Clinical Documentation Burden and Relational Quality of Care

Christian de Hoogh

Clinical Documentation Burden and Relational Quality of Care

Author(s)	Prof. Christian de Hoogh
Country	United States
Abstract	Clinical documentation is essential for continuity, accountability, communication, billing, quality measurement, and patient safety, yet excessive documentation requirements can compete with the interpersonal work through which therapeutic relationships are established. Electronic health records have increased the availability and organization of clinical information but have also introduced substantial time demands involving data entry, order management, inbox processing, chart review, and after-hours documentation. Earlier time-motion research demonstrated that ambulatory physicians could spend substantially more working time on electronic health record and desk activities than on direct patient interaction, while studies of clinician–computer interaction have shown that gaze patterns and the manner in which the electronic record is used can influence patient participation and perceptions of communication. This simulation-based study examines the relationship between documentation burden and relational quality of care using a hypothetical sample of 240 ambulatory clinical encounters. Documentation burden was categorized as low, moderate, or high according to documentation minutes, number of electronic tasks, after-visit work, and perceived clerical workload. Relational quality was modeled through clinician presence, uninterrupted listening, patient participation, eye-contact continuity, shared decision-making, and patient-reported trust. Simulated relational-quality scores decreased from 86/100 under low documentation burden to 75/100 under moderate burden and 62/100 under high burden. High-burden encounters also demonstrated less uninterrupted patient-facing time, more documentation multitasking, and lower patient-rated clinician presence. The findings do not imply that electronic documentation is inherently harmful; instead, they illustrate how poorly balanced documentation requirements may reduce the attentional resources available for relationship-centered care. Because all numerical findings are simulated, the study is methodological rather than empirical. Future prospective research should combine EHR event logs, direct observation, validated relational-care measures, patient experience, clinician well-being indicators, and documentation-quality outcomes to determine how documentation can be redesigned without compromising either informational integrity or the human relationship at the center of clinical care.
Keywords	clinical documentation burden; electronic health records; relational quality of care; patient–clinician communication; clinician presence; patient-centered care; administrative burden; health informatics
Field	Engineering
Published In	Volume 4, Issue 5, September-October 2023
Published On	2023-09-18

View / Download PDF File

About AJAMIR Fees & Payment Current Issue Publication Archive	Submit Research Paper Track Submission Status Publication Guidelines Publication Ethics Peer Review & Plagiarism	Join as a Reviewer Editors & Reviewers Reviewer Referral Program Get Reviewer Membership Certi.	Website/Journal Policies Usage Policy Content Policies Privacy Policy

Contact Us		+1-872-302-3851	editor@ajamir.com

American Journal of Advanced Multidisciplinary Innovation and Research

A Widely Indexed Open Access Peer Reviewed Multidisciplinary Bi-monthly Scholarly International Journal

Clinical Documentation Burden and Relational Quality of Care

Share this