A typology of electronic health record workarounds in small-to-medium size primary care practices

Journal of the American Medical Informatics Association

Volumn 21, Issue E2, 2014, Pages

  Friedman, Asia ^a   Crosson, Jesse C ^b,c   Howard, Jenna ^c   Clark, Elizabeth C ^c   Pellerano, Maria ^c   Karsh, Ben Tzion ^d   Crabtree, Benjamin ^c   Jaén, Carlos Roberto ^e   Cohen, Deborah J ^f  

^a UNIVERSITY OF DELAWARE   (United States)

^b MATHEMATICA POLICY RESEARCH   (United States)

^c ROBERT WOOD JOHNSON MEDICAL SCHOOL   (United States)

^d University of Wisconsin Madison   (United States)

^e UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO   (United States)

^f OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CASE STUDY; COMPARATIVE STUDY; DECISION SUPPORT SYSTEM; ELECTRONIC MEDICAL RECORD; ELECTRONIC PRESCRIBING; HEALTH CARE QUALITY; HUMAN; INTERVIEW; MEDICAL INFORMATION; PATIENT CARE; PATIENT SAFETY; PRIMARY MEDICAL CARE; UNITED STATES; WORK SCHEDULE; WORKFLOW;

ELECTRONIC HEALTH RECORDS; HEALTH INFORMATION TECHNOLOGY; PRIMARY CARE; WORKAROUNDS;

COMMUNITY HEALTH SERVICES; ELECTRONIC HEALTH RECORDS; HUMANS; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; PATIENT SAFETY; PRIMARY HEALTH CARE; WORKFLOW;

EID: 84893629953     PISSN: 10675027     EISSN: 1527974X     Source Type: Journal    
DOI: 10.1136/amiajnl-2013-001686     Document Type: Article

References (74)

