UC Berkeley

Advanced use of electronic health record (EHR) tools that standardize care and increase patient access to their providers are purported to improve care quality and safety; however, clinician uptake of these advanced tools has been slow. As U.S. health care reform measures continue to encourage the use of teams in care delivery, team dynamics may play a role in innovation adoption decisions of clinicians. Little detail is known about whether clinicians' use of technological innovations is influenced by peer and team use patterns.

From the patient perspective, clinical trials are the primary mechanism by which new approaches to cancer treatment are evaluated; yet, only a small proportion of eligible cancer patients are offered the opportunity to participate in clinical trials, and fewer actually become enrolled. Trends toward more patient-centered care delivery have encouraged shared decision-making between patients and their care providers, which may influence patient awareness and consideration of medical innovations as treatment options, and ultimately decide to enroll in clinical trials.

This dissertation research assesses whether there are team effects associated with individual adoption of innovations, as well as whether there are normative pressures or internal motivations, as opposed to more passive interpersonal influences, that are related to clinician innovation adoption. It also assesses whether individual attitudes and awareness alone, or more active information sharing are more likely to result in patient innovation uptake.

Findings from self-reported clinician and patient surveys in an integrated delivery system suggest that interpersonal interactions contribute to individual clinician and patient awareness and eventual use of innovations in the clinical setting. Specifically, clinician adoption of advanced EHR tools was associated with their team members' use of the innovation. However, team cohesion was not directly associated with individual adoption and did not moderate the relationship between team use and eventual individual use of advanced tools. This suggests that more a passive transfer of knowledge may account for team influence on individual team member's adoption of advanced EHR tools. Conversely, medical oncologist behaviors and patient care experience, both play important roles in patients' ultimate decision to enroll in cancer clinical trials. This points to the need for clinicians to more actively engage with their patients, and greater patient understanding of trials to effectively encourage cancer clinical trial participation.