Table 3.

Prominent EHR workarounds concerning Persons and their scope and potential impact (↑ denotes an increase, ↓ denotes a decrease, • denotes a negligible influence, and ? denotes undecided. P stands for patient, C for health care professional [clinician or clerk], and O for the overall organization).

Rationale	Workaround	Scope	Safety	Effectiveness	Efficiency
Declarative knowledge	Manually reentering patient data from the EHR into a letter due to not knowing how to use the automatic letter generation tool	C	↓	•	↓
	Asking colleagues for assistance when not knowing the correct referral codes when referring patients to colleagues of another specialty	C	•	•	↓
	Not registering treatments due to not knowing what treatments are supposed to be registered and which ones should not	O	•	↓	↑
	Not signing treatment plans due to not knowing how to	PO	↓	↓	•
	Asking colleagues how to order antihemorrhagic drugs in emergency situations due to not knowing how to	PC	↓	↓	↓
Procedural knowledge	Requesting colleagues to review draft orders (eg, allergy tests) due to being uncertain whether the draft orders have been entered properly	PC	↑	•	↓
	Entering patient data via progress notes due to being unsure how to use certain EHR functionalities (eg, family history matrix)	PC	↓	↓	•
	Entering the same patient data in 2 near-identical data fields due to being unsure which data field entry will be forwarded to the right colleague	C	•	•	↓
	Rebooting the EHR due to not knowing how to efficiently navigate back to the main screen	C	•	•	↓
	Purposefully ordering too great a quantity of drugs (eg, 2 tubes instead of 1) due to being unsure of what quantity will eventually be delivered	P	↓	↓	↓
Memory aid	Temporarily boldfacing, italicizing, or underling parts of text in progress notes as a memory aid for questions to be asked or appointments made	CO	•	•	•
	Writing down keywords in a patient’s progress note in advance of an outpatient consultation session as a reminder	C	•	•	•
	Writing patient data from other EHR tabs or external information systems down on paper as a memory aid to avoid excessive toggling between EHR tabs or windows while writing a progress note	C	↓	•	↑
Awareness	Purposefully entering patient data perceived important for other colleagues to see in data fields that are directly shown on the user’s screen when opening a patient’s health record, rather than in the intended field(s)	PCO	↓	↓	↑
	Bookmarking scheduled patient consultation sessions with specific colors, indicating these patients will be seen by clinicians not yet having a personal identity	CO	•	•	•
	Writing specific patient data down on paper next to entering this into the EHR as a heads-up for the following clinician seeing the patient afterwards	C	•	•	↓
Social norms	Copying a workaround after having heard of or seen a workaround being used by a colleague in practice (eg, entering patient data into a data field supposed to be exclusively used by another specialty)	C	?	?	↓
	Entering patient data (eg, allergies or vital signs) into an inappropriate data field as commanded by a superior, without entering these data into the appropriate data field(s)	PCO	↓	↓	?
	Entering patient data (eg, allergies or vital signs) into an inappropriate data field as requested by a fellow clinician, in addition to entering these data into the appropriate data field(s)	PCO	?	?	↓