My friend and hero Patty Sengstack DNP RN-BC FAAN is leading yet another ground-breaking project, documented in an American Nursing Informatics Association (ANIA) position paper: The Six Domains of Burden: A Conceptual Framework to Address the Burden of Documentation in the Electronic Health Record. I have groused about the heavy toll taken by EHRs on nursing and welcome Patty’s more formal analysis.
Central to the concept of burden is what the authors term “The Six Domains” — the reasons why we must use EHRs and why they make nursing work more onerous. I have pontificated elsewhere about the motivations for EHRs and how they are the opposite of what I term “nurse-centric”. The “burdens” are:
- Reimbursement (charge capture)
- Regulatory (keep the gov’t off our backs)
- Quality (proof that we’re doing a good job; when we do a great job we’re paid more thanks to value-based pricing)
- Usability (with time we’ll get this right but today the perception is that working the computers is slow and painful)
- Interoperability (data entered in one system must often be re-entered in another)
- Self-Imposed: “We’ve done it to ourselves” (artifacts of institutional culture and control/power structures)
Let me be clear, however, that I am an enthusiastic advocate of this technology. In graduate school (1978–1983, UCSF) my master’s thesis (and resulting publication) was an EHR I programmed from scratch and that was briefly used in live clinical practice (as proof of concept only). I am convinced that well-designed and well-implemented clinical data systems can and already often do much to improve quality of care, efficiency, accuracy and above all safety.
However, there is also a strong case to be made that these systems sometimes have the opposite effect.
One thing that makes Patty’s paper especially valuable is that for each of the six burdens it gives real-life examples, most of which will be recognized by nurses and other clinicians from their experience of their professional environments. On reading it, many will be tempted to say, “Amen, amen!”
Go Patty! Go nurses!