Types of Care
Clinician-Friendly Pick-List Guide
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0
Our VisionBetter data. Better decisions. Healthier Canadians.
Our MandateTo lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care.
Our ValuesRespect, Integrity, Collaboration, Excellence, Innovation
Table of Contents Acknowledgements ..................................................................................................................... 4
About the Canadian Institute for Health Information .................................................................... 6
Introduction ................................................................................................................................. 7 Background/Purpose ............................................................................................................... 7 About This Document .............................................................................................................. 7 Value to Stakeholders ............................................................................................................. 7 Stakeholder Inputs ................................................................................................................... 8
Clinician-Friendly Pick-Lists ........................................................................................................ 9 Overview ................................................................................................................................. 9 CFPL Scope ............................................................................................................................ 9 PHC EMR CS Use Case Scenario ........................................................................................ 10 CFPL Licensing ..................................................................................................................... 13
Adoption, Maintenance and Governance .................................................................................. 14 Adoption ................................................................................................................................ 14 Maintenance .......................................................................................................................... 14 Governance ........................................................................................................................... 14
Stakeholder Implementation Considerations ............................................................................. 15 PHC EMR CS Data Elements ................................................................................................ 15 Additional Data Elements ...................................................................................................... 15 Data Extraction ...................................................................................................................... 15 Other Data Sources ............................................................................................................... 16 PHC Practice Considerations ................................................................................................ 16 PHC Reference Sets ............................................................................................................. 16
Next Steps ................................................................................................................................ 17 Stakeholder Engagement ...................................................................................................... 17 EMR Demonstration .............................................................................................................. 17 CIHI Contact Information and Companion Products .............................................................. 17
Appendix A: PHC EMR CS Data Elements ............................................................................... 18
Appendix B: PHC EMR CS Priority Subset—Data Element Matrix ............................................ 19
Appendix C: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Definitions ........................ 28
Appendix D: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Relation to the Priority Subset of Data Elements ...................................................................................... 38
Appendix E: Glossary of Terms ................................................................................................. 45
Bibliography .............................................................................................................................. 47
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Acknowledgements The Canadian Institute for Health Information (CIHI) would like to acknowledge and thank the many individuals and organizations that contributed to the development of this product. In particular, CIHI would like to acknowledge and express its appreciation to the members of the Jurisdictional Advisory Group (JAG) who provided invaluable guidance in developing the content for the Primary Health Care Electronic Medical Record Content Standard Priority Subset.
CIHI would also like to acknowledge the stakeholders who were engaged to validate and provide input to the Clinician-Friendly Pick-Lists (CFPLs). This included a pan-Canadian mix of primary care clinicians, nurse practitioners, decision-support specialists, jurisdictional representatives and Canada Health Infoway.
Jurisdictional Advisory Group Tom Fogg (Co-Chair) Consultant, Primary Health Care Manitoba Health
Jeff Aitken Director, Conformance and Integration Services, Health IT Strategy Branch British Columbia Ministry of Health
Tom Alteen Project Manager Newfoundland and Labrador Centre for Health Information
Claire Bernatchez Health Information Management Advisor Treasury Board Secretariat of Canada
Neil Gardner Strategic Advisor Saskatchewan Health
Christine Grimm Acting Chief Health Information Officer eHealth Nova Scotia
Caroline Heick (Co-Chair) Executive Director, Ontario, Quebec and Primary Health Care Information Canadian Institute for Health Information
Cheryl Hansen Executive Director, Innovation, eHealth New Brunswick Department of Health
Michele Herriot Chief Information Officer Northwest Territories Department of Health and Social Services
Martin Joy Director, Health Information Nunavut Department of Health and Social Services
Denise Junek Vice President, eHealth and Business Relations eHealth Saskatchewan
Janet Nyberg Manager, Information Systems Yukon Department of Health and Social Services
Sylvia Robinson Director, Primary Care British Columbia Ministry of Health
Christine Sham Manager, Strategy, Planning and Alignment eHealth Liaison Branch Ontario Ministry of Health and Long-Term Care
Sonya Stasiuk Director, Data Management Unit Alberta Health and Wellness
Liam Whitty Executive Director, Health Information Management Health PEI
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CFPL Validation Stakeholders Dr. Tim Kolotyluk Family Physician Alberta
Dr. Leo Wong Family Physician British Columbia
Gillian Brennan Project Director Manitoba
Dr. Carol Critchley Family Physician Nova Scotia
Dr. Leslie Griffin Family Physician Nova Scotia
Dr. John Campbell Family Physician Newfoundland and Labrador
Dr. Avnish Mehta Family Physician Ontario
Sheri Ross Senior Clinical Analyst Alberta
Dr. Leslie Sank Family Physician British Columbia
Dr. Robert Oliver Family Physician Nova Scotia
Pamela Biggs Business Analyst Nova Scotia
Patsy Smith Nurse Practitioner Nova Scotia
Cindy Hollister Clinical Leader, Clinical Adoption Canada Health Infoway
Dr. Ben Chan Assistant Professor University of Toronto
Dr. Ed Hirvi Family Physician Ontario
Dr. Mohamed Alarakhia Family Physician Ontario
Dr. Jennifer Rayner Family Physician Ontario
Sara Dalo Quality Improvement Decision Support Ontario
Dr. Wayne Parsons Family Physician Ontario
Carol Quinlan Nurse Practitioner Ontario
Chelsea Good Quality Improvement Decision Support Ontario
Ibrahim Omar Nurse Practitioner Ontario
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CIHI Project Team The core CIHI project team responsible for developing the Pan-Canadian Primary Health Care Electronic Medical Record Content Standard included
• Alison Bidie, Project Lead, Primary Health Care Information Program
• Jing Howard, Senior Coordinator, Primary Health Care Information Program
• Deepak Swain, Analyst, Primary Health Care Information Program
• Mary Byrnes, Manager, Primary Health Care Information Program
• Caroline Heick, Executive Director, Ontario, Quebec and Primary Health Care Information
Significant project contributions were also made by Husam Alqatami, Finnie Flores, Andrew Goosen, Alana Lane, Shaheena Mukhi, Martin Ortuzar, Isabelle Roberge, Maria Sanchez, Ginette Therriault, Cristina Tomsa and Jennifer Trebell.
This product could not have been completed without the generous support and assistance of many other CIHI departments, including Classifications and Terminology, Information Technology and Services, Publishing and Translation, Communications, and Distribution, and the CIHI Standards Working Group, who provided ongoing support to the core team.
About the Canadian Institute for Health Information The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI in 1994 as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal is to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. The year 2014 marks CIHI’s 20th anniversary of operation.
For more information, visit our website at www.cihi.ca.
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Introduction Background/Purpose CIHI has been leading the initiative to improve primary health care (PHC) data and information across Canada, in alignment with Canada’s federal, provincial and territorial governments and electronic medical record (EMR) programs. Data and information standards are the foundation of relevant and useful information. Standards ensure the consistent collection of data that is comparable and measurable. The Pan-Canadian Primary Health Care Electronic Medical Record Content Standard (PHC EMR CS) was thus created as a pan-Canadian solution to facilitate the capture of structured EMR data at the point of care. Environmental scans and stakeholder consultation recommended a smaller, more focused scope of priority data elements and highlighted the need for Clinician-Friendly Pick-Lists (CFPLs). In April 2014, CIHI released a PHC EMR CS Priority Subset (45 of the 106 data elements) to accelerate EMR content standards adoption across Canada. Refer to Appendix A for the data elements that are in scope. CIHI also developed CFPLs for 8 priority data elements. For more information, please refer to Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—Business View, available at www.cihi.ca/phc.
About This Document This guidance document is intended to provide jurisdictions and EMR vendors with information about the use of PHC EMR CS data elements, CFPLs and PHC reference sets (ref sets). The guide includes details about the scope and intended use of the standard, the value to stakeholders and implementation considerations. It is anticipated that the Priority Subset and associated CFPLs and ref sets will be included in EMR vendor requirements. This document does not contain technology-specific implementation guidance (e.g., how to extract data from an EMR, how to design EMR user interfaces to facilitate clinician data capture, how to load EMR data into a repository to support health system use). Over time, future EMR demonstration projects and implementation experience will inform version updates of the CS, CFPLs and associated guidance materials.
