Table 4.

Reasons for use of workarounds to follow-up on diagnostic test results: Main themes and categorization

Main Themes	Categories*1 (Saleem et al.)	Freq.	Saleem et al.’s Description	Examples
Memory Aid	Memory	62	Reminder about “old” or existing information.	I keep a notepad to remind myself if a patient had a test done or followed up on treatment recommendations.
	Awareness	26	Recognize new/important information: notify, alert, trigger; adjusting “signal to noise” ratio.	Nurses at my clinic and the other clinics make a list of patients that have had INR done for that particular day and give that to me to remind me to take action the next day.
Improved efficiency	Efficiency	68	Using a workflow process that improves actual or perceived efficiency.	There are quite a few other things such as coding and identifying to the computer multiple times who I am when I’m obviously signed in, that are time consuming, tedious, detract my attention and inefficient. Writing the info on paper as I am informed of completed tests yet no results are available for viewing until days later--no other way of tracking (a potential safety issue)
	Data organization	28	Data layout issues; need to view existing data differently, accessing data.	When I need to follow up on an alert that I have already reviewed (once reviewed you cannot go back) such as test result that was scanned into vista imaging but it is not visible yet, I print out the alert.
	Knowledge/ skill/ease of use	3	Training/support/experience/ease of finding needed information.	I keep a notebook of specific things that I need to follow up on that I cannot easily tag in CPRS.
	Task specificity	3	Need specificity or ability to customize to patient, provider, department, etc.; some signal/ noise issues.	I cannot request a subset of labs, say for testosterone and urinalysis, without getting ALL the labs (which I don’t need), so I have to follow some patients on paper.
	Task complexity	5	Complexity of task dictates workflow issues or functionality issues.	I write notes on routing slips or scrap sheets of paper. I have a notebook that I write some things down on that require multiple follow ups or coordination of multiple services.
	Sensory-motor preferences	29	Preferred sensory input for task: “hear,” “tangible,” easily modified (i.e., hand notes); mobility, something to “deliver.”	I HATE lab alerts on CPRS unless they are panic values. I try to keep alerts to one screen at all times so I can see new ones as they pop up. Lab alerts TOTALLY clog this up. I prefer printed copies on paper which I can look at, organize and prioritize on my own. I really want to continue this.
	Longitudinal data processes	1	Task requires processing multiple data points across time.	Paper Coumadin flowsheet for each of my Coumadin pts – I need to see the past trends, dose/ INR correlations, as I am deciding on management.
Facilitate Internal and external workflow*2	N/A	61	N/A	I receive paper copies of critical labs and tests sent outside the VA system.

*¹ The categorization presented in the table is based on applying framework of 11 reasons for use of paper- and computer-based workarounds developed by Saleem et al. [3]

*²“Facilitate Internal and external workflow” – this theme does not map to Saleem’s framework.