Appendix 1:Telephone Interview Script for Patients
Appendix 1:Telephone Interview Script for Patients
I’d like to repeat myself in order to get this on tape: Do I have your permission to record this call? ... ********* Identify interviewee, state the date. ************
Our clinics started using ‘computer records’ in May of 2012 to help keep track of your medical records. I am going to ask you some questions about how your doctors use the computer records while you are in the clinic room together.
a. How long have long have you been a patient at the University of Chicago?
b. May I ask you how old you are?
1. Do you like it when your doctor uses the computer when you see him/her in the clinic?
- If yes, why?
- Probe- Did you have any positive experiences with doctors using the computer during your clinic visit?
- Probe- What does your doctor do with the computer that you like? Can you give me any examples?
- Probe- What does your doctor do with the computer that you don’t like?
- If no, why?
- Did you have any bad experiences with doctors using the computer in clinic?
- Probe- What does your doctor do with the computer that you don’t like? Can you give me any examples?
- Probe- What does your doctor do with the computer that you do like? Can you give me any examples?
2. When your doctor uses the computer during the clinic visit, does it make it harder for you to talk to your doctor?
- If yes:
- What makes it hard for you to talk to your doctor when they he/she is using the computer?
- Probe- Do you feel like the doctor is more distracted?
- Probe- Do you feel the doctor isn’t fully listening to you?
- Probe- Do you have any specific examples you can share?
- If no:
- Do you think the computer makes it easier to talk to your doctor? Or do you think it doesn’t make a difference in how your talk with your doctor?
- If answers ‘easier’-
- Probe- Can you give me some examples of how the computer makes it easier to talk to your doctor?
- If answers ‘doesn’t make a difference’
- Probe- Can you tell me more?
3. When your doctor uses the computer during the clinic visit, does it have a positive or negative effect on your relationship with the doctor?
- If positive, why? Can you give any examples?
- Probe- does the doctor use the computer to explain your medical conditions or treatments?
- If negative, why? Can you give any examples?
- Probe- how has your relationship with your doctor changed since he/she started using the computer.
On a scale of Never to Always, how much do you agree with the following statements:
4. My doctor positions the computer so that I can see the screen.
Never Rarely Sometimes Very often AlwaysN/A
12 3 4 5
5. My doctor looks at the computer screen more than he/she makes eye contact with me during the clinic visit.
Never Rarely Sometimes Very often AlwaysN/A
12 3 4 5
6. When I am talking about a sensitive topic, my doctor stops using the computer, stops typing and pays full attention to me.
Never Rarely Sometimes Very often AlwaysN/A
12 3 4 5
On a scale of strongly disagree to strongly agree, how much do you agree with the following statements:
7. I feel that computer use is disruptive to my clinic visit and prevents the doctor from focusing on me.
Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
1 2 3 4 5
8. I feel that my doctor’s use of the computer in the clinic room, allows me to better understand my medical conditions and treatment plans.
Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
1 2 3 4 5
9. I feel that my doctor’s use of the computer makes it easier for us to communicate.
Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
1 2 3 4 5
10. Ifeel that my doctor’s use of the computer strengthens our relationship.
Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
1 2 3 4 5
11. Overall, I am satisfied with my doctor’s use of the computer in the clinic room.
Strongly Disagree Disagree Neutral Agree Strongly Agree N/A
1 2 3 4 5
12. Do you have any additional concerns about your doctor using the computer in the clinic room that you would like to share?
