Table 5.

Themes and subthemes describing how use of EMR worsened the quality of personal cognitive performance

	% Mentioning theme
	Both hospitals	Hospital 1	Hospital 2
WORSENED QUALITY OF PERSONAL COGNITIVE PERFORMANCE
Worsened situation awareness and ability to stay informed	45%	36%	56%
Unaware/uninformed because clinical notes less personal and less complete
Copy-and-pasted notes do not provide new information
Difficult to take in gestalt
Difficult to tell trends
Unaware/uninformed when problem list is missing from records
Unaware/uninformed when no indication that tests have been done
At discharge, cannot tell what medications were added or removed during hospitalization
Unclear what was colleagues' thought process (garbage in-garbage out)	35%	9%	67%
EMR use diverts attention from primary task	25%	36%	11%
Worsened communication	10%	0%	22%
Worsened communication between physicians
Reduced (face-to-face) communication with nurses and other hospital staff
Worse communication between physicians and patients' families
Overreliance on possibly incorrect information	10%	0%	22%
Reliance on notes with inaccuracies created and perpetuated by copying and pasting
Unable to flip through EMR looking for information as was possible with paper chart	10%	0%	22%
Reduced attention to detail	5%	0%	11%
Templates do not convey or integrate thought as well as prose	5%	0%	11%