Towards a Regulatory Framework for Electronic Medical Record Interoperability in Canada

Area of Science:

• Health Services Research
• Systems Engineering
• Patient Safety

Background:

• Complex systems, including healthcare, are prone to failure.
• The Canadian healthcare system is experiencing significant strain due to provider shortages, burnout, inefficient workflows, and inadequate digital infrastructure.
• Healthcare errors can have severe consequences for patients and providers.

Purpose of the Study:

• To identify failure modes in Canadian primary care settings using Failure Mode and Effects Analysis (FMEA).
• To propose mitigation strategies to prevent patients from experiencing adverse events due to system failures.
• To outline preliminary requirements for an electronic health record regulatory regime to enhance safety and efficiency.

Main Methods:

• Applied Failure Mode and Effects Analysis (FMEA) to analyze care delivery in primary care.
• Identified specific failure points within the patient journey.
• Developed recommendations for risk mitigation and electronic health record system improvements.

Main Results:

• Key failure modes identified in appointment scheduling, patient-provider communication, referrals, laboratory/diagnostic procedures, and medication prescriptions.
• Vulnerable patients are most at risk of falling through the cracks due to these failures.
• Proposed solutions focus on 'closing the loop' to prevent system-induced harm.

Conclusions:

• Systemic failures in primary care pose significant risks to patient safety in Canada.
• Implementing targeted solutions and robust electronic health record regulations can mitigate these risks.
• Improving system efficiency, provider well-being, and patient outcomes requires addressing identified failure modes.