Abstract
Research Objective
Coordination of care between specialists and primary care clinicians (PCCs) is a critical component of providing patients with high‐quality specialty care. Previous research has demonstrated care coordination may benefit from use of a shared electronic health record (EHR). Yet reliance on a shared EHR may undercut opportunities to build and maintain personal and professional relationships among clinicians, a factor also positively associated with care coordination. We examine how use of a shared EHR and personal relationships between clinicians interact to influence medical specialists’ experiences of coordination with PCCs.
Study Design
We surveyed a national sample of clinicians from 10 medical specialties concerning their experiences of care coordination with referring PCCs. Participants completed the Coordination of Specialty Care (CSC)‐Specialist Survey 2.0 which comprehensively assesses coordination with referring PCCs as experienced by the specialist across four domains: mutually respectful relationships (Relationships), clarity and agreement on roles and responsibilities (Roles and Responsibilities), timely and helpful communication (Communication), and timely access to well‐organized patient data (Data Transfer). The survey also included single‐item measures assessing Overall Coordination, proportion of referring PCCs the specialist knew personally, and proportion of referring PCCs with whom they shared an EHR. Multiple regression analyses assessed the independent and interactive influence of shared EHR and personal relationships on specialists’ experiences of coordination after controlling for age, gender, and percentage of work in outpatient care.
Population Studied
Participants (analysis N = 514) were medical specialist members of the American College of Physicians (ACP) or a participating society in the ACP Subspecialty Societies (ACP CSS). All received an emailed link to complete the survey online.
Principal Findings
Specialists experienced better coordination if they reported knowing more referring physicians personally, in terms of both Overall Coordination (B = 0.30, P < .0001) and each of the four separately assessed coordination domains: Relationships (B = 0.14, P < .0001); Roles and Responsibilities (B = 0.19, P < .0001); Communication (B = 0.18, P < .0001); and Data Transfer (B = 0.12, P = .001). Having a shared EHR with more referring physicians was positively associated with better Overall Coordination (B = 0.21, P < .0001) and Data Transfer (B = 0.28, P < .0001). The extent of shared EHR also moderated the effect of knowing referring PCCs personally on some aspects of care coordination. For both Overall Coordination and Relationships, the influence of knowing PCCs personally was significantly stronger in the absence of a shared EHR (interactions: B = ‐0.09, P = .03, and B = ‐0.04, P = .04, respectively). However, these interactions accounted for <1% of the variance in reported experiences of coordination.
Conclusions
Both having a shared EHR and having personal relationships with PCCs independently contributed to specialists’ experiences of coordination. Although having greater access to a shared EHR reduced the influence of personal relationships on some aspects of care coordination, personal relationships with PCCs remained a significant independent predictor of coordination as experienced by specialists across all measures.
Implications for Policy or Practice
A shared EHR is considered a cornerstone of care coordination. However, our findings suggest that a shared EHR cannot replace the important contribution of personal relationships to clinicians’ experiences of coordination. Health care systems may benefit by augmenting use of a shared EHR with opportunities for personal connection and communication among clinicians.
Primary Funding Source
Department of Veterans Affairs.