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Paper and computer workarounds challenge but may improve health IT
Date:6/3/2011

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 refe
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Contact: Cindy Fox Aisen
caisen@iupui.edu
317-274-7722
Indiana University School of Medicine
Source:Eurekalert  

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