| Learning over time |
“I'm learning things, as we go, I'm learning how to more efficiently use the system.” (Anesthesiologist, H1, on learning new features) “ …there are so many different ways of doing things that you have to figure out which way… works best for you. And we all do it differently, um, that I've, you know, it takes you awhile to find out which way is the right way for you, and what vitals, data, you know, do you like it in the graph form, do you like it in the table form, do you like it in a chart form, you know, which is the easiest way for you to process, and then customizing it.” (General medicine hospitalist, H2) “Once you get used to the organization [of data], you can find things where they're supposed to be.” (Family medicine physician, H1)
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| Typing proficiency |
“I'm not efficient enough as a typer [sic], uh, I talk much quicker than I can type.” (Family medicine physician, H1) “… if you know keyboarding, which I'm a very fast typist, um, then you can have more substance into your notes. But if you don't know keyboarding, you're hunting and pecking. You're not going to have a lot of content in your note, because it takes you too long.” (General medicine hospitalist, H2)
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| Understanding of EHR system |
“…presuming you know where to find the data, you can find the data.” (General medicine hospitalist, H2) (Interviewer: “And so anything else that you're able to think of, any issues that come to mind of being able to use, uh, the system?”) “No, I think probably just my level of understanding the system and lack of understanding of, you know, some of the basic computer principles.” (Family medicine physician, H2) “…for like, uh, checking on particular lab trends, you know, I don't know quite how to use the graphing function over time.” (Rheumatologist, H1)
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| Motivation and personal initiative to explore and learn EHR system |
“I just went on there and started doing it. #laughter# That's how I do everything” (Psychiatrist, H1, on learning to use EHR on her own) “I worked hard, I haven't dictated … I started decreasing dictation as a method of documentation” (Family medicine physician, H2, on taking initiative to type clinical notes) “…it doesn't bother me a bit to learn a new way to do things.” (Family medicine physician, H2)
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| User-developed strategies and workarounds |
“We find … little shortcuts here and there all the time” (Family medicine physician, H1) “I'm typing in an order to the nurse, and I'll say, you know, I'll just write it out freehand, change the diet to this, you know, change the IV to that, and then basically, I'm using the electronic tool to do what I used to do in the paper world, which is write down exactly what I want, send it to somebody else and let them figure out how to make it happen, because I am not going to spend that 20 minutes figuring out something that takes five seconds. That's a workaround.” (Family medicine physician, H2) “I came up with a new flow about a month ago, so that I wasn't sitting there doing all this documentation in front of the patient … between every single patient, I go into my office and document while they're, you know, checking in the next one. And I think it's better patient, better flow for the patients, more running around for me” (Ophthalmologist, H2)
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| Other |
“If I can't remember my password, I can't use the system.” #laughs# (Obstetrician, H1) “It's just the fact that I'm using it somewhat sporadically … So the intermittent, or sporadic use and the sporadic use of different aspects of the inpatient software, you know what I mean, where I might have used it really well at one point, but I've kind of forgotten exactly how best to use it. And I go back to using it in a clunkier way, because I understand how to use it that way. I'd forgotten some of the tips I learned.” (Family and sports medicine physician, H2) “I have two hands, all my fingers function, and my eyes work. If I didn't have that, it would be a problem. I've wondered many times, so what happens when you have someone who has visual impairment or has, is handicapped and, you know, they might be able to talk and dictate fine, but they can't manipulate a computer, for some reason.” (Family medicine physician, H2)
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