i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 1 ( 2 0 1 2 ) 461–474 j ourna l homepage: www.ijmijournal.com Caring for individual patients and beyond: Enhancing care through secondary use of data in a general practice setting Marianne Tolar * , Ellen Balka Assessment of Technology in Context Design Lab, School of Communication, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6 a r t i c l e i n f o Article history: Received 19 October 2011 Received in revised form 6 January 2012 Accepted 6 January 2012 Keywords: Medical records systems, Computerized Community health centres Primary health care Organizational case studies Quality assurance, Health care Reminder systems a b s t r a c t It is argued that with the introduction of electronic medical record (EMR) systems into the primary care sector, data collected can be used for secondary purposes which extend beyond individual patient care (e.g., for chronic disease management, prevention and clinical perfor- mance evaluation). However, EMR systems are primarily designed to support clinical tasks, and data entry practices of clinicians focus on the treatment of individual patients. Hence data collected through EMRs is not always useful in meeting these ends. Purpose: In this paper we follow a community health centre (CHC), and document the changes in work practices of the personnel that were necessary in order to make EMR data useful for secondary purposes. Methods: This project followed an action research approach, in which ethnographic data were collected mainly by participant observations, by a researcher who also acted as an IT support person for the clinic’s secondary usage of EMR data. Additionally, interviews were carried out with the clinical and administrative personnel of the CHC. Results: The case study demonstrates that meaningful use of secondary data occurs only after a long process, aimed at creating the pre-conditions for meaningful use of secondary data, has taken place. Preconditions: Specific areas of focus have to be chosen for secondary data use, and initiatives have to be continuously evaluated and adapted to the workflow through a team approach. Collaboration between IT support and physicians is necessary to tailor the software to allow for the collection of clinically relevant data. Data entry procedures may have to be changed to encourage the usage of an agreed-upon coding scheme, required for meaningful use of secondary data. And finally resources in terms of additional personnel or dedicated time are necessary to keep up with data collection and other tasks required as a pre-condition to sec- ondary use of data, communication of the results to the clinic, and eventual re-evaluation. Consequences: Changes in the work practices observed in this case which were required to support secondary data use from the EMR included completion of additional tasks by clinical and administrative personnel related to the organization of follow-up tasks. Among physicians increased awareness of specific initiatives and guideline compliance in terms of chronic disease management and prevention was noticed. Finally, the clinic was able to evaluate their own practice and present the results to varied stakeholders. ∗ Corresponding author. Tel.: +1 778 782 7296; fax: +1 778 782 4024. E-mail addresses: mtolar@sfu.ca (M. Tolar), ellenb@sfu.ca (E. Balka). 1386-5056/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2012.01.003