Interventions to mitigate EHR and documentation burden in health professions trainees: A scoping review.

Abstract

Background: Health professions trainees (trainees) are unique as they learn a chosen field while working within electronic health records (EHR). Efforts to mitigate EHR burden have been described for the experienced health professional (HP), but less is understood for trainees. EHR or documentation burden (EHR burden) affects trainees, although not all trainees use EHRs, and use may differ for experienced HPs.

Objectives: To develop a model of how interventions to mitigate EHR burden fit within the trainee EHR workflow: the Trainee EHR Burden Model. 1) Examine trainee experiences of interventions aimed at mitigating EHR burden(scoping review). 2) Adapt an existing workflow model by mapping included studies(concept clarification).

Methods: We conducted a 4-database scoping review applying PRISMA-ScR guidance, examining scholarly, peer-reviewed studies that measured trainee experience of interventions to mitigate EHR burden. We conducted a concept clarification categorizing, then mapping studies to workflow model elements. We adapted the model to intervenable points for trainee EHR burden.

Results: We identified 11 studies examining interventions to mitigate EHR burden that measured trainee experience. Interventions included: curriculum, training, coaching on the existing EHR for both simulated or live tasks; evaluating scribes' impact; adding devices or technology tailored to rounds; team communication or data presentation at end-of shift handoffs. Interventions had varying effects on EHR burden, most commonly measured through surveys, and less commonly, direct observation. Most studies had limited sample sizes, focused on inpatient settings, and physician trainees.

Conclusion: Few studies measured trainee perspectives of interventions aiming to mitigate EHR burden. Many studies applied quasi-experimental designs and focused on inpatient settings. The Trainee EHR Burden Model, adapted from an existing workflow model, offers a starting place to situate points of intervention in trainee workflow. Further research is needed to design new interventions targeting stages of HP trainee workflow, in a range of clinical settings.