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Background: In 2003, the Vancouver Coastal Health Authority (VCH) chose Mid-Main Community Health Centre (Mid-Main) as one of the clinics to receive primary health care renewal funds. A portion of the funding has been used to purchase and implement an electronic medical record (EMR) system that has some capacity to support chronic disease management through patient registries. In implementing their electronic medical record, Mid-Main has had ongoing contact with Elaine Grenon, Director of New Practice Design with the VCH Primary Health Care Network. In addition, Mid-Main has worked with Dr. Ellen Balka (professor and research scientist at Vancouver Coastal Health) who is the principal investigator of ACTION for Health, a 4-year, $3 million project that has focussed on the role of technology in the production, consumption, and use of health information. Since 2003, several ACTION for Health research projects have been carried out at Mid-Main, including a project which investigated the implementation and use of Wolf Medical Systems’ electronic medical record. The proposed project seeks to build on existing partnerships between Mid-Main, Wolf Medical Systems, VCH, and Balka’s research group through 3 related ‘knowledge to action’ projects of interest to all parties.

Objectives:
Project objectives are to support the translation of knowledge to action through:

1. Demonstration of enhanced use of data from electronic medical records in support of continuity of care in clinical settings and practice research. This project will focus on building capacity within Mid-Main to increase use of electronic record data to support practice improvement initiatives, particularly those targeted at the population of people who live with 3 or more chronic conditions within the cardiovascular and respiratory clusters, and people with persistent mental illness, who have been identified by VCH as using disproportionately high levels of health service resources.
2. Knowledge translation (KT) from research literature to local users (Mid-Main and VCH) and from local users (Mid-Main) to decision makers (VCH) and technology producers (Wolf), and subsequently potential electronic record adapters, about challenges related to enhanced use of electronic records for management of patients with multiple chronic conditions.
3. Translation of primary research results into good practice guidelines. In B.C., the Ministry of Health has developed a chronic disease management toolkit (CDM Toolkit) used by Mid-Main and other practices. Plans for management of patients with multiple co-morbidities involve increased use of the CDM Toolkit. Primary research will be undertaken in order to better understand how the CDM Toolkit is being used, and identify issues associated with data sharing between clinics and the CDM Toolkit. Results will be disseminated as a good practice guide, suitable for use by clinics.

Hypothesis: That knowledge translation activities will result in evidence of practice changes at Mid-Main, evidence of utilization of research results by VCH, and reflected in software (Wolf).
Research Plan

• Objective 1: Develop a base-line understanding of use of EMR data at Mid-Main through observation and interviews; develop a plan for increased use of EMR data with Mid-Main; implement the plan; evaluate extent to which KT activities contributed to practice changes (through document analysis, observations, and interviews).
• Objective 2: Through on-going engagement, respond to informational needs of potential research users. Collect data about appropriateness of materials produced through post-use evaluation of research materials, and interviews with potential users aimed at assessing utilization.
• Objective 3: Conduct interviews with Mid-Main and other CDM Toolkit users about use of the CDM Toolkit; develop good practice guide (GPG) to support implementation of the CDM Toolkit; evaluate GPG through post-use surveys and interviews.