Mature EMR Use by Primary Care Physicians in Ontario: A Multi-Methods Study

Abstract

There is a need globally to strengthen primary health care to address population health issues, such as the increased prevalence of chronic diseases. While there is evidence supporting the benefit of using electronic medical records (EMRs) in chronic disease prevention and management (CDPM), use of advanced EMR features by health care professionals is limited. As such, little is known about the barriers and facilitating factors that influence the mature use of advanced EMR features by primary care physicians (PCPs). Furthermore, there is a gap in our knowledge of how advanced EMR features are being used to achieve their intended benefits. This study applies a multi-method approach to explore the mature use of advanced EMR features used by PCPs in the province of Ontario, Canada. Methods: This study involved three phases: 1) A systematic review to identify factors influencing PCPs’ mature use of EMR features. 2) A qualitative study to explore PCPs’ experiences with the use of advanced EMR features to support CDPM. 3) A lean process mapping study to understand how PCPs integrate advanced EMR features into their laboratory results management workflow and a recommendation for a future-state process to enhance their current-state processes of laboratory results management.

Results: 1) Of the 1893 studies identified, 14 were eligible. Reported factors that influenced PCPs’ mature use of EMRs fell into one of the following five categories: technology, people, organization, resources, and policy. Common barriers to the use of advanced EMR features were concerns about the functionality of the features, limited physician availability to learn more EMR features, poor vendor training, and lack of physician readiness. Common facilitating factors were physician’s motivation, user satisfaction, coaching and peer mentoring, physicians’ perceptions towards the benefits of using advanced EMR features with respect to the quality of care, adequate technical support and training, and practices that were in an integrated delivery system. 2) Nine face-to-face interviews with PCPs revealed key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, their level of training and technical support, user satisfaction, provider’s productivity, PCPs’ characteristics, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. 3) Observations of nine Ontario PCPs led to six improvement strategies to enhance their current-state processes of laboratory results management using advanced EMR features: (1) encourage physicians to analyze patients’ laboratory results prior to meeting them, (2) ensure that laboratory results are available on the patient’s chart prior to the patient’s appointment, (3) provide on-going training for physicians and support staff, (4) use a checklist or a software tool to reduce the mismatch rate of laboratory results to a patient’s chart, (5) maintain an adequate physician-to-staff ratio to minimize backlog, and (6) provide a mechanism (e.g., use of the EMR reminder feature or a software tool) to track patients’ laboratory results in their EMR. Conclusion: The mature use of advanced EMR features by PCPs was influenced by several factors. The findings from this study can inform vendors (e.g., IndiviCare, Telus), policymakers (e.g., The College of Physicians and Surgeons of Ontario), federal and provincial organizations responsible to drive EMR maturity (e.g., Canada Health Infoway, OntarioMD), and health care professionals in devising approaches to overcome barriers to and support mature use of EMR features for CDPM.