Electronic health records (EHRs) represent a growing focus of federal initiatives to improve patient safety and quality. Successful implementation of these systems will depend on their capacity to effectively engage frontline personnel, in terms of both the system-user interface and workflow process. This systematic review discovered that EHRs reduced documentation time for nurses but increased it for physicians, particularly when using centrally located desktop workstations rather than bedside point-of-care systems. The latter finding of workstation choice is perhaps the most striking, as interpretation of overall documentation times is limited by the software design, user interface, and available decision support for a given system. While some systems undoubtedly perform better than others in this regard, efforts to implement EHRs will need to address the potential for increased physician documentation times and associated workflow. Only then will implementation of EHRs begin to achieve the downstream safety effects desired.