Workarounds in Healthcare: Risks, Ethics, and Solutions
This paper examines workarounds in healthcare facilities — informal, alternative methods practitioners use when official systems are inefficient or outdated. Using the example of personal mobile devices used to share patient data, the paper describes how workarounds bypass organizational databases, create privacy vulnerabilities, and expose facilities to legal liability. Drawing on survey data, federal regulations including the HITECH Act, and academic literature, the paper analyzes why practitioners engage in workarounds and what risks these behaviors create for patient safety and institutional reputation. It concludes with a three-part management strategy — awareness, mitigation, and control — alongside technology-based and training-focused solutions.
- Introduction to Healthcare Workarounds: Defines workarounds as at-risk informal behaviors
- Workarounds in Practice: A Facility Example: Mobile device use to share patient data
- Trends, Statistics, and the HITECH Act: Federal regulation and breach reporting data
- Why Practitioners Choose Workarounds: Outdated systems drive informal device use
- Legal, Ethical, and Patient Safety Risks: Fines, privacy violations, and patient harm
- Addressing and Managing Workarounds: Training, encryption, and three-part strategy
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What makes this paper effective
- Uses a concrete, relatable scenario — a nurse photographing a patient's wound on a personal device — to illustrate abstract policy risks in tangible terms.
- Balances multiple dimensions of the issue: operational convenience, patient safety, legal liability, and ethical obligation, giving the paper a well-rounded analytical structure.
- Grounds its claims in real regulatory context (the HITECH Act, HHS reporting requirements, the omnibus rule) and survey evidence, lending credibility to the argument.
Key academic technique demonstrated
The paper demonstrates issue-framing through layered consequence analysis. Each workaround scenario is unpacked across three levels — operational, ethical, and legal — showing how a single informal behavior can produce cascading institutional risks. This technique is effective in policy and healthcare management writing, where decisions must be evaluated beyond immediate convenience.
Structure breakdown
The paper opens with a definitional introduction establishing workarounds as at-risk behaviors. It then grounds the discussion in a specific facility scenario involving personal mobile devices. Two analytical sections follow: one on prevalence and regulatory history, another on practitioner motivations. The paper then pivots to legal and ethical consequences before concluding with a practical management framework built around awareness, mitigation, and control.
Introduction to Healthcare Workarounds
Workarounds refer to the alternative methods "of accomplishing an activity when the usual system or process is not working well" (Pennsylvania Patient Safety Advisory, 2013). Insofar as workarounds may temporarily solve existing problems, they also indicate inefficiencies and deficiencies in the current system. Workarounds may at times be effective and more convenient compared to the system in existence, but regular use of the same could endanger both the safety of patients and the facility's reputation. A workaround can therefore be termed an at-risk behavior that does not yield concrete long-term solutions to existing problems. As a result, "workarounds perceived as necessary by the user for patient care, efficiency, or safety may be beneficial, neutral, or dangerous for patients' safety" (Koppel, Wetterneck, Telles & Karsh, 2008, p. 1).
Workarounds in Practice: A Facility Example
Workarounds can take a variety of forms. One common situation involves practitioners bringing personal mobile devices to work and using them to facilitate workarounds. These devices include personal smartphones, tablets, laptops, and similar technology. A range of workarounds is involved in such cases. One of the more common examples involves storing or transferring patient data to other workers using up-to-date applications available on these devices. In some cases, this data exchange takes the form of text messages, emails, or social media platforms.
One possible scenario is a nurse sending a doctor a photograph of a patient's wound via her personal device. The doctor views the image on his own device and then issues instructions to the nurse. The logic is straightforward: communication is faster, and the nurse can efficiently serve multiple patients. However, this kind of workaround carries several significant implications. First, the photograph and the instructions given bypass the facility's electronic database. Second, there is a risk of data breach should the mobile devices fall into the wrong hands. Third, the existing system may never be updated, as the facility's IT unit may never be made aware of these kinds of exchanges.
Trends, Statistics, and the HITECH Act
Workarounds have been a common phenomenon within the health sector — but so have the number of associated breaches. The federal government intervened in an attempt to curb their spread through the HITECH Act of 2009. The Act requires health facilities to report to the U.S. Department of Health and Human Services (HHS) any data breaches involving at least 500 individuals. As of the 21st of February of the reference year, a total of 543 such breaches had been reported. It is estimated that "these breaches of health information have affected more than 21 million individuals" (Intel, 2013). Most of these data breaches are the result of stolen devices.
References
Flanagan, M. E., Saleem, J. J., Millitello, L. G., Russ, A. L., & Doebbeling, B. N. (2013). Paper- and computer-based workarounds to electronic health record use at three benchmark institutions. Journal of the American Medical Informatics Association, 20(e1), e59–e66.
Intel (2013). Workarounds in healthcare, a risky trend. Retrieved from http://www.intel.com/content/www/us/en/healthcare-it/workarounds-in-healthcare-risky-trend.html
Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408–423.
Merrill, M. (2009). Using pen and paper workarounds could boost EMR efficiency. Retrieved from http://www.healthcareitnews.com/news/using-pen-and-paper-workarounds-could-boost-emr-efficiency
Pennsylvania Patient Safety Advisory (2013). Workarounds: A sign of opportunity knocking. Retrieved from
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