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

Abstract Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or dir...

Full description

Bibliographic Details
Main Authors: Albert Boonstra, Tess L. Jonker, Marjolein A. G. van Offenbeek, Janita F. J. Vos
Format: Article
Language:English
Published: BMC 2021-06-01
Series:BMC Medical Informatics and Decision Making
Subjects:
Online Access:https://doi.org/10.1186/s12911-021-01548-0
_version_ 1818588637829267456
author Albert Boonstra
Tess L. Jonker
Marjolein A. G. van Offenbeek
Janita F. J. Vos
author_facet Albert Boonstra
Tess L. Jonker
Marjolein A. G. van Offenbeek
Janita F. J. Vos
author_sort Albert Boonstra
collection DOAJ
description Abstract Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.
first_indexed 2024-12-16T09:27:55Z
format Article
id doaj.art-7dff17347079486999aa029b629f986c
institution Directory Open Access Journal
issn 1472-6947
language English
last_indexed 2024-12-16T09:27:55Z
publishDate 2021-06-01
publisher BMC
record_format Article
series BMC Medical Informatics and Decision Making
spelling doaj.art-7dff17347079486999aa029b629f986c2022-12-21T22:36:37ZengBMCBMC Medical Informatics and Decision Making1472-69472021-06-0121111410.1186/s12911-021-01548-0Persisting workarounds in Electronic Health Record System use: types, risks and benefitsAlbert Boonstra0Tess L. Jonker1Marjolein A. G. van Offenbeek2Janita F. J. Vos3Faculty of Economics and Business, University of GroningenCustomer Service ERP, AFAS SoftwareFaculty of Economics and Business, University of GroningenFaculty of Economics and Business, University of GroningenAbstract Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.https://doi.org/10.1186/s12911-021-01548-0Electronic Health RecordHealthcare organizationWorkaroundsWorkflow
spellingShingle Albert Boonstra
Tess L. Jonker
Marjolein A. G. van Offenbeek
Janita F. J. Vos
Persisting workarounds in Electronic Health Record System use: types, risks and benefits
BMC Medical Informatics and Decision Making
Electronic Health Record
Healthcare organization
Workarounds
Workflow
title Persisting workarounds in Electronic Health Record System use: types, risks and benefits
title_full Persisting workarounds in Electronic Health Record System use: types, risks and benefits
title_fullStr Persisting workarounds in Electronic Health Record System use: types, risks and benefits
title_full_unstemmed Persisting workarounds in Electronic Health Record System use: types, risks and benefits
title_short Persisting workarounds in Electronic Health Record System use: types, risks and benefits
title_sort persisting workarounds in electronic health record system use types risks and benefits
topic Electronic Health Record
Healthcare organization
Workarounds
Workflow
url https://doi.org/10.1186/s12911-021-01548-0
work_keys_str_mv AT albertboonstra persistingworkaroundsinelectronichealthrecordsystemusetypesrisksandbenefits
AT tessljonker persistingworkaroundsinelectronichealthrecordsystemusetypesrisksandbenefits
AT marjoleinagvanoffenbeek persistingworkaroundsinelectronichealthrecordsystemusetypesrisksandbenefits
AT janitafjvos persistingworkaroundsinelectronichealthrecordsystemusetypesrisksandbenefits