Persisting workarounds in Electronic Health Record System use: types, risks and benefits

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Healthcare Management

Background:

• Electronic Health Records (EHRs) are widely adopted but often create mismatches with healthcare professionals' working practices.
• These mismatches lead to the development of workarounds, which are alternative practices not imposed by the EHR system.
• Understanding these workarounds is crucial for optimizing EHR implementation and use.

Purpose of the Study:

• To inductively develop a typology of enduring Electronic Health Record (EHR) workarounds.
• To explore the user-perceived consequences of these persistent EHR workarounds.
• To provide insights for managing and optimizing EHR use in clinical settings.

Main Methods:

• A single case study was conducted in the Internal Medicine department of a Dutch hospital.
• Data collection involved observations of six EHR users and 17 semi-structured interviews with various healthcare staff.
• Qualitative analysis was used to identify and categorize EHR workarounds.

Main Results:

• Eleven workarounds were identified, primarily used by physicians, and categorized into three types: in-system workflow sequence, in-system data entry, and out-system workarounds.
• These workarounds appear to offer short-term benefits to the individual user.
• However, they can introduce risks for the user, patient, organization, and the EHR system itself.

Conclusions:

• The study presents a typology of enduring EHR workarounds, enhancing understanding of this phenomenon.
• This typology can assist EHR users and managers in identifying and differentiating between harmful and less harmful workarounds.
• The findings can inform decisions on discouraging, obviating, or legitimating specific EHR workarounds.