1. 42 CFR Parts 412, 413, 422. Medicare and Medicaid programs, electronic health record incentive program, final rule. Federal Register: Rules and Regulations 2010:75:44313-588.
2. Patterson ES, Rogers ML, Chapman RJ, et al. Compliance with intended use of bar code medication administration in acute and long-term care: an observational study. Hum Factors 2006;48:15-22.
3. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005;293:1197-203.
4. Schoen C, Osborn R, Huynh PT, et al. On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff 2006;25:w555-71.
5. Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care: an interactive sociotechnical analysis. J Am Med Inform Assoc 2007;14:542-9.
6. Ash J, Sittig D, Dykstra R, et al. Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inform 2007;76: S21-7.
7. Ash JS, Sittig DF, Seshadri V, et al. Adding insight: a qualitative cross-site study of physician order entry. Stud Health Technol Inform 2004;107:1013-17.
8. Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144:742-52.
9. DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care-a national survey of physicians. N Engl J Med 2008;359:50-60.
10. Edmondson AC. Learning from failure in health care: frequent opportunities, pervasive barriers. Qual Saf Health Care 2004;13(Suppl. 2):ii3-9.
11. Garrido T, Jamieson L, Zhou Y, et al. Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. BMJ 2005;330:581.
12. Karsh BT, Weinger MB, Abbott PA, et al. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010;17:617-23.
13. Sittig DF, Singh H. Defining health information technology-related errors: new developments since to err is human. Arch Intern Med 2011;171:1281-4.
14. Carayon P, Hundt AS, Karsh B, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2006;15(Suppl. I):i50-8.
15. Simon SR, Soran CS, Kaushal R, et al. Physicians' use of key functions in electronic health records from 2005 to 2007: a statewide survey. J Am Med Inform Assoc 2009;16:465-70.
16. Fernandopulle R, Patel N. How the electronic health record did not measure up to the demands of our medical home practice. Health Aff 2010;29:622-8.
17. Nutting PA, Crabtree BF, Stewart EE, et al. Effect of facilitation on practice outcomes in the National Demonstration Project model of the patient-centered medical home. Ann Fam Med 2010;8(Suppl. 1):S33-44; S92.
18. Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. Health Aff 2004;23:116-26.
19. Rose AF, Schnipper JL, Park ER, et al. Using qualitative studies to improve the usability of an EMR. J Biomed Inform 2005;38:51-60.
20. Bostrom AC, Schafer P, Dontje K, et al. Electronic health record: implementation across the Michigan Academic Consortium. Comput Inform Nurs 2006;24:44-52.
21. Christensen T, Grimsmo A. Instant availability of patient records, but diminished availability of patient information: a multi-method study of GP's use of electronic patient records. BMC Med Inform Decis Mak 2008;8:12.
22. Gamm LD, Barsukiewicz CK, Dansky KH, et al. Pre-and post-control model research on end-users' satisfaction with an electronic medical record: preliminary results. Proc AMIA Symp 1998:225-9.
23. Crosson JC, Ohman-Strickland PA, Cohen DJ, et al. Typical electronic health record use in primary care practices and the quality of diabetes care. Ann Fam Med 2012;10:221-7.
24. Crosson JC, Ohman-Strickland PA, Hahn KA, et al. Electronic medical records and diabetes quality of care: results from a sample of family medicine practices. Ann Fam Med 2007;5:209-15.
25. Linder JA, Ma J, Bates DW, et al. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med 2007;167:1400-5.
26. Zhou L, Soran CS, Jenter CA, et al. The relationship between electronic health record use and quality of care over time. J Am Med Inform Assoc 2009;6:457-64.
27. Stead WW, Lin HS.eds Computational technology for effective health care: immediate steps and strategic directions. Washington, DC: National Academies Press, 2009.
28. Carayon P, Karsh B-T, Cartmill RS, et al. Incorporating health information technology into workflow redesign-summary report. (Prepared by the Center for Quality and Productivity Improvement, University of Wisconsin-Madison, under Contract No. HHS 290-2008-10036c). AHRQ Publication No. 10-0098-EF. Rockville, MD: Agency for Healthcare Research and Quality, October 2010.
29. Cresswell K, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak 2012;12:15.
30. Halbesleben JRB, Wakefield DS, Wakefield BJ. Workarounds in healthcare settings: literature review and research agenda. Health Care Manage Rev 2008;33:2-12.
31. Halbesleben JRB, Rathert C, Bennett S. Measuring nursing workarounds: tests of the reliability and validity of a tool. J Nurs Adm 2013;43:50-5.
32. Flanagan ME, Saleem JJ, Millitello LG, et al. Paper-and computer-based workarounds to electronic health record use at three benchmark institutions. J Am Med Inf Assoc 2013:20:e59-e66.
33. Rack L, Dudjak L, Wolf G. Study of nurse workarounds in a hospital using bar code medication administration. J Nurs Care Qual 2012;27:232-9.
34. Niazkhani Z, Pirnejad H, van der Sijs H, et al. Evaluating the medication process in the context of CPOE use: the significance of working around the system. Int J Med Inform 2011;80:490-506.
35. Rathert C, Williams E, Lawrence E, et al. Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework. Int J Nurs Stud 2012;49:969-77.
36. Carayon PP, Wetterneck TBMD, Hundt ASP, et al. Evaluation of nurse interaction with bar code medication administration technology in the work environment. J Patient Saf 2007;3:34-42.