The companion products supporting the PHC EMR CS include an information sheet, the Business View v3.0, Data Models v3.0, Technical Guidance v3.0 and CFPL Spreadsheets v1.0. These products are available on CIHI’s website at www.cihi.ca/phc.
Value to Stakeholders When implemented at the point of care, it is anticipated that the Priority Subset and the associated CFPLs will increase the availability of structured, comparable EMR data to support priority information needs at the practice and health system levels. The focused scope of the CFPLs is intended to support priority PHC information needs and CIHI’s pan-Canadian PHC EMR–related indicators. For PHC clinicians, this means better EMR data to inform improvements to the quality of care, patient safety and efficiency in their practices.
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Similarly, structured EMR data will be an asset at the health system level and will support monitoring of chronic disease prevention and management, health outcomes, health promotion and quality of care. EMR vendors will also benefit from a single, usable pan-Canadian standard that has the potential to lower EMR implementation and maintenance costs in the longer term.
Stakeholder Inputs The Priority Subset was developed in consultation with the JAG, whose members validated the data elements with their respective stakeholders. Prince Edward Island, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the Northwest Territories provided input. In addition, stakeholders representing federal organizationsi were engaged to provide feedback. The final 45 data elements were endorsed by the JAG in December 2013.
Stakeholder input also informed the development of the CFPLs. In March 2014, the draft clinician-friendly terms were validated by a cross-section of stakeholders, including PHC clinicians, nurse practitioners, decision-support specialists, jurisdictional representatives and Canada Health Infoway. Feedback from stakeholders informed the final CFPL scope. In May 2014, the updated CFPLs and a plan to map them to relevant code systems were also reviewed by the JAG.
i. Health Canada, Department of National Defence, Public Health Agency of Canada, Correctional Service Canada.
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Clinician-Friendly Pick-Lists Overview The CFPLs are constrained lists of clinician-validated terms commonly used in PHC settings. CFPLs were developed for 8 Priority Subset data elements: Health Concern, Clinician Assessment, Social Behaviour, Reason for Visit, Intervention, Diagnostic Imaging Test Ordered, Referral and Vaccine Administered.
The CFPLs were developed to support aggregate-level reporting and analysis; in order to facilitate this, the CFPL terms were mapped to recognized code systems. Table 1 summarizes the CFPLs and the corresponding code system maps.
Table 1: CFPL Mapping to Code Systems
CFPL Description Code System Maps Available In Health Concern ICD-10-CA and ICD-9 Clinician Assessment ICD-10-CA and ICD-9 Social Behaviour ICD-10-CA and ICD-9 Reason for Visit ICD-10-CA and ICD-9
Intervention CCI Diagnostic Imaging Test Ordered CCI Referral Service SNOMED CT Vaccine Administered SNOMED CT
Note See Appendix E for descriptions of the code systems.
CFPL Scope The CFPL terms are intended to be captured as a minimum priority subset of information to facilitate standardized data capture at the point of care. Terms were identified to support a variety of needs for aggregate information at the practice level and to support quality improvement. Consideration was also given to uses such as population health and disease surveillance. Other scope considerations, such as enabling the use of PHC priority indicators and jurisdictional PHC information needs, were taken into account. Refer to Table 2 for detailed scope information.
The CFPLs do not include terms that are typically not critical to priority information needs expressed by CIHI’s stakeholders. For example, signs and symptoms (e.g., knee pain) as well as individual problem lists were not included in the Health Concern CFPL. In addition, the scope is mostly focused on data relevant to the PHC environment. For instance, past surgical interventions are out of scope, with a few exceptions required to support a PHC priority indicator.
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Table 2: CFPL Scope
CFPL Name In Scope Out of Scope Reason for Visit High-frequency complaints, symptoms, follow-ups,
requests for referral/services/medicine renewals
Health Concern Chronic conditions, comorbidities, ambulatory care and family practice sensitive conditions, special interests of population health, major previous medical history
Signs and symptoms, suspected/ query conditions, past surgeries
Social Behaviour Negative social behaviours (e.g., tobacco use, abuse of prescription drugs)
Occupations, positive social behaviours
Clinician Assessment Diagnoses, comorbidities, chronic conditions, ambulatory care sensitive conditions
Signs and symptoms, past history
Intervention Services/procedures relevant to PHC setting (e.g., counselling, education, examinations, past surgical interventions performed outside the PHC setting but relevant to PHC care)
Activities captured discretely in other data elements (e.g., diagnostic imaging tests, medications, lab tests, vaccines)
Diagnostic Imaging Test Ordered
Diagnostic imaging tests required for priority indicators such as cancer screening (mammogram) and bone density screening (bone mineral densitometry), high-frequency and special interest diagnostic imaging tests
Referral Types of specialty services (e.g., cardiology) Specialist descriptions (e.g., cardiologist), low-frequency services (e.g., faith healer)
Vaccine Administered High-frequency and mandatory vaccines and those included by the National Advisory Committee on Immunization (NACI); supports indicators on influenza, pneumococcal and childhood immunizations
PHC EMR CS Use Case Scenario What Is a Use Case? Use cases provide scenarios that describe the electronic transmission points of a common set of data elements between an end user and another system to link knowledge and achieve a specific business goal. For example, the structured capture of patient administrative and clinical data from a PHC encounter supports the calculation of PHC priority health indicators for clinicians, health system planners and policy-makers.
A use case includes the following components:
• Narrative: A brief story about people’s interactions with specific aspects of the PHC system.
• Swim lane diagram: A picture of the people, systems and EMR data involved in specific aspects of PHC systems. Each swim lane represents the action of a person or a system. In each lane, actions are initiated by an actor and result in data inputs or outputs to the system.
• Flow of events: A sequential flow of actions, derived from the narrative, that corresponds to key points in the swim lane diagram. Each step in the sequential flow of actions is referenced in the diagram as a numbered circle.
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Use Case: Narrative
At the onset of an encounter, patient administrative details are captured in the EMR, followed by the additional clinical data captured by a nurse and then a PHC clinician. Priority data elements such as Health Concern, Social Behaviour (risk factors) and Intervention are captured in the EMR in a structured format. Other data elements are captured when applicable, such as Vaccine Administered and Diagnostic Imaging Test Ordered. The collection of these priority data elements is supported by underlying CFPLs and PHC ref sets to enable structured EMR data at the point of care.
Once captured within the EMR, the structured data is used to support improvements to quality of care and health outcomes. In a standardized format, the EMR data can be aggregated for comparable reporting to support performance measurement at the practice and health system levels. The priority data elements can also be used to directly support the calculation of priority PHC indicators for use by clinicians, health system planners and policy-makers.
Use Case: Swim Lane Diagram
Figure 1 provides an example of a swim lane diagram.
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Figure 1: Use Case: Swim Lane Diagram
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Notes * Data element with an associated CFPL. † Data element with an associated constrained PHC ref set. Please refer to Appendix C for indicator definitions.
Patient arrives at PHC clinic based on his/her appointment
(set up before)
Administrative details • Patient Identifier • Patient Date of Birth • Patient Gender • Reason for Visit* • Visit Date
Nurse assesses the patient
• Blood pressure • Height • Weight
Physician assesses the patient based on
the Reason for Visit
Social Behaviour* • Smoking • Physical inactivity • Obesity
Relevant past and present medical history followed by physical examination (both general and regional based on Reason for Visit and risk factors)
• Health Concerns* • Clinician Assessment* • Intervention* • Diagnostic Imaging
Test Ordered* • Vaccine Administered†
Electronic medical record
Administrative details recorded by receptionist/
nurse
1 2
Indicators related to monitoring population health (for policy-makers) • Breast cancer screening • Cervical cancer screening • Child immunization • Overweight and obesity rate
Indicators related to chronic disease management (for clinicians) • Blood pressure control for hypertension • Screening for modifiable risk factors in adults with hypertension • Screening for modifiable risk factors in adults with diabetes • Screening for modifiable risk factors in adults with coronary artery disease
3
4 5
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Use Case: Flow of Events
1. The patient arrives at a PHC clinic for a scheduled appointment.
2. The receptionist/nurse records administrative details and Reason for Visit of the patient.
3. The nurse assesses the patient and captures systolic blood pressure, diastolic blood pressure, height, weight, etc., in the EMR.
4. The physician reviews the nurse’s assessment information in the EMR and, based on Reason for Visit, gathers relevant past and present medical history and performs physical examination and risk factor assessment.
