Table 2.

Specialty, Sex, Years at AMC and Self-reported Comfort with EHR

Adaptation factors	Example quotes	Potential improvement strategies
Positive Mindset toward Change	“Understanding how to do your job is part of being a doctor, and part of being a good doctor.”	• Cultivate specialty-specific physician champions
	“The last big change that I remember was when they changed all the templates, the font, and everything looked different. It didn’t really impact it too much. Maybe the first two patients that I did in clinic. It only really affects me in clinic because that’s where I’m doing all my major notes.”
Recognizing Benefits of the EHR	“I mean despite all the stuff I just said, nobody is gonna recommend that we go back to paper. I think everybody understands the value of it, and this is the direction. It is a good thing. I can see all the things.”	• Highlight benefits of EHR and upgrades in all communication efforts • Provide explanation for why changes are made
	“Yeah, it’s better. It’s not paper charts. Again, I remember paper charts. Everybody complains about, oh, EHR takes so long. No. Paper charts take forever’”
	“… we often didn’t do it [chart temperatures], because it was just too burdensome to do on a daily basis. So, we’d just do it occasionally when we’re trying to figure it out. But, now we have this extra information available to us at all times. I’m not sure if I know if that’s helpful to patients or not. It seems helpful.”
	“I think from an efficiency standpoint, I can see, definitely, gains there.”
	“Prior to that, we were using—to my knowledge, at least—three different, coexisting systems. … it was highly inefficient.”
	“I mean to put that into perspective of what it was like in the 1990s, every service had their own chart. I had a chart from a patient I saw in gastroenterology, and the patient was also seeing a cardiologist and a rheumatologist. They had their charts. There was no unified chart.”
Tailored training and physician voice in modifications	“At least in the Department of Emergency Medicine, we’ve managed to get several people onto different committees.”	• Provide general as well as specialty-specific training • Incorporate stakeholder input into training development
	“If it was actually specific for my specific inpatient job, like let’s just talk about consultants, and we had some say in it.”
	“I think that they feel like if it’s somebody from our division, they have our best interests in mind. Not to say that somebody outside the division couldn’t do that training, but I think it would have to be—it would likely need to be connected with somebody in the division, so it feels like it’s more personalized.”
	“I think it works well for us because it’s someone that we know that inherently knows our workflow. Sell that idea and efficiency to our group.”
	“It has all these stock phrases that make life so much simpler… They made ‘em, and then I stole them.”
Learning from Colleagues	“It’s usually things like at a division meeting someone will say, I can’t figure out how to do this, and someone else would say, oh, you just have to do this and this and this.”	• Create electronic mechanisms that facilitate sharing of stock phrases • Allow time for colleagues to share challenges and solutions
	“I just had some other colleagues show me tips or tricks, and you can use the share function to steal tools other people have made.”
	“I think you need some initial basic instruction, but you learn more on the job from your colleagues.”