Table 2.

Summary of common considerations for increasing EMR data use for performance measurement in the Canadian context

Consideration	Main challenge	Lessons from initiatives
Governance
Vision and political will	Gaining momentum to establish privacy and technology regulations and prioritize use of data due to lack of high-level commitment.	Build indicators into new PT-initiatives, strategies or reforms; define clear roles and uses of data from the outset.
Privacy and data sharing regulations	Clarifying the relationship between patients, physicians and vendors regarding data ownership versus custodianship.	Engage across stakeholders from the outset including data users; improve utilisation of existing standards.
Aligned financing structures	Ensuring PHC workforce will be paid for their time due to different payment models in primary care.	Embed measurement and improvement into payment system for fee-for-service PHC physicians; consider incentives (financial and non-financial) for salaried physicians.
Contextual
Information system infrastructure	Lagging saturation of EMRs due to time and resource burden of negotiating with vendors and standardizing the information architecture.	Leverage developed tools from vendors for use in other contexts to accelerate progress; prioritize standardization from the outset.
Data quality	Investing considerable time and resources to improve the quality of data due to lack of common regulations specifying data standards.	Standardize what, how and where information is to be recorded in patient records; increase use and adherence to standards through trainings.
Workforce capacity	Ensuring PHC professionals appreciate the importance for high quality data capture and its use due to lack of training in population health and quality improvement.	Define and invest in data literacy as a PHC professional competency; ensure all levels are equipped with performance intelligence competencies.
Professional culture	Changing behavior and professional culture due to misaligned accountability, concerns of trust, time span needed for behavior change and critical mass of users.	Engage champions to demonstrate data use in practice; integrate data use into accountability arrangements.
Implementation
Selecting indicators	Selecting meaningful indicators due to unclear purposes of use, undefined priority indicators, challenges to capture multi-professional teamwork.	Ensure the intended use of data is clear from the outset; standardize core indicators; continuously review indicator sets with end-users.
Accessing data	Configuring across EMR vendors to gain access to data due to varied vendors with unharmonized standards and lack of regulations for EMR vendors.	Standardize workflows for data entry; support PHC professionals through initial and continuous training.
Displaying findings	Designing a simple, user-friendly display of findings due to differing uses and lack of prioritization of outputs.	Ensure outputs of data are intuitive, easy to navigate and improved upon with feedback from users over time.
Reaching decision-makers	Using data in practice due to time constraints, users’ uncertainty of interpretation and lack of familiarity with tools.	Provide hands-on coaching; embed use within quality management cycles; engage improvement facilitators for change management support.

Abbreviations: AFHTO Association of Family Health Teams, The Alliance The Alliance for Healthier Communities, BIRT Business Intelligence Reporting Tool, CHCs community health centres, CPCSSN Canadian Primary Care Sentinel Surveillance Network, D2D Data2Decisions, FHTs family health teams, HDC Discover Health Data Coalition Discover, Manitoba PCQI Manitoba Primary Care Quality Indicators, QIDSS Quality Improvement Decision Support Specialists.