The Beach Boys - I Get Around - Workarounds

In the recent article Targeting EHR Workarounds, the author makes the following comments: Workarounds, depending on the system and the user, might be harmless in some cases but potentially dangerous in others.

 

Whatis.com states the definition: A workaround is a method, sometimes used temporarily, for achieving a task or goal when the usual or planned method isn't working. In information technology, a workaround is often used to overcome hardware, programming, or communication problems.

The fundamental problem is that these workarounds may solve problems, but may inadvertently create hidden/unknown downstream issues.

1.      Potentially created by a non-authorized user, circumventing safeguards
2.      Putting the facility, the user, and the supervising hierarchy at liability risk
3.      Affecting data collection
4.      Missing financial credit for the documentation
5.      Missing data qualifying for “meaningful use” credit
6.      Potentially using macros with cut and paste that obscure the individuality of the encounter
7.      Potential fraud issues as to what discussions and acts were actually performed.
8.      Very important: avoiding definitive resolution of the issue. That is, by taking the workaround short-cut, and not communicating with the vendor about the problem (sometimes easier said than done), it will continue to appear for everyone.
9.      Customization may be creative but cost-prohibitive.
10.  ETC.

Many workarounds are designed to avoid alert fatigue. These may do the job most (99%) of the time but can be disastrous if key information happens to be ignored at a crucial time. See our prior blog on “Alert Fatigue”.  For example, scanning-in of relevant documents (say, a medication list) may make life apparently simpler, but if physician eyes do not see a key item (e.g. warfarin) the EH R and its decision support mechanisms will be missing critical data (so, the patient may bleed to death if sent to surgery without anticoagulant reversal).

 

Workarounds are most often created by the most innovative and intelligent clinicians among us (and the ED seems to have it share of them), trying to overcome tedious workflow issues in their E H R.  Many are guilty of discovering and using them. No names will be given. Unfortunately, however, the problems noted above can (and have) come back to haunt the provider and the facility. The best solution is find an EHR designed specifically for your area of work and engage the vendor in a continuous process of making the product more user-friendly. In that way, workarounds can quickly become a principle source of EHR and workflow improvement. “Workaround types” would enjoy listening to the Beach Boys classic –I Get Around.