BACKGROUND
Electronic health record system (EHR) users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, quality of care, and efficiency of care.
OBJECTIVE
To aid in identifying, analyzing, and resolving EHR workarounds, a sociotechnical EHR workaround analysis framework (SEWA) was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment.
METHODS
A scoping literature review was performed on studies related to EHR workarounds published between 2010-2021 in MEDLINE, EMBASE, CINAHL, Cochrane or IEEE databases. 737 studies were retrieved, of which 62 were included in the final analysis. Using an analytic frame, the included studies were investigated to uncover rationales EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impact of workarounds.
RESULTS
The SEWA framework was validated and refined based on the scoping review. Extensive support for the preexisting rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple preexisting rationales for workarounds were refined to describe each rationale more accurately.
CONCLUSIONS
SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and as such provides a validated and more complete synthesis on EHR workaround rationales, attributes, possible scopes, and types of impact. Moreover, SEWA is likely now also applicable in settings other than academic hospitals. The revised SEWA framework can aid researchers and practitioners in a wider range of healthcare settings to identify, analyze, and resolve workarounds. This to improve user centered EHR (re)design, ultimately leading to improved patient safety, quality of care, and efficiency of care.
Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA
