Electronic medical records and primary care quality: Evidence from Manitoba

Abstract

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient-and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs. K E Y W O R D Selectronic medical records, Manitoba, primary care, quality of care | INTRODUCTIONRapid physician adoption of digital records to support healthcare delivery has occurred over the last decade, with estimates of only 15% of primary care practitioners (PCPs) still using paper-based records by 2017 in Canada (Gheorghiu & Leaver, 2019). An electronic medical record (EMR), the term used throughout this study, 1 is a secure and integrated digital collection of a patient's encounters with clinicians (Canada Health Infoway, 2019). This includes but is not limited to patient demographics, progress notes, medications, vital signs, medical history, immunizations, laboratory data, and radiology reports (WHO, 2012). The current versions of EMRs also comprise an embedded set of professional decision support tools such as practice guidelines, expert analysis, reminders, and secure communications with other clinicians and health care practitioners such as pharmacists (WHO, 2012).