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Handling anticipated exceptions in clinical care: investigating clinician use of 'exit strategies' in an electronic health records system.

TitleHandling anticipated exceptions in clinical care: investigating clinician use of 'exit strategies' in an electronic health records system.
Publication TypeJournal Article
Year of Publication2011
AuthorsZheng, K, Hanauer, DA, Padman, R, Johnson, MP, Hussain, AA, Ye, W, Zhou, X, Diamond, HS
JournalJ Am Med Inform Assoc
Date Published2011 Nov-Dec
KeywordsAmbulatory Care Information Systems, Delivery of Health Care, Electronic Health Records, Hospitals, Urban, Humans, Information Storage and Retrieval, Medical Records Systems, Computerized, Medical Records, Problem-Oriented, Pennsylvania, Point-of-Care Systems, User-Computer Interface

Unpredictable yet frequently occurring exception situations pervade clinical care. Handling them properly often requires aberrant actions temporarily departing from normal practice. In this study, the authors investigated several exception-handling procedures provided in an electronic health records system for facilitating clinical documentation, which the authors refer to as 'data entry exit strategies.' Through a longitudinal analysis of computer-recorded usage data, the authors found that (1) utilization of the exit strategies was not affected by postimplementation system maturity or patient visit volume, suggesting clinicians' needs to 'exit' unwanted situations are persistent; and (2) clinician type and gender are strong predictors of exit-strategy usage. Drilldown analyses further revealed that the exit strategies were judiciously used and enabled actions that would be otherwise difficult or impossible. However, many data entries recorded via them could have been 'properly' documented, yet were not, and a considerable proportion containing temporary or incomplete information was never subsequently amended. These findings may have significant implications for the design of safer and more user-friendly point-of-care information systems for healthcare.

Alternate JournalJ Am Med Inform Assoc
PubMed ID21676941
PubMed Central IDPMC3197991
Grant ListD28HP10107 / / PHS HHS / United States
UL1RR024986 / RR / NCRR NIH HHS / United States
David Hanauer
University of Michigan Comprehensive Cancer Center at North Campus Reserach Complex
1600 Huron Parkway, Bldg 100, Rm 100 
Mailing Address: 2800 Plymouth Rd, NCRC 100-1004
Ann Arbor, MI 48109-2800 
Ph. (734) 764-8848 Fax. (734) 615-0517
Please acknowledge the Cancer Center Support Grant (P30 CA046592) when publishing manuscripts or abstracts that utilized the services of the University of Michigan's Comprehensive Cancer Center's Shared Resource: Cancer Informatics.
Suggested language: "Research reported in this [publication/press release] was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA046592."

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