Table 4 User perceptions of elements of effort expectancy extracted from nurses, doctors and pharmacists’ interviews

Doctors (Review & prescribe)

- Order sets have reduced the MD for simple regimens. However, there was a general lack of system flexibility, which was paradoxically often a symptom of the system attempting to improve safety (eg, by making certain tasks or viewing of screens compulsory or sequential).

• Doctor 3: ‘I think it’s quite straightforward, it’s difficult as soon as you need to alter something … because the reality is more patients are coming back for treatment and it’s when you’re having to alter cycle 2 or 3 or 5 and you have to drop this dose, change that, delay the treatment, change treatment. Which is reality for majority of patients at some stage’.

- The EMMS has introduced new steps that increases the pressure on doctor’s memory.

• Doctor 1: ‘It still requires a clinician to remember certain things and check certain things that perhaps goes against of what an intuitive path would be’.

- The EMMS has allowed for tracking of previous prescribing and remote access has reduced TD for prescribing simple regimens.

• Doctor 4: ‘The time pressure for prescribing simple regimens and searching through paper for previous treatments has reduced, facilitated by the digital print and remote access.’

-Increased time pressure felt when troubleshooting, exacerbated by the inability to individually solve the problem.

• Doctor 2: ‘I find it very difficult to troubleshoot if I’m asked to change something by nursing or pharmacy, I often don’t know. I find it difficult to understand what I’m being asked to change’

Pharmacists (Review & dispense)

- The increased steps to perform simple tasks are mentally draining.

• ‘Pharmacist 5: The number of steps to get one label out is just so much more. It’s just very labor intensive’.

Greater time pressure due to:

- More administrative tasks due to changed workflow

 • Pharmacist 3: ‘If they don’t want something you have to reverse the repeat, re-attach it, go find the file again and like yeah, the amount of time you spend looking for stuff is ridiculous in an EMMS world’.

- Reliance of doctors to troubleshoot their prescribing issues, confirmed by a doctor’s view:

 • Doctor 6: ‘I think they (pharmacists) frequently seem to prioritize those queries from us, just not sure how much of a burden it puts on them’.

Nurses (Review & administer)

- Layout of charted medication as well as ease of access to all parameters required in treatment such as BSA and pathology has reduced the mental demand required to determine the order of administration of medication.

• Nurse 2: ‘I think it’s great in the sense that it’s all there, I can look at the bloods, I can look at the BSA I can look at the medication, it’s listed out like following a recipe’.

- Layout and remote access allow you to better prepare for patients and reduces time pressure to complete tasks.

• Nurse 2: ‘We couldn’t prepare earlier before. We didn’t have the file in hand and sometimes you don’t have time when the file arrives. But now say the patient was not there yet, I look at their Medication Administration Record and I can communicate well, and I know what exactly I need to do’.