5. Based on Reason for Visit, medical history and clinical examination, all health concerns are listed. Finally, the most relevant health concern related to the Reason for Visit is identified as the Clinician Assessment.
6. The data captured in the EMR at different stages during an encounter is used by clinicians and health system policy-makers to aggregate information to facilitate quality improvement and analysis of health system performance.
CFPL Licensing In order to protect the integrity of the CFPL terms and associated mapping to the relevant code systems, licence agreements are required for use by stakeholders, including commercial vendors, governments, non-commercial entities and others.
These agreements provide stakeholders with access to the CFPLs and the code mappings so they can adopt and implement them. Stakeholders are required to sign and submit an annual licence agreement before gaining access to the CFPLs.
For additional information about licence agreements, send an email to [email protected].
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Adoption, Maintenance and Governance Adoption It will be critical for jurisdictions to include the Priority Subset and associated CFPLs and PHC ref sets in their EMR vendor requirements to realize the benefits of structured EMR data collection at the point of care. However, incorporating the PHC EMR CS into an EMR specification does not, on its own, translate into the collection of meaningful, structured EMR data. Other key enablers to adoption include jurisdictional and clinician leadership, clear data governance, collaborative partnerships, change management, capacity-building and policy frameworks.
CIHI’s role in supporting the PHC EMR CS is to provide usable tools and products to jurisdictional stakeholders that are aligned with their priorities. CIHI will also offer subject matter expertise and technical guidance to implementers.
It is anticipated that jurisdictions will include the PHC EMR CS and CFPLs in their EMR vendor requirements. For details on PHC EMR CS data elements, refer to Appendix B. For additional information about obtaining the CFPLs, send an email to [email protected].
Maintenance CIHI will work with jurisdictions and other key partners to inform the refinement and evolution of the PHC EMR CS and CFPLs over time. Changes to data elements and clinician-friendly terms and further mapping to code systems will be driven by jurisdictional priorities and information needs, as well as the capability and interest of clinicians to collect additional data in a structured format. A maintenance plan will be developed by CIHI. The plan will include a stakeholder change request process with input from the JAG. However, the Priority Subset and CFPLs will remain stable and unchanged until piloting of the CFPLs has been completed. Additional implementation considerations will be identified at that stage and incorporated into the next generation of PHC EMR CS products.
Canada Health Infoway will continue to retain accountability for the PHC ref sets associated with the PHC EMR CS. CIHI will continue to collaborate with Canada Health Infoway in the area of standards and other opportunities to influence the standardization of EMR data.
Governance Oversight of the PHC EMR CS and CFPLs will be the responsibility of the Primary Health Care Information program at CIHI. Governance and endorsement of these products will continue to be driven through consultation with jurisdictional stakeholders. It should be noted that the use of the PHC EMR CS and CFPLs by jurisdictions and PHC providers is on a voluntary basis. Jurisdictions may choose to endorse these products and/or mandate their use by all PHC providers or by subsets of regional/local providers; they may also choose to encourage their use through other accountability mechanisms and agreements. CIHI does not have the authority to mandate the use of these products or the collection of data using these standards.
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Stakeholder Implementation Considerations PHC EMR CS Data Elements Stakeholders are encouraged to adopt all Priority Subset data elements in their EMR vendor requirements. The Data Element Matrix in Appendix B provides a detailed view of the Priority Subset of 45 data elements, including data element definitions, data types, valid formats, examples in primary care use and applicable CFPLs or PHC ref sets.
Note that the Priority Subset of data elements supports CIHI’s pan-Canadian PHC indicators. Information about the EMR-related indicators and how the data elements relate to the specific indicators can be found in appendices C and D, respectively.
Additional Data Elements Federal, provincial and territorial stakeholders may choose to define and collect additional EMR data elements beyond the Priority Subset and/or the original 106 data elements in the PHC EMR CS. This decision will be driven and supported by individual jurisdictional program needs. In turn, CIHI will consider including these additional elements in the Priority Subset and/or PHC EMR CS in the longer term.
When jurisdictional stakeholders consider using additional data elements beyond the Priority Subset, it is recommended that the core relationships in the underlying data models be retained. This will facilitate the use of the resulting EMR data for PHC indicator calculations.
Please send an email to [email protected] or visit CIHI online at www.cihi.ca/phc for further guidance when considering the inclusion of additional data elements. For more information, please refer to Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—Technical Guide (April 2014), available at www.cihi.ca/phc.
Data Extraction CIHI’s current focus is on providing tools to facilitate the capture of structured EMR data at the point of care. As such, the previously released pan-Canadian Data Extraction Specification (DES) v2.1 has not been updated. CIHI will evaluate the need to update the DES, depending on the needs of jurisdictions choosing to implement the PHC EMR CS.
When stakeholders plan for EMR data extraction, it is important that the solution supports the data relationship as reflected in the PHC EMR Data Models, v3.0. Jurisdictions are advised to consider existing jurisdictional data transfer solutions, as well as pan-Canadian directions/trends in data interoperability.
Please contact CIHI for further guidance when considering EMR data extraction. CIHI is interested in collaborating with jurisdictions that are implementing the PHC EMR CS, including the CFPLs.
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Other Data Sources PHC data may also include data that is transferred into the EMR from other external sources, such as a drug information system (e.g., lab prescriptions, dispenses), a lab system (e.g., lab results), diagnostic imaging repositories (e.g., diagnostic imaging reports), provincial electronic health record (EHR) repositories (e.g., clinical documents, allergies) or other EMRs (e.g., clinical summaries, referrals). Implementers will need to consider how to transform the data transferred into the EMR from external sources to align with the supported Priority Subset and/or CFPL code system(s) (e.g., to convert free-text information to coded data).
PHC Practice Considerations Should there be existing pick-lists in a PHC practice, it is recommended that these local lists be compared with the CFPL terms for alignment. The CFPL terms are generally broad descriptions (e.g., depression, asthma) that map to high-level codes to support aggregate-level reporting at the practice level and for health system use.
In order to maintain a standard approach to data capture, terms in the CFPLs are recommended as the terms of choice that can be easily viewed in the EMR interface to facilitate standardized data capture at the point of care. For example, when Alzheimer’s disease is typically captured in a PHC practice, the standardized description for Alzheimer’s disease from the CFPL should be adopted, not the local description, to reduce duplication and potential data quality issues.
Additional terms can be implemented as required by PHC clinicians. However, it will be the responsibility of the implementer to incorporate these additional terms into the EMR and undertake associated mapping to code systems where needed. In order to align to the CFPL development process, it is recommended that additional terms remain broad, unless there is a specific need for added granularity. For example, should additional mental health diseases be included in the pick-list, include the general description as a starting point and map to a high-level code category. This approach will facilitate analysis and aggregate-level reporting. Over time, through implementation experience and stakeholder feedback, the CFPL scope will evolve, and CIHI may include more granular terms and codes where required. For additional guidance on the CFPLs, please send an email to [email protected].
PHC Reference Sets Canada Health Infoway, in collaboration with CIHI, led the development of the PHC ref sets. The ref sets are intended to support the PHC EMR CS data elements and, when implemented, will enable structured EMR data at the point of care. For example, Patient Gender, Visit Type and Patient Identifier Type all have associated ref sets. The Priority Subset data elements are supported by 15 PHC ref sets in addition to the 8 CFPLs. Refer to Appendix A for details.
In the development of CFPLs, some ref sets were constrained to support the focused scope (e.g., Vaccine Administered, Referral). For more information about the ref sets, visit Canada Health Infoway at https://infocentral.infoway-inforoute.ca/2_Standards.
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Next Steps Stakeholder Engagement CIHI will engage jurisdictional representatives and vendors to promote the PHC EMR CS and CFPLs. In turn, jurisdictions and other primary health care stakeholders should consider the potential implementation of these products via PHC EMR programs and with jurisdictional partners.
EMR Demonstration CIHI will explore opportunities with ready jurisdictions or partners to engage in EMR demonstration projects or pilot projects where there is a commitment by the jurisdiction and/or partner to collect some structured data at the point of care. These local projects will form the basis for larger regional initiatives leading to a pan-Canadian approach. Future EMR demonstration projects will inform the evolution of the PHC EMR CS and CFPLs to ensure they continue to support health system use and priority PHC information needs for clinicians, health system planners and policy-makers. These projects will also inform CIHI’s approach and timing in considering resuming the collection of EMR data in a systematic way.
