Table 2.

Summary of recommendations by physicians to address EHR-related burnout and connection to the sociotechnical model

Recommendation Level	Intervention Theme	Specific Interventions Suggested by Physicians	Sociotechnical Domain(s) Addressed	Citations
Policy	Reduce regulatory burden for documentation	Evaluate impact of documentation regulations Consider implementing regulations to permit progress notes to be shorter Redesign or discontinue Meaningful Use requirements	External rules, regulations, and pressures; workflow and communication	Holden et al,51 Copley et al,34 Flanagan et al,52 Colligan et al53
Organizational	General EHR training and technical support	Provide EHR training to address steep learning curves associated with learning how to use the EHR Provide ample time for EHR training Offer on-site EHR support services	Internal organizational policies, procedures, and culture; workflow and communication; human-computer interface	Holden et al,51 Copley et al,34 Ayers,54 Khairat et al43
	Implement organizational and management policies on EHR usage	Use support staff to triage in-basket messages Use scribes and support staff to assist in writing notes and orders Shorten the length of patient visits Track prevalence of after-hours EHR use Implement protected time to complete visit notes Design and deliver patient education that focuses on appropriate messages to send via patient portals	Internal organizational policies, procedures, and culture; people; workflow and communication; system measurement and monitoring	Holden et al,51 Miyasaki et al,55 Contratto et al,56 Ayers,54 Copley et al,34 Flanagan et al,52 Colligan et al,53 Dillon et al57
IT	Tools to help the physicians document and enter orders	Offer capabilities to automatically prepopulate visit notes with select content from prior visits Develop and offer preference lists/bookmarks Enable documentation templates/dot phrases Allow remote EHR access Implement e-prescribing Offer voice dictation systems that integrate with the EHR	Workflow and communication; clinical content	Holden et al,51 Contratto et al,56 Copley et al, 2017,34 Khairat et al,43 Hauer et al,46 Flanagan et al,52 Ward36
	Data management and sharing capabilities	Develop and refine interoperability capabilities within EHR to share information Develop patient summary dashboards Implement flowsheets for efficient downstream research and quality improvement	Hardware and software computing infrastructure; workflow and communication	Copley et al,34 Ayers,54 Colligan et al,53 Ward36
	Streamline global usability features of the EHR and optimize how patient information is displayed to make chart review and navigation more efficient	Reduce number of clicks and typing Limit displaying irrelevant information on screen Moderate the amount of information on screen to improve information clutter Ensure consistent user interface designs and color-codes Place Assessment and Plan sections of signed visit notes at top of note for easier review	Human-computer interface; workflow and communication; clinical content	Holden et al,51 Koopman et al,58 Colligan et al,53 Miyasaki et al,55 Ayers,54 Khairat et al,43 Ward,36 Copley et al34
	Re-examine EHR workflows for fit to physician’s workflows	Adjust sensitivity of automated pop-ups and alarms Design specialty-specific EHR content rather than “one-size-fits-all” content	Workflow and communication; system measurement and monitoring	Holden et al,51 Copley et al,34 Ayers,54 Khairat et al43

EHR: electronic health record; IT: information technology.