"Most of what I do is a workaround now": Clinician Use of Workarounds Following an EHR Transition.

Abstract

Background: The Department of Veterans Affairs (VA) is transitioning from a homegrown electronic health record (EHR) system to a single-vendor Federal EHR system, the largest EHR transition in history. Research shows that this transition was profoundly disruptive to care during the early implementation phase, yet limited data exist on clinician experience with and response to the transition in the years following implementation of the new system.

Objective: To investigate the use and perceptions of workarounds among VA clinicians using the new Federal EHR system.

Design: A descriptive exploratory qualitative study.

Participants: Using a mix of purposive and snowball sampling, we recruited direct care clinicians across a range of professions currently employed at the first five VA medical sites to transition to the new Federal EHR. Of the 104 clinicians invited, 30 (28.8%) participated in interviews.

Approach: We conducted semi-structured interviews with clinicians approximately 1.5 to 4 years post-go-live across sites. We performed a hybrid inductive-deductive content analysis using an approach that combined templated summaries with matrix analysis. KEY RESULTS: Workarounds emerged as highly salient to clinician experience with the new EHR. Analyses generated four themes relevant to EHR workarounds: (1) ongoing EHR-related challenges impeded clinicians' job performance; (2) workarounds emerged in response to continued EHR challenges; (3) workarounds were perceived as necessary but risky to patients, users, and the health care system; and (4) as EHR problems persisted, workarounds became routine.

Conclusions: Many of VA's EHR transition challenges have persisted beyond the initial implementation phase, contributing to a reliance on workarounds to overcome obstacles to care delivery. Workarounds were perceived as both beneficial and risky to users, patients, and the healthcare system. These findings highlight the importance of evaluating the role and impact of workarounds during EHR-to-EHR transitions to inform system improvements and workflow optimization.