CIHI Contact Information and Companion Products For more information on the PHC EMR CS or CFPLs, or to learn more about PHC in Canada, please email the Primary Health Care Information program at [email protected] or visit CIHI’s website at www.cihi.ca/phc. The website also provides access to the following companion products: Business View (version 3.0); Technical Guide (version 3.0); Data Models (version 3.0) and an information sheet. Contact CIHI to learn how to purchase and access the Pan-Canadian Clinician-Friendly Pick-List Spreadsheets (version 1.0).
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Appendix A: PHC EMR CS Data Elements DE # Data Element Name DE # Data Element Name A1 Patient Identifier E29 Height Unit of Measure* A2 Patient Identifier Type* E30 Weight A3 Patient Identifier Assigning Authority* E31 Weight Unit of Measure* A4 Patient Date of Birth E34 Clinician Assessment A5 Patient Gender* F1 Intervention A9 Patient Status* F2 Intervention Date A14 Patient Postal/Zip Code G1 Lab Test Ordered* B4 Clinician Identifier G2 Lab Test Ordered Date B5 Clinician Identifier Type* H1 Lab Test Performed Date B6 Clinician Identifier Assigning Authority* H2 Lab Test Name* B7 Clinician Role* H3 Lab Test Result Value C1 Service Delivery Identifier H4 Lab Test Result Unit of Measure* C4 Service Delivery Postal Code I1 Diagnostic Imaging Test Ordered D1 Appointment Creation Date I2 Diagnostic Imaging Test Ordered Date D2 Reason for Visit J1 Diagnostic Imaging Test Performed Date D3 Visit Date K1 Referral* D4 Visit Type* K2 Referral Requested Date E11 Health Concern L1 Referral Occurred Date E12 Health Concern Date of Onset M1 Prescribed Medication E14 Social Behaviour M2 Prescription Date E23 Systolic Blood Pressure O1 Vaccine Administered* E24 Diastolic Blood Pressure O2 Vaccine Administered Date E28 Height
Notes * Data elements with PHC ref sets. Data elements highlighted in grey have CFPLs.
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Appendix B: PHC EMR CS Priority Subset—Data Element Matrix
Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type
Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
A1 Patient Identifier
Client Identifier Represents a unique identifier assigned to the Client.
Identifier N/A N/A N/A N/A Used in the provision and administration of care. Can be used to associate administrative information (e.g., demographic) and health information (e.g., lab results) with the Client.
A2 Patient Identifier Type
Client Identifier Type Code
Represents the type of Client Identifier (e.g., jurisdictional health care identifier, passport).
Code N/A Jurisdictional health number
ClientIdentifierTypeCode
PHC Reference Set
SNOMED CT®
2.16.840.1. 11388.3.2.20. 3.255
Helps differentiate the type of identifier used to identify the Client. In conjunction with the Client Identifier, can be used to associate administrative information (e.g., demographic) and health information (e.g., lab results) with the Client.
A3 Patient Identifier Assigning Authority
Client Identifier Assigning Authority Code
Represents the legal entity/ organization responsible for assigning the Client Identifier.
Code N/A Ministry of Health Alberta (qualifier value)
ClientIdentifier AssigningAuthorityCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.256
Helps identify the organization that issued the identifier when a Client can have multiple identifiers. In conjunction with the Client Identifier, can be used to associate administrative information (e.g., demographic) and health information (e.g., lab results) with the Client.
A4 Patient Date of Birth
Client Birth Date
Represents the Client’s date of birth.
Date YYYYMMDD 20101001 N/A N/A N/A N/A Birthdate is used to validate the identity of the Client. It is also used to ensure that the right drug and lab reference ranges are used for the Client.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
A5 Patient Gender
Client Administrative Gender Code
Represents the reported gender category of the Client at a given time.
Code N/A Male AdministrativeGender
PHC Reference Set
HL7 2.16.840.1.113883.2.20.3.308
Used for administrative purposes. Can be used for identification matching and confirmation.
A9 Patient Status
Client Status Code
Represents whether or not the PHC Provider considers the Client to be actively seeking PHC services through him or her.
Code N/A Patient active (finding)
ClientStatusCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.191
Ensures that inappropriate reminders are not sent to Clients who have a status of inactive with the Provider.
A14 Patient Postal/Zip Code
Client Residence Postal Code
Represents the postal code of the Client’s primary residence.
String ANA NAN K0K 3R0 N/A N/A N/A N/A Provides a part of the Client’s address, which can be used to help find Service Delivery Locations that are close to the Client’s home.
B4 Clinician Identifier
Provider Identifier
Represents a unique identifier assigned to the Provider.
Identifier N/A 82356743 N/A N/A N/A N/A Can be used to link Client records and billing information to a specific Provider. Can be used to support authorization to access sensitive records.
B5 Clinician Identifier Type
Provider Identifier Type Code
Represents the type of Provider Identifier.
Code N/A Provider billing number (qualifier value)
ProviderIdentifierTypeCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.257
In conjunction with the Provider Identifier, can be used to link Client records and billing information to a specific Provider. Can be used to support authorization to access sensitive records.
B6 Clinician Identifier Assigning Authority
Provider Identifier Assigning Authority Code
Represents the legal entity responsible for assigning the unique identifier to the Provider.
Code N/A Health regulatory body for physicians and surgeons (qualifier value)
ProviderIdentifierAssigningAuthorityCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.252
In conjunction with the Provider Identifier, can be used to link Client records and billing information to a specific Provider. Can be used to support authorization to access sensitive records.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
B7 Clinician Role Provider Role Type Code
Represents the role of the Provider in relation to his or her participation in a specific health care event.
Code N/A Primary care physician (occupation)
ProviderRoleCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.265
Used to distinguish roles within a health care setting. Can be used to restrict access to Client data by role type.
C1 Service Delivery Identifier
Service Delivery Location Identifier
Represents the unique identifier of the practice (Service Delivery Location) where the Client received care.
Identifier N/A 897564RT N/A N/A N/A N/A Name of the Service Delivery Location is referenced on letters sent to Clients.
C4 Service Delivery Postal Code
Service Delivery Location Postal Code
Represents the postal code where the Client received the PHC service.
String ANA NAN K0K 3R0 N/A N/A N/A N/A Provides a part of the Service Delivery Location address, which helps Clients know where to go for service.
D1 Appointment Creation Date
Encounter Request Date
Represents the date on which an appointment was created for the Client by the Provider (or his or her staff).
Date YYYYMMDD 20100430 N/A N/A N/A N/A Helps identify wait times for specific Providers.
D2 Reason for Visit
Client Encounter Reason Code
Represents the reason for the encounter as conveyed by the Client.
Code N/A R51 Reason for Visit CFPL
CFPL ICD-10-CA
2.16.840.1.113883.3.1780.5.12.2.3
Can be used to give the Provider advance notice of information that may need to be addressed with the Client during the encounter. Can assist in scheduling the amount of time a Client may need with the Provider.
D3 Visit Date Encounter Date
Represents the date the Client had an encounter with the Provider.
Date YYYYMMDD 20101001 N/A N/A N/A N/A Can report on Client wait times for scheduled Clients and track the continuum of care provided to Clients.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
D4 Visit Type Encounter Mode Code
Represents the type of contact between the Provider and the Client.
Code N/A Direct Encounter Client Alone (procedure)
EncounterTypeCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.207
Can be used to track services provided that may require special billing processes. Can be used to track percentage of Clients treated through various modes of visits.
E11 Health Concern
Observation Health Concern Code
Represents the Client’s relevant conditions, diagnoses and major past medical history.
Code N/A J44.9 Health Concern CFPL
CFPL ICD-10-CA
2.16.840.1.113883.3.1780.5.12.2.1
Provides a longitudinal record of health problems for a Client. Clinicians can use this information to monitor the health of their Clients, recommend treatments and assist in the formation of diagnoses.
E12 Health Concern Date of Onset
Observation Health Concern Start Date
Represents the date on which the Client’s health concern started.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Provides a longitudinal record of health problems for a Client. Clinicians can use this information to monitor the health of their Clients.
E14 Social Behaviour
Observation Social Behaviour Code
Represents a type of Client social behaviour that increases the possibility of disease or injury for the Client. This can include risk factors such as tobacco use, alcohol use and abuse of illicit or prescription drugs.
