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2020‐06‐26
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Technology for Integration and ContinuityOrientation for Clinic Managers: Primary Care and PediatricianJune 2020
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CII and CPAR were at the Request of Physicians
The Central Patient Attachment Registry was at the request of Family Medicine (SGP at the time).
A commitment was made to build this tool for primary care.
Alberta’s community specialists requested technology to submit consult reports to Netcare (CII) at AMA Rep Forum.
Partners
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Why Technology for Integration& Continuity?
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Patient’s Medical Home and CII/CPAR
CFPC Vision Alberta Implementation
ModelDimensions of Continuity of
Care
Technology for Integration
and Continuity
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How We Are Working Together
Clinic
eHealth Support Services
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What are CII and CPAR?
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CII is a system that collects select patient information from community Electronic Medical Records (EMRs) and shares it with other members of the patient’s care team through Alberta Netcare.
Community Information Integration (CII)
Community Physician Office
EMRs
CII Data Hub
Alberta Netcare
Healthcare DataRepository
Heath InformationData Governance Committee
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• A provincial system that captures theconfirmed relationship of a primaryprovider and their paneled patients.
• Receives information automatically fromclinic EMRs on a monthly basis
• Next logical step for practices that haveinvested in panel management
• Foundational for enhancements ofinformational continuity such aseNotifications
Central Patient Attachment Registry (CPAR)
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How Does CII/CPAR Work?
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CII/CPAR OverviewCurrent Capabilities
CII Data Hub
Provincial ClientRegistry
Community Physician Offices
Provincial ITSystems
1. Clinic Encounters
2. Specialist Consult
Reports
3. Patient Panels
Alberta Netcare
Central Patient Attachment Registry
Healthcare DataRepository
• Clinical Encounter Digests
• Specialist Consult Reports
* Patient Panel Data
* Clinical Encounter Data* Patient Panel Data
Patient Validation by Hub
Patient Data Uploaded to CII Data Hub
Patient Data/Reports Uploaded to Provincial
IT Systems
Panel Data Extracted
eNotifications
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CII/CPAR: You Share, Receive & EnhanceShare
Confirmed Panel lists
Patient encounter data
Consult Reports
Receive Reports
1) Demographic Mismatch report
2) Conflict Reports
3) eNotifications
Enhance Netcare
4) Community Encounter Digest
5) Consult Reports
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Sending Encounter Information to Netcare
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CommunityPhysician Office
EMREMR Encounter
Data fromDefined Fields Automated
CII Data Hub
Alberta Netcare
CED ReportEncounter Data to Community Encounter Digest
Healthcare DataRepository
Example BP (Accuro)
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Keeping Information Confidential
Clinic EMR
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A new category/folder called “Community Reports” has been added to the Clinical Document Viewer (CDV) tree in Netcare
Community Encounter Digest (CED) In Netcare
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CED SampleCommunity Encounters• Encounter Date• Location• Provider Name/Role• Reason for Encounter• Clinical AssessmentHealth Concern
History• Encounter Date• Health Concern • Provider Name• Source (clinic) Possible Allergy
• Encounter Date• Possible Allergy• Provider Name• Source (clinic)Measured
Observations• Encounter Date• BP, Height, Weight, Waist
Circumference• Source (clinic)
Referrals• Type• Request date• Occurrence date• Source (clinic)
ImmunizationsDisclosure Statement
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Sending Consult Reports to Netcare
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Consult Reports to Netcare
CommunityPhysician
Office EMRCII Data
Hub
Alberta Netcare
Consult ReportConsult Reports
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Sending Panels to CPAR
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CommunityPhysician Office
EMR
Confirmed Panel Lists
CII Data Hub
Central Patient Attachment Registry
Panel Conflict Report
Demographic Mismatch Report
Confirmed Panel Lists to CPAR
Healthcare Data
Repository
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CPARUploads and Reports
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TELUS uploads panels automatically on the 10th of the month *
CPAR starts to find overlap amongst all submitted panels. No uploads between the 22ndand last day of the month.
