HJBR May/Jun 2026

THE FUTURE OF HEALTHCARE 20 MAY / JUN 2026 I  HEALTHCARE JOURNAL OF BATON ROUGE practice, the EHR has evolved into one of the most significant sources of friction in modern medical practice. A growing body of evidence — synthesized by both the National Academy of Medicine and the American Medical Association — has identified documentation burden, poor us- ability, and excessive clerical work as central, system-level contributors to clinician burnout. Empirical data reinforce this conclusion. In a landmark study, Tait Shanafelt and colleagues demonstrated that physicians experiencing higher clerical burden and less efficient elec- tronic work environments were significantly more likely to report burnout and reduced pro- fessional satisfaction. Notably, the signal was not simply the presence of the EHR, but the degree to which it imposed nonclinical work onto physicians. Time-motion analyses provide further granu- larity. Physicians spend substantially more time interacting with the EHR and performing ad- ministrative tasks than in direct patient care. In one study, nearly half of physician time was devoted to EHR and desk work compared to just over one-quarter in face-to-face clinical care. This imbalance extends beyond clinic hours, with physicians spending an additional one to two hours per day on after-hours docu- mentation — commonly referred to as “pajama time.” The implications extend beyond inconve- nience. The EHR has, in many settings, func- tionally transformed physicians into the final in- tegration point for fragmented administrative, regulatory, and billing requirements. Tasks that were once distributed across a care team — or did not exist at all — are now consolidated within the physician workflow, often without commensurate redesign of team structure or support systems. The result is predictable: cog- nitive overload, reduced efficiency, and erosion of professional meaning. Importantly, the issue is not digital infrastruc- ture per se, but how it has been operational- ized. In its current form, the EHR is optimized less for clinical reasoning or longitudinal pa- tient care, and more for documentation, com- pliance, and revenue capture. Until that un- derlying orientation is addressed, incremental usability improvements are unlikely to mean- ingfully reduce the burden it imposes. These findings underscore how EMRs — ness, but not necessarily for clarity or clinical utility. In doing so, we have optimized a system built around encounters, even though health is created longitudinally. Prevailing EMR constructs excel at a few spe- cific functions: the storage of massive amounts of information, the facilitation of fee-for-service billing transactions, the capture of documenta- tion to justify varying levels of evaluation and management (E&M) coding, and the accom- modation of widely varying preferences in how individual physicians choose to document. What they do far less effectively is support syn- thesis, clinical reasoning, or the clear communi- cation of a shared patient-centered action plan. The Hidden Cost of EMRs: Physician Experience and the Erosion of Humanism While some elements of the patient experi- ence have improved, the provider experience has, in many respects, deteriorated. In an en- vironment where economic realities demand high patient throughput — physicians moving rapidly from one discrete office encounter to the next — the transition from pen and paper to keyboard-based documentation has often slowed workflow and introduced a new layer of cognitive and administrative complexity. The act of caring for a patient is increasingly medi- ated by the demands of the screen. There is a well-known 19th-century painting, “The Doctor,” which depicts a physician seated at the bedside of a critically ill child, fully ab- sorbed in observation and contemplation, with the family quietly gathered around. It captures, in a single frame, many of the ideals that draw individuals into medicine: presence, empathy, focus, and the intellectual engagement of problem-solving in service of another human being. In contrast, a more modern depiction of the clinical encounter might show a patient sit- ting on an exam table while the physician, back turned to them, gazes intently at a computer screen — navigating checkboxes, fields, and documentation requirements. The technology that was intended to enhance care has, in this context, too often reoriented attention away from the patient and toward the system itself. The widespread adoption of electronic health records (EHRs) was intended to modernize care delivery, improve coordination, and enable data-driven clinical decision-making. Yet in tures and insurance design. For many patients, coverage itself is episodic; medications may be affordable early in the year, only to become unattainable after entering the coverage gap, forcing patients into dangerous interruptions in therapy until the calendar resets. In this con- text, the promise of technology feels incom- plete — capable of smoothing the surface, but not yet addressing the structural fractures beneath. Electronic Medical Records: Digitizing a Flawed System Electronic medical records offer a clear ex- ample of this dynamic. To be clear, there is no reasonable argument for a return to paper charting; healthcare was long overdue for digi- tization, and the transition into the 21st century was both necessary and inevitable. But in many ways, we digitized a fundamentally flawed sys- tem without first addressing its underlying de- sign problems. When a “solution” is applied to a structurally unsound foundation, it may produce incremental gains — better legibility, improved data access, enhanced documenta- tion — but it can also obscure the deeper is- sues, creating the illusion of progress while prolonging the time it takes to recognize the true nature of the dysfunction. It is akin to rein- forcing a cracked foundation with cosmetic re- pairs: The structure may appear more stable in the short term, but the core instability remains unaddressed. In these situations, the highest-value inter- vention is not optimization but redesign. Tech- nology can amplify what already exists, but it rarely transforms a system whose incentives, workflows, and architecture are misaligned. Ex- pecting it to do so risks mistaking digitization for innovation — and incremental improvement for transformation. Nowhere is this more apparent than in the evolution of clinical documentation. The aver- age length of a medical note has grown sub- stantially over time, often spanning multiple pages and containing an overwhelming volume of data. And yet, paradoxically, the signal is of- ten harder to find within the noise. When re- viewing charts, it is not uncommon to struggle to discern the actual plan of care, let alone the patient’s goals, preferences, or priorities. The note, in many cases, has become a repository rather than a tool — optimized for complete-