Table 3 Themes by coherence constructs for DialysisConnect
Coherence construct | Theme | Illustrative quotes |
|---|---|---|
Differentiation: Participants’ understanding of how the technology is distinct from the current approach | Differentiating as a communication channel | “All I really cared about was the fact that you could exchange like ‘Hey, I want a med rec, or I want XYZ.’”—Hospitalist “I, honestly, would probably try to text and say, ‘Hey, can you just tell me what their potassium was yesterday?’ instead of asking ‘Can you upload all their labs?’—Hospitalist nurse practitioner |
Differentiating as an information dashboard | “When I log in, am I gonna see a dashboard like this [DialysisConnect] or do I have to search the patient, then one patient comes up?”—Hospital registered nurse “We sort of get an idea about how many patients or what percent of patients are hospitalized at any given time, which may be pretty high.”—Nephrologist “You get all of your patients’ information all at once. The alerts will tell you these patients are hospitalized, as opposed to looking them up one by one.”—Dialysis clinic social worker | |
Differentiating as expedited discharge information delivery | “Having DialysisConnect is better than not having it at all, specifically for communicating discharge.”—Hospitalist “To me this is an extra step to try to complete my discharges, because I [currently] don’t have to do my discharges on the same day”—Hospital nurse practitioner “The discharge summary depends on when the hospitalist is able to complete it…Other information, like the labs, medications, any access-related followup, can be done right away”—Nephrology fellow (working in hospital) “I think it’ll be very helpful, compared to we don’t really have anything right now, if hospitals are able to give us some information.”—Dialysis clinic social worker | |
Not differentiating meaningfully | “I totally rely on [name of the healthcare system’s] nephrologists, and we talk with them every single day. But when you are asking us to do extra and extra things, it creates lots of distraction.”—Hospitalist “They [dialysis clinic staff] don’t take the initiative to pick up the phone. Why would we think they’re gonna take the initiative to input things [into DialysisConnect] when we need them?”—Hospital nurse practitioner “It’s another layer of bureaucracy. Because we’re supposed to check in the EMR once a day, and this is another thing to check.”—Nephrologist | |
Communal specification: Participants’ assessment of the value of the technology | Perceiving too much effort to benefit within local health system | “I can’t imagine somebody would be tasked with having to enter a reason for admission when they don’t really have any specific benefit from that. I think the whole point is to help us to connect. But I think we’re going to contaminate [DialysisConnect] with so much information I think we can find in the chart that I think that it becomes very redundant.”—Hospitalist “It’s too much going on in the day and we’re seeing too many patients. We don’t have time to sit and say, ‘Let me look up this system. Let me go through this system.’ Because we already have our own system that I’m already going back through.”—Hospital nurse practitioner “Right now we just call the dialysis unit, and we get information that way. I don’t have to wait for documents to be scanned and sent to me. That’s more effective than me trying to wait for something.”—Nephrology fellow (working in hospital) “I’ll second that.”—Nephrologist |
Perceiving effort to benefit as worthwhile within broader health system | “I understand it in the big scope of things.”—Hospitalist “There’s great potential outside of [name of the healthcare system]. But within [name of the healthcare system] there may not be.”—Nephrologist “We do have PowerChart, so that is helpful. We’re able to obtain some information, and I guess for the outside hospitals we’re just kind of like, whoa. We don’t have any information.”—Dialysis clinic social worker “We really don’t have any”—Dialysis clinic nurse practitioner | |
Individual specification: Individual team members’ understanding of specific tasks and responsibilities in relation to the technology | Delegating tasks and responsibilities to others | “The Emergency Room has resources”—Hospitalist “Your best bet would be to have one person whose responsibility it is to make sure that discharge is complete. Cause I feel like if you have too many people touching a dashboard, it’s gonna be off. What I’m concerned about is … if the day is busy, I’m not gonna keep pulling this up. It’s a whole separate system to log into.”—Hospital nurse practitioner “So it wouldn’t be the physician then, right? I mean, if one of my patients gets admitted to the hospital and the person on the hospital side wants information about it, going to me isn’t going to help. So that would have to be directed to one of the staff at the clinic.”—Nephrologist “I say the AAs (dialysis administrative assistants) should be handling these requests”—Dialysis clinic registered nurse, with unanimous agreement from group |
Doubting that others can or will participate | “A lot of this nice uploading and putting comments, you’re being nice, but if you’re really busy, this is not what somebody’s going to do.”—Hospitalist “Who is going to be the gatekeeper and who is going to pay that gatekeeper? That’s gonna be the bottom line. Who’s gonna pay somebody to man a system that isn’t going to benefit the hospital wide?”—Hospital registered nurse “The charge nurse, she’s busy with all sorts of other things. So I think it’s going to be difficult for her to do all of that”—Nephrology fellow “At the dialysis clinic, we can assign someone’s job at doing it and they would have to do it, and that would be the end of it. Ok. So that could be done. I don’t think we can tell hospital personnel what to do in terms of their responsibility there.”—Nephrologist | |
Internalization: Participants’ belief in how the technology will help them or their patients in their work | Comparing to other technologies, unfavorably or favorably | “It would be great to have a unified system so that we don’t have to create sub systems”—Hospitalist “All the clinics in New Orleans when Katrina hit were under water. But all Davita clinics, they all, every night, everything was pushed up onto the Tacoma server. I sat in Houston and with my login could actually log into the clinic although the clinic was under water because it was going up on the server in Tacoma.”—Hospital nurse practitioner “Can we take staff out and seamless get those last flow sheets, labs and medications, automatically uploaded for these patients?”—Nephrology fellow “They’re already doing it now, recently for the past year”—Nephrologist [misunderstanding] “It is like that with T-REX [transplant referral management technology similar to DialysisConnect]. I think it’s easy”—Dialysis clinic social worker |
Embracing idea for long-term care of dialysis patients | “We need to do this. We need to communicate clearly. No doubt about that…That is why we are here. We want it to be better for our patients and these people are super complicated and very sick.”—Hospitalist “I see this as being positive more in physician-to-physician communication regarding a long-term care of a patient”—Nephrology fellow DialysisConnect would mean “Just giving more continuity of care”—Dialysis clinic social worker |