Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study

Appendix: Interview questions

Establish organisational level of respondent’s commentary. I’d like you to pitch your answers at a level you feel comfortable with. Am I right in thinking that it would mainly be:

Eg:

Yourself and your immediate workgroup

The clinic as a whole

The Department

The Hospital

The Hawaii Region.

Practice culture. And how would you describe the culture of your unit/practice/department/hospital/region? What makes it unique in terms of the way things are done around here?

Eg:

Like a family

Entrepreneurial

Bureaucratic

Is efficiency of operation highly valued?

Other.

Cultural mediation. Would you say that the culture of the unit/organisation(s)/region has affected how CIS was implemented? In what ways?

Eg:

Pace of implementation

Choice of initial implementation sites

Clinical leadership for CIS

Leadership. Do you think leadership styles influenced CIS implementation in this clinic/hospital/region?

Eg:

Senior staff provide highly visible leadership for CIS implementation

Leaders generate confidence that CIS will be implemented successfully

Effective leadership for CIS implementation has been lacking here

Clinicians have not needed leadership to implement CIS

Defining moments/critical events/turning points. Have there been any defining moments in the implementation of the CIS: any critical event marking a turning point in clinicians’ interpretation and use of the system?

Previous IT implementations. How has your experience of CIS implementation been affected by previous IT implementations?

Eg:

Expected CIS would be better than previous systems

Confident that people would have learned not to replicate the same mistakes as occurred when implementing previous systems

Sceptical of the value of the new system

Dreaded the implementation.

Use of EMR. In your experience, what changes has CIS implementation actually made to clinical practice or care processes?

Eg:

Has it changed how consultations are conducted?

How a clinician’s work is organised

How clinical work is coordinated between individuals/across sites.

Automation of existing care processes

Redesign of care processes.

For chronic disease management

Chronic disease management. Would you say that CIS is an effective vehicle to develop more effective chronic disease management programs (at unit/org/regional levels)?

Eg:

Diabetes

Asthma

Congestive heart failure

Depression

Other illnesses?

CIS Functionality. Which, in your view, are the most useful aspects or functions of CIS to improve chronic disease management?

Eg:

Electronic patient record

Access to records from other clinicians and sites

Tests and procedures ordering

Diagnosis and treatment outcomes reporting

Drug order entry

Automated alerts and reminders.

Electronic communication with patients

Health history

The new Epic system. What are your thoughts about the decision to install a new Epic system to all Kaiser Permanente regions?

Eg:

In terms of integration

For chronic disease management

For individual health care

For population health.

Any other comments. Can you think of anything else that might help us to learn from implementing CIS in Hawaii?

Eg:

Including anyone else that we should talk to.