Improving coordination of care supported by health IT is an ongoing and important theme. One way to improve that care is by delving into both paper and computerized workarounds.
A new study by Jason Saleem, a research scientist at Regenstrief Institute, Inc., which included 11 health care workers across nine specialty clinics, four physicians from primary care clinics and one administrator, found that paper and computerized workarounds persist in the most developed electronic medical record (EMR) systems.
For example, if a specialist used a computer spreadsheet to track a patient’s medical results instead of an EMR — that’s a workaround. But it’s not the end of the world for providers to fall back on to paper if it helps them to be efficient, and helps developers understand where the flaws are in electronic systems, according to the researchers.
Indeed, the spreadsheet could help the specialist find results in a more timely fashion, but it poses a risk — namely gaps between information on the spreadsheet and in an EMR, said Saleem.
Workarounds prove that paper still plays an integral role in health care. The most common paper workaround noted in the study included clinicians passing printed consultations to specialists.
It is essential to review these workarounds, urges Saleem, because it will help the next generation of electronic systems to not require similar deviations. Furthermore, beneficial workarounds “need to be formalized so that they are well connected and integrated with the EMR,” said Saleem.
That’s precisely why workarounds shouldn’t have a negative connotation, Saleem said. It may provide benefits to physicians in terms of documentation, especially when using paper. “Many of the workarounds we discovered are quite positive, especially when they improve efficiency, serve as important memory aids or alerts (when the EMR could not), and help better display or track data or pending consults.”
Saleem’s full report, “Paper Persistence, Workarounds, and Communication Breakdowns in Computerized Consultation Management,” will appear in the July 2011 issue of the International Journal of Medical Informatics.