How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature.

BACKGROUND: Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context. OBJECTIVES: This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels. METHODS: Seven bibliographic databases were searched using primary health care and EMR keywords. Publication abstracts were reviewed and categorised. First author affiliation was used to identify country of origin. Proportions of Canadian- and non-Canadian-authored publications were compared using Fisher's exact test. For countries having 10 or more primary healthcare EMR publications, publications per 10 000 researchers were calculated. RESULTS: After exclusions, 750 publications were identified. More than one-third used primary healthcare EMRs as a study data source. Twenty-two (3%) were Canadian-authored. There were significantly different publication levels in three categories between Canadian- and non-Canadian-authored publications. Based on publications per researchers, the Netherlands ranked first, while Canada ranked eighth of nine countries with 10 or more publications. CONCLUSIONS: A relatively small body of literature focused on EMRs in primary health care exists; publications by Canadian authors were low. This study highlights the need to develop a strong evidence base to support the effective implementation and use of EMRs in Canadian primary health care.

Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak.

BACKGROUND: Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. METHODS: Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. RESULTS: The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. CONCLUSIONS: The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks.

Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training.

OBJECTIVE: To increase the overall 2007 response rate of the National Physician Survey (NPS) from the survey's 2004 rate of response with the implementation of various methodologic strategies. DESIGN: Physicians were stratified to receive either a long version (12 pages) or a short version (6 pages) of the survey (38% and 62%, respectively). Mixed modes of contact were used-58% were contacted by e-mail and 42% by regular mail-with multiple modes of contact attempted for nonrespondents. The self-administered, confidential surveys were distributed in either English or French. Medical residents and students received e-mail surveys only and were offered a substantial monetary lottery incentive for completing their surveys. A professional communications firm assisted in marketing the survey and delivered advance notification of its impending distribution. SETTING: Canada. PARTICIPANTS: A total of 62 441 practising physicians, 2627 second-year medical residents, and 9162 medical students in Canada. RESULTS: Of the practising physicians group, 60 811 participants were eligible and 19 239 replied, for an overall 2007 study response rate of 31.64% (compared with 35.85% in 2004). No difference in rate of response was found between the longer and shorter versions of the survey. If contacted by regular mail, the response rate was 34.1%; the e-mail group had a response rate of 29.9%. Medical student and resident response rates were 30.8% and 27.9%, respectively (compared with 31.2% and 35.6% in 2004). CONCLUSION: Despite shortening the questionnaires, contacting more physicians by e-mail, and enhancing marketing and follow-up, the 2007 NPS response rate for practising physicians did not surpass the 2004 NPS response rate. Offering a monetary lottery incentive to medical residents and students was also unsuccessful in increasing their response rates. The role of surveys in gathering information from physicians and physicians-in-training remains problematic. Researchers need to investigate alternative strategies for achieving higher rates of response.

Stepping Up to the Plate: An Agenda for Research and Policy Action on Electronic Medical Records in Canadian Primary Healthcare.

Building on a previous study, which identified gaps in primary healthcare electronic medical record (emr) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. one facet focuses on the need for research. The second facet focuses on harnessing the knowledge of primary healthcare emr stakeholders. finally, the third facet focuses on policy actions. this paper offers consensus-based suggestions with a view to improving the overall primary healthcare emr landscape in canada.

Gaps in primary healthcare electronic medical record research and knowledge: findings of a pan-Canadian study.

While the barriers to electronic medical record (EMR) adoption by physicians are well-known, we have much less knowledge about the broader challenges regarding EMR use faced by primary healthcare (PHC) EMR stakeholders in Canada. Therefore, we conducted interviews (from June 2009 to September 2010) and consultation sessions (in October and November 2009) with these stakeholders, as well as carrying out a research capacity assessment, to identify, describe and prioritize gaps in PHC EMR knowledge and research. Twelve thematic gaps emerged; four were identified as the most important: the need to ascertain the value of EMRs, the need to better understand elements of EMR implementation and adoption, the need to develop innovative data entry and extraction procedures, and a lack of agreement and understanding of data sharing. To advance EMR use, Canada needs to address these gaps; yet, we currently have a lack of research capacity with which to accomplish this.