Usability Challenges in Electronic Health Records: Impact on Documentation Burden and Clinical Workflow: A Scoping Review

Olufisayo Olakotan; Ray Samuriwo; Hadiza Ismaila; Samuel Atiku

doi:10.1111/jep.70189

Usability Challenges in Electronic Health Records: Impact on Documentation Burden and Clinical Workflow: A Scoping Review

J Eval Clin Pract. 2025 Jun;31(4):e70189. doi: 10.1111/jep.70189.

Authors

Olufisayo Olakotan¹, Ray Samuriwo^{2

3}, Hadiza Ismaila³, Samuel Atiku^{4

5}

Affiliations

¹ Department of Neonatology, Women and Children's Directorate, University Hospitals Leicester NHS Trust, Leicester, UK.
² School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, Scotland, UK.
³ Centre for Digital Innovations in Health and Social Care (CDIHSC), Faculty of Health Studies, University of Bradford; Bradford, England, UK.
⁴ Digital Technology and Innovation, University of Staffordshire, UK.
⁵ Research Services, Aston University Birmingham, UK.

Abstract

Background: The adoption of Electronic Health Records (EHRs) has become integral to today's healthcare by supporting preventive care; however, it often imposes significant documentation burdens that disrupt workflows. These challenges may stem from usability issues driven by system or interface design flaws that result in the misalignment of EHR with clinical workflows, increasing clinicians' cognitive load. This study aims to identify and analyze the usability issues contributing to documentation burdens and subsequently lead to workflow disruptions.

Methods: The scoping review employed the methodology developed by Levac. Three databases, namely PubMed, Scopus, and Ovid MEDLINE, were searched to identify relevant studies published in English between 2007 and 2024. Handsearching of key journals was also conducted to ensure comprehensive coverage of the literature. All findings were reported according to PRISMA guidelines for scoping reviews.

Results: Of 2387 identified records, only 28 studies met the inclusion criteria, employing qualitative, mixed methods as well as time-motion studies. The studies noted that clinicians frequently experienced significant workflow disruptions caused by poorly designed interfaces, which led to task-switching, excessive and prolonged screen navigation, and fragmented critical information across EHR. These challenges often necessitated workarounds, such as duplicating documentation and using external tools, further increasing the risk of data entry errors and prolonging documentation times.

Conclusion: Our study findings highlight the critical need for improved EHR design that minimises workflow disruptions associated with documentation burden. Addressing these challenges requires human factors approach that streamlines information retrieval, optimizes interface usability, and eliminates unnecessary task complexity.

Keywords: clinical workflow; data entry; documentation burden; electronic health records; interface usability.

Publication types

Scoping Review

MeSH terms

Documentation* / standards
Electronic Health Records* / organization & administration
Electronic Health Records* / standards
Humans
User-Computer Interface
Workflow*

Grants and funding

The authors received no specific funding for this work.