Evaluating the impact of electronical medical record systems on patient-centered primary care

OBJECTIVESThere is a strong movement towards patient-centered care, as well as electronic medical record systems (EMRS) implementation, particularly in primary care settings. The actual impact of EMRS on patient-centered primary care (PCPC) has yet to be investigated. The Canada Health Infoway national survey offers an opportunity to explore the link between PCPC and EMRS. The objective of this thesis is: (1) to identify a conceptual framework for PCPC that can be used to evaluate the impact of EMRS on PCPC, (2) to evaluate what elements of a screening survey provides relevant information to assess how EMRS impact PCPC, and (3) to evaluate to what extent elements of a screening survey provides adequate information to assess how EMRS impact PCPC.METHODSThe initial step consisted of conducting a literature search using articles from Embase and MEDLINE, to identify an optimal conceptual framework for PCPC to evaluate the impact of EMRS on PCPC. For the subsequent steps, secondary data from the Canada Health Infoway national screening survey was used. Surveys completed from 70 primary care clinics across Canada were obtained. Variable matching was used for each of the survey’s EMRS impact statements to qualitatively identify their relevance to each of the dimensions of the indentified PCPC conceptual framework. Subsequently, PCPC impact scores (%) were calculated from variable matching relevance scores to identify the relevance of patient-centeredness of each of the national survey’s EMRS impact statements in primary care. Additionally, for each dimension, PCPC dimensional relevance (%) as ratios amongst each other, were calculated from variable matching relevance scores to identify if the survey unequivalently captured dimensions. Finally, for each EMRS impact statement, physician agreement and PCPC impact scores were used in combination to capture physician agreement on the degree of the EMRS impact on PCPC.RESULTSThe most prevalently cited conceptual framework for patient-centered care was the 6 dimensional Patient-Centered Clinical Method. Subsequently this framework went on to be revised and condensed into the 5 dimensional Mead and Bower model. Based on these conceptual frameworks the Hudon framework was identified and adopted for this thesis. This framework consists of four over-lapping dimensions of the previous two frameworks, specifically for primary care. Out of the survey`s 20 EMRS impact statements, only 11 were positive for relevance to PCPC (PCPC impact score > 0%). The Canada Health Infoway national screening survey could only assess 12.3% (s.d. 30.2, overall mean PCPC impact score) of EMRS impact on PCPC. The PCPC dimensional relevance revealed that the survey did not equally capture the four PCPC dimensions: 42.9% for Clinician-Patient Relationship (Therapeutic Alliance) dimension, followed by 28.6% for Whole Person Care (BioPsychoSocial Perspective), 14.3% for Common Ground (Sharing Power and Responsibility), and 14.3% for Disease and Illness Experience (Patient As A Person). Physicians were in agreement that the EMRS apparently had no significant impact on PCPC (0.04 s.d. 0.63, on a Likert scale of -2 to +2).CONCLUSIONSThe Hudon conceptual framework for patient centered care was identified as the optimal model for evaluating the impact of EMRS on PCPC. The data from the Canada Health Infoway national survey was able to assess some of the dimensions of PCPC and examine the impact of EMRS on PCPC, but did not capture all the elements consistently. Certain PCPC dimensions may be more sensitive than others to EMRS implementation. Further studies need to be conducted that target the impact of EMRS on PCPC. Additionally, studies need to be conducted to identify if EMRS implementation preferentially affects the distribution of different dimensions of PCPC.

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