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CHI '26 · Best paper · full-paper review · confidence high

Managing Medication Plans When Information Is Scattered: Clinicians' Strategies and Tools

Anastasiya Zakreuskaya , Ignacio Avellino , Wendy E. Mackay

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This is a strong CHI paper because it does more than describe workarounds: it reframes them as durable clinical practices and converts them into a concrete design agenda. The main value is the shift from “fix the EHR” to “support situated repair” with traceable, clinician-controlled tools.

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Axes Lens

Rare contribution shape, typical evidence profile. The point here is not a score. It is to show what kind of claim the paper makes, and whether the evidence pattern is unusual or baseline in this 268 -review set.

Review Summary

This paper is compelling because it takes a familiar HCI/healthcare problem—fragmented medication management—and pushes beyond the usual “add more EHR features” response. The empirical material shows that clinicians are not simply failing to use the system correctly; they are actively compensating for structural fragmentation, resource constraints, and incompatible representations by building personal routines, external artifacts, and ad hoc translation practices. The authors then do something especially useful for the field: they translate those observations into a design space with concrete implications, including macros for frequent actions, anchors for traceability, mechanisms for capturing exceptions, and personal workspaces for translation across systems. That move from observation to design framing is the paper’s real contribution. It is also why the work reads as more than a local case study: the argument is that repair work is not an edge case but a stable feature of clinical practice whenever heavyweight infrastructure cannot fully absorb local variability. The paper also makes a sharper conceptual intervention by rejecting the idea that these behaviors are merely temporary workarounds on the path to a future integrated system. Instead, it argues that such practices are enduring forms of situated reasoning and coordination. That matters for HCI because it redirects design attention away from total standardization and toward accountable flexibility. The limits are real: the evidence is qualitative, bounded to a small set of hospitals and roles, and the proposed tools remain design implications rather than deployed or safety-tested interventions. Even so, the paper is strong because it offers a field-grounded explanation of why clinicians improvise, identifies recurring repair strategies across contexts, and articulates a credible design agenda for supporting improvisation without abandoning traceability or clinical responsibility.

What Changed

Canon before

The dominant assumption or baseline is that formal electronic health record (EHR) systems can fully integrate and standardize medication management workflows, providing a single, coherent medication plan across care settings, thereby eliminating the need for local workarounds or improvisations by clinicians.

Departure from common sense

This paper challenges the common assumption that a single formal EHR can fully coordinate medication work. It shows that fragmented systems, local constraints, and mismatched representations force clinicians to rely on personal routines, external artifacts, and improvisational repair work to keep medication plans coherent across settings.

Actual novelty

The paper’s novelty is not a new EHR feature set but a design argument and empirically grounded design space for supporting clinician improvisation. It identifies three repair strategies—shortcuts, tweaks, and translation—and turns them into design implications such as macros, anchors, exception handling, and personal workspaces that preserve traceability while accommodating local practice.

Evidence

The claims are grounded in a 144-hour field study at a German hospital plus group interviews with 20 clinicians from France and Germany. The paper triangulates observations, interviews, and examples of personal tools and routines to support its argument about fragmented medication management and clinician improvisation.

Limits

Method limits

The evidence comes from a small number of sites and roles: one German hospital in Study 1 and a comparatively narrow set of clinicians in Study 2, with heavy emphasis on physicians and residents. The paper itself notes differing infrastructures and configurations, so transferability beyond similar hospital contexts should be treated cautiously.

Deployment limits

The proposed macros, anchors, exception-capture mechanisms, and personal workspaces are design directions rather than deployed interventions. They have not been implemented or evaluated in live clinical systems, so feasibility, safety, and workflow fit remain open questions.

Boundary conditions

The findings apply most directly to hospital medication management under fragmented, resource-constrained EHR infrastructures where different care settings require different representations and manual translation between systems. They are less directly applicable to highly integrated environments with stable, uniform tooling.

Manual check: repair_bundle_offsets_and_pdf_url_should_be_manually_verified

Position in field

The paper positions itself against the idea that workaround behavior is merely transitional. Instead, it reframes repair work as a durable part of clinical practice and argues for lightweight, user-driven tools that complement heavyweight EHR infrastructure. That makes it a strong HCI contribution at the intersection of clinical workflow, repair, and design.

Abstract

Current hospital medication management systems generate fragmented clinical workflows,forcing clinicians to improvise repairs by creating external artifacts. We argue that instead of formalizing their workarounds into new electronic health record (EHR) features, future systems should explicitly support improvisation capabilities that help clinicians better handle unpredictable breakdowns. In a field study (144 hours) with 11 clinicians, we observed how resource constraints require local optimizations - "expert hacks'' by clinicians - at the expense of global consistency. Subsequent group interviews with 20 clinicians highlighted three distinct issues: one clinician's shortcut often becomes another clinician's roadblock; annotations fail to distinguish between norms and deviations; and clinicians often reify personal routines to translate information across systems. We argue that simply adding new EHR features will not suffice. Instead, we propose a novel design approach that focuses on helping clinicians create personal tools that let them successfully manage information breakdowns in their particular context.