Table 2.

Aspects that situate the process of chart biopsy

Aspect	How	Representative quotations
Notification technology and practices	Frames patient through description, diagnosis, chief complaint information, etc.	If a patient is being admitted for something that is related to a cancer, then I'll look at the last note from their oncologist, because that will let me know where is their cancer at right now
Past experiences	Attune the receiving physician to certain common concerns in the case of patients with particular presenting conditions	I look them up, look for certain criteria, make sure their stability makes sense for the floor as opposed to the ICU, because sometimes that's not always been reviewed
Information encountered in the chart	Alerts clinician to issues not mentioned in the alphanumeric admission page and triggers further information seeking both within the chart and with ED physicians during the subsequent handoff conversation	Field note excerpt: [The participant] looks up the patient in CareWeb. She sees that amylase lipase labs were ordered in the ED. From this, she knows [the admission] will be ‘abdominal pain’
Other work demands	Constrain the time spent in the chart and the extent to which the record is examined	Well by now I do have a system [for chart biopsy], unless, let's say I'm swamped, and I'm in seeing a patient, and ER keeps paging me, paging me, paging me. I step out and just call without even looking up
EHR design (including functionality and usability)	Enables or limits clinician's ability to see the big picture	Field note excerpt: [The participant] wants an easy way to view labs from previous visits side by side with current labs. He has to switch back and forth between windows to compare numbers

ED, emergency department; EHR, electronic health record; ER, emergency room; ICU; intensive care unit.