Physicians often feel uncomfortable speaking up about challenges and accuracy concerns with EHRs, leading to a "culture of silence" in healthcare organizations, suggests a recent study.
Researchers interviewed 16 physicians from two Midwestern health systems regarding their experience with EHRs. The interviews revealed two key themes of EHR use: the prevalence of EHR workarounds and physicians remaining silent about inaccuracies spotted in the electronic records.
Physicians who appeared to have "adapted positively" to EHRs had often implemented such workarounds in their clinical work, such as using paper charts during patient encounters and entering data later in the EHR.
While workarounds are not uncommon, researchers noted the culture of silence was more surprising. "Many [physicians] simply implied that, 'We just don't talk about information inaccuracies in the EHR,' [and] others stated this directly," the study reads.
This inaction on EHR inaccuracies may stem from fear of job security, suggest the researchers, who wrote there are differing perceptions about the safety of voicing concerns depending on a healthcare worker's position is in the professional hierarchy. Physicians, they write, are closer to the top of the hierarchy, and likely more comfortable speaking up than nurses or other clinicians.
"There has been a lot of data collected about EHRs but little analysis of how the people using the technology actually feel about it," said Tracy Porter, college associate lecturer within the Department of Management at Cleveland State University and co-author of the study. "Our work indicates that there are clear problems being identified by the EHR user but due in part to workarounds and the culture of silence these issues are not being properly addressed, reducing the benefits of the technology and potentially leading to additional problems."
The research will be presented at the Academy of Management's 2016 Annual Meeting in August.
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