Background: We know little about clinicians’ documentation and communication challenges and how these might affect the safety of ambulatory oncology care. The present study investigated variation in electronic health record (EHR) capability and satisfaction, clinician communication, and clinicians’ actions that enable a safety culture. Methods: We distributed paper questionnaires to nurses and prescribers (physicians, nurse practitioners, and physician assistants) in 28 practices that participate in a statewide quality improvement collaborative. Previously-validated measures included the Safety Organizing Scale (SOS) that reflects actions consistent with a safety culture, satisfaction with clinic technology, and satisfaction with communication with other clinicians. We constructed an index to reflect EHR capability (1 = all paper to 5 = all electronic). Linear regression models (with robust standard errors to account for clustering) were used to examine the relationship between covariates of interest and the SOS, adjusting for practice size and ownership. Results: The survey response rate was 68%. The mean (SD) of the SOS was 5.3(1.1), with a practice-level range of 4.9-5.4 (based on 7-point scale where higher scores reflect increased safety actions). Higher satisfaction with technology and clinician communication was significantly associated with increased SOS scores, while increased EHR capability was associated with lower SOS scores. Prescribers reported lower SOS scores than nurses (see table). Conclusions: Practices vary in their performance of patient safety actions. Supporting clinicians to integrate increased technology is a promising target for interventions. The inverse relationship between EHR capability and safety suggests that technology distracts clinicians from attending to patient safety. Improvement strategies may benefit from tailoring by clinician type to account for observed differences.

***p< .001