Table 3. Sample interview guide. Main structure Confidentiality, aims, thanks Any questions? About yourself Main drivers for structuring and/or coding clinical information in depression Do the structures and/or clinical codes cover what you feel needs to be recorded – any areas for improvement? Overall How well do the available clinical systems support structuring and/or encoding the clinical information? Any other barriers to collecting good quality information? Any drivers or incentives that would improve the quality or uses made of this information? Any international developments in relation to structuring and/or coding clinical information in depression they are aware of? Aware of any other areas e.g. prisons, learning disability, homeless shelters and clinical coding there? Concluding remarks Anything else? Thanks, any questions? Anyone they can recommend for interview? Any relevant literature? doi:10.1371/journal.pone.0043831.t003 Analysis Data collection and analysis took place concurrently to allow emerging issues to be fed back into future data collection. A coding framework was developed and refined based on the topic guide and literature review to include the following themes: background and context (relating to systems, interviewees and settings); existing practices; definitions and diagnoses; facilitators and barriers to structuring and/or coding of clinical information in depression; perceived benefits; and recommendations for improvement. In addition to this deductive approach, inductive approaches were employed to allow new themes to emerge from the data [31]. The lead researcher (KC, a psychologist with experience in qualitative health services research, particularly in relation to the use of IT in healthcare) coded the data, combining different data sources within the coding framework in order to look for patterns of convergence, maintaining a field journal throughout the process in order to capture key analytical processes. Existing and emerging findings were discussed in designated analysis workshops with the extended research team exploring inconsistencies and unexpected findings seeking novel and potentially unexplored evidence [32]. Analytic themes were extracted based on frequency of occurrence and relevance. Results Three main themes emerged from the analysis (Table 4). These themes are examined in detail below, illustrated with quotes from the data. ‘‘There Are Too Many, but Never Enough’’ Specific topics and issues Theorized and actual benefits and risks, drivers, incentives, barriers and how to address these Role, do you capture and store health information yourself and, if yes, what and how? (setting, profession, clinical coding system, electronic system) In what instances is structured and/or coded clinical information really helpful? What impact does the use of structures and/or clinical codes have on clinical care and outcomes, or on patient experience and engagement? In terms of completeness and accuracy and in terms of enabling good use of the information Any potential uses of the information that are under- exploited? If yes, why? Any examples of innovation/centers of excellence? Varying Contexts and Practices Surrounding the Coding of Clinical Information in Depression Most participants stated that contexts and conditions in depression were distinct from other ‘‘more biomedical’’ areas of care: disorders were felt to be difficult to define, care occurred over periods of time with often changing pathways, and wide variations in responsiveness to treatment. Consequently, there were often no prescribed care pathways once a diagnosis of a mental disorder had been made. Although certain information would be coded (e.g. symptoms and diagnoses), this was almost always accompanied by free text (e.g. investigation findings and treatment plans) to reflect the subtleties of a patient’s situation and the thoughts and feelings of the practitioner. ‘‘…actually often a mental health consultation will just exist in history, and in that history chunk will be…feeling more depressed this time, what’s been going on…and even my thoughts and formulation may all just sit in that box [of free text] because actually it comes out of my head in one chunk that is…three or four lines of text.’’ (Interview 1, Academic GP). GPs coded clinical information relating to symptoms, diagnoses, history, and investigations. In the UK, depression is included in a centrally-led payment incentive scheme, the Quality and Out- comes Framework [33], which requires GP practices to submit PLOS ONE | www.plosone.org 4 August 2012 | Volume 7 | Issue 8 | e43831