TABLE 5.

Summarized challenges from qualitative interviews with 4 emergency physician groups

EHR data section	Summarized challenges
Emergency Physician Group 1 (Epic)
General (applicable to all sections)	Inconsistency and variation in how documentation is conducted by healthcare practioner (eg, some use note writer, some use SOAP, some use scribes)
Problem history	Blending of the patient's problem list and visit diagnoses
Medications	Blending of prior medications, medications administered during the ED visits, and new prescriptions at discharge
Social history	Inconsistency and variation in documentation of substance use history by healthcare practitioner
Emergency Physician Group 2 (Epic)
Visit diagnosis	Incorrect extraction of diagnoses that may be related to mis‐mapped ICD codes and descriptions; either ICD code or description was correct, but not both
Problem history	Incorrect extraction of diagnoses that may be related to mis‐mapped ICD codes and descriptions; either ICD code or description was correct, but not both
Insurance information	Extraction of insurance information from previous encounters rather than the current visit
Medications	Blending of inpatient hospitalization medications and ED visit medications Extract showed medications that were ordered but cancelled before administration
Social history	Blending of prior and current visits (eg, current and former smoker extracted for the same patient)
Emergency Physician Group 3 (MEDHOST 49 days of study; Cerner 316 days of study)
Problem history	Blending of the patient's problem list and visit diagnoses
Medications	Blending of inpatient hospitalization medications and ED visit medications Absence of prescription medications
Results observation	ACEP's CEDR did not pull any laboratory results
Social history	EHR platform variation: nurses consistently documented social history in Cerner; social history documentation different in Cerner and does not seem to populate clinician note; could be a local issue with the Cerner template
Emergency Physician Group 4 (T‐Systems Chart for Clinicians and Meditech for Nursing)
General (applicable to all sections)	Used 2 chart systems during 2018: T‐Systems for clinician documentation and Meditech for nursing documentation
Medications	Many ACEP's CEDR extracts were missing medications administered in the ED Blending of inpatient hospitalization medications and ED visit medications
Social history	Discrepancies between T‐Systems and Meditech documentation made smoking history chart review problematic

Abbreviations: ACEP, American College of Emergency Physicians; CEDR, Clinical Emergency Data Registry; ED, emergency department; EHR, electronic health record; ICD, International Classification of Diseases; SOAP, subject, objective, assessment, and plan.