The digital transformation of routine patient care is much more than doing the same but with electronic instead of paper-based health records. The current literature provides strong evidence for the gap between the promises of electronic health record (EHR) systems and our knowledge on how to design systems that fit the requirements of daily clinical practice. Following the design science research paradigm, we develop a framework that allows one to empirically assess EHR system use in routine patient care. The suggested framework describes an objective assessment of physicians’ way of executing routines to identify the user interface elements that afford and constrain physicians’ executions of routines. We demonstrate our framework’s use in a field study that reveals actionable insights into how to adapt physicians’ ways to perform a routine and to identify potential misconceptions in EHR system design. This study contributes to and complements existing research on clinical routines and EHR systems, providing a framework to unpack the ‘black box’ of EHR systems and their use in daily clinical practice.