Article Figures & Data
Figures
- Figure 1
Rates of EMR adoption by province in Canada
AB—Alberta, BC—British Columbia, EMR—electronic medical record, MB—Manitoba, NB—New Brunswick, NL—Newfoundland and Labrador, NPS—National Physician Survey, NS—Nova Scotia, ON—Ontario, PE—Prince Edward Island, QC—Quebec, SK—Saskatchewan.
*The provincial response rates to the Commonwealth Fund survey ranged from a low of 2% of physicians in ON (n=488) and BC (n=147) to a high of 15% of physicians in NL (n=161).
†The provincial response rates to the NPS ranged from a low of 16% of physicians in QC (n=1534) to a high of 23% of physicians in NS (n=494). Data from Schoen et al,10 the NPS,31 and various regional EMR organizations.21–30
- Figure 2
Level of provincial funding and adoption of EMRs
EMR—electronic medical record, NPS—National Physician Survey.
Data from the NPS31 and various regional EMR organizations.21–30
Tables
- Table 1
Summary of incentives and funding for implementation of EMRs in Canadian provinces
PROVINCE, Y ORGANIZATION SYSTEMS IN PLACE FUNDED SYSTEMS PHYSICIAN COMPENSATION NL,21 1996 Department of Health and Community Services • PACS
• DIS• Wolf EMR
• Nightingale InformatixNo current policy PE,22 2008 One Island Health System • CIS
• CPOE
• DIS
• PACS
• RIS• Cerner Millennium Physicians on salary contract (70% of physicians) access this as part of their contract but they are not individually compensated NS,23 2005 Primary Healthcare Information Management Program • PACS • Dymaxion (Practimax)
• Nightingale Informatix• $11 000 for licence and training
• $5300 implementation grant
• $9600 for annual participationNB,24 2012 Velante • None • Intrahealth • Maximum $16 000
• 67% of cost of setup, installation, integration, and runningQC,25 1996 Quebec EMR adoption program • RIS
• PACS• Info-Data
• Soft Informatique
• Omnimed
• Purkinje
• KinLogix• Maximum $12 710
• 70% of setup costs (up to $3710)
• Annual Internet (up to $2400)
• $1400 for operating costs
• 70% of equipment cost (up to $3500 over 4 y)ON,26 2004 OntarioMD • CPOE
• PACS• ABELSoft
• Alpha Global IT
• Canadian Health Systems
• Jonoke
• Med Access
• MD Financial Management
• Nightingale Informatix
• QHR Accuro
• OSCAR
• P & P Data Systems
• York-Med Systems• Maximum $29 899
• $3500 readiness grant
• $2000 performance grant
• $675/mo for 36 moMB,27 2007 Manitoba Health, Manitoba eHealth, and Canada Health Infoway • RIS
• PACS• Clinicare
• QHR Accuro
• Med Access
• Jonoke• Maximum $20 000 for new clients
• Maximum $10 000 before 2009
• 70% of EMR implementation costs
• 70% of operating costs for 2 ySK,28 2008 Saskatchewan EMR Program • iEHR
• PIP
• RIS
• PACS• Med Access
• QHR Accuro• Maximum $7200
• $300/mo if 50% of encounters are captured in the
EMR in the first y
• 95% of encounters must be captured in the EMR to obtain continued support after first yAB,29 2001 Physician Office System Program • PIN
• DI• Med Access
• MD Financial Management
• Wolf EMR• Maximum of $50 000
• 52% of setup cost (up to $10 400)
• $389/mo for 54 mo for maintenanceBC,30 2006 Physician Information Technology Office • PLIS • Intrahealth
• Med Access
• Wolf EMR
• Osler Systems• Maximum of $25 840
• 70% of implementation costs
• 70% of equipment costs
• 70% of operating costs for 3 yAB—Alberta, BC—British Columbia, CIS—clinical information system, CPOE—computerized physician order entry, DI—diagnostic imaging, DIS—drug information system, EMR—electronic medical record, iEHR—interoperable electronic health record, MB—Manitoba, NB—New Brunswick, NL—Newfoundland and Labrador, NS—Nova Scotia, ON—Ontario, PACS—picture archive and communication system, PE—Prince Edward Island, PIN—pharmaceutical information network, PIP—pharmaceutical information program, PLIS—Provincial Laboratory Information Solution, QC—Quebec, RIS—radiology information system, SK—Saskatchewan.
