25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action.

Studies have shown that documentation burden experienced by clinicians may lead to less direct patient care, increased errors, and job dissatisfaction. Implementing effective strategies within health care systems to mitigate documentation burden can result in improved clinician satisfaction and more time spent with patients. However, there is a gap in the literature regarding evidence-based interventions to reduce documentation burden. The objective of this review was to identify and comprehensively summarize the state of the science related to documentation burden reduction efforts. Following Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a comprehensive search of multiple databases, including PubMed, Medline, Embase, CINAHL Complete, Scopus, and Web of Science. Additionally, we searched gray literature and used Google Scholar to ensure a thorough review. Two reviewers independently screened titles and abstracts, followed by full-text review, with a third reviewer resolving any discrepancies. Data extraction was performed and a table of evidence was created. A total of 34 articles were included in the review, published between 2016 and 2022, with a majority focusing on the United States. The efforts described can be categorized into medical scribes, workflow improvements, educational interventions, user-driven approaches, technology-based solutions, combination approaches, and other strategies. The outcomes of these efforts often resulted in improvements in documentation time, workflow efficiency, provider satisfaction, and patient interactions. This scoping review provides a comprehensive summary of health system documentation burden reduction efforts. The positive outcomes reported in the literature emphasize the potential effectiveness of these efforts. However, more research is needed to identify universally applicable best practices, and considerations should be given to the transfer of burden among members of the health care team, quality of education, clinician involvement, and evaluation methods.

BackgroundElectronic health record (EHR) usage measures may quantify physician activity at scale and predict practice settings with a high risk for physician burnout, but their relation to experiences is poorly understood.ObjectivesThis study aimed to explore the EHR-related experiences and well-being of primary care physicians in comparison to EHR usage measures identified as important for predicting burnout from a machine learning model.MethodsExploratory qualitative study with semi-structured interviews of primary care physicians and clinic managers from a large academic health system and its community physician partners. We included primary care clinics with high burnout scores, low burnout scores, or large changes in burnout scores between 2020 and 2022, relative to all primary care clinics in the health system. We conducted inductive and deductive coding of interview responses using a priori themes related to the machine learning model categories of patient load, documentation burden, messaging burden, orders, and physician distress and fulfillment.ResultsInterviews with 16 physicians and 4 clinic managers identified burdens related to three dominant themes: (1) messaging and documentation burdens are high and require more time than most physicians have available during standard working hours. (2) While EHR-related burdens are high they also provide patient-care benefits. (3) Turnover and insufficient staffing exacerbate time demands associated with patient load. Dimensions that are difficult to quantify, such as a perceived imbalance between job demands and individual resources, also contribute to burnout and were consistent across all themes.ConclusionEHR-related work burden, largely quantifiable through EHR usage measures, are major source of distress among primary care physicians. Organizational recognition of this work as well as staffing and support to predict associated work burden may increase professional fulfillment and reduce burnout among primary care physicians.

For decades, medication titration has been within nurses' scope and practice. In 2017 The Joint Commission (TJC) revised elements for orders for the titration of continuous intravenous medications. To explore the practice and perceptions of nurses regarding TJC standards for titration of continuous intravenous medications. Nurses with experience titrating medications completed an investigator-designed, validated cross-sectional survey. Inductive thematic analysis was conducted in order to analyze the open-ended comments from that quantitative survey. From among 730 completed surveys, 159 comments were received. Analysis of the comments yielded 3 levels of abstraction. Two overarching themes were harm and professionalism. Additional abstraction for the harm theme revealed categories of erosion of workplace wellness, moral dilemma, and patient safety, which were coded as relating to workplace stress, workload, burnout/turnover, physical risk, inefficiency, demeaning/devalued, falsification of records, problematic orders, burden of documentation, suboptimal care, delay in care, individualized care, and provider availability. Within the professionalism theme, categories of autonomy and nurse proficiency were identified, with 7 associated codes: top of scope, critical thinking, overregulation, teamwork, education, registered nurse knowledge, and novice registered nurse guidance. The standards from TJC impose harm by eroding workplace wellness and introducing moral dilemmas and patient safety concerns. Professionalism is threatened through limits on scope and autonomy. Further advocacy is necessary in order to resolve unanticipated consequences related to the titration standards.

