Doctors are frustrated by EMRs, of that there’s little doubt. The question is, how do they cope with the limitations of their particular EMR and get through the day? A new study published in the Journal of the American Medical Informatics Association concludes that doctors and their staff use a combination of paper- and computer-based workarounds to address EMR limitations.
To gather data, the researchers directly observed clinical workflows at several institutions, reports InformationWeek. These included 11 primary care clinics across two VA medical centers, Partners Healthcare in Boston and Indianapolis-based Regenstrief Institute. All told, 120 clinic staff and providers were observed, caring for 118 patients, according to the magazine.
In studying the workarounds, researchers classified them in several ways.
One was dubbed “no correct path,” in which the EMR didn’t provide a way to accomplish a given task and forced clinicians to enter data incorrectly.
Other workarounds involved shortcuts related to efficiency. For example cutting and pasting progress notes, vital signs or health maintenance information was classed as a workaround because it was against hospital policy, InformationWeek notes. Another workaround showed up when a staff member who entered vital signs and health screening responses was absent; patients were asked to fill out paper questionnaires or an interviewer wrote down responses.
Still others involved “memory” — writing reminders on paper — and “awareness” — writing down key patient data so a doctor would have it during an exam.
Not too surprisingly, researchers also noted a class of workarounds related to overcoming design errors in EMRs, such as a case in which a doctor couldn’t enter an order with one EMR without closing the progress note he was working on, because if he made the order with the progress note open, the note would be deleted. The unfortunate physician had to log out then log in again to enter orders.
In perhaps the ultimate workaround, some physicians were observed to keep separate paper notes because they weren’t confident that the EMR would be available when they needed it. Now that’s a vote of no confidence.