Making Electronic Health Records (EHRs) Work: Informal Talk and Workarounds in Healthcare Organizations

Abstract

A key provision of the American Recovery and Reinvestment Act of 2009 mandated that electronic health records (EHR) be adopted in US healthcare organizations by 2015. The purpose of this study is to examine the communicative processes involved as healthcare workers implement an EHR and make changes, known as workarounds. Guided by theories in social influence, and diffusion of innovations, we conducted a survey of healthcare professionals using an EHR system in an organization. Our structural equation modeling (SEM) and multiple regression results reveal coworker communication, in the form of informal social support and feedback, play an important role in whether people engage in workarounds. Understanding this relationship is important because our study also demonstrates that workarounds predict healthcare employees' overall satisfaction with the EHR system. Specifically, workarounds are associated with higher perceptions of the EHR's relative advantage, higher perceptions of EHR implementation success, and lower levels of resistance to EHR change. This study offers a health communication contribution to the growing research on EHR systems and demonstrates the persuasive effects that coworkers have on new technology use in healthcare organizations.

Theories Informing eHealth Implementation: Systematic Review and Typology Classification

“…“When relating social information processing theory and the social influence model to organizational change situations, we see that both theories provide a framework for understanding previous scholars’ arguments advocating the noteworthy role informal, coworker communication plays in effective organizational and healthcare change.” (Barrett and Stephens, 2017) [ 71 ]…”

The Impact of Coworkers’ Safety Violations on an Individual Worker: A Social Contagion Effect within the Construction Crew

“…This research reveals the horizontal coworker-employee dynamics, which complements the previous occupational safety research that mainly focused on the hierarchical supervisor-employee relationships such as safety leadership [ 36 ]. Second, the intentional but non-malevolent safety violations, and other similar behaviors, such as “workarounds” [ 81 ] and “cutting corners” [ 82 ], are common in many hazardous occupations where workers should deal with the conflicting relationships between safety and other production performance. This research gives the evidence that a group-level focus is appropriate and important for understanding safety violations because individuals’ decisions to break safety rules are closely related to their coworkers’ safety violations.…”

The Effect of Unmet Expectations of Information Quality on Post-Acceptance Workarounds among Healthcare Providers

“…The literature recommends PLS over covariance-based SEM (CBSEM), such as maximum likelihood (ML) estimation [81]. PLS is a better fit for prediction when hypotheses are derived from a general theory that does not recognize all relevant variables, making the theory is less sound [91]. CBSEM provides a better fit for the purpose of theory confirmation.…”

“…Final recommendation for future studies is to explore the effect of workaround as a mediator on satisfaction. Literature indicates that fixing problems and working around rules in the sake of patient care enhances perceived personal proficiency [73] and confidence in their competence [88], and in turn may affect the satisfaction with the system as reduces frustration and stress [39] and workarounds were found to increase healthcare employee's over satisfaction with EHR systems [91].…”