By Dr. Suliman E. Ahmed, M.D. | Founder, Dr. Suliman Advisory Group (DSAG)
Electronic health records were adopted to make care safer and better coordinated, and in many ways they have delivered. But anyone who has worked a hospital shift knows the other side of the story. Documentation demands have grown faster than clinicians’ capacity to absorb them, and every hour spent charting is an hour not spent at the bedside.
This is not a complaint about technology. It is a strategy problem. The evidence on documentation burden is now substantial, and it points to specific, fixable causes. The challenge, as with so much in healthcare, is closing the gap between what we know and what we actually do.
The problem is real and measurable
Documentation burden is often described as an inconvenience. The research says it is more serious than that. A 2024 study in Health Affairs found that for every additional hour primary care physicians spent on documentation, their likelihood of reviewing patient records from outside providers dropped by 7.1% (Holmgren et al., 2024). In plain terms, mandatory charting crowds out the work that helps clinicians see the full picture of a patient’s history.
The problem is also broad. A 2024 systematic review identified 135 articles measuring documentation burden across 11 different categories, from total time in the EHR to after-hours work (Murad et al., 2024). The same review raised an important caution: most of these measures lack strong validity evidence. We know the burden exists, but the field still needs better tools to measure it consistently.
What drives the burden
Two themes stand out in the published evidence.
Poor usability. A 2025 scoping review of 28 studies found that poorly designed EHR interfaces force clinicians into constant task-switching, excessive screen navigation, and fragmented information. Clinicians respond with workarounds such as duplicate documentation, which lengthens charting time and raises the risk of error (Olakotan et al., 2025).
Workload without support. In an IRB-approved survey of 69 registered nurses using validated instruments, documentation burden showed a weak to moderate correlation with emotional exhaustion, a core feature of burnout (r = 0.404), and poorer EHR usability was also linked to higher exhaustion (r = −0.360) (Gesner et al., 2022). The strongest correlation in that study pointed in a protective direction: nurses who felt leadership understood their documentation demands reported less emotional exhaustion (r = −0.549).
That last point matters for executives. It suggests the solution is not only software. How leaders acknowledge and respond to the burden appears to be part of the fix.
What about AI scribes?
Ambient AI documentation tools, which listen to a clinical encounter and draft the note, are the most talked-about solution today. The evidence is promising but more modest than the marketing. A 2025 randomized trial of 238 physicians across 14 specialties, published in NEJM AI, found that one ambient AI tool reduced documentation time by about 41 seconds per note, while a second tool’s smaller reduction was not statistically significant. Both tools were associated with roughly a 7% improvement in burnout scores, and AI-generated notes occasionally contained clinically significant inaccuracies, most often omissions (Lukac et al., 2025).
The lesson is balanced. AI scribes can help, but they require clinician review, patient consent, and a non-AI backup for patients who decline recording. They are one tool, not the whole answer.
Four practical moves for hospital leaders
Based on the published evidence, I would recommend pairing quick wins with deeper structural work:
- Pilot voice recognition and ambient AI documentation carefully. Start with a defined group, require accuracy review, build in patient consent, and measure documentation time before and after.
- Audit and remove redundant compliance fields. Many required fields exist for quality and billing reasons, so this work must include compliance and quality teams, not clinicians alone. But fields that duplicate information captured elsewhere are a direct target.
- Redesign EHR workflows with frontline input. Usability is the root cause the research keeps returning to (Olakotan et al., 2025). Include nurses, not only physicians, in design decisions. This work is slower and often depends on the vendor, which is exactly why it should start now.
- Make leadership support visible. Scribes, staffing adjustments, and simply demonstrating that leaders understand documentation demands are all linked to lower exhaustion (Gesner et al., 2022). Support is not a soft measure; it is part of the intervention.
How confident should we be?
Honesty about evidence is part of good strategy. The Holmgren study focused on primary care physicians, so the effect in hospital settings may differ. The Gesner findings are correlations from a relatively small sample, which means they show relationships rather than proof of cause. The AI scribe trial ran for only two months in one health system. Taken together, the evidence is strong that documentation burden is real and harmful, and moderately strong on which levers matter. It is weaker on exactly how much any single fix will deliver in your organization, which is why measuring before and after is essential.
From evidence to execution
The research on documentation burden is not lacking. What is often lacking is a deliberate plan to act on it: a clear baseline, a small number of targeted changes, and honest measurement of results. Organizations that treat documentation burden as a strategic priority, rather than an unavoidable cost of modern care, will be better positioned to protect both their clinicians and their patients.
DSAG is also conducting exploratory work with clinicians on documentation burden, and we look forward to sharing more in a future article.
Dr. Suliman Advisory Group (DSAG) helps healthcare organizations turn evidence into practical, measurable strategy. To discuss documentation burden or clinician workforce challenges in your organization, contact DSAG through info@drsulimanahmed.com.
References
Gesner, E., Dykes, P. C., Zhang, L., & Gazarian, P. (2022). Documentation burden in nursing and its role in clinician burnout syndrome. Applied Clinical Informatics, 13(5), 983–990. https://doi.org/10.1055/s-0042-1757157
Holmgren, A. J., Adler-Milstein, J., & Apathy, N. C. (2024). Electronic health record documentation burden crowds out health information exchange use by primary care physicians. Health Affairs, 43(11), 1538–1545. https://doi.org/10.1377/hlthaff.2024.00398
Lukac, P. J., et al. (2025). Ambient AI scribes in clinical practice: A randomized trial. NEJM AI. https://doi.org/10.1056/AIoa2501000
Murad, M. H., Vaa Stelling, B. E., West, C. P., Hasan, B., Simha, S., Saadi, S., Firwana, M., Viola, K. E., Prokop, L. J., Nayfeh, T., & Wang, Z. (2024). Measuring documentation burden in healthcare. Journal of General Internal Medicine, 39(14), 2837–2848. https://doi.org/10.1007/s11606-024-08956-8
Olakotan, O., Samuriwo, R., Ismaila, H., & Atiku, S. (2025). Usability challenges in electronic health records: Impact on documentation burden and clinical workflow: A scoping review. Journal of Evaluation in Clinical Practice, 31(4), e70189. https://doi.org/10.1111/jep.70189
