JMIR Publications

ABSTRACT

Background:

The benefits of a fully integrated EMR system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians (PCPs), specialist physicians, and other healthcare providers.

Objective:

This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in three specific areas, namely patient diagnosis tracking, patient care management, and patient coordination.

Methods:

A comprehensive, mixed-method examination using three different data sources (EMR consultation data, clinician survey data, and in-depth interviews) was conducted. The EMR data consists of patient encounters referred to a specialist clinic from six primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,505 specialist consultation episodes referred to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. Econometric modeling was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted on the clinicians 18 months post-integration. The clinicians’ perception of the integration was measured to triangulate the empirical observation from the patient encounters and the post-implementation perception survey was analyzed to triangulate the earlier econometric results. Concurrently, a total of 30 interviews were conducted between 16 Mar 2021 to 28 Jul 2021 with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration which further inform our quantitative findings.

Results:

The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (p< 0.01). Patients were also subjected to less repeated procedures and tests; the number of procedures, X-rays, and overall bill sizes all decreased to between 7.8% and 39.7% (p<0.01), resulting in reduced healthcare resource wastage while maintaining similar medical outcomes (p>0.1).

Conclusions:

Our study's results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in healthcare delivery and joint patient management in a medical neighbourhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature.