Appl Clin Inform 2024; 15(01): 010-025
DOI: 10.1055/a-2203-3787
Review Article

Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review

Chaerim Kang
1   Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
Indra Neil Sarkar
1   Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
2   Rhode Island Quality Institute, Providence, Rhode Island, United States
› Author Affiliations


Background Electronic health records are a significant contributing factor in clinician burnout, which negatively impacts patient care.

Objectives To identify and appraise published solutions that aim to reduce EHR-related burnout in clinicians.

Methods A literature search strategy was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six databases were searched for articles published between January 1950 and March 2023. The inclusion criteria were peer-reviewed, full-text, English language articles that described interventions targeting EHR-related burnout in any type of clinician, with reported outcomes related to burnout, wellness, EHR satisfaction, or documentation workload. Studies describing interventions without an explicit focus on reducing burnout or enhancing EHR-related satisfaction were excluded.

Results We identified 44 articles describing interventions to reduce EHR-related burnout. These interventions included the use of scribes, EHR training, and EHR modifications. These interventions were generally well received by the clinicians and patients, with subjective improvements in documentation time and EHR satisfaction, although objective data were limited.

Conclusion The findings of this review underscore the potential benefits of interventions to reduce EHR-related burnout as well as the need for further research with more robust study designs involving randomized trials, control groups, longer study durations, and validated, objective outcome measurements.

Protection of Human and Animal Subjects

Human and/or animal subjects were not included in the project.

