The EMR Ontario Is Building Toward. Day 4: What It Will Actually Take
Yesterday I said the hardest part isn’t the technology. It’s helping tired clinicians make a change. So today, what would it really take to make that happen?
If on Day 3 I showed you the wall, this is how you get over it. Here’s the good news: the team that wrote this RFP has learned from past programs and included most of the right tools. The real question is whether we all have the will to use them. I have some advice.
Don’t sell a switch. Sell relief.
“Just as good” gets rejected. Relief gets adopted. For a burned-out workforce, the way in is the thing my old EMR simply cannot do:
- An inbox that triages, sorts, and summarizes itself.
- Automation of repetitive clerical tasks
- A scribe that writes the note so I can look at my patient instead of my screen.
- One login to the provincial tools instead of the daily password tax.
- A single view of the patient that finally kills the fax.
- Knowledge and evidence as part of my clinical day.
The change has to come with less misery.
The change has to come with less misery. Telling people, “Your inbox is a third smaller by Friday,” motivates them. “New buttons” does not.
Make the migration a promise, and make it reversible
The data lock only opens when migration stops being my ordeal and becomes the vendor’s guaranteed job: move everything, keep the originals viewable, and put it in writing with real penalties for mistakes. And here’s the surprising part:
If you guarantee people they can leave, and they’ll be far more willing to arrive.
The “you can always get your data out, on open formats, at no cost” clause isn’t just about avoiding monopolies. It’s the best argument for adoption in the whole document, because it removes clinicians’ fears of being trapped again.
Move the money, not the mandate
The province’s strongest tool isn’t a rule. It’s the cheque. If you order doctors to switch, they resist. Change what gets funded and the numbers quietly shift. That’s not just a theory; it’s how Ontario got physicians onto EMRs in the first place. Carrots, at scale, work better than sticks.
Go slow to go fast, and let incumbents carry their own
Onboard in waves. Prove it with early clinics that are willing, and let their results encourage the next group. Alberta’s Connect Care and PEI’s single-vendor approach show consolidation is possible, but they also show that scaling up before proving results can backfire or even set you back.
Let the vendor you already trust do the moving. Same relationship, same support line, familiar feel. Incumbents have the numbers game, but smaller companies are innovative and eager to please. It’s not clear to me that either is any more likely to actually pull this off.
Use the “talks to everything” layer as an on-ramp
This is where the two halves of this series come together. That interoperability and AI layer isn’t just the destination; it’s the bridge. Let the old EMR keep running while the new platform reads and writes alongside it. The province gets its connected data now, and the doctor switches the actual record only when ready. Make this transition seamless.
If you turn the cliff into a ramp, people will walk down it. If you ask them to jump, they won’t.
None of this will happen in two years. It will take most of a decade, led by trusted messengers like colleges, the OMA, and clinical champions, and driven by funding, not orders. The technology is the easy part. Change management is everything.
Tomorrow is the finale, Part 5—the fun one. What would the perfect EMR actually look like? Just one more chapter to go.
