Date

12-2014

Document Type

Capstone

Degree Name

M.B.I.

Department

Dept. of Medical Informatics and Clinical Epidemiology

Institution

Oregon Health & Science University

Abstract

Objective

To examine the root causes and unintended consequences of the persistent use of paper following implementation of an electronic health record (EHR) in the ambulatory environment.

Methods

Mixed qualitative and survey methods were used to study the persistent use of paper in ambulatory practices in three distinct regions in Maine following the implementation of an EHR. Semi-structured interviews were analyzed and coded using published categories of paper-based workarounds; grounded theory was also used to develop new themes.

Results

Paper persists due to a variety of paper based workarounds related to human interaction with the EHR, as previously reported. Paper use was also found to support several unique use cases, including clinician communication surrounding transitions of care, which are not yet fully supported by the current state of document exchange and EHR interoperability. Paper persistence in the EHR environment leads to unintended consequences including extra work and information chaos.

Conclusions
It may be possible to reduce paper persistence in the EHR environment by adopting interoperability standards which support document level exchange between clinicians and by increasing attention to EHR usability and the human factors leading to paper-based EHR work-arounds.

Identifier

doi:10.6083/M4HD7TDK

School

School of Medicine

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