Table 2.

Bias assessment of studies reviewed in detail (n = 23)

Author	Key theme	Study design	Data collection method	Triangulation	Bias assessment
Salmon et al. (2016)35	Purposes	Mixed-methods study	Interviews, chart review	Yes	Data collection methods seem adequate. Interviewees’ perceptions are augmented by review of patient summaries’ content.
Ho et al. (2014)28	Purposes	Qualitative study	Focus group	No	Findings could have been augmented by observations of the note-entry workflow to identify factors influencing physicians’ decision about note purpose.
Campion et al. (2010)29	Purposes	Qualitative study	Chart review	No	Findings could have been augmented by observations of the note-entry workflow to identify factors influencing physicians’ decision about note purpose.
Koopman et al. (2015)34	Purposes/note-retrieval/reading	Qualitative study	TA, interviews	Yes	Data collection methods seem adequate. Inferences from TA are augmented by semi-structured interviews.
Tuepker et al. (2016)27	Purposes/reasoning	Qualitative study	Interviews	No	Findings could have been augmented by observations of the note-entry workflow to identify factors influencing physicians’ decision about what to document in their notes.
Farri et al. (2013)30	Reasoning	Qualitative study	TA	No	Findings could have been augmented by observations of physicians in naturalistic settings to determine the impact of interruptions in real clinical scenarios.
Farri et al. (2012)36	Reasoning	Qualitative study	TA, video recordings	Yes	Although sample size is small (6 interns), data collection methods seem adequate. Inferences from TA are augmented by video recordings.
Haglin et al. (2017)37	Note-entry	Mixed-methods study	Video recordings, survey, chart review	Yes	Data collection methods seem adequate. Self-evaluations from the survey are complemented by video recordings and chart review.
Wilcox et al. (2010)38	Note-entry	Qualitative study	Observations, interviews, TA	Yes	Data collection methods seem adequate. Researchers use observations to create an EHR prototype, then evaluate it with TA and semi-structured interviews.
Patel et al. (2000)39	Note-entry	Descriptive study	Chart review, interviews, EHR log data	Yes	Data collection methods seem adequate. Findings from chart review are augmented by video recordings of physicians’ interaction with the EHR and EHR log data.
Robelia et al. (2017)31	Note-entry	Descriptive study	Survey	No	Findings could have been augmented by in-depth interviews with a subset of survey respondents to identify factors affecting physicians’ decision about what to communicate in discharge summaries.
Cao et al. (2003)41	Note-entry	Descriptive study	Database search, chart review	Yes	Findings could have been augmented by adding clinicians’ perceptions of documentation of medical errors in clinical notes with interviews or survey.
Rizvi et al. (2016)40	Note-entry/note-retrieval/reading	Qualitative study	Observations,survey	Yes	Data collection methods seem adequate. Findings from ethnographic observations are compared to data from a survey.
Nolan et al. (2017)32	Note-retrieval/reading	Qualitative study	Observations	No	Findings from ethnographic observations could have been augmented by comparing researchers’ notes with video recordings as demonstrated by42.
Pain et al. (2017)33	Note-retrieval/reading	Qualitative study	Focus group	No	Findings from focus group interviews could have been augmented by direct observations, video recording or use of eye-tracking device to monitor the note-retrieval/reading process.
Kendall et al. (2013)42	Note-retrieval/reading	Mixed-methods study	Observations, screen recording, video recording	Yes	Data collection methods seem adequate. Researchers cross data from observations with screen and video recording to identify note retrieval/reading strategies.
Staggers et al. (2011)43	Note-retrieval/reading	Qualitative study	Observations, audio recording, interviews	Yes	Data collection methods seem adequate. Findings from observations are augmented by audio recording of clinicians’ interaction and semi-structured interviews.
Callen et al. (2014)44	Note-retrieval/reading	Mixed-methods study	Interviews, focus group, observations	Yes	Data collection methods seem adequate. Findings from ethnographic observations are augmented by in-depth interviews and focus groups.
Wright et al. (2016)45	Note-retrieval/reading	Qualitative study	Eye-tracker, interviews	Yes	Data collection methods seem adequate. Findings from eye tracking in naturalistic setting are augmented by semi-structured interviews.
Hilligoss and Zheng (2013)46	Note-retrieval/reading	Qualitative study	Observations, audio recording, interviews	Yes	Data collection methods seem adequate. Findings from ethnographic observations are augmented by audio recording of clinicians’ interaction and semi-structured interviews.
Brown et al. (2014)47	Note-retrieval/reading	Descriptive study	Eye-tracker, audio recording	Yes	Data collection methods seem adequate. Findings from eye tracking were compared to audio recording of simulated handoffs.
Clarke et al. (2014)48	Note-retrieval/reading	Qualitative study	TA, interviews	Yes	Data collection methods seem adequate. Inferences from TA are augmented by follow-up questions.
Horsky and Ramelson (2016)49	Note-retrieval/reading	Qualitative study	TA, open card sorting,interviews	Yes	Data collection methods seem adequate. Inferences from card sorting are augmented by TA and semi-structured interviews.

Abbreviations: EHR: electronic health records; TA: think-aloud protocol.