25x5 Symposium Drives Ongoing Efforts to Reduce Documentation Burden on U.S. Clinicians
Reducing documentation burden on U.S. clinicians is an urgent priority within the healthcare community, and leaders around the field continue to collaborate on this effort since the conclusion of the 25×5 Symposium, held over six weeks early in 2021 to set the foundation for those efforts.
The 25×5 Symposium was developed to establish strategies and approaches to reduce clinician documentation burden on US clinicians to 25% by 2025.
In December 2021, AMIA assumed leadership responsibility for the 25×5 initiative to address this nation-wide problem by leveraging the collective expertise of key stakeholders in health care, industry, and policy to prioritize and implement the Calls to Action and Recommendations established by the 25×5 Symposium.
Funded by the National Library of Medicine (1R13LM013581-01)
Full Symposium Series Materials
Individual Session Agenda & Materials
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 De-identified Session 1 Chat Here
• Current Challenges Related to What We Document
• Symposium Introduction and Overview • Slides
• 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 • Slides
– 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) • Video • Slides
– Cognitive Burden: Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS (Chief Nursing Informatics Officer, Banner Health) • Video • Slides
– 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”
Download De-identified Session 2 Chat Here
• 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 2 • Video • Slides
• 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) • Video • Slides
– “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&A • Video
• 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) • Video • Slides
– Copy & Paste – Benefits and other safety issues – Lorraine Possanza, DNP, JD, MBE (Program Director, Partnership for Health IT Patient Safety) • Video • Slides
• Panel 2 Discussion and Q&A • Video
• Summarization & Prioritization of Challenges/use audience polling and Wrap-Up and Set the Stage for Session 3 and beyond • Video
• 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)
Download De-identified Session 3 Chat Here
• Introduction • Video
• Exemplars panel
– CDARS – Clinical Data Analysis and Reporting System: NT Cheung (Chief Medical Informatics Officer, Hong Kong’s Hospital Authority) • Video • Slides
– 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
• Discussion • Video
• 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
– CareAlign: 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 beyond • Video
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)
Download De-identified Session 4 Chat Here
• Introduction • Video
• COVID-19 Documentation Reduction Survey Results • Video • Slides
• Moderated Panel Discussion: What is the Job of Documentation in the Future? • Video
– 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) • Slides
– 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? • Video
– 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)
Session Leader: Trent Rosenbloom, MD, MPH, FACMI, FAMIA (Vice Chair of Faculty Affairs & Associate Professor, Departments of Biomedical Informatics, Internal Medicine & Pediatrics, Vanderbilt University)
Download De-identified Session 5 Chat Here
• Introduction • Video
• Keynote Presentation: Where Might We Go From Here? • Video
– 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 • Video
Session Leader: Sarah Collins Rossetti, RN, PhD, FACMI, FAMIA (Assistant Professor of Biomedical Informatics and Nursing, Columbia University)
Download De-identified Session 6 Chat Here
• Introduction • Video
• Plenary Speaker for convergent actions • Video
– 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”
• Brief report back from breakout sessions / Concluding Remarks • Video
Join The Ongoing Discussions
AMIA hosts a 25×5 Community as part of the AMIA Connect platform to continue discussions and keep track of ongoing work surrounding our movement to reduce clinician documentation burden on US clinicians to 25% by 2025.
Contact Katy Sidwell of the 25×5 Symposium Committee Community to gain access to this community.
Presentations Following The 25×5 Symposium
AMIA Clinical Informatics Conference (May 19)
Panel: 25×5 Symposium to Reduce Documentation Burden: Report-out and Call for Action
The 25 by 5: Symposium to Reduce Documentation Burden on US Clinicians by 75% by 2025 will be held over six sessions in January and February 2021. The overall goal of the symposium goal is to establish strategies and approaches to reduce clinician documentation burden on US clinicians to 25% by 2025. This panel will report-out on overall themes and specific calls for actions from the 25×5 Symposium. We will discuss the collaborative and actionable pathways identified during the Symposium to further the mission of reducing clinician documentation burden. By raising awareness of the outputs, action items, and initiatives that result from this symposium series we hope to continue and grow these efforts. After attending this panel individuals will be aware of the immediate, medium term and long term Calls to Action and opportunities to become involved.
• Sarah Collins Rossetti, RN, PhD, FAAN, FAMIA
• Trent Rosenbloom, MD, MPH, FACMI, FAMIA
• Kevin Johnson, MD, MS, FAAP, FACMI
• Kenrick Cato, PhD, RN, CPHIMS
• Judy Murphy, RN, FACMI, LFHIMSS, FAA
• Don Detmer, MD, FACMI
ONC Annual Meeting (March 29)
Panel: Efforts to Reduce Clinician Burden: Success, Partial Success, or a Future Not Yet Realized
This panel will feature real-world input from clinicians discussing how the evolving regulatory landscape and advances in technology contribute to clinician burden reduction.
• Andy Gettinger, MD, ONC, Moderator
• Tom Mason, MD, ONC, Moderator
• Peter Basch, MD, MACP, MedStar Health
• Jackie Gerhart, MD, FAAFP, Epic and The University of Wisconsin
• Yaa Kumah-Crystal, MD, MPH, Vanderbilt University Medical Center
• Sarah Collins Rossetti, RN, PhD, FAAN, FAMIA, Columbia University Medical Center
ACMI Winter Symposium (Feb. 24)
Presentation: 25 By 5 Summary and Recommendations
• Sarah Collins Rossetti, RN, PhD, FAAN, FAMIA, Columbia University Medical Center
• Trent Rosenbloom, MD, MPH, FACMI, FAMIA, Vanderbilt University
• Kevin Johnson, MD, MS, FAAP, FACMI, Vanderbilt University
Relevant Resources
There are several articles relating to the subject of documentation burden that the 25×5 Symposium Committee found relevant to discussions that were held throughout the event. Most of the articles are linked here, while another is available here.
July 2021 update: Here are two new documents.
• Reducing Clinician Burden Data Segmentation for Clinical Integrity
• Reducing Clinician Burden-End to End Fidelity Clinical Documentation
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
• Mollie Hobensack, RN, BSN PhD Student, National Institute of Nursing Research Predoctoral Trainee, Columbia University School of Nursing
• Rachel Y. Lee, RN, PhD Postdoctoral Research Fellow, National Institute of Nursing Research Postdoctoral Trainee, Columbia University School of Nursing
• Jennifer B. Withall, RN, PhD Postdoctoral Research Fellow, National Institute of Nursing Research Postdoctoral Trainee, Columbia University School of Nursing
• Deb Levy, MD, MPH Internal Medicine Physician (Boston) and Post-Graduate Informatics Certificate Student, Oregon Health & Science University
• Craig Sachson Associate Director of Cross Campus Communication and Collaboration, Columbia University