Code N/A Z72.0 Social Behaviour CFPL
CFPL ICD-10-CA
2.16.840.1.113883.3.1780.5.12.2.4
Can be used to identify Client behaviours or risk factors that, if treated, could lead to improvements in the Client’s health and wellness.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
E23 Systolic Blood Pressure
Observation Systolic Blood Pressure Number
Represents the Client’s systolic blood pressure value (in mmHg) as measured. The unit of measure (mmHg) is implied when representing the value.
Number N/A 120 N/A N/A N/A N/A A discrete value provides the ability to graph and trend values over time. The measurement supports clinical decisions.
E24 Diastolic Blood Pressure
Observation Diastolic Blood Pressure Number
Represents the Client’s diastolic blood pressure value (in mmHg) as measured. The unit of measure (mmHg) is implied when representing the value.
Number N/A 120 N/A N/A N/A N/A A discrete value provides the ability to graph and trend values over time. The measurement supports clinical decisions.
E28 Height Observation Height Number
Represents the height of the Client as measured.
Number N/A 3.25 N/A N/A N/A N/A A decrease in female height could be an early sign of osteoporosis and trigger a need for a bone mineral density test.
E29 Height Unit of Measure
Observation Height Unit of Measure Code
Represents the unit of measure used to capture the Client’s height.
Code N/A Centimetre HeightUnitofMeasureCode
PHC Reference Set
UCUM 2.16.840.1.113883.2.20.3.194
A decrease in female height could be an early sign of osteoporosis and trigger a need for a bone mineral density test.
E30 Weight Observation Weight Number
Represents the weight of the Client as measured.
Number N/A 75.6 N/A N/A N/A N/A Weight is used to calculate body mass index (BMI).
E31 Weight Unit of Measure
Observation Weight Unit of Measure Code
Represents the unit of measure used to capture the Client’s weight.
Code N/A Kilogram WeightUnitofMeasureCode
PHC Reference Set
UCUM 2.16.840.1.113883.2.20.3.195
Weight is used to calculate BMI.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
E34 Clinician Assessment
Observation Encounter Clinical Assessment Code
Represents the Provider’s professional opinion of the most significant condition related to the Client’s current encounter following clinical assessment.
Code N/A J45.9 Clinician Assessment CFPL
CFPL ICD-10-CA
2.16.840.1.113883.3.1780.5.12.2.6
The clinical assessment of the encounter can be used to help track episodes of care. Can also support the automatic creation of billing information.
F1 Intervention (Treatment)
Intervention Code
Represents the services or activities performed for the Client within the PHC setting as well as relevant intervention history that occurred beyond the PHC setting.
Code N/A 7.SP.10.VK Intervention CFPL
CFPL CCI 2.16.840.1.113883.3.1780.5.12.2.2
Tracked interventions performed on a Client can help guide future interventions. Used to track Client’s progressive improvement on the continuum of care timeline (e.g., counselling for smoking cessation delivered in 2012).
F2 Intervention (Treatment) Date
Intervention Date
Represents the date the intervention was performed.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Used in the provision of care to track the date a particular intervention was performed by the Provider.
G1 Lab Test Ordered
Laboratory Test Name Ordered Code
Represents the lab test ordered by the Provider for the Client.
Code N/A Hemoglobin A1c in Blood
ObservationOrderableLabType
PHC Reference Set
LOINC®, pCLOCD
2.16.840.1.113883.2.20.3.164
Used in the provision of care (e.g., confirmation of suspected diagnoses). The lab test name is required to know what test is being ordered.
G2 Lab Test Ordered Date
Laboratory Test Order Date
Represents the date the lab test was ordered by the Provider.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Supports scheduling of future appointments based on the tracked turnaround time of lab tests.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
H1 Lab Test Performed Date
Laboratory Test Performed Date
Represents the date the lab test was performed.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Schedule future appointments based on the tracked turnaround time of lab tests.
H2 Lab Test Name
Laboratory Test Result Name Code
Represents the lab test performed.
Code N/A Hemoglobin (Mass/ Volume) in Blood
ObservationResultableLabType
PHC Reference Set
LOINC®, pCLOCD
2.16.840.1.113883.2.20.3.105
Used to ensure that the name of the test performed is understood by the Provider, researcher, etc.
H3 Lab Test Result Value
Laboratory Test Result Value Text (Number, Code)
Represents the result of the lab test.
String (Number, Text)
N/A Sickle cell trait
N/A N/A N/A N/A Used in the provision of care (e.g., confirmation of suspected diagnoses). For instance, blood sugar monitoring (Accu-Chek) values are tracked over time and compared with yearly HbA1c test results at a central lab.
H4 Lab Test Result Unit of Measure
Laboratory Test Result Value Unit of Measure Code
Represents the unit of measure of the lab result for the lab test performed.
Code N/A mg/mmol (milligram per millimole)
LaboratoryObservationUnitOfMeasureCode
PHC Reference Set
UCUM 2.16.840.1.113883.2.20.3.152
Ensures that the unit of measure associated with the value is provided.
I1 Diagnostic Imaging Test Ordered
Diagnostic Imaging Test Ordered Code
Represents the type of diagnostic imaging test ordered by the Provider for the Client.
Code N/A 3.GY.10 Diagnostic Imaging Test Ordered CFPL
CFPL CCI 2.16.840.1.113883.3.1780.5.12.2.5
Diagnostic images can be used to assist in the confirmation of suspected diagnoses.
I2 Diagnostic Imaging Test Ordered Date
Diagnostic Imaging Test Ordered Date
Represents the date the diagnostic imaging test was ordered by the Provider.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Schedule future appointments based on the tracked turnaround time of diagnostic imaging tests.
J1 DI Test Performed Date
Diagnostic Imaging Test Performed Date
Represents the date the diagnostic imaging test was performed.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Schedule future appointments based on the tracked turnaround time of diagnostic imaging tests.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
K1 Referral Service Code
Referral Represents the type of service required for the Client.
Code N/A 310063007 ReferralServiceCode
PHC Reference Set
SNOMED CT®
2.16.840.1.113883.2.20.3.197
Identifies the general type of care or category of referral services requested.
K2 Referral Requested Date
Referral Requested Date
Represents the date the referral request was created by the PHC Provider.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Assists Providers in tracking when a request to obtain a consult was first requested.
L1 Referral Occurred Date
Referral Occurred Date
Represents the actual date the Client had the encounter with the referred-to Provider.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Assists Providers in understanding which referral services have longer wait times.
M1 Prescribed Medication
Medication Prescribed Name Code
Represents the medications prescribed to the Client.
Code N/A Amoxicillin N/A N/A TBD N/A Can be used to create a longitudinal medication record to support the provision of care.
M2 Prescription Date
Medication Prescribed Date
Represents the date the prescription for the medication was created for the Client.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Can be used to create a longitudinal medication record to support the provision of care.
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Data Element Number
Data Element Common Name
Data Element Standard Name
Data Element Definition
Data Type Valid Format
Example Values
Permissible Values Source Name
Type of Source for Permissible Values
Code System
Permissible Values Source ID
Example of Primary Care Use
O1 Vaccine Administered
Vaccine Administered Name Code
Represents the vaccine administered to the Client within and beyond the PHC setting, including current and past vaccination history.
N/A Influenza virus vaccine (product)
VaccineAdministeredNameCode: • VaccineAdministeredTradeNameCode • VaccineHistoricalNameCode • PassiveAdministeredImmunizingAgentCode • PassiveHistoricalImmunizingAgentCode
PHC Reference Set
SNOMED CT®
• 2.16.840.1.113883.2.20.3.281 • 2.16.840.1.113883.2.20.3.282 • 2.16.840.1.113883.2.20.3.279 • 2.16.840.1.113883.2.20.3.262
Can be used to create reminders about vaccines to be administered and track past history of vaccinations.
O2 Vaccine Administered Date
Vaccine Administered Date
Represents the date the vaccine was administered to the Client.
Date YYYYMMDD 20100430 N/A N/A N/A N/A Can be used to support vaccine reminders to relevant Clients or to flag that a vaccine has already been given and is not required until a future date.
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Appendix C: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Definitions This information comes from the Pan-Canadian Primary Health Care Indicator Update Report, which is available from www.cihi.ca/phc. The following is a subset of EMR-related indicators.
