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Ease of use of electronic health records and relational coordination among primary care team members

Watterson, Jessica L.; Rodriguez, Hector P.; Aguilera, Adrian; Shortell, Stephen M.

doi: 10.1097/HMR.0000000000000222
Features: PDF Only

Background: Electronic health records (EHRs) have potential to improve quality, health outcomes, and efficiency, but little is known about the mechanisms through which these improvements occur.

Purpose: One potential mechanism could be that EHRs improve care team communication and coordination, leading to better outcomes. To test this hypothesis, we examine whether ease of EHR use is associated with better relational coordination (RC), a measure of team communication and coordination, among primary care team members.

Methodology: Surveys of adult primary care team members (n = 304) of 16 practices of two accountable care organizations in Chicago and Los Angeles were analyzed. The survey included a validated measure of RC and a measure of ease of EHR use from a national survey. Linear regression models estimated the association of ease of EHR use and RC, controlling for care site and patient demographics and accounting for cluster–robust standard errors. An interaction term tested a differential association of ease of EHR use and RC for primary care providers (PCPs) versus non-PCPs.

Results: Ease of EHR use (mean = 3.5, SD = 0.6, range: 0–4) and RC were high (mean = 4.0, SD = 0.7, range: 0–5) but differed by occupation. In regression analyses, a 1-point increase in ease of EHR use was associated with a 0.36 point higher RC score (p = .001). The association of ease of EHR and RC use was stronger for non-PCPs than PCPs.

Conclusion: Ease of EHR use is associated with better RC among primary care team members, and the benefits accrue more to non-PCPs than to PCPs.

Practice Implications: Ensuring that clinicians and staff experience EHRs as easy to use for accessing and integrating data and for communication may produce gains in efficiency and outcomes through high RC. Future studies should examine whether interventions to improve EHR usability can lead to improved RC and patient outcomes.

Jessica L. Watterson, PhD, MPH, is Researcher, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley. E-mail: jessica.watterson@gmail.com.

Hector P. Rodriguez, PhD, MPH, is Professor and Co-Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley.

Adrian Aguilera, PhD, is Professor, School of Social Welfare, University of California, Berkeley, and School of Psychiatry, University of California, San Francisco

Stephen M. Shortell, PhD, MPH, MBA, is Professor and Co-Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley.

Research reported in this work was funded through a Patient-Centered Outcomes Research Institute award (HIS-1310- 06821). The views, statements, and opinions presented in this work are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors, or Methodology Committee.

The authors declare no conflicts of interest.

Ethical approval for this study was obtained from the University of California Berkeley Center for the Protection of Human Subjects.

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