| Physical space |
“…for sure you need organized workspace … some of our workstations there are so damn cluttered now, because we've plopped technology on the old [workspace] … in this workstation, there was literally nowhere #chuckles# where you could even set down something, because there were so many wires and everything piled … and it's like holy cow, I got to dig to find the keyboard.” (Family medicine physician, H2) “Right now, we're in a transition phase where a majority of our medical record is still in the [paper] chart. The chart has to be set down someplace and written in, right? Which means that I have to find a horizontal surface upon which I can set the chart in proximity to a computer where I can also look up the labs or whatever else I'm looking for, right? Um, there is one incompletely inadequate space where I work to do that, and usually there's already four people sitting there. Um, the work, those [computers on wheels] can't be used for that because there's no place to put the chart … normally I have to shoo about eight, you know, eight people out of the away and say, I need to be in this space right now.” (Obstetrician, H1, referring to needing space for paper chart when using EHR) “I'm fairly tall, they've put some [computers on wheels] on some floors in a place that I have a difficult time standing and trying to use, because they're way too low and they're not adjustable.” (Family medicine physician, H2) “I could be driving to the office in my car and because I have a cell phone people have a way to get a hold of me and ask me do I want to change this or create this order, and I'm not at a computer terminal, nor will I be for an hour…” (Family medicine physician, H2, on not putting in orders directly in the system)
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| Electricity |
“When the power goes out, you're pretty much sunk. Fortunately, that's only happened, um, oh, I'd say a total of two and a half hours over the last three years we've been up on it, at, in an outpatient world. Inpatient, um, honestly, I don't think I've ever seen them where they haven't had power, but they have a back-up generator, too, so it's, you know that's helpful.” (Family medicine physician, H1) “…if you have a power failure, which isn't common but has happened to us. We've, you know, been in the middle of taking care of patients, they were doing construction, they cut into a power line, boom, no power in the whole clinic. Suddenly, uh, we're back to #laughs# writing things on, you know, on pieces of paper, and you can literally access none of the information. So when you don't have a paper backup, you're screwed if you don't, you know, if the technology is not available to you.” (Family medicine physician, H2)
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| Wireless connectivity |
“…all I need is a broadband line, that would be one facilitator, I'm thinking…” (Obstetrician, H1) “…the biggest things are, is that, you know, in the operating room there is a wireless network, you know, set up with routers spread throughout the operating rooms. You can actually walk around the operating room with … tablet computers up there. Um, and, so you don't have to be locked into one spot in the operating room, the ability to access [EHR] is anywhere in the operating room and recovery room theater.” (Anesthesiologist, H1) “…there are some technical barriers. Um, we don't have … widespread wireless available [in outpatient clinics across the state].” (Cardiologist, H1)
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| Social environment |
“I worry about using computers around the patients sometime. Because when you pop into your patient's list, the family is hovering around the computer, then they can see other people's name and that would be, I mean, it's a HIPAA violation, so you're real reluctant to use it. And more when you use it, you got to kind of pull it away where only you can see it kind of a thing. And I've been on computers where I'm talking to a doctor, looking at data in the computer, and somebody, you know, a patient family member or something walks up. And they just stand there, and I'm trying to push them away or shoo them away, because I need the data out of the computer while I'm talking to the consultant, and they're not getting it. #laughter#” (General medicine hospitalist, H2)
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