![]() ![]() Unfortunately, reaping these potential benefits continues to be challenging and EHRs’ organization-wide optimal adaptation and use are rare. EHRs are designed to integrate medical specialties’ specific working routines into one, organization-wide, software application. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.Įlectronic Health Records (EHRs) have been widely implemented because of their promise of improved patient service, quality, healthcare safety, and reduced costs. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. 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. 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. 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). Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). 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. 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. 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 Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. ![]() However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. ![]() Get the full story when you read the complete case study.Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. With 100% adoption, the benefits would be huge: complete and universally available electronic patient records, increased physician efficiency, Meaningful Use, Joint Commission compliance, and the ability to bill more accurately for services. The EHR wouldn’t provide a complete picture of the patient physicians might be making decisions without key patient data. Until AIMMC achieved 100% use of Cerner PowerNote, it would be living in a “hybrid” environment, with parts of the patient record on paper and other parts in digital format. To ensure rapid and comprehensive adoption while still maintaining physician satisfaction, AIMMC implemented Dragon® Medical 360 | Network Edition from Nuance Healthcare. When a Joint Commission site visit revealed indecipherable and incomplete documentation in its GI and surgery departments - illegible documentation, missing signatures, dates and time stamps - AIMMC chose PowerNote, part of the Cerner Millennium EHR, to fix things. One of the top health systems in the U.S., Advocate Illinois Masonic Medical Center (AIMMC) is a 408-bed hospital in Chicago with a Level I trauma center and a Level III Neonatal Intensive Care Unit, with nearly 900 physicians, 300 residents and 700 nurses using Cerner Millennium. ![]()
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