The purpose of the EMR Data Management (EMR-DM) subcommittee is to facilitate improvement of quality of care through the implementation and enhancement of EMR data management tools by:
The working group, essentially a sub-committee of the QIDS Steering Committee (QSC) informs the development and implementation of indicators, processes and principles for measuring, reporting and ultimately driving continued high performance in primary care.
Within a framework of policies and priorities established by AFHTO board, QSC sets specific project priorities and objectives to demonstrate the value of team-based primary care and ultimately improve the quality of care delivered
Revised April 2019
Revised July 2021
Membership and contact information for the EMR Data Management Subcommittee (EMR-DM)
|
Member |
Role |
Affiliation |
|
Phone |
|
Andrew King |
EMR Product Strategy and Planning Consultant |
Ontario MD |
Andrew.King@ontariomd.com |
416-623-1248 |
|
Brice Wong |
QIDS Specialist |
Windsor FHT |
bwong@windsorfht.ca |
226-787-2074 |
|
Carol Mulder |
Provincial Lead – QIDS program |
AFHTO |
carol.mulder@afhto.ca |
647-234-9470 |
|
Craig Nicks |
Executive Director |
Stratford FHT |
CNicks@sfht.on.ca |
519-273-7017 |
|
Darren Larsen |
Chief Medical Information Officer |
Ontario MD |
darren.larsen@ontariomd.com |
|
|
David Barber |
Assistant Professor – Department of Family Medicine and Regional Network Director CPCSSN |
Queen’s University |
david.barber@dfm.queensu.ca |
613-533-6000 x 73923 |
|
Dawn Olsen |
QIDSS |
Great Northern FHT |
dolsen@greatnorthernfht.com |
705-647-6100 |
|
Elizabeth Keller |
Director – Product Management |
Ontario MD |
Elizabeth.Keller@ontariomd.com |
416-623-1248 |
|
Greg Mitchell |
Knowledge Translation & Exchange Specialist – QIDS Program |
AFHTO |
greg.mitchell@afhto.ca |
647-234-8605 ext. 202 |
|
Jamie Sample |
Project Coordinator, QIDS Program |
AFHTO |
jamie.sample@afhto.ca |
|
|
Kevin Samson (Chair) |
IT Lead |
East Wellington FHT – QIDS Steering Committee |
kevin.samson@ewfht.ca |
519-856-4681 |
|
Kirk Miller |
Business Services Manager |
Guelph FHT |
Kirk.Miller@guelphfht.com |
519-837-4444 |
|
Knut Rodne |
Director of Change Management |
Ontario MD |
Knut.Rodne@ontariomd.com |
1.866.339.1233 |
|
Meghan Peters |
QIDS Specialist |
City of Lakes FHT |
mpeters@yourfamilyhealthteam.com |
705-560-1018 |
|
Gina Palmese |
Manager, Practice Engagement |
Ontario MD |
Gina.Palmese@ontariomd.com |
|
AFHTO is capturing widespread attention: Stories about the measurement and improvement work that AFHTO members are doing together have been accepted at four major primary care conferences (see below). These presentations will be posted on the AFHTO website at the close of each conference:
Ready… set… D2D! If you want a head start in your preparations for D2D 4.0, here are a few easy steps you can take now. For example, start gathering your data and talking to your team. Much of the data you’ll need can be found at the links below:
Consider nominating your team for a Bright Lights award. Nominations open on Monday. As you prepare for D2D, consider telling stories about your improvement journey as a Bright Lights nomination. Bright Lights awards come with a $3000 education grant for the winning team. Are you a QIDS Specialist (QIDSS) host or member of a QIDSS partnership? Please join us for the next QIDSS Host-Partner ED forum.
You can use the EMR tools shown below to get even better at tracking how well your patients with depression are doing.
Depression affects about 5% of adults in Canada each year and double that (i.e., 12%) at some point in their lives[i]. ALL Canadians are affected by depression, even they don’t have the disease themselves. This is because depression costs the Canadian economy at least $32.3 billion each year[ii]. In spite of this, people still have real fears of what people around them (families, friends, people at work, etc.) would think of them if they asked for help with depression. This keeps many people from asking for this help. This is where primary care teams come in. They have long term relationships with patients and can work with them to find the best ways to help them with their health.
We can start by making sure we know which patients have depression. If you have a list of all patients that have depression, it will be easier to make sure all the right people are invited to the programs, with less risk of people falling through the cracks. The search tools below can help you find which patients in your EMR are likely to have depression.
You might not need to use this tool if you already have a good list of patients who have depression in your EMR. The search is meant for teams that do not yet have a list of patients with depression and do not have a way to check the records of all their patients to come up with such a list.