Publication History

Received: 10 August 2023

Accepted: 02 November 2023

Accepted Manuscript online:
03 November 2023

Article published online:
03 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Shanafelt TD, Boone S, Tan L. et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012; 172 (18) 1377-1385
  • 2 Alkhamees AA, Aljohani MS, Kalani S. et al. Physician's burnout during the COVID-19 pandemic: a systematic review and meta-analysis. Int J Environ Res Public Health 2023; 20 (05) 4598
  • 3 Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis. J Adv Nurs 2021; 77 (08) 3286-3302
  • 4 Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci (Basel) 2018; 8 (11) 98
  • 5 Frintner MP, Kaelber DC, Kirkendall ES, Lourie EM, Somberg CA, Lehmann CU. The effect of electronic health record burden on pediatricians' work-life balance and career satisfaction. Appl Clin Inform 2021; 12 (03) 697-707
  • 6 Gesner E, Dykes PC, Zhang L, Gazarian P. Documentation burden in nursing and its role in clinician burnout syndrome. Appl Clin Inform 2022; 13 (05) 983-990
  • 7 Muhiyaddin R, Elfadl A, Mohamed E. et al. Electronic health records and physician burnout: a scoping review. Stud Health Technol Inform 2022; 289: 481-484
  • 8 Tran B, Lenhart A, Ross R, Dorr DA. Burnout and EHR use among academic primary care physicians with varied clinical workloads. AMIA Jt Summits Transl Sci Proc 2019; 2019: 136-144
  • 9 Kroth PJ, Morioka-Douglas N, Veres S. et al. Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (08) e199609
  • 10 Moy AJ, Schwartz JM, Chen R. et al. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. J Am Med Inform Assoc 2021; 28 (05) 998-1008
  • 11 Brady KJS, Trockel MT, Khan CT. et al. What do we mean by physician wellness? A systematic review of its definition and measurement. Acad Psychiatry 2018; 42 (01) 94-108
  • 12 Baxter SL, Gali HE, Chiang MF. et al. Promoting quality face-to-face communication during ophthalmology encounters in the electronic health record era. Appl Clin Inform 2020; 11 (01) 130-141
  • 13 Sinsky C, Colligan L, Li L. et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
  • 14 Hobensack M, Levy DR, Cato K. et al. 25 × 5 symposium to reduce documentation burden: report-out and call for action. Appl Clin Inform 2022; 13 (02) 439-446
  • 15 Yan Q, Jiang Z, Harbin Z, Tolbert PH, Davies MG. Exploring the relationship between electronic health records and provider burnout: a systematic review. J Am Med Inform Assoc 2021; 28 (05) 1009-1021
  • 16 West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018; 283 (06) 516-529
  • 17 West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016; 388 (10057): 2272-2281
  • 18 Aryankhesal A, Mohammadibakhsh R, Hamidi Y. et al. Interventions on reducing burnout in physicians and nurses: a systematic review. Med J Islam Repub Iran 2019; 33: 77
  • 19 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
  • 20 Sequeira L, Almilaji K, Strudwick G, Jankowicz D, Tajirian T. EHR “SWAT” teams: a physician engagement initiative to improve electronic health record (EHR) experiences and mitigate possible causes of EHR-related burnout. JAMIA Open 2021; 4 (02) ooab018
  • 21 Hsieh H-Y, Henker R, Ren D. et al. Improving effectiveness and satisfaction of an electronic charting system in Taiwan. Clin Nurse Spec 2016; 30 (06) E1-E6
  • 22 Buivydaite R, Reen G, Kovalevica T. et al. Improving usability of electronic health records in a UK mental health setting: a feasibility study. J Med Syst 2022; 46 (07) 50
  • 23 Gao RW, Dugala A, Maxwell J. et al. Effect of medical scribes on outpatient oncology visits at a multidisciplinary cancer center. JCO Oncol Pract 2020; 16 (02) e139-e147
  • 24 O'Connor AW, Helfrich CD, Nelson KM, Sears JM, Singh H, Wong ES. Changes in electronic notification volume and primary care provider burnout. Am J Manag Care 2023; 29 (01) 57-63
  • 25 Day MA, Belden JL. EMR happy hour: new approach to electronic medical record continuous learning. Ann Fam Med 2019; 17 (04) 373
  • 26 Heckman J, Mukamal KJ, Christensen A, Reynolds EE. Medical scribes, provider and patient experience, and patient throughput: a trial in an academic general internal medicine practice. J Gen Intern Med 2020; 35 (03) 770-774
  • 27 Hindman A. Utilizing scribes to improve patient-centered care and efficiency and reduce burnout. Oncol Issues 2019; 34 (04) 46-50
  • 28 Lin S, Duong A, Nguyen C, Teng V. Five years' experience with a medical scribe fellowship: shaping future health professions students while addressing provider burnout. Acad Med 2021; 96 (05) 671-679
  • 29 Livingston K, Bovi J. Department-focused electronic health record thrive training. JAMIA Open 2022; 5 (02) ooac025
  • 30 Stevens LA, DiAngi YT, Schremp JD. et al. Designing an individualized EHR learning plan for providers. Appl Clin Inform 2017; 8 (03) 924-935
  • 31 Hartman-Hall H, Kanwal A, Jory L. et al. Scribes with PGY-1 residents on inpatient medicine teams: effect on time spent in meaningful work. J Community Hosp Intern Med Perspect 2023; 13 (01) 25-29
  • 32 Bauer JC, John E, Wood CL, Plass D, Richardson D. Data entry automation improves cost, quality, performance, and job satisfaction in a hospital nursing unit. J Nurs Adm 2020; 50 (01) 34-39
  • 33 Scott K, Hathaway E, Sharp K, Smailes P. The development and evaluation of an electronic health record efficiency workshop for providers. Appl Clin Inform 2020; 11 (02) 336-341
  • 34 Tohmasi S, Naaseh A, Thompson S, Smith BR. Improved perceptions of education and wellness among general surgery residents and faculty after the implementation of outpatient scribes. Am Surg 2021; 87 (10) 1616-1620
  • 35 Gidwani R, Nguyen C, Kofoed A. et al. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Ann Fam Med 2017; 15 (05) 427-433
  • 36 Koshy S, Feustel PJ, Hong M, Kogan BA. Scribes in an ambulatory urology practice: patient and physician satisfaction. J Urol 2010; 184 (01) 258-262
