Navigation Links
Paper and computer workarounds challenge but may improve health IT

INDIANAPOLIS A new research study investigates the challenges that pen and paper workarounds or computerized communication breakdowns pose to the use of electronic health records. Understanding these challenges may lead to improved coordination of care supported by health IT.

Focusing on referrals by primary care physicians to specialists and communications from the specialists back to the referring physician, "Paper Persistence, Workarounds, and Communication Breakdowns in Computerized Consultation Management" appears in the July 2011 issue of the International Journal of Medical Informatics. It is a follow-up to a pilot study, "Exploring the Persistence of Paper with the Electronic Health Record," published in the September 2009 issue of the same journal.

"We sought to develop an understanding of the current challenges to the outpatient consult management process in the Veterans Health Administration, which uses an electronic health record to support consultations requested by primary care physicians with specialists such as cardiologists, gastroenterologists or neurologists. We also wanted to see if two years after our pilot study, paper workarounds remained popular with the medical staff," said Regenstrief Institute investigator Jason Saleem, Ph.D., a research health scientist at the Health Services Research and Development Center on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis.

Using an electronic health record system for referrals provides a variety of advantages, including legibility of patient data, decreased likelihood of misplaced information, physician reminders that prompts actions, as well as simultaneous, distributed access and integration with other information systems. Potential disadvantages to using a computerized system for consultations had not received significant study prior to Dr. Saleem's work.

"Electronic health records are a vast improvement on the old consultation process which involved paper medical records and phone calls, faxes or even letters to specialists to request consultations and then another phone call, fax or letter with the result sent back to the primary care physician. Yet our study of workarounds and communication breakdowns showed that switching to an electronic health record system isn't without flaws.

"We found, for example, that unless the specialist took the step of indicating the primary care physician should get a notification, or view alert, through the electronic health record, the referring physician may not know that the results of the consultation were available. And it was not uncommon for the specialist to write findings on a piece of paper, which carried the risk that medical orders would not be entered into the electronic health record, potentially creating gaps in documentation or, if entered, producing unverified medical orders put in by someone other than the ordering provider," said Dr. Saleem, who is an assistant research professor of electrical and computer engineering in the School of Engineering and Technology at Indiana University-Purdue University Indianapolis.

The researchers noted that clinicians created their own shadow processes and tools to support their work when they believed that the computer system did not do so. In fact, the most frequent pen and paper workaround involved a clinic staff member giving printed consultation notes to the specialist. The specialist then reviewed the paperwork and handwrote orders such as 'please see patient in 2-4 weeks.' Another common workaround was the creation of electronic spreadsheets, outside of the electronic health record, to give the specialist more flexibility and functionality for tracking pending consults.

"It's rather ironic that automation that was supposed to improve contact between colleagues, in this case primary care doctors and the specialists to whom they refer their patients, may actually reduce contact. Our findings are framed to help understand how organizational policies and pressures can potentially have a negative impact on work practices. Although some of the paper-based workarounds revealed are problematic, others offer efficiencies and other advantages over corresponding electronic workflows and disclose potential limitations of the design of the computerized systems, giving us ideas of how to improve electronic health records," said Dr. Saleem, a human factors engineer.


Contact: Cindy Fox Aisen
Indiana University School of Medicine

Related medicine news :

1. Cloud Computing Platforms Address Unique M2M Application Needs, According To New SensorLogic White Paper
2. Paper Kills 2.0 Book by Center for Health Transformation Features Chapter by StatCom
3. buySAFE, Inc. Releases a Breakthrough White Paper that is a Must Read for Every Internet Retailer Interested in Increasing Website Conversion
4. SEBM Best Paper Awards for articles published in 2009
5. Stonebranch Publishes Healthcare IT White Paper
6. PCI Compliance and Data Security Requires Private Key Management – New Industry White Paper Explains
7. Centice Corporation Releases a Two Part Whitepaper on its PASS Rx Pharmacy Quality Solution
8. PaperFree Florida to help move physicians towards electronic health records
9. Go Green With Your Curriculum by Choosing A Paperless Option
10. FileHold Document Management Software Helps National Tax Consulting Firm Reduce Paper and Streamline Tax Preparation for Their Clients
11. Wyatt Matas & Associates Releases White Paper on Future Home Healthcare Business Model
Post Your Comments:
Related Image:
Paper and computer workarounds challenge but may improve health IT
(Date:6/25/2016)... ... June 25, 2016 , ... "With 30 hand-drawn hand gesture animations, FCPX users ... - CEO of Pixel Film Studios. , ProHand Cartoon’s package transforms over 1,300 ... Pro X . Simply select a ProHand generator and drag it above media or ...
(Date:6/25/2016)... ... 2016 , ... As a lifelong Southern Californian, Dr. Omkar Marathe earned his ... David Geffen School of Medicine at UCLA. He trained in Internal Medicine at Scripps ... in hematology/oncology at the UCLA-Olive View-Cedars Sinai program where he had the opportunity to ...
(Date:6/25/2016)... ... , ... On Friday, June 10, Van Mitchell, Secretary of the Maryland Department ... in recognition of their exemplary accomplishments in worksite health promotion. , The Wellness at ... Wellness Symposium at the BWI Marriott in Linthicum Heights. iHire was one of 42 ...
(Date:6/24/2016)... ... 2016 , ... A recent article published June 14 on E ... goes on to state that individuals are now more comfortable seeking to undergo not ... as calf and cheek reduction. The Los Angeles area medical group, Beverly Hills Physicians ...
(Date:6/24/2016)... ... 2016 , ... June 19, 2016 is World Sickle Cell Observance Day. In ... benefits of holistic treatments, Serenity Recovery Center of Marne, Michigan, has issued ... Sickle Cell Disease (SCD) is a disorder of the red blood cells, which can ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Research and Markets ... Market by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic ... Coating, Parenteral) - Global Forecast to 2021" report ... The global pharmaceutical excipients market is projected to ... of 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... Research and Markets has announced the ... report to their offering. ... favourable commercial environment for MedImmune to enter. The US ageing ... serve to drive considerable growth for effective anti-influenza medications. The ... sales considerably, but development is still in its infancy. ...
(Date:6/23/2016)... , June 23, 2016 Revolutionary ... Oticon , industry leaders in advanced audiology ... of Oticon Opn ™, the world,s first internet ... possibilities for IoT devices.      (Photo: ... introduces a number of ,world firsts,: , ...
Breaking Medicine Technology: