Table 1.

Summary of Research and Reporting Recommendations for Studying Workflow and Workarounds in EHR-supported Work

Recommendations for research	Recommendations	Examples
	Recognize the importance of direct study of workflow and workarounds, as opposed to distal or proxy measures.	Workflow measures directly capture the completion of a set of tasks, and their chronology, that seek to accomplish a given goal. Instead of directly measuring workflow, studies instead report indications that workflow is suboptimal as evidenced by distal measures (e.g., guideline compliance) or proxy measures (e.g., time spent using EHR).
	Clearly define clinical workflow and develop proper measures of workflow in the context of the study.	A clear definition involves specifying the goal of the workflow as well as the tasks and their chronology that are expected to result in the goal, along with how each was measured. If relevant, people/roles and resources can also be defined and measured.
	Become familiar with the range of available data sources and methods, as well as strengths and limitations of each. If appropriate, gather data beyond what is captured in the EHR to gain a fuller picture of work.	Key data sources include human observational data and software/sensor observational data (e.g., log-file data, screen-capture data, eye-tracking data). Key methods include human-factors workflow modeling, time-motion analysis, and computational ethnography.
	Use established methods for common research activities used in workflow studies.	There are established methods for conducting common workflow research activities such as calibrating inter-observer reliability, reducing variation in pre-post data collection, and accounting for multitasking.
Recommendations for reporting	Recommendations	Examples
	Use standards for reporting work and workflow studies.	Consistency in results reporting is desired to provide adequate details regarding research design, as well as findings that can be readily compared across studies. Publication guidelines exist for certain types of workflow studies, e.g. the Suggested Time and Motion Procedures (STAMP) (25) offer reporting guidance.
	Report variability in measures of workflow and workarounds.	While workflow often aspires to be standardized, standardization is rarely achieved. Studies of workflow and workarounds should therefore explicitly measure and report variability – either to provide context for study findings or as a direct measure that explains variation in outcomes achieved.