Arndt and colleagues (Ann Fam Med, 2017) pulled the EHR event logs of 142 primary care physicians over three years. The headline number — 5.9 hours of EHR work in an 11.4-hour workday, including 1.4 hours of "pajama time" — gets cited a lot. What gets cited less is the breakdown.

Of those 5.9 hours:

1.4 hours on inbox management (results to acknowledge, messages to respond to)
1.3 hours on clinical review (chart review, looking up past visits)
1.0 hours on documentation (note writing)
0.7 hours on order entry
0.6 hours on chart review
0.5 hours on logging in, switching contexts, navigating menus

The number that should make every clinician uncomfortable is the 0.5 hours on logging in and navigating. Half an hour per day, every workday, spent on the navigational overhead of the EHR. Not on documentation. Not on care. Just on moving between screens.

I cannot find a comparable Indian study with similar rigor. But the residents I've spoken with at AIIMS, RG Kar, and JIPMER describe the same fragmentation — except instead of EHR navigation, the time is spent flipping between paper charts, lab reports, ECG strips photocopied at the back of the file, and WhatsApp messages from the lab.

The point of these numbers is not that the EHR is bad. The point is that the cumulative micro-overhead — half a minute here, two minutes there — adds up to hours, and the work that gets squeezed out is the work that has no built-in timekeeper: thinking about the patient.

What I keep coming back to as a designer is this. The tool that holds the ward list, the tool that captures vitals, the tool that records the handover — these should all be the same tool, in the same surface, with the same login. Not because integration is fashionable, but because every "open a different tool" is a working-memory tax.

Medows is built as a single surface for the doctor on rounds, not because we don't believe in specialised tools elsewhere in the hospital, but because at 2 a.m. with 28 patients, the navigation tax is the difference between catching the K+ and not.