EHR usabilty flaws causing doctors to revert to paper

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Improved efficiency was one promise that proponents of electronic health record systems often touted to physicians to persuade them to adopt the systems. But many doctors have found the only way they can accomplish certain tasks in a reasonable amount of time is to do them on paper.

A study published online March 14 in the Journal of the American Medical Informatics Assn. Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN of the Indiana University (IU) Center for Health Services and Outcomes Research measured the extent to which 11 primary care practices use so-called workarounds instead of their EHRs. Researchers found 10 of 11 paper-based workarounds identified in previous studies were being used. The three most consistent reasons for the paper-based approach were efficiency, memory and awareness.

The researchers observed 120 clinical staff members at the 11 practices, which were part of three larger health care organizations, to determine how and when they turned to paper to accomplish certain tasks. Each organization had an EHR system designed in-house that had been in use for several years. But despite all three health systems using different EHRs, and the presumed tailoring done to each EHR to fit an organization's needs, the researchers found many of the same workarounds at all 11 sites.

One common workaround was to write patient vitals on paper instead of entering them in the EHR if the person responsible for entering the data was unavailable. Another was using paper-based reminders to accomplish a task (i.e., Post-it notes). Also common were paper-based reminders alerting co-workers of new or important information that was added to a patient's record.

“Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools,” the study's authors wrote.

See http://www.ncbi.nlm.nih.gov/pubmed/23492593/ for the study report on Pubmed.

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