Physicians using electronic health records still resort to the paper workarounds, according to a study published recently in Applied Clinical Informatics.

EHRs can improve patient care, but they still suffer from design problems causing physicians to compensate by using workarounds, which can cause inaccuracies and make it much harder to track information. The researchers examined data from 2,554 primary care physicians in the Department of Veterans Affairs system and reviewed workarounds in test results management.

They found that 43 percent of the respondents used workarounds to follow up on test results. Of those, 70 percent used paper-based workarounds such as sticky notes, faxes and paper lists. More than 22 percent used a combination of paper and electronic methods, such as e-calendars, to follow up.

Physicians used workarounds primarily as memory aids, to improve efficiency and to facilitate internal and external care coordination. For instance, respondents reported that it was hard to find test result information in the EHR once the physician had reviewed it once; it was also difficult to track the information. Workarounds improved efficiency because the EHRs generated an overload of alerts, reminders and other information. Paper was used to coordinate care because other providers, such as non-VA labs, used it to report test results.

The researchers suggested that EHRs could be redesigned, such as allowing for electronic self-reminders, reduction of administrative burdens, and better support for notification processing.

"[P]aper-based workarounds are common," the researchers said. "The main reasons for use of workarounds are to improve efficiency, trigger memory and improve care coordination. Future EHRs and their respective work systems around them will need to evolve to meet these needs."

To learn more: 
- here's the abstract