CPAR panel conflict reports available by the 2nd of the month
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QHR uploads automatically on the 12th of the month from Accuro *
Healthquest users must submit to CPAR by the 21st of the month *
* Upload error reports available
next day. Demographic
mismatch reports available in 2 days
after upload.
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And Patient Stories
eNotifications
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eNotifications
• Notice of:• Emergency Department Discharge• Hospital Admission• Hospital Discharge• Day Surgery Discharge*in any AHS Facility in Alberta
• Notices 7 days/week @ 6 am and 2 PMExample: at a glance view in Med Access
Appears in EMRs similar to lab reports.
*Most but not all AHS day surgery sites are connected.
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eNotification - Example
Info includes:• Pt demographics• Facility location• Date/time• Attending provider• Admission reason• Additional providers
notified
ScheduleLive EMRs: MQ Healthquest TELUS Wolf TELUS Med Access
In Development: TELUS PS Suite Q3 QHR Accuro - 2020If a patient is paneled in CPAR to more than one provider both
providers receive the eNotification
The notice remains in a patient chart similar to a lab result.
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eNotification Data and Statistics
Average number of eNotifications per provider/per day:
1.5*
Average # of e-Notifications per 7 days per 1000 patients on panel
11.0/week
*Average is observed to be higher for rural physicians than urban
https://actt.albertadoctors.org/cii-cpar/toolsresources
Details are available for each EMR.
See the Guide or Orientation Presentations by EMR for
more details:
Available for Wolf, MA and HQ
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Real Patient Story“I have a young adult woman in my practice for whom I received three notification of ER visits within one week for IV hydration needed for cannabis hyperemesis syndrome. Because of these notifications, I was able to connect with her to start working on the underlying anxiety from COVID 19 which had caused her to start smoking marijuana again. After a couple of virtual visits, she is now doing much better and has been connected to resources to help with her anxiety, hopefully preventing any further ER visits. She had not intended to contact me, but was very grateful that I had reached out.”- Dr. Heidi Fell, Symons Valley Firstcare, Calgary (CFPCN)
Community Physician Office
EMR
Emergency
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Real Patient Story
Physician choosesCII/CPAR
i
Community Physician Office
EMR
CII Data Hub
Alberta Netcare
!
Emergency
!Alberta Netcare
Patient
CommunityEncounterDigest
eNotification
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Participation Options
Provider and Submission Types Panels EncountersConsult Reports
Family physician, pediatrician or nursepractitioner with panel Optional
Physician, NP or allied health teammember that takes appointments (nopanels)
Optional
Community Specialist Optional
See Team Toolkit page 10
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CII/CPAR OverviewFuture State
CII Data Hub
Community Physician Offices
Provincial ITSystems
* Clinic Encounters* Patient Panels* Specialist Consult Reports* eNotifications* Patient Summary Reports
Alberta Netcare
Central Patient Attachment Registry
Healthcare DataRepository
• Community Encounter Digests
• Specialist Consult Reports• Patient Summary Reports• Identify PCP in Netcare
* Patient Panel Data
* Clinical Encounter Data* Patient Panel Data
Patient Data Uploaded to Hub
Patient Data/Reports Uploaded to Provincial
IT Systems
Panel Data Extracted
Notifications Downloaded to Clinic EMRs
MyHealth Records
Patient SummaryUploaded to MyHealth
* Patient SummaryReports
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What is the Current Progress?
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What is the CII/CPAR rollout so far?
Data as June 1, 2020
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Deployment by PCN and by Zone
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Evaluation Data
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Evaluation Report – May 2020
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Onboarding with CII/CPAR was resource intensive for our clinic (e.g., time, money)
3%
38%
14%
35%
3% 7%
Level of Agreement
Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable
41% agree/strongly agree that onboarding was resource-intensive
38% disagree/ strongly disagree that onboarding was resource-intensive
14% were neutral
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The practice changes as a result of CII/CPAR were not overly burdensome or difficult to make
Burdensome or difficulty of practice change
Not Were
86% indicated the practices changes were NOT overly burdensome or difficult to make
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Clinic Quote – Big Country PCN
Our doctors wanted this. The decision for the clinic as a whole to participate was a simple one to make. The challenge was ensuring we set dedicated time to complete the paper work. There is a lot of paper and a lot of details. Once you get through the paper, the value to patients is immediate. Within days of being live, we saw Community Encounter Digest reports and knew we were impacting our patients informational continuity. Within a month, we will be validating provider relationships and helping our patients and providers manage this relationship as they navigate the health system. Keeping the end in mind is what got our team through the administrative work.
