title: Understanding the Impact of Electronic Medical Record Use on Practice-Based Population Health Management: A Mixed-Method Study.
abstract: BACKGROUND
  Practice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown.
  
  
  OBJECTIVE
  We conducted the Canadian Population Health Management Challenge to determine the capacity and preparedness of primary care settings to engage in PBPH using their existing medical record systems and to understand the complexities that may exist in PBPH implementation.
  
  
  METHODS
  We recruited a sample of electronic medical record (EMR) -enabled and paper-based clinics from across Canada to participate in the challenge. The challenge required clinic staff and physicians to complete time-controlled, evidence-based practice reviews of their patients who may benefit from evidence-informed care, treatment, or interventions across five different areas (immunization, postmyocardial infarction care, cancer screening, diabetes management, and medication recall). We formulated a preparedness index to measure the capacity of clinics to engage in PBPH management. Finally, we conducted follow-up qualitative interviews to provide richer understanding of PBPH implementation and related issues (ie, challenges and facilitators).
  
  
  RESULTS
  A total of 11 primary care clinics participated, representing 21 clinician practices. EMR-enabled clinics completed a full review of charts in an average of 1.37 hours. On the contrary, paper-based clinics reviewed nearly 10% of their charts in an average of 3.9 hours, hinting that they would have required an estimated 40 hours to complete a review of charts in their practice. Furthermore, the index revealed a major gap in preparedness between the EMR and paper-based clinics (0.86-3.78 vs 0.05-0.12), as well as a broad range among the EMR clinics. Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.
  
  
  CONCLUSIONS
  Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH. The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.
authors.affiliation: School of Management, State University of New York at Binghamton, Binghamton, NY, United States. svaghefi@binghamton.edu.
authors.forename: Isaac
authors.identifier: http://orcid.org/0000-0002-8143-0832
authors.initials: I
authors.lastname: Vaghefi
authors.forename: John B
authors.identifier: http://orcid.org/0000-0002-4513-2395
authors.initials: JB
authors.lastname: Hughes
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0001-5196-2267
authors.initials: S
authors.lastname: Law
authors.forename: Michel
authors.identifier: http://orcid.org/0000-0002-6779-930X
authors.initials: M
authors.lastname: Lortie
authors.forename: Chad
authors.identifier: http://orcid.org/0000-0002-4562-5202
authors.initials: C
authors.lastname: Leaver
authors.forename: Liette
authors.identifier: http://orcid.org/0000-0001-5647-0886
authors.initials: L
authors.lastname: Lapointe
keywords: electronic medical records; medical informatics; population health management; practice-based care; primary health care