Table 5

Problems encountered by GPs in use of eCDS

Problems with access and use of eCDS
Lack of integration of the software with the clinical systems (n=7)‘Yes, we had plenty of training. The tool itself wasn't difficult to use it’s just that it didn't integrate particularly well with our system’. (GP1)
‘It didn’t really integrate very well with SystmOne – you opened it parallel to SystmOne’. (GP8)
Slow to access and/or use (n=6)‘You had to open up something completely separate to the clinical system that you’re working in, and when you’ve got very very limited time that was a negative almost pushing you to not using it’. (GP9)
‘I wasn’t very successful with it to be honest because I found that it slowed the computer down, I had the perception that it slowed the computer down…’. (GP8)
Software not compatible and crashes SystmOne (n=4)‘We’ve been having quite a lot of issues with it crashing our SystmOne and making everything run very slow’. (GP2)
Did not autopopulate (n=3)‘At the moment, I'm having an issue that the platelets and the demographics are not being automatically populated. I suspect that’s just that we've got a version out of date. A couple of weeks back, I did ask the manager just to make sure we got the most recent version’. (GP6)
Tool is clunky or confusing to use (n=2)‘But yes,…it is a little bit clunky because it’s not all that obvious that you have to press on “Tools” when you get on to it. And then you get to the “Cancer Decision Support” icon and then you need to pick the right one, so because we don’t do it sort of every day or every week, it could be made slightly easier, I think…It’s also a little bit confusing that it asks you for a password but you can actually ignore that, but it doesn’t feel very logical, you need to have been talked through it once because otherwise it’s difficult to figure it out’. (GP1)
Problems integrating use of the tool with clinical practice
Not enough time within consultations (n=5)‘They [patients] never come in with one symptom, or one, sort of, issue, so they come with a few different things, and whether it’s psychological or not, the tool really, for my practice anyway, hasn’t become embedded …. we won’t automatically think, when a patient, like out of three problems, one of them is related to a gastric or oesophageal cancer, erm, I’m not necessarily going into the tool’. (GP5)
‘No way on this planet any of the GPs under the pressure we were under(…)was going to use a separate program’. (GP8)
Did not aid decision making (n=3)‘So, I put the symptoms in, erm, it just felt, and I documented it in the notes a couple of times I think, but I can’t, I couldn’t see what it added- I know it’s for research, but I couldn’t see that it added anything for us, it didn’t help me really with any decision-making’. (GP9)
Concerns about the accuracy of the data used within the tool (n=4)I feel a bit uncomfortable that the tool requires or populates several boxes with old information’. (GP1)
‘It had so many different words for very slightly different symptoms and I found that a little bit confusing and I’m not sure that anyone would be… how specific everyone would be about exactly what kind of symptoms the patient had and also if the patient could be particularly specific’. (GP3)
‘We do a lot of our work by free text. We put under headings in free text. So a lot of symptoms it uses, it won't pick up because it will be in free text. Sometimes it will be there and it will pick up things like the platelets, which is great, and the main thing is it’s a gastro-intestinal thing. All the other things that we might put in free text, it wouldn't pick up’. (GP7)
  • eCDS, electronic clinical decision support; GP, general practitioner.