Documentation is a critical responsibility for direct support professionals (DSPs) who work with adults with autism spectrum disorder (ASD); however, it contributes significantly to their workload. Targeted efforts must be made to mitigate the burden of necessary data collection and documentation, which contributes to high DSP turnover rates and poor job satisfaction. This mixed methods study aimed to explore how technology could assist DSPs who work with adults with ASD and prioritize aspects of technology that would be most useful for future development efforts. In the first study, 15 DSPs who worked with adults with ASD participated in 1 of the 3 online focus groups. The topics included daily tasks, factors that would influence the adoption of technology, and how DSPs would like to interact with technologies to provide information about their clients. Responses were thematically analyzed across focus groups and ranked by salience. In the second study, 153 DSPs across the United States rated the usefulness of technology features and data entry methods and provided qualitative responses on their concerns regarding the use of technology for data collection and documentation. Quantitative responses were ranked based on their usefulness across participants, and rank-order correlations were calculated between different work settings and age groups. The qualitative responses were thematically analyzed. In study 1, participants described difficulties with paper-and-pencil data collection, noted benefits and concerns about using technology instead, identified benefits and concerns about particular technology features, and specified work-environment factors that impact data collection. In study 2, participants rated multiple features of technology as useful, with the highest usefulness percentages endorsed for task views (ie, by shift, client, and DSP), logging completed tasks, and setting reminders for specific tasks. Participants also rated most data entry methods (eg, typing on a phone or tablet, typing on a keyboard, and choosing from options on a touch screen) as useful. Rank-order correlations indicated that the usefulness of technology features and data entry methods differed across work settings and age groups. Across both studies, DSPs cited some concerns with technology, such as confidentiality, reliability and accuracy, complexity and efficiency, and data loss from technology failure. Understanding the challenges faced by DSPs who work with adults with ASD, and their thoughts about using technology to meet those challenges, represents an essential first step toward developing technology solutions that can increase DSPs' effectiveness and job satisfaction. The survey results indicate that technology innovations should incorporate multiple features to account for different needs across DSPs, settings, and age groups. Future research should explore barriers to adopting data collection and documentation tools and elicit input from agency directors, families, and others interested in reviewing data about adults with ASD.

The South Bronx neighborhood in New York City (NYC) is disproportionately affected by hepatitis C, with a rate of reported hepatitis C cases approximately twice the rate for all of NYC (260 vs. 138 reported cases per 100,000 residents in 2004) (unpublished data, NYC Department of Health and Mental Hygiene [DOHMH] Bureau of Communicable Diseases). In 2004, collaboration between the South Bronx community and the Hepatitis C Program of the NYC DOHMH yielded the South Bronx Hepatitis C Task Force (SBHCTF). The DOHMH Hepatitis C Coordinator recruited community residents and health-care providers concerned about hepatitis C to participate in the SBHCTF. Initially, a steering committee of eight dedicated individuals with firsthand hepatitis C knowledge and influence in the South Bronx was organized, including two physicians, two physician's assistants, two executive directors of community agencies, and two DOHMH staff. At the first SBHCTF meeting, mission and goals were drafted, information was presented on two South Bronx programs that offer integrated viral hepatitis services, and a survey to help identify the community's greatest hepatitis C service needs was administered to participants. The 70 participants at this meeting included providers who serve people affected by hepatitis C (e.g., doctors, nurses, physician's assistants, community advocates, epidemiologists, psychologists, addiction counselors, social workers, program directors, pharmacists, and lawyers) as well as individuals infected and affected by hepatitis C. At the next meeting, results of the survey were reviewed and participants worked to make recommendations to address the following critical hepatitis C concerns identified in the survey: (1) identification of available hepatitis C services, (2) development of peer-delivered services (support and education), (3) improved access to sterile syringes, (4) improved community awareness, (5) increased knowledge of hepatitis C among providers, (6) increased mental health services to facilitate and accompany treatment, and (7) improved service linkages for people released from jail or prison. The steering committee met separately and prioritized the issues the Task Force wanted to address, based on potential for completion and impact on the community. At the third meeting, three SBHCTF working groups were established to develop the top hepatitis C action items: creating a resource guide, initiating a peer support group, and developing a patient education guide. The groups met and reported progress regularly to the full SBHCTF at monthly meetings through project completion. Three important project outcomes were: (1) creation of the “Hepatitis C Services in the South Bronx” directory, which lists hepatitis C-related services in the South Bronx (e.g., substance abuse treatment, medical care) and includes information such as types of payment accepted and treatment eligibility for active drug users; (2) establishment of a monthly hepatitis C support group, led by volunteer medical providers; and (3) creation of a patient pocket guide, “Hepatitis C: How to Stay Healthy and Informed,” a practical education tool for patients newly diagnosed with hepatitis C that outlines steps patients can take with their medical provider following a hepatitis C diagnosis. The pocket guide has been adapted and used by other health departments. The service directory and pocket guide are available online (http://www.nyc.gov/html/doh/html/cd/cdhepc-hcp5.shtml). The DOHMH originally contributed $50,000 to support the projects, and civic groups, pharmaceutical companies, and social service agencies donated resources such as mailing lists, printing and graphics services, distribution of meeting notices, and food for meetings. Another outcome of the SBHCTF work was a Substance Abuse and Mental Health Services Administration (SAMHSA) funding award for a project to integrate substance use, human immunodeficiency virus, and viral hepatitis prevention in community-based services targeting minority residents and residents reentering the community after release from jail or prison. The SBHCTF Steering Committee serves as the Advisory Board for the SAMHSA project, which has established a coordinated care model for facilitating access to prevention and case-management services by the residents of the South Bronx and inmates of city correctional facilities who return to the South Bronx. The SBHCTF accomplishments illustrate the power of a motivated group of people from different organizations, collaborating toward common goals to tackle an important health issue such as hepatitis C. The SBHCTF continues to evolve, currently focusing on expanding mental health services for people with hepatitis C, providing training to community-based organizations and medical providers, and helping to initiate similar task forces in other NYC boroughs.

