Table 1.

Frequent, redundant, and difficult tasks identified by participants and derived contributing work system factors.

Task	Contributing work system factor(s)	Representative quotation
Chart reviewa	People: Extent of reliance on electronic records varied between participants Environment: Electronic chart was not accessible at bedsides Tools/technology: EHRb did not push notifications of important changes Tasks: Patients with more status changes needed more frequent review Organization: Multifactor authentication was required before every EHR session	“Ideally, you would like to be able to harvest that information in the room with the patient by handheld device so that if memory fails and patients have questions, you can use that to help answer their questions. Mostly, I do that from memory now.”
Ordersc	People: Preferences varied in when to start and when to submit orders Environment: Electronic ordering was not accessible at bedsides Tools/technology: Finding the right order form in the EHR was difficult Tasks: Orders depended on having the most up-to-date patient information Organization: All orders had to be made through the EHR	“There are multiple clicks to get to different boxes, lots of pop-ups that you have to go through...the computer system itself adds considerably to the amount of time that we take and takes away from our patient care”
Documentationd	People: Content of attendings’ notes depended on the content of their residents’ notes Environment: EHR was not accessible at bedsides Tools/technology: Authoring notes in the EHR sometimes involved copying forward text from older notes Tasks: These were sometimes based on a single encounter, and other times more longitudinal (eg, discharge summaries) Organization: Facility required a series of documentation and ordering steps before discharge	“I think documentation is by far the thing that takes us the longest— documentation for sure.”

^aChart review: going through patient information and history.

^bEHR: electronic health record.

^cOrders: services like lab tests and referral.

^dDocumentation: summarizing encounters, making or changing care plans, and adding to patient information.