Examining Electronic Medical Record Migration in a Team-Based Primary Care Clinic: Case Study

Area of Science:

• Health Informatics
• Primary Care Management
• Health Services Research

Background:

• Electronic Medical Record (EMR) systems are widely adopted in Ontario primary care, impacting clinical and administrative workflows.
• EMR migrations are complex transitions involving data conversion, workflow redesign, and change management.
• Understanding the practical challenges of EMR migration from frontline staff perspectives in Canadian primary care is limited.

Purpose of the Study:

• To describe an EMR migration within a team-based Family Health Organization (FHO) from the perspective of frontline clinicians and staff.
• To assess factors influencing the migration decision, implementation, and practical lessons learned.
• To provide insights for supporting and evaluating future EMR transitions in primary care settings.

Main Methods:

• A single-site, physician-led quality improvement project utilizing an exploratory case study approach.
• Purposive sampling of 23 individuals involved in the EMR migration (physicians, administrators, interprofessional providers, MOAs).
• Data collection through semi-structured interviews, focus groups, and document review over planning, implementation, and stabilization phases.

Main Results:

• Four themes emerged: invisible labor burden, cost/uncertainty as a catalyst, physician leadership importance, and early stakeholder engagement.
• Migration is resource-intensive, influenced by unpaid work, cost pressures, governance, and vendor responsiveness.
• Successful transitions require addressing hidden work, physician-led governance, and collaborative vendor engagement.

Conclusions:

• EMR migrations necessitate resourcing 'invisible' change work and sustained physician leadership.
• Early, collaborative engagement with vendors and partners is crucial for effective transitions.
• Actionable lessons include protected training time, local workflow adaptation, staged validation, and assessing vendor responsiveness.