BackgroundThe Learning Health System (LHS) framework is designed to enhance healthcare by systematically integrating internal data and external evidence to promote quality, safety, and efficiency, aligning science, informatics, incentives, and culture for continuous improvement, innovation, and equity.MethodsThe Agency for Healthcare Research and Quality (AHRQ) also outlined key LHS learning goals structured around four interconnected approaches: (1) evidence generation to create new knowledge, (2) evidence adoption to translate findings into practice, (3) evidence dissemination to share best practices across systems, and (4) evidence management to integrate internal and external insights using technology and informatics. We propose this model can also enhance workforce well‐being (also termed “flourishing” or eudaimonia by Aristotle) through system‐level changes informed by rigorously collected local data.FindingsHealthcare workers who flourish realize their purpose, improve patient health, and align themselves through daily decisions and actions toward this end. However, excessive workload, documentation burden, and unsupported caregiving responsibilities can detract from this goal. A wide range of LHS methods can be applied to address healthcare worker well‐being and result in LHS cycles of learning and improvement. We present four examples demonstrating how LHS‐concordant research methods align with AHRQ's learning goals to transition from mitigating burnout to actively promoting flourishing.ContributionTogether, the application of the AHRQ learning goals forms a continuous feedback loop that facilitates mutual enhancement between healthcare delivery and research, advancing clinician well‐being and system‐wide improvement. This change in focus offers a new method for the design and evaluation of workforce well‐being interventions, can restore excellence in patient care, and contributes to creating sustainable, human‐centered healthcare systems.

Objective: To describe the impact that electronic medical record (EMR) documentation has on nurses’ and midwives’ practice. Background: Although both advantages and disadvantages of a digitised health system have been documented, nurses and midwives continue to express concerns about the effect EMRs and computers have on their practice and patient relationships. Study design and methods: A cross-sectional survey design was used. An anonymous questionnaire was distributed in electronic and paper formats to identify nurses’ and midwives’ opinions of the impact of EMRs and computers on their practice and patient relationships in a regional tertiary-level hospital. Quantitative data was analysed descriptively; free-text responses were analysed thematically. Results: Nurses (n=31) and midwives (n=49) responded. Both respondent groups disagreed that the EMR had improved teamwork with other health professionals. Overwhelmingly, midwives disagreed that EMRs had improved the quality of care (n=43, 87.8%). Nurses agreed EMRs had improved documentation standards (n=24, 77.4%) and patient safety (n=22, 71%). However, midwives responded that EMRs had not improved women’s safety (n=31, 63%). Three themes emerged from the data: computers affect my productivity; computers affect my relationship with the patient/woman; the EMR increases my frustration and stress levels. Nurses and midwives felt the heavy documentation load and lack of integration across the EMR platform reduced efficiency, discouraged teamwork, and further excluded patients/women from participating in their care. Discussion: Although nurses and midwives agreed that the accessibility of EMRs to all health care staff is advantageous, the documentation demands of each clinical area are vastly different. The hybrid system of paper and electronic documentation increases documentation workload. Generally, midwives were more critical of the impact of EMRs on their practice. Conclusion: Nurses and midwives identified current challenges of EMRs with respect to productivity, relationships with patients and colleagues, and user wellbeing aligning with results of other published studies. As primary users of EMRs, nurses and midwives can offer valuable feedback to health services to help deliver digitised healthcare that is user-friendly, and patient/woman centred. Implications for research, policy, and practice: Organisations need to enact policies and procedures that facilitate nurses and midwives identifying areas of potential improvement to increase the usability and operability of the EMR. Such processes should lessen the negative impacts of EMR (such as documentation burden) on nursing/midwifery practice, with the aim of enhancing clinical and safety outcomes. It is suggested that ethnographic research studies be undertaken to gain a deeper understanding of the EMRs on nurse/midwife productivity, wellbeing, job satisfaction and patient safety concerns. What is already known about the topic: Positive and negative EMR outcomes for patients and clinicians have been documented. Involving clinicians (especially nurses and midwives) in the development of digital systems prior to implementation has been shown to reduce negative attitudes towards them. Ongoing user analysis is recommended in human-centred design to improve usability and user wellbeing. What this paper adds: Description of the differing experiences and challenges faced by nurses and midwives using the EMR program and computers in the same hospital. Positive and negative effects of the current EMR program and computers have been identified. This paper verifies the results of other national studies about the effects of EMRs and computers on nurses’ and midwives’ productivity, relationships, and wellbeing.

