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Cited by 40Electronic Health Records SystemsArtificial Intelligence in Healthcare and EducationTechnology and Human Factors in Education and Health

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

Open access
Fletcher, Emily, Burns, Alex, Wiering, Bianca, Lavu, Deepthi, Shephard, Elizabeth, Hamilton, Willie, Campbell, John L., Abel, Gary·2023·BMC Primary Care
DOI 10.1186/s12875-023-01973-2PMC PMC9857918

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Abstract

Background: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. Methods: A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. Results: The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”. Conclusions: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

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  • Existing approaches for evaluating the impact of CDS on provider EHR-use activities and clinical workflow heavily rely on manual data collected through surveys, qualitative interviews, direct observation, and audio/video recording.

    “Existing approaches for evaluating the impact of CDS on provider EHR-use activities and clinical workflow heavily rely on manual data collected through surveys, qualitative interviews, direct observation, and audio/video recording.10,13,16–19”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [10]

    The Results (Description of included articles; page not available) report frequent use of surveys, interviews and observations, and the Discussion says most articles relied on clinicians’ subjective perceptions. The review also reports EMR and tool-usage data, while audio/video recording was used in only a few studies; it therefore does not support heavy reliance on every listed manual method. Its scope is eCDS in primary care, not provider EHR-use activities generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Studies objectively measuring the time spent using CDS tools or their impact on workflow and workload are limited, often relying on small-scale simulations with direct observation.

    “Studies objectively measuring the time spent using CDS tools or their impact on workflow and workload (eg, consultation duration) are limited, often relying on small-scale simulations with direct observation.10”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [10]

    The Discussion says evidence on objectively measured consultation duration is much smaller than evidence on perceived impacts, although many quantitative articles measured time spent using eCDS tools. The Results report researcher-timed consultations or scenarios in four articles, alongside several other measurement methods; they do not establish that objective studies often relied on small-scale simulations with direct observation. No page numbers are available in our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • EHR-based CDS tools can streamline workflows by automatically presenting relevant information, thus reducing the need for providers to manually search through extensive records.

    “EHR-based CDS tools can streamline workflows by automatically presenting relevant information, thus reducing the need for providers to manually search through extensive records.10,13”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [10]

    The Introduction says eCDS tools can draw directly on electronic medical records, and the Results (Decrease in consultation duration) report that some helped clinicians complete tasks more quickly. Our copy does not establish that automatically presenting relevant information reduces providers’ need to search through extensive records manually; that specific mechanism is unsupported. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Prior studies found that providers often perceived or experienced increased workload such as extended duration of patient consultation, interrupted workflow, and alert overload associated with using CDS tools.

    “Prior studies found that providers often perceived or experienced increased workload such as extended duration of patient consultation, interrupted workflow, and alert overload associated with using CDS tools.10,11”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [10]

  • Implementing a CDS tool can result in important downstream effects, both intended and unintended.

    “Implementing a CDS tool can result in important downstream effects, both intended and unintended.”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [10]

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Cites

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Research works printed but not linked: 16

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Authors
Fletcher, E., Burns, A., Wiering, B., Lavu, D., Shephard, E., Hamilton, W., Campbell, J. L., & Abel, G.
Affiliations
University of Exeter (GB)
Corresponding author
Fletcher, Emily
ORCID
Venue
BMC Primary Care
Publisher
Springer Science and Business Media LLC
Published
2023-01-20
Volume
24
Issue
1
Pages
23-23
ISSN
  • 1471-2296 (ISSN-L)
  • 2731-4553
DOI
10.1186/s12875-023-01973-2
PMC
PMC9857918
OpenAlex
W4317545824
Cited by
40
References
118
Citations by year
2026: 15 · 2025: 10 · 2024: 8 · 2023: 7
FWCI
1.57
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
Funders
  • The Dennis & Mireille Gillings Foundation
  • Cancer Research UK
  • University of Exeter
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
Keywords
electronic clinical decision support, general practice, primary care, clinician workload, workflow, consultation time, alarm fatigue, mental workload, clinician-patient communication, risk assessment tools
MeSH terms
Family Practice, Humans, Referral and Consultation, Workload, Decision Support Systems, Clinical, Workflow, General Practitioners, General Practice

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