Lessons Learned and the Potential of
EMR Data to Support Quality of Care
and Performance Measurement
Alison Bidie
Project Lead, Primary Health Care Information
Canadian Institute for Health information
Canadian Respiratory Conference, Calgary
April 26, 2014
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Conflict of Interest Declaration
The following presentation has no Conflict of Interest with
any other parties or sources
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Outline
1. Insights to EMR data
2. Overview of PHC EMR Content Standard and Clinician
Friendly Pick Lists
3. Respiratory Indicators
4. Key Enablers to Improving EMR data
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Insights to EMR Data
• EMR data is non-standard, unstructured and mostly free text
• Process to extract, manipulate and analyze data very labour
intensive and not sustainable
• PHC EMR Standards (data elements combined with clinicianfriendly picklists) require focus to facilitate implementation at the
point of care
• Need other key elements to facilitate the capture of meaningful
information at the point of care include:
• leadership, clear data governance, capacity building, change
management, collaborative partnerships
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PHC EMR CS Priority Subset
• 45 priority data elements; support 24 CIHI PHC
indicators
– Response to environmental scan
– Accelerate implementation
– Aligned to jurisdictional priorities
• Endorsed by the Jurisdictional Advisory Group
• Primary Objective: Jurisdictions include the panCanadian PHC EMR CS priority subset in their EMR
vendor requirements (to support improvements in care
delivery and health system management)
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Clinician-Friendly Pick Lists (CFPL)
• Objective: Support adoption of EMR CS Priority Subset
with 8 Pick Lists to facilitate structured data capture at the
point of care:
Health Concern, Clinician Assessment, Reason for Visit,
Intervention, Social Behaviour, Referral, DI Test Ordered,
Vaccine Administered
• Description: Constrained clinician-friendly terms mapped
to appropriate code system supporting Health System
Use, Priority PHC Indicators, PHC information needs
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Respiratory Indicators Supported by EMR CS
1. Smoking cessation advice in PHC
2. Influenza immunization, 65+
3. Pneumococcal immunization, 65+
4. Childhood immunization
5. Health risk screening in PHC
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Respiratory Indicator Definitions
Description
Definition
PHC Domain
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.
Appropriateness
Influenza
immunization,
65+
Percentage of patient population, age 65 and older,
who received an influenza immunization.
Appropriateness
Pneumococcal
immunization,
65+
% of PHC clients/patients, 65 years and over, who
have received a pneumococcal immunization.
Appropriateness
Childhood
immunization
Percentage of population currently age 7, who have
received recommended primary childhood
immunizations.
Appropriateness
Health risk
screening in
PHC
% of PHC clients/patients, 12 years and over, who
were screened by their PHC provider for the following
common health risks over the past 12 months.
Appropriateness
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Key Messages
1. The PHC EMR CS Priority Subset and CFPLs are the foundation to
enable high quality, standardized EMR data for point of service and
health system use needs
2. CIHI is collaborating with jurisdictions and clinicians to ensure that
the Priority Subset and CFPLs are aligned to priorities and
information needs
3. The focused scope of the Priority Subset and associated CFPLs
directly supports performance measurement for chronic disease
management and health promotion
4. Other enablers needed: jurisdictional and clinician leadership, clear
data governance, collaborative partnerships, change management,
capacity-building and engagement.
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CIHI Resources
• PHC EMR CS Priority Subset
(Business View, data models, technical guide):
https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2576&
lang=en
• PHC VRS Insight Report: http://www.cihi.ca/CIHI-extportal/pdf/internet/LESSONS_PHC_VRS_PROTO_EN
• Analysis In Brief: Chronic Disease Management in PHC Settings: A
Demonstration of the Potential of EMR data for Health System Use and
Quality Monitoring:
https://secure.cihi.ca/estore/productSeries.htm?pc=PCC995
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Thank You
For information or
questions about the
PHC EMR CS contact
Alison Bidie
[email protected]
(416) 549-5463
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Appendix
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PHC EMR Content Standard
Priority Subset and Clinician-friendly Pick-lists
DE #
A1
A2
A3
A4
A5
A9
A14
B4
B5
B6
B7
C1
C4
D1
D2
D3
D4
E11
E12
E14
E23
E24
E28
Data Element Name
Patient Identifier
Patient Identifier Type
Patient Identifier Assigning Authority
Patient Date of Birth
Patient Gender
Patient Status
Patient Postal/Zip Code
Clinician Identifier
Clinician Identifier Type
Clinician Identifier Assigning Authority
Clinician Role
Service Delivery Identifier
Service Delivery Postal Code
Appointment Creation Date
Reason for Visit
Visit Date
Visit Type
Health Concern
Health Concern Date of Onset
Social Behaviour
Systolic Blood Pressure
Diastolic Blood Pressure
Height
DE #
E29
E30
E31
E34
F1
F2
G1
G2
H1
H2
H3
H4
I1
I2
J1
K1
K2
L1
M1
M2
O1
O2
Data Element Name
Height Unit of Measure
Weight
Weight Unit of Measure
Clinician Assessment
Intervention (Treatment)
Intervention (Treatment) Date
Lab Test Ordered
Lab Test Ordered Date
Lab Test Performed Date
Lab Test Name
Lab Test Result Value
Lab Test Result Unit of Measure
Diagnostic Imaging Test Ordered
Diagnostic Imaging Test Ordered Date
Diagnostic Imaging Test Performed Date
Referral
Referral Requested Date
Referral Occurred Date
Prescribed Medication
Prescription Date
Vaccination Administered
Vaccination Administered Date
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Performance Measures Supported by Priority Subset
PHC Domain
Health Status
PHC Indicators
Overweight and obesity rate*
Influenza immunization, 65+*
Child immunization*
Pneumococcal immunization, 65+
Health risk screening
Well baby screening*
Blood pressure testing*
Colon cancer screening*
Cervical cancer screening*
Breast cancer screening*
Appropriateness
Dyslipidemia screening for women
Dyslipidemia screening for men
Screening for modifiable risk factors in adults with coronary artery disease*
Screening for modifiable risk factors in adults with hypertension*
Screening in adults with diabetes*
Screening for visual impairment in adults with diabetes
Bone density screening
Treatment of dyslipidemia*
Treatment of anxiety*
Treatment of acute myocardial infarction*
Smoking cessation advice in PHC*
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Performance Measures Supported by Priority Subset
PHC Domain
PHC Indicators
Blood pressure control for hypertension*
Effectiveness
Complications of diabetes
Glycemic control for diabetes
PHC Domain
Additional Quality Measures
Wait-times for PHC provider
Accessibility
Coordination
Wait-times for specialist referral
Referrals for patients with chronic conditions
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