The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study.

backgroundThe benefits of a fully integrated electronic medical record (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, specialist physicians, and other health care providers.

objectiveThis 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 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination.

methodsA comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians' perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings.

resultsThe 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<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08% and 39.7%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37).

conclusionsOur 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 health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature.