Best EHR System: Usability, CDS, Interoperability, and Workflow Evidence: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object digital::BEST_EHR_SS
Creator: SAIMSARA
License: https://saimsara.com/license/

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doi:10.62487/saimsara40f2f857

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Best EHR System: Usability, CDS, Interoperability, and Workflow Evidence: Scoping Review with ☸️SAIMSARA.

Digital Health & Biotech

Issue 3, Volume 1, 2026

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DOI: 10.62487/saimsara40f2f857

Editorial note

• Last update: 2026-05-20 13:04:52

What is this paper about

Electronic health records are not won by one “best” vendor: the evidence shows that usability, clinical decision support, interoperability, analytics readiness, workflow fit, and governance decide whether an EHR actually improves care. Built from 57 references and 130 original studies, the full ☸️SAIMSARA evidence map gives a practical, reference-linked view of what makes EHR systems work — and where they fail in real clinical settings.

Human-verified editorial review Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.

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Abstract: To synthesize evidence regarding the performance, usability, and clinical impact of various Electronic Health Record (EHR) systems and their integrated components to identify best practices for implementation and optimization. The review uses 57 references and builds its evidence map from 130 original studies with 11.977.859 total participants/sample observations (topic-deduplicated ΣN). Overall, the evidence suggests that no single EHR system is universally best; instead, performance depends on the combination of user-centered design, embedded clinical decision support, and interoperable, analytics-ready architecture. Recurrent signals indicate that usability remains a critical weakness, with installed systems scoring a median System Usability Scale of 53 in UK emergency departments compared with 77.8 for a user-centered prototype, while workflow redesign and integrated pathways were associated with meaningful documentation and care improvements, including a 30% process-time reduction in one OpenEMR implementation. Single-vendor architectures appeared to support broader organizational capabilities than best-of-breed configurations, though context and workflow fit dominated outcomes. Practically, this highlights that EHR optimization should prioritize design, training, and governance alongside vendor choice. Future research should focus on prospective, multi-site comparative evaluations using standardized usability and interoperability outcomes to clarify which configurations best serve specific clinical settings.

Keywords: EHR Usability; Clinical Decision Support; Blockchain Protocols; Machine Learning Models; Interoperability Standards; Physician Satisfaction; Workflow Optimization; Data Security; Patient Portal Adoption; System Performance Metrics

Review Stats

Final search date and database lock: 2026-05-15 19:59:37 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 838569
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 149
Included original Abstracts/Papers (Vote counting by direction of effect): 130
Reference Index (links used in paper): 57
Total participants/sample observations (topic deduplicated ΣN): 11.977.859

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Reference Index (57)

[1] Streamlining Honduran Healthcare: EHR Implementation for Improved Clinical Workflows — https://doi.org/10.1109/conescapan62181.2024.10891088
[2] A simulation-based AHP approach to analyze the scalability of EHR systems using blockchain technology in healthcare institutions — https://doi.org/10.1016/j.imu.2021.100576
[3] Analysis of Secure EHR Storage Methods on Blockchain and Integrating ML to Predict Chronic Kidney Disease — https://doi.org/10.1109/icraie56454.2022.10054247
[4] Usability of electronic health record systems in UK EDs — https://doi.org/10.1136/emermed-2020-210401
[5] Using Electronic Clinical Decision Support to Examine Vision Rehabilitation Referrals and Practice Guidelines in Ophthalmology — https://doi.org/10.1167/tvst.11.10.8
[6] Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines — https://doi.org/10.1097/jmq.0000000000000036
[7] Development, Implementation, and Evaluation of a Personalized Machine Learning Algorithm for Clinical Decision Support: Case Study With Shingles Vaccination — https://doi.org/10.2196/16848
[8] Sharing Clinical Notes while Protecting Adolescent Confidentiality and Maintaining Parental Insight — https://doi.org/10.1055/a-2084-4650

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