How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature

Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context.

This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels.

Seven bibliographic databases were searched using primary health care and EMR keywords. Publication abstracts were reviewed and categorised. First author affiliation was used to identify country of origin. Proportions of Canadian- and non-Canadian-authored publications were compared using Fisher's exact test. For countries having 10 or more primary healthcare EMR publications, publications per 10 000 researchers were calculated.

After exclusions, 750 publications were identified. More than one-third used primary healthcare EMRs as a study data source. Twenty-two (3%) were Canadian-authored. There were significantly different publication levels in three categories between Canadian- and non-Canadian-authored publications. Based on publications per researchers, the Netherlands ranked first, while Canada ranked eighth of nine countries with 10 or more publications.

A relatively small body of literature focused on EMRs in primary health care exists; publications by Canadian authors were low. This study highlights the need to develop a strong evidence base to support the effective implementation and use of EMRs in Canadian primary health care.