Bridge the Continuity Gap! Edmonton Zone June 2020 Hear how - PowerPoint PPT Presentation

Bridge the Continuity Gap! Edmonton Zone June 2020 Hear how community physicians are bridging the continuity gap through CII/CPAR 1

Welcome! Start Time: 5:30 PM promptly Please note: your mic and camera are disabled by default 2

Bridge the Continuity Gap! Edmonton Zone June 2020 Hear how community physicians are bridging the continuity gap through CII/CPAR 3

Adjusting Your Screen Zoom technical support (+1.888.799.9666 ext. 2) 4

Asking Questions • At any time, type questions in the Q & A • At the end we will also invite you to ask live questions • Click on “ Participants ” • Use the ‘ Raise Hand ’ feature To raise your hand • Moderator will invite you to unmute 5

Live Recording • Privacy Statement: Please note that the webinar you are participating in is being recorded. By participating, you understand and consent to the webinar being made publicly available via a link on the Edmonton Southside PCN website for an undetermined length of time. • By participating in the live Q&A, your name as entered into the Zoom sign-in may be visible to other participants during the webinar and/or in the recording. 6

Land Acknowledgment We would like to recognize that we are webcasting from, and to, many different parts of Alberta today. The province of Alberta is located on Treaty 6, Treaty 7 and Treaty 8 territory and is a traditional meeting ground and home for many Indigenous Peoples. 7

Presenters AMA – Accelerating Change Transformation Team • Sheena George - CII CPAR Primary Care Lead Edmonton West PCN Dr. Janet Craig – Glenora Medical Clinic & Edmonton Zone Physician Champion • Edmonton Southside PCN • Dr. Ghalib Ahmed - Ottewell Medical Clinic • Alma Woronuk – Clinic Manager • Gabriel Molley -PCN Panel Management Assistant/EMR Consultant • Leslie Bortolotto - PCN Improvement Facilitator Edmonton North PCN • Dr. Chris Le – Ideal Medical Center • Tara Seibert – PCN Quality Improvement Facilitator 8

Webinar Support Southside PCN • Leslie Bortolotto, Improvement Facilitator • Brittany Faux, Improvement Facilitator AMA Accelerating Change Transformation Team • Edna DeChamplain • Jessica Simpson • Crystal Hall • Anthonia Taiwo • Kylie Kidd Wagner • Angille Heintzman • Sheena George • Barbra McCaffrey 9

Presenter Disclosures Sheena George: AMA – Accelerating Change Transformation Team Dr. Janet Craig: AMA-physician contractor, Honoraria - UofA, Custom Learning Systems, Alberta AIM, AMA, Edmonton West PCN Dr. Ghalib Ahmed: Ottewell Medical Clinic; Speaker’s Bureau; Honoraria – MD Briefcase, Canadian Heart Research Centre; multiple drug companies Alma Woronuk: Ottewell Medical Clinic Gabriel Molley: Edmonton Southside PCN Leslie Bortolotto: Edmonton Southside PCN Dr. Chris Le: Ideal Medical Center Tara Seibert: Edmonton North PCN 10

Moderator Disclosures Edmonton Southside PCN • Leslie Bortolotto • Brittany Faux AMA – Accelerating Change Transformation Team • Edna DeChamplain • Sheena George • Kylie Kidd Wagner • Barbra McCaffrey 11

Disclosure of Financial Support This program has not received any financial or in-kind support. 12

CII/CPAR Overview Sheena George CII/CPAR Primary Care Lead AMA - ACTT 13

Agenda 1. CII/CPAR overview 5. Edmonton zone milestones 2. Edmonton zone priority 6. How to get involved connections 7. Questions and answers 3. Benefits during COVID-19 4. Three physician and team stories 14

Wayne’s Story 15

Wayne’s Journey Paneled with ER  Hospital ER docs had Referred to ++Relational UTI x 6 limited access to Urologist Continuity Urosepsis x 2 information Follow-up reliant on family, or… Recorded in Outpatient No notification to EMR Procedure Family Physician 16

Continuity Defined Quality of Connection patient care across health over time with care events a primary care and providers provider Continuity of Care: a multidisciplinary review, JL Haggerty et al, 2013 17

What is CII/CPAR? 18

Community Information Integration (CII) 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. Alberta Netcare Community CII Data Physician Office Hub EMRs Health Information Healthcare Data Data Governance Repository Committee 19

