How We Are Working Together Why Technology for Integration ... · 2 3 Technology for Integration and Continuity Orientation for Clinic Managers: Primary Care and Pediatrician June

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


• 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


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


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)


EMR

Emergency

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Real Patient Story

Physician choosesCII/CPAR

i


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



• 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 [email protected]

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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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


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‐[email protected]@

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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?