• EM supports vital access

"We're kind of the glue that pulls together this broken fragmented system. If the patient doesn't have a place where they can go to receive one's care and it's kind of a one off thing, they land in an urgent care center or emergency department. So it's really important for us to think about how to provide comprehensive care in that context, and comprehensive care would include EPT."

• STI are not an EM problem

"No one goes into emergency medicine to stamp out STIs"

• ED are sentinels for Infectious diseases

“I think this [COVID crisis] is a serious canary in the coal mine, we should really be paying more attention to pandemics and infectious diseases and trying to nip them in the bud when we have the opportunity to do so. And I think STIs are a great example of that."

• Providers are uncomfortable with sexual health topics

"I'd say there's cultural discomfort with talking about sexuality and there can be jokes and exaggerations. "I had to click that three partners thing five times."

• Patients are embarassed to discuss sexual health

"70% of people who come to the emergency department come with this guise like, "I think I have an STI." They whisper it to you when you walk into their room, the door is closed."

• Necessary details present roadblocks to full understanding

"I don't know even know how you'd call in an EPT prescription... Then if you print it, how do you get it to the patient? Do you have to mail it? Do you write a prescription? We don't even have prescription pads anymore ...,

• Processes cannot be burdensome given competing demands

"It was more about, "is it easy for me to do?" Like, "I agree with this, but if it takes me 10 minutes to figure out on a shift, I'm not going to do it."

• Division of labor facilitates task completion

"The pharmacy team in Epic, we get all the culture results and we review them kind of continuously throughout the day. That's part of our protocol we work usually with the APPs to do the prescriptions and follow up and stuff like that."

• Perception of incomplete liability protection

"We're not well-protected. Even if the litigation goes nowhere, the fact is if you get sued, it takes a good 40 to 60 hours of your time."

• Patient situations may lead to concern for intimate partner violence

"Wait, are they going to tell my partner?" Because there are questions about infidelity and multiple partners, and it gets really, really complicated for safety. "

• Empiric EPT may lead to over treatment

“I think there's this perception that it might compound diagnostic inaccuracy. So if you're making a judgment call for the patient in front of you, ...now you're asking that patient to distribute potentially to partners that you don't feel as confident about."

• EMR system is harder to change than it seems

"We've learned that nothing in Epic is easy I'll just be like, "No, I just need this, " and he's like, "You don't understand, that is like 40 hours of work for someone to do,"

• Organizational hierarchies can create bottlenecks to system change

"I'm just a cog in the wheel. I'm a medical director, I have a chair, we have a vice chair… I have influence but not authority and that's just the way it is."

• Champions are more effective if focus is narrow

"Medical directors are terrible champions often unless they're truly passionate about stuff, and most have too many competing priorities to be passionate about any specific thing."

• Power to change processes is tied to role

"Well, yeah. I mean, a lot of it is a role. You're right, like being a leader, having a leadership role in the department, and in the system, is helpful in that we can champion these really important causes"