title: The value of connected health information: perceptions of electronic health record users in Canada.
abstract: As health care becomes more complex, it becomes more important for clinicians and patients to share information. Electronic health information exchange can help address this need. To this end, all provinces and territories (PTs) in Canada have created interoperable electronic health records (iEHRs). These secure systems offer authorized users an integrated view of a person's healthcare history across the continuum of care. They include information such as lab results, medications, diagnostic images, clinical reports and immunization profiles. This study explores user experiences and perceived outcomes of iEHR use.
  
  
  
  Surveys conducted between 2006 and 2014 asked iEHR users in six Canadian PTs about system, information and service quality; iEHR use and user satisfaction; and net quality and productivity benefits. The surveys had a core set of questions that used Likert-type scales. Results were synthesized across surveys for each evaluative dimension. Consensus among researchers and subject matter experts on whether to classify the outcomes as positive, mixed/neutral, or negative was established using a modified Delphi technique.
  
  
  
  A total of 2316 iEHR users responded to the six surveys. Information quality was the most studied area. Results varied across PTs, but positive outcomes were more common than mixed/neutral or negative outcomes by a 19:1:1 ratio across this dimension. The next most frequently studied aspects were user satisfaction, the impact of iEHR use on quality of care, and the impact on productivity. In all three areas, there were more positive than mixed/neutral or /negative results (ratios of 13:1:1, 14:3:1, and 15:2:1respectively).
  
  
  
  Overall, users of iEHRs that provide secure access to patient information collated from across the health system tend to report positive outcomes, including quality of care and productivity. This study is an important first step in understanding user perspectives on iEHRs and health information exchange more broadly.
authors.affiliation: Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada. stharmalingam@infoway-inforoute.ca.
authors.forename: Sukirtha
authors.identifier: 0000-0003-2666-3585
authors.initials: S
authors.lastname: Tharmalingam
authors.affiliation: Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Hagens
authors.affiliation: Canada Health Infoway-Inforoute Santé du Canada, 150 King St. W., Ste 1300, Toronto, M5H 1 J9, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zelmer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: Benefits; Electronic health records; Evaluation; Health information exchange; Interoperability