Table 3 Core themes in clinicians’ initial concerns about implementing Seva

 Fitting it in to the workflow (10)

We’re so busy here. What’s the right workflow? How do we interface the systems? Don’t make me log in to another system, don’t send me an email attachment, don’t make me open a document. How will this fit into the huddle?

 Difficult to engage physicians (8)

I’ve talked to [some doctors] but they’re pretty overwhelmed right now… Medical providers have so many pieces they use right now, I just don’t think that they would log on.

 Having time for Seva (7)

I’m in a storm and can’t really see out of the storm. I worry about having another thing added if I don’t get extra time carved out for it.

 Encourage needy patients (4)

I worry that this is going to increase burden on staff. Some of these patients are in bad shape and out of control. I worry they will use the phones to hound the staff even more.

 Other initiatives compete for time & energy (3)

A lot of things start to happen and then don’t stick. Some pan out and some don’t… We were going to be involved in a brain mapping system and that didn’t pan out because of funding and logistics. And we’re very close to contracting with a casino upstate to be gambling treatment providers. And, 2015, we have a big depression care initiative. And we have to meet the demands of all these licensing bodies.

 Possible unanswered suicidality on the discussion board (5)

I could be held liable. I could lose my license. I am uncomfortable with the idea of giving out the phone and not getting this information directly…People who are not me making clinical decisions about my patients. If one of our patients were to do something self-injurious, I would be thoroughly investigated, and this is never far from my mind.

 Patients understand what clinicians can see (4)

Particularly when there are possible disclosures about substance use that have not previously been shared with the medical team and place them at risk based on their current medication regimen (someone is disclosing heavy benzo use while on suboxone for one example)… I want to be upfront for their protection and for ours-it’s my license if I’m documenting stuff.

 Not use Seva or misuse the phone (6)

My biggest fear is patients not using or misusing the system. That they’d just be signing up to get a free phone and then they’d be pawning it or that they’d throw it in the river.

 Toxic interactions on discussion board (6)

Particularly when individuals are reaching out during low moments, their pre-existing negative emotional valence may be inadvertently infused into their interpretation of the messages and statements they are reading, particularly if the messages are ambiguous, have multiple meanings, or are written poorly.