Abstract
BackgroundElectronic Medical Records (EMRs) are a rich data source to measure and improve quality of care. As Canadian primary health care (PHC) EMRs mature, there is increasing potential use of EMR data for performance measurement. This study identifies and describes current uses of EMR data for performance measurement and considerations to further its potential in the Canadian context.MethodsWe applied a qualitative case study design and descriptive assessment in three phases, consulting multiple data sources including scientific and grey literature, system leaders (n = 41), and clinician/researchers (n = 20). Phases included a multimethod approach to identify initiatives using EMR data for performance measurement across Canadian jurisdictions; in-depth review of current initiatives identified from a healthcare performance intelligence lens; and triangulation and thematic analysis across data sources to explore considerations for advancing performance measurement uses of EMR data in the Canadian context.ResultsSix initiatives of EMR data use for performance measurement were identified: one multi-jurisdictional; five jurisdiction-specific in the provinces of British Columbia, Manitoba and Ontario. EMR data uses were predominately for micro-level PHC physician and team performance improvement, with some use for meso-level organization/network-wide improvement. Indicator sets varied in number, though shared emphasis on chronic disease management and prevention/screening and to a lesser extent medication management. Key considerations for governing, resourcing and implementing EMR data for performance measurement were identified.ConclusionsThe extent of EMR data use for performance measurement varies across Canada. To further its potential, pan-Canadian data and privacy standards, performance intelligence competencies and renewed core PHC indicators should be prioritized. Experiences across countries, coupled with increasing momentum for performance measurement using real-world data, should be leveraged to avoid unnecessarily slow progress in Canada and abroad.
Highlights
Electronic Medical Records (EMRs) are a rich data source to measure and improve quality of care
We aimed to explore challenges to be overcome for furthering the potential uses of EMR data for primary health care (PHC) performance measurement
We explored the following three questions in the Canadian context: Where is EMR data currently used as a source for performance measurement? What are the purposes of use and indicators sourced from EMR data for the initiatives identified? And, what are key considerations to furthering the use of EMR data for PHC performance measurement?
Summary
Electronic Medical Records (EMRs) are a rich data source to measure and improve quality of care. The resulting performance intelligence has important uses that extend across the micro-meso-macro contexts of health systems These uses include, for example, improving the management of a practice panel by individual physicians or PHC teams at the micro-level, assuring care standards are adhered to across networks or community health centres at the meso-level, or identifying gaps in care for population subgroups to inform strategic priorities at the macro-level [6, 8, 9]. The rich patientlevel data generated in EMRs has a number of advantages relative to other PHC data sources, such as administrative data or surveys This includes its granularity, especially for diagnosis and intervention-related information [10, 11], and its potential to link with other data sets, such as hospital discharge data. Countries with advanced secondary uses of EMR data, such as the Netherlands [12] and United Kingdom [13], have leveraged EMRs as a source for measuring the spread of community infection and its impact on population health and health services
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