Table 4 Emerging themes from our study
From: Integration of a nationally procured electronic health record system into user work practices
Software characteristics and their consequences | Design did not reflect reality of clinical practice |
|---|---|
| Â | Lack of customizability |
| Â | Perceived lack of fitness for purpose and lack of usability resulted in increased workloads for users |
| Â | Implementation strategy soft: initially parallel use of paper: intended workarounds |
Coping strategies by users in different contexts | Some more powerful users resisted use |
| Â | Embedding of the system over time in smaller scale implementations that allowed intensive user involvement in software design |
| Â | Users who could not avoid using the system devised various ways to compensate for the increasing demands on their time and perceived shortcomings of the technology |
| Â | Often workarounds were unintended by management |
Direct and indirect knock-on effects | Collaborative working-hierarchical structures and communication |
| Â | Time spend with patients and quality of interactions |
| Â | Paper: more distributed across geographical locations |
| Â | Managerial outputs became unpredictable often not reflecting the reality of what actually happened |
| Â | The medical record itself-delayed data entry |