title: Electronic health records and support for primary care teamwork.
abstract: OBJECTIVE
  Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges.
  
  
  METHODS
  Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size.
  
  
  RESULTS
  EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time.
  
  
  CONCLUSIONS
  Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges.
  
  
  CONCLUSIONS
  EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time.
authors: Mathematica Policy Research aomalley@mathematica-mpr.com.
authors: Ann S
authors: AS
authors: O'Malley
authors: Mathematica Policy Research.
authors: Kevin
authors: K
authors: Draper
authors: Mathematica Policy Research.
authors: Rebecca
authors: R
authors: Gourevitch
authors: Mathematica Policy Research.
authors: Dori A
authors: DA
authors: Cross
authors: National Committee for Quality Assurance (NCQA) Scholle@ncqa.org.
authors: Sarah Hudson
authors: SH
authors: Scholle
mesh_terms: D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008490:Medical Informatics; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D014481:United States
keywords: electronic health record; health services research; primary health care; qualitative research; team; teamwork
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