What is Ontario’s new primary care record system? Silence from the ministry sparks chaos and concern

When the Ontario Ministry of Health announced on March 19 that it’s “advancing a new provincewide primary care medical record system,” there was more than a little confusion about exactly what it meant. Was it going to ditch the 12 or more EMRs that primary care in Ontario currently uses in favour of one standardized EMR? No one knew for sure and the ministry wasn’t much help clarifying the matter as repeated media enquiries went unanswered.Interviewed days after the announcement, even Ontario Medical Association president Dr. Zainab Abdurrahman couldn’t say if the ministry was proposing a single, province-wide EMR, telling the Medical Post, “It’s hard to say. It’s probably best for the Ministry of Health to answer because we’re also waiting to hear. From our perspective, the priority is to ensure that the solution reduces administrative burden, supports clinic workflow and improves how patient information is shared across the system.” Two months after the announcement there has still been no attempt by the ministry to explain exactly what it intends to advance. On May 1, Chris LeBouthillier, executive director of the West Carleton Family Health Team in Carp, just west of Ottawa, published a lengthy LinkedIn post critiquing the idea of a single, province-wide EMR. In “Enabling primary care transformation in Ontario: A practical path forward through shared data, not shared systems,” LeBouthillier argued that: “In today’s environment, clinics are already stretched . . . (and) there is little tolerance or capacity for disruptive change,” especially at a time when Ontario is attempting to increase attachment and access.“A single EMR is a real challenge that might be unnecessary,” and not only because of the change management costs, he complained. Many clinics have different programs and add-ons to their existing EMRs to support them. These would be lost if they had to change.Transitioning to a single, province-wide EMR, said LeBouthillier, would require a “full workflow redesign” across 2,500 to 3,500 clinics and retraining of between 120,000 and 160,000 primary care staff, not to mention “complex data migration across heterogeneous systems.”LeBouthillier knows what he’s talking about. He switched EMRs in 2023. “It was a one-year effort that cost hundreds of thousands of dollars in change management costs,” he recalled. “Change is hard and if you try to do it across the province, how long would it take and is it actually something that’s necessary?”Interviewed May 14 by the Medical Post, LeBouthillier claims “there was a moment of anxiety” when he read the announcement and initially assumed the ministry was indeed proposing a single province-wide EMR. He’s not so sure now, but “If I knew with 100% certainty, I probably wouldn’t have written my LinkedIn article,” he said.In its March 19 announcement, the ministry said, “Family physicians will be able to choose to transition to the new system” and promised to “explore options” to assist with “the related costs of those choosing to take part,” but LeBouthillier warned the proposed model underestimates the number of clinics that would volunteer to switch. “Primary care clinics are not passive recipients of policy decisions,” he said. “They are independent operators who must weigh the time required for transition, the impact on revenue and staffing and the immediate benefit to their patients and teams. In a strained system, the question becomes ‘Why should I disrupt my clinic today for a benefit that may come years from now.’”The Ontario Ministry of Health may be disappointed about the number of clinics adopting a new EMR given Telus’s lack of success convincing PS Suite users to convert to its Collaborative Health Record software, warned Will Falk, a healthcare strategist and executive-in-residence at the University of Toronto’s Rotman School of Management. After several years of trying to move its clients to the CHR, there are still more than 9,000 users of the PS Suite and only 1,134 clinics that have made the switch.Also, what happens to the tens of thousands of people employed by digital health companies that will lose most of their customers if a single, province-wide EMR is introduced? asks Falk.“Sometimes, monopolies work, but more often than not, they end up being smelly, cold beer fridges like Brewers’ Retail,” he warned. “The problem with monopolies in the tech world is that technology is moving at a faster pace than government can reasonably keep up. It’s moving so quickly that even people who follow it every day have trouble keeping up. We need a competitive environment in which people are bringing new things to the table.“What’s surprising to me is that the Ontario government has had so much success bringing competitive forces to bear,” added Falk. “In two years, the ambient scribe program has achieved unheard of adoption precisely because it didn’t limit choice for physicians.“I hope they’re not looking at one vendor. I can’t imagine they’re looking at just one. Their experience with the ambient scribe program has shown why multiple vendors makes sense.”“Putting all your eggs in one basket is a big problem,” agreed LeBouthillier.Instead of moving to a single, provincewide EMR, LeBouthillier proposes what he calls “a shared primary care medical record system built on a federated, push-pull data architecture” – essentially “a shared, standardized data repository. . . (of patient information) enabling access across sectors without requiring uniform software.”Making core clinical data including medications, problem lists, care plans and encounters accessible across settings would enable smoother transitions between hospital and community, better co-ordination with how care and community services are delivered and improved continuity for complex patients, claims LeBouthillier.Falk proposes the use of the international patient summary (IPS) standard with some Canadian customizations. Saved to a patient’s smartphone, for example, or a government health information repository, the IPS could be available to hospital-based physicians in the event of an emergency and to other doctors in Ontario and across Canada.If the Ontario Ministry of Health was indeed proposing a shared, standardized data repository, wouldn’t that be the result of the federal government’s Bill S-5, the Connected Care for Canadians Act, which is in the Senate with third reading in progress and destined to become law? The goal is the enforcement of digital health interoperability through the adoption of common data standards and the prohibition of data blocking by vendors. Both patients and providers would have timely access to their medical records, but surely not the entirety of a patient’s medical record that can span decades of engagement with a family doctor and include a blizzard of information.The ministry hasn’t commented on the result of a so-called market sounding exercise held April 1 for EMR vendors, nor has it issued any updates or public clarifications about its plans, but LeBouthillier says he has been assured “through other channels and messaging” that a single province-wide EMR isn’t in the cards.

What is Ontario’s new primary care record system? Silence from the ministry sparks chaos and concern

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