Table 2.

Reasons for paper- and computer-based workarounds to the electronic health record system across three benchmark institutions for health information technology

Reason for workaround	Definition	Institutions	Workaround medium
Observed across three institutions
Efficiency	Using a workflow process that improves actual or perceived efficiency	VHA, RI, PHS	Paper, computer
Memory	Reminder about ‘old’ or existing information	VHA, RI, PHS	Paper, computer
Awareness	Recognize new/important information: notify, alert, trigger, adjusting ‘signal-to-noise’ ratio	VHA, RI, PHS	Paper, computer
Observed across two institutions
Knowledge/skill/ease of use	Training/support/experience/ease of finding needed information	RI, PHS	Paper, computer
Task complexity	Complexity of task dictates workflow issues or functionality issues	VHA, PHS	Paper
Trust	Greater trust in paper over electronic version	RI, PHS	Paper
No correct path*	A desired option did not exist in the computer workflow	VHA, RI	Computer
Observed within one institution
Data organization	Data layout issues; need to view existing data differently	VHA	Paper, computer
Task specificity	Need specificity or ability to customize to patient, provider, department, etc; some signal-to-noise concerns	VHA	Paper
Sensorimotor preferences	Preferred sensory input for task: ‘hear’, ‘tangible’, easily modified (ie, hand-written notes); mobility, something to ‘deliver’	PHS	Paper
Longitudinal data processes	Task requires processing multiple data points across time	VHA	Paper

*A new category not part of the original coding developed from previous work.

PHS, Partners HealthCare System; RI, Regenstrief Institute; VHA, Veterans Health Administration.