The implementation of electronic health records (EHRs) has revolutionized modern clinical practice, increasing efficiency, accessibility, and quality of care. Nevertheless, EHR-related workload has been considered as a significant contributor to healthcare professionals' burnout, a syndrome associated with emotional exhaustion, depersonalization, and reduced personal accomplishment. As modern health system explores technological solutions, artificial intelligence (AI) has gained attention for its potential to facilitate documentation processes and alleviate cognitive burden. This systematic review aims to explore and understand the impact of artificial intelligence on burnout associated with electronic health records among healthcare professionals. A systematic literature review was conducted following the PRISMA 2020 guidelines. Relevant studies published between 2019 and 2025 were retrieved from three electronic databases: PubMed, Scopus, and Web of Science. The search strategy included three main domains: artificial intelligence, electronic health records, and healthcare professional burnout. Eligible included studies are peer-reviewed original research articles that evaluated the impact of AI-based technologies on burnout among healthcare professionals. The screening and selection processes were carried out by following the PRISMA framework. Methodological quality assessment of the included studies was performed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 287 records initially identified, eight studies met the inclusion criteria. The majority of identified studies were conducted in the United States and Canada. The identified interventions were categorized into four domains: ambient artificial intelligence scribes, clinical decision support systems, large language models, and natural language processing tools. Most studies focused on mitigating documentation or inbox-related burdens and reported positive outcomes, including decreased documentation time, enhanced workflow efficiency, and reduced symptoms of burnout among healthcare professionals. Nonetheless, several methodological limitations were observed, including the absence of control groups, small sample sizes, and short follow-up periods, which constrain the generalizability of the findings. The integration of artificial intelligence into electronic health record systems may have potential to alleviate documentation burden and inbox management burden. Although preliminary findings are promising, further methodologically robust research is necessary to evaluate long-term outcomes, assess usability across diverse clinical contexts, and ensure the safe and effective implementation of AI technologies in routine healthcare practice. https://osf.io/pevfj.

BACKGROUND: Although women are the majority of medical students in the United States, women in academic medicine leadership positions continue to face challenges such as pay equity and hostile work environments 1 . In our large health system, we identified a need to support women in academic medicine leadership positions across specialties and training programs. We organized a one-day conference to provide support and explore the specific needs of this group. SUMMARY of WORK: All women in academic leadership positions across our health system were invited to the conference via email. Registered participants completed a pre-survey to identify needs. During the conference, we conducted a ranking exercise to clarify major priority areas from topics submitted. Small groups described the ideal state, the current state, and generated solutions to close the gap for each priority area. The large group then used these to set action items for each priority area. Participants were invited to complete a post-survey at the end of the day. SUMMARY of RESULTS: A total of 29 women leaders attended the conference, ranging in age, academic rank, career length, and specialty. Of 22 topics submitted, 6 were ranked as highest priority. Two focused on individual benefit (career growth and work-life balance) and 4 focused on collective benefit (promotion of women leaders, future goals of the group, supporting one another, and supporting women trainees). The larger group generated 1-2 feasible, tangible action items for each priority area, as well as identified volunteers to follow through with each. Post-surveys showed increased feelings of connection and support, and increased hopefulness about the future for women leaders in academic medicine at our institution. DISCUSSION: In addition to meeting our initial goal of increasing connection and support for women leaders, we found that having the group prioritize their own needs and collectively create action items significantly increased hopefulness for the future. Feelings of hope and control over one’s environment are important for individuals (professional growth, vitality) but can also benefit the institution (faculty retention, benefits the programs they lead). TAKE HOME MESSAGE: The generation of tangible action items is feasible and can contribute to a sense of autonomy important for supporting women leaders in academic medicine.

