CRPCN Patient Information Road Map

Seeking timely and seamless patient communication

January 8, 2018

The Patient Medical Home (PMH) model in Alberta began in 2013 when the Alberta Medical Association’s Primary Care Alliance introduced the PCN Evolution Vision and Framework to Primary Care Networks and, in turn, family physicians. This model, embraced by Alberta Health and Alberta Health Services, places the patient at the center of their care, and it is in alignment with the direction that other provinces in Canada are taking with their patient care delivery.

A key dependency for patient continuity of care is the timely exchange of patient information. Indeed, robust communication between health care providers in Alberta’s complex health care system is paramount to ensure informed decision making toward optimal patient care and safety. In order for the PMH model to be effective, communication between all parties within and linked to the PMH must be reliable, timely, secure, legible and effective.

And yet, digital patient information does not flow seamlessly between health care providers, which results in missing data, medication errors, duplicated or absent testing and adverse events that include serious injury and even death. Four years after gaps in Alberta’s health care system led to the highly publicized death of Greg Price in 2012, both Price’s family and family physicians are not seeing the changes required to prevent such an event to occur again, despite the numerous and thorough investigative work, reports and recommendations that followed these discussions.

As such, the Calgary Rural Primary Care Network (CRPCN) launched the Patient Information Road Map (PIRM) Project to define the problem in a new way. This project illustrates how digital patient information currently flows within the PMH, and it identifies gaps, barriers and bottlenecks to timely delivery of this information. While the PIRM Project is viewed from the lens of CRPCN representatives, confirmation with family physicians and PCN executive directors assures that the implications highlighted extend across Alberta.

The PIRM project was guided by a steering committee of equal representation from CRPCN member physicians, nurses, clinical and administrative staff across 14 communities. The steering committee identified the types and sources of digital patient information based on the highest volume of referrals. This included diagnostic imaging, laboratory results, transcribed reports, electrocardiogram results, and prescriptions from consultants, acute care and urgent care.

The PIRM project was guided by the steering committee vision statement: The delivery of digital patient information must be current, legible, easily accessible, and captured in the patient’s medical home system to inform patient care and ensure patient safety. This information is delivered as soon as it is processed, prioritized by the need for patient follow up and that follow up is clearly specified.

The project conducted a review of publicly available discussion papers, reports and presentations offered by Alberta Health, the AMA, AHS, the College of Physicians & Surgeons of Alberta, the College of Family Physicians of Alberta (CFPA), the PCN Project Management Office, Calgary Laboratory Services, peer-reviewed journal articles and national reports. Further discussion ensued with representatives from these organizations and regular meetings with the PIRM steering committee. By use of a high-level process mapping technique, the PIRM project examined the current state of digital patient information flow from the types and sources of information identified by the steering committee to the PMH.

Perhaps ironically, instead of integrating the Alberta health care system, the introduction of various health information technologies have started to create bigger gaps in the timeliness of digital patient information delivery and in relaying pertinent details to the PMH regarding patient care and follow-up. Part of the reason for this is a misunderstanding of the function, purpose and interconnectivity of current health information technologies in the Alberta health care system. Further, compartmentalized work from each organization in providing patient-centered care also results in fractured care via missing, delayed or incomplete digital patient information. With the current state flow defined by the PIRM project, the opportunity to strengthen existing and create new partnerships is at hand to solve this problem. Failure to do so risks continuity of care, preventable costs, patient safety and trust in the health care system.

As with the introduction of any change, there are many components to consider – partnerships, policies, procedures, processes – in meeting the goals laid out for the PMH model. This will take time and effort, as the PIRM project highlights the needs for a cultural change to truly adopt the PMH model, or Albertans will continue to be at an otherwise preventable risk. The next steps are to ensure stakeholders within the PMH model, the medical neighborhood, other information producers, Alberta Health, AHS, AMA, CPSA, CFPA and other decision makers are aware of these challenges so that, collectively, we can work to improve the continuity of patient information flow.

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