HJAR May/Jun 2026

THE FUTURE OF HEALTHCARE 24 MAY / JUN 2026 I  HEALTHCARE JOURNAL OF ARKANSAS gation, organization, and reconciliation of in- formation across the entire continuum of care. The EMR, rather than simplifying this respon- sibility, often amplifies it. The result is a level of preparatory work that extends well beyond the visit itself: On the evening before my clinic day, I routinely spend about two hours review- ing charts and synthesizing data so that I can be fully prepared to deliver care that is thoughtful, personalized, and comprehensive. A practical example illustrates this well. As part of my pre- charting workflow, I routinely assess for meta- bolic dysfunction–associated steatotic liver disease (MASLD/MASH) in all patients who are overweight or have obesity. This requires man- ually reviewing historical liver enzymes for evi- dence of elevation, scanning prior imaging for hepatic steatosis, and calculating a Fib-4 score using a dot phrase. Based on that synthesis, I may identify the need for additional steps so that these issues can be addressed thought- fully during the visit itself. While these actions could be deferred until after the encounter, do- ing so would fragment the conversation and delay care. Instead, they require deliberate preparation in advance — time that is largely invisible, but essential to delivering high-quali- ty, comprehensive care. A similar pattern emerges in cardiovascular risk assessment, which has become a central component of managing patients with cardio- metabolic disease. As part of my pre-charting workflow, I routinely review the most recent lipid panel, verify whether a lipoprotein(a) level has been checked at least once in accordance with current guideline recommendations, and calculate the patient’s 10-year atherosclerotic cardiovascular disease risk using the pooled cohort equations. Ideally, this would be done using the newer PREVENT risk score, which has been shown to offer improved risk estima- tion in certain populations, but it has yet to be meaningfully integrated into most electronic medical records. This preparatory work allows me to define appropriate LDL and non-HDL cholesterol targets that are specific to each patient — values that must often be manually calculated and entered — as well as determine whether statin or other lipid-lowering therapy is indicated. As with other aspects of care, this process depends heavily on manual review, cal- culation, and synthesis, rather than being sup- ported natively by the system itself. And even as I contemplate a final chapter of 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 — while improving data capture and access — have shifted a substantial clerical load onto clinicians. Increasingly, there is concern that burnout is not simply a function of workload, but of misalignment — where over-digitization, at the expense of human connection, distanc- es physicians from the very relationships and sense of purpose that drew them into medi- cine. For technology to fulfill its promise in healthcare, it must do more than digitize work; it must eliminate the mundane, restore atten- tion to the patient, and create space for the hu- man connection that sustains both patients and those who care for them. As I reflect on my own journey in medicine, I cannot ignore the role that the electronic medical record has played, at least in part, in one of the most difficult decisions of my career: stepping away from a full-time practice and the thousands of patients I had come to care about deeply. I still see patients one day a week in a clinic model I designed myself, and while that day is often the most fulfilling of my week, I con- tinue to feel the friction imposed by current iterations of the EMR on how I deliver care. My practice style has always been comprehensive; I am comfortable managing a wide spectrum of conditions and I take pride in providing that level of continuity for my patients. But that breadth comes at a cost within the current digi- tal framework. Each encounter requires synthe- sizing a vast and fragmented dataset: medica- tions across all conditions, multi-organ system histories, preventive care, acute complaints, and chronic disease management, all of which must be meticulously documented. In contrast, specialists often operate within a narrower clinical scope — focused histories, targeted medication reviews, and problem- specific documentation. For the primary care internist, the cognitive and administrative load is fundamentally different. Our role demands not only clinical breadth, but also the aggre- 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 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.