Abstract
Introduction: Despite the increasing uptake of electronic medical record
(EMR) software in Primary Care, there has been little effort to date to
utilize this software to conduct pragmatic comparative effectiveness
research (CER) trials in Primary Care. Objectives: The primary objective
of the study was to design an implementation framework composed of key
self-reflective questions and a prototype patient recruitment interface
to aid in CER studies in Primary Care using current-generation EMR
products. Research Questions: What is the current state of EMR usage for
CER in Primary Care? What are the barriers (technological,
methodological, ethical and practical) to implementing CER in Primary
Care? Methods: We incorporated selected key stakeholders in discussions
to improve on an initial CER framework prototype and “sham” EMR module
for patient recruitment. We iterated on both after discussions with each
participant. Participants included researchers with an interest in
Primary Care research, technical representatives of EMR vendors, and
Family Physicians. Results: There was little familiarity and no apparent
impetus from the vendor to collaborate in this type of research. There
is a common theme of frustration from researchers directed at the
difficulty in access EMR databases from a large field of vendors. From
the clinician side, physicians are generally reluctant to participate in
CER research without effective compensation for time spent. Patient
recruitment interfaces should be designed to be as simple and
straightforward as possible. Conclusion: There are currently multiple
barriers to conducting EMR-enabled research in Primary Care. The largest
and most important barrier is the lack of effective IT infrastructure to
support this type of research. Although this type of research is overall
more cost-effective, there are significant upfront costs in creating the
initial study infrastructure that private vendors are unlikely to bear
themselves. Ideally, government would step forward and implement the
backend infrastructure with which EMR vendors can interface to help
enable this type of research. In the future, researchers will need to
clearly outline the business case for vendors to participate in Primary
Care research.