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Communication during patient transitions is difficult in a fragmented health care system. eHealth technologies are often seen as a panacea, but a large proportion of eHealth projects fail, primarily because of human, not technological, elements. To combat this tendency, concepts derived from institutional ethnography were applied to create an electronic communications solution, which enabled careful mapping of communications gaps; their consequences; and the diverse needs of multiple health care providers. Institutional ethnography allowed researchers to trace social relations across locations in the health system and determine how action could be coordinated to ensure that family physicians were informed of patients' acute care encounters, while simultaneously strengthening relations between clinicians and information technology workers. As a result, an automated electronic notification system was piloted, evaluated, and spread to more than 92 percent of community physicians in one region of British Columbia, Canada, improving communication between providers and enhancing patient care. [ABSTRACT FROM AUTHOR]