Kneehill Medical Clinic, Three Hills, ABBig Country PCN
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Netcare, Privacy and Panel
What are the Prerequisites?
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CII/CPAR Prerequisites
1. Netcare Live
2. PIA is up to date
3. Panel Ready(for clinics with panels)
4. EMR • Microquest Healthquest*• QHR Accuro*• TELUS Med Access• TELUS PS Suite• TELUS Wolf* Latest version if own server
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they are obligated to place a Health Collection Notice poster within a patient’s view. A customizable template is provided to the clinic.
If patients have further questions, CII Patient Brochures are also provided.
A Custodian and Clinic Script for Patients is provided which outlines how to discuss patient’s expressed wishes and the use of confidential flags.
The Patient Frequently Asked Question (FAQ) document explains the CII/CPAR initiative and its implications to patients of CII/CPAR clinics. It also
provides patients with contact details* if they have more questions.
The CII/CPAR Privacy & Security FAQ further details the sharing of health information.
Health Collection Poster
Patient Brochure
?? Custodian & Clinic Script
Patient FAQ
Privacy & Security FAQ
CII/CPAR falls under the Alberta Netcare umbrella, which is covered by the Health Information Act. Providers are not required to
have direct conversations with their patients, however…
* eHealth Netcare Support Services at 1‐855‐643‐8649 or ehealthsupport@cgi.com
About Privacy…
HealthCollection Poster
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Keeping Information Confidential
Clinic EMR
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What do Albertans think?
Over 70% of patients think care providers already have access to all or some of their records. •Patients think there is more sharing than is actuallyhappening.
When offered a detailed description of the CII system, over (93%) say they approve• Concerns are:
– who else would have access to this information (16%),
– security from hackers (10%), – patient consent (9%).
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Panel Ready* – Panel Readiness Checklist
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All boxes must be checked off on the readiness checklist
*Panel readiness does not apply to providers that will participate and submit encounters and/or consult reports but no panels.
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Testimonials
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CII/CPAR is the best thing that has happened to us for
continuity of care.
Dr. Joseph Ojedokun,Life Medical Clinic, WhitecourtMcLeod River PCN
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“I requested my primary health care panel reports from the HQCA which includes measures such as panel size, burden of illness and social deprivation index. By participating in CII/CPAR I asked if CPAR can enhance the data that I have access to, and the answer is yes!First, participating in CII/CPAR is the most accurate way to validate and share my panel information. Measures in my panel report represents my patients for whom I am the most responsible provider.Second, I will be informed if patients are no longer on my panel. Such as when they are deceased. That information helps my team and me update our EMR and accurately know which patients are due for cancer screening or chronic disease management.Overall, while there is an investment of time and energy upfront, CII/CPAR is designed to be a low maintenance highly automated way of enhancing and supporting care.”
Dr. Chris Le,Ideal Medical Clinic, EdmontonEdmonton North PCN
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What is Important for Clinic Managers?
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Roles and ResponsibilitiesDocument
https://actt.albertadoctors.org/file/CII_CPAR_Roles_and_Responsibilities.pdf
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CPAR Panel Administrator
Roles & Responsibilities
Site LiaisonCPAR Access Administrator
https://actt.albertadoctors.org/file/CII_CPAR_Roles_and_Responsibilities.pdf
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Clinic Manager and Team:
CII/CPAR Clinic Manager & Team ExperienceEngagement and Interest
Receive information about CII/CPAR including mapping in the EMR
Work with physician(s) to make the decision to participate in CII/CPAR
Find Privacy Impact Assessment and complete PIA Update Self‐Assessment
Identify team member to be Site Liaison (usually clinic manager)
Completes the Confirmation of Participation Form – submits to eHealth
CoP
Team works with PCN facilitator partner
PIA
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Clinic Manager and Team:
CII/CPAR Clinic Manager & Team ExperienceRegistration and Participation
Identify a team member to be the CPAR Panel Administrator
Complete Forms
Liaise with your eHealth Support Services consultant
Meet with eHealth Privacy specialist for PIA Risk Assessment
PIA
Identify a team member to be CPAR Access Administrator
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Clinics will be asked to adopt Identity and Access Management while implementing CII/CPAR if not already enabled
What is IAM?
