The EMR Ontario Is Building Toward. Day 1: What the PCMR Really Is (And What It Isn’t)
The EMR Ontario Is Building Toward. Day 1: What the PCMR Really Is (And What It Isn’t)
This is a five-part series about the PCMR, what Ontario is asking for, and whether we can actually achieve it.
Ontario Health has just released one of the most important digital health documents in years. This is a procurement, so they are asking vendors to bid on a new Primary Care Medical Record, or PCMR. At first, it might seem like just a contract for a new EMR, but it goes further. If you look closely, it is really about changing what an EMR is, who owns the data, and how the whole sector moves forward.
I’ve spent a lot of time reviewing this document and comparing it to the OntarioMD certification program I know well. Like many clinicians, I wonder: is someone about to take away the system I’ve relied on for my whole career? Even if it is not perfect, does this mean I will have to face a forced change?
The answer isn’t just a simple yes or no. Over the next five parts, I want to walk you through it:
What the PCMR really is and what it is not
What it means for our EMR vendors, and for the doctors who use them
The hardest problem: getting doctors to change
What it will actually take to succeed
What the perfect EMR would look like
Let’s go.
credit: @gapiingvoid
Let’s start with the most basic question: what did Ontario actually ask for?
Part 1 — What the PCMR Really Is (And What It Isn’t)
When you look at a 33-page government procurement, the real goals are hidden in how it’s put together. Once you see how this one is structured, it’s clear things are going to change.
The document grades vendors in two piles
The RFP scores bidders in two ways, and the split tells you everything.
The first pile is pass/fail. Must-haves. Answer “yes” or you’re out. And when you read them, they’re familiar: validate a health card, bill OHIP, connect to the lab system, pull hospital reports, verify drug interactions, manage consent. This is, almost line for line, what an EMR already has to do today to be certified in Ontario. Nothing new here. This is the keep-the-lights-on pile.
The second pile is scored from zero to five, and this is where Ontario Health and the Ministry show the direction they want the industry to take. If you look closely, you will notice a pattern. Each item has a minimum score you need to meet. Some are set high because you are expected to already do them well. But for many of the most forward-looking items, the minimum is set at zero.
Setting the minimum at zero isn’t about lowering the bar. It’s about future-proofing and showing where Ontario wants to take the whole industry next.
That list with a zero minimum is the EMR we’re working toward. Ontario is pointing out the features the market doesn’t have yet and inviting the industry to create them.
So what is it, really?
credit: @gapingvoid
Strip away the procurement language and Ontario is asking for:
One system for the whole province, instead of thousands of separate versions. Right now, every clinic runs its own EMR, similar to each house on a street running its own generator. The PCMR is more like a shared power grid.
A record that connects to everything automatically, so data follows the patient instead of being sent by fax or even by mail.
A front door for patients, with video visits, online intake, and results in plain language. They might even have their own view.
A platform that is ready for AI helpers and agents, with strong safeguards to check consent and purpose before anything can access your patient’s chart.
A record that no one can lock up. The vendor does not own the data and cannot charge you a fee to leave.
This is not just a product you buy. It is about joining a province-wide system
This is not just a product you buy. It is about joining a province-wide system. Becoming part of this is a complex, multi-vendor, multi-year transformation that the government is supporting with real funding. This is not something that changes overnight.
What it isn’t
credit: @gapingvoid
Three tempting misreadings, and why they’re wrong:
It is not just a clever AI layer added to the EMRs we already have. That is the tempting ‘do minimal’ approach, leaving the record as it is and just adding intelligence on top. But you cannot create a truly portable, governed system if the data is still locked inside different proprietary products on separate servers. The AI layer is part of the new system, but it is not a replacement for building it.
It is not a command to remove your EMR tomorrow. Nothing in it requires that. It is deliberately built to move in stages.
This is not just a certification update. Certification used to ask, “can this EMR safely connect to Ontario’s systems?” The PCMR is asking a much bigger question: “can this become the province’s single primary care platform?”
The bigger idea
This is the part I find most interesting. Right now, one vendor usually controls the record, the data, and the connections, which makes sharing harder than it should be. It is not anyone’s fault; this is just how things developed. The PCMR is meant to change that by creating shared standards, portable data, and a common platform that vendors, the province, and clinicians can all build on together, with the patient at the center.
The vendor still provides the record, but now it is designed to be portable and work well with other systems. The lasting layer on top, such as the standards, consent rules, app marketplace, and provincial data fabric, becomes shared infrastructure that everyone in the system can use and trust.
This is not just a list of features. It is a blueprint.
And it is a blueprint the government is supporting with funding and a long-term commitment to change. This is very different from simply replacing one product with another.
This is something different, and I believe it is a good thing.
Tomorrow, in Part 2, I will look at what this blueprint means for the EMR vendors we rely on today and for the doctors using those systems. Stay tuned.credit: @gapingvoid
One Reply to “The EMR Ontario Is Building Toward. Day 1: What the PCMR Really Is (And What It Isn’t)”
Calling the PCMR “the EMR we’re working toward” risks perpetuating the very paradigm Ontario should be moving beyond.
The destination should be interoperable, longitudinal, patient-centred health information, with EMRs as participating systems not the destination itself.
And this is why the statement;
“This isn’t just a list of features. It’s a blueprint” deserves closer examination.
A blueprint for what?
The post describes the PCMR as “a blueprint.” I would ask: a blueprint for a better EMR, or for a genuinely interoperable provincial health-information ecosystem?
The PCMR may be an important building block, but the destination should be bigger than a better EMR.
Given how far Ontario and Canadastill have to go in digital health, we should be asking whether this initiative advances us toward longitudinal, interoperable, patient-centred health information, rather than simply defining the next generation of primary-care EMR.
One Reply to “The EMR Ontario Is Building Toward. Day 1: What the PCMR Really Is (And What It Isn’t)”
Calling the PCMR “the EMR we’re working toward” risks perpetuating the very paradigm Ontario should be moving beyond.
The destination should be interoperable, longitudinal, patient-centred health information, with EMRs as participating systems not the destination itself.
And this is why the statement;
“This isn’t just a list of features. It’s a blueprint” deserves closer examination.
A blueprint for what?
The post describes the PCMR as “a blueprint.” I would ask: a blueprint for a better EMR, or for a genuinely interoperable provincial health-information ecosystem?
The PCMR may be an important building block, but the destination should be bigger than a better EMR.
Given how far Ontario and Canadastill have to go in digital health, we should be asking whether this initiative advances us toward longitudinal, interoperable, patient-centred health information, rather than simply defining the next generation of primary-care EMR.