Community Information Integration

Providing better access to primary care and community health information

September 29, 2017

Michel G. Donoff, MD, CCFP, FCFP | Professor and Associate Chair, Department of Family Medicine, University of Alberta

Contributed by: Michel G. Donoff, MD, CCFP, FCFP | Professor and Associate Chair, Department of Family Medicine, University of Alberta

The Alberta Medical Association, Alberta Health and the College of Physicians & Surgeons of Alberta have collaborated to promote the Community Information Integration (CII) Initiative. The goal of this initiative is to improve the continuity of care for Albertans across the health system through better access to primary care and community health information. To achieve this goal, CII will:

  • Collect health data from all primary care and community clinics in Alberta.
  • Present this data in Alberta Netcare through clinically relevant reports.
  • Make this data available to appropriate stakeholders for secondary use (quality improvement, population health planning and research).

The principles to guide this work include:

  • Keep it simple and move quickly.
  • Learn and evolve rather than wait for the perfect solution.
  • Collect data once and use it for all eligible purposes.
  • Minimize impact on clinics and providers. The selection of data to be extracted from community electronic medical records (EMRs) put priority on avoiding disruption of clinical workflows.

The initial phase of CII will upload three kinds of data:

1. Canadian Institute for Healthcare Improvement (CIHI) Pan-Canadian EMR standard data fields. Seventy-eight data fields will be extracted from the community EMRs on a daily basis and go to a community data hub where some of the data will be formatted into reports for sharing on Netcare. Examples of CIHI data fields include patient identifier (PHN), birthdate, gender, provider name, role, expertise, clinic location, clinical observations (immunizations, allergies, blood pressure, height, weight and diagnostic assessment).

Data can also be aggregated and available for secondary use. Some CIHI data fields are already loaded onto Netcare, such as lab and diagnostic imaging results. These will not be duplicated onto Netcare. Text and narrative notes made by clinicians will not be uploaded from the EMR. One of the considerations with uploading CIHI data elements for clinical sharing, is to avoid overloading or cluttering Netcare and at the same time providing useful clinical reports. The Community Encounter Digest report will be a summary of the relevant information from community encounters for the prior 12 months. The format and content of community integration reports will evolve guided by clinical experience.

2. Canadian Primary Care Sentinel Survey Network (CPCSSN) data will be uploaded and integrated with the CII Initiative. Many Alberta family physicians have experience with CPCSSN data processes already, and are demonstrating minimal disruption to practice and producing high quality validated patient information. The expanded integration of CPCSSN promises to increase development of new case resources and improvement of timely access. Clinicians will obtain CPCSSN dashboards to assist identification of clinical needs within their patient panels.

3. Community-based specialist consultation letters. Community-based specialists will be able to upload a copy of a patient consult report to Netcare as a PDF document.

Surveys of Albertans show the majority (greater than 80%) support automatic sharing of their community health care data. However, most clinicians anticipate that sometimes information or encounters will be sensitive to some patients. The CII Initiative will allow clinicians to respect patient wishes for specific encounters or longer term preferences.

In the future, when resources and supports are available, new functionalities of community integration may include better access to patient summaries and comprehensive patient-centered care plans. Some of these activities might become part of the patient-centered medical home relationship with patients. However, the initial and careful limited scope of the CII Initiative is necessary to engage patients and providers with safe and efficient IT evolution.

Successful evolution of community IT effectiveness will require ongoing patient and provider oversight and stewardship. To this objective, Alberta Health has implemented two new committees with significant provider and patient participation to review and advise on effective policies and operations for community information sharing.

The Health Quality Council of Alberta will be conducting an independent evaluation of the CII Initiative. Alberta Health, AMA and CPSA will also be providing feedback to community physicians based on the results of the evaluation. Ongoing physician and public discussion about improving safety and quality of community information sharing is underway!

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.