{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:28:11Z","timestamp":1774351691468,"version":"3.50.1"},"reference-count":75,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T00:00:00Z","timestamp":1608595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,23]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician\u2019s experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout.<\/jats:p><\/jats:sec><jats:sec><jats:title>Target audience<\/jats:title><jats:p>This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Scope<\/jats:title><jats:p>We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocaa274","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T19:12:44Z","timestamp":1602875564000},"page":"967-973","source":"Crossref","is-referenced-by-count":80,"title":["Electronic health records and clinician burnout: A story of three eras"],"prefix":"10.1093","volume":"28","author":[{"given":"Kevin B","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}]},{"given":"Michael J","family":"Neuss","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}]},{"given":"Don Eugene","family":"Detmer","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA"}]}],"member":"286","published-online":{"date-parts":[[2020,12,22]]},"reference":[{"key":"2021042419053450800_ocaa274-B1","author":"Myrick"},{"issue":"6","key":"2021042419053450800_ocaa274-B2","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/jamia\/ocx080","article-title":"Electronic health record adoption in US hospitals: the emergence of a digital \u201cadvanced use\u201d divide","volume":"24","author":"Adler-Milstein","year":"2017","journal-title":"J Am Med Inform Assoc"},{"issue":"6","key":"2021042419053450800_ocaa274-B3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJMp1006114","article-title":"The \u201cmeaningful use\u201d regulation for electronic health records","volume":"363","author":"Blumenthal","year":"2010","journal-title":"N Engl J Med"},{"issue":"10","key":"2021042419053450800_ocaa274-B4","doi-asserted-by":"crossref","first-page":"677","DOI":"10.7326\/0003-4819-159-10-201311190-00006","article-title":"Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review","volume":"159","author":"Goldzweig","year":"2013","journal-title":"Ann Intern Med"},{"issue":"2","key":"2021042419053450800_ocaa274-B5","doi-asserted-by":"crossref","first-page":"e10949","DOI":"10.2196\/10949","article-title":"Physician use of electronic health records: survey study assessing factors associated with provider reported satisfaction and perceived patient impact","volume":"7","author":"Williams","year":"2019","journal-title":"JMIR Med Inform"},{"issue":"1","key":"2021042419053450800_ocaa274-B6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/jamiaopen\/ooy016","article-title":"The electronic elephant in the room: physicians and the electronic health record","volume":"1","author":"Kroth","year":"2018","journal-title":"JAMIA Open"},{"issue":"1","key":"2021042419053450800_ocaa274-B7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1055\/s-0037-1620263","article-title":"The impact of physician EHR usage on patient satisfaction","volume":"9","author":"Marmor","year":"2018","journal-title":"Appl Clin Inform"},{"issue":"3","key":"2021042419053450800_ocaa274-B8","doi-asserted-by":"crossref","first-page":"e190554","DOI":"10.1001\/jamanetworkopen.2019.0554","article-title":"Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization","volume":"2","author":"Del Carmen","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"13","key":"2021042419053450800_ocaa274-B9","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1001\/jama.2016.1509","article-title":"Era 3 for medicine and health care","volume":"315","author":"Berwick","year":"2016","journal-title":"JAMA"},{"key":"2021042419053450800_ocaa274-B10","doi-asserted-by":"crossref","DOI":"10.56021\/9780801840906","volume-title":"Hippocrates in a World of Pagans and Christians","author":"Temkin","year":"1991"},{"key":"2021042419053450800_ocaa274-B11","first-page":"24","volume-title":"Hippocrates and Medical Education: Selected Papers Read at the XIIth International Hippocrates Colloquium Universiteit Leiden","author":"Horstmanshoff"},{"key":"2021042419053450800_ocaa274-B12","volume-title":"Typologie des sources duMoyen Age Occidental","author":"Agrimi","year":"1994"},{"key":"2021042419053450800_ocaa274-B13","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1086\/368698","article-title":"Theory, everyday practice, and three fifteenth-century physicians","volume":"6","author":"Jacquart","year":"1990","journal-title":"Osiris"},{"key":"2021042419053450800_ocaa274-B14","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511524035","volume-title":"Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century.","author":"Maulitz","year":"1987"},{"key":"2021042419053450800_ocaa274-B15","volume-title":"Medical Records, Medical Education, and Patient Care: The Problem-Oriented Record as a Basic Tool","author":"Weed","year":"1969"},{"issue":"2\u20133","key":"2021042419053450800_ocaa274-B16","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S1386-5056(02)00131-4","article-title":"VistA\u2013U.S. Department of Veterans Affairs national-scale HIS","volume":"69","author":"Brown","year":"2003","journal-title":"Int J Med