Central Patient Attachment Registry (CPAR) • A provincial system that captures the confirmed relationship of a primary provider and their paneled patients. • Receives information automatically from clinic EMRs on a monthly basis • Next logical step for practices that have invested in panel management • Foundational for future enhancements of informational continuity 20

CII/CPAR: What You Share, Receive & Enhance Share Receive Reports Enhance Netcare  Confirmed Panel 1) Demographic 4) Community Lists Mismatch Report Encounter Digest  Patient 2) Conflict Reports 5) Consult Reports Encounter Data 3) eNotifications  Consult Reports 21

Wayne’s Journey Follow-up Paneled with ER  Hospital Referred to with Family ++Relational UTI Urologist Physician Continuity Outpatient eNotification to Recorded in Procedure Family Physician EMR 22

Common CII/CPAR Questions 23

Do patients need to be notified that I am participating in CII/CPAR? 24

Privacy of Information Clinic EMR • Only mapped fields in EMR flow to Netcare • Document confidential information in unmapped fields • Each EMR has confidentiality features • HIA requires Health Collection Notice Posters • Most patients do NOT ask questions • If they do, questions are about Netcare (HQCA survey) • Starting conversations with patients is NOT necessary 25

As of May 2020… 11.0 Average # of e-Notifications per 7 days (week) per 1000 patients on panel 1.5 Average eNotifications physicians receive daily 26

CII/CPAR EXPERIENCES 27

Glenora Medical Clinic’s CII/CPAR Journey Dr. Janet Craig Edmonton Zone Physician Champion Edmonton West PCN 28 28

CII/CPAR Alignment Zone Priorities 1. Transitions of Care 2. Specialty Access & Linkages 3. Addictions & Mental Health Patient’s Medical Home 29

https://actt.albertadoctors.org/file/Clinical-Management-Algorithm-Primary-Specialty-Care-Teams.pdf 30

Our Story • Why we got involved • Who did what • Physicians • Clinic Manager • eHealth Consultant • PCN Practice Facilitator • ACTT Consultant 31 31

Lessons Learned 1. Socialize what CII/CPAR is (and isn’t) with your clinic team 2. Leverage Microquest (HQ) knowledge about data mapping options 3. First demographic mismatch report might be big, once cleaned up should be quite small 32 32

Biggest Challenge “We went live with CII/CPAR during COVID-19 pandemic, so training and communication amongst team members were challenging because we weren’t all in the clinic at the same time” 33 33

OPTIMIZE INFORMATION EXCHANGE FOR CARE DELIVERY CII/CPAR 34

Ottewell Medical Clinic’s CII/CPAR Journey 35 35

Alma Woronuk, Gabriel Molley, Leslie Bortolotto, Clinic Manager PMA/EMRc - ESPCN Improvement Facilitator - ESPCN OTTEWELL Dr. D. Millard Dr. C. Safranovich Madeleine Fraser, Nurse Practitioner - ESPCN Dr. G. Ahmed 36

37

Roles 38

Process Development Mismatch report Conflict report 39

eNotifications 40

41

42

My Win as a Physician • Community Encounter Digest identified Dr. Le as a physician who treated the patient • Multiple substance use issues with concurrent mental health issues • Cared for patient while in Poundmaker’s Lodge • Medication titration • eNotifications • Enable follow-up 43

Lessons Learned Start with the willing CII/CPAR is a Team Sport eHealth Support Services Patience is key: start small and go forward at a pace that works for the team 44

Getting Started eHealth Privacy contacts SL to confirm PIA readiness Let’s talk about I’m your your PIA eHealth consultant. I’ll CoP form communicate with the Site emailed to Liaison and copy the PCN eHealth through go- live 45

Moving Forward Download Demographic Draft process Identify Team Mismatch and for managing Roles and Log into CPAR Panel Conflict Panel Conflicts Responsibilities Reports 46

Panel Conflict Management Process Improvement Ask patient to Discuss patient complete Panel Add Chart Note attachment Confirmation (PC) Form Receiving clinic Save PC Form to Fax PC Form to removes patient the patient’s the clinic(s) from their panel chart list 47

Challenges • Failed encounters due to a dash in the field for Average BP Consult with Patient Pharmacist Visit • Issue with uploading multiple patient Consult encounters on the same day; only one with Physician Netcare Note was getting uploaded Specialist Only one Netcare Note was getting uploaded 48

Benefits Can CII/CPAR enhance the data that physicians already have access to through the HQCA’s Primary Healthcare Panel Reports? YES! 49

Where are we at? 50