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Centre for Addiction and Mental Health

Centre for Addiction and Mental Health

Analyzing and relieving documentation burden at CAMH

Centre for Addiction and Mental Health

“In Canada and around the world, we have an unprecedented shortage of healthcare professionals,” so says Dr. Gillian Strudwick, the Chief Clinical Informatics Officer (CCIO) at the Centre for Addiction and Mental Health (CAMH) in Toronto. The numbers back up this claim too, with the World Health Organization (WHO) estimating that there will be a global shortfall of 15 million health workers by the end of the decade.

To make the caring profession as appealing as possible, organizations need to support those who have dedicated their careers to it. With this in mind, CAMH undertook a process that sought to engage with nurses to reduce their documentation burden so that they can spend more time with patients, attend to other tasks, and – according to Gillian – “bring back some joy to nursing.”

CAMH conducted a benchmarking survey and needs assessment in 2021, which found that 34% of nurses felt like they were under significant stress, with 23% reporting one or more symptoms of burnout. The organization’s electronic health record (EHR) – known as I-CARE – was described as one of the contributing factors with 29% agreeing or strongly agreeing that it contributed to their frustrations, while 44% thought it sometimes contributed to their burnout symptoms.

CAMH is not alone in this discovery about their EHR – KLAS research shows that such systems are considered to be contributors to both physician and nurse burnout across the US. Additionally, the 2020 National Survey of Canadian Nurses found a number of barriers to full EHR adoption, including redundant data capture, the use of multiple systems and logins, and inappropriate training.

With baselines in place, CAMH was able to use Lights On Network® and Cerner Advance to analyze how its 1,140 nursing users were working with the EHR. They are looking at a number of possible pain points, as Gillian explains: “What time during the day, evening, or night are they actually doing documentation? Are there areas that we could improve by getting rid of fields because no one uses them, as an example? These are things that we can learn by looking at our back-end data analytics.”

CAMH isn’t just looking at the quantitative data but is actively engaging with staff to collect qualitative information too. A staff nomination process allows respondents to suggest changes they would like to see, with suggestions going through a streamlined governance process. Minor changes go straight to a group of clinicians who review and decide collectively, with more complex suggestions going through relevant advisory groups in order to give the final advisory board as much information as possible.

The strategy isn’t just confined to improving I-CARE itself, with Dr. Strudwick noting, “the final goal of this is really to improve communication, education, and training. So, we are doing things like having a newsletter, mapping our education and training practices to best practices, and training and education for EHR use”.

There is no end point for CAMH’s program – its focus is on continual engagement in order to implement ongoing improvements over time and make the lives of nursing staff less challenging. A status check in October 2022 showed that progress has been made already: nursing time spent in the EHR was down two minutes to 13 minutes per patient compared to December 2020, while documentation time had reduced by 50 seconds to six-and-a-half minutes. These time savings increased the number of patients being seen from 59,530 to 80,534 over the period.

Dr. Strudwick concludes, “For us, it's really important to work with Oracle Cerner to better understand what all the opportunities and possibilities are for being able to reduce documentation.”

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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.