Semantic Challenges in Electronic Health Record Systems: A User-Centric Study
Semantic interoperability; Electronic Health Records (EHR); User-centered design; Health informatics; Clinical decision-making; Data standardization; Digital health systems
AuthorsAbstractElectronic Health Record (EHR) systems have become foundational to contemporary healthcare infrastructures, yet persistent semantic inconsistencies continue to undermine their interoperability and clinical utility. While prior research has emphasized technical standardization, comparatively limited attention has been paid to how these semantic disruptions are experienced and negotiated by end users. This study adopts a user-centric perspective to examine how clinicians, patients, and administrative staff interpret, navigate, and respond to semantic ambiguities embedded within EHR environments. Drawing on a mixed-methods design, the study integrates survey data analyzed באמצעותstructural equation modeling (SEM) with in-depth qualitative interviews across diverse healthcare settings. The findings reveal that semantic misalignment—manifested through inconsistent coding schemes, ambiguous terminologies, and fragmented data representations— significantly impairs perceived usability and introduces latent risks into clinical decision-making processes. Notably, users frequently engage in informal cognitive workarounds, which, while adaptive, may further exacerbate systemic inconsistencies (Zhang et al., 2021; Neter & Brainin, 2022). The study contributes theoretically by extending user-centered health informatics frameworks to incorporate a semantic dimension, highlighting the interplay between data meaning, user cognition, and system design. Practically, it underscores the need for context-aware standardization strategies, enhanced interface design, and targeted training interventions to mitigate semantic friction. By foregrounding the lived experiences of EHR users, this research advances a more nuanced understanding of interoperability—one that moves beyond technical compatibility toward meaningful, actionable data exchange in clinical practice.
IntroductionThe rapid digitization of healthcare has positioned Electronic Health Record (EHR) systems at the core of contemporary clinical and administrative practice. As health systems increasingly transition toward data-driven models of care, EHRs are expected not only to store patient information but also to enable seamless data exchange, support clinical decision-making, and facilitate coordinated care across institutional boundaries. This transformation aligns with broader digital health agendas that emphasize interoperability, real-time analytics, and patient-centered service delivery (Kickbusch et al., 2021; van Kessel et al., 2022). Yet, despite substantial investments in infrastructure and standardization, the promise of fully interoperable and meaningfully integrated health information systems remains only partially realized. A central, yet often underexamined, barrier lies in the semantic layer of EHR systems. Semantic interoperability—the ability of systems not merely to exchange data, but to ensure that exchanged information is interpretable and meaningful across contexts—continues to present persistent challenges. In practice, EHR environments are characterized by heterogeneous coding •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
EJPRD
Copyright © 2026 by Riset Publishing Services LLC