New horizons in bladder cancer research

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Population aging and rising health expenditures are forcing health systems to seaxrch for new ways to deliver care with limited human and fiscal resources. The aim of this paper is to analyze how AI-generated content (AIGC), powered by large language and multimodal models, is moving from a “content toy” to a key layer of infrastructure across elderly care, clinical services, wellness consumption, and health policymaking. First, it outlines the basic features of AIGC and explains why it is well-suited to unstructured, multimodal health data. It then examines concrete applications in three front-end domains: smart companionship, remote monitoring, and operational support in elderly care; clinical documentation, chronic disease coaching, and hospital operations in healthcare; and personalized marketing, product strategy, and consumer insight in the dietary supplements sector. The paper further discusses how AIGC-driven analytics can translate fragmented health data into actionable insights for providers, insurers, companies, and regulators. The analysis indicates that AIGC can alleviate documentation burdens, enhance chronic disease self-management, and improve the efficiency of elderly-care operations under tight fiscal constraints. Finally, it highlights major risks—including privacy breaches, bias, hallucinations, deepfake-driven misinformation, unclear liability, and the digital divide for older adults—and argues that robust governance and inclusive design are essential. The conclusion suggests that AIGC can help aging societies keep their health and care systems sustainable, but only if technological innovation is matched by strong ethical and regulatory safeguards.

A recent special article in this journal reviewed the history, accomplishments, and goals of the American Neuropsychiatric Association (ANPA) on the occasion of the tenth anniversary of its founding. The suggestion was made that to sustain ANPA’s early and remarkable success, its leadership should engage in an organized strategic planning process to include development of a formal mission and vision statement, as well as identification of strategic priorities to guide the future resource investment of the association over the next three to five years. On May 19, 1999, 13 current and past officers of ANPA convened in Washington, D.C., to begin this important process. (Participants included C. Edward Coffey, M.D.; Jeffrey L. Cummings, M.D.; Barry Fogel, M.D.; Jordan Graffman, Ph.D.; Robert Green, M.D.; Edward Lauterbach, M.D.; Tom McAllister, M.D.; Robert Robinson, M.D.; Stephen Salloway, M.D.; Randolph Schiffer, M.D.; Jonathan Silver, M.D.; Gary Tucker, M.D.; and Stuart Yudofsky, M.D.). This half-day strategic planning retreat was facilitated by Anne Barrins, C.S.W., Director of Quality Management for the Department of Psychiatry, Henry Ford Behavioral Health. Participants prepared for the retreat by reviewing literature on strategic planning and the building of a shared vision for an organization. The retreat began with some words of wisdom from the cartoon character Dilbert (a self-proclaimed expert on organizational development). Ms. Barrins then led the attendees through a series of group exercises designed to identify the key stakeholders in the association, as well as the association’s core values. Identified as key stakeholders were (listed in no particular order of significance): ANPA members and leaders, patients, patient advocacy groups, the medical industry (e.g., pharmaceutical companies), allied medical organizations (e.g., the Behavioral Neurology Society, the British Neuropsychiatry Association), students and trainees, The Journal of Neuropsychiatry and Clinical Neurosciences, clinicians in neuropsychiatry, and neuroscience researchers. Three core values were identified for the association (again, not listed in any order of significance): advancing knowledge of brain–behavior relationships; providing a forum for learning; and promoting excellent, scientific, and compassionate health care. Breakout groups were then formed to begin the process of crafting a mission and vision for the association, with special reference to the key stakeholders and core values just identified. The requirement for the mission statement was that it express ANPA’s raison d’etre and that it be applicable for at least 100 years (in contrast to goals and strategies that would change many times in 100 years). Dialogue sparked by a variety of initial drafts led to strong consensus on the following:

IntroductionMedication adherence is fundamental to achieving optimal patient outcomes. Reporting research on medication adherence suffers from some issues—including conceptualisation, measurement and data analysis—that thwart its advancement. Using the ABC taxonomy...