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CC BY-NC-ND 4.0 · Appl Clin Inform 2025; 16(01): 111-127
DOI: 10.1055/a-2434-5177
Review Article

Interventions to Mitigate EHR and Documentation Burden in Health Professions Trainees: A Scoping Review

Authors

  • Deborah R. Levy

    1   Department of Medical Informatics and Clinical Epidemiology (DMICE), Oregon Health and Sciences University, Portland, Oregon, United States
    2   Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education (PRIME) Center, VA-CT, West Haven, Connecticut, United States
    3   Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States

  • Sarah C. Rossetti

    4   Department of Biomedical Informatics, Columbia University New York, New York, United States
    5   Columbia University School of Nursing, New York, New York, United States

  • Cynthia A. Brandt

    2   Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education (PRIME) Center, VA-CT, West Haven, Connecticut, United States
    3   Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States

  • Edward R. Melnick

    3   Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States
    6   Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
    7   Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, United States

  • Andrew Hamilton

    8   Oregon Health and Sciences University (OHSU), OHSU Library, Portland, Oregon, United States

  • Seppo T. Rinne

    9   VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, United States
    10   Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States

  • Dana Womack   *

    1   Department of Medical Informatics and Clinical Epidemiology (DMICE), Oregon Health and Sciences University, Portland, Oregon, United States

  • Vishnu Mohan   *

    1   Department of Medical Informatics and Clinical Epidemiology (DMICE), Oregon Health and Sciences University, Portland, Oregon, United States

Funding D.R.L. receives fellowship support from the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations, Office of Research and Development, and with resources and the use of facilities at the VA Connecticut Healthcare System, West Haven, CT (CIN-13-407).
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Abstract

Background Health professions trainees (trainees) are unique as they learn a chosen field while working within electronic health records (EHRs). Efforts to mitigate EHR burden have been described for the experienced health professional (HP), but less is understood for trainees. EHR or documentation burden (EHR burden) affects trainees, although not all trainees use EHRs, and use may differ for experienced HPs.

Objectives This study aimed to develop a model of how interventions to mitigate EHR burden fit within the trainee EHR workflow: the Trainee EHR Burden Model. (We: 1) Examined trainee experiences of interventions aimed at mitigating EHR burden (scoping review) and (2) Adapted an existing workflow model by mapping included studies (concept clarification).

Methods We conducted a four-database scoping review applying Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extensions for Scoping Review (PRISMA-ScR) guidance, examining scholarly, peer-reviewed studies that measured trainee experience of interventions to mitigate EHR burden. We conducted a concept clarification categorizing, then mapping studies to workflow model elements. We adapted the model to intervenable points for trainee EHR burden.

Results We identified 11 studies examining interventions to mitigate EHR burden that measured trainee experience. Interventions included curriculum, training, and coaching on the existing EHR for both simulated or live tasks; evaluating scribes' impact; adding devices or technology tailored to rounds; and team communication or data presentation at end-of-shift handoffs. Interventions had varying effects on EHR burden, most commonly measured through surveys, and less commonly, direct observation. Most studies had limited sample sizes and focused on inpatient settings and physician trainees.

Conclusion Few studies measured trainee perspectives of interventions aiming to mitigate EHR burden. Many studies applied quasi-experimental designs and focused on inpatient settings. The Trainee EHR Burden Model, adapted from an existing workflow model, offers a starting place to situate points of intervention in trainee workflow. Further research is needed to design new interventions targeting stages of HP trainee workflow, in a range of clinical settings.

Keywords

electronic health records and systems - documentation burden - EHR burden - clinician documentation - health professions trainees - students

Authors' Contributions

D.R.L. conceptualized the project with the advice of D.W. and V.M., as her independent study (2021, V.M.) and capstone (2023–2024, D.W. and V.M.) faculty advisors. The authors (D.R.L., D.W., and A.H.) designed the search strategies. D.R.L. and D.W. independently evaluated the titles and abstracts for inclusion and exclusion criteria. Data were extracted by D.R.L. and D.W. in joint sessions, due to the small corpus. All authors contributed to the concept clarification phase. The manuscript was drafted by D.R.L., with detailed feedback from D.W. and V.M. for early drafts and all coauthors for later drafts. The workflow model was adapted by D.R.L. and D.W., which was then reviewed in detail by expert coauthors (C.A.B., E.R.M., S.C.R., and S.T.R.). The complete manuscript (drafts and final version) was reviewed in detail by all the coauthors.


Protection of Human and Animal Subjects

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


Data Availability Statement

The data underlying this article including the detailed search strategy are available in the article and its online supplementary appendix information.


Disclaimer

The contents of this manuscript represent the view of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States Government.


* These authors are co-senior authors.


Supplementary Material



Publication History

Received: 25 June 2024

Accepted: 30 September 2024

Accepted Manuscript online:
04 October 2024

Article published online:
05 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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