Table 2 Major themes in free text responses from physicians
ThemesSub-themesIllustrative quotes
Hospital-basedOffice-based
Less time spent with patient, more time spent on computerN/AReduces the amount of time I spent with patients due to need to spend time documenting in EHR.It [takes] 90% of the time that would otherwise go to the patient.
Reduces quality of the interaction and patient–physician relationshipImpedes eye contact/looking directly at patients’ facesI can’t stand typing instead of making eye contact with a patient. The computer limits my observations during visits.I feel like I spend most of my visit looking at the computer screen instead of at my patient.
Depersonalizes and distractsCan depersonalize as we try to enter data while also speaking to patients.Creates a less personal experience for the patient.
No effect on patient interactionTruly no effectDoes not affect my interaction with patients.I have been able to maintain my interaction with patients.
No effect due to altered workflow by the physicianNone, I interact with the patients and then I go to the computer. I don't use the computer with the patient present.I do not use the EHR when I am with patients. I have tried this in other settings, and it degrades the quality of my interactions with patients. It's rude as well.
Improves information accessHelps physicians feel prepared for interaction.Allows me in the ED to look at an old record before I see the patient to learn some history.I get results from labs, x-rays and consults much quicker and in a more organized fashion.
Ability to share information with patientsAble to provide up to date data to patients.I use a laptop in the exam room and show patients their data.
Increases communication between physiciansMore up to date information communication esp[ecially] p[atien]ts seeing other MD specialists.Only helpful with patients I do not know and am covering as compared with a paper model.
Negative but non-specificN/AMarkedly adverse impact.Impedes, of course!