Physicians’ experience adopting the electronic transfer of care communication tool: barriers and opportunities

Figures & data

Figure 1 Screenshot of the electronic transfer of care tool.

Table 1 AcPs’ characteristics (N=138)

	N (%)
Age (years)*
20–30	102 (73.9)
31–40	24 (17.4)
41–50	3 (2.2)
>50	1 (0.7)
Sex
Female	60 (43.5)
Specialty
Internal medicine	52 (37.7)
Family medicine	21 (15.2)
Clerk	19 (13.8)
Other**	46 (33.3)
Trainee
Yes	51 (36.9)
Years since medical school graduation***
<2000	3 (2.2)
2000–2014	104 (75.4)

Notes:

* Eight AcPs did not provide age;

** other consists of dermatology, otolaryngology, and neurology;

*** 31 AcPs did not provide years since graduation.

Abbreviation: AcP, acute care physician.

Table 2 CcP ratings of quality based on completeness, pertinence, organization, and overall for electronic and traditional TOC summaries as means (SD)

Quality (0= worst, 10= best)	e-TOC Summary (N=80)	Traditional TOC summary (N=67)	t-tests
	Mean (SD)	Mean (SD)	P-value
Completeness	8.55 (1.16)	8.54 (1.31)	0.95
Pertinence	8.44 (1.47)	8.55 (1.44)	0.63
Organization	8.15 (1.71)	8.60 (1.44)	0.87
Overall rating	8.28 (1.48)	8.55 (1.45)	0.26

Abbreviations: CcP, community care physician; e-TOC, electronic TOC; SD, standard deviation; TOC, transfer of care.

Table 3 Qualitative results from acute care and community care physicians

Physicians’ themes	Barriers	Opportunities
Acute care
1. Timeliness	“Slow and tedious process – takes physicians away from care duties and spend more time as stenographer – poor economics.”	“Efficient, time saving.”
2. Usability	“Electronic discharge is difficult to navigate.”	“Easy to use, use to see what is written so that I may provide quick corrections.”
3. Presentation	“When reading the summary it’s far too cluttered with unnecessary detail compared to the dictated ones.”	“Less mistakes – everything laid out in front of me, ie, won’t forget anything.”
Community care
1. Access	“Access is not always available as Netcare website is unreliable and slow and X-rays are not always there.”	“Very helpful to have discharge summaries.”
2. Timeliness	“In the summary received 3 weeks after discharge, it asked me to check on her in a week […].” “Often wait very long before discharge summary available.”	“Timeliness and completeness revolutionary improvement over earlier pancreatitis admission.” “This patient had two admissions; within a few days we received summaries for both in good time, thank you.”
3. Quality of information and continuity of care	“[…] no note from her social worker was included in the summary and no follow-up from social worker was done after patient was discharged. She presented to my office in ++distress […].” “Summary didn’t provide consultant notes which would have been very useful.”	“Very helpful with ongoing management. Thanks!” “Appreciate the summaries – very legible and useful.” “Keep it up for continuity of patient care, hospital stay and f/u of medications.”

Abbreviation: f/u, follow-up.

Table S1 Users experiences with the transfer of care tool- pre-rotation

Users Experiences with the Transfer of Care Tool – Pre-rotation
Your initials (including middle initial) *for linkage purposes only, answers will remain anonymous ________________
Physician characteristics
1.	Age (circle)		20–30		31–40	41–50	>50
2.	Gender		Female	Male
3.	Specialty _______________
4.	Trainee?		Yes	No
i. If yes, provide level _________
5.	Years on staff ___________
6.	Year of medical school graduation __________
Pre-rotation questionnaire
1.	On average, how long does it take you to complete a dictated discharge summary?
_____________________ minutes
2.	Have you used the electronic discharge tool before?
Yes		No
If yes, please continue to the next question. If no, please skip to question 7.
3.	Approximately how many discharges have you completed with the electronic tool?
_____________________
4.	On average, how long does it take you to complete an electronic discharge summary?
_________________ minutes
5.	How difficult is it to complete the electronic discharge summary?
Very difficult 1 2 3 4 5 6 7 8 9 10 Very easy
6.	Please indicate which discharge summary method you prefer:
Prefer dictation 1 2 3 4 5 6 7 8 9 10 Prefer electronic
7. Please provide any comments about what you would like to see in an electronic discharge:

Table S2 Seamless transfer of care tool survey - post-rotation

Seamless Transfer of Care Tool Survey – Post-rotation

Your initials (including middle initial) *for linkage purposes only, answers will remain anonymous ________________

Post-rotation questionnaire

1. Approximately how many discharges have you completed with the electronic tool?

_____________________

2. On average, how long does it take you to complete an electronic discharge summary?

_________________ minutes

3. How difficult is it to complete the electronic discharge summary? Please circle:

Very difficult 1 2 3 4 5 6 7 8 9 10 Very easy

4. Please indicate which discharge summary method you prefer. Please circle:

Prefer dictation 1 2 3 4 5 6 7 8 9 10 Prefer electronic

5. Did you find there was a learning curve with using the electronic tool?

Yes  No

a. If yes, how long did it take you to feel comfortable using the tool?

_______________________days

6. Please provide any comments about the electronic discharge tool:

Table S3 Physician perception survey

Abbreviation: N/A, not applicable.