Examining Electronic Medical Record Migration in a Team-Based Primary Care Clinic: Case Study

Abstract

Abstract Background Electronic medical record (EMR) systems are now ubiquitous in Ontario primary care, with near-universal adoption among family physicians. EMRs have become critical pieces of clinic infrastructure that can affect nearly every aspect of clinical and administrative work. As EMR vendors consolidate and functionality evolves, some clinics undertake EMR migrations—complex transitions that require data conversion, workflow redesign, training, and change management. Despite their importance and wide adoption, there is a gap in understanding how community-based primary care organizations in Canadian settings navigate migration in practice, particularly from the perspective of frontline clinicians and staff. Objective The project aimed to describe a single case of EMR migration within an 11-physician, team-based Family Health Organization (FHO) in Peterborough, Ontario, from the perspective of frontline clinicians and staff. This included assessing the factors influencing the decision to migrate, the operational and human factors that shaped implementation, and practical lessons for supporting and evaluating future EMR transitions. Methods A single-site, physician-led quality improvement project was conducted in collaboration with the Peterborough Ontario Health Team using an exploratory case study approach. This approach was used to examine a complex, real-world health IT transition in its local organizational context. This project examined one FHO’s migration between EMR providers using purposive sampling of individuals directly involved in the transition, including a lead physician (n=1), a lead administrator (n=1), family physicians (n=9), interprofessional health care providers (n=12), and medical office assistants (n=9). Data sources included 2 semistructured interviews, 2 focus groups, and 1 comprehensive document review. Data collection spanned the planning, implementation, and stabilization phases of the migration from February 2022 to November 2024. Sessions were recorded, transcribed, and deidentified. Documents included emails, meeting minutes, training communications, project planning materials, and troubleshooting records. Interview and focus group transcripts were analyzed thematically. Study documents were reviewed separately to construct a narrative chronology of the migration. Results Four interrelated themes emerged: (1) burden of invisible labor, (2) cost and uncertainty as a catalyst, (3) importance of physician leadership, and (4) engage stakeholders early. Participants described migration as a resource-intensive organizational transition shaped by unpaid preparation work, cost pressures, clinical governance, quality assurance, and the responsiveness of internal and external stakeholders, particularly the vendor. Conclusions This study illuminates the process of an EMR migration within one team-based FHO. 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 emphasizing protected time for training and quality assurance, local workflow adaptation, staged validation to shorten the transition period (“gray zone”), and explicit assessment of vendor responsiveness. Lessons are readily actionable for similar group practices and clinics planning future migrations or optimizations.