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CC BY 4.0 · Appl Clin Inform 2025; 16(05): 1815-1827
DOI: 10.1055/a-2751-1896
Research Article

A Preliminary Conceptual Framework of Clinical Documentation Burden: Exploratory Factor Analysis Investigating Usability, Effort, and Perceived Burden among Health Care Providers

Autor*innen

  • Rhiannon Doherty

    1   College of Health Professions – Medical University of South Carolina, Charleston, South Carolina, United States

  • Abby Swanson Kazley

    1   College of Health Professions – Medical University of South Carolina, Charleston, South Carolina, United States

  • Eva Karp

    1   College of Health Professions – Medical University of South Carolina, Charleston, South Carolina, United States

  • Jennifer Ferrand

    2   Department of Well-Being - Hartford Healthcare, Hartford, Connecticut, United States
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Abstract

Background

For every 30 minutes a provider spends seeing a patient, they spend 36 minutes charting in the electronic health record (EHR). Clinical documentation burden in U.S. health care is driven by increasing administrative tasks associated with EHRs, regulatory demands, and workflow inefficiencies. This burden contributes to increased cognitive load, fragmented care, and staff burnout. No comprehensive conceptual framework guides researchers addressing these challenges.

Objectives

This study aimed to develop a conceptual framework clarifying the interplay between psychological factors, technology, and documentation attributes—usability, effort, and perceived burden—among health care providers.

Methods

Data were collected from a cross-sectional survey using a convenience sample of hospital- and ambulatory-based physicians, advanced practice registered nurses, and physician assistants. A newly constructed questionnaire was used, incorporating elements from well-established instruments. Descriptive and exploratory factor analysis was performed to identify significant findings and develop the preliminary Clinical Documentation Burden Framework.

Results

The analysis revealed three main factors underpinning clinical documentation burden: Poor usability, perceived task value, and excessive mental exertion. These factors were significantly correlated with professional dissonance (PD) and burnout, underscoring the complex interplay between time requirements, design challenges, task engagement, and cognitive load. The resulting conceptual framework highlights the importance of aligning documentation tasks with provider values to mitigate burden.

Conclusion

The study offers new insights into the complex phenomenon of documentation burden affecting health care providers by incorporating key psychological factors. This conceptual framework provides a preliminary foundation for understanding this multifaceted problem. Like prior burnout research, conceptual clarity is key to creating shared definitions and a dedicated measurement instrument to support effective interventions. Given that the sample was predominantly advanced practice providers with underpowered subgroup comparisons, the framework should be interpreted as preliminary. This new appreciation of the dimensionality of documentation burden expands the potential levers available to alleviate operational strain and reduce PD and burnout.

Keywords

electronic health records (MeSH) - cognitive load (MeSH) - burnout - professional (MeSH) - usability (MeSH) - health care providers (MeSH) - clinical documentation burden - psychological factors - EHR optimization

Protection of Human and Animal Subjects

The study was conducted in accordance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. It was reviewed and approved by the Medical University of South Carolina's Institutional Review Board, with Exemption Category 2.


Supplementary Material



Publikationsverlauf

Eingereicht: 02. Mai 2025

Angenommen: 18. November 2025

Accepted Manuscript online:
24. November 2025

Artikel online veröffentlicht:
12. Dezember 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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