ArticleBMC medical informatics and decision making2021
Persisting workarounds in Electronic Health Record System use: types, risks and benefits.
Article in BMC medical informatics and decision making, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- Electronic health record adaptation and innovation among healthcare professionals in hospitals: an integrative framework based on a systematic review.BMC health services research · 2026Pooled it
- "Most of what I do is a workaround now": Clinician Use of Workarounds Following an EHR Transition.Journal of general internal medicine · 2026Article
- User Experiences of Electronic Controlled Substance Surveillance Among Health Care Professionals in a Large Academic Hospital: Cross-Sectional Survey.Journal of medical Internet research · 2026Article
- After-Hours Use of the Electronic Health Record Among Medical and Surgical Specialists After Implementation of a System-Wide Integrated Clinical Information System in Alberta, Canada: Longitudinal Descriptive Study.Journal of medical Internet research · 2026Article
- We need to create a competitive market for electronic health record systems.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Understanding Antecedents of Nurses' and Physicians' Workaround Behavior Regarding Hospital Information Systems: Qualitative Interview Study.Journal of medical Internet research · 2025Article
- Implementing Oncologic Nursing Care Plans in Electronic Health Records With Two Taxonomies: A Pilot Study.Western journal of nursing research · 2025Article
- "I know I shouldn't but …" the inevitable tension of using workarounds to be a "good nurse".Frontiers in health services · 2025Article
- Challenges in reaching patients with severe mental illness for trials in general practice-a convergent mixed methods study based on the SOFIA pilot trial.Pilot and feasibility studies · 2023Article
- Finding the 'sweet spot' between customisation and workflows when optimising ePrescribing systems: a multisite qualitative study.BMJ open · 2022Article
- Transition to a new nursing information system embedded with clinical decision support: a mixed-method study using the HOT-fit framework.BMC medical informatics and decision making · 2022Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElectronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences?
methodsThis single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol).
resultsThrough a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system.
conclusionThis study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.