Attribute	Definition
Source	These codes deal with characteristics of support for use of the EMR
Formal	Support provided by an official source such as manuals created by the vendor, a help desk, or personnel from the vendor. Personnel from the FHT whose job includes at least some component of IT related duties are considered to be formal sources of support. Use this code to code negative comments (ie “support from outside agencies like the vendor and OntarioMD is lacking”) as well as positive comments.
Informal	Support provided from peers whose job is not IT related; can include a local champion or local expert user (e.g. one of the other physicians in our group is very familiar with the EMR so he is able to help us with things like searches”). Manuals created internally by the FHT are considered informal sources. Use the informal code to code comments about “super users” that originate from the vendor;
Personal	Support provided directly by a person either on site or by telephone. A help desk is an example of a formal/personal source of support.
Impersonal	Support provided by documents or websites. No direct contact with a person is involved.
Location	The location from where support is provided
On site	Refers to support provided on site regardless of who is providing it.
Off Site	Refers to support provided from an offsite location.
Activities	Actions provided to help those using the EMR
Infrastructure Support	Assistance or lack of assistance with the acquisition, maintenance, or use of EMR infrastructure including items usually thought of as hardware ie computers, printers, and also of items such as network connections, log in mechanisms and connections to external providers such as a hospital based system.
Data Support	Activities undertaken to ensure data is entered consistently and completely. This code is used to refer to activities related to data, not the quality of the data itself.
Functional Support	Assistance provided (or not provided) to use or solve problems related to the PS program itself. Assistance with learning the various functions; i.e. how to do searches, how to make templates, short cuts etc. (E.g. “They come to me if they are having problems with the scheduler or problems with messaging.”
Training and Education	Refers to teaching users how to use the program initially when the organization is converting to an EHR and also the training that is required on an on-going basis when new staff are hired.
Project Management Support	Refers to the overall activities and efforts the organization must take in order to ensure the successful operation of the EHR. Use this code to code comments that interviewees from the vendor use to describe things that need to happen to ensure successful training and adoption of the EHR;
Characteristics	Describe the attributes of the support provided to users of the EMR
Counseling Skills	The ability of the person providing support to listen, to reinforce training or usage, to communicate patiently and in an empathetic manner, and with a willingness to try various alternatives. “ (E.g. patience and the ability to multi task and drop what I am doing to help someone who needs help are the most important factors)”
Knowledge	Includes technical knowledge and the ability of those providing the support to understand the problem being described and provide an appropriate answer.
Homophily/Heterophily	Refers to comments that indicate there is, or is not, a gap between the technical knowledge the support person has and their understanding of the day to day work of the user. Must be used in the context of the support provided.(Eg The problem is the person that did it, I don’t think they ever did clinical work so they were OK at showing us the system but I don’t think they really understood how that applied to a patient.”)
Service Quality	Comments related to the overall quality of the support provided including timeliness, responsiveness and accessibility (Eg “the service we get is very prompt” or “They usually have the problem fixed in an hour but an hour is a long time in a doctor’s office.)Add continuity to the definition ie the desire of the client for someone who will deal with the entire problem and/or the desire of the client to deal with someone they have dealt with previously regarding a problem.
Business/Operational Model	Refers to issues around the need to pay, and the amount of payment, required to obtain support from the vendor. Also refers to comments from the vendor about the way they organize support.
System Quality	This section refers to the characteristics of the EMR itself. Note if there are quality issues identified that do not fit into one of the attributes below, code as system quality (sys qual)
Availability	Is the program and the computers that run it generally available to the user when needed; use this term to capture comments related to down time. (e.g. “,It’s improving all the time; when I first started it would go down a lot but it is better over time.”)
Response Time	Does the program and the computers respond quickly to commands or do the users find it slow; e.g.,“ For the most part it works well but sometimes it’s very slow and that’s very frustrating”
Interoperability	Comments related to the ability of the users of the EHR to communicate with other providers outside the FHT such as labs; pharmacies or hospitals who use different information systems
Information Quality	Comments related to the completeness and accuracy of the information available from the EMR.
Completeness	Is the information that is in the EMR complete and accurate; is all patient data entered?
Consistency	Is data entered in the same way, using the same terms and acronyms? Use this code for comments that include a garbage in/garbage out component.
