Examining the adoption of electronic health records software in Canadian long-term care: For what and for whom?


Krystle Shore, University of Waterloo

The COVID-19 pandemic exposed serious inadequacies within Canada’s long-term care (LTC) system, including poor infection control, communication gaps, staffing and supply shortages, and overall low standards of care. Federal and provincial governments have since directed considerable funding toward these issues, citing innovative healthcare technologies as a key response measure. Health informatics literature also suggests ‘smart’ technologies—like electronic health records (EHR) software integrated with operations management tools and clinical machine learning—can improve LTC efficiency and resident well-being. However, it is unclear whether such outcomes are empirically confirmed. Further, extant research focusing on the promises of technology in healthcare administration tends to ignore important social contexts that shape how the technology is used in practice. Research that does account for how integrated EHRs are used by frontline LTC staff, though sparse, suggests person-centered care practices are tempered by the impersonal, burdensome, and often dysfunctional elements of the software. More generally, the rationales supporting innovative technology as a solution to public crises often rest on false pretenses and prioritize economic interests over public good. Given these concerns and the increasing adoption of integrated EHR software in the wake of identified deficiencies in Canadian LTC, it is crucial to examine whether this technology truly addresses LTC needs or whether it reflects other, discursive interests. This presentation outlines the methodological and analytical approach employed in a qualitative, multi-phased study of the rationales driving the implementation of integrated EHR software in Canadian LTC and whether adoption of the technology aligns with LTC staff needs. Phase one of the described study focuses on how private vendors market EHR software to LTC facilities and aims to identify the assumptions and vested interests embedded within these vendor rationales. Phase two of the study seeks to understand how frontline LTC staff perceive of and use the technology. Foucauldian discourse analysis is then employed to compare phase one and phase two findings to identify any disconnects between how EHR software is framed through marketing discourse and how the technology operates in practical LTC contexts. As such, this project aims to identify whether integrated EHR software responds to frontline LTC staff needs as well as the broader social, cultural, and political forces that situate innovative technologies as a solution to crises in Canadian healthcare administration (e.g., neoliberal imaginaries that situate technology as a more ‘cost-effective’ solution in health administration). The number of Canadians aged 75 or older will more than double between 2017 and 2037. If identified LTC deficiencies are left unadressed they will compound over time as Canadas population ages. Digital healthcare administration technologies like integrated EHR software carry a potential to improve LTC, though research is needed to substantiate whether this potential translates into practice. The project described here seeks to identify whether integrated EHR software responds to the needs and perspectives of frontline care staff in a post-pandemic era, thereby evaluating the technology to enhance healthcare delivery for Canadas rapidly growing elderly population. In describing the methodological and analytical apporach used in this study, I advocate for research to address critical gaps in our understanding of how smart healthcare administration technologies are rationalized as a solution to public health crises, whether these technologies and the rationales underpinning them align with practical healthcare needs, and the broader socio-political forces that condition them.

This paper will be presented at the following session: