In a perfect world, all software used by clinicians would help provide better patient care while improving workflows. But that is not always the case. Sometimes software obstructs the workflow. If a task takes too long or can be done more easily outside of the system, people will develop workarounds. The workarounds, over time, become part of the way things are done and a true solution remains elusive.

Clinicians are going to find a way to make something work in the moment. A provider can't just stop clinical care to diagnose and solve computer problems. Most providers are so overloaded that reporting the issue and waiting for a solution is last on their priority list. Although it may seem like workarounds are just "part of the job", and some of them are downright ingenious, they ultimately place an undue burden on clinicians. There are enough clinical problems to solve without having to work with software that gets in the way.

EHRs are a primary source of workarounds. One scenario could be trying to get a lab sent to another department. Maybe the method for viewing the lab is easy, but the method for sending the lab is hard to find. Instead of interrupting a colleague's work or tracking down an IT person to solve the mystery, they could instead call to share the results. Although this got the job done, was the software supposed to track the transmission of the lab test? The provider wasted at least a few minutes of their time, and they will probably have to repeat the process from now on. This scenario may seem harmless, but when more workarounds are added, the inefficiencies pile up.

There can be a disconnect between the administration and providers on workarounds. Those actively using workarounds might keep it to themselves out of fear of disciplinary action. But this perpetuates the problem, and the likelihood of a proper solution is low. Organizations need to encourage reporting of workarounds as a part of improvement policy, and administration needs to be open to listening to clinical staff about the shortcomings of the software in use. It is important to provide an easy and convenient way to report a problem as well as a method of tracking the progress of creating and distributing the solution.

Software developers can help combat workarounds. A good way of determining if the software is not performing up to par is to monitor the speed and steps taken to accomplish tasks in the software. This could mean keeping counts of how many clicks it takes to complete an action in the software. Or better yet, schedule follows to see how people use the system in daily routines. Usability must be a top priority when developing clinical software.

Building better healthcare software takes into account all of the needs of clinicians and gives them the tools to execute tasks efficiently and reliably. What are some examples of workarounds that you have seen? Did they ever get resolved? If so, how?