Linking our findings back to the predicted sources of paper generation in Fig. 1, we found elements of (d), (e), and (f) across our list of 11 emergent categories (Table 3). The human-technology integration factors in Fig. 1 broadly included poor integration of the HER into clinical workflow, and an incompatibility of clinicians’ mental models for working with clinical data in the EHR. For example, paper-based workarounds related to ‘efficiency’, one of our most frequently occurring categories, included cases that involved all three human-technology integration factors outlined in Fig. 1.