Study: Paper-based workarounds may improve EMR functionality

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The pen-and-paper workarounds employed by healthcare providers who use an EMR system may help make EMRs even more useful, according to research in the September issue of the International Journal of Medical Informatics.

Lead author Jason Saleem, PhD, a Regenstrief Institute investigator and assistant research professor in the Purdue School of Engineering and Technology at Indiana University-Purdue University in Indianapolis, said that EMRs are "instantly accessible to the healthcare team. But so much information is included in an EMR, how does the individual healthcare provider pick out what is important at a specific time? Not all uses of paper are bad and some may give us ideas on how to improve the interface between the healthcare provider and the electronic record."

In the study of 20 healthcare workers at the Roudebush VA Medical Center in Indianapolis, the investigators found 125 instances of paper use that fell into 11 categories. The most frequently cited reasons for using paper workarounds were efficiency and ease of use. Second most frequently was as a memory aid. The third most frequent reason was to recognize or alert others to new or important information.

"Any use of pen-and-paper workarounds needs to be coordinated with the electronic record because if it circumvents the electronic medical records it creates the potential for medical error," said Saleem, who is also a research scientist at the Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice at the Roudebush VA Medical Center in Indianapolis.

An example of use of paper which the researchers labeled as useful was the issuing of pink index cards upon arrival at a clinic to patients who had high blood pressure. The data also was entered into the EMR. The pink cards were passed along to the physician to alert him or her to elevated blood pressure. The study, which was descriptive in nature, did not speculate on whether this alert function could be performed equally as well by the electronic system.

Noting that electronic systems have the capability to alert clinicians reliably and consistently, the study recommended that designers of these systems consider decreasing the overall number of alerts so clinicians do not ignore them due to information overload.

The U.S. Department of Veterans Affairs funded the study.