Using Electronic Medical Records to Assess and Improve Primary Care Physicians’ Performance of Chronic Disease Management in Ontario

Through five original studies, this thesis studies if and how electronic medical records (EMRs) can be used meaningfully to target improvements in chronic disease management in primary care practices in Ontario. The thesis answers four areas concerning primary care EMRs. First, it identifies if EMRs can be used to accurately identify patients with chronic disease (COPD). Second, it studies if EMR systems can measure primary care physicians’ adherence to clinical practice guidelines for patients with respiratory or cardiovascular diseases (CVD) or risk. Third it looks at if EMRs can be used to assess provider or patient characteristics that are associated with the provision or receipt of guideline adherent care respiratory or vascular disease management. Finally, this thesis examines the barriers to and facilitators for the adoption and routine use of EMR tools designed to increase guideline-adherence in primary care. Identifying patients with certain conditions is essential to target quality improvement initiatives and audit current performance. The thesis demonstrates that EMRs could be used to accurately identify patients with COPD. Aspects of chronic disease care, namely primary care physicians’ adherence to clinical practice guidelines and quality indicators for CVD and COPD are possible to measure when they are quantifiable or coded in semi-structured or structured formats in the EMR. It is possible to link EMR data to external data sources to investigate if there are provider or patient characteristics associated with meeting the quality indicator criteria (including the effects of health service utilization data, socioeconomic data and clinical data). This thesis provides insight into important considerations for building a quality improvement intervention using EMR data as a platform or data source by identifying key barriers to, and facilitators for the adoption of EMR-based tools designed to increase guideline-adherence in primary care. We identified key limitations to using EMR data to measure primary care quality, which would be important to consider in future efforts to use EMRs for primary care quality improvement and performance management. It is essential that policymakers take into consideration sociotechnical aspects of the healthcare system and delivery when considering the use of EMRs for quality improvement.Ph.D