Indicator Name Indicator Definition Numerator Denominator Child Immunization Percentage of patient population,
currently age 7, who have received recommended childhood immunizations.
Number of individuals in the denominator who have received childhood immunizations in accordance with the recommended schedule.
Inclusions • Individual is in the denominator • Individual has received all immunizations listed
in the National Advisory Committee on Immunizations (NACI) recommended schedule, or had a contraindication for immunizations that were not received
Exclusions None
Number of primary health care (PHC) clients/patients currently age 7.
Inclusions • PHC client/patient • Age of individual is 7 years
Exclusions None
Colon Cancer Screening Percentage of patient population, age 50 to 74, who had a screening test ordered for colon cancer.
Number of individuals in the denominator who had a screening test for colon cancer ordered within an appropriate time frame.
Inclusions • Individual is in the denominator • Individual who had at least one of the following
screening tests ordered: − Fecal occult blood test (FOBT) within the past
24 months − Sigmoidoscopy within the past 5 years − Colonoscopy within the past 10 years
Exclusions None
Number of primary health care (PHC) clients/patients, age 50 to 74.
Inclusions • PHC client/patient • Age of individual is between 50 and
74 years
Exclusions None
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Indicator Name Indicator Definition Numerator Denominator Breast Cancer Screening Percentage of female population,
age 50 to 74, who reported having had a mammogram.
Number of individuals in the denominator who had a mammogram ordered within the past 36 months.
Inclusions • Individual is in the denominator • Individual had a mammogram ordered within
the past 36 months
Exclusions None
Number of female primary health care (PHC) clients/patients age 50 to 74.
Inclusions • PHC client/patient • Sex of individual is female • Age of individual is between 50 and
74 years
Exclusions • Individual has had a bilateral
mastectomy
Cervical Cancer Screening Percentage of female patient population, age 18 to 69, who had a Papanicolaou test.
Number of individuals in the denominator who had a Papanicolaou test within the past 36 months.
Inclusions • Individual is in the denominator • Individual had a Papanicolaou test within the
past 36 months
Exclusions None
Number of female primary health care (PHC) clients/patients, age 18 to 69.
Inclusions • PHC client/patient • Sex of individual is female • Age of individual is between 18 and
69 years
Exclusions • Individual had a hysterectomy
Smoking Cessation Advice in PHC
Percentage of patient population who are smokers, age 12 and older, who were offered specific help or information to quit smoking.
Number of individuals in the denominator who were offered specific help or information to quit smoking within the past 15 months.
Inclusions • Individual is in the denominator • Individual was offered smoking cessation
education within the past 15 months
Exclusions None
Number of primary health care (PHC) clients/patients, age 12 and older, who are smokers.
Inclusions • PHC client/patient • Age of individual is at least 12 years • Individual is a smoker • Individual visited his or her PHC
provider within the past 15 months
Exclusions • Individual uses tobacco only for a
purpose other than smoking
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Indicator Name Indicator Definition Numerator Denominator Influenza Immunization, 65+ Percentage of patient population,
age 65 and older, who received an influenza immunization.
Number of individuals in the denominator who received an influenza immunization within the past 12 months.
Inclusions • Individual is in the denominator • Individual received an influenza immunization
within the past 12 months
Exclusions None
Number of primary health care (PHC) clients/patients, age 65 and older.
Inclusions • PHC client/patient • Age of individual is at least 65 years
Exclusions None
Well Baby Screening Percentage of patient population, currently age 3, who received screenings for congenital hip displacement, eye and hearing problems.
Number of individuals in the denominator who received screening for congenital hip displacement, eye and hearing problems.
Inclusions • Individual is in the denominator • Individual received screening for congenital
hip displacement • Individual received screening for eye problems • Individual received screening for
hearing problems
Exclusions None
Number of primary health care (PHC) clients/patients, currently age 3.
Inclusions • PHC client/patient • Age of individual is 3 years
Exclusions None
Blood Pressure Testing Percentage of patient population, age 18 and older, who have had their blood pressure measured by their primary health care (PHC) provider.
Number of individuals in the denominator who had their blood pressure measured by their PHC provider in the past 15 months.
Inclusions • Individual is in the denominator • Individual had a blood pressure measurement
taken by his or her PHC provider within the past 15 months
Exclusions None
Number of PHC clients/patients, age 18 and older.
Inclusions • PHC client/patient • Age of individual is at least 18 years
Exclusions None
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Indicator Name Indicator Definition Numerator Denominator Screening for Modifiable Risk Factors in Adults With Coronary Artery Disease
Percentage of patient population, age 18 and older, with coronary artery disease (CAD) who received testing for all of the following: • Full fasting lipid profile screening; • Blood pressure measurement; and • Obesity/overweight screening.
Number of primary health care (PHC) clients/patients who received testing within the past 12 months for all of the following: • Full fasting lipid profile screening; • Blood pressure measurement; and • Obesity/overweight screening.
Inclusions • Individual is in the denominator • Individual had a lipid profile screening
performed within the past 12 months • Individual had a blood pressure measurement
taken by his or her PHC provider within the past 12 months
• Individual had at least one of the following: − Weight measured by his or her PHC provider
within the past 12 months − Waist circumference measured by his or her
PHC provider within the past 12 months
Exclusions None
Number of PHC clients/patients, age 18 and older, with CAD.
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has a diagnosis of CAD
Exclusions None
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Indicator Name Indicator Definition Numerator Denominator Screening in Adults With Diabetes
Percentage of patient population, age 18 and older, with diabetes mellitus who received testing for all of the following: • Hemoglobin A1c (HbA1c); • Full fasting lipid profile screening; • Nephropathy screening
(e.g., albumin/creatinine ratio, microalbuminuria);
• Foot examination; • Blood pressure measurement; and • Obesity/overweight screening.
Number of individuals in the denominator who received testing for all of the following: • At least two HbA1c tests within the past
12 months; • Full fasting lipid profile screening within the
past 36 months; • Nephropathy screening (e.g., albumin/
creatinine ratio, microalbuminuria) within the past 12 months;
• Foot examination within the past 12 months; • Blood pressure measurement within the past
12 months; and • Obesity/overweight screening within the past
12 months.
Inclusions • Individual is in the denominator • Individual had at least two HbA1c tests within
the past 12 months • Individual had a lipid profile screening within
the past 36 months • Individual had a nephropathy screening test
within the past 12 months • Individual had a foot examination from his or
her primary health care (PHC) provider within the past 12 months
• Individual had a blood pressure measurement taken by his or her PHC provider within the past 12 months
• Individual had at least one of the following: − Weight measured by his or her PHC provider
within the past 12 months − Waist circumference measured by his or her
PHC provider within the past 12 months
Exclusions None
Number of PHC clients/patients, age 18 and older, with diabetes mellitus
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has a diagnosis of
diabetes mellitus
Exclusions None
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Indicator Name Indicator Definition Numerator Denominator Screening for Modifiable Risk Factors in Adults With Hypertension
Percentage of patient population, age 18 and older, with hypertension who received testing for all of the following: • Fasting blood sugar; • Blood pressure measurement; and • Obesity/overweight screening.
Number of individuals in the denominator who received testing, within the past 12 months, for all of the following: • Fasting blood sugar; • Blood pressure measurement; and • Obesity/overweight screening.
Inclusions • Individual is in the denominator • Individual had a blood pressure measurement
taken by his or her primary health care (PHC) provider within the past 12 months
• Individual had at least one of the following: − Weight measured by his or her PHC provider
within the past 12 months − Waist circumference measured by his or her
PHC provider within the past 12 months • Individual had at least one of the following:
− A blood sugar test within the past 12 months − A diagnosis of diabetes mellitus
Exclusions None
Number of PHC clients/patients, age 18 and older with hypertension
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has a diagnosis of
hypertension
Exclusions • Individual is pregnant
Treatment of Dyslipidemia Percentage of patient population, age 18 and older, with established coronary artery disease (CAD) and elevated low-density lipoprotein cholesterol (LDL-C) who were offered lifestyle advice and lipid-lowering medication.
Number of individuals in the denominator who were offered lifestyle advice and lipid-lowering medication within the past 12 months.
