Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment

Abstract

This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.

Dynamics of Physicians’ Trust in Fellow Health Care Providers and the Role of Health Information Technology

“…Personal interactions within teams can give physicians insight into the actions or inaction other providers will take for the betterment of patients; over technology, inadequate responsiveness can appear neglectful and careless. This observation is well-aligned with recent case study–based findings that communication via EHR on behalf of an oncology patient could lead to lapses in communication between team members and redundant performance of tasks, eroding patient trust (Gross, Leib, Tonachel, & Tonachel, 2016). Some physicians described that providers may rely too much on the abundance of information available via HIT and limit their own critical thinking; today’s culture of medical practice might be facilitating the replacement of experience with information.…”

Understanding primary care-oncology relationships within a changing healthcare environment

“…While formal primary care-oncology relationships benefited from the broader health system infrastructure, informal relationships had the advantage of increased rapport between providers in primary care and oncology settings. Although these personal primary care-oncology relationships were often tied to one individual within the organization and thus may not be sustainable long-term, they had the advantages of shared familiarity, trust, and commitment, characteristics that have been noted in other team-based care studies [29–31]. Given that rapid changes in primary care ownership across the U.S. are ongoing, it is important for health systems to encourage team-building between primary care and oncology settings, in addition to strengthening infrastructure for information transfer.…”

“Go Make Your Face Known”: Collaborative Working through the Lens of Personal Relationships

“…However, they also include relationship issues. For example, Gross et al [ 48 ] describe a case study where the introduction of an electronic health record system led to damage to mutual trust amongst members of the inter-professional team. A study of the use of e-mail between primary and secondary care in the UK found that while some practitioners said they had been able to build good relationships beginning with e-mail contact, others felt that they required a personal, face-to-face relationship before they could use e-mail effectively [ 42 ].…”