Introduction: The Promise and Challenge of Electronic Health Records
According to the Office of the National Coordinator for Health Information Technology, “Electronic Health Records (EHRs) are real-time, patient-centered records that make health information available immediately and securely to authorized users.” Physicians use these devices to create detailed documentation because medical notes serve clinical, legal, and insurance billing purposes. In addition, they greatly improve medical accuracy, legibility, information accessibility, and data coordination. For instance, EHRs provide instant access to demographic data, medical history and diagnoses, progress notes, test results, treatment plans, and other information instantaneously. While EHRs have many benefits, the act of gazing at the screen and typing introduces a barrier which is referred to as the “third party” in the examination room.
The Evolution of Medical Documentation: From Clinical Reasoning to Administrative Requirement
Medical documentation was designed not just to record patient information, but to also capture physician reasoning and communicate clinical decisions. According to John Lee’s article, “Medicine's Note Problem Isn't That Writing Got Hard. It's That the EMR Made It Too Easy,” the structure of medical notes helped physicians organize their thoughts by connecting patient history, objective findings, assessments, and treatment plans. However, as the healthcare field transitioned from paper records to electronic health records, documentation became influenced by administrative requirements, including the need to support insurance billing and reimbursement. This shift transformed the medical note from a tool focused on clinical reasoning into a document that must satisfy financial and obligatory requirements. As a result, physicians now face the challenge of extreme and excessive burnouts.
The Impact of EHRs on Physician–Patient Communication
A study analyzing eight experienced family medicine physicians and 80 patients illustrated that physicians spend more time looking at screens than those using paper charts (Asan et al., 2014). There were a total of 80 visits, 40 utilizing paper and 40 utilizing EHRs. This comparative study showed that physicians using EHRs spent 35.2% of the consultation gazing at a screen, while physicians using a simple paper chart only spent 22.1% of their consultation looking at charts. Additionally, it demonstrated that physicians utilizing EHRs spent only 45.6% of their time maintaining eye contact with their patient, while physicians utilizing a paper chart spent 52.6% of their time maintaining eye contact with their patient. These findings suggest that patients may perceive consultations utilizing EHRs negatively as they can create emotional distance. When a patient enters an examination room, they look for eye contact to build trust and empathy. However, that is lacking as the doctor is too consumed in entering data.
Another study reviewed the impact of EHRs on cognitive load and how it related to physician burnout, with the purpose of identifying strategies to reduce the cognitive burden associated with this technology (Asgari et al., 2024). The research findings suggest that EHR systems are poorly designed, in the sense that this platform presents massive amounts of medical data onto the screen simultaneously, and the menus are too complicated. Physicians cannot control how they view this information and are forced to face the cognitive burden of navigating the system. To fix this problem, the review states that healthcare organizations need to improve the software design to make the data easier to view, and to cut down the amount of paperwork doctors are required to fill out. It is suggested that technologies such as AI can make these fixes happen.
A similar study by Merriweather et al. (2025) explored the same core problem examined by Asgari et al. (2024), but added a unique angle. This study evaluated 564 physicians across 32 specialties to analyze how system usability and data quality impact clinical decision-making. The findings revealed that when the medical data are high-quality, it promotes deeper engagement with the clinical information and increases germane cognitive load. The findings also showed that when EHR menus are easy to navigate, they minimize extraneous cognitive load. This study illustrated that when data is well-organized, it assists physicians’ cognitive performance, and concluded that enhancing data usability supports intensive diagnostic work, while enhancing system usability lowers extraneous cognitive effort.
While data organization shapes a physician’s cognitive performance, it also influences how they interact with patients. According to Taft et al. (2014), EHR communication scores were slightly better when residents used EHRs. Residents scored statistically better in 6 out of 23 specific communication skills areas when given a laptop. It is noted that a computer functions as an intuitive tool rather than a distraction. However, the authors also agree that typing and continuous attention to the computer screen may cause emotional distance and separation. Among clinician leaders, there is a concern that computers in the examination room are a distraction for both the doctor and the patient in terms of communication.
