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

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.