Varying clarity in signaling the transition to silent EHR use	Some clinicians overtly voiced a need to pause to use the EHR, Most clinicians gave non-verbal signals (e.g., turning body or gaze) without verbal warnings. Some clinicians drifted into silence without signaling awareness they were halting conversation with patients.	• “I’m going to look into the computer for a second, okay?”
		• “Give me a minute, I want to review in the computer what we’ve done before.”
		• “Let me just…oops…hold on one second.”
		• After period of multitasking history- taking: “So…umm…we…” & drifts into 17 sec silence while typing.
		• “There aren’t specific treatments…but they’re going to…uh…uh…uh…”
Breaking the silence	Clinicians & patients may break silent EHR use, leading to multitasking. Clinicians may emerge from EHR tasks to re-engage patients. Patients often interjected “chit-chat,” but also voiced biomedical or psychosocial concerns.	• After 43 sec, clinician explains: “I’m going to send this to your pharmacy now, ok? This is the new dose of the furosemide.”
		• After 25 sec, pt asks “So are you ready for Christmas?”
		• After 32 sec, pt asks: “So they didn’t talk to you either about my pap machine?”
		• After 12 sec, pt lifts his foot “My [primary] doctor was worried about this…”. Clinician replies “Oh yeah…when did this happen?” and examines it.
Unaddressed patient concerns	Both multitasking and silent EHR use offer risks of unaddressed patient concerns.	Multitasking EHR Use:
		• Pt describes friend who had a stroke: “He called me to tell me what happened.” Clinician: “So let’s just review, you’re taking simvastatin which is a cholesterol medicine…”
		• “Yes and sometimes I have tremendous pain.” Clinician: “Mm-hm..and you’re still taking…?”
		Silent EHR Use: Pt explains problems with getting medications on time from pharmacy. Clinician: “That’s weird” & resumes silent EHR use.