Table 3. Themes regarding dashboard use from research assistants.

Theme	Subtheme	Representative quotes
Variation in the Dashboard access and use	Method of accessing the Dashboard evolved with training	“All users of the Dashboard have been initially taught to pin it to their epic start menu as a ‘favorite’ of sorts in order to simplify the process of accessing it”
	Dashboard use frequency and timing	“Neuro providers only used it during a 30-minute interdisciplinary round, but GMS providers conducted bedside rounds and used it then (which lasted all morning). Nurses checked the dashboard periodically throughout the entire day” “On neuro: the chief PA was really behind the dashboard, and wanted it up at all [interdisciplinary] rounds so that as the residents were actively entering orders in Epic they could also address any documentation issues shown on the dashboard” “During piloting, we saw residents using the dash prerounds/we saw the nurse director looking at the dashboard to check on quality metrics”
	Provider’s preference for unit level display versus patient view	“Most users clicked on the patient's name after opening up the unit level view to see all flags that were relevant for that patient” “Nurses tend to log into the unit view, especially as charge nurse, because they are regionalized of course. I think the patient view was used more by MDs and PAs because they were less regionalized/maybe only ‘owned’ a few patients on each pod”
Social and cultural barriers influencing user retention and adoption	Division of responsibility	“Most successful usage initially on neuro where chief PA would have a resident pull it up during interdisciplinary rounds” “Felt very much like every role did not want to take on the responsibility for checking it so would ‘share’ it, leading to things getting missed” “I don't know how much of it was “dividing responsibility” versus “that's not my problem.” For instance, MDs had no idea what to do with the ulcer and fall columns. So they just said “that side is for nursing.” Nursing would get frustrated when they would bring it up and then get shot down (e.g., ‘code status is red’ ‘yup’) with no further action”
	Threats to workflow	“Might not have seen full value and didn't have incentive or expectation to use tools so didn't. Not wanting to complicate or change workflow”
Usability and technical issues	Clinical relevance of dashboard alerts	“Many issues over the course of the study, usually because our logic was faulty (not pulling all required fields in epic, etc.) … Other times there were disagreements about what patient status necessitated a red/yellow/green/gray and these issues warranted discussions around our logic” “Most people found a few easy ‘wins’ from the dashboard (e.g. ‘red’ showed who didn't have code status, or morphine equivalent dose), and that was how they usually found value in it” “… Providers did get frustrated by items that would just always be red or yellow that they felt they couldn't change”
	Technical bugs	“For the dashboard, main concerns that I heard were persisting bugs that probably discouraged widespread use. Other concerns I heard were that it could have been designed to look more streamlined/not create too much cognitive overload”
	Performance and speed	“Dashboard loading times were an issue that caused usability problems”
Overall impressions and suggestions	Dashboard success	“Large-scale implementation of novel health IT, which led to some successes in terms of streamlining inpatient care. This success was only possible because both sides (research and clinical users) put the time and effort to make sure that it was fully disseminated across the study units”
	Suggestions for improvement	“Advanced planning about how to engage stakeholders in order to have consistent and effective engagement—ensuring follow through on engagement – regular meetings or rounding to discuss issues that come up from clinicians” “Bring in clinical users early. Clinical users who can pilot constantly. Clinical users who work on the floors all the time. Better communication with leadership early so they have agency over the intervention and therefore have a little bit more excitement about it because they were part of the conception”

Abbreviations: GMS, general medicine service; IT, information and technology; PA, physician assistant.