For doctors overloaded by EHRs, a new watchword: digital minimalism

Timothy M. Smith , Contributing News Writer

Physicians’ digital clerical work has been on the rise in health care since the advent of EHRs, but the COVID-19 pandemic has caused many doctors to feel as though they are now working harder for their computers than they are for their patients.

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A perspective essay published in The New England Journal of Medicine explores “digital minimalism,” an approach organizations and policymakers can take to better design, implement and regulate physician-facing technology.

“Rather than either categorically rejecting digital technology or endorsing the current maximalist approach to it, health systems taking a digital minimalist approach would carefully consider whether and how each digital technology should be used,” wrote the authors, who include Christine Sinsky, MD, vice president of professional satisfaction at the AMA.

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The authors draw on the philosophy of Cal Newport, PhD, a computer science professor at Georgetown University, who coined the term in his 2019 book, Digital Minimalism: Choosing a Focused Life in a Noisy World.

Newport, they wrote, “believes the idea can be important not only in reducing the anxiety-inducing background hum of personal technologies, such as Twitter, Facebook and Instagram, but also in professional settings.”

His recommendations for tackling the technology juggernaut can be summed up in these three core beliefs.

Eliminate clutter. The first of Newport’s tenets, “Clutter is costly,” is easy to appreciate, the authors wrote, citing data showing that “the average patient’s EHR has 56% as many words as Shakespeare’s longest play, Hamlet.”

In addition, once a physician gets past chart review, “electronic interruptions, such as clinical decision-support alerts and secure chat messages from other staff members, contribute to clinicians’ cognitive load,” says the essay, co-written by Nina Singh, Katharine Lawrence, MD, MPH, and Devin M. Mann, MD, of the New York University medical school and health system.

Set clear boundaries. Newport’s second tenet, “Optimization is vital,” is key to finding joy in practice, the authors noted.

“The possibility of missing an urgent message leads some physicians to frantically check each mode of communication multiple times per hour, ensuring frequent interruptions by nonurgent messages,” the authors wrote, adding that secure chat programs produce “a constant influx of undifferentiated messages, with no clear signal of which are urgent and which are not.”

Be intentional. The third of Newport’s tenets, “Intentionality is satisfying,” speaks to the mission of medicine.

“In addition to getting rid of stupid stuff, using remaining technology with more explicit and strategic intention is key to digital minimalism,” the authors wrote. They cited efforts such as the AMA Joy in Medicine™ Health System Recognition Program, which “can help provide metrics and recognition that lead to the prioritization of minimalist approaches to digital technology.”

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Redesigning workflows to accommodate and optimize digital technology is vital, the authors noted, adding that allocating electronic work to other team members can free up physicians to focus more on diagnosis, treatment and relationship-building.

“We need software that is designed to reduce its users’ cognitive load,” they noted, citing wiki-style EHRs and health care AI algorithms as examples. “Speech-recognition technologies may reduce documentation burden by generating note drafts while the clinician and patient are speaking.”

No matter the efforts by individual physicians and their employers, medicine’s relationship with digital technology is often dependent on national policy, the authors noted.

“It seems clear that better reimbursement is needed for the substantial amount of digital work that clinicians do,” they wrote.

But better interoperability and a lower documentation burden have to be pursued too.

“The current approach often focuses on saying ‘yes’ to each additional form of technology, without considering the cumulative impact, and then retroactively making small changes,” the authors wrote. “Minor tweaks alone will never lead to a sustainable relationship with digital technology if our underlying philosophy of technology use remains maximalist.”

Learn more about the “AMA STEPS Forward® Taming the EHR Playbook.”