Inform"},{"issue":"1\u20132","key":"2021042419053450800_ocaa274-B17","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0020-7101(96)01176-2","article-title":"The computer-based record: patient moving from concept toward reality","volume":"42","author":"Detmer","year":"1996","journal-title":"Int J Biomed Comput"},{"issue":"5","key":"2021042419053450800_ocaa274-B18","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/0010-4809(68)90013-X","article-title":"Computer-stored medical record","volume":"1","author":"Davis","year":"1968","journal-title":"Comput Biomed Res"},{"key":"2021042419053450800_ocaa274-B19","volume-title":"Key Capabilities of an Electronic Health Record System: Letter Report","year":"2003"},{"key":"2021042419053450800_ocaa274-B20","volume-title":"Institute of Medicine Committee on Improving the Patient Record. The Computer-Based Patient Record: An Essential Technology for Health Care","author":"Dick","year":"1997"},{"key":"2021042419053450800_ocaa274-B21","article-title":"Tiger'sbones, and other plays for children. Illustrated by AlanE","author":"Hughes","year":"1974","journal-title":"Cober. New York"},{"issue":"7","key":"2021042419053450800_ocaa274-B22","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/j.1467-9566.2005.00463.x","article-title":"Dynamic professional boundaries in the healthcare workforce","volume":"27","author":"Nancarrow","year":"2005","journal-title":"Sociol Health Illness"},{"issue":"1","key":"2021042419053450800_ocaa274-B23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.7326\/M18-0139","article-title":"Physician burnout in the electronic health record era: are we ignoring the real cause?","volume":"169","author":"Downing","year":"2018","journal-title":"Ann Intern Med"},{"issue":"3","key":"2021042419053450800_ocaa274-B24","first-page":"29","article-title":"Documentation tips for reducing malpractice risk","volume":"7","author":"Teichman","year":"2000","journal-title":"Fam Pract Manag"},{"issue":"10","key":"2021042419053450800_ocaa274-B25","doi-asserted-by":"crossref","first-page":"742","DOI":"10.7326\/0003-4819-144-10-200605160-00125","article-title":"Systematic review: impact of health information technology on quality, efficiency, and costs of medical care","volume":"144","author":"Chaudhry","year":"2006","journal-title":"Ann Intern Med"},{"issue":"1","key":"2021042419053450800_ocaa274-B26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/00001888-199301000-00003","article-title":"Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior","volume":"68","author":"Massaro","year":"1993","journal-title":"Acad Med"},{"key":"2021042419053450800_ocaa274-B27","volume-title":"To Err is Human: building a Safer Health System","author":"Kohn","year":"2000"},{"key":"2021042419053450800_ocaa274-B28","volume-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","year":"2001"},{"key":"2021042419053450800_ocaa274-B29","volume-title":"Institute of Medicine Committee on Data Standards for Patient Safety. Patient Safety: Achieving a New Standard for Care","author":"Aspden","year":"2004"},{"key":"2021042419053450800_ocaa274-B30","volume-title":"Institute of Medicine Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors","author":"Aspden","year":"2007"},{"key":"2021042419053450800_ocaa274-B31","volume-title":"RTI Press Policy Brief","author":"Gillen","year":"2010"},{"issue":"7","key":"2021042419053450800_ocaa274-B32","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jama.2017.19148","article-title":"Administrative costs associated with physician billing and insurance-related activities at an academic health care system","volume":"319","author":"Tseng","year":"2018","journal-title":"JAMA"},{"issue":"11","key":"2021042419053450800_ocaa274-B33","doi-asserted-by":"crossref","first-page":"753","DOI":"10.7326\/M16-0961","article-title":"Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties","volume":"165","author":"Sinsky","year":"2016","journal-title":"Ann Intern Med"},{"issue":"3","key":"2021042419053450800_ocaa274-B34","doi-asserted-by":"crossref","first-page":"169","DOI":"10.7326\/M18-3684","article-title":"Physician time spent using the electronic health record during outpatient encounters: a descriptive study","volume":"172","author":"Overhage","year":"2020","journal-title":"Ann Intern Med"},{"issue":"1","key":"2021042419053450800_ocaa274-B35","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3109\/0142159X.2013.849801","article-title":"Automatic scoring of medical students' clinical notes to monitor learning in the workplace","volume":"36","author":"Spickard","year":"2014","journal-title":"Med Teach"},{"key":"2021042419053450800_ocaa274-B36","first-page":"574","article-title":"Observational Health Data Sciences and Informatics (OHDSI): opportunities for observational researchers","volume":"216","author":"Hripcsak","year":"2015","journal-title":"Stud Health Technol Inform"},{"key":"2021042419053450800_ocaa274-B37","first-page":"207","article-title":"Using natural language processing to improve accuracy of automated notifiable disease reporting","volume":"2008","author":"Friedlin","year":"2008","journal-title":"AMIA Annu Symp Proc"},{"key":"2021042419053450800_ocaa274-B38","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2147\/PROM.S141630","article-title":"PCORnet's