DIGITAL WORKFLOW SYSTEMS IN EMERGENCY DEPARTMENTS: A SOCIO-TECHNICAL ANALYSIS OF STAFF EFFICIENCY AND WELL-BEING
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5157Keywords:
Emergency Department Workflow, Socio-Technical Systems, Technostress, SEIPS, Staff Burnout, Health Information Systems (HIS)Abstract
Background: The rapid digitization of healthcare has transformed the Emergency Department (ED) into a complex socio-technical system. While Digital Workflow Systems (DWS), including Electronic Health Records (EHR) and Clinical Decision Support Systems (CDSS), aim to optimize operational metrics, their impact on the cognitive ecosystem of healthcare professionals is often overlooked. This article conducts a socio-technical analysis of the dichotomy between IT-driven efficiency and staff well-being.
Methods: Employing a hybrid systematic–narrative review approach underpinned by the SEIPS 2.0 framework, this study synthesizes literature published between 2018 and 2025. The analysis focuses on identifying how poorly designed interfaces contribute to systemic failures within the ED work system.
Results: The findings reveal that interface design flaws significantly contribute to "technostress," cognitive overload, and moral injury among staff. The review identifies a "productivity paradox" where digital tools, intended to assist clinical workflows, instead become primary sources of professional burnout.
Conclusion: To address these challenges, the paper proposes a framework for resilient, human-centric design. It emphasizes the critical need for integrating cognitive ergonomics and explainable AI into future ED information systems to ensure both patient safety and operator well-being.
References
Apathy, N. C., & Holmgren, A. J. (2023). Opting out of the “click” economy: Electronic health record use and physician burnout. Journal of General Internal Medicine, 38, 2667–2669.
Atasoy, H., Greenwood, B. N., & McCullough, J. S. (2019). The digitization of patient care: A review of the effects of electronic health records on health care quality and outcomes. Annual Review of Public Health, 40, 487–500.
Baxter, R., Comms, K., & Wild, N. (2022). Socio-technical systems design for healthcare: A review. Applied Ergonomics, 102, Article 103723.
Carayon, P., & Wooldridge, A. (2020). Improving patient safety in the sociotechnical work system of the emergency department. Emergency Medicine Clinics, 38(3), 483–494.
Gardner, R. L., Cooper, E., Haskell, J., et al. (2019). Physician stress and burnout: The impact of health information technology. Journal of the American Medical Informatics Association, 26(2), 106–114.
Gregory, M. E., Etchegaray, J. M., & Sinsky, C. A. (2019). Cognitive workflow, interruptions, and the digital environment in emergency care. Joint Commission Journal on Quality and Patient Safety, 45(8), 527–535.
Harris, D. A., & Chen, J. (2022). Technologies and technostress in the emergency department: A scoping review. International Emergency Nursing, 60, Article 101115.
Holden, R. J., Carayon, P., Gurses, A. P., et al. (2020). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669–1686.
Holmgren, A. J., Downing, N. L., Tang, M., et al. (2020). Assessing the impact of the US Electronic Health Record Incentive Program on EHR usability. Applied Clinical Informatics, 11(04), 604–610.
Howe, J. L., Adams, K. T., Hettinger, A. Z., & Ratwani, R. M. (2018). Electronic health record usability issues and potential contribution to patient harm. JAMA, 319(12), 1276–1278.
Joukes, E., Abu-Hanna, A., Cornet, R., & de Keizer, N. (2018). Time spent on documentation in a modern electronic health record in the emergency department. International Journal of Medical Informatics, 113, 22–29.
Kane-Gill, S. L., O'Connor, M. F., Rothschild, J. M., et al. (2021). Technostress in the intensive care unit and emergency department: The impact of new technologies. Critical Care Medicine, 49(5), e532–e540.
Kroth, P. J., Morioka-Douglas, N., Veres, S., et al. (2019). Association of electronic health record design and use factors with clinician stress and burnout. JAMA Network Open, 2(8), e199609.
LaVergne, N. A., & Burrell, S. A. (2019). Technostress in nursing: We are not immune. Online Journal of Nursing Informatics, 23(2).
Melnick, E. R., Dyrbye, L. N., Sinsky, C. A., et al. (2020). The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clinic Proceedings, 95(3), 476–487.
Moy, A. J., Schwartz, J. M., Chen, R., et al. (2021). Measurement of clinical documentation burden among physicians and nurses using electronic health records: A scoping review. Journal of the American Medical Informatics Association, 28(5), 998–1008.
Paterno, M. D., Maviglia, S. M., & Rocha, R. A. (2018). Best practices for alerts in clinical decision support. Applied Clinical Informatics, 9(04), 879–889.
Phung, M., Tran, T., & Nguyen, H. (2023). Alert fatigue in modern clinical decision support systems: A systematic review. International Journal of Medical Informatics, 170, Article 104928.
Ratwani, R. M., Savage, E., Will, A., et al. (2018). A usability and safety analysis of electronic health records: A multi-center study. Journal of the American Medical Informatics Association, 25(9), 1197–1201.
Reis, Z. S. N., Maia, T. A., Marcolino, M. S., et al. (2020). Is there evidence of cost-effectiveness of electronic health records in emergency departments? A systematic review. International Journal of Medical Informatics, 142, Article 104259.
Rotenstein, L. S., Torre, M., Ramos, M. A., et al. (2018). Prevalence of burnout among physicians: A systematic review. JAMA, 320(11), 1131–1150.
Shanafelt, T. D., & Noseworthy, J. H. (2019). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Sinsky, C. A., Rule, A., Cohen, G., et al. (2020). Metrics for assessing physician activity using electronic health record log data. Journal of the American Medical Informatics Association, 27(4), 639–643.
Sutton, R. T., Pincock, D., Baumgart, D. C., et al. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3, 17.
Topol, E. J. (2019). High-performance medicine: The convergence of human and artificial intelligence. Nature Medicine, 25(1), 44–56.
Traub, S. J., & Stewart, C. F. (2021). Emergency department triage and process improvement using digital tools. Emergency Medicine Clinics, 39(4), 693–706.
Turer, R. W., Dutta, S., & Weizman, A. V. (2021). Information fragmentation in the emergency department: An academic medical center experience. Applied Clinical Informatics, 12(02), 263–272.
Wisner, K., Lyndon, A., & Chesla, C. A. (2019). The electronic health record's impact on nurses' cognitive work: An integrative review. International Journal of Nursing Studies, 94, 74–84.
Yan, H., Guo, Y., & Dam, A. (2022). Technostress among nurses in the emergency department: A qualitative study. Journal of Nursing Management, 30(8), 3452–3460.
Zahabi, M., Kaber, D. B., & Swangnetr, M. (2019). Usability and safety in electronic medical records interface design: A review of recent literature and guideline formulation. Human Factors, 61(1), 150–166.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Beata Szreder, Joanna Ślusarczyk, Piotr Pietrzyk, Natalia Stanek, Patrycja Krawczyk, Maja Łapaj, Aleksandra Jagiełło, Zuzanna Noweta, Milena Lewicka, Tamara Chodań

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

