Table 5 Barriers and facilitators to optimisation

	Order	Definition	Coded	Frequency (%)
Barriers	1	People, resistance to change	17	23.9
	2	Limited resources	11	15.5
	3	Bureaucratic process and/or multiple layers of approval	10	14.1
	4	Poor communication/poor channel to connect IT/IS	10	14.1
	5	Lack of standardised practice/process/policies	7	9.9
	6	Time – too busy people/everybody calling highest priority	6	8.5
	7	Difficulty in reaching consensus among stakeholders, competing interests	4	5.6
	8	Lack of coordination between requests	2	2.8
	9	Technically not possible to make it happen	2	2.8
	10	Complexity of EHR	1	1.4
	11	Misunderstanding optimisation as a sole IT project	1	1.4
Facilitators	1	Dedicated resources, commitment	49	13.0
	2	Advisory councils/groups/executive committees	47	12.5
	3	Connection with users & business owners face-to-face or indirectly	43	11.4
	4	Informatics people	39	10.4
	5	Engagement – super users, end users, physicians	33	8.8
	6	Engagement – operation/leadership	25	6.6
	7	Regular meetings	25	6.6
	8	Supportive leadership/management	19	5.1
	9	Aligning optimisation with the organisation’s goals/strategies	18	4.8
	10	Identifying champions	14	3.7
	11	Training/learning/education	13	3.5
	12	Usability test	12	3.2
	13	User’s needs	10	2.7
	14	Process improvement	9	2.4
	15	Demonstrating value in optimisation	7	1.9
	16	ROI	5	1.3
	17	Good timeline to implement/test/train, not rushing	2	0.5
	18	Culture of organisation driving improvement	2	0.5
	19	Organisational change (e.g. leadership change)	2	0.5
	20	Regulatory requirements/changes	2	0.5