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 impact educational and clinical activities, yet little has been reported in this regard. We conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC.

Design Cross-sectional study employing semi-structured interviews with faculty (n=10) and a group interview with residents (n=10) at a VAMC teaching hospital.

Measurements Content analysis of field notes and taped transcripts was performed 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.

Conclusion 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.