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

Friedman, Asia; Crosson, Jesse C.; Howard, Jenna; Clark, Elizabeth; Pellerano, Maria; Karsh, Ben Tzion; Crabtree, Benjamin F.; Jaén, Carlos Roberto; Cohen, Deborah J.

doi:10.1136/amiajnl-2013-001686

Cited by 51 publications

(91 citation statements)

References 60 publications

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“…Work-arounds, another type of strategy, represent “behaviors of users to overcome perceived limitations (workflow problems) in a technical system” (Friedman et al, 2014). Work-arounds have been found in the hospital environment where “informal temporary practices” are used to manage exceptions to normal workflow (Halbesleben, Savage, Wakefield, & Wakefield, 2010; Halbesleben et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Technology barriers and strategies in coordinating care for chronically ill patients

2019

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Care managers who coordinate care for chronically ill patients in hospitals and outpatient settings use multiple health information technologies for accessing, processing, documenting, and communicating patient-related information. Using a combination of 41 interviews and observations of 15 care managers, we identified a range of technology-related barriers experienced by care managers (total of 163 occurrences). The barriers are related to (lack of) access to information, inadequate information, limited usefulness and usability of the technologies, challenges associated with using multiple health IT, and technical problems. In 43% of the occurrences, care managers describe strategies to deal with the technology barriers; these fit in three categories: nothing/delay (9 occurrences), work-arounds (32 occurrences), and direct action at the individual, team, and organization levels (29 occurrences). Our data show the adaptive capacity of care managers who develop various strategies to deal with technology barriers and are, therefore, able to care for chronically ill patients. This information can be used as input to work system redesigns.

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Section: Introductionmentioning

confidence: 99%

Technology barriers and strategies in coordinating care for chronically ill patients

2019

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“…53,54 Failing to optimally integrate people, information, and technology 54 workarounds, ways of working that address perceived system limitations. [58][59][60][61][62] Workarounds can become de facto elements of the workflow.…”

Section: Part 1: Contextmentioning

confidence: 99%

Comprehensive process model of clinical information interaction in primary care: results of a “best-fit” framework synthesis

Veinot

Senteio

Hanauer

et al. 2017

Journal of the American Medical Informatics Association

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“…Even this use of workflows has been hindered by EHR platforms that contain unstructured data 18 or that do not allow electronic data transfer from external organizations. 19 Our methods build on the work of Johnson et al that emphasizes the importance of understanding the context in which data are collected and used (referred to as the "data provenance"). Johnson and colleagues underscore the importance of knowing 1) the local clinic workflows and provider charting behavior; 2) the EHR's data model and local implementation (i.e., some functions are available for use, some are not); and 3) the external context -that is, legal requirements and reimbursement incentives.…”

Section: Malhoutra Et Almentioning

confidence: 99%

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

Coronado¹,

Retecki²,

Petrik³

et al. 2017

eGEMs

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Objective: Variations in processes for different clinics and health systems can dramatically change the way preventive interventions are implemented. We present a method for documenting these variations using workflow diagrams and demonstrate how understanding workflow aided an electronic health record (EHR) embedded colorectal cancer screening intervention. Materials and Methods:We mapped variation in processes for ordering and documenting fecal testing, current colonoscopy, prior colonoscopies, and pathology results. This work was part of a multi-site cluster-randomized pragmatic trial to test a mailed approach to offering fecal testing at 26 safety net clinics (in eight organizations) in Oregon and Northern California. We created clinic-specific workflow diagrams and then distilled them into consolidated diagrams that captured the variations.Results: Clinics had varied practices for storing and using information about colorectal cancer screening. Developing workflow diagrams of key processes enabled clinics to find optimal ways to send fecal test kits to patients due for screening. The workflows informed the rollout of new EHR tools and identified best practices for data capture.Discussion: Diagramming workflows can have great utility when implementing and refining EHR tools for clinical practice, especially when doing so across multiple clinical sites. The process of developing the workflows uncovered successful practice recommendations and revealed limitations and potential effects of a research intervention. Conclusion:Our method of documenting clinical process variation might inform other EHR-powered, multi-site research and can improve data feedback from EHR systems to clinical caregivers.

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

Abstract: This workaround typology provides a framework for EHR users to identify and address workarounds in their own practices, and for researchers to examine the effect of different types of EHR workarounds on patient safety, care quality, and efficiency.

Cited by 51 publications

References 60 publications

Technology barriers and strategies in coordinating care for chronically ill patients

Technology barriers and strategies in coordinating care for chronically ill patients

Comprehensive process model of clinical information interaction in primary care: results of a “best-fit” framework synthesis

Mapping Multi-Site Clinic Workflows to Design Systems-Enabled Interventions

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