Table 2.

Factors in choosing a tool

	Factors in choice	Representative quotes
Favorable factors	Ease of integration	“We implement a lot of Epic functionality it’s tightly integrated…there’s a little bit more work to do when we introduce…third-party models”
		“We had some trouble getting the information across to them…it was taking upwards of 10–15 seconds which in a clinical workflow is really just not okay”
	Customization capability	“Why did we decide to build it ourselves versus go with what’s in the EMR? The problem was it still would have taken quite a bit of lifting and we still wouldn’t have had much control over the parameters”
		“The other major problem…is the one size fits all nature because it is designed to be implemented by multiple different organizations they had to dumb it down. Had to normalize, smooth out the curve, sacrifice accuracy for being able to universally implement…So there are probably some features …we could have used, but they excluded because they didn’t feel confident that all Epic organizations would have that data available”
	Predictive potential	“Every study we saw said to identify patients sooner in order to have better outcomes because… earlier our ability to intervene, the better outcomes… So wanting to know sooner was inherent in identifying those patients at all”
		“I would say that we tried [SIRS criteria rule based surveillance] at first…and realized that it would fire way too frequently. It would have a huge false positive rate. In fact it fired for somewhere between 20 to 30% of all patients that were admitted to the hospital”
Avoided factors	Contracting	“We generally like to do things as much as possible within our EMR without involving third-party vendors”
		“You know there’s always contracting issues and a lot of components like that which are often out of scope of the clinical team to manage… having to get legal involvement adds steps to things…it was not as easy as using your own EMR”
	Cost	“We looked at outside solutions but we didn’t purchase. The cost was too high”
		“And because we have Epic, because there was no additional cost to implement their method, this is in all honesty, it was determined that that could be where we could start.”
	Distrust	“Either you purchase a program through your EMR vendor, or you try to build it yourself, or you purchase a third-party solution and hope that they are not lying to you. Or you know putting lipstick on the pig. Or you know just making it sound better… ”
		“I think it was… the external one because they really were pushing artificial intelligence and the predictive model. People didn’t understand that as much and because they’re not your employees and they’re still people you’re always skeptical about what people are telling you and selling to you is very different”