting quality or access to care 3) Establish approaches for immediate (<3 months) and short-term (6 months) reduction in clinical documentation burden 4) Generate approaches to longer term (10 years) elimination of clinical documentation burden. Attendees are expected to commit to furthering the mission of reducing clinician documentation burden by leading and raising awareness of the outputs, action items, and initiatives that result from this symposium series.

If you have any questions or wish to join our listserv, please send your name, institution and email address to 25by5@lists.cumc.columbia.edu.
Funded by the National Library of Medicine (1R13LM013581-01)

Symposium Series Schedule – Save The Dates!

Session Leaders: Kevin Johnson, MD, MS, FAAP, FACMI (Professor and Chair of Biomedical Informatics, Vanderbilt University) and Judy Murphy, RN, FACMI, LFHIMSS, FAAN (Previous IBM CNO and ONC Deputy National Coordinator for Programs and Policy)

Download Session 1 chat here. If you want to use the chat for analysis and need a text file, please reach out to a member of the steering committee. 

Symposium Introduction and OverviewSlides

• Current Challenges Related to What We Document  
     Keynote Panel: Policy and Reimbursement Issues
          – ONC Cures Act Final Rule and Challenges Tackled: Andrew Gettinger, MD (Chief Clinical Officer, ONC) • Video
          – Documentation Requirements: Balancing Quality, Safety and Program Integrity: Mary Greene, MD (Director, Office of Burden Reduction & Health Informatics, CMS) • Video
          – Quality Measurement for Ranking versus Change and Implications on Expense and Burnout: Brent James, MD (Clinical Professor (Affiliated), Dept of Medicine, Stanford University School of Medicine) • Video Slides

Policy and Reimbursement Discussion / Q&A Video

     Keynote Panel:  Clinical Practice and Documentation Issues
          – Nursing Documentation and Med Rec: Sharon Kirby, MSN, RN-BC (Previous Chief Nursing Informatics Officer, Department of Nursing, Mayo Clinic) • VideoSlides
Cognitive Burden: Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS (Chief Nursing Informatics Officer, Banner Health) • VideoSlides
Diversity, Equity & Inclusion: Kenrick Cato, PhD, RN, CPHIMS (Assistant Professor, Columbia University School of Nursing; Nurse Researcher, NewYork-Presbyterian Hospital) • Video Slides

Clinical Practice and Documentation Discussion/Q&A Video

Summarization & Prioritization of Challenges/use audience polling Video

Wrap-Up and Set the Stage for Session 2 and beyond Video

Session Leaders: Patty Sengstack, DNP, RN-BC, FAAN (Senior Associate Dean of Informatics, Vanderbilt University School of Nursing) and Chris Lehmann, MD, FAAP, FACMI, FIAHSI (Director, Clinical informatics Center, UT Southwestern Medical Center)

• Current Challenges Related to “How We Document” 

Symposium Re-Introduction and Overview, Session 1 Review: Trent Rosenbloom, MD, MPH, FACMI (Vice Chair for Faculty Affairs and a Professor of Biomedical Informatics, Vanderbilt University) Video • Slides

Introduction of Session 2VideoSlides

• Keynote Panel 1: Data Entry Challenges 
Introduction of panel members
     – “Oh the pain” – Usability – (Aaron) Zachary Hettinger, MD (Director of Cognitive Informatics, MedStar Health National Center for Human Factors in Healthcare) • Video Slides
     – “Oh the interruptions” – Workflow – Kim Unertl, PhD (Associate Professor of Biomedical Informatics in the School of Medicine at Vanderbilt University) VideoSlides
     – “Oh all these boxes” – Forms based documentation and device integration – Susan McBride PhD, RN-BC, CPHIMS, FAAN (Professor, Program Director Nursing Informatics Graduate Program, Texas Tech University Health Sciences Center) • Video