http://www.albertanetcare.ca/learningcentre/CommUsers.htm
Once a clinic is IAM enabled it allows for theclinic Access Administrator to electronically permission staff for Netcare and CPAR roles
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CII/CPAR Clinic Manager& Team ExperiencePost Go-Live
Clinic Manager and Team:
Go LiveCIICPAR
Retrieve and review panel conflict report with physician and give
feedback
Support team on process improvement for acting on eNotifications & panel conflicts
Provider or delegate views CEDs in Netcare for quality assurance
Optional evaluation
Quality and process improvement meetings
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Ready to Participate?
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: For clinics with Panels
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CoP Form Submission
CoP form emailed to
eHealth
eHealth confirms receipt of form
eHealth Privacy contactsSL to confirm PIA readiness
I’m your eHealth
consultant. I’ll communicate with the Site Liaison and
copy the PCN through go-live
Let’s talk about
your PIA
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Minor or Major PIA Update?
The PIA Update Self-Assessment will assist in determining if you need to update your PIA.Potential PIA Updates Triggers: Common Examples• EMR system change• EMR change from local to “in the cloud”• New EMR user access role or group introduced• Adding EMR access to an organization not in your PIA• New ways of communicating with patents (e.g., email, text messages)• Adding wireless access to EMR• Adding remote access to EMR• Adding new device access to EMR (e.g., mobile, tablets, laptops)Minor change/update• Update clinic privacy policy and procedures (e.g., 2018 breach
reporting requirement)
PIA Update Self-Assessment
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Live Confirmation of Participation Form
https://actt.albertadoctors.org/file/Confirmation_of_Participation-Up_to_10_Providers.pdf
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“Since we went live on CII/CPAR I got two notifications that patients of mine were being discharged from Obstetrics. I went on Netcare to make sure that they had delivered and that they were not just admitted for a prenatal issue. I found out that, yes, both of these women had delivered babies. I phoned their cell phones and left a brief message saying “Congratulations, I would like to see you and the baby in the office in one to two weeks but, if you are having any issues, please call sooner”. Both of those ladies called me by the next day and told me they
were having issues with breast feeding and jaundice and I was able to liaise with Healthy Beginnings and we had a plan and we were able to do that work before
they came to the office. I would not have known that they had delivered and been discharged were it not for CII/CPAR. That is just a story about how
CPAR/CII can really help you and help your patients”.
Dr. Janet Craig, Glenora Medical Clinic,Edmonton West PCN
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Next Steps & Support Tools
A C IResponsibility Accountability Consulted Informed
CII CPAR Project AMA PCN Clinic AH
PCN engagement & training A R C I
Clinic engagement & training C A R I
PCN‐Managed Clinic Go Live C A R R
Clinic Go Live C R A R
Post Implementation Support C R A R
MatrixR
PCN Facilitator/PCN Contact
Do you know who your PCN contact is?
What if my clinic is not
part of a PCN?
cii‐specialty@albertadoctors.org@
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More Information and Resources
https://actt.albertadoctors.org/cii-cpar/toolsresources
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Clinic Journey – Checklist, RACI, Visio
Clinic Journey Documents – Checklist, Process, RACI
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EMR Orientation Presentation
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Team Toolkit
Comprehensive Guide
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CII/CPAR
EXPERIENCES
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Feedback and Testimonials
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Questions
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Connect Care1300 to 1
Y 1Y 2
Y 3
e‐Delivery (labs, DI, etc.)
e‐Notifications
Wolf
M‐A
AccuroPSS
HQ
Community EMRs
My Health Record
CII
CPAR
Healthcare Data
Repository
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How do we access the reports?
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Do patients need to be notified that I am participating
in CII/CPAR?
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Can PCN clinics submit
consult reports?
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