Using data from electronic medical records: theory versus practice.

The Issue In Canada, the measurement of quality of healthcare has historically focused on specialized hospital-based care. Considerably less is known about the quality of care provided in the offices of primary care physicians. Primary care research has relied on data collected manually from physicians’ offices or from administrative databases. Manual data collection from paper-based patient charts in primary care physicians’ offices is costly and time consuming, and often only a small portion of the information in the charts is useable due to the lack of uniform documentation. Although data from administrative databases are more readily accessible and encompass the entire population, they are limited in their depth of clinical information. The increased use of electronic medical records (EMRs) by primary care physicians presents an opportunity for the efficient extraction and use of large quantities of clinical information. EMRs capture comprehensive longitudinal information on individual patients not available from other sources, including important risk factors for health outcomes such as smoking status, family history and clinical and laboratory measurements (e.g., blood pressure, body mass index and cholesterol levels). EMR use in Canada has expanded rapidly, with many provincial governments providing funding for primary care physicians to adopt EMRs into their practices. In 2006, approximately 22% of primary care physicians in Canada (24% in Ontario) were using EMRs (Forster 2006). Canada Health Infoway, an organization established to spearhead the movement toward a national electronic health records system, has estimated that $10–12 billion dollars are needed to establish basic EMR infrastructure in Canada by 2015 (Canada Health Infoway 2007). Researchers in the United States and the United Kingdom have demonstrated the utility of EMR data for chronic disease surveillance, management and prevention and for health services research (Holt et al. 2008; Ornstein 2001; Roskell et al. 2004). However, research organizations in these countries obtain the data from a common EMR format. In Canada, there are multiple provincially accredited EMR formats in use (currently 11 in Ontario and 10 in Alberta) (Alberta Netcare 2008; OntarioMD 2008). There is also no single EMR vendor that has accreditation across all provinces. Although Canada Health Infoway and the provincial agencies are setting standards for interoperability between EMRs, the multitude of software vendors represents a particular challenge for research. In theory, gathering data that are already in an electronic format should be uncomplicated; but in practice, extracting comprehensive information from even a single EMR poses many challenges.