Listen to Dr. Heidi Fell's presentation on Informatics at the fall 2018 Alberta Medical Association RF/AGM.

Continuity and coordination of care. More comprehensive patient information and records. Common clinical standards. Safer care and improved outcomes. These aspects of health care delivery are improved with the implementation of health information systems that enable the right information to be available to the right care provider.

The ability to share patient information between community-based physician practices and the rest of the health care system is here, and there are big changes coming to the Alberta health information landscape.

“We seem to be reaching a tipping point where organized medicine, funders, regulators and patients are all coming to agreement that an integrated patient record is a necessity,” says Dr. Heidi Fell, Chair, AMA Informatics Committee. “There are major initiatives underway that will push toward this, some of which are being put in place right now.” 

The three biggest initiatives currently are the Community Information Integration/Central Patient Attachment Registry, MyHealth Records personal health portal, and Connect Care. At least one of these initiatives will affect almost every doctor in the province; together they will enhance the care that patients receive in Alberta by providing improved informational continuity.

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“We seem to be reaching a tipping point where organized medicine, funders, regulators and patients are all coming to agreement that an integrated patient record is a necessity,” says Dr. Heidi Fell, Chair, AMA Informatics Committee.
At our doorstep

Community Information Integration (CII) is a system that transfers select patient information between community electronic medical records (EMRs) and other members of the patient’s care team through Alberta Netcare, including community specialist consultation reports and specific information from the primary care chart. The Central Patient Attachment Registry (CPAR), a module under CII, is a provincial system that captures the relationship between a family physician or nurse practitioner and their paneled patients. The CII initiative is currently being used in early-adopter clinics and is expected to fully roll out in April, with further enhancements coming later in 2019. 

For patients, Alberta Health will be launching MyHealth Records shortly. This is a secure online application that will allow adult Albertans to view dispensed medications, many immunizations and common lab test results drawn from Netcare. Additionally, patients will be able to track and securely store their own health information such as blood pressure measurements or fitness tracker information.

Evidence from other jurisdictions in Canada and the rest of the world has shown that this type of patient access to information can improve the quality of patient-physician interactions without increasing physician workload. This is a key finding as physicians reasonably fear that changes in informatics tools will bring adverse change to their workloads or workflows.

On the horizon

Connect Care is the Alberta Health Services provincial care transformation initiative. It is powered by a common provincial clinical information system that will replace most of the more than 1,300 existing systems across AHS. Epic was the vendor chosen through a competitive process, and AHS will be rolling out the Connect Care platform over the next three years, beginning in November, to areas where AHS holds the legal record of care.

“Connect Care is an excellent example of an initiative that appears to be about informatics on the surface, but it is really about care transformation,” explains Dr. Fell. “It will enable consistent practices by care providers across the province by giving them a central access point for best health care practices, common clinical standards and patient information. This means patients across Alberta will receive the same standard of care.”

As separate systems, each of the three initiatives provides benefits for patients and physicians. As integrated systems, they help establish and maintain continuity of patient care. Work is also underway to ensure that these systems can talk to one another so that there is truly one record for one patient.

What it means for physician and patients

While physicians can agree that filling gaps in the patient record will improve continuity of care, they will need to spend some time learning the ins and outs of the new technology if they are to truly take advantage of all the benefits of an integrated record. There are also implications for physician and patient roles as patients become more knowledgeable and have access to more of their own health information. 

“Moving in this direction presents physicians with many opportunities,” notes Dr. Fell. “These are three complex systems, and we need to consider all factors that will affect proper implementation so that physicians can fully use them to benefit their patients and practices.” 

Take secure messaging as an example. Although it is not a part of the initial implementation for these systems, it can be used to illustrate the thought that must go into any system change – even a seemingly simple one. With secure messaging, communications between physician and patient may be more immediate, but what technology will be needed? How will physicians use it and integrate it into their workflow? How is patient consent obtained if it is required? Will it change how patients relate to their physicians? What information is appropriate to share in this format? How will physicians ensure messages are in patient-friendly language? These are a few of the questions related to one small technology change.

The Alberta Medical Association is working with its partners in Alberta and nationally to ensure all aspects of these changes are considered – from daily patient interactions to policy that governs privacy and the patient-provider relationship. Adequate supports need to be in place for physicians as these changes roll out in the coming months. 

“The changes that are coming are profound and will have a positive but significant impact on physicians, patients and the health system,” concludes Dr. Fell. “The potential benefits are enormous, but the same can be said for the work needed to make them successful. Despite the potential downsides, the AMA is very optimistic. We see a vibrant profession, one that has effectively grasped and harnessed information to strengthen our relationships with our patients and to enhance the care that we deliver.”  

Banner photo credit: Julie McMurry,
Related video: How a new Clinical Information System will help Albertans