TY - JOUR
T1 - Exploring the persistence of paper with the electronic health record
AU - Saleem, Jason J.
AU - Russ, Alissa L.
AU - Justice, Connie F.
AU - Hagg, Heather
AU - Ebright, Patricia R.
AU - Woodbridge, Peter A.
AU - Doebbeling, Bradley N.
N1 - Funding Information:
This research was supported by the VA HSR&D Center of Excellence on Implementing Evidence-Based Practice (CIEBP), US Department of Veterans Affairs, pilot grant #LIP 87-012 and HSR&D Center grant #HFP 04-148. A VA HSR&D Associated Health Postdoctoral Fellowship supported Dr. Russ. The views expressed in this article are those of the authors and do not necessarily represent the view of the Department of Veterans Affairs. The authors thank the VA healthcare workers who participated in this study, as well as the members of the File Room Processing 100-Day Project for their contributions in informing this study. Preliminary results from this study were presented at the 52nd Annual Meeting of the Human Factors and Ergonomics Society, New York City, September 22–26, 2008.
PY - 2009/9
Y1 - 2009/9
N2 - Objective: Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR. Methods: We conducted semi-structured interviews with 20 key-informants in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EHR, to understand the use of paper-based alternatives. Participants included clinicians, administrators, and IT specialists across several service areas in the medical center. Results: We found 11 distinct categories of paper-based workarounds to the use of the EHR. Paper use related to the following: (1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security. We define each of these and provide examples that demonstrate how these categories promoted paper use in spite of a fully implemented EHR. Conclusions: In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EHR design and implementation.
AB - Objective: Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR. Methods: We conducted semi-structured interviews with 20 key-informants in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EHR, to understand the use of paper-based alternatives. Participants included clinicians, administrators, and IT specialists across several service areas in the medical center. Results: We found 11 distinct categories of paper-based workarounds to the use of the EHR. Paper use related to the following: (1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security. We define each of these and provide examples that demonstrate how these categories promoted paper use in spite of a fully implemented EHR. Conclusions: In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EHR design and implementation.
KW - Computerized medical record
KW - Data display
KW - Electronic health record
KW - Human information processing
KW - Paper-based workarounds
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U2 - 10.1016/j.ijmedinf.2009.04.001
DO - 10.1016/j.ijmedinf.2009.04.001
M3 - Article
C2 - 19464231
AN - SCOPUS:67650167718
SN - 1386-5056
VL - 78
SP - 618
EP - 628
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 9
ER -