Evaluation of Electronic Medical Record Administrative Data Linked Database (EMRALD)

Although the United States and Canada have historically lagged behind other industrialized countries in the adoption of electronic medical records (EMRs) in primary care, 1 with the introduction of the Health Information Technology for Economic and Clinical Health Act in 2009 in the United States 2 and the establishment of Canada Health Infoway 3 and provincial EMR adoption support programs in Canada, the uptake of EMRs in both countries is rapidly increasing. 4 This development, especially in primary care physician practices, has resulted in a new, potentially rich source of clinical information not only for point-of-care clinical practice but also for secondary purposes such as research and quality performance evaluation. Because of its single-payer healthcare system, Canada has comprehensive health-related administrative databases that cover the entire population. Complete, provincewide, population-level administrative databases have been shown to be highly accurate in capturing hospitalizations and prescriptions for Ontario residents 65 years and older. 5 Also in these databases, physician billing data accurately capture frequency of patient encounters, but the depth and details of patient clinical encounters are unavailable. Indeed, a previous study in the United States found that EMR data in community health centers were more complete than Medicaid claims data for assessing diabetes preventive care. 6 Because use of primary care EMR data in Canada for secondary purposes is in its relative infancy, we set out to determine the completeness and comprehensiveness of the EMR data compared with administrative data.