Objective Systematically scrutinize the situational relevance of EKR-derived information items in and outside clinical settings.

Background Physicians' use EKRs to accomplish four cognitive objectives (C1-4), and three organizational objectives (O1-3): (C1) Answer questions/solve problems/support decision-making in a clinical context; (C2) fulfill educational-research objectives; (C3) search for personal interest or curiosity; (C4) overcome limits of human memory; (O1) share information with patients, families or caregivers; (O2) exchange information with other health professionals; (O3) plan-manage-monitor tasks with other health professionals.

Methods Longitudinal mixed methods multiple case study: Cases were 17 residents' critical searches for information, using a commercial EKR, during a 2-month block of family practice. Usage data were automatically recorded. Each "opened" item of information was linked to an impact assessment questionnaire, and 1,981 evaluations of items were documented. Interviews with residents were guided by log files, which tracked use and impact of EKR-derived information items. Thematic analysis identified 156 critical searches linked to 877 information items. For each case, qualitative data were assigned to one of the seven proposed objectives.

Results Residents achieved their search objectives in 85.9% of cases (situational relevance). Additional sources of information were sought in 52.6% of cases. Results support the seven proposed objectives, levels of comparative relevance (less, equally, more), and levels of stimulation of learning and knowledge (individual, organizational).

Conclusion Our method of systematic assessment may contribute to user-based evaluation of EKRs.