The search tool was based on the case definition from CPCSSN and the input from experts in depression at Hamilton FHT and St Michaels’ Hospital. The tool has been tested with the help of the eHealth Centre of Excellence EMR environment. The search gives few false negatives but does give some false positives. For every 100 patients that the search finds in your EMR, 62 patients will actually have depression but 38 might not. That means you will have to check the list of patients found in your EMR to be sure that they really do have depression. For a team with 10000 patients, you would likely have 500 patients to review. This is better than looking at all 10,000 patients – or not looking at any at all.
Searches are available for TELUS PS, OSCAR, and Accuro EMRs.
You do not need to clean your EMR data before you use the tool. The testing was done on EMR data as they are right now, for better or worse, so you can be sure there is a good chance it will help you too. You can just load it into your EMR and run it – ie it is plug-and-play. [i] 5% of Canadians 15 years or over affected by depression any given year. 12% of Canadians affected by depression over their lifetime. Statistics Canada’s 2012 CCHS. [ii] The Conference Board of Canada: Annual costs of depression due to lost productivity.
(click image to see larger version) 
The Depression query is intended for teams that do not yet have a reliable list of patients with depression and don’t have the time or resources to start from scratch in reviewing all their patients to generate such a list. Right now, it is also only for teams with PSS or Accuro although work is continuing to expand the standardized query to OSCAR and Nightingale. The following steps will help your team use the query to generate a list of CHF patients, starting from your EMR.
Step 1. Estimate how many patients you think this will affect. Multiply the number of patients your team serves by 0.05 (the average rate of depression in Ontario) to get a rough idea of how many of your patients likely have depression. If you still think this is a big enough group of patients for you to generate a registry for, carry on to step 2.
Step 2. Import the query into your EMR. Right now, you can only do this if you have either Telus PSS or QHR Technologies Accuro EMRs. You will likely need the help of your QIDSS, IT staff or other person who usually works with your EMR to do this.
Step 3. Run the query in your EMR. Again, you might need the help of your QIDSS, IT staff or other person who usually runs queries in your EMR. Running the query will produce a list of patients with depression. The list will not be perfect – probably 38% of the patients identified by the query will NOT have depression. The query gets you STARTED in building the depression registry but doesn’t do the whole job for you.
Step 4. Find the patients who might not have depression. Review the list of patients generated by the query to separate out those patients that are clearly already coded as having depression. What’s left will the list of patients who MIGHT have depression based on other data in the EMR besides formal coding.
Step 5. Prepare your physicians to review the list Subdivide the list of possible patients with depression into separate, shorter lists for each physician. Work with your physicians to find out if they would prefer a list on paper or electronically and how they might like it sorted (i.e. by name or most recent visit or some other parameter).
Step 6. Invite each physician to review their list of patients. They know their patients best and can likely quickly confirm which ones do or do not have depression, even though that information might not be easy for others to find in the EMR.
Step 7. Clean up your EMR data. Add depression codes to the EMR for each patient that the physician confirms as having depression. This so-called “data cleaning” work is a great job for a student. AFHTO has created a toolkit to assist members in recruiting and using students for data clean-up. Click here for the toolkit.
Step 8. Re-run the query. After you have corrected the EMR, re-run the query to generate a list of patients with depression. This is your new depression patient registry. Going forward, you can run the query anytime you need to generate a list of patients with depression. You can use the list to invite patients to a depression program, track progress with outcomes on these patients or any other purpose.
Step 9: Recruit patients to your depression programs. We will soon be posting resources in setting up a care program for patients with depression.
Step 10: Measure progress with patient prognosis, management, and overall care. Here are some example outcome measures:
This query was produced by and for QIDSS with assistance from eHealth Centre of Excellence in support of all AFHTO members. If you have any questions, please contact improve@afhto.ca.