The Future of Documentation: Designing Technology Around Physicians and Patients
Recent advances in the medical field have been created to lessen the effect of documentation burden and clinician burnout. According to Razaghi et al. (2026), AI scribes aim to address this by capturing consultations and generating documentation. This technology combines artificial intelligence, automated speech recognition, natural language processing, and generative AI. It has been found that AI scribes improve workflow efficiency, save time, and enhance patient-clinician interaction by allowing greater clinician focus. However, studies report that AI scribes can create errors, which is especially risky in a field that requires precise detail. AI scribes show promise in improving efficiency and reducing workload for many physicians; however, this tool has not been studied enough, and may create errors.
An observational study by Tan et al. (2026) has demonstrated the potential use of ambient AI scribes to improve physician-patient interactions. The study compared clinical consultations with AI scribes and without AI scribes. It was found that AI scribes reduced documentation time by 15% while increasing physician eye contact with patients by 10.6%. Additionally, 69.2% of surveyed patients agreed that their physician appeared to be more focused on them when using the AI scribe. Although the overall consultation length did not significantly decrease, the reduction in documentation burden allowed physicians to give more of their attention to their patients. However, the study did not necessarily evaluate documentation accuracy.
Conclusion: Redefining the Purpose of Medical Documentation
To conclude, EHRs provide significant convenience for physicians as the database allows them to access the information, coordinate data efficiently, and improve medical accuracy. However, the connection between the patient and physician is lacking because the computer in the room acts as a “third party”, or a barrier. Furthermore, the burden is not just interpersonal, but also cognitive. EHR menus are often poorly organized, creating information overload and forcing physicians to expend additional mental effort navigating complex systems. The future success of EHR systems depends on leveraging tools such as AI to improve software usability and reduce data clutter. This way, the healthcare system can help physicians combat cognitive burnout and focus on what matters most: the patient.
References
Asan, O., Smith, P. D., & Montague, E. (2014). More screen time, less face time – implications for EHR design. Journal of Evaluation in Clinical Practice, 20(6), 896–901. https://doi.org/10.1111/jep.12182
Asgari, E., Kaur, J., Nuredini, G., Balloch, J., Taylor, A. M., Sebire, N., Robinson, R., Peters, C., Sridharan, S., & Pimenta, D. (2024). Impact of electronic health record use on cognitive load and burnout among clinicians: Narrative review. JMIR Medical Informatics, 12, e55499. https://doi.org/10.2196/55499
Harry, E., Sinsky, C., Dyrbye, L. N., Makowski, M. S., Jones, C. D., Barden, A., ... & Linzer, M. (2021). Physician EHR workload and burnout: Effects of clinical environment and EHR usability. Journal of General Internal Medicine, 36(12), 3631–3638. (Formerly pubmed.ncbi.nlm.nih.gov/34117715 / 41915701) https://doi.org/10.1007/s11606-020-06281-x
Kroth, P. J., Morioka-Douglas, N., Veres, S., Pollock, K., Babbott, S., & Poplau, S. (2019). Association of electronic health record design and use factors with clinician stress and burnout. JAMA Network Open, 2(8), e199609. (Formerly pubmed.ncbi.nlm.nih.gov/31411700 / 41815573) https://doi.org/10.1001/jamanetworkopen.2019.9609
Lee, J. (2026). Medicine's note problem isn't that writing got hard. It's that the EMR made it too easy. The Epic Edge. https://hitdoc.substack.com/p/medicines-note-problem-isnt-that
Merriweather, C. A., Jr., Lyytinen, K., Aron, D., & Cauley, M. R. (2025). When better data meets better design: How EHR data usability and system usability shape physicians' cognitive load. npj Digital Medicine, 8, Article 22. https://doi.org/10.1038/s41746-025-02243-4
Office of the National Coordinator for Health Information Technology. (n.d.). Benefits of EHRs. HealthIT.gov. https://healthit.gov/health-it-basics/benefits-ehrs/
Taft, T., Lenert, L., Sakaguchi, F., Stoddard, G., & Milne, C. (2014). Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study. Journal of the American Medical Informatics Association, 22(1), 192–198. https://doi.org/10.1136/amiajnl-2014-002871
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