collaborative research groups","volume":"9","author":"Pletcher","year":"2018","journal-title":"Patient Relat Outcome Meas"},{"issue":"5","key":"2021042419053450800_ocaa274-B39","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1136\/amiajnl-2011-000308","article-title":"Health information exchange usage in emergency departments and clinics: the who, what, and why","volume":"18","author":"Johnson","year":"2011","journal-title":"J Am Med Inform Assoc"},{"key":"2021042419053450800_ocaa274-B40","first-page":"144","article-title":"Progress and challenge in meeting meaningful use at an integrated delivery network","volume":"2011","author":"Bowes","year":"2011","journal-title":"AMIA Annu Symp Proc"},{"issue":"1","key":"2021042419053450800_ocaa274-B41","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s10916-017-0865-6","article-title":"An EPIC switch: preparing for an electronic health record transition at Vanderbilt University Medical Center","volume":"42","author":"Johnson","year":"2018","journal-title":"J Med Syst"},{"issue":"10","key":"2021042419053450800_ocaa274-B42","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1001\/jama.293.10.1197","article-title":"Role of computerized physician order entry systems in facilitating medication errors","volume":"293","author":"Koppel","year":"2005","journal-title":"JAMA"},{"key":"2021042419053450800_ocaa274-B43","first-page":"794","article-title":"Applying direct observation to model workflow and assess adoption","volume":"2006","author":"Unertl","year":"2006","journal-title":"AMIA Annu Symp Proc"},{"issue":"e1","key":"2021042419053450800_ocaa274-B44","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1136\/amiajnl-2013-001686","article-title":"A typology of electronic health record workarounds in small-to-medium size primary care practices","volume":"21","author":"Friedman","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2021042419053450800_ocaa274-B45","first-page":"21","article-title":"The false claims act and its impact on medical practices","volume":"26","author":"Vogel","year":"2010","journal-title":"J Med Pract Manage"},{"issue":"4","key":"2021042419053450800_ocaa274-B46","first-page":"206","article-title":"Are you committing health care fraud under the False Claims Act? The answer may not be as simple as you think","volume":"17","author":"Goldberg","year":"2002","journal-title":"J Med Pract Manage"},{"key":"2021042419053450800_ocaa274-B47","volume-title":"The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age","author":"Wachter","year":"2017"},{"key":"2021042419053450800_ocaa274-B48","volume-title":"The New Yorker","author":"Gawande","year":"2018"},{"key":"2021042419053450800_ocaa274-B49"},{"issue":"4","key":"2021042419053450800_ocaa274-B50","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1093\/jamia\/ocaa008","article-title":"National health information technology priorities for research: a policy and development agenda","volume":"27","author":"Zayas-Caban","year":"2020","journal-title":"J Am Med Inform Assoc"},{"key":"2021042419053450800_ocaa274-B51","first-page":"1008","article-title":"Breadcrumbs: assessing the feasibility of automating provider documentation using electronic health record activity","volume":"2018","author":"Tang","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"issue":"163","key":"2021042419053450800_ocaa274-B52","article-title":"Protocol for the \u201cImplementation, adoption, and utility of family history in diverse care settings\u201d study","volume":"10","author":"Wu","year":"2015","journal-title":"Implement Sci"},{"issue":"3","key":"2021042419053450800_ocaa274-B53","first-page":"7","article-title":"Using a patient portal to transmit patient reported health information into the electronic record: workflow implications and user experience","volume":"4","author":"Sorondo","year":"2016","journal-title":"eGEMs (Wash DC)"},{"issue":"5","key":"2021042419053450800_ocaa274-B54","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s40271-014-0100-1","article-title":"Computer-based clinical decision support systems and patient-reported outcomes: a systematic review","volume":"8","author":"Blum","year":"2015","journal-title":"Patient"},{"issue":"2","key":"2021042419053450800_ocaa274-B55","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMp1615745","article-title":"The 21st century cures act - a view from the NIH","volume":"376","author":"Hudson","year":"2017","journal-title":"N Engl J Med"},{"issue":"21","key":"2021042419053450800_ocaa274-B56","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1016\/j.jcin.2018.05.010","article-title":"The 21st century cures act and early feasibility studies for cardiovascular devices: what have we learned, where do we need to go?","volume":"11","author":"Holmes","year":"2018","journal-title":"J Am Coll Cardiol Intv"},{"issue":"4","key":"2021042419053450800_ocaa274-B57","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1310\/hpx5204-264","article-title":"21st Century Cures Act","volume":"52","author":"Gabay","year":"2017","journal-title":"Hosp Pharm"},{"issue":"3","key":"2021042419053450800_ocaa274-B58","doi-asserted-by":"crossref","first-page":"e201753","DOI":"10.1001\/jamanetworkopen.2020.1753","article-title":"The views and experiences of clinicians sharing medical record