The impact of electronic health record systems on clinical documentation times: a systematic review
Abstract
Background Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation.Methods A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time.Results Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%).Conclusions There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.
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Electronic Health Records have substantially increased clinicians' documentation workload.
“physicians spend more time documenting since the introduction of Electronic Health Records (EHRs), with some spending more than 50% of their time using EHRs [3,4].”
From Implementation of large language models in electronic health records (2025) · cites this paper as [4]
Some physicians spend more than 50% of their time using EHRs.
“with some spending more than 50% of their time using EHRs [3,4].”
From Implementation of large language models in electronic health records (2025) · cites this paper as [4]
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Provider burnout: Implications for our perinatal patients
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Utilizing nursing standards in electronic health records: A descriptive qualitative study
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Data-Driven Scheduling for Improving Patient Efficiency in Ophthalmology Clinics
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Artificial Intelligence: A Review of Progress and Prospects in Medicine and Healthcare
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Explainable clinical coding with in-domain adapted transformers
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Khashan, M. A., Alaskar, T. H., Ghonim, M. A., & Elsotouhy, M. M. (2024) · Marketing Intelligence & Planning · doi:10.1108/mip-05-2023-0225 · Cited by 21 · see citing works
AI-generated draft replies to patient messages: exploring effects of implementation
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Analysis of 10-year trends in Medicare Physician Fee Schedule payments in surgery
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Enhancing Healthcare Quality in Hospitals through Electronic Health Records: A Systematic Review
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Implementation of large language models in electronic health records
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The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice
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Electronic Health Records in Ophthalmology: Source and Method of Documentation
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Increasing Nursing Documentation Efficiency With Wearable Sensors for Pressure Injury Prevention
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Barriers to Adoption of Electronic Health Record Systems from the Perspective of Nurses
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Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit
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- Authors
- Baumann, L. A., Baker, J., & Elshaug, A. G.
- Affiliations
- University of Bremen (DE)
- The University of Sydney (AU)
- Corresponding author
- Elshaug, Adam G.
- Venue
- Health Policy
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 122
- Issue
- 8
- Pages
- 827-836
- ISSN
- 0168-8510 (ISSN-L)
- OpenAlex
- W2805432200
- Cited by
- 320
- References
- 45
- Citations by year
- 2026: 37 · 2025: 47 · 2024: 52 · 2023: 42 · 2022: 45 · 2021: 45 · 2020: 27 · 2019: 22 · 2018: 1
- FWCI
- 4.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Policy (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- HCF Research Foundation Professorial Research Fellow
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- electronic health records, physician documentation, nursing documentation, medical interns, hospital staff workload, EHR implementation
- MeSH terms
- Documentation, Patient Care, Hospitals, Humans, Patient Care Team, Quality of Health Care, Time Factors, Workload, Electronic Health Records
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