Pen and paper workarounds used in conjunction with an electronic medical record system may make EMRs even more useful, suggests a new study.

The study, led by Jason Saleem, a Regenstrief Institute investigator and assistant research professor in the Purdue School of Engineering and Technology at Indiana University-Purdue University Indianapolis, documents how and why healthcare providers are still using paper when they have an EMR.

"Electronic medical records are instantly accessible to the healthcare team. But so much information is included in an electronic medical record, how does the individual healthcare provider pick out what is important at a specific time?" asked Saleem, who is also a research scientist at the Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice at the Roudebush Veterans Affairs Medical Center in Indianapolis. "Not all uses of paper are bad, and some may give us ideas on how to improve the interface between the healthcare provider and the electronic record."

In a study of 20 healthcare workers at the Roudebush VA Medical Center, researchers found 125 instances of paper use, which fell into 11 categories: efficiency, knowledge/skill/ease of use, memory, sensorimotor preferences, awareness, task specificity, task complexity, data organization, longitudinal data processes, trust and security.

The most frequently cited reasons for using paper workarounds were efficiency and ease of use, the second most frequent reason was as a memory aid, and the third most frequent reason was to recognize or alert others to new or important information.

"Any use of pen and paper workarounds needs to be coordinated with the electronic record because if it circumvents the electronic medical records it creates the potential for medical error," said Saleem.

An example of use of paper which the researchers labeled as useful was the issuing of pink index cards upon arrival at a clinic to patients who had high blood pressure. The data also was entered into the electronic medical record. The pink cards were passed along to the physician to alert him or her to elevated blood pressure.

Noting that electronic systems have the ability to alert clinicians reliably and consistently, the study recommended that designers of these systems consider decreasing the overall number of alerts so clinicians don't ignore them due to information overload.