JMIR Publications

ABSTRACT

Background:

Electronic medical record (EMR) systems are now ubiquitous in Ontario primary care, with near universal adoption among family physicians. As EMR vendors consolidate and functionality evolves, some clinics undertake EMR migrations, complex transitions that require data conversion, workflow redesign, training, and change management. Yet migration processes in community based Canadian settings remain under documented, particularly from frontline perspectives.

Objective:

To describe the operational, organizational, and human factors shaping an EMR migration within a Family Health Organization (FHO) in Peterborough, Ontario, and to distil actionable lessons for similar practices.

Methods:

A single-site, physician-led Quality Improvement (QI) study was conducted in collaboration with the Peterborough Ontario Health Team. Data sources included two semi-structured interviews, two focus group interviews, and a comprehensive document review. Sessions were recorded, transcribed, and de-identified. Themes were generated from a thematic analysis of the interviews and document review.

Results:

A total of 545 documents were reviewed including emails, meeting notes, and planning materials, to construct a chronology from initial interest (February 2022) to completion (November 2024). Four interrelated themes emerged: (1) burden of invisible labour, (2) cost and uncertainty as catalyst, (3) importance of physician leadership and (4) engage stakeholders early. Vendor partnership quality and protected time were decisive enablers.

Conclusions:

This study illuminates the process of an EMR migration within one team-based Family Health Organization. Effective transitions depend on resourcing the often-invisible work of change, sustaining physician led governance, and securing early, collaborative engagement with vendors and external partners. These findings complement provincial migration guidance by emphasising protected time for training and quality assurance (QA), local workflow adaptation, staged validation to shorten the transition period (“grey zone”), and explicit assessment of vendor responsiveness. Lessons are readily actionable for similar group practices and clinics planning future migrations or optimisations.