Exploring Workarounds Related to Electronic Health Record System Usage: A Study Protocol

Abstract

BackgroundHealth care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow that are unintentionally imposed by electronic health record (EHR) systems. Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness, and efficiency of care. Identifying workarounds and understanding their motivations, scope, and impact is pivotal to support the design of user-friendly EHRs and achieve closer alignment between EHRs and work contexts.ObjectiveWe propose a study protocol to identify EHR workarounds and subsequently determine their scope and impact on health care providers’ workflows, patient safety, effectiveness, and efficiency of care. First, knowing whether a workaround solely affects the health care provider who devised it, or whether its effects extends beyond the EHR user to the work context of other health care providers, is key to accurately assessing its degree of influence on the overall patient care workflow. Second, knowing whether the consequence of an EHR workaround is favorable or unfavorable provides insights into how to address EHR-related safety, effectiveness, and efficiency concerns. Knowledge of both perspectives can provide input on optimizing EHR designs.MethodsIn the study, a combination of direct observations, semistructured interviews, and qualitative coding techniques will be used to identify, analyze, and classify EHR workarounds. The research project will be conducted within three distinct pediatric care processes and settings at a large university hospital.ResultsData was collected using the described approach from January 2016 to March 2017. Data analysis is underway and is expected to be completed in May 2017. We aim to report the results of this study in a follow-up publication.ConclusionsThis study protocol provides a grounded framework to explore EHR workarounds from a holistic and integral perspective. Insights from this study can inform the design and redesign of EHRs to further align with work contexts of healthcare professionals, and subsequently lead to better organization and safer provision of care.

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care

“…A more comprehensive description of the research approach taken for this study has been published as a study protocol [ 53 ].…”

“…After coding all transcriptions, VB, KK, MW, and MJ analyzed each workaround in terms of its source of origin, scope, and impact. To facilitate this, we adapted one of the most widely used health care human factors systems frameworks, the SEIPS framework [ 52 ] (see [ 53 ] for more details). With the integrated and holistic perspective of the SEIPS framework, relationships between a health care work system (including workarounds), processes, and outcomes can be studied.…”

Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff

“…Challenges related to providing this training include difficulty in reaching trainees across different specialties, lack of time in an already crowded curriculum, lack of a patient-centered EHR use curriculum, and lack of trained educators to provide the instruction [ 18 ]. Without formal education on best practices, trainees may pick up bad habits and develop negative “workaround behaviors,” informal practices designed to help them coordinate their day’s work especially under conditions of time pressure and constraints [ 19 ]. Although these workarounds may help trainees get through the tasks of their day, they are generally suboptimal and can negatively influence the delivery, safety, effectiveness, and efficiency of care [ 19 ].…”

“…Without formal education on best practices, trainees may pick up bad habits and develop negative “workaround behaviors,” informal practices designed to help them coordinate their day’s work especially under conditions of time pressure and constraints [ 19 ]. Although these workarounds may help trainees get through the tasks of their day, they are generally suboptimal and can negatively influence the delivery, safety, effectiveness, and efficiency of care [ 19 ]. As such, appropriately using the EHR and information technology to not only manage the process of patient care but to also engage, communicate with, educate, and empower patients is an essential redesign of clinical practice today, and it is critical trainees learn best practice behaviors early on [ 18 ].…”

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

“…They circumvent or temporarily ‘fix’ an evident or perceived workflow hindrance in order to meet a goal or to achieve it more readily’ [ 7 , p.2]. In an EHR context, a workaround can involve skipping prescribed steps, entering data that should be entered by others, or registering activities later in the EHR system rather than letting the system guide these activities [ 8 , 9 ]. Working around an EHR system is common [ 3 , 10 ] and could have severe consequences, especially given the high interdependence among healthcare workers.…”