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Research ArticleCollege

Caring for the whole practice

The future of primary care

Tyler Williamson, Nandini Natarajan, David Barber, Dave Jackson and Michelle Greiver
Canadian Family Physician July 2013; 59 (7) 800;
Tyler Williamson
Senior Epidemiologist for CPCSSN and Assistant Professor at Queen’s University in Kingston, Ont.
PhD
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Nandini Natarajan
MD CCFP
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David Barber
MD CCFP
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Dave Jackson
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Michelle Greiver
MD MSc CCFP FCFP
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The third of CFPC’s 4 principles of family medicine states that “the family physician is a resource to a defined practice population” who must view his or her patients as a “population at risk,” organizing the practice to maintain all patients’ health, whether or not they are visiting the office.1 Population management, often impractical with paper records, is made easier by adopting electronic medical records (EMRs) and other information systems, which provide opportunities to look after the whole practice.1 However, many physicians customize how they use EMRs and enter data, which might improve their own efficiency but can hinder the consistent recording needed for reports comparing practices. Physicians and teams need ways to standardize data to produce reliable, comparable information. And EMRs, while optimized for rapid data entry and single-patient searches, are not yet designed for larger scale queries,2 which can slow systems, interfering with clinical activities. We need new approaches3 and new systems for analyzing and reporting data for managing patient populations. Improved reporting tools for population management can transform EMR data into more meaningful information, helping primary care groups identify and address needs based on their own data. Better reports better inform clinical care and monitor quality improvement.

To this end, the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has worked out ways to extract and merge data from multiple EMRs.4 These methods allow standardized regional, provincial, and national reports for participating physicians and primary care teams.5 These reports include demographic information about individual practices and groups; proportions of patients with selected chronic conditions and comorbidities; quality indicators, such as percentages of hypertension patients with blood pressure (BP) below 140/90 mm Hg or taking BP medications, or of diabetes patients with hemoglobin A1c levels at or below 7%, with BP below 130/80 mm Hg, or taking cardioprotective medications.

CPCSSN is actively exploring methods for returning improved data to primary care groups and is currently testing its Data Presentation Tool (DPT),5 interactive software that can quickly and easily generate reports and identify patients at risk. The DPT reports various data, such as health conditions (both coded and free text) in the cumulative patient profile, demographic information, encounters, vital signs, medications, immunizations, and selected laboratory values and procedures. Groups receive their original data and the cleaned and standardized CPCSSN data, allowing them to assess the data cleaning needed at the local level. The DPT reports thus far have included data on patients with diabetes and at least 2 of elevated hemoglobin A1c, BP, or low-density lipoprotein levels; patients with chronic obstructive pulmonary disease who are current smokers; and patients prescribed certain medications in the past year, to help manage a drug recall. As CPCSSN’s processes evolve, future reports could add more screening tests and information on family history.

The DPT allows identification of patients for clinical purposes, following strict, defined privacy policies and procedures. Groups could identify, for example, diabetes patients who are smokers and invite them to enhanced smoking cessation programs, or patients aged 65 or older with no record of pneumonia vaccination to inform them of the vaccine. Groups could then monitor the programs’ effects.

Our personalized care for individual patients can be complemented by practising population management, using group processes and agreed-upon standards.6 Use of EMRs can support all 4 of the principles we strive to embody in family medicine: enhancing our skills as clinicians, fostering patient-physician relationships of trust, keeping our practices community-based, and acting as true resources to our patients. CPCSSN is grateful to contribute to the evolution of Canadian primary care. For more information, please visit www.cpcssn.ca.

Acknowledgments

The DPT software was initially programmed by CPCSSN data managers Dave Jackson and Brian Forst. Funding for this publication was provided by the Public Health Agency of Canada. The views expressed do not necessarily represent the views of the Public Health Agency of Canada.

Notes

Sentinel Eye is coordinated by CPCSSN, in partnership with the CFPC, to highlight surveillance and research initiatives related to chronic illness prevalence and management in Canada. Please send questions or comments to Anita Lambert Lanning, CPCSSN Project Manager, at all{at}cfpc.ca.

Footnotes

  • La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro juillet 2013 à la page e341.

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    Four principles of family medicine. Mississauga, ON: College of Family Physicians of Canada; 2006. Available from: www.cfpc.ca/Principles. Accessed 2013 May 7.
  2. ↵
    1. Fernandopulle R,
    2. Patel N
    . How the electronic health record did not measure up to the demands of our medical home practice. Health Aff (Millwood) 2010;29(4):622-8.
    OpenUrlAbstract/FREE Full Text
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    1. Greiver M,
    2. Barnsley J,
    3. Aliarzadeh B,
    4. Krueger P,
    5. Moineddin R,
    6. Butt DA,
    7. et al.,
    8. North Toronto Research Network (NorTReN)
    . Using a data entry clerk to improve data quality in primary care electronic medical records: a pilot study. Inform Prim Care 2011;19(4):241-50.
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  4. ↵
    1. Birtwhistle RV
    . Canadian Primary Care Sentinel Surveillance Network: a developing resource for family medicine and public health. Can Fam Physician 2011;57(10):1219-20.
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    1. Greiver M,
    2. Keshavjee K,
    3. Jackson D,
    4. Forst B,
    5. Martin K,
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    . Sentinel feedback: path to meaningful use of EMRs. Can Fam Physician 2012;58(10):1168, e611-2.
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    1. Bohmer RM
    . Leading clinicians and clinicians leading. N Engl J Med 2013;368(16):1468-70.
    OpenUrlCrossRefPubMed
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Canadian Family Physician: 59 (7)
Canadian Family Physician
Vol. 59, Issue 7
1 Jul 2013
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Caring for the whole practice
Tyler Williamson, Nandini Natarajan, David Barber, Dave Jackson, Michelle Greiver
Canadian Family Physician Jul 2013, 59 (7) 800;

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Tyler Williamson, Nandini Natarajan, David Barber, Dave Jackson, Michelle Greiver
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