Paper Habits Die Hard, New Study Shows

Writing patient vitals on paper.

Using paper reminders (i.e. Post-it notes) to accomplish a task.

Passing a paper reminder to co-workers to alert them to the fact that new information was added to the patient’s record.

Such practices were supposed to become extinct when health care organizations adopted electronic health records.  However, a recent study published online by the Journal of the American Medical Informatics Association found that such workarounds are alive and well. Researchers observed 120 clinical staff members at 11 medical practices to determine how and when they turned to paper to accomplish certain tasks. Each organization had an EHR system designed in-house that had been in use for several years. 

Even though each provider used a unique home-grown EHR, the researchers identified many of the same workarounds at all 11 sites. In fact, researchers found 10 of 11 paper-based workarounds that had previously been identified in a 2009 study were still being used. The three most consistent reasons for the paper-based approach were efficiency, memory and awareness.

 “Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools,” the study's authors wrote.  In addition, the authors concluded that “consistent workarounds across institutions suggest common challenges in outpatient clinical settings and failures to accommodate these challenges in EHR design.”

While the study examined only custom-built EHRs, vendors might want to consider the design implications as usability is a measurable criterion that will be included in the Meaningful Use Stage 2 certification process.