Are family physicians comprehensively using electronic medical records such that the data can be used for secondary purposes? A Canadian perspective

Abstract

BackgroundWith the introduction and implementation of a variety of government programs and policies to encourage adoption of electronic medical records (EMRs), EMRs are being increasingly adopted in North America. We sought to evaluate the completeness of a variety of EMR fields to determine if family physicians were comprehensively using their EMRs and the suitability of use of the data for secondary purposes in Ontario, Canada.MethodsWe examined EMR data from a convenience sample of family physicians distributed throughout Ontario within the Electronic Medical Record Administrative data Linked Database (EMRALD) as extracted in the summer of 2012. We identified all physicians with at least one year of EMR use. Measures were developed and rates of physician documentation of clinical encounters, electronic prescriptions, laboratory tests, blood pressure and weight, referrals, consultation letters, and all fields in the cumulative patient profile were calculated as a function of physician and patient time since starting on the EMR.ResultsOf the 167 physicians with at least one year of EMR use, we identified 186,237 patients. Overall, the fields with the highest level of completeness were for visit documentations and prescriptions (>70 %). Improvements were observed with increasing trends of completeness overtime for almost all EMR fields according to increasing physician time on EMR. Assessment of the influence of patient time on EMR demonstrated an increasing likelihood of the population of EMR fields overtime, with the largest improvements occurring between the first and second years.ConclusionsAll of the data fields examined appear to be reasonably complete within the first year of adoption with the biggest increase occurring the first to second year. Using all of the basic functions of the EMR appears to be occurring in the current environment of EMR adoption in Ontario. Thus the data appears to be suitable for secondary use.

Identifying Patients With Atrial Fibrillation in Administrative Data

“…At the time of the study the data in EMRALD were contributed by 83 primary care physicians who had been using their EMR for at least 2 years and whose data met quality and completeness standards. 3 EMRALD patients and physicians are similar to all Ontario patients and physicians for most characteristics. 3 A random sample of 7500 adult patients aged 20 years or older as of December 31, 2010 was drawn from 73,014 adult patients of EMRALD physicians.…”

Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

“…The physician level factor is years the physician has been using EMRs. It was previously shown that it takes approximately 2 years for a physician to adequately populate the EMR records for their practice 12. Patient level factors examined were age and sex.…”

“…However, research networks, such as the Canadian Primary Care Sentinel Surveillance Network11 and the Electronic Medical Record Administrative data Linked Database (EMRALD)12 in Canada, and the Electronic Pediatric Research in Office Settings (ePROS) network in the United States, have attempted to move EMR research forward by acting as an intermediary between primary care providers and researchers. Multiple studies have been published using these data sources to estimate both child and adult obesity rates 13 – 15.…”

Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach

“…The representativeness of EMRALD patients and physicians, in addition to the quality and comprehensiveness of EMRALD data, has been previously found to be generally reflective of the Ontario population. 28,29 Young adults and people with lower socioeconomic status are slightly under represented in EMRALD compared with the general Ontario population; however, this is likely characteristic of the types of people that see a physician and not anything specific to EMRALD patients. Relative to all Ontario physicians, EMRALD physicians practise more in rural locations and fewer are foreign-trained physicians.…”