Historical trauma as a contributor to postpartum depression among Indigenous mothers.

In Canada, the term electronic medical record (EMR) refers to a computerized patient health record system often used within a physician’s practice to support clinical care delivery and practice operations []. Rates of EMR adoption continue to rise across Canada, and in 2024, Canada Health Infoway found that 97% of family physicians used an EMR []. In Ontario, family physicians and group practices select and implement their own EMR systems, supported by OntarioMD, a subsidiary of the Ontario Medical Association []. OntarioMD certifies EMR offerings that meet provincial requirements for use in primary care, including technical and interoperability requirements. Despite the availability of more than a dozen certified EMR vendors in Ontario, the following 3 vendors dominated the market: Telus Health Solutions Inc, QHR Technologies Inc, and WELL EMR Group Inc. In 2025, these 3 vendors alone accounted for 84% of the market share []. In Ontario, individual physicians and practices are responsible for selecting, implementing, and, if required, migrating between EMR systems for their clinical use. Early EMR adoption and implementation have been well documented in both the United States and Canada over the last 20 years [-], with most literature focusing on the transition from paper-based charts to EMRs. However, since initial EMR adoption, group practices and clinics across Ontario have completed EMR migrations—the process of moving a health care organization’s EMR from one system to another. The earliest and largest instance of this in Ontario was documented by Fisher [] in 2013, in which a team of 46 physicians migrated from one EMR provider to a different one. Although EMR migrations are known to occur in Ontario primary care settings, they are infrequently described despite their relevance to the needs of clinicians today. EMR migrations are recognized as complex, high-risk endeavors requiring significant resources []. Beyond the expected tasks, such as extracting, mapping, and validating data, practices must also redesign workflows, train staff, and manage staff during periods of transition []. In a 2023 systematic review of transitions from one EMR to another, Miake-Lye et al [] identified 40 studies, of which only 11 addressed provider perspectives; only 2 included information on satisfaction and lessons learned; and 3 discussed satisfaction and perceptions of the new EMR. Many of the studies came from large institutions with limited generalizability to smaller outpatient clinics, and only 1 study was Canadian []. This review recommended considering human factors and mixed methods approaches to capture the organizational change in EMR transitions. The outcomes of EMR transitions are largely shaped by the experiences of frontline workers []. In the Canadian context, a 2025 study by Taneja et al [] found that user experiences of EMR implementation varied based on local configuration decisions and on the extent to which the system aligned with existing workflows. Similarly, Zharima et al [] found that successful EMR implementation depended on effective engagement strategies that help stakeholders understand, participate in, and sustain the work of change. However, this critical frontline perspective is underrepresented in the existing literature.