title: Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.
abstract: OBJECTIVE
  Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC.
  
  
  METHODS
  A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital.
  
  
  METHODS
  Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing.
  
  
  RESULTS
  Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care.
  
  
  CONCLUSIONS
  CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. mail@embi.net
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Embi
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Yackel
authors.forename: Judith R
authors.initials: JR
authors.lastname: Logan
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bowen
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Cooney
authors.forename: Paul N
authors.initials: PN
authors.lastname: Gorman
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003430:Cross-Sectional Studies; D004282:Documentation / Q000379:methods; D005180:Faculty, Medical; D006784:Hospitals, Teaching / Q000458:organization & administration; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D007388:Internal Medicine; D016347:Medical Records Systems, Computerized; D008505:Medical Staff, Hospital; D009922:Oregon; D009936:Organizational Innovation; D014584:User-Computer Interface