From Burnout to Balance: Reimagining EHR Usability in Healthcare

Across hospitals globally, a silent crisis is emerging, not only in intensive care units (ICUs) or emergency rooms, but also behind computer monitors. Physicians are experiencing burnout. Nurses are feeling overwhelmed. Alarmingly, it’s not the patients but the technology pushing them towards this breaking point.

Clinicians now spend more time on computers than with the people they care for. In the United States, primary care physicians spend nearly six hours a day interacting with the electronic health record (EHR), often outside of scheduled clinic hours [1]. This invisible labor costs their “pajama time” too. After a full day of seeing patients, doctors often go home to complete notes, respond to alerts, and check off checkboxes long into the night.

What’s fueling this? One major culprit is the lack of usability in electronic health records. Poorly designed interfaces, endless clicks, non-intuitive layouts, and overwhelming alerts are turning tools meant to help into a frustration.

But it doesn’t have to be this way. By rethinking EHR design from a human-centered usability perspective, we can reduce burnout and restore satisfaction in clinical work.

Burnout Is a Systems Problem, Not a Personal Failure

Clinical burnout isn’t just about being tired. It’s a syndrome characterized by emotional exhaustion, depersonalization, and a loss of meaning in work. The World Health Organization now classifies burnout as an occupational phenomenon resulting from chronic workplace stress [2].

Studies from the Mayo Clinic and Stanford have shown that EHR usability is one of the strongest organizational predictors of physician burnout, ranking second only to workload [3, 4]. It’s not just that systems are complex to use; it’s that they waste time, fragment focus, and loose professional satisfaction.

Consider this: For every hour of direct patient care, clinicians spend nearly two additional hours on EHR tasks [5]. Instead of meaningful interactions, they’re clicking through poorly organized screens, wrestling with templated notes, and responding to low-value alerts.

This isn’t a failure of resilience. It’s a failure of design.

What Makes an EHR Hard to Use?

The problem is multi-layered, but key factors are seen again and again:

• Cognitive overload: Cluttered interfaces require clinicians to scan, search, and remember too much, too quickly.
• Excessive documentation: Regulatory, billing, and medico-legal demands have expanded the note length far beyond what is clinically necessary.
• Alert fatigue: Non-stop notifications and clinical decision support warnings cause clinicians to ignore even important alerts, which is a phenomenon likened to “crying wolf” [6].
• Navigation inefficiency: Critical tasks, such as ordering lab investigations, reviewing notes, and prescribing medicines, are often buried in nested menus or spread across multiple screens.
• Lack of personalization: Systems fail to adapt to different workflows or specialties, resulting in a one-size-fits-all experience.

These design flaws don’t just cause frustration. They consume cognitive bandwidth, worsen patient safety, and fuel emotional exhaustion.

Usability Is Not Just Aesthetics, It’s Clinical Safety

The concept of usability is grounded in human-computer interaction (HCI) and defined by ISO 9241-11 as the extent to which specified users can use a system to achieve specified goals effectively, efficiently, and with satisfaction [7].

In healthcare, usability isn’t cosmetic; it’s clinical. Poor design can lead to medication errors, delayed diagnoses, and missed safety alerts [8]. A 2019 study in JAMA found that hospitals using less usable EHRs reported significantly more patient safety events [9].

Designing for usability involves creating systems that support human thinking, align with clinical workflows, and minimize unnecessary mental strain.

Designing for Healing: Principles That Make a Difference

So what would an EHR look like if it were built to protect not just data, but the people who use it?

Minimize cognitive load

Interfaces should be clean, organized, and intuitive. Key information should be easily visible without excessive scrolling or clicking. Decision-support tools should be context-aware, surfacing relevant insights without clutter.

Streamline documentation

Notes should be structured for both readability and clinical value, rather than billing jargon. Smart text tools, voice recognition, and templates should help to enter information. "Note bloat" becomes a reason for dysfunction, referring to unnecessary and lengthy documentation in patient medical records, which often leads to a cluttered and difficult-to-navigate record.

