With the more than 80% of primary care physicians in Ontario now using OntarioMD-certified EMRs, physicians are shifting their focus from adoption to maturity of use and integrating their EMRs with other provincial digital health assets, which together, encompass electronic health records (EHRs) for Ontarians.

With this shift, OntarioMD’s EMR Certification Program is also evolving its focus towards requirements that drive maturity of use through clinical tools, EHR connectivity, service delivery, privacy and security and the exchange of health information with EMRs.

OntarioMD’s renewed EMR Certification Program also aligns with a key objective within the Ontario Ministry of Health and Long-Term Care’s Patients First: Digital Health Strategy “to realize the full potential of EMRs to support clinical practice or to share key information needed to improve care coordination; this should include improved interoperability and connection to provincial assets, and increased maturity of EMR use”.

Two key objectives driving mature use of EMRs include:

• Improved clinical value of EMRs:
• Access to new/updated provincial EHR Solutions and Services (e.g.,  Ontario Laboratories Information System (OLIS), Health Report Manager (HRM) and future services such as eConsult, immunizations, medications)
• Fit-for-purpose EMRs and use of Clinical Tools such as an EMR Dashboard
• Use of centrally-managed (hosted) EMRs
• Innovative solutions by EMR vendors and their partners
• Improved exchange of EMR data:
• Improved data quality
• Access to, and exchange of EMR data

Open Primary Care EMR Certification

As of August 1, 2017, OntarioMD is moving to an “Open” Certification model for Primary Care EMR Offerings which will enable new entrants to apply at any time. Certification will be open to new entrants not previously certified.

EMR offerings that are currently certified will remain certified subject to their ongoing alignment to the applicable EMR Specification(s) and their obligations under the current Certification Agreement.

Market Opportunity / EMR Landscape

It is important for new entrants to consider that while there are some community-based physicians who have yet to adopt an EMR, EMRs have already been adopted by over 14,000 community-based physicians in Ontario. Market share information is updated regularly by OntarioMD. As the EMR landscape continues to mature, practices/physicians may:

• Decide to choose an alternate EMR which more closely aligns to their practice needs, e.g., a ‘fit-for-purpose’ EMR targeted for their specialty, care group or care delivery model
• Decide to choose to migrate away from their EMR installed locally within their practice towards a centrally managed (hosted) EMR solution
• Be required to choose an alternate EMR, e.g., driven by the market exit of an EMR vendor.

EMR Offering

An EMR offering means a specific single version of an EMR product and the services related to the provision and support of that particular product, including development, delivery, maintenance, administration, facilities, operation and support, and services including Tier 1 and Tier 2 support and interfaces to provincial EHR Solutions and Services and laboratories.  An EMR offering may also include hardware, third-party software, peripherals and communications equipment and may be either a Hosted EMR or a Local EMR.

History of OntarioMD EMR Certification

OntarioMD’s EMR Certification Program was established in 2001 to promote the adoption of EMRs by community-based physicians. Funding was provided to physicians for adopting EMRs certified by OntarioMD as “Funding Eligible”. 

“Funding Eligible” EMRs drove expectations for:

• Technical and clinical requirements for primary care EMRs
• EMR vendor agreements between OntarioMD and the EMR vendor
• Funding agreements between OntarioMD and physicians
• Client agreements between EMR vendor and the physician (practice)

Physician Funding

Physician enrollment into the OntarioMD EMR Adoption Program’s funding programs closed in March 2015. Some physicians who are still receiving funding under these programs will continue to do so as long as they remain in compliance with their funding agreement obligations (e.g., use of an OntarioMD-certified EMR).

EMR Certification Fundamentals

To attain and maintain certification, a vendor must:

• Be validated and maintain its alignment with applicable EMR Specifications
• Uphold  obligations as set forth in  an EMR Certification Agreement

Various events may trigger (re-)validation, conformance assessments or other investigations:

• Monthly reporting, semi-annual reviews, incident reporting
• Concerns raised by physicians, vendors or other stakeholders
• Updated/new EMR Specifications

EMR Specifications

EMR Specifications define a minimum set of requirements which drive maturity of EMR use.

• Foundational services (e.g., Core Data Set, Hosting, Privacy and Security, Data Migration)
• EHR connectivity and tools (e.g., Health Report Manager (HRM), Ontario Laboratories Information System (OLIS))
• Functional requirements (e.g., Primary Care)

Clinical involvement is critical to the development of all EMR Specifications and include a consistent use of messaging and data standards. Historically, primary care certification was one comprehensive specification, but in 2014 was divided into independent, modular specifications to streamline validation, and support certification for other care domains beyond primary care.

The latest EMR Specifications (draft) to be used for Open Primary Care Certification available on August 1, 2017 can be found at here.

Validation

Validation is a multi-staged process which evaluates an EMR offering’s alignment to EMR Specifications. The process has five stages:

1. Application for certification, including a set of artifacts that provides details of the EMR offering and its alignment to the applicable EMR Specifications
2. Assessment of the application and collaboration with the EMR vendor
3. Demonstrated alignment of the EMR offering to functional requirements
4. Demonstrated alignment of the EMR offering to EHR Connectivity
5. Demonstrated deployment of the EMR offering in a clinical setting

Why Certify?

EMR offerings must be certified by OntarioMD in order to access provincial EHR Solutions and Services like HRM, OLIS and future provincial services such as eConsult, Immunizations, Drugs, etc.

OntarioMD has a trusted, long-standing relationship with physicians, has established leading practices and a representative voice to EMR vendors.

OntarioMD’s EMR Certification Program:

• Ensures consistent and repeatable access to provincial EHR solutions and services, clinical tools and the exchange of health information (through Specifications and certification) across EMR offerings
• Provides direction, prioritization and/or oversight of provincial EMR integration initiatives (EMR Roadmap)
• Provides opportunities for collaborating on emerging EHR integration solutions (e.g., Proof of Concepts)
• Provides national market visibility for EMR vendors with certified EMRs
• Coordinates practice-level change management services with deployments coordinated through OntarioMD (e.g., issues resolution, change management and support)
• Physicians should expect that their chosen certified EMR (and its vendor) uphold requirements and obligations for certification which support enhanced clinical tools, data quality and the exchange of health information with EMRs

Application Process for Open Primary Care Certification

The application process will be announced on August 1, 2017.