Table 1.
PICOS (participants, intervention, results [compared with a control], outcome, and study design) characteristics of the included studies.
| Authors | Participants | Intervention | Result themes | Medical outcome themes | Study design |
| Hu et al [24] | Adult health care professionals in the ICUa (1122 or 46.54% doctors, 1289 or 53.46% nurses) | EHRb | Low frequency of exercise, comorbidities, high-quality hospital has high expectations, more night shifts, longer on the job, few paid vacations | None reported | Qualitative |
| Rialon et al [25] | Adult health care professionals in pediatrics (68% male, 84% White, 42-60 years old) | EHR | Long hours or workload, no time for themselves, poor work-life balance, loss of autonomy, poor relationships with colleagues | None reported | Qualitative |
| Giess et al [27] | Adult nonradiologists and radiologists | EHR | Radiologists more likely to report symptoms of burnout | None reported | Qualitative |
| Kinslow et al [28] | Adult health care professionals (41, 50.6% identified as male; 39, 48.1% identified as female; 1, 1.2% preferred not to answer; 62, 76.5% reported being a resident in a community teaching hospital; 19, 23.5% reported being a resident in a university hospital | EHR | Women at higher risk of burnout and more likely to report suicidal ideations, poor work-life balance, long hours or workload, community-affiliated residents more likely to report suicidal ideation | None reported | Qualitative |
| Anderson et al [26] | Adult family medicine trainees (postgraduate years 1 through 3) and 10 family medicine faculty at the University of Arizona College of Medicine-Phoenix Family Medicine Residency | EHR | Long hours or workload | None reported | Observational |
| Khairat et al [11] | Adult physicians completing an EHR simulation activity, 52% female, mean age 33.2 years | EHR | Cognitive fatigue, design issues | Physical fatigue, cognitive weariness | Cross-sectional |
| Murphy et al [31] | Adult physicians (68% primary care physicians, 32% specialists) at 6 large health care organizations using 4 different EHR systems | EHR | Message complexity, design issues, cognitive fatigue, poor relationships with colleagues, message content | None reported | Qualitative |
| Tran et al [34] | Adult faculty physicians at 10 university-affiliated primary care clinics; survey sent to 190 faculty members and completed by 107 (56%) providers (86 physicians [MD/DO], 19 advanced practice providers [NP/PA], 2 providers who declined to answer the question); women = approximately two-thirds of the survey respondents; majority of the providers trained in family medicine (57%), internal medicine (27%), or pediatrics (18%) | EHR | Long hours or workload, poor work-life balance | None reported | Qualitative |
| Gardner et al [29] | Adult practicing physicians in Rhode Island | EHR | EHR-related or work-related stress | Work stress | Qualitative |
| Kroth et al [30] | Adult ambulatory primary care and subspecialty clinicians from 3 institutions (85.5% physicians, 56.7% women, 68.4% worked in primary care) | EHR | Design issues, lack of interoperability, poor work-life balance, seated position caused problems with back or wrist pain and posture | Posture, back pain | Qualitative |
| Sieja et al [33] | Adult clinicians in endocrinology, neurology, hematology, obstetrics, and gynecology as well as advanced practice providers | EHR Sprint process improvement | Long hours or workload | None reported | Pre-post |
| Quinn et al [32] | Adult physicians with an EHR | EHR | Design issues | None reported | Mixed methods |
| Robinson and Kersey [41] | Adult physicians from 30 specialties completing a total of 46 trainings from 2014 to 2016 | EHR training | EHR improves quality and safety, readability, clinical workflow, and accuracy of documentation; efficiency gains with training; system speed and reliability issues | None reported | Mixed methods |
| Pozdnyakova et al [40] | Adult faculty and a convenience sample (n=325) of their patients at an academic clinic (of patients: 69% Black, 65% female, 48% >65 years old); 373 patients completed surveys; 48 (13%) excluded due to incomplete data, and 325 analyzed (166 scribed and 159 nonscribed visits; Figure 1) | Scribes to assist with EHR workload | Long hours or workload | None reported | Pre-post |
| Marmor et al [39] | Adult physicians of internal medicine, cardiology, and gastroenterology | EHR | Time spent in EHR affects patient satisfaction | None reported | Meta-analysis |
| Denton et al [35] | Adult physicians at 2 urban emergency departments | EHR | EHR improves clinical workflow, door-to-doctor and time to decision, and quality and safety | None reported | Qualitative |
| Kroth et al [38] | Adult clinicians from 2 focus groups at 3 health care facilities with different EHRs (71% women, 98% physicians, 73% worked in primary care for an average of 11 years) | EHR | Long hours or workload, EHR-related or work-related stress, poor work-life balance | Eye strain, hand or wrist pain, back pain | Qualitative |
| Hauer et al [36] | Adult member and nonmember physicians practicing in Wisconsin whose email address is listed in the Wisconsin Medical Society’s database | EHR | Loss of autonomy, poor relationships with colleagues, loss of autonomy, poor work-life balance | None reported | Qualitative |
| Young et al [42] | Adult family physician attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas | EHR | Long hours or workload | None reported | Observational |
| Khairat et al [37] | Adult ED physicians at a large tertiary academic hospital, 50% female, 43% residents, 57% attendings | EHR | Design issues, long hours or workload, system speed or reliability issues | None reported | Mixed methods |
| Arndt et al [47] | Adult family medicine physicians in a single system in southern Wisconsin (100% Epic users; 43% female) | EHR | Long hours or workload | None reported | Cohort |
| Shahmoradi et al [44] | Adult workforce at 15 ambulatory hospitals (67% female, 75.05% with at least a BSc degree, 45.5% with age of 31-41 years, 46.67% employed <15 years) | EHR | Design issues | None reported | Qualitative |
| Gregory et al [43] | Adult primary care physicians at a large medical center | EHR alerts | Alert fatigue, cognitive fatigue | Physical fatigue, cognitive weariness | Mixed methods |
| Jamoom et al [45] | Adult physicians | EHR | Long hours or workload, longer on the job | None reported | Qualitative |
| Reuben et al [46] | Adult physicians were surveyed, including the pilot physicians and others who had experienced ≥1 session with a physician partner | Physician partners to help with EHR workload | Scribes or physician partners can decrease symptoms of burnout. | None reported | True experiment |
aICU: intensive care unit.
bEHR: electronic health record.