title: The association between EHRs and care coordination varies by team cohesion.
abstract: OBJECTIVE
  To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites.
  
  
  METHODS
  Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N=565), 2006 (N=678), and 2008 (N=626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement.
  
  
  RESULTS
  Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p<.05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams.
  
  
  CONCLUSIONS
  The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams.
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Rundall
authors.forename: Jim
authors.initials: J
authors.lastname: Bellows
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003299:Cooperative Behavior; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D011159:Population Surveillance; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation
keywords: Electronic health records; care coordination; primary care; team cohesion; teams