CoChat
Sign Up
Cited by 146Electronic Health Records SystemsNursing Diagnosis and DocumentationInformation Systems Theories and Implementation

The DOI matches its Crossref record; 28 of the 28 references it cites were found in a registry or an index.

Exploring the persistence of paper with the electronic health record

Saleem, Jason J., Russ, Alissa L., Justice, Connie F., Hagg, Heather, Ebright, Patricia R., Woodbridge, Peter A., Doebbeling, Bradley N.·2009·International Journal of Medical Informatics
DOI 10.1016/j.ijmedinf.2009.04.001
Open this paper in CoChat — free account

Abstract

Objective Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR.Methods We conducted semi-structured interviews with 20 key-informants in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EHR, to understand the use of paper-based alternatives. Participants included clinicians, administrators, and IT specialists across several service areas in the medical center.Results We found 11 distinct categories of paper-based workarounds to the use of the EHR. Paper use related to the following: (1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security. We define each of these and provide examples that demonstrate how these categories promoted paper use in spite of a fully implemented EHR.Conclusions In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EHR design and implementation.

Overview

Integrity signals

Registry

Crossref · 10.1016/j.ijmedinf.2009.04.001

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Cited by

Sorted by citations

See all 146

Related

See all

Metadata

Authors
Saleem, J. J., Russ, A. L., Justice, C. F., Hagg, H., Ebright, P. R., Woodbridge, P. A., & Doebbeling, B. N.
Affiliations
  • Regenstrief Institute (US)
  • Indiana University Indianapolis (US)
  • VA Nebraska Western Iowa Health Care System (US)
Corresponding author
Saleem, Jason J.
ORCID
Venue
International Journal of Medical Informatics
Publisher
Elsevier BV
Published
2009-09
Volume
78
Issue
9
Pages
618-628
ISSN
1386-5056 (ISSN-L)
DOI
10.1016/j.ijmedinf.2009.04.001
OpenAlex
W1965739756
Semantic Scholar
6f73746d8f0c94b5309f7465ff317ebb22d05f29
Cited by
145
References
28
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 8 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 10 · 2017: 6 · 2016: 12 · 2015: 11 · 2014: 12 · 2013: 15 · 2012: 9
FWCI
29.55
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Medical Informatics (publishedVersion)
  • PubMed (publishedVersion)
Funders
Health Services Research and Development
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Nursing › Research and Theory › Nursing Diagnosis and Documentation
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Information Systems Theories and Implementation
Keywords
electronic health records, human-technology integration, health information technology adoption, EHR design, clinical documentation, medical errors, veterans' health care, clinician behavior, task complexity, data security
MeSH terms
Documentation, Indiana, Medical History Taking, Paper, Practice Patterns, Physicians', Medical Records Systems, Computerized

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review