Table 3.

Examples of ‘no correct path’ computer-based workarounds

Description	Observation or opportunistic question response
Using incorrect but equivalent computer documentation to match actual plan	Physician: ‘We tell them to split that pill (for blood pressure) but the EHR med list will only show the full pill and then there's a mismatch (in timing of when the medication needs to be renewed). That's a problem. There's all these little things we have to do’ (to correct for and make the system work)
Clicking inaccurate option to satisfy reminder since none is the ‘right’ one	Nurse practitioner indicates that the CRC reminder sometimes has no good option. If a colonoscopy is already scheduled, the reminder still comes. It asks when it was last done, but doesn't allow you to enter that one is scheduled. She clicks the box that says patient has declined the colonoscopy to turn off the reminder
Gaming the system: change to medication order to comply with system requirements (‘cannot dispense this quantity’)	Physician 1 is using EHR to order medicine for a patient. She is receiving alerts indicating ‘…cannot dispense this quantity…’ Physician 1 complains to physician 2 next to her that the orders are ‘not taking’ and explaining what she's doing to get the ‘orders to take’. (by ‘getting the orders to take’ she means being accepted by the EHR order entry system)

CRC, colorectal cancer; EHR, electronic health record.