By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“The average patient’s Electronic Health Record has 56% as many words as Shakespeare’s longest play, Hamlet.”

– Jackson Steinkamp et al, JAMA Open Network 2022

Consider these statistics:

1. The average electronic visit note in the United States is four times longer than notes in other developed countries
2. Email messages from patients to their clinicians grew by an average of 57% in the past 3 years.
3. Focused efforts to reduce useless alerts led to a quick reduction in alerts by 45%.

In an era when many policymakers think that the key to improving health outcomes is more data, and more data exchange, there is a contrary voice that is articulating the opposite view: that the way we have implemented our technology is contributing to clinician burnout, decreased patient satisfaction, and sloppy decision-making with poor outcomes.

Hence the need for “Digital Minimalism.” The term was coined by a computer scientist and has implications for everyone, from middle school students to doctors to managers to policy makers. An excellent, concise and compelling summary of a theoretical framework for Digital Minimalism was published in the March 30, 2023 edition of New England Journal of Medicine by physicians from New York University and the American Medical Association (pages 1158 to 1159).

This framework has three tenets, which, on reflection, are key principles of the Lean approach to Quality Improvement popularized by Toyota in the middle of the last century. The framework also has echoes of author and uber-decluttering guru Marie Kondo.

1. Clutter is costly. Find ways to remove yourself at strategic times from the clutter of email, text, and social media interruptions to dedicate your cognitive power to core work.
2. Optimization is vital: optimize workflows and set boundaries. This includes programing out useless alerts and extra steps that could be done by someone else, automated or eliminated.
3. Intentionality is satisfying. The idea is that systematically working to optimize workflows and reducing clutter will quickly yield results that decrease cognitive load and stress; that makes work more satisfying and medical decision-making more accurate.

An even catchier name for Digital Minimalism is “Getting Rid of Stupid Stuff,” a term coined by Hawaii Pacific Health, in which 86% of “Stupid Stuff” identified by their medical staff was changed in some way, or even eliminated.

Having a dedicated staff member focused on EMR configuration and EMR workflows is a key step to addressing the “stupid stuff” problem. The improvement in efficiency and decreased clinician burnout alone justify the cost of such a position. The other key is finding some time for different staff to work on this effort. While it may feel like you are too short-staffed and busy to be able to afford to take them away from clinical activities, this pressure-cooker environment is perhaps the most critical place to begin the process of Digital Minimalization in order to make the staff you still have feel better about the work they are doing and for them to have more control over their work environment.