Top EHR shortcomings that catalyze workarounds

By Tom Sullivan
10:39 AM

Workarounds are nothing new in the software world and are becoming part of everyday life in healthcare as physicians implement electronic health records.

“The most popular reasons for workarounds are efficiency, memory, and awareness,” the Agency for Healthcare Research and Quality, aka AHRQ, wrote in the September issue of its Health Research Activities newsletter. 

AHRQ cited shortcomings including complex order entry processes and alerts, that were uncovered in a report it supported in part that was originally published in the Journal of the American Medical Informatics Association.

As a result of these and other shortcomings, AHRQ noted, “providers invent ways to get around using elements of the EHR.”

Researchers observed 120 clinic providers and staff, and 118 patients across 11 outpatient clinics affiliated with three healthcare organizations, which involved two leading VA medical centers.

Workarounds included the contentious practice known as cloning, essentially cutting and pasting text from an existing patient note into a new note. In another case, researchers found that a single individual has been designated to enter patient information into the EHR. Yet another workaround involved giving patient’s paper-based screening and medication lists to check for accuracy.

Such realities are not entirely surprising. In his final HIT Policy Committee meeting remarks, Farzad Mostashari, MD, in fact, said “it’s still too hard for [doctors] to use EHRs in the ways they want to.”

Mostashari pointed to examples like harnessing third-party applications or querying other providers’ data as additional shortcomings.

Moving forward, Mostashari said that the challenge will be “getting to a common base of capabilities around the country, so that these providers ... have some common assumption of what the capabilities of the systems will be around interoperability and patient health management and patient engagement.”

The AHRQ report also identified an entirely new category — the “no correct path” workaround — in which the lack of a desired option in the EHR interface triggers a workaround.

“By studying workarounds,” AHRQ explained, “EHR designers can make future innovations and changes to improve provider use of this technology.”

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