Appendix 2: Qualitative Sub-Category Definitions
Major Theme 1) Clinical Functions of EMRSubtheme 1a) Clinical Care
Codes / Definition of Positive Code / Definition of Negative Code
- Clinical Efficiency
2. Teamwork / Promotes collaboration and enhances communication between physicians / Impedes collaboration and complicates communication between physicians
3. Chart review / Reviews interval results, notes, imaging from other physicians, ensures continuity of care / Does not review interval results, notes, imaging from other physicians; does not ensure continuity of care
4. Coordination of Care / Coordinates care with other physicians, alert patient of upcoming appointments / Coordinates care with other physicians, alert patient of upcoming appointment
Subtheme 1b) Documentation
Codes / Definition of Positive Code / Definition of Negative Code
5. Medical history / Confirms that the medical information in the EMR is accurate and up to date / Does not confirm that the medical information in the EMR is accurate and up-to date
6. Records Information / Efficiently captures accurate information in computer in real-time with patient present / Inefficiently captures information in computer, as a result visits take too long
7. Conscientious (i.e. follow-up labs, vaccines, etc.) / Uses protocoled reminders in computer to ensure that timely issues are addressed: i.e. ensures medication refills, orders preventative health, etc. / Does not make use of protocoled reminders in computer: i.e. forgets to refill medication, order preventative health, etc.
8. Chart review / Physicianreviewed computer/EMR prior to clinic visit / Physician did NOT review the computer/EMR prior clinic visit
Subtheme 1c) Information Access
Codes / Definition of Positive Code / Definition of Negative Code
9. Accessibility of information / Physiciancan easily navigate EMR to get information, patients can access their clinical information on patient portal / Physicianis not knowledgeable about how to navigate EMR, patients have no access to their clinical information on patient portal
10. Suitable information access / Physiciansafeguards patient health information, ensures patient privacy by logging off of EMR at close of visit etc. / Physiciandoes not safeguards patient health information, does not log off of EMR at close of visit etc.
Subtheme 1d) Educational Resource
Codes / Definition of Positive Code / Definition of Negative Code
11. Medical Questions / Takes opportunity to look for answers to medical questions on line or using the EMR database with patient / Does not work with patient to look for answers to medical questions on line or on the EMR database
12. Patient Education / Uses EMR to access and provide patient education on health condition or treatment / Does not use EMR to access and provide patient education on health condition or treatment
Major Theme 2) Communication Functions of EMR (487)
Subtheme 2a)Patient Engagement
Codes / Definition of Positive Code / Definition of Negative Code
1. Facilitate patient discussion / Physicianuses technology to engage patient in discussion or provide patient education.
Promotes patient centered care and engagement / Physiciandoes not use technology to engage patient in discussion or provide patient education.
Does not promote patient centered care and engagement
2. Quality of care / Physician’s computer use results in better clinical care and management / Physician’s computer use impedes clinical care and management
3.Use of visuals (charts, graphics etc.) / Physicianpresents information in visually appealing format, integrates pictures, charts, scans, etc. to discuss diagnosis or treatment plans / Physiciandoes not present information in visually appealing format, does not integrate pictures, charts, scans, etc. to discuss diagnosis or treatment plans
4. Explain what they are doing on computer / Physicianis transparent with actions; explain what they are doing as they do it and allowing patients to follow along. / Physicianis not transparent with actions, does not explain what they are doing as they do it and do not allow patients to follow along
5. Patient Questions / Physician’s interactive EMR use prompts patient to remember relevant medical information, ask questions, or raise concerns about medial conditions, medications, etc. / Physicianis distracted by EMR, did not engage patient, patient was not able toask relevant questions or update doctor on medical conditions
Subtheme 2b) Physical Focus
Codes / Definition of Positive Code / Definition of Negative Code
6. Balance of Focus / Physicianis able to shift focus and attention between the computer and the patient in a balanced and patient centered manner / Physicianis more focused on the computer (typing, entering orders, etc.), distracted, not patient centered in the interaction
7. Eye contact / Physicianbalances focus of gaze between the patient and the computer screen / Physicianlooked at the screen primarily, and made little eye contact with patient
8. Screen positioning / “Physicianpromoted transparency, turned screen so the patient could see and follow along during the visit / Physiciandid not allow patient to share the screen, patient not able to follow along during the visit
9. Body Positioning / Physicianpositioned in manner where they face the patient and see the screen at the same time / Physicianhad back to patient, could not easily interact with patient and computer at same time
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