Perceived Benefits and Challenges in Implementing an EHR from Clerical and Nursing Staff Focus Groups
| Variable | Perceived Benefits | Perceived Challenges |
|---|---|---|
| Physician documentation | I think if they have the computer in there, they’ll document better (clerical staff, before implementation and during transition) [Some doctors] do their notes electronically. And then they print them off for me (clerical staff, before implementation and during transition) Some [physicians] will be very, very good (nurses, before implementation and during transition) [Doctors’ notes] are more accurate now. Plus I think your notes are done more in real time now…before they used to hold onto charts forever (nurses/clerical, after implementation) So if they want me to do refills, then I send them notes. If you don’t close your chart and finish your chart, I cannot update your med list, and hello, I can’t help you. So I think that’s helped too (nurses/clerical, after implementation) | The doctors are going to be the barriers (clerical staff, before implementation and during transition) They don’t like transitions. Some of them don’t like change. They like to keep that piece of paper (clerical staff, before implementation and during transition) They’re more comfortable writing instead of typing (clerical staff, before implementation and during transition) The older ones [physicians], forget it (clerical staff, before implementation and during transition) Some… [like to] just flip through the pages [of the paper chart] and get what they want, you know? (clerical staff, before implementation and during transition) You’ll just have to pray they do it. Some are doing it [using the computer] more than others (nurses, before implementation and during transition) Right now having one foot in and one foot out, how many times do we look in the chart and say...[a medication] wasn’t documented in the computer because…somebody didn’t have time, or somebody didn’t know how to do it (nurses, before implementation and during transition) And some [physicians] will be very, very bad (nurses, before implementation and during transition) And the very, very bad ones are going to have to get very, very good real quick (nurses, before implementation and during transition) If [physicians] are in the chart and they haven’t finished their note, I can’t update their med list (nurses/clerical, after implementation) |
| Work flow | You spend so much time [now] splitting charts and repairing charts, getting them together, filing them, trying to find room for them (clerical staff, before implementation and during transition) Everybody was nervous about [the EHR for referrals], but then when we started doing it, we all loved it (clerical staff, before implementation and during transition) Once you start doing [computer referrals], it just gets easier as you do it (clerical staff, before implementation and during transition) It will free up a lot of the girls from finding the charts which are always missing…it’s always right there on the computer (nurse’s aides, before implementation and during transition) I think they [the patients] might like it…because if…they can’t find the chart, they complain… (nurse’s aides, before implementation and during transition) It’s more accessible for the secretary (nurse’s aides, before implementation and during transition) We’ll always have the record…and we will no longer have to worry…they can’t find it or people taking it out… (nurses, before implementation and during transition) I can just go into the EMR and say, “Oop, this person never had another pap smear”… and I just type out a letter and off it goes (nurses, before implementation and during transition) I don’t have to pull charts anymore. I used to pull about a hundred charts at a time, review the chart, send out letters, track them every month. And now I can do it all by Logician. I’m one of the non believers that turned to a believer (nurses, before implementation and during transition) Now I can do it [input data] in between patients because I don’t have to worry about going and pulling charts, getting the charts back to medical records one more time that the chart could be lost because I may have kept them in my spot for days, you know? So it’s been working out really good for me (nurses, before implementation and during transition) It’s going to save hours in the day, hours (nurses, before implementation and during transition phases) There are fewer missing charts. Referrals it’s great for. It saves a lot of time. [Physician notes are] more legible. That’s a major thing (nurses/clerical, after implementation) I personally think it’s wonderful. I think it’s a quick flow. We can get them [patients] right in [the rooms] (nurses/clerical, after implementation) [for legal correspondence] Oh my gosh, all I have to do is print everything up…. You can fax it, send it, whatever (nurses/clerical, after implementation) | With slow laptops…write the vitals on scraps of paper… (nurses/clerical, after implementation) The only thing is when the computer goes down (nurses/clerical, after implementation) [Double entry] labs in the computer and lab slips in docs’ boxes, which then have to be filed in the chart. Also have to file MRIs and x-rays. Double the work (nurses/clerical, after implementation) |
| Patient safety/confidentiality/transparency | It will definitely make all of us more accountable if the patient has access to their records (nurses, before implementation and during transition) I think patients are going to become more knowledgeable (nurses, before implementation and during transition) It makes a patient responsible for knowing what their medications [and other medical concerns] are (nurses/clerical, after implementation) I think having our patients being curious about what’s in their chart and what’s going on about them—it’s good. A lot of the doctors are printing off their last note and giving it to the patient…and it makes…them responsible (nurses/clerical, after implementation) I had patients that are forging prescriptions, and so I write that in the computer…. The doctor knows it. And I tell the patient. You know, we know that your pharmacy called us, and you have copied prescriptions. That’s a felony… (nurses/clerical, after implementation) I think parents looking at the computer is a great thing (nurses/clerical, after implementation) | But is that [patient access to their EHR] really a good thing? I mean you know when they put like a patient is noncompliant…or mildly obese (nurses, before implementation and during transition) You’re asking me if I’m using drugs, and where are you putting this information? I mean where is it going? Who can see it? Who’s the father of my baby? Who’s going to get that information? (nurses, before implementation and during transition) My only concern is confidentiality issues (nurse’s aides, before implementation and during transition) You have to sign into it and sign out…because you don’t want to leave a chart open in there and anybody can go into the chart… (nurse’s aides, before implementation and during transition) I would think people [patients] would wonder who’s going to have access to this in the hospital… (nurses, before implementation and during transition phases) I have reservations about [putting in patient information]…. Like when they put in things about, you know, seeking drugs or… (nurses/clerical, after implementation) It’s fine [looking at the computer] if it’s their own chart (nurses/clerical, after implementation) |
| Relationship | I’m afraid that when the computer is in the room, the doctor is going to be asking questions and just typing whatever the patient says. And is the doctor actually going to physically touch the patient or look at the patient anymore? (nurses, before implementation and during transition) | |
| Other | We’re not breaking computers. We’re not losing keyboards (nurses/clerical, after implementation) I think it’s a great thing that they’re going in there to do something. They should put something educational on there for them (nurses/clerical, after implementation) | We find kids on the Internet all the time (nurses/clerical, after implementation) We tell them to get off, but the parents just allow them to get on the computer, and we have many adults we find on the computers (nurses/clerical, after implementation) |