Research Activities, September 2013
Health care professionals devise ways to get around using electronic health record systems
Health Information Technology
Despite more widespread use, electronic health records (EHRs) are not always embraced by health care professionals. Some shortcomings, such as complex order entry processes and alerts, can be perceived as impediments to delivering efficient patient care by some. As a result, providers invent ways to get around using elements of the EHR, called workarounds.
A new study found that the most popular reasons for workarounds are efficiency, memory, and awareness. The researchers collected data from 11 primary care outpatient clinics affiliated with 3 health care organizations, including 2 Veterans Affairs medical centers considered leaders in health information technology implementation. Observations were made at each site to discover best practices and to identify barriers to using colorectal cancer clinical decision support tools. During the time they were observed, providers were asked questions about their use of the EHR. A total of 120 clinic providers and staff and 118 patients were observed.
Efficiency was cited as one of the reasons for using workarounds. One type of workaround designated one individual to enter patient information into the EHR. Patients also received paper-based health screenings and medication lists to confirm for accuracy. Computer-based workarounds included copying and pasting text from previous patient progress notes into a new note.
Workarounds that increased awareness included such things as writing down vital signs at intake in addition to entering them into the EHR. Staff also used paper-based memory workarounds, such as making reminder notes to complete future tasks or to follow-up on a patient issue. The researchers also identified a new category of workaround, called the "no correct path." This consisted of a desired option that did not exist in the computer interface, resulting in a workaround.
By studying workarounds, EHR designers can make future innovations and changes to improve provider use of this technology. The study was supported in part by AHRQ (Contract No. 290-06-00013).
See "Paper-and computer-based workaround to electronic health record use at three benchmark institutions," by Mindy E. Flanagan, Ph.D., Jason J. Saleem, Ph.D., M.S., Laura G. Millitello, M.A., and others in the Journal of the American Medical Informatics Association 20, pp. e59-e66, 2013.