ArticleHealth services research2023
Documentation dynamics: Note composition, burden, and physician efficiency.
Article in Health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07742761 (Emergency Medicine Practitioners Overall Well-being Enhancement With Ambient AI Scribes), which is not on this map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Emergency Medicine Practitioners Overall Well-being Enhancement With Ambient AI Scribes
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Measuring Documentation Burden in Healthcare.Journal of general internal medicine · 2024Pooled it
- What happens at the postpartum visit? Discordance between patient-reported and electronic medical record-documented postpartum care.Annals of epidemiology · 2026Trial
- Implementation Readiness for National Cancer Survivorship Care Standards.JAMA network open · 2026Article
- An Evaluation of AI-Generated Clinical Notes in the OpenNotes Era: A Thematic Analysis of Clinician Discourse.Journal of evaluation in clinical practice · 2026Article
- Charting Tomorrow: A Practical Review of Artificial Intelligence in Medical Documentation.Plastic and reconstructive surgery. Global open · 2026Article
- Electronic health record use factors linked to efficiency and productivity: an explainable machine learning analysis.JAMIA open · 2026Article
- Nested order panels for adult primary care modestly improves ordering efficiency among high utilizers.JAMIA open · 2026Article
- Copy Tools in the Electronic Health Record: Perceptions, Implications, and Future Directions.JMIR medical informatics · 2025Article
- Feasibility of extracting key elements from thoracic surgical operative notes using foundational large language models.Journal of thoracic disease · 2025Article
- Behavioral Phenotypes in Electronic Health Record Use by Primary Care Providers: a Cluster Analysis.Journal of general internal medicine · 2025Article
- A Preliminary Conceptual Framework of Clinical Documentation Burden: Exploratory Factor Analysis Investigating Usability, Effort, and Perceived Burden among Health Care Providers.Applied clinical informatics · 2025Article
- Effect of a generative artificial intelligence digital scribe on pediatric provider documentation time, cognitive burden, and burnout.JAMIA open · 2025Article
- Exploring Provider Perceptions and Attitudes toward Copy-Paste and Copy-Forward in Clinical Documentation.Applied clinical informatics · 2025Article
- Does autotext usage decrease documentation time among resident physicians? A retrospective analysis of electronic health record usage data.JAMIA open · 2025Article
- Analyzing Physician In Basket Burden and Efficiency Using K-Means Clustering.Applied clinical informatics · 2025Article
- Physician Perspectives on Ambient AI Scribes.JAMA network open · 2025Article
- Effects of Aligning Residency Note Templates with CMS Evaluation and Management Documentation Requirements.Applied clinical informatics · 2025Article
- Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Ambient artificial intelligence scribes: utilization and impact on documentation time.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- The Impact of Diagnosis-Specific Plan Templates on Admission Note Writing Time: A Quality Improvement Initiative.Journal of graduate medical education · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
objectiveTo analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. DATA SOURCES AND STUDY
settingSecondary EHR use metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. STUDY
designIn this cross-sectional study, we analyzed physician clinical note length and note composition (e.g., content from manual or templated text). Our primary outcomes were three time-based measures of EHR burden (time writing EHR notes, time in the EHR after-hours, and EHR time on unscheduled days), and one measure of efficiency (percent of visits closed in the same day). We used multivariate regression to estimate the relationship between our outcomes and note length and composition. DATA EXTRACTION: Physician-week measures of EHR usage were extracted from Epic's Signal platform used for measuring provider EHR efficiency. We calculated physician-level averages for our measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. PRINCIPAL
findingsPhysicians in the top decile of note length demonstrated greater burden and lower efficiency than the median physician, spending 39% more time in the EHR after hours (p < 0.001) and closing 5.6 percentage points fewer visits on the same day (p < 0.001). Copy/paste demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day (p < 0.001) and spending more time in the EHR after hours and on days off (both p < 0.001). Templated text (e.g., Epic's SmartTools) demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
conclusions"Efficiency tools" like copy/paste and templated text meant to reduce documentation burden and increase provider efficiency may have limited efficacy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.