Types of workarounds identified and how these align with the current literature
| Workarounds observed | Workarounds identified in the literature2041–45 |
|---|---|
| As a result of the cumbersome switching between screens and a lack of information integration between systems, users in some instances used other programmes such as Microsoft Word as intermediary storage of information. | Efficiency (when paper or other software was perceived to improve efficiency) |
| Due to the perceived necessity to compensate for the increased time it took to use the system, we found that users drew on paper and other software systems to accommodate the increased time required to perform tasks. | Knowledge/skill/ease of use (when paper or other software use was perceived to be easier) |
| Paper was often used as an intermediary storage of information, for example, to remind doctors to look something up on the system. | Memory (using paper or other software as a reminder) |
| ‘Tricking the system’ (eg, inserting inaccurate or incomplete information to be able to click through screens, temporary data, insertion of predefined terms). | ‘No correct path’ (can consist of ticking an option that is incorrect to be able to move on in the system, gaming to satisfy system demands, using incorrect electronic documentation to reflect paper-based plan) |
| Not observed | Sensorimotor preferences (paper preferred as it is more tangible) |
| Not observed | Awareness (paper or other software can serve to more effectively draw attention to information) |
| Paper was often used as an intermediary means to store information in instances where users did not have easy access to electronic means or were too busy to transfer information electronically. Paper was also used when users wanted to memorise something that needed to be transferred from one screen and to another (store and transmit). | Task specificity (using paper as it can fulfil certain needs for tasks better than the system) |
| If prescribers wanted to use specific medicines that were not held in the system, then workarounds drawing on paper systems were created to compensate for this. | Task complexity (Electronic Health Record (EHR) presents problems to workflow so paper preferred) |
| Cumbersome switching between screens necessitated users to find shortcuts. | Data organization (difficult to view data in desired format in EHR so drawing on paper or other software) |
| Not observed | Longitudinal data processes (user needs quick and repeated data recording/processing) |
| Not observed | Trust (in paper when compared with EHR) |
| Not observed | Security (perceptions around EHR security and view that paper is safer) |
| Delegating input of electronic information | Not observed |
| Deferring input of electronic information | Not observed |
| Entering electronic information in batches | Not observed |
| Using electronic shortcuts to save time | Not observed |
| Cross-referencing to paper notes | Not observed |