Research Activities, March 2014
Workarounds to procedures embedded in electronic health records are common, even among early adopters
Health Information Technology
Using observation techniques initially developed in cultural anthropology, researchers found that staff in primary care outpatient clinics (PCOCs) find it helpful to develop paper or computer workarounds to electronic health record (EHR) processes. Paper and computer workarounds to improve efficiency, memory, and awareness were found at all three health care institutions involved in the study, which were all leaders in the development and application of EHRs. Workarounds involving knowledge/skill/ease of use, task complexity, trust, and no correct path were each found at two of the institutions. Four more workaround categories were each observed within a single institution.
The researchers noted that the workaround category "no correct path," previously unidentified in workaround research, described tactics developed at two of the institutions when a desired option did not exist in the computer workflow. Examples included lack of an option to show that the physician ordered a patient to take half a blood pressure pill twice daily, or when an EHR brings up a colonoscopy reminder even when the patient is already scheduled for a colonoscopy appointment.
Overall, the researchers observed 120 clinic staff and providers and 118 patients at 11 PCOCs affiliated with the three benchmark institutions. The study was funded in part by AHRQ (Contract No. 290-06-00013).
More details are in "Paper- and computer-based workarounds to electronic health records use at three benchmark institutions," by Mindy E. Flanagan, Ph.D., Jason J. Saleem, Ph.D., M.S., Laura G. Millitello, Ph.D., and others in the Journal of the American Medical Informatics Association 20, pp. e59-e66, 2013.