Table 3.

Adult Oncology Program Pilot Qualitative Interview Feedback on Content and Context Modifications to the Electronic Health Record-Enabled Best Practice Advisory Screening and Referral Pathway

Target	Content modifications	Rationale–illustrative quotations	Potential solution
BPA: Consult already ordered	Adding elements	“It [the BPA] did pop up on one of my patients the other day, and I hadn't had that before where I looked in the chart and like the consult was already ordered. And I assume … by the surgeon, and you know, I kind of wanted to make sure … that I wasn't just kind of ignoring the fertility concerns and I wanted there to be a way that I could say, you know, consult is already happening or something like that.” (Breast Team Physician)	Add reason for not ordering referral: consult already ordered
BPA: Remind on next visit	Adding elements	“If there was a way like instead of ordered, you know, order there was like, you know, a button for next time like or, you know, remind our next visit, because that would be helpful.” (Breast Team APP)	Add reason for not ordering referral: address next visit
Referral order: Anticipated Treatment Course field	Tailor/tweaking/refining	“The hard thing about the anticipated treatment courses sometimes we just don't know.” (Breast Team APP) “I'm the surgical person, right. And so, I'm putting orders in, and I'm just guessing what the medical oncology treatment is, it's not really appropriate.” (Breast Team APP)	Remove as a requirement Change to “potential treatment course”
Referral order: Medical provider contact information field	Removing elements	“I would remove medical provider because yeah, you can just call whoever made the order.” (Breast Team APP) “So I mean, because typically what you see if you see the referral, you know who it's from. So that just could be one thing you could potentially think about taking out.” (Hematology Team Physician)	Remove field

Target	Context modifications	Rationale—illustrative quotations	Potential solution
BPA: Fire during patient visit rather than during pre-charting	Format	BPA firing when providers were precharting and not in real time when they see patients: “I'm doing, most of, my notes are done at home…if you're not with the patient, and you're not discussing it with them at that time, right. We just said that'll be their next visit.” (Hematology Team Physician)	Add criterion for patient to have arrived before the reminder fires
BPA: Remind at second visit	Format	“Especially when I'm very first seeing the woman, it's very overwhelming, right? And so, at first they'll might say, you know what, I don't want to even think about that—I'm just wanting to do this right now. And so, they're saying no. It's sometimes that second visit where they've had time to kind of think about things, and I think that's the, that's my problem with it is that it, it makes it only on their very first meeting. And especially on the surgical side where we're meeting them literally after they've been biopsied. And they found out it's so fresh, there's a lot of emotions… I'm not only doing more work up done in oncofertility, but I'm also talking about you know, Social Work, Psychology and so on. And again, it's a lot of things. And when somebody gets diagnosed with cancer, it's already scary enough. And they're walking out with, you know, 10 referrals and 20 tests to do. That's, that's a lot.” (Breast Team APP)	Add reason for not ordering referral: address next visit
BPA: Add nurses to providers eligible for the reminder	Personnel	“I mean, so most of us in hematology, we don't have APPs. So then, you know, we rely a lot on nurses to assist us. So, in that regard, then the nurse, maybe don't make it for an MA but make it maybe make it for the nurse and also the pop up so that would potentially, they could have a reminder to so they can always remind the clinicians.” (Hematology Team Physician)	Add additional personnel category, that is, nurses, to BPA specification