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How ONC is Addressing EHR Clinician Burnout, Health IT Barriers

Since the passage of the HITECH Act, ONC has aimed to mitigate EHR clinician burnout and improve EHR satisfaction through regulations.

Fully comprehending a future path to mitigating EHR clinician burnout requires a complete understanding of the intent and development of health IT regulations and why these regulations exist, according to a recent article published in the Journal of the American Medical Informatics Association (JAMIA).

Two health IT experts from the Office of the National Coordinator of Health Information Technology (ONC), Andrew Gettinger and Teresa Zayas-Cabán, penned an article about the administration’s current and future efforts to mitigate clinician burnout and improve clinician EHR satisfaction.

Since the 2009 passage of the HITECH Act, clinician burnout has grown rapidly across the healthcare industry. Healthcare leaders expected health IT adoption to address critical deficiencies, such as poor EHR usability, unintuitive EHR design, and high clinician workload. However, that has not been the case.

“More than a decade later, these goals have been met with mixed success and the clinical community is struggling with burnout directly attributed to health IT; in part caused by usability issues, nonintuitive workflows, use of structured forms that impact the ability to construct and interpret a cohesive patient narrative; and an inability to incorporate disparate electronic health data into a single, consolidated, comprehensive, and up-to-date patient view,” Gettinger and Zayas-Cabán wrote.

The two health IT experts said addressing these issues will require improved health IT system designs, enhanced system configuration decisions, and increased end user training during health IT implementation.


Throughout the last decade, leaders at ONC have developed EHR usability tools, implemented usability regulations, and increased conversation about health IT, the report authors said.

Some efforts are also underway to address the EHR usability problem.

ONC developed the Strategic Health IT Advanced Research Project (SHARP) program to focus on the key issues that interfered with health IT adoption. It also constructed a project to address barriers to health IT use through patient-centered cognitive support.

HHS and ONC linked clinician burnout and patient safety when it established a set of safety-enhanced design certification requirements for EHR usability.

Additionally, ONC funded research to examine policies, such as UCD processes by health IT developers. Researchers found compliance with regulations, but implementation could improve.

“The study described challenges health IT developers faced in incorporating UCD practices into development processes,” the authors wrote. “Findings showed that UCD processes and understanding of UCD varied across health IT developers. Opportunities for improvement included conducting usability testing with practicing providers and ensuring adequate numbers of participants in testing.”

Next, ONC expanded the 2015 Edition Health IT Certification Criteria to support UCD principles, design principles, and software testing.

Gettinger and Zayas-Cabán also predicted the EHR reporting program, a newer program mandated by the 21st Century Cures Act, could address EHR usability and drive patient safety.  

Congress tasked ONC with developing an EHR reporting program to dissect and distribute data on EHR performance and usability.

The program asks EHR developers to submit data on the functions of their health IT products, thus contribute to the establishment of new EHR certification requirements. Gaining feedback and information from the stakeholders is the next phase of the EHR reporting program development and it allows the ONC to prioritize patient safety.


In February 2020, HHS published a set of strategies to combat health IT-related burdens on healthcare providers.

Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs fulfilled a provision in the 21st Century Cures Act requiring HHS, ONC, and CMS to produce a report for Congress on the strategies and recommendations to aid this overwhelming epidemic.

Experts linked clinician burden to EHR usability, which puts clinicians in harm and can also impact patient safety and care. HHS received feedback from hundreds of industry stakeholders, which made it clear there were still actionable ways to make health IT more usable for providers.

The report intended to target these issues and help clinicians focus on patient care, rather than EHR documentation.

HHS and industry stakeholders crafted three main goals to improve EHR usability:

  • Reduce the time and effort of EHR recording time during patient visits
  • Reduce the time and effort of EHR reporting requirements by clinicians, hospitals, and health systems
  • Ease the use of EHRs and improve EHR functionality

Furthermore, ONC worked with CMS to further its Patients Over Paperwork initiative to evaluate and streamline regulatory burden, boost administrative efficiency, and improve the beneficiary experience.


Although health IT experts are attempting to improve usability design and testing practices, further opportunities exist going forward.

“We need to continue to build on current efforts to improve user-centered design and use of human factors and ergonomics in design and implementation of health IT,” explained Gettinger and Zayas-Cabán.

“This will become critically important as the recent Cures Act rules are implemented: health IT developers should make design decisions based on a robust understanding of clinician’s cognitive and workflow needs, and providers should make configuration decisions with an understanding of their impact on usability and use of the systems,” they continued.

Gettinger and Zayas-Cabán said stakeholders should work toward a future in which where all health IT users feel they cannot provide healthcare without their EHR system.

“In the coming year, ONC will be continuing to develop plans to make that happen by addressing usability challenges identified in our report,” the two authors concluded. “We will also continue to collaborate with CMS and other federal partners in reducing health IT-related documentation requirements that add to clinician burden. We at ONC look forward to doing our part in advancing the field through policy and technical development and by continuing to engage the broad community of health IT stakeholders.”

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