More needs to be known about how communication challenges and documentation affect ambulatory oncology care. In a presentation on Saturday, June 2, at the 2018 American Society of Clinical Oncology Annual Meeting, researchers revealed study findings about how patient safety is directly affected by electronic health record (EHR) capability and satisfaction, clinician communication, and clinicians’ actions.

Nurses and prescribers (i.e., physicians, nurse practitioners, and physician assistants) who worked in 28 practices participating in a statewide quality-improvement collaborative completed paper questionnaires; the survey response rate was 68%.

Researchers constructed an index to measure EHR capability (1 = all paper to 5 = all electronic) and used the previously validated Safety Organizing Scale (SOS), which measures actions consistent with a safety culture, satisfaction with clinic technology, and satisfaction with communication with other clinicians. Researchers examined the relationship between covariates of interest and the SOS with linear regression models, adjusting for practice size and ownership.

Results showed that increased SOS scores were significantly associated with a higher satisfaction with technology and clinician communication; however, lower SOS scores were associated with increased EHR capability. Nurses had higher SOS scores than prescribers (see Table 1).

“The inverse relationship between EHR capability and safety suggests that technology distracts clinicians from attending to patient safety,” the authors said. “Improvement strategies may benefit from tailoring by clinician type to account for observed differences.”

Table 1. Safety Organizing Scale Scores



95% CI

Technology satisfaction


0.5, 0.8

Clinician communication satisfaction


0.1, 0.4

Electronic health record capability index


–0.2, –0.1

Prescriber (versus nurse)


–0.7, –0.1

***p < 0.001