Dept. of Medical Informatics and Clinical Epidemiology
Oregon Health & Science University
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.
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.
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.
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.
School of Medicine
Lafleur, Joel D., "The Persistence of paper following ambulatory electronic health record implementation" (2014). Scholar Archive. 3594.