COMMENTARY

EHR Workarounds: Work Smarter, Not Harder

Tom G. Bartol, NP

Disclosures

January 19, 2017

Working Around the Electronic Health Record

Electronic health records (EHRs) have become the standard for healthcare documentation. Barrett and Stephens[1] analyzed qualitative data about using EHRs, derived from 345 employees of a healthcare network in the Southwest region of the United States. The sample included healthcare clinicians, technicians, nurses, and administrators who used the EHR system on a daily basis.

These investigators explored the effects of coworker social influence on EHR workarounds and sought to understand the role of workarounds on perceptions of the relative advantages of the new EHR technology, resistance to EHR use, and perceptions of EHR change success. Workarounds, also known as "change reinvention," are defined as "departures from an intended change design due to employees dynamically shaping innovations as they diffuse into an organization."[1]

The results of this study showed that coworker communication in the form of informal social support and feedback played an important role in whether people engaged in workarounds when using the EHR. Workarounds were associated with higher perceptions of the EHR's relative advantages and higher perceptions of successful EHR implementation. Workarounds were also associated with lower levels of resistance to change.

Workarounds were typically learned from coworkers and gave employees a mutual sense of control over the system. Developing workarounds through interactions with coworkers improved perceptions of the EHR and reduced resistance to its use. The workaround process was not programmed or planned into the implementation of the EHR but occurred through employee interactions and sharing, and gave them more flexibility and functionality in the system.

Viewpoint

The EHR has dramatically changed the delivery of healthcare over the past decade. EHR systems leave little control of the process and product of health record management in the hands of users. With templates, formats, check boxes, and buttons to click, the entire flow of a clinician visit with a patient has changed. The computer may be seen as a third party in the room, and it changes the visit dynamics as the clinical staff member interacts with both the patient and the electronic record.

EHR systems are unique in that they are essential for clinical practice but clinicians often have little input into how they are developed and designed. Changes or improvements come slowly. End users may feel helpless at times and "ruled" by the system.

I regularly read EHR records of patients transferring into my practice. A simple office visit note typically consists of 4-8 pages with little clinically useful information. The function of continuity of care of medical records has been diluted by redundancy of data and confusing formats. Check boxes can result in a mechanistic description of the problem and the exam. This may make data gathering and coding easier for administrators, but it does not benefit our patient care. For the clinician, the result is often frustration.

Workarounds are created to make things better for our patients and clinicians, and to improve continuity of care. This study points to the concept that workarounds likely will not come from the EHR system administrators or trainers, but rather from the users, through social and work networks. The more we can interact with other end users and share tips about what we have learned, the more workarounds we will discover.

In my own practice, I have discovered and shared several workarounds with colleagues that have made our workflow more efficient. Among the simplest workarounds I use are keyboard commands. These commands can usually be found in the "help" section of the EHR, and some may be similar to keyboard commands used with other software. They allow the user to keep the fingers on the keyboard rather than using the mouse or track pad, facilitating more efficient flow once they are learned. In my EHR system, I have been able to enter the history of present illness (HOPI) in a comment field for each of the patient's problems; in doing so, I can enter all problem histories on a single template rather than opening and closing a template for each problem. These workarounds will be unique for each system, so users must explore their systems and consult with coworkers to see what they have discovered. I have learned many ways to better use the EHR simply by watching over the shoulders of a colleague who is using the EHR.

Employers can benefit as a result of less employee resistance and greater satisfaction by encouraging and even facilitating the exploration and discovery of workarounds. There are many ways to use an EHR system, and the more interaction among the users that can be encouraged, the greater the benefit to patients and clinicians. The EHR is here to stay. Rather than fight it, we can network with colleagues and coworkers to explore ways to adapt our EHR to better work for us.

Editor's note: Do you have any EHR tips or tricks to share with fellow Medscape readers? Please tell us in the comments section.

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