Inclusions • Individual is in the denominator • Individual was offered lifestyle advice within the
past 12 months • Individuals who have one or both of
the following: − Individual was prescribed lipid-lowering
medication within the past 12 months − Individual has a documented contraindication
to lipid-lowering medication
Exclusions None
Number of primary health care (PHC) clients/patients, age 18 and older, with established CAD and elevated LDL-C (i.e., greater than 2.0 mmol/L).
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has a diagnosis of
coronary artery disease • Individual has an LDL-C value
greater than 2.0 mmol/L
Exclusions None
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Indicator Name Indicator Definition Numerator Denominator Treatment of Acute Myocardial Infarction
Percentage of patient population who have had an acute myocardial infarction (AMI) and are currently prescribed a beta-blocking drug.
Number of individuals in the denominator who are currently prescribed a beta-blocking drug.
Inclusions • Individual is in the denominator • Individuals who had one or both of
the following: − Individual was prescribed a beta-blocking
drug within the past 12 months − Individual has a contraindication to beta-
blocking drugs
Exclusions None
Number of primary health care (PHC) clients/patients who had an AMI between 12 and 24 months ago.
Inclusions • PHC client/patient • Individual had an AMI between 12
and 24 months ago
Exclusions None
Treatment of Anxiety Percentage of patient population, age 18 and older, with a diagnosis of panic disorder or generalized anxiety disorder who were offered treatment or referral to a mental health provider.
Number of individuals in the denominator who were offered treatment or referral to a mental health provider within the past 12 months.
Inclusions • Individual is in the denominator • Individual received at least one of the following
from his or her primary health care (PHC) provider within the past 12 months: − A prescription for anti-anxiety medication − A referral to a mental health provider − An offer for non-pharmacological treatment
(psychological interventions: individual non-facilitated self-help, individual guided self-help and psychoeducational groups)
Exclusions None
Number of PHC clients/patients, age 18 and older, with a diagnosis of panic disorder or generalized anxiety disorder.
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has a diagnosis of at least
one of the following conditions: − Panic disorder − Generalized anxiety disorder
Exclusions None
(cont’d on next page)
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Indicator Name Indicator Definition Numerator Denominator Blood Pressure Control for Hypertension
Percentage of patient population, age 18 and older, with hypertension for a duration of at least 12 months, who have blood pressure measurement control.
Number of individuals in the denominator who have had blood pressure measurement control within the past 12 months.
Inclusions • Individual is in the denominator • Individual had a blood pressure measurement
taken by his or her primary health care (PHC) provider within the past 12 months
• If patient does not have a diagnosis of diabetes mellitus: − The latest blood pressure reading is less
than 140/90 • If patient does have a diagnosis of
diabetes mellitus: − The latest blood pressure reading is less
than 130/80
Exclusions None
Number of PHC clients/patients, age 18 and older, with hypertension for duration of at least 12 months.
Inclusions • PHC client/patient • Age of individual is at least 18 years • Individual has had a diagnosis of
hypertension for at least 12 months
Exclusions • Individual is currently pregnant
Overweight and Obesity Rate Percentage of patient population, age 2 and older, who are currently overweight or obese.
Number of individuals in the denominator who have a height and weight corresponding to a body mass index (BMI) in the overweight or obese range.
Inclusions • Individual is in the denominator • Individual has a height and weight
corresponding to a BMI in the overweight or obese range
Exclusions None
Number of primary health care (PHC) clients/patients age 2 and older.
Inclusions • PHC client/patient • Age of individual is at least 2 years
Exclusions • Individual is currently pregnant • Individuals who are
− Age 18 and older; and − Shorter than 0.914 metres
• Individuals who are − Age 18 and older; and − Taller than 2.108 metres
(cont’d on next page)
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Indicator Name Indicator Definition Numerator Denominator Complications of Diabetes Percentage of population, age
50 to 74, with established diabetes mellitus who had an acute myocardial infarction, had an above- or below-knee amputation or began chronic dialysis.
Number of individuals, age 50 to 74, with diabetes mellitus who had an acute myocardial infarction, had an above- or below-knee amputation or began chronic dialysis within the past 12 months.
Inclusions • Age of individual is between 50 and 74 years • Individual has a diagnosis of diabetes mellitus • Individual had one or more of the following
within the past 12 months: − Acute myocardial infarction − Amputation above or below the knee − Initiation of chronic dialysis
Exclusions None
Number of individuals, age 50 to 74, with diabetes mellitus who had an acute myocardial infarction, had an above- or below-knee amputation or began chronic dialysis within the past 12 months.
Inclusions • Age of individual is between 50 and
74 years • Individual has a diagnosis of
diabetes mellitus • Individual had one or more of the
following within the past 12 months: − Acute myocardial infarction − Amputation above or below
the knee − Initiation of chronic dialysis
Exclusions None
Health Risk Screening in PHC Percentage of PHC clients/patients, age 12 and older, who were screened by their PHC provider for the following common health risks over the past 12 months: • Tobacco use; • Unhealthy eating habits; • Problem drug use; • Physical inactivity; • Overweight status; • Problem alcohol drinking; • Unintentional injuries (home
risk factors); • Unsafe sexual practices; and • Unmanaged psychosocial stress
and/or depression.
Number of PHC clients/patients who report being screened by their PHC provider for common health risks over the past 12 months
Total number of PHC clients/patients, 12 years and over
(cont’d on next page)
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Indicator Name Indicator Definition Numerator Denominator Glycemic Control for Diabetes Percentage of PHC clients/patients,
age 18 and older, with diabetes mellitus in whom the last HbA1c was 7.0% or less (or equivalent test/reference range depending on local laboratory) in the last 15 months.
Number of PHC clients/patients with diabetes mellitus in whom the last HbA1c was 7.0% or less (or equivalent test/reference range depending on local laboratory) in the past 15 months
Total number of PHC clients/patients, 18 years and over with diabetes mellitus within the past 15 months
Dyslipidemia Screening for Women
Percentage of PHC women clients/patients, age 55 and older, who had a full fasting lipid profile measured within the past 24 months.
Number of PHC women clients/patients who had a full fasting lipid profile measured within the past 24 months
Total number of PHC women clients/patients, age 55 years and older, within the past 24 months
Dyslipidemia Screening for Men
Percentage of PHC men clients/ patients, age 40 and older, who had a full fasting lipid profile measured within the past 24 months.
Number of PHC men clients/patients who had a fasting lipid profile measured within the past 24 months
Total number of PHC men clients/ patients age 40 years and older
Screening for Visual Impairment in Adults With Diabetes
Percentage of PHC clients/patients, age 18 to 75, with diabetes mellitus who saw an optometrist or ophthalmologist within the past 24 months.
Number of PHC clients/patients with diabetes mellitus who saw an optometrist or ophthalmologist within the past 24 months
Total number of PHC clients/patients, age 18 to 75 years, with diabetes mellitus within the past 24 months
Bone Density Screening Percentage of women PHC clients/patients, age 65 and older, who received screening for low bone mineral density at least once.
Number of women PHC clients/patients who received screening for low bone mineral density at least once
Total number of women PHC clients/ patients age 65 years and older
Pneumococcal Immunization, 65+
Percentage of PHC clients/patients, age 65 and older, who have received a pneumococcal immunization.
