Why Encounter-Based EMR Design Is Holding Back Canadian Primary Care

We’ve talked before about the rising tide of physician burnout and the promise of AI to solve the "pyjama time" problem. But if we only focus on these symptoms, we miss the underlying disease.

Canadian primary care isn't just facing a staffing or funding issue. There are serious design issues in the tooling used by primary care clinicians. Most EMRs currently powering Canadian clinics were built in an era of paper-to-digital transition. They were designed to solve the problem of storage, not the problem of workflow. As a result, the modern clinician is essentially a highly-trained data entry clerk for a 1990s-era database.

To fix the workflow, we have to move beyond the "Encounter-Based" model.

1. The Diagnosis: Why More Features Won't Save Us

Most "modernization" efforts focus on adding features: a better billing macro here, a patient portal there. But adding features to a broken workflow is like putting a spoiler on a tractor—it might look faster, but you’re still plowing a field at 5 mph.

The fundamental mismatch is that legacy EMRs treat The Visit as the only unit of work that matters. In reality, Canadian primary care is longitudinal. It’s the work that happens between the visits—the lab follow-ups, the MOA handoffs, and the complex care coordination—where the system actually breaks down.

2. The Encounter-Based Trap (Billing = Care)

Legacy systems are optimized for the billable event. This makes sense for provincial reporting, but it’s a disaster for clinical logic.

• Legacy Logic: A patient is a collection of discrete, chronological visits.

• Workflow-First Logic: A patient is a continuous narrative.

When your EMR treats data as a static archive, you spend the first five minutes of every appointment "re-learning" the patient. A workflow-first system surfaces Data Liquidity—the right information, at the right time, without the hunt.

The "Legacy Tax": For every 1 hour of clinical care, Canadian physicians currently can spend up to 2 hours on EMR-related administrative tasks. This is the direct result of "Encounter-Based" design.

3. Cognitive Flow vs. Click Efficiency

In our previous deep dive into the hidden cost of clicks, we explored why "faster templates" aren't the answer.

Primary care is high-bandwidth cognitive work. You are balancing competing priorities, detecting subtle trends, and managing uncertainty. A "modern" EMR that forces you to toggle between six tabs to see a trend-line in A1c levels isn't just annoying—it’s a safety risk.

A Workflow-First EMR optimizes for "Mental Space":

• Reduces Context Switching: Keeps relevant history, current meds, and active labs in a single field of vision.

• Contextual Intelligence: Embeds insights directly into the charting flow rather than hiding them in "Alert Fatigue" pop-ups.

4. The "Team-Based" Reality Gap

The College of Family Physicians of Canada (CFPC) has long championed the Patient’s Medical Home (PMH) model. This model relies on a high-functioning team: MOAs, nurses, and pharmacists.

However, most EMRs are "Physician-Centric." They treat the MOA as a "helper" who enters data for the doctor, rather than an Air Traffic Controller who manages the clinic’s engine.

If your MOA is still using "sticky notes" or a separate spreadsheet to track referrals and follow-ups because the EMR is too clunky, you don't have a team-based workflow—you have a fragmented one.

The Workflow-First Checklist: Is Your EMR Failing You?

If you are evaluating your current system or looking for a new one, ask these four questions:

1. The "Between-Visit" Test: Does the system have a dedicated workspace for "In-Basket" work that doesn't require opening a dummy encounter?

2. The MOA Test: Can your staff manage the entire patient journey (booking → check-in → follow-up) without ever leaving the main clinical view?

3. The Trend Test: Can you see a 3-year history of a specific lab value with a single click, or do you have to open three different PDFs?

4. The Integration Test: Does the billing logic sit underneath the clinical work, or does it dictate how you document?

The Opportunity: A Calmer Practice

The goal of a workflow-first EMR isn't to help you see more patients; it's to help you see the same patients with half the mental overhead. At Aeon, we aren't building a faster database. We are building a "calmer" system—one that recognizes that in Canadian primary care, the workflow is the work.

Ready to move beyond the encounter? Request a Trial to see what we're building at Aeon.