Personalize workflows

Clinicians should be able to customize their dashboards, shortcuts, and orders. An oncologist shouldn’t navigate the same menus as a pediatrician. Let the system adapt to the user, not the other way around.

Reform alert design

Not every alert needs to pop up. Use tiered notification systems that prioritize high-risk situations. Allow clinicians to adjust thresholds or mute non-critical alerts.

Include clinicians in the design

User-centered design starts by listening. Involve frontline users in the prototyping, testing, and iteration process. Feedback loops should be continuous, not just at launch.

Measure usability like a clinical outcome

Tools like the System Usability Scale (SUS) or the Health IT Usability Evaluation Model (Health-ITUEM) can benchmark performance and guide improvement [10]. If a system impairs confidence, slows care, or increases risk, that’s a measurable failure.

A Future Worth Building

This isn’t just theory. Organizations that have redesigned their Electronic Health Records (EHRs) with usability in mind are seeing tangible benefits.

The University of California, San Francisco (UCSF) implemented a “reboot” of their EHR that reduced clicks per prescription by 50%, cut documentation time by 30%, and significantly improved physician satisfaction [11].

The Veterans Health Administration (VHA) is now actively involving frontline staff in usability testing as part of its EHR modernization strategy, recognizing that clinician voice is a patient safety measure [12].

The evidence shows that when design considerations prioritize the user, all stakeholders benefit, including clinicians, patients, and the system as a whole.

Conclusion: Bringing Back the Human in Healthcare

Technology isn’t inherently harmful. At its best, it can amplify empathy, enhance insight, and extend the reach of healing. However, when digital tools dominate the clinician’s attention and become a source of stress rather than support, they can impair the relationship between caregiver and patient.

Reducing burnout isn’t about more yoga or better snacks in the breakroom. It’s about rethinking how we design the digital systems that shape clinical life.

Every additional click, every overlooked alert, and every hour wasted on screens are not merely technical flaws but rather represent human costs. In the field of medicine, human costs are of paramount importance.

References

1. Arndt, B. G., Beasley, J. W., Watkinson, M. D., et al. (2017). Tethered to the EHR: Primary care physician workload. Annals of Family Medicine, 15(5), 419–426.
2. World Health Organization. (2019). Burn-out an "occupational phenomenon": International Classification of Diseases. https://www.who.int
3. Shanafelt, T. D., Dyrbye, L. N., et al. (2016). Relationship between EHR use and physician burnout. Mayo Clinic Proceedings, 91(7), 836–848.
4. Gardner, R. L., Cooper, E., Haskell, J., et al. (2019). Physician stress and burnout: The impact of health information technology. Journal of the American Medical Informatics Association, 26(2), 106–114.
5. Sinsky, C., Colligan, L., Li, L., et al. (2016). Allocation of physician time in ambulatory practice: A time and motion study. Annals of Internal Medicine, 165(11), 753–760.
6. Ancker, J. S., Edwards, A., Nosal, S., et al. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue. Medical Care, 55(8), 693–700.
7. ISO 9241-11:2018. Ergonomics of human-system interaction—Usability definitions and concepts.
8. Ratwani, R. M., Fairbanks, R. J., Hettinger, A. Z., & Fong, A. (2015). EHR usability contributes to safety events. Journal of the American Medical Association, 314(22), 2400–2401.
9. Ratwani, R. M., Savage, E., Will, A., et al. (2019). Identifying electronic health record usability and safety challenges in pediatric settings. JAMA Pediatrics, 173(12), 1174–1176.
10. Yen, P.-Y., & Bakken, S. (2012). Review of health information technology usability study methodologies. Journal of the American Medical Informatics Association, 19(3), 413–422.
11. UCSF Center for Digital Health Innovation. (2020). EHR usability improvement initiatives. https://cdhi.ucsf.edu
12. U.S. Department of Veterans Affairs. (2022). Electronic Health Record Modernization. https://www.va.gov/ehr-modernization