A Guide to Canadian Primary Care's Electronic Medical Record
Table of Contents
Healthcare providers have been using electronic medical records (EMRs) for decades as digital versions of paper-based medical records. By using an electronic medical record, doctors, nurses, and other healthcare professionals can securely store and access patient information, including their medical history, diagnoses, medications, and test results.
It has become increasingly common for primary care providers in Canada to use electronic medical records to improve the quality and efficiency of their patient care. The use of electronic medical records (EMRs) allows primary care providers to access a patient's medical history in real time, allowing them to make informed decisions about their care. EMRs also facilitate the coordination of care between healthcare professionals, which is particularly important in the context of primary care, where patients may visit several doctors and specialists for a variety of health conditions.
EMRs have proven to be beneficial for Canadian primary care clinics in improving patient outcomes, improving the patient experience, and streamlining their daily operations.
The purpose of this blog post is to provide an overview of the adoption and use of EMRs in Canadian primary care.
What is an EMR?
Electronic Medical Records (EMR) are digital versions of paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment.
Electronic Health Records (EHR) are digital health information records that include a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results. EHRs are designed to be shared across healthcare settings, such as hospitals, clinics, Imaging Centres, etc. EHRs contain information from all clinicians involved in a patient’s care; all authorized clinicians can access the record.
The main difference between EMRs and EHRs is that EHRs are maintained by multiple providers, while EMRs are maintained only by one provider. This means that an EHR contains more information and offers a more wholistic view to a patient's medical history compared to an EMR. Another difference is that EHRs are designed to be interoperable, while EMRs are not. Interoperability means that different systems can share and use data with each other. This is important because it allows providers access to a patient’s complete medical history even if they see multiple providers.
Procuring an EMR requires careful consideration of the needs of the practice or hospital. The following factors should be considered when procuring an EMR: cost, ease of use, interoperability with other systems, security features, and training requirements for staff.
Overview of EMR Adoption in Canada
More than 87% of Canadian primary care physicians are using an Electronic Medical Record (EMR) to store patient records as part of their daily practice. Even though most hospitals and large organizations have moved to more advanced and modern EMRs like Epic, Cerner, and Meditech recently, most clinics and medical practices still use old, outdated software.
There are, however, several factors contributing to the growth of EMRs in Canadian primary care. For example, finance and support from the government and other stakeholders have been key drivers of the revolution. The Canadian federal government provides grants and other incentives to encourage primary care providers to adopt EMRs. Furthermore, many primary care clinics and organizations are investing in EMRs due to their benefits.
Another factor contributing to EMR growth in primary care is the development of user-friendly, cheap EMR systems. Before EMRs became more widely adopted, primary care providers were wary due to concerns about their complexity and cost.
The costs of implementing a modern EMR are high, and many clinics and practices opt to stay with what they are already using, despite numerous reports that many traditional EMR methods contribute to physician burnout.
Listed below are the major Canadian electronic medical record companies. Over 95% of primary care EMRs in healthcare are operated by these three software companies; Telus Health, WELL Health, and QHR Technologies.
In essence, these companies acquire and manage a large number of electronic medical records (EMRs) used in primary care. As an example:
Telus Health: Telus Health is a division of Telus Corporation, one of Canada's largest telecommunications companies. Telus Health operates the largest number of electronic medical record (EMR) systems in Canada. They provide various EMR solutions, including CHR (Input Health), PS Suite ( PSS), Med Access and Medesync (active mostly in the province of Quebec) among others. With over 40,000 physicians and estimated 110,000 clinicians using Telus EMRs, Telus Health has a significant presence in Canadian primary care.
WELL Health: WELL Health is a technology company that specializes in digital health solutions. They operate several EMR systems in Canadian primary care, including Oscar Pro, Intra Health, Juno, and Cerebrum. They have a large customer base, serving more than 23,000 clinicians. WELL Health also focuses on integration and extendibility, offering an integration layer through their Apps.health store, where physicians can choose additional solutions to enhance their EMR functionality.
QHR Technologies: QHR Technologies is another prominent player in the Canadian EMR market. They primarily operate the Accuro EMR system, which is used by around 20,000 physicians. QHR Technologies focuses on delivering EMR solutions that meet the needs of healthcare providers.