To the leaders of AFHTO’s member organizations: As AFHTO’s President, I’m writing to let you know our board of directors is launching the search for its next CEO. With a combination of sadness and support for her decision, the board received notice from Angie Heydon, AFHTO’s first ED/CEO, that she would like to retire from this role at an appropriate point after the 2016 AFHTO Conference in October and before the end of the fiscal year in March 2017. Angie started with AFHTO in August 2010 as our association’s first employee. In her first year she worked tirelessly to engage virtually all FHTs in the AFHTO membership. Two years later she helped AFHTO to welcome NPLCs and any other interested interprofessional primary care organization into this association. Under her leadership, we have seen AFHTO grow its engagement with FHTs and NPLCs, the support services it offers to members, and the influence it exerts in the health system. With last week’s introduction of the Patients First Act, AFHTO members are heading into significant change. I can assure you that Angie and the AFHTO board have carefully worked through steps to ensure a smooth transition and continuing strength in our collective ability to lead and shape the direction for primary care. We see plenty of evidence of that strength, from AFHTO’s influence on government’s direction in the Act, growing interest and strong support for our work to advance measurement, governance, leadership and improvement, and the tangible support shown through government’s commitment to increased funding for compensation in primary care teams. As the Act moves through the legislative process to what we expect will be enactment on April 1, the next AFHTO CEO will be ready to fully take up the role. Angie will continue to provide support on these key files as long as needed. Our CEO search is now underway. Tony Woolgar, Legacy Partners Executive Search, has been contracted to assist. As a first step the search notice has been posted on AFHTO’s website. With Tony’s expert leadership and guidance, the board anticipates it will find the ideal candidate to become AFHTO’s next CEO. We are aiming to conclude the search by end of September so we can introduce the next CEO at the AFHTO 2016 conference. We hope to see you there to meet the new CEO, and to join in a thank you to Angie for her service to our membership and wish her well in the next stage of her life. Sean Blaine MD Family Physician, Stratford, Ontario Clinical Lead, STAR Family Health Team President, Association of Family Health Teams of Ontario (AFHTO)
AFHTO’s Health Link Community of Practice met on May 26th. This communique provides an overview and highlights key items discussed:
Ben King (Program Manager – Primary Health Care Branch) provided a brief overview on the status of health links. Key topics included:
Current focus for health links includes preparing 2016/17 funding packages and finalizing funding allocations; working with LHINs to improve clarity and consistency re. terms of funding; and building sustainability by enabling local leadership to grow successes achieved to date.
The Government has now taken a key step to move forward with its proposal for health care – the Patients First Act was tabled in the legislature on June 2nd. The Ministry indicated that once funding allocations are completed they will turn attention to how health links will need to evolve and the critical role health links will play in the context of Patients First and the establishment of sub-LHIN regions.
The ministry is mindful of the need for a long term shift to more outcome based metrics – to give a better sense of how health links are performing and the value they are providing. Performance data will be a critical component of the future, while streamlining and minimizing unreasonable reporting burdens.
Coordinated care plans (CCP) that define how providers, patients and their families work together to coordinate and deliver care for complex patients, has been a prominent facet of Health Links. However, the approach and intent of designing CCPs has varied across the province. The ministry recognizes that care plans do ensure some measure of accountability and volume of patients; however, the focus should not be solely on the “# of care plans” achieved but the value they are providing. The ministry encourages conversations with your LHINs to improve long term metrics and the approach to target stetting to maximize the intended benefits of care plans.
Developing collaborative and integrated service delivery of primary care and mental health and addiction services remains a top priority for the Ministry; they continue to seek advice on how to decrease the gaps in service and coordination of care, and to build the interface with primary care.
The care coordination tool was deployed in 17 sites as an initial release and proof of concept phase is now complete. Orion will be the authorizing platform for the CCT. A very intensive evaluation has been provided to the Ministry regarding usability and functionality with a number of recommendations to consider before widespread implementation across the province occurs. AFHTO staff will follow up with AFHTO members who participated in this proof of concept, to collect feedback and develop recommendations for the Ministry and LHINs.
A reminder that ETHEeL has completed a legal review and comments from the lawyer are available for use by any Health Link that will be using the CCT tool. If you would like more information, please contact Kavita Mehta (Kavita.mehta@setfht.on.ca).
If teams are using PSS as their EMR and are interested in a customized data entry tool please contact Jennifer.Mackie@guelphfht.com.
Through discussion led by Dr. Dale Guenter (McMaster Academic FHT + Hamilton Central Health Link), members of the CoP shared their experiences and approach to the development of care plans. Highlights include:
East Toronto Health Link is offering a free Advance Care Planning E-Learning Module. Click here to register. Anyone can sign-up!
AFHTO has created a section on our website to share tools, resources and updates for Health Link leaders to support knowledge translation and promote a culture of continuous learning. We ask that you submit any health link related materials you are willing to share to support the members of the Community of Practice; please send these to Bryn.Hamilton@afhto.ca.
The Health Link CoP is looking for a new leader! If you are interested in chairing the CoP, please contact AFHTO (Bryn.Hamilton@afhto.ca). We ask that you are from a lead/host organization health link.
Thank you to everyone who submitted an abstract for concurrent session and poster presentations at the AFHTO 2016 Conference. The working groups have now reviewed all submissions and a notification e-mail has been sent to each contact person. If you are part of a group that has prepared an abstract, please ensure your group contact has received an email including the words “AFHTO 2016 Conference” in the subject on June 3rd 2016. If your contact person has NOT received this notification, please contact info@afhto.ca before Friday, June 10, 2016. The notification e-mail is your assurance that your abstract has been reviewed by a working group for presentation at the conference and a decision made. The program with all concurrent session descriptions will be announced when registration opens in late June 2016.
We look forward to seeing you at the AFHTO 2016 Conference! Leading primary care to strengthen a population-focused health system October 17 & 18, 2016 Westin Harbour Castle, One Harbour Square, Toronto