Number of PHC clients/patients who received a pneumococcal immunization
Total number of PHC clients/patients age 65 years and older
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Appendix D: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Relation to the Priority Subset of Data Elements
DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral O
verw
eigh
t and
Obe
sity
Rat
e
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
A1 Patient Identifier X X X X X X X X X X X X X X X X X X X X X X X X X X
A4 Patient Date of Birth
X X X X X X X X X X X X X X X X X X X X X X X
A5 Patient Gender X X X X
A9 Patient Status X X X X X X X X X X X X X X X X X X X X X X X X X
D1 Appointment Creation Date
X
D3 Visit Date X X X X X X X X X X X X X X
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
E11 Health Concern X X X X X X X X X X X X X
E12 Health Concern Date of Onset
X X X X X
E14 Social Behaviour
X X
E23 Systolic Blood Pressure
X X X X X
E24 Diastolic Blood Pressure
X X X X X
E28 Height X X
E29 Height Unit of Measure
X X
E30 Weight X X X X X
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
E31 Weight Unit of Measure
X X X X X
E34 Clinician Assessment
X X X X X X X X X X X X X
F1 Intervention X X X X X X X X X
F2 Intervention (Treatment) Date
X X X X X X X X X
G1 Lab Test Ordered
X
G2 Lab Test Ordered Date
X
H1 Lab Test Performed Date
X X X X X X
H2 Lab Test Name X X X X X X
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
H3 Lab Test Result Value
X X
H4 Lab Test Result Unit of Measure
X X
I1 Diagnostic Imaging Test Ordered
X X
I2 Diagnostic Imaging Test Ordered Date
X
K1 Referral X X X
K2 Referral Requested Date
X X X
L1 Referral Occurred Date
X X
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
M1 Prescribed Medication
X X X
M2 Prescription Date
X X X
O1 Vaccine Administered
X X X
O2 Vaccine Administered Date
X X X
A2 Patient Identifier Type
Used for administrative purposes
A3 Patient Identifier Assigning Authority
Used for administrative purposes
A14 Patient Postal/ Zip Code
Used to distinguish urban and rural patient populations or to stratify quality indicators by geographic region; can also be used to calculate travel distance to PHC clinic to inform equity of care
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
B4 Clinician Identifier
For Provider-level analysis and reporting; required to calculate which patients will be aggregated into which provider’s report
B5 Clinician Identifier Type
Used for administrative purposes
B6 Clinician Identifier Assigning Authority
Used for administrative purposes
B7 Clinician Role Used to restrict indicator calculations to appropriate provider types (e.g., access information on a specific type of PHC provider); can also inform coordination of care within a PHC setting
C1 Service Delivery Identifier
For practice-level analysis and reporting; required to identify the PHC practice where the patient received care in order to generate practice-level statistics
C4 Service Delivery Postal Code
Used to distinguish urban and rural clinics; paired with A14 to calculate travel distance to clinic to inform equity of care
D2 Reason for Visit Used to inform how often patients come to PHC clinic for a specific chronic health condition
(cont’d on next page)
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DE #
PHC Indicator Data Element Name
Health Status
Appropriateness
Effectiveness
Other Quality Measures
Immunization Screening Treatment and
Education Wait
Times Referral
Ove
rwei
ght a
nd O
besi
ty R
ate
Influ
enza
Imm
uniz
atio
n, 6
5+
Chi
ld Im
mun
izat
ion
Pne
umoc
occa
l Im
mun
izat
ion,
65+
Hea
lth R
isk
Scre
enin
g in
PH
C
Wel
l Bab
y Sc
reen
ing
Blo
od P
ress
ure
Test
ing
Col
on C
ance
r Scr
eeni
ng
Cer
vica
l Can
cer S
cree
ning
Bre
ast C
ance
r Scr
eeni
ng
Dys
lipid
emia
Scr
eeni
ng (M
en a
nd W
omen
)
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
C
oron
ary
Arte
ry D
isea
se
Scr
eeni
ng fo
r Mod
ifiab
le R
isk
Fact
ors
in A
dults
With
H
yper
tens
ion
Scr
eeni
ng in
Adu
lts W
ith D
iabe
tes
Scr
eeni
ng fo
r Vis
ual I
mpa
irmen
t in
Adu
lts W
ith D
iabe
tes
Bon
e D
ensi
ty S
cree
ning
Trea
tmen
t of D
yslip
idem
ia
Trea
tmen
t of A
nxie
ty
Trea
tmen
t of A
cute
Myo
card
ial I
nfar
ctio
n
Sm
okin
g C
essa
tion
Adv
ice
in P
HC
Blo
od P
ress
ure
Con
trol f
or H
yper
tens
ion
Com
plic
atio
ns o
f Dia
bete
s
Gly
cem
ic C
ontro
l for
Dia
bete
s
Wai
t Tim
es fo
r PH
C P
rovi
der
Wai
t Tim
es fo
r Spe
cial
ist R
efer
ral
Ref
erra
ls fo
r Pat
ient
s W
ith C
hron
ic C
ondi
tions
D4 Visit Type Used for administrative purposes
J1 DI Test Performed Date
Used to calculate diagnostic imaging wait times
45
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—Clinician Friendly Pick List Guide
Appendix E: Glossary of Terms
Term Acronym (if Applicable) Description
Canadian Classification of Health Interventions
CCI The Canadian Classification of Health Interventions (CCI) is the new Canadian national standard for classifying health care procedures. CCI is the companion classification system to ICD-10-CA. CCI replaces the Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures (CCP) and the intervention portion of ICD-9-CM in Canada. It is designed to be provider and location neutral so that it may be used across the continuum of health care settings in Canada.
Canadian Institute for Health Information
CIHI CIHI is an independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians.
Clinician-Friendly Pick-Lists
CFPLs The CFPLs are constrained lists of clinician-friendly terms mapped to 1 appropriate code system, aimed at supporting adoption of the PHC EMR CS Priority Subset. The scope of the CFPLs is focused on supporting PHC indicators for clinicians and jurisdictions.
Content Standard Working Group
CSWG The CSWG provides input and expert advice on the adoption, implementation and maintenance of the PHC EMR CS to ensure that it remains clinically and technically relevant and aligned with existing standards, where applicable. The group includes jurisdictional standards experts, PHC providers, researchers and Canada Health Infoway.
Electronic Medical Record
EMR An EMR is a computer-based patient medical record used by physicians, nurses and administrative staff. EMRs contain patient information that authorized health professionals can access electronically rather than through a traditional paper chart.
Health System Use HSU HSU of information refers to the use of health information to monitor, manage and improve the health of Canadians and the health care system.
International Statistical Classification of Diseases and Related Health Problems, Ninth Revision
ICD-9 ICD-9 is a publication from the World Health Organization comprising a set of codes that are used worldwide to classify diseases and injuries. The ICD-9 is split into several sections that correspond to a type of disease or injury. Each section is assigned to a range of numbers, each of which denotes a medical condition.
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada
ICD-10-CA ICD-10-CA is an enhanced version of ICD-10 developed by CIHI for morbidity classification in Canada. ICD-10-CA represents the broadest scope of any previous ICD revision to date. Unlike ICD-9, ICD-10-CA applies beyond acute hospital care. ICD-10-CA also includes conditions and situations that are not diseases but represent risk factors to health, such as occupational and environmental factors, lifestyle and psycho-social circumstances.
Jurisdictional Advisory Group
JAG The JAG is a pan-Canadian working group that supports adoption and implementation of the PHC EMR CS by providing approval, advice and strategic guidance on adoption, implementation, stakeholder engagement and ongoing governance. The group consists of senior-level representatives from jurisdictions across Canada.
Primary Health Care
PHC PHC refers to first-contact care that deals with the majority of health problems. It is the foundation of any health care system, and countries with strong primary care seem to have better health than those without.
(cont’d on next page)
46
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—Clinician Friendly Pick List Guide
Term Acronym (if Applicable) Description
Primary Health Care Electronic Medical Record Content Standard
PHC EMR CS The PHC EMR CS is composed of priority data elements that are commonly captured in EMRs in a PHC setting and that support both primary and health system use of EMR data.
Primary Health Care Reference Sets
PHC Ref Sets PHC ref sets are effectively constrained lists of allowable values from the source code system(s) that are applicable to the delivery and administration of PHC. They support the implementation of the PHC EMR CS by facilitating standardization of PHC data for primary and health system use.
Primary Health Care Voluntary Reporting System
PHC VRS The PHC VRS is a pan-Canadian PHC data source to support PHC performance measurement and health system improvement. It collects a minimum data set of patient data extracted from the PHC EMR systems of PHC VRS participants.
Systematized Nomenclature of Medicine—Clinical Terms
SNOMED CT SNOMED CT is a comprehensive clinical terminology that contains more than 300,000 active concepts with unique meanings, ranging from diagnoses and therapies, to medications, results and orders. For more information on SNOMED CT, please visit Canada Health Infoway’s website: https://infocentral.infoway-inforoute.ca/2_Standards.
47
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—Clinician Friendly Pick List Guide
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Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Toronto, ON: CCS; 2013.
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INSightful Information TEchnologies for Family Medicine. Electronic Nomenclature and Classification of Disorders and Encounters for Family Medicine, Version 5.0. Ottawa, ON: INSITE-Family Medicine Inc.; 2009. http://www.insite-fm.com/Products/ENCODE-FMver5.0.pdf. Accessed September 10, 2014.
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Wait Time Alliance. Wait time benchmarks for sight restoration. http://www.waittimealliance.ca/ waittimes/sight_restoration.htm. Accessed September 10, 2014.
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