Table 2 Summary of common considerations for increasing EMR data use for performance measurement in the Canadian context

Governance

  Vision and political will

Gaining momentum to establish privacy and technology regulations and prioritize use of data due to lack of high-level commitment.

Build indicators into new PT-initiatives, strategies or reforms; define clear roles and uses of data from the outset.

  Privacy and data sharing regulations

Clarifying the relationship between patients, physicians and vendors regarding data ownership versus custodianship.

Engage across stakeholders from the outset including data users; improve utilisation of existing standards.

  Aligned financing structures

Ensuring PHC workforce will be paid for their time due to different payment models in primary care.

Embed measurement and improvement into payment system for fee-for-service PHC physicians; consider incentives (financial and non-financial) for salaried physicians.

Contextual

  Information system infrastructure

Lagging saturation of EMRs due to time and resource burden of negotiating with vendors and standardizing the information architecture.

Leverage developed tools from vendors for use in other contexts to accelerate progress; prioritize standardization from the outset.

  Data quality

Investing considerable time and resources to improve the quality of data due to lack of common regulations specifying data standards.

Standardize what, how and where information is to be recorded in patient records; increase use and adherence to standards through trainings.

  Workforce capacity

Ensuring PHC professionals appreciate the importance for high quality data capture and its use due to lack of training in population health and quality improvement.

Define and invest in data literacy as a PHC professional competency; ensure all levels are equipped with performance intelligence competencies.

  Professional culture

Changing behavior and professional culture due to misaligned accountability, concerns of trust, time span needed for behavior change and critical mass of users.

Engage champions to demonstrate data use in practice; integrate data use into accountability arrangements.

Implementation

  Selecting indicators

Selecting meaningful indicators due to unclear purposes of use, undefined priority indicators, challenges to capture multi-professional teamwork.

Ensure the intended use of data is clear from the outset; standardize core indicators; continuously review indicator sets with end-users.

  Accessing data

Configuring across EMR vendors to gain access to data due to varied vendors with unharmonized standards and lack of regulations for EMR vendors.

Standardize workflows for data entry; support PHC professionals through initial and continuous training.

  Displaying findings

Designing a simple, user-friendly display of findings due to differing uses and lack of prioritization of outputs.

Ensure outputs of data are intuitive, easy to navigate and improved upon with feedback from users over time.

  Reaching decision-makers

Using data in practice due to time constraints, users’ uncertainty of interpretation and lack of familiarity with tools.

Provide hands-on coaching; embed use within quality management cycles; engage improvement facilitators for change management support.