Legibility	Refers to the ease of reading information on the EHR.
Usage	Describes the use of the EMR in the FHT or among the staff.
Functions	What functions or features of the EMR are used or are particularly liked or disliked or that are most useful to particular categories of users; (e.g. we chart all information about the visit, the past medical history; all the labs”). Do not use this code for desired functions; an additional node has been established under desired functions which is now added to the usage node. Also use for comments about the extent to which or how much of the system capability is used or the efficiency of use (e.g. “people probably are using about 20 to 30 % of what this thing is capable of”) Use for positive and negative comments about functions built into the system (eg “the system wants you to put in drug orders in a certain way such as 1 tablet for 30 days but then after 30 days the prescription will disappear and so you have to kind of look to see was the drug prescribed” Code functions/workflow when the function of the EMR causes a change to the way work is done; If a function causes a problem to the user and you want to note that, then write an annotation(1)
Desired Functions	Use when the interviewee comments about attributes or functions that she/he wishes were available in the system
Satisfaction	Comments related to how satisfied the interviewee is with the system and how they perceive the satisfaction of others.
Overall satisfaction	Use to code comments about the degree to which the interviewee is satisfied or not satisfied with the use of the EMR. (“I don’t have a lot of complaints about it-I really like it”) and also how the interviewee describes how other users like the system. Use also to code comments they make about their satisfaction with specific features of the system; (Eg Its user friendly, I don’t have to be afraid of making mistakes”)
Individual Impact
Workload	Use to describe any comments about the effect of the EMR on the amount of work required of the person being interviewed (e.g., “I don’t find it adds to the workload but it takes just as much time.”)
Workflow	Changes in work processes that occur as a result of the EMR; Use this code for comments about changes to the way a provider communicates with other providers and for comments that relate to the ability to access information quickly and easily, from remote sites, or by other providers. (e.g.” it’s a lot easier to find things-- to keep track of things)”
Patient provider Communication	Code comments related to communication between providers and their patients. (Eg you find you are not paying as much attention to them in terms of eye contact initially although I am getting better at that.”)
Organization Impact	Refers to changes at the organizational level as a result of use of the EHR.
Technical dependency	Use to code comments related to the inability of the organization to do any work if the system is down.
Coordinated Care	Refers to quotes that indicate how EMR use affects the process of communication among providers and facilitates coordination of care; eg I think it puts everybody involved in the health care in a position to recognize that the information goes into a central place, to be coordinated, if the chips are down, by just one person whose job it is to pull all your health, all that information, and I think that’s a tremendous benefit to health care.
Patient Care Impact	Use for comments on the impact of the EMR in patient care.
Preventative Health Care	Used for comments related to use of EMR for preventative health care such as immunizations and periodic tests (mammography, pap smears, colonoscopies, etc.). May also refer to adhering to preventive care guidelines
Monitoring and Surveillance	Use to describe the use of the EHR for follow up on patients with chronic conditions, effect of treatments, or test results (HbA1c, Vit. D levels, blood pressures…)
Patient Education	Used for comments related to use of EMR as an education tool for patients’ (Eg “you can trend data to show patients, provide patients access to guidelines”.
Patient Safety	Used to note the effect on patient safety that results from use of the EMR ie drug interaction alerts;
Emerging Themes	Themes that emerge from the data and do not fit with any of the other categories
Digital Island	Use to code comments related to the fact that users are operating in an electronic arena but working in a community where their colleagues are using paper systems.
Learning by trial and error	Use to code comments related to the interviewees need or ability to learn the functions of the program on their own, on a trial and error basis.
User Characteristics	This is a new node added to code characteristics of the users of vendor provided support and training.
Age	Comments related to the age of those seeking training support or training.
Practice Characteristics	Code comments relating to the number of physicians in the practice or the geographic location i.e. rural vs. urban practices
User Role	Use to identify the role of those who participate in training programs or who call for support; could include doctors, admin staff or super users.
Computer Experience	Use to code comments related to the expertise, or lack of computer expertise, of those participating in training or requesting support;
Resistance	Use to code comments related to computer fear or other comments that might indicate resistance to working with computers.

^*Code definitions were first published in Shachak et al., 2012, Informatics in Primary Care, 20(3): 185–195 and are reprinted here with permission of the publisher.