J Am Med Inform Assoc - A typology of electronic health record workarounds in small-to-medium size primary care practices.

Tópicos

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Resumo

JECTIVE: Electronic health record (EHR) use in ambulatory care can improve safety and quality; however, problems with design, implementation, and poor interface with other systems lead users to develop 'workarounds', or behaviors users adopt to overcome perceived limitations in a technical system. We documented workarounds used in independent, community-based primary care practices, and developed a typology of their key features.MATERIALS AND METHODS: Comparative case study of EHR use in seven independent primary care practices. Field researchers spent approximately 1 month in each practice to observe EHR use, conduct patient pathways, and interview clinicians and staff.RESULTS: We observed workarounds addressing a wide range of EHR-related problems, including: user interface issues (eg, insufficient data fields, limited templates), barriers to electronic health information exchange with external organizations, and struggles incorporating new technologies into existing office space. We analyzed the observed workarounds inductively to develop a typology that cuts across specific clinical or administrative processes to highlight the following key formal features of workarounds in general: temporary/routinized, which captures whether the workaround is taken for granted as part of daily workflow or is understood as a short-term solution; avoidable/unavoidable, referring to the extent to which the workaround is within the practice's power to eliminate; and deliberately chosen/unplanned, which differentiates strategically chosen adaptations from less thoughtful workarounds.CONCLUSIONS: 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.

Resumo Limpo

jectiv electron health record ehr use ambulatori care can improv safeti qualiti howev problem design implement poor interfac system lead user develop workaround behavior user adopt overcom perceiv limit technic system document workaround use independ communitybas primari care practic develop typolog key featuresmateri method compar case studi ehr use seven independ primari care practic field research spent approxim month practic observ ehr use conduct patient pathway interview clinician staffresult observ workaround address wide rang ehrrel problem includ user interfac issu eg insuffici data field limit templat barrier electron health inform exchang extern organ struggl incorpor new technolog exist offic space analyz observ workaround induct develop typolog cut across specif clinic administr process highlight follow key formal featur workaround general temporaryroutin captur whether workaround taken grant part daili workflow understood shortterm solut avoidableunavoid refer extent workaround within practic power elimin deliber chosenunplan differenti strateg chosen adapt less thought workaroundsconclus workaround typolog provid framework ehr user identifi address workaround practic research examin effect differ type ehr workaround patient safeti care qualiti effici

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