Even when practices adopt electronic health records, it's not uncommon for physicians to devise workarounds that allow them to cling to paper-based processes. A study from the U.S. Department of Veterans Affairs, published in the July 2011 issue of the International Journal of Medical Informatics, reveals good and bad news about this phenomenon.
For the study, researchers examined how such workarounds affect communication between primary care and specialists regarding consultations. The researchers included Jason Saleem, PhD, of the Health Services Research and Development Center on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis and his colleagues.
Among the 11 categories of workarounds identified in "Paper Persistence, Workarounds, and Communication Breakdowns in Computerized Consultation Management," researchers found some of them to be problematic. For example, the common habit among specialists to write findings on a piece of paper "carried the risk that medical orders would not be entered into the electronic health record, potentially creating gaps in documentation or, if entered, producing unverified medical orders put in by someone other than the ordering provider," Saleem wrote.
On the other hand, the research also revealed that physicians tended to create 'shadow processes' to support work for which they felt the computerized system was inadequate, such as by creating spreadsheets outside the EHR to give specialists more flexibility and functionality for tracking pending consults.
This deeper understanding of why physicians actively seek to thwart EHR systems, the authors concluded, will in the long run give designers valuable ideas as to how to enhance the efficiency and eliminate work-flow problems with their products.