37. Ferneley EH, Sobreperez P. Resist, comply or workaround? An examination of different facets of user engagement with information systems. Eur J Inf Syst 2006;15:345-56.
38. Yeung M, Lapinsky S, Granton J, et al. Examining nursing vital signs documentation workflow: barriers and opportunities in general internal medicine units. J Clin Nurs 2012;21:975-82.
39. Grossman J, Cross D, Boukus E, et al. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. J Am Med Inform Assoc 2012;19:353-9.
40. Karsh B. Clinical practice improvement and redesign: How change in workflow can be supported by clinical decision support. AHRQ Publication 2009; No. 09-0054-EF.
41. Chan BC, Perkins D, Wan Q, et al. Finding common ground? Evaluating an intervention to improve teamwork among primary health-care professionals. Int J Qual Health Care 2010;22:519-24.
42. Karsh BT, Holden RJ, Alper SJ, et al. A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional. Qual Saf Health Care 2006;15(Suppl.1):i59-65.
43. Holden RJ. Cognitive performance-altering effects of electronic medical records: an application of the human factors paradigm for patient safety. Cogn Technol Work 2010;13:11-29.
44. Alper SJ, Karsh B-T. A systematic review of safety violations in industry. Accid Anal Prev 2009;41:739-54.
45. Hollnagel E. The design of fault tolerant systems-prevention is better than cure. Reliab Eng Syst Saf 1992;36:231-7.
46. Halbesleben JRB, Savage GT, Wakefield DS, et al. Rework and workarounds in nurse medication administration process: Implications for work processes and patient safety. Health Care Manage Rev 2010;35:124-33.
47. Saleem JJ, Russ AL, Neddo A, et al. Paper persistence, workarounds, and communication breakdowns in computerized consultant management. Int J Med Inform 2011;80:466-79.
48. van der Sijs H, Rootjes I, Aarts J. The shift in workarounds upon implementation of computerized physician order entry. In: Moen A, et al. User centered networked health care. European Federation for Medical Informatics, 2011:290-4.
49. Spear SJ, Schmidhofer M. Ambiguity and workarounds as contributors to medical error. Ann Int Med 2005;142:627-W-128.
50. Vestal K. Lessons learned. Nursing and the art of the workaround. Nurse Lead 2008;6:8-9.
51. Koppel R, Wetterneck T, Telles JL, et al. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008;15:408-23.
52. Holden RJ, Rodriguez AJ, Faye H, et al. Automation and adaptation: nurses' problem-solving behavior following the implementation of bar coded medication administration technology. Cogn Technol Work 2013:15:283-96.
53. Hysong SJ, Sawhney MK, Wilson L, et al. Provider management strategies of abnormal test result alerts: a cognitive task analysis. J Am Med Inform Assoc 2010;17:71-7.
54. Smith PC, Araya-Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. JAMA 2005;293:565-71.
55. Saleem JJ, Russ AL, Justice CF, et al. Exploring the persistence of paper with the electronic health reacord. Int J Med Inf 2009;78:618-28.
56. O'Malley AS, Grossman JM, Cohen GR, et al. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med 2010;25:177-85.
57. Institute of Medicine (US). Committee on Patient Safety and Health Information Technology. Health IT and patient safety: building safer systems for better care. Washington, DC: National Academies Press, 2012.
58. Balasubramanian BA, Chase SM, Nutting PA, et al. Using learning teams for reflective adaptation (ULTRA): insights from a team-based change management strategy in primary care. Ann Fam Med 2010;8:425-32.
59. Ferrante JM, Ohman-Strickland P, Hahn KA, et al. Self-report versus medical records for assessing cancer-preventive services delivery Cancer Epidemiol Biomarkers Prev 2008;17:2987-94.
60. Pommerenke FA, Dietrich A. Improving and maintaining preventive services. Part 1: applying the patient path model. J Fam Pract 1992;34:86-91.
61. Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage, 1990.
62. Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med 2008;6:331-9.
63. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet 2001;358:483-8.
64. Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res 1999;34:1189-208.
65. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage, 1985.
66. Weber M. The methodology of the social sciences. Shils EA, Finch HA (ed. and trans.). New York: Free Press, [1904] 1949.
67. Beasley JW, Wetterneck T, Temte J, et al. Information chaos in primary care: implications for physician performance and patient safety. J Am Board Fam Med 2011;24:745-51.
68. Crosson JC, Schueth AJ, Isaacson N, et al. Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation. J Am Board Fam Med 2012;25:24-32.
69. Coordinator. Health IT.gov. (http://www.healthit.gov/) (accessed 9 Mar 2012).
70. Wickens CD. Multiple resources and mental workload. Hum Factors 2008;50:449-55.
71. Altmann EM, Gray WD. Forgetting to remember: the functional relationship of decay and interference. Psychol Sci 2002;13:27-33.
72. Nemeth C, Cook R. Hiding in plain sight: what Koppel et al. tell us about healthcare IT. J Biomed Inform 2005;38:262-3.
73. Lapin J, Beasley J, Smith P, et al. Proactive risk assessment of primary care of the elderly. ARHQ Conference. Bethesda, MD, September 7-10, 2008.
74. Goodwin MA. Using direct observation in primary care research-the Hawthorne effect: defining the nature and impact of the presence of researcher observers on patients and physicians in community family practices [doctoral dissertation] Case Western Reserve University, 2003.