Table 4.
Themes and subthemes describing how use of EMR worsened the (a) ease and (b) time efficiency of personal cognitive performance
| % Mentioning theme | |||
|---|---|---|---|
| Both hospitals | Hospital 1 | Hospital 2 | |
| (a) PERSONAL COGNITIVE PERFORMANCE MADE MORE DIFFICULT, MORE COMPLEX | |||
| Access to information difficult or impossible | 70% | 73% | 67% |
| Difficult to find information | |||
| Information difficult to find due to information overload or variety of options; Information in printed-out version of records is difficult to find; Difficulty finding nurses' notes; Difficulty finding information in physical therapy notes; Difficulty finding scanned-in ophthalmology drawings; Medications put together for discharge are difficult to distinguish | |||
| Difficult to access information from other hospital systems | |||
| Cannot access old notes when writing new ones | |||
| Some information not available electronically (e.g., EKGs, pre-1999 data, progress notes) | |||
| No information if physician did not take initiative to make changes in record | |||
| New demands and extra steps | 55% | 45% | 67% |
| Order entry requires many steps, extra steps, numerous clicks | |||
| Medication reconciliation is an extra step and creates redundancies | |||
| Creating problem list adds work | |||
| Entering documentation imposes memory burden | |||
| New steps to copy and paste arriving radiology reports | |||
| Remote log-in requires extra steps | |||
| Patient with multiple problems requires multiple, pre-formatted notes for each problem | |||
| System use is burdensome | 30% | 36% | 22% |
| Remote log-on process is inconvenient | |||
| Difficult to make system do what you want it to | |||
| Reviewing past notes is cumbersome | |||
| Navigating system is difficult | |||
| When system times out on its own, current work is not always preserved | |||
| Blocks in performance | 25% | 9% | 44% |
| Allergy warnings require response before order can be completed | |||
| If consult was not ordered in system, cannot do consult | |||
| Nurses must put in (verbal) order before physician signs off | |||
| System stops user when diagnosis does not match | |||
| Medicare-allowable orders | |||
| System blocks removal of items from record | |||
| Data entry difficult | 20% | 0% | 44% |
| Difficult to obtain desired order | |||
| Difficult to enter data and attend to patient concurrently | |||
| Increased complexity of work | 5% | 0% | 11% |
| (b) WORSENED TIME EFFICIENCY OF PERSONAL COGNITIVE PERFORMANCE | |||
| Loss of time | 80% | 64% | 100% |
| Time consuming to do data entry | |||
| Time consuming to order medications; to document patient history following new compliance policy; to respond to warnings during medication order entry; to fill out post-operative order sheet | |||
| Time consuming to log in and out of system | |||
| Log-in from outside hospital takes time because of slowness, multiple steps and connection speed; Within-hospital log-in takes time because system is slow | |||
| Time consuming to access data from other hospitals | |||
| Time consuming to learn to use system | |||
| Time consuming to read notes that provide no additional information because they were copied from before | |||
| Takes away patient care time | |||
| Takes longer to accomplish tasks than with paper | |||
| Having to wait | 15% | 9% | 22% |
| Waiting to load up computer or software | |||
| Waiting for slow software to process | |||
| Waiting for nurse to find a way to enter (verbal) order | |||
| Waiting for test results to arrive in system | |||