Item identifiedRepresentative quote
Construct: Process improvement
Better follow-up with patientsWe’re now being more diligent with following up on tests. We have new guidelines from the [regulatory body] about having a tracking system for tests. Do you know what’s been ordered, whether it’s been received, whether the patient is aware, whether it’s been acted upon? (physician 2)
Greater focus on preventative care for patientStaff are doing different things. There’s more shifted now to looking at preventative care criteria. (physician 2)
Greater flexibility in where work can be doneIf I’m tired at 5:30 when everything is closed up I can go home and do this at night or in the morning when I wake up. It doesn’t matter where I’m at I can actually ‘do management’. (physician 1)
Staff ease of response to patient inquiriesI love it. It definitely is… the turnaround time to have the results in the chart. A lot of patients come in and they’re like ‘oh I want to follow-up with such and such’, so it’s great (Admin 2)
Improved information sharing among teamThis is important because ‘only whoever has the report can see it. The idea of the electronic chart is that everyone can share it. That’s one of the greatest benefits is that everybody can look at it at the same time. It’s not this one piece of paper floating around’. (physician 1)
Construct: Information quality
Improved organization of informationThe reports all are very standardized so that’s neat. It’s boring but they all look very standard—everything is here. Sometimes with the hospital reports you get different things, nice headers etc. which is nice but with this you know everything is here and standardized. (physician 1)
Improved ability to search for patient informationWe [are able to] do all kinds of searches. We do searches for whether people have had different types of screening (mammograms, colonoscopies). We do searches for diagnostic criteria, so for patients who have diabetes or other disease states. (physician 2)
Improved legibility of information compared to paperAnd the other thing is the legibility of a doctor’s handwriting. You know, in those charts, I look at them and think how can they read this? Seriously! It’s just chicken scratch. But now everybody can read it, everybody knows if it’s a 7 or a 0 for the meds and all this kind of stuff and I really think that that helps the next person to come along. (admin 1)
Ease of access to informationWhat I was doing differently before? Chasing down paper sometimes, so that’s an advantage too …
I mean, it’s electronic so anybody can access the report even if it’s signed off or not. But if it’s sitting in my box here {referring to the inbox from the paper world} and I’m away for a day and a half, it’s locked up. It’s mine; people have to come in here to take a look at it (physician 1).
Construct: Ease of completing tasks
Ease of creating alerts by cutting and pastingSo you can actually highlight this with your text and cut and paste and put it into an alert and then with the electronic chart the advantage would be that you can also put it into a recall. (physician 1)
Ease of creating referrals by cutting and pastingPlus you have the ability to cut and paste within the report. So you can search it and you can…if I’m doing a letter to a consultant and there’s a certain paragraph in the [computed tomography] (CT) report I can just copy and paste into my letter and it’s wonderful. (physician 2)
Ease of updating CPPThe other part of my job is to update the CPP for bone density, mammograms and that type of thing so anybody can pick that up and see that a patient is due in two years or whatever. Instead of flipping through the chart [and deciphering hand written notes] the doctor now sends a task for me to update the CPP with the information.
Construct: Report quality issues
Extra space in reports that makes reading difficultSometimes the way the reports come in is a bit awkward still. So, if it’s a short report (here he picks up a piece of paper and indicates a report where the text occupies only about quarter of the page) and the rest is all blank, when it actually comes into the chart, this will be it and there will be a big blank space. So when I put my next entry into the EMR it will be down here (below the blank space). And I find myself putting the cursor in and deleting the extra space. (physician 2)
Lack of support for imagesPhysicianConnect has no images, just text. Before a doctor could draw a simple image to represent part of a note.
Date formats from reports not compatible with EMRAnd dates sometimes get confused, that’s another one that happens to (e.g., DMY versus MDY). Sometimes they file backwards. (Admin 2)
Not enough reports are available through PhysicianConnectI was asking our vendor this too…we should stick [lab tests from private labs] in there too. We should stick everything we possibly can through there.
Do not want all of the reports that currently comeInitially, we received data on things happening during a hospital stay (e.g. bloodwork, ICU, etc.). This is problematic because of the risk of information overload and also for medical-legal reasons. We need to have it filtered so we only get what we previously received via fax. (physician 1)
Duplicate reports receivedThere was a while there where we were getting multiple copies of reports and it had to do with any time the transcriptionist at the hospital edited something or changed the transcription, it would generate another copy of the report. So there was a while there where we were getting 3-4-5-6-7 copies of a discharge summary and it was just because every time there was a change or addendum made, we would get another copy. (physician 2)
Unable to upgrade EMR due to version incompatibilityWe like it so much that we have in fact delayed our upgrade to the next version of [our EMR]. We’ve heard from other clinics that the new version of the EMR somehow broke the interface. … But lose the features of the upgrade that we can’t take advantage of. That was a big downside. (physician 2)
Construct: System reliability
System reliability (i.e. stops sending reports)Even though, going into this, we were of the same mind; we can change what we want, but we went down a bit of a rabbit hole there and found out that it’s a pretty temperamental interface. If you start changing things, for some reason, on the other side of the fence {the vendor side} things go south. We don’t know why. (Hospital 1)
Reports received in a way that does not allow cut-pasteNow sometimes when the reports come in they’re not cut and paste-able. And that’s another weird negative. And I know every once in a while they go through a thing where ‘we can’t do this now’ so I don’t understand how that happens or works but…. (physician 2)
Reports received for mis-identified or unknown patientsOccasionally we get unidentified patients or unknown patients and I think it has to do something with maybe the way a name is spelled or … but it’s happening less and less, that. (physician 2)
No way to tell whether data are flowingI don’t really have an understanding about when they are coming in, how often they are coming in. I just see them and when I stop seeing them I realize that maybe something is wrong. And that’s when I say to the staff gee I haven’t had any hospital reports in a while. (physician 2)
Construct: Service quality
Lack of support from hospitals about systemSupport is very frustrating when you are working with two different places and you’re working with your EMR and with the hospital who’s sending the reports, you don’t know who to go to and how…that’s a big one that’s hard to deal with cause no one’s really helpful and you’re just expected to figure it out. (admin 2)
Lack of support from EMR vendor about systemAnd I don’t think that the vendor has been quite as forthcoming as they could have been with what the problems are. I think [they] are a very popular company but they’ve grown really really quickly and they’re probably in a little over their head right now trying to keep up. (physician 2)
Construct: Impact on care
Speed of obtaining patient resultsIt is very cool, for instance, that if I see somebody in the morning, and I order a chest X-ray, that by the afternoon that chest X-ray is already on the interface and may be in my inbox and could well be in the chart. I mean, that’s just never happened before…that quickly (physician 2).
Filing errorsNow we are finding that there’s less error. Nobody’s perfect because if you’re coming in at 6 in the morning…a Smith’s a Smith and unless you’re checking the birthdate and the health card you could easily put it in the wrong Smith. You might get it on the right team but it might be in the wrong chart. So that used to happen, not a lot, but everybody’s human. But now they’re finding it’s less error. (admin 1)
Errors versus reports that were scannedBefore PhysicianConnect, we would have had to read through [the incoming reports] to check them because they are [optical character recognized] and they’re not 100%.
Report reorderingThere were a lot more not found or not received reports prior to PhysicianConnect so it saves [having to reorder tests]. (Physician 2)
Speed of referralsYou get the report electronically and when it comes into the chart it’s there and you can generate a referral [very quickly] (physician 2)
Construct: Impact on workload
Administrative staff workloadSeriously [filing] was a 3-4 hour a day job. But it never got done. It was never completed. Whereas now you could actually say ‘my pile is done for today’. (admin 2)