Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health Information Science

Supervisor

Gibson, Candace J.

2nd Supervisor

Ajiferuke, Isola

3rd Supervisor

Terry, Amanda L.

Abstract

Regional initiatives in the health care context in Canada are typically organized and administered along geographic boundaries or operational units. Regional integration of Electronic Medical Records (EMR) has been continuing across Canadian provinces in recent years, yet the use and impact of regionally integrated EMRs are not routinely assessed and questions remain about their impact on and use in physicians’ practices. Are stated goals of simplifying connections and sharing of electronic health information collected and managed by many health services providers being met? What are physicians’ perspectives on the use and impact of regionally integrated EMR? In this thesis, I examined how primary health care and family physicians use electronic medical records and associated electronic health information resources in South West Ontario, the challenges they face in doing so, as well as the impact of an integrated EMR. A mixed methods-grounded theory research approach was employed to explore physician EMR use, and data acquired using participant consultation, observership and shadowing, semi-structured interviews, and a self-administered questionnaire. The study revealed that there are clear and present challenges to regional integration of EMR. Although regional integration initiatives such as implementation of ClinicalConnect, a regional EMR clinical viewer, continue to expand, physicians face challenges related to implementation, support and advanced use of electronic records. Not every patient has data access, patient portals are often not fully integrated, and the impact of EMR transitioning can reshape a primary care physician practice. A comprehensive model of physician integrated EMR use and a six-stage maturity model were developed from this study: The comprehensive model conceptualizes how the experience of EMR transitioning, managing patient expectation, meeting information needs, engaging regional entities, support and practice context, influence physician perception of EMR integration, and often resulted in practice changing moments. It further describes influences on physician perception of EMR use by EMR offering, EMR content, integration tools, information attributes, practice type, and patient and physician characteristics. The six-stage maturity model provides a framework that describes key elements of operative EMR use within the context of regional integration of electronic health information resources. It enhances understanding of EMR maturity by shifting orientation from theoretical evolutionary improvement path, which characterized prior maturity models, to assessment of EMR maturity based on how practicing physicians actually use EMR in primary health care. Insights from this study will advance understanding of regional integration of electronic medical records and serve as additional resource for individuals interested in assessment of the use and impact of electronic health information resources in primary health care.

Summary for Lay Audience

In this thesis, I examined how primary health care and family physicians use electronic medical records and associated electronic health information resources in South West Ontario, the challenges they face in doing so, as well as the impact of an integrated EMR. A mixed methods-grounded theory research approach was employed to explore physician EMR use, and data acquired using participant consultation, observership and shadowing, semi-structured interviews, and a self-administered questionnaire. The study revealed that there are clear and present challenges to regional integration of EMR. Although regional integration initiatives such as implementation of ClinicalConnect, a regional EMR clinical viewer, continue to expand, physicians face challenges related to implementation, support and advanced use of electronic records. Not every patient has data access, patient portals are often not fully integrated, and the impact of EMR transitioning can reshape a primary care physician practice. A comprehensive model of physician integrated EMR use and a six-stage maturity model were developed from this study: The comprehensive model conceptualizes how the experience of EMR transitioning, managing patient expectation, meeting information needs, engaging regional entities, support and practice context, influence physician perception of EMR integration, and often resulted in practice changing moments. It further describes influences on physician perception of EMR use by EMR offering, EMR content, integration tools, information attributes, practice type, and patient and physician characteristics. The six-stage maturity model provides a framework that describes key elements of operative EMR use within the context of regional integration of electronic health information resources. It enhances understanding of EMR maturity by shifting orientation from theoretical evolutionary improvement path, which characterized prior maturity models, to assessment of EMR maturity based on how practicing physicians actually use EMR in primary health care. Insights from this study will advance understanding of regional integration of electronic medical records and serve as additional resource for individuals interested in assessment of the use and impact of electronic health information resources in primary health care.

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