Panel 1 Discussion and Q&AVideo

• Keynote Panel 2: Alternative Data Entry  
Introduction of panel members
    – “Is anyone listening?” Issues related to team-based documentation and use of scribes – Peter Chabot Smith, MD (Department of Family Medicine, University of Colorado) • Video
     – “Computer- are you there?” Voice recognition – Yaa Kumah-Crystal, MD, MPH, MS (Assistant Professor of Biomedical Informatics and Pediatric Endocrinology at Vanderbilt University Medical Center) VideoSlides
     – Copy & Paste – Benefits and other safety issues – Lorraine Possanza, DNP, JD, MBE (Program Director, Partnership for Health IT Patient Safety) VideoSlides

Panel 2 Discussion and Q&AVideo

Summarization & Prioritization of Challenges/use audience polling and Wrap-Up and Set the Stage for Session 3 and beyondVideo

• Chat Moderators: Kenrick Cato, RN, PhD and Judy Murphy, RN, FACMI, LFHIMSS, FAA

Session Leaders: Kenrick Cato, PhD, RN, CPHIMS (Assistant Professor, Columbia University School of Nursing; Nurse Researcher, NewYork-Presbyterian Hospital) and Karthik Natarajan, PhD (Assistant Professor in the Department Biomedical Informatics at Columbia University)

IntroductionVideo

• Exemplars panel 
     – CDARS – Clinical Data Analysis and Reporting System: NT Cheung (Chief Medical Informatics Officer, Hong Kong’s Hospital Authority)VideoSlides
     – NHSX: Natasha Phillips, RN (Chief Nursing Information Officer NHSX, London, England, United Kingdom)Video Slides
     – HL7: Viet Nguyen, MD (Founder, Stratametrics; Technical Director, HL7 Da Vinci Project)Video Slides
     – Evidence-Based Documentation: William Dan Roberts, PhD (Vice President Care Delivery and Performance at HCA Healthcare)Video Slides

DiscussionVideo

• Exemplars panel
     – Project JOY: Bonnie Adrian, PhD (RN-BC, Research Nurse Scientist, Clinical Informatics, UC Health)Video Slides
     Clickbusters: Adam Wright, PhD, FACMI, FAMIA, FIAHSI (Professor Department of Biomedical Informatics, Vanderbilt University)Video
     – TrekIt: Subha Airan-Javia, MD (CEO & Founder CareAlign.AI; Associate Professor of Clinical Medicine, University of Pennsylvania)Video
     – Approaching DEI from a Cancer Survivorship planning perspective: Helen Palomino, LCSW (Chief Executive Officer, The Cancer Resource Center of the Desert)Video Slides

Discussion, wrap-up and set the stage for Session 4 and beyondVideo

Session Leader and Panel Moderator: Kenneth D. Mandl, MD, MPH (Director, Computational Health Informatics Program, Boston Children’s Hospital; Donald A.B. Lindberg Professor of Biomedical Informatics and Pediatrics, Harvard Medical School)

• Introduction 

• COVID-19 Documentation Reduction Survey Results

• Moderated Panel Discussion: What is the Job of Documentation in the Future?
     – Jesse M. Ehrenfeld, MD, MPH (Immediate Past Chair, Board of Trustees, American Medical Association; Senior Associate Dean, Tenured Professor of Anesthesiology, Medical College of Wisconsin; Professor of Anesthesiology and Health Policy, Vanderbilt University) 
     – Molly K. McCarthy MBA, RN-BC (National Director, US Health Providers and Plans, Microsoft)
     – Marc Overhage, MD, PhD (Healthcare Information Technology Executive, Indianapolis, Indiana)
     – Eric Topol, MD (Founder & Director, Scripps Research Translational Institute, Executive Vice-President, Scripps Research Institute)
     – Ross Koppel, PhD, FACMI (Professor of Biomedical Informatics and Sociology, University of Pennsylvania; Professor of Biomedical Informatics, University at Buffalo (SUNY))