  • 37 Dastagir MT, Chin HL, McNamara M, Poteraj K, Battaglini S, Alstot L. Advanced proficiency EHR training: effect on physicians' EHR efficiency, EHR satisfaction and job satisfaction. AMIA Annu Symp Proc 2012; 2012: 136-143
  • 38 DiAngi YT, Stevens LA, Halpern-Felsher B, Pageler NM, Lee TC. Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers' perceived control over their workload in the EHR. JAMIA Open 2019; 2 (02) 222-230
  • 39 English EF, Holmstrom H, Kwan BW. et al. Virtual sprint outpatient electronic health record training and optimization effect on provider burnout. Appl Clin Inform 2022; 13 (01) 10-18
  • 40 Gordon JE, Belford SM, Aranguren DL. et al. Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record. J Am Med Inform Assoc 2022; 29 (09) 1518-1524
  • 41 Imdieke BH, Martel ML. Integration of medical scribes in the primary care setting: improving satisfaction. J Ambul Care Manage 2017; 40 (01) 17-25
  • 42 Ip IK, Giess CS, Gupte A. et al. A prospective intervention to reduce burnout among academic radiologists. Acad Radiol 2023; 30 (06) 1024-1030
  • 43 Kadish SS, Mayer EL, Jackman DM. et al. Implementation to optimization: a tailored, data-driven approach to improve provider efficiency and confidence in use of the electronic medical record. J Oncol Pract 2018; 14 (07) e421-e428
  • 44 Lam C, Shumaker K, Butt M, Leiphart P, Miller JJ, Anderson BE. Impact of medical scribes on physician and patient satisfaction in dermatology. Arch Dermatol Res 2022; 314 (01) 71-76
  • 45 Lourie EM, Utidjian LH, Ricci MF, Webster L, Young C, Grenfell SM. Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program. J Am Med Inform Assoc 2021; 28 (05) 931-937
  • 46 Martel ML, Imdieke BH, Holm KM. et al. Developing a medical scribe program at an academic hospital: the Hennepin County Medical Center experience. Jt Comm J Qual Patient Saf 2018; 44 (05) 238-249
  • 47 McCormick BJ, Deal A, Borawski KM. et al. Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction. World J Urol 2018; 36 (10) 1691-1697
  • 48 Micek MA, Arndt B, Baltus JJ. et al. The effect of remote scribes on primary care physicians' wellness, EHR satisfaction, and EHR use. Healthc (Amst) 2022; 10 (04) 100663
  • 49 Mishra P, Kiang JC, Grant RW. Association of medical scribes in primary care with physician workflow and patient experience. JAMA Intern Med 2018; 178 (11) 1467-1472
  • 50 Morawski K, Childs-Roshak J, Weitberg A. Scribes: re-writing the story on patient and provider experience. Healthc (Amst) 2017; 5 (03) 95-97
  • 51 Pfoh ER, Hong S, Baranek L. et al. Reduced cognitive burden and increased focus: a mixed-methods study exploring how implementing scribes impacted physicians. Med Care 2022; 60 (04) 316-320
  • 52 Platt J, Altman W. Can medical scribes improve quality measure documentation?. J Fam Pract 2019; 68 (05) E1-E7
  • 53 Pozdnyakova A, Laiteerapong N, Volerman A. et al. Impact of medical scribes on physician and patient satisfaction in primary care. J Gen Intern Med 2018; 33 (07) 1109-1115
  • 54 Raney L, McManaman J, Elsaid M. et al. Multisite quality improvement initiative to repair incomplete electronic medical record documentation as one of many causes of provider burnout. JCO Oncol Pract 2020; 16 (11) e1412-e1416
  • 55 Robinson KE, Kersey JA. Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout. Medicine (Baltimore) 2018; 97 (38) e12319
  • 56 Sattler A, Rydel T, Nguyen C, Lin S. One year of family physicians' observations on working with medical scribes. J Am Board Fam Med 2018; 31 (01) 49-56
  • 57 Sieja A, Markley K, Pell J. et al. Optimization sprints: improving clinician satisfaction and teamwork by rapidly reducing electronic health record burden. Mayo Clin Proc 2019; 94 (05) 793-802
  • 58 Sieja A, Whittington MD, Patterson VP. et al. The influence of a Sprint optimization and training intervention on time spent in the electronic health record (EHR). JAMIA Open 2021; 4 (03) ooab073
  • 59 Stephens J, Kieber-Emmons AM, Johnson M, Greenberg GM. Implementation of a virtual asynchronous scribe program to reduce physician burnout. J Healthc Manag 2022; 67 (06) 425-435
  • 60 Jhaveri P, Abdulahad D, Fogel B. et al. Impact of scribe intervention on documentation in an outpatient pediatric primary care practice. Acad Pediatr 2022; 22 (02) 289-295
  • 61 Johnson E, Roth E. Improving physician wellness through electronic health record education. Int J Psychiatry Med 2021; 56 (05) 327-333
  • 62 Simpson JR, Lin CT, Sieja A, Sillau SH, Pell J. Optimizing the electronic health record: an inpatient sprint addresses provider burnout and improves electronic health record satisfaction. J Am Med Inform Assoc 2021; 28 (03) 628-631
  • 63 Lindsay MR, Lytle K. Implementing best practices to redesign workflow and optimize nursing documentation in the electronic health record. Appl Clin Inform 2022; 13 (03) 711-719
  • 64 Yan C, Rose S, Rothberg MB, Mercer MB, Goodman K, Misra-Hebert AD. Physician, scribe, and patient perspectives on clinical scribes in primary care. J Gen Intern Med 2016; 31 (09) 990-995
  • 65 Kruse CS, Mileski M, Dray G, Johnson Z, Shaw C, Shirodkar H. Physician burnout and the electronic health record leading up to and during the first year of COVID-19: systematic review. J Med Internet Res 2022; 24 (03) e36200
  • 66 Lääveri T, Viitanen J. Physicians' perspectives on EHR usability: results from four large cross-sectional surveys from 2010 to 2021. Stud Health Technol Inform 2023; 304: 16-20
  • 67 Ahmed I, Ishtiaq S. Reliability and validity: importance in medical research. J Pak Med Assoc 2021; 71 (10) 2401-2406
  • 68 Knox M, Willard-Grace R, Huang B, Grumbach K. Maslach Burnout Inventory and a self-defined, single-item burnout measure produce different clinician and staff burnout estimates. J Gen Intern Med 2018; 33 (08) 1344-1351
  • 69 Aggarwal R, Ranganathan P. Study designs: part 4 - interventional studies. Perspect Clin Res 2019; 10 (03) 137-139