Conclusions: The case describes the secondary usage of data by a clinic aimed at improving management of the clinic’s patients. It illustrates that creating the pre-conditions for secondary use of data from EMRs is a complex process which can be seen as a shift in paradigms from a focus on individual patient care to chronic disease management and performance measurement. More research is needed about how to best support clinics in the process of change management necessitated by emerging clinical management goals. (Source: International Journal of Medical Informatics).