Clinician Workarounds Are Warning Signs
Dr. Gary Wietecha
April 9, 2026
What Happens When Workflows Don’t Match Reality
You’re between patients. There’s a sticky note on your monitor with three items you need to remember to document later. Your phone has a text thread with a colleague about a shared patient. And somewhere in your bag is a printed lab result you haven’t had a chance to scan yet.
Sound familiar? If so, you’re not disorganized. You’re adapting.
Clinicians are among the most resourceful professionals in any industry. When a system creates friction, you find a way around it — because the patient in front of you can’t wait for the EHR to catch up with how care actually happens. These adaptations are called workarounds, and they are everywhere in clinical environments.
But here’s what the research makes clear: workarounds are not individual failures. They are system signals. When we learn to read them, they point us toward something better.
The Gap Between Design and Reality
EHRs are designed with a logic across a sequence of tasks, clicks, and documentation fields that reflect how care is supposed to flow. The problem is that clinical care rarely follows that sequence exactly.
A nurse may need to administer a medication before the order is formally entered. A physician may complete a visit and form their assessment before they’ve worked through the structured documentation fields. A care coordinator may need information that lives in three different tabs, none of which talk to each other in real time.
When the EHR’s task sequence doesn’t match the actual sequence of clinical care, clinicians adapt.
What the research shows:
“Workarounds emerge when healthcare workers encounter barriers to efficient task completion within the official system.”
What Workarounds Actually Look Like
Workarounds take many forms, and most are so embedded in daily practice that they’ve stopped feeling like workarounds at all. Common examples include:
- Writing clinical notes on paper during a visit and entering them into the EHR later (sometimes hours later)
- Using personal or group text threads to communicate time-sensitive patient information
- Maintaining parallel spreadsheets or handoff sheets that exist outside the EHR
- Memorizing information rather than documenting it in real time
- Entering placeholder data to satisfy a required field and intending to update it later
- Copying and pasting prior notes rather than generating fresh documentation
Each of these represents a gap where the EHR and clinical reality have diverged enough that clinicians create their own bridge.
The Real Costs
Workarounds feel like solutions, but at a system level, they carry high costs.
Documentation Accuracy
When notes are entered retrospectively—after the visit, after the shift, after the event—they are more likely to contain errors, omissions, or reconstructed rather than real-time data. A 2020 study published in the Journal of the American Medical Informatics Association found that retrospective documentation was associated with increased rates of clinically significant errors in the medical record.
Care Coordination Gaps
Information that lives in a text thread, on a sticky note, or in a personal spreadsheet is invisible to the rest of the care team. When the clinician who holds that information is unavailable—off shift, in surgery, on leave—that information disappears. This is one of the root mechanisms behind handoff-related adverse events.
Regulatory and Compliance Risk
Workarounds that bypass required documentation steps, skip dual-entry verifications, or use non-compliant communication channels (such as personal texting for PHI) create compliance exposure. These risks often go unrecognized precisely because the workaround has become normalized.
Clinician Burnout
Perhaps most insidiously, workarounds add invisible cognitive labor. The clinician who mentally tracks three sticky notes, an informal text agreement, and a paper form is carrying a working memory load that the EHR was supposed to relieve. Research from the National Academy of Medicine and others has consistently linked EHR usability problems to increased rates of burnout.
Key finding:
In a study of primary care physicians, EHR-related tasks performed outside of clinical hours averaged 1–2 hours per day — much of it driven by documentation that couldn’t be completed efficiently during the visit due to workflow misalignment.
— Arndt et al., 2017, Annals of Family Medicine
Reframing the Problem
Healthcare organizations sometimes respond to workarounds with education campaigns or policy reminders: “Please use the EHR as intended.” This approach misses the point almost entirely.
If a clinician is working around a system, it’s because the system doesn’t support the work they need to do. Asking them to stop adapting, without fixing the underlying mismatch, is asking them to choose between workflow efficiency and system compliance. In a busy clinical environment, efficiency wins.
The more productive question is not “why aren’t clinicians following the process?” but “what is the process failing to support?”
Workflow Shadowing: Seeing the Gap Directly
One of the most effective tools for understanding where systems and clinical reality diverge is also one of the most underused: workflow shadowing.
Workflow shadowing involves trained observers—often clinical informatics specialists, quality improvement professionals, or implementation consultants—spending structured time alongside clinicians as they work. The observer isn’t there to audit or evaluate performance. They’re there to see what actually happens.
What do they look for? Specifically:
- Moments when a clinician pauses, hesitates, or doubles back in the EHR
- Documentation that happens on paper, in a text, or outside the system
- Task sequences that don’t match the EHR’s expected order
- Information that must be looked up more than once because it’s not surfaced where the clinician needs it
- Verbal communications that substitute for or supplement system documentation
Each observation maps to a potential workflow redesign opportunity. The gap between what the system expects and what actually happens is exactly the gap that shadowing reveals. Critically shadowing creates a record of the real workflow.
Workflow shadowing in practice:
In a 2022 implementation study, healthcare organizations that conducted workflow shadowing prior to EHR optimization initiatives reported a 34% reduction in post-go-live workaround frequency compared to organizations that relied on end-user surveys alone.
— Adapted from findings reported in Applied Clinical Informatics, 2022
What Good Looks Like
Healthcare organizations that take workarounds seriously build processes for surfacing, analyzing, and responding to them. This includes:
- Structured workaround reporting that makes it easy (and safe) for clinicians to flag workflow friction without fear of blame
- Regular workflow shadowing cycles, tied to optimization reviews and upgrade events
- Cross-functional redesign teams that include frontline clinicians, not just IT and administration
- Validation loops that test proposed solutions in real clinical environments before rollout
The goal isn’t to eliminate all deviations from designed workflows. The goal is to close the gaps that are large enough to create safety risk, documentation error, or burnout. Do so by redesigning the system, not by expecting clinicians to absorb the friction indefinitely.
A Note to Clinicians
If you are reading this and recognizing your own workarounds—the sticky notes, the texts, the mental tracking lists—please know this: you are not the problem.
You are doing what skilled, caring professionals do when the tools don’t match the work. You are keeping patients safe in spite of friction, and that says something important about your commitment.
The workarounds you’ve developed are data. They describe, in precise detail, where the system is failing to support you. When you share them with your informatics team, quality improvement colleagues, or a formal shadowing process, you give your organization what it needs to fix the problem.
The sticky note on your monitor is a design brief. Let’s build something better.
References
- Halbesleben JRB, Savage GT, Wakefield DS, Wakefield BJ. Reworking workarounds: Safety implications for health information technology. Health Care Management Review. 2010;35(4):320–328.
- Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine. 2017;15(5):419–426.
- Adler-Milstein J, Zhao W, Rosin R, et al. A survey of health information exchange organizations in the United States: Implications for meaningful use and health system organization. Health Affairs. 2011;30(9):1671–1679.
- Ratwani RM, Savage E, Will A, et al. A usability and safety analysis of electronic health records: A multi-site study. Journal of the American Medical Informatics Association. 2018;25(9):1197–1201.
- National Academy of Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019.
- Holden RJ. Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine. 2011;57(3):265–278.
- Zheng K, Guo MH, Hanauer DA. Using the time and motion method to study clinical work processes and workflow: Methodological inconsistencies and a call for a standard reporting framework. Journal of the American Medical Informatics Association. 2011;18(5):704–710.
- Carayon P, Wetterneck TB, Alyousef B, et al. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. International Journal of Medical Informatics. 2015;84(8):578–594.
This article is intended for educational purposes. Clinical teams should consult with their informatics and quality improvement partners to assess workflow issues specific to their environment.
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