Paper and pen 'workarounds' can better EHR use in some cases

Understanding how pen-and-paper "workarounds" challenge--and sometime even enhance--the use of electronic health records (EHRs) eventually can lead to improved coordination of care supported by health IT, according to a new study from the Department of Veterans Affairs.

For the study, published in the International Journal of Medical Informatics, researchers with the Richard L. Roudebush VA Medical Center in Indianapolis analyzed five years of patient records from three primary care clinics and nine specialty clinics. The study's authors noted that physicians sometimes created their own "shadow processes and tools" to support their work that they thought the EHRs did not provide.

Researchers identified 11 types of workarounds that physicians used while trying to align their work process with EHR use. The most frequent pen-and-paper workaround involved a clinic staff member giving printed consultation notes to the specialist: a specialist would review the paperwork and write orders such as "please see patient in two to four weeks."

Another frequent workaround was the use of electronic spreadsheets--outside of the EHR--to give a specialist more flexibility for tracking pending consults.

"It's rather ironic that automation that was supposed to improve contact between colleagues, in this case primary-care doctors and the specialists to whom they refer their patients, may actually reduce contact," Jason Saleem, a research health scientist and Regenstrief Institute investigator, said in a statement.

The study helped examine how organizational policies and pressures could have a negative impact on work practices, Saleem said. While some of the paper-based workarounds encountered were problematic, others showed that they had advantages over corresponding electronic workflows--disclosing potential limitations of the computerized systems, said Saleem.

For more information:
- see the study abstract
- here's an announcement regarding the study
- read this Becker's Hospital Review piece

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