Box 3.

Ease of use

Navigation

“There's times I've gone oh I don't want to go that way . . . when that happens, to be honest, I tend to exit out of it; you know it's a catastrophe reaction” (General practitioner, interview study)

“It's got a little bit to do with pride and how you perceive your role; you ought to be able to use your tools; you ought to be able to use your blood pressure machine properly to take a blood pressure . . . I don't mind making the odd mistake and you do sometimes with the prescribing, the stuff that we've been doing for years you still hit the wrong keys every now and again, but you can at least demonstrate you know that you've hit the wrong key . . . but if I hit the wrong key with [the system] I'm lost” (General practitioner, interview study)

“The next screen it asks me . . . ‘which represents the patient’s current state' right? Now suppose this is someone I'd never seen or very rarely seen; he is usually seen by one of my partners—how on earth am I going to know what state this patient is in? I can go directly to the prescribing screen, which is handy, but what would be neat would be to go to the consultation screen here, scroll back to his consultations, be able to work out which one of these he was, and then go back in because what tends to happen here is that you think, oh my god, I can't answer this question, so I will then exit out of the guideline” (General practitioner, interview study)

Training

“It was a fun day, a good day, but I came away slightly confused about actually using it; but before I go and teach my colleagues, I'll have a good play with it” (Nurse, attended training day, interview study)

“Running through the system, despite the training, I find exasperating” (General practitioner, trial practice, feedback)

“Most systems have pretend patients, certainly we do . . . so a few exercises to say you know, put this code in, we'll set up a patient who is already halfway through and then just try it out, just, it gives you that reassurance that . . . if you don't get the answer that is the next step in the tutorial then at least you go and try and work out why. [NR: Do you think people would find the time to do that?] It depends upon whether or not they're keen; you'd only find the time to do it if you wanted to learn” (General practitioner, attended training day, interview study)

“It was difficult to get there [training workshop] to be honest with it being that far away, so that was a shame, so we just sort of started experimenting really” (General practitioner, did not attend training day, interview study)