- As EHR adoption becomes more ubiquitous throughout the healthcare industry, one study shows that the cohesiveness of a care team using these technologies can affect patient outcomes.
In a retrospective study, Kaiser Permanente Northern California (KPNC) looked at care teams of varying levels of cohesiveness using EHRs to treat their diabetic outpatients. The results showed that those patients being treated by more cohesive care teams saw a modest but notable reduction in both low-density lipoprotein cholesterol (LDL) and glycated hemoglobin (A1C) values.
“...it is important to understand how the team environment in particular impacts the adoption and effectiveness of new technology,” the research team wrote. “Team cohesion is a measure of the constructive work relationships among primary care team members. How well teams work together may be an important factor in helping practices maximize the potential benefits of EHRs.”
This study highlighted how critical it is that care teams work closely in order to deliver the highest quality of care. While effectively utilizing an EHR is important for improving patient care, it is how that EHR is used between members of a care team that can make all of the difference in patient outcomes.
Work relationships are crucial for providing safe and reliable patient care and establishing the collective capacity for change, such as adopting new technologies, which demands considerable changes to the clinical work flow.Team cohesion may promote an atmosphere of more informal learning, in which members are more comfortable experimenting with the EHR and sharing best practices with each other. Consequently, cohesion among team members likely influences the success of teams at adopting EHRs and achieving desired improvements in patient care.
The researchers measured team cohesion by mailing out a provider survey in 2005, prior to KPNC’s EHR implementation. Based on answers provided in the survey, the researchers categorized care teams’ cohesiveness.
From there, the researchers looked at LDL and A1C levels in patients as their care teams were adopting EHR technology. As stated above, those patients who received care from a cohesive team tended to see lower LDL and A1C levels than those who received care from less cohesive care teams.
“For patients cared for by more cohesive primary care teams, using an EHR was associated with statistically significantly greater reductions in their glycemic and lipid levels than for patients cared for by less cohesive teams,” the researchers explained. “These findings highlight the importance of attributes of the organizational environment, such as team cohesion, in the successful adoption of new technologies and practices.”
There are several reasons why cohesive teams are more successful at adopting and using EHRs, one of which being the inevitable environment of informal learning. Those working in a cooperative and unified care team may be more likely to use informal learning strategies to establish best practices for using the technology.
“Members in more cohesive primary care teams may be more open to sharing best practices and minimizing unintended consequences than members of less cohesive teams,” the team wrote. “For example, use of an EHR may increase the amount of information included in the patient’s record, creating new processing challenges. It is possible that the members working in less cohesive teams had fewer agreed-upon approaches to document and retrieve critical patient health information.”
Although the report suggests that team cohesion is important in implementing an EHR, the researchers conclude that there is not yet evidence to suggest that team cohesiveness will make a difference in the long run. That is to say, team cohesiveness may be irrelevant once all providers reach a point of comfort using the technology.
“Nonetheless, while team cohesion enhanced the EHR adoption process and its short-term effect on clinical outcomes, it is possible that, in the longer term, all clinicians will achieve comparable improvements in care,” the team explained. “Future studies should examine whether differences in the EHR-associated changes in care by team cohesion persist over time.”
That said, this information could be valuable as team-based care models begin to gain popularity in the healthcare industry. For example, both patient-centered medical homes and accountable care organizations (ACOs) foster team-based approaches. Provided this information on team-based care using an EHR, providers may be able to better shape their approaches to yield the best possible patient outcomes.
“New care models, such as patient-centered medical homes and accountable care organizations, emphasize the importance of multidisciplinary teams to ensure high-quality, coordinated care,” the researchers concluded. “Our findings are particularly timely given the ongoing federal incentive payments for meaningful use of EHRs and concurrent efforts to promote team-based primary care with patient-centered medical homes.”