Creating the nucleus of an electronic health record: Benefits, challenges and successes in establishing a client registry

Background. A major challenge in the organization of an increasingly complex healthcare system is the maintenance of health records. The introduction of computers and the Internet has provided a means for a significantly more efficient system of recordkeeping. It has been recommended that each Canadian should have a personal electronic health record (EHR) that both they and their physician can access. EHRs have been linked with potential benefits that include more accurate and complete health records and a resultant higher standard of patient safety. Such a record is being built in Newfoundland and Labrador and across Canada. A unique personal identifier-based client registry is an essential and primary building block in the creation and implementation of the electronic record. An interoperable EHR could benefit from an overview of the challenges that are faced in the establishment of this type of registry.Methods. A questionnaire was distributed to and a focus group conducted with the Health Records Directors in the province. In addition, in-depth interviews were conducted with key individuals involved in the development and maintenance of the registry. Participants were chosen based on their knowledge and experience in dealing with health records, client registry output, and registry creation.Findings. The participants agreed that the creation of the client registry in Newfoundland and Labrador is beneficial to both the government and residents of this province. Benefits discussed by participants include improved standards, cost savings and data quality. The challenges discussed include technical issues and the difficulty in establishing funding and support.Implications and recommendations. The findings are discussed with reference to lessons learned, and the implications for the creation of the client registry as the primary component for an interoperable EHR.Aims. This study was designed to assess the perceived benefits and challenges of the initial implementation of the client registry in the province, and to describe the opinions and experiences of those who work closely with the registry.