title: Progress in the Enhanced Use of Electronic Medical Records: Data From the Ontario Experience.
abstract: BACKGROUND
  This paper describes a change management strategy, including a self-assessment survey tool and electronic medical record (EMR) maturity model (EMM), developed to support the adoption and implementation of EMRs among community-based physicians in the province of Ontario, Canada.
  
  
  OBJECTIVE
  The aim of our study was to present an analysis of progress in EMR use in the province of Ontario based on data from surveys completed by over 4000 EMR users.
  
  
  METHODS
  The EMM and the EMR progress report (EPR) survey tool clarify levels of capability and expected benefits of improved use. Maturity is assessed on a 6-point scale (0-5) for 25 functions, across 7 functional areas, ranging from basic to more advanced. A total of 4214 clinicians completed EPR surveys between April 2013 and March 2016. Univariate and multivariate descriptive statistics were calculated to describe the survey results.
  
  
  RESULTS
  Physicians reported continual improvement over years of use, perceiving that the longer they used their EMR, the better patient care they provided. Those with at least two years of experience reported the greatest progress.
  
  
  CONCLUSIONS
  From our analyses at this stage we identified: (1) a direct correlation between years of EMR use and EMR maturity as measured in our model, (2) a similar positive correlation between years of EMR use and the perception that these systems improve clinical care in at least four patient-centered areas, and (3) evidence of ongoing improvement even in advanced years of use. Future analyses will be supplemented by qualitative and quantitative data collected from field staff engagements as part of the new EMR practice enhancement program (EPEP).
authors.affiliation: OntarioMD, Toronto, ON, Canada.
authors.forename: Mavis
authors.identifier: http://orcid.org/0000-0002-6701-3186
authors.initials: M
authors.lastname: Jones
authors.affiliation: OntarioMD, Toronto, ON, Canada.
authors.forename: Chad
authors.identifier: http://orcid.org/0000-0001-8634-5672
authors.initials: C
authors.lastname: Koziel
authors.affiliation: OntarioMD, Toronto, ON, Canada.
authors.forename: Darren
authors.identifier: http://orcid.org/0000-0003-0614-4251
authors.initials: D
authors.lastname: Larsen
authors.affiliation: Formerly with OntarioMD, Toronto, ON, Canada.
authors.forename: Plumaletta
authors.identifier: http://orcid.org/0000-0003-1085-2357
authors.initials: P
authors.lastname: Berry
authors.affiliation: Formerly with the Ontario Medical Association, Toronto, ON, Canada.
authors.forename: Elena
authors.identifier: http://orcid.org/0000-0001-9921-2887
authors.initials: E
authors.lastname: Kubatka-Willms
keywords: electronic medical record; primary care; quality of health care