• Industry Panel Discussion: What are the solutions coming out of industry?
     – Marshall Ruffin, MD, MPH, MBA (Founder and Chief Executive Officer, Salutary, Inc.)
     – Susan Kressly, MD, FAAP (Kressly Pediatrics, and Medical Director Office Practicum)
     – Michael Wang (CEO and Founder, Inspiren) 
     – Jacqueline Gerhart, MD, FAAFP (Director of Clinician Engagement, Epic)
     – Jeff Wall, MD (Senior Director, Clinical Innovation, Cerner)
– Peter Durlach (Senior Vice President, Healthcare Strategy and New Business Development, Nuance Communications)

• Wrap-Up and Set the Stage for Session 5 and beyond

Session Leader: Trent Rosenbloom, MD, MPH, FACMI, FAMIA (Vice Chair of Faculty Affairs & Associate Professor, Departments of Biomedical Informatics, Internal Medicine & Pediatrics, Vanderbilt University)

• Introduction

• Keynote Speaker: Where Might We Go From Here?     
     – Isaac Kohane, MD, PhD (Marion V. Nelson Professor & Chair, Department of Biomedical Informatics, Harvard Medical School)

• Breakout Sessions
     – Facilitator: Peter Durand
     – Goal: To identify actions based on prior sessions and prioritize short-term, medium term, long-term actions

     – Breakout Topics: 
          – Reimbursement 
          – Regulatory
          – Quality
          – Usability
          – Interoperability/Standards
          – Self-Imposed (by the healthcare organization) aka – “We’ve Done it To Ourselves”

• Brief report back from breakout sessions

• Wrap-Up and set the stage for Session 6 and beyond

Session Leader: Sarah Collins Rossetti, RN, PhD, FACMI, FAMIA (Assistant Professor of Biomedical Informatics and Nursing, Columbia University)

• Introduction

• Plenary Speaker for convergent actions
     – Christine A. Sinsky MD FACP (VP, Professional Satisfaction, American Medical Association)

• Breakout Sessions: Insights for Action
          – Reimbursement
          – Regulatory 
          – Quality
          – Usability
          – Interoperability/Standards
          – Self-Imposed (by the healthcare organization) aka – “We’ve Done it To Ourselves”

• Stakeholder Engagement with Identified Actions

• Concluding Remarks

Relevant Resources

There are several articles relating to the subject of documentation burden that the 25×5 Symposium Committee found relevant to discussions that will be had throughout the event. Most of the articles are linked here, while the final one from that list is available here. AMIA hosts a 25×5 an informatics discussion community for the Symposium Committee, invited speakers and subject matter experts, and individuals who responded to the survey about reducing documentation burden.  The 25×5 Community is part of AMIA’s Connect platform.  Contact Jeff Williamson of the 25×5 Symposium Committee Community with questions.

Symposium Committee

Co-Chairs

Sarah Collins Rossetti, RN, PhD, FACMI, FAMIA Assistant Professor of Biomedical Informatics and Nursing, Columbia University
S. Trent Rosenbloom, MD, MPH, FACMI Vice Chair of Faculty Affairs & Associate Professor, Departments of Biomedical Informatics, Internal Medicine & Pediatrics, Vanderbilt University

Steering Committee Members

Don Detmer, MD, FACMI Professor of Medical Education, Dept. Public Health Sciences, University of Virginia School of Medicine
Kevin Johnson MD, MS, FAAP, FACMI Professor and Chair of Biomedical Informatics, Vanderbilt University
Kenrick Cato, RN, PhD, FAAN Assistant Professor of Nursing, Columbia University
Dasha Cohen Director of Meetings, AMIA
Jeff Williamson M.Ed. Vice President of Education and Academic Affairs, AMIA
Judy Murphy, RN, FACMI, LFHIMSS, FAAN Previous IBM CNO and ONC Deputy National Coordinator for Programs and Policy
Amanda Moy, MPH National Library of Medicine Pre-doctoral Trainee, Columbia University
Jessica Schwartz, RN, BSN National Institute of Nursing Research Pre-doctoral Trainee, Columbia University
Eugene Lucas, MD Internal Medicine Physician, Clinical Informatics Fellow, Columbia University   
Craig Sachson Associate Director of Cross Campus Communication and Collaboration, Columbia University