Among other notable EMR companies in Canada are MedFar (primarily in QC), HealthQuest (primarily in Alberta), Ava (primarily in Alberta), Arya (primarily in BC).
When it comes to deciding which EMR best suits your practice, you should take into account the following factors:
Key Factors to Consider When Choosing an EMR System
Selecting the right Electronic Medical Record (EMR) system is crucial for healthcare providers in Canadian primary care. Several factors should be taken into account when making this decision. This section will briefly outline the key considerations to help healthcare professionals choose an EMR system that best suits their practice. The factors include:
Web-based EMR vs. Desktop-based EMR
Choosing between a web-based or a desktop-based EMR involves assessing the accessibility and convenience of accessing patient records from various locations. Web-based EMRs are the software solutions you can open in a browser (Google Chrome, Firefox, etc.). Desktop applications on the other hand, are the ones you need to install on your machine.
Note: Your EMR can still be cloud-based whether it is a web or a desktop application. A cloud-based EMR, will store patient records on a remote server which gives you the flexibility of accessing the records later at home or from other locations. On the other hand, for EMRs that are not cloud based, you would have to be at the location of the clinic or the hospital to get access to the records which is historically (and not necessarily realistically) perceived to be more secure.
| Criteria | Web-based EMR | Desktop-based EMR |
|---|---|---|
Accessibility | Accessible from any location with an internet connection (home, hospital, mobile devices) | Limited accessibility, typically restricted to the device on which the EMR is installed |
Convenience | Convenient and flexible for practices with multiple locations or providers who need remote access | Requires physical presence in the office or access to the device with the installed EMR for record access |
Infrastructure | Relies on a secure internet connection and data servers | Requires local installation and may need additional hardware infrastructure |
Updates & Maintenance | System updates and maintenance handled by the EMR provider | Updates and maintenance need to be managed locally by the practice |
IT Requirements | Minimal IT infrastructure required, as most technical aspects are managed by the EMR provider | Practices need to manage and maintain their IT infrastructure, including hardware, backups, and security measures |
Cost | Often subscription-based, with regular fees for usage and support | Typically involves higher upfront costs for software licenses and infrastructure setup |
Scalability | Easily scalable for growing practices or those with multiple locations | Limited scalability and may require additional setup for expansion |
Internet Dependence | Reliant on a stable internet connection for access and functionality | Not dependent on internet connectivity for local access and operations |
Security | Data is stored on secure servers, with encryption and backup measures in place | Data security relies on local measures implemented by the practice |
Interoperability & Extendibility
Integrating other technologies with an EMR is a great way to extend its functionality. With their apps.health store, WELL Health is leading the way in providing an integration layer for other technologies. Similar to the Apple App Store for iPhone, the Apps.health store allows physicians to choose the solutions that they want to use to make their EMR more intelligent. Tali AI is one example of these apps. It is a voice assistant that helps clinicians save time on documentation and administrative tasks using a voice interface.
There are other EMRs that are also moving toward this concept, but at the time of this article in 2024, apps.health is the only EMR app store in Canada.
Maintenance
Each of these companies has a different level of service based on which company maintains your EMR and where it ranks on its priority list. For example, Telus Health has developed a strategy to gradually move all of its physicians to a CHR (Input Health).
As a result, if you use one of their other EMRs (PS Suite, for example), you won't receive as many bug fixes and feature enhancements as you would with CHR.
WELL Health on the other side is gradually moving all their clinicians to Oscar Pro, so compared to their other EMRs like Juno, you will have a better chance at getting support and continuous improvement if you start with Oscar Pro.
Certified EMRs
You can also talk to your local health authority for recommendations for certified EMRs for physicians in addition to all of the items mentioned above. For instance, OntarioMD reviews and validates EMRs for physicians on this list. They review and validate the EMRs of these organizations so that practices and physicians do not have to go through the process individually.
Final Thoughts
Ultimately, EMRs improve patient care and increase efficiency in the healthcare industry. There are still opportunities and challenges associated with the implementation of EMRs in Canada, but the adoption of these systems is growing.
Throughout this blog post, we have provided an overview of the guide and highlighted some key considerations. By implementing the right EMR, healthcare providers can better serve their patients and support the Canadian healthcare system as a whole.
Contact us if you would like to learn more about different EMRs in Canadian primary care, and their use cases.
Documentation and Administrative Tasks?