- Table 2
Summary of barriers and success factors for implementation of EMRs in clinicians’ offices
ARTICLE STUDY DETAILS SUCCESS FACTORS BARRIERS Boonstra and Broekhuis,6 2010 Review of 22 articles concerning barriers to EMRs as perceived by physicians (17 American, 2 Canadian, 1 Israeli, 1 Irish, and 1 Norwegian study) • Treat EMR implementation as a change project led by quality change managers • Financial
• Technical
• Time
• Psychological
• Social
• Legal
• Organizational
• Change processTerry et al,12 2009 30 new users in southwestern Ontario • Assess computer skills before implementing the system
• Retain a full-time “superuser” for consultation• Poor staff computer literacy
• Frustration with navigating the
systemDenomme et al,11 2011 Follow-up of 19 of 30 users from a previous study • Training to ensure consistent use by all staff
• Retaining a full-time “superuser”
• Improved internal communication• Need for consistent input into EMR
• Lack of enthusiasm for efficient usePaterson et al,13 2010 Interviews in 20 clinics encoded 3749 physician comments and assigned 20 themes (2 clinics per province, except 4 in ON, 3 in QC, and 1 each in the Maritime provinces) • Personal leadership and commitment
• Funding
• Management change
• Payment model
• Collaborative culture
• Integrated business and clinical aspects
• Consistent, reliable data
• Improved quality of care
• Legibility of notes• Lack of interoperability with other systems
• Need to scan documents from non-EMR systems into patient EMRsLudwick and Doucette,9 2009 Semistructured interviews at AB clinics NA • Time constraints
• Insufficient computer skills
• Complex HIT user interfaces
• Fee-for-service remuneration model
• Poor vendor supportGagnon et al,19 2010 15 semistructured interviews of family medicine groups in QC • A “champion” combining roles of clinical technology and knowledge
• Supportive organization open to change
• Locally adapted implementation strategyNA Rozenblum et al,18 2011 Interviews with 29 stakeholders: national, AB (most advanced), BC (moderately advanced), and ON (least advanced) • Funding
• National standards
• Patient registries
• Digital imaging• Lack of electronic health policy
• Inadequate clinician involvement
• Lack of a business case to use EMRs
• Focus on national not regional interoperabilityLau et al,14 2012 Systematic review of EMR use and effect on practice worldwide • Micro: user support aids adoption
• Meso: better productivity and work flow
• Macro: funding incentive to changeNA Price et al,17 2013 57 interviews in clinics using EMRs
> 6 mo in MBNA • Ceiling effect of current technology
• Underuse owing to lack of awareness of EMR functionalityKuhn and Lau,20 2014 Study in 1 Canadian jurisdiction 4 y after EMR implementation; 46 surveys on EMR use, benefits, system, and service; paired with extraction of actual system log data on EMR use • Relevant, accurate, complete information
• Perceived enhanced efficiency
• Perceived improvement in continuity of care• Training limitations
• Security of information concernsAB—Alberta, BC—British Columbia, EMR—electronic medical record, HIT—health information technology, MB—Manitoba, NA—not applicable, ON—Ontario, QC—Quebec.
OFFICE BENEFITS PATIENT BENEFITS REVENUE USES • Improved access to patient records20,29–31
• Improved security of patient records29,31
• Improved record and report preparation29,30
• Reduced repeated tests and tasks1,20,30,31
• Track and share prescriptions, tests, procedures20,29,32• Improved patient care1,20,28–31
• Improved practice efficiency1,20,30,31
• Improved patient safety1,28,30,32
• Improved continuity of care for chronic conditions and reduced delays1,20,29,31
• Improved drug safety1,29,32• Improved billing accuracy30
• Paperless or reduced paper28,30
• Improved or same revenue28,32• Write prescriptions28,29,32
• Access laboratory reports20,28,30,31
• Record patient encounters28
• Drug interaction checking1,29,31,32
• Referrals1EMR—electronic medical record.
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