notes with patients","volume":"3","author":"DesRoches","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2021042419053450800_ocaa274-B59","volume-title":"Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: workshop Series Summary","author":"Grossmann","year":"2011"},{"key":"2021042419053450800_ocaa274-B60","volume-title":"Large Simple Trials and Knowledge Generation in a Learning Health System: Workshop Summary","author":"Grossmann","year":"2013"},{"issue":"9","key":"2021042419053450800_ocaa274-B61","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1056\/NEJMe1800449","article-title":"Patient-centered outcomes and resuscitation fluids","volume":"378","author":"Myburgh","year":"2018","journal-title":"N Engl J Med"},{"issue":"4","key":"2021042419053450800_ocaa274-B62","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.amepre.2017.02.010","article-title":"National academy of medicine social and behavioral measures: associations with self-reported health","volume":"53","author":"Prather","year":"2017","journal-title":"Am J Prev Med"},{"issue":"3","key":"2021042419053450800_ocaa274-B63","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.2196\/jmir.1346","article-title":"Public health in an era of personal health records: opportunities for innovation and new partnerships","volume":"12","author":"Bonander","year":"2010","journal-title":"J Med Internet Res"},{"issue":"4","key":"2021042419053450800_ocaa274-B64","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1136\/jamia.2010.006098","article-title":"Activating a full architectural model: improving health through robust population health records","volume":"17","author":"Detmer","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"14","key":"2021042419053450800_ocaa274-B65","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1056\/NEJMp1314927","article-title":"Responding to the sexual exploitation of minors","volume":"370","author":"Todres","year":"2014","journal-title":"N Engl J Med"},{"key":"2021042419053450800_ocaa274-B66","article-title":"Biomedical informatics and health information technology: a critical, pragmatic collaboration for clinical transformation","author":"Johnson","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"8","key":"2021042419053450800_ocaa274-B67","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1056\/NEJMp1413945","article-title":"Patients in context\u2013EHR capture of social and behavioral determinants of health","volume":"372","author":"Adler","year":"2015","journal-title":"N Engl J Med"},{"issue":"1","key":"2021042419053450800_ocaa274-B68","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/s41591-018-0272-7","article-title":"Privacy in the age of medical big data","volume":"25","author":"Price","year":"2019","journal-title":"Nat Med"},{"issue":"11","key":"2021042419053450800_ocaa274-B69","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1377\/hlthaff.2010.0635","article-title":"A proposal to protect privacy of health information while accelerating comparative effectiveness research","volume":"29","author":"Peddicord","year":"2010","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2021042419053450800_ocaa274-B70","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/intqhc\/12.1.1","article-title":"Your privacy or your health\u2013will medical privacy legislation stop quality health care?","volume":"12","author":"Detmer","year":"2000","journal-title":"Int J Qual Health Care"},{"key":"2021042419053450800_ocaa274-B71","author":"Herbert"},{"issue":"6","key":"2021042419053450800_ocaa274-B72","doi-asserted-by":"crossref","first-page":"479","DOI":"10.3414\/ME15-01-0064","article-title":"Combining health data uses to ignite health system learning","volume":"54","author":"Ainsworth","year":"2015","journal-title":"Methods Inf Med"},{"issue":"6","key":"2021042419053450800_ocaa274-B73","doi-asserted-by":"crossref","first-page":"477","DOI":"10.3414\/ME15-11-0004","article-title":"At last! A working model of a data ecosystem for continuous learning in the evolving health noosphere","volume":"54","author":"Detmer","year":"2015","journal-title":"Methods Inf Med"},{"issue":"2","key":"2021042419053450800_ocaa274-B74","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/jamia\/ocy158","article-title":"Impact of document consolidation on healthcare providers' perceived workload and information reconciliation tasks: a mixed methods study","volume":"26","author":"Hosseini","year":"2019","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2021042419053450800_ocaa274-B75","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat Med"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/28\/5\/967\/37335284\/ocaa274.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/28\/5\/967\/37335284\/ocaa274.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T22:45:36Z","timestamp":1696891536000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/28\/5\/967\/6053200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,22]]},"references-count":75,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,12,22]]},"published-print":{"date-parts":[[2021,4,23]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocaa274","relation":{},"ISSN":["1527-974X"],"issn-type":[{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2020,12,22]]}}}