Levy Deborah R, Rossetti Sarah C, Brandt Cynthia A, Melnick Edward R, Hamilton Andrew, Rinne Seppo T, Womack Dana, Mohan Vishnu
Department of Medical Informatics and Clinical Epidemiology (DMICE), Oregon Health and Sciences University, Portland, Oregon, United States.
Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education (PRIME) Center, VA-CT, West Haven, Connecticut, United States.
Appl Clin Inform. 2025 Jan;16(1):111-127. doi: 10.1055/a-2434-5177. Epub 2024 Oct 4.
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 () affects trainees, although not all trainees use EHRs, and use may differ for experienced HPs.
This study aimed to develop a model of how interventions to mitigate EHR burden fit within the trainee EHR workflow: the . (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).
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.
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.
Few studies measured trainee perspectives of interventions aiming to mitigate EHR burden. Many studies applied quasi-experimental designs and focused on inpatient settings. The , 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.
卫生专业学员在使用电子健康记录（EHR）开展工作的同时学习所选专业领域，具有独特性。减轻电子健康记录负担的措施已针对经验丰富的卫生专业人员（HP）进行了描述，但对学员的了解较少。电子健康记录或文档负担（）会影响学员，尽管并非所有学员都使用电子健康记录，且经验丰富的卫生专业人员的使用情况可能有所不同。
本研究旨在建立一个模型，说明减轻电子健康记录负担的干预措施如何融入学员电子健康记录工作流程：即[具体模型名称未给出]。（我们：1）研究旨在减轻电子健康记录负担的干预措施的学员体验（范围综述），以及（2）通过对纳入研究进行映射来调整现有的工作流程模型（概念澄清）。
我们按照系统评价和Meta分析扩展的首选报告项目用于范围综述（PRISMA-ScR）指南，对四个数据库进行了范围综述，审查了测量旨在减轻电子健康记录负担的干预措施的学员体验的学术性、同行评审研究。我们进行了概念澄清，对研究进行分类，然后将其映射到工作流程模型元素。我们将该模型调整为针对学员电子健康记录负担的可干预点。
我们确定了11项研究，这些研究考察了旨在减轻电子健康记录负担且测量学员体验的干预措施。干预措施包括针对模拟或实际任务在现有电子健康记录方面的课程、培训和辅导；评估抄写员的影响；添加适合查房的设备或技术；以及在交接班时进行团队沟通或数据展示。干预措施对电子健康记录负担有不同影响，最常见的是通过调查来衡量，较少通过直接观察。大多数研究样本量有限，且侧重于住院环境和医师学员。
很少有研究测量学员对旨在减轻电子健康记录负担的干预措施的看法。许多研究采用准实验设计，且侧重于住院环境。从现有工作流程模型改编而来的[具体模型名称未给出]，为在学员工作流程中确定干预点提供了一个起点。需要进一步开展研究，以设计针对卫生专业学员工作流程各阶段的新干预措施，涵盖一系列临床环境。
