Background

Although barriers exist to secondary use of primary care electronic medical record (EMR) data, the Alliance for Healthier Communities (the Alliance) in Ontario, Canada has successfully created one of the largest structured primary care EMR datasets in Canada. In 2018, the Alliance and the Canadian Institute for Health Information (CIHI), an organization that provides comparable and actionable data to accelerate improvements in health across Canada, entered into a partnership to share EMR data. In this paper, we describe (i) the processes that enabled the collection of structured EMR data by the Alliance; (ii) how CIHI connected with the Alliance to share data and assess its quality; and, (iii) demonstrate the value of linking structured EMR data to administrative acute care data in illustrating the patient journey through the care continuum, using COPD as a case study.

Methods

CIHI and the Alliance entered into a formal data sharing agreement that enabled the sharing of linkable structured EMR data by the Alliance’s 75 community health centres (CHCs) with CIHI. By leveraging the Alliance’s Business Intelligence Reporting Tool, 3 years of EMR data containing patient-level clinical data were shared with CIHI. CIHI assessed the EMR data quality using its Data Source Assessment Tool to ensure fitness for analytical use. By linking the patient level EMR records with hospital records (CIHI’s discharge abstract database (DAD) and the national ambulatory care reporting system (NACRS)), we examined aspects of COPD patient management in primary care and followed their journey through the health care continuum, including follow-up in primary care after hospital discharge.

Results

Alliance EMR data representing approximately 570,000 patients and 8.5 million primary care encounters between April 1, 2015 and March 31, 2018 were shared with CIHI. A data quality assessment, centered on completeness and concordance, confirmed that the data was fit for analytical purposes. Overall, 13,023 enrolled primary care patients were identified as having COPD, representing an overall crude prevalence of 8.7%. The average age of COPD patients was 64 years and equally affected males and females. Patients were most likely to have completed high school education or equivalent, speak English, live alone, and have a household income less than $15,000. They most commonly had between 10–19 primary care encounters a year with a range of providers where they most commonly sought services for health advice/ instructions, to discuss their treatment plans and for medication renewals. By linking the EMR data to CIHI’s NACRS and DAD, we found that 74.1% of COPD patients had at least one ED visit and that 34.4% of COPD patients had at least one acute care hospitalization during the study period. Further, 16.2% of ED visits resulted in an acute care hospital admission. Of those hospitalized, the majority of COPD patients were discharged home (81.6%) and received timely follow-up in primary care (81.0% within 30 days).

Conclusion

Structured and linkable EMR data provides opportunities to examine the patient journey through the care continuum in an innovative way. Using structured EMR data from the Alliance, linked with CIHI’s NACRS and DAD databases, we were able to generate a cohort of patients with COPD, explore the complexities of their primary care encounters and follow them through the continuum of care, namely emergency department visits and hospitalizations. It is hoped that the partnership between the Alliance and CIHI will help drive future efforts on addressing the gap in comparable EMR data in Canada, and internationally.

中文翻译：

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说明患者在整个护理过程中的旅程：利用慢性阻塞性肺病作为案例研究，利用加拿大安大略省的结构化初级护理电子病历（EMR）数据。

背景

尽管初级保健电子病历（EMR）数据的二次使用存在障碍，但加拿大安大略省的健康社区联盟（联盟）已成功创建了加拿大最大的结构化初级保健EMR数据集之一。在2018年，联盟与提供健康数据并在整个加拿大加快健康改善的机构加拿大健康信息研究所（CIHI）建立了共享EMR数据的合作伙伴关系。在本文中，我们描述（i）使联盟能够收集结构化EMR数据的过程；（ii）CIHI如何与联盟建立联系以共享数据并评估其质量；（iii）展示了将结构化的EMR数据与急诊管理数据联系起来的价值，以说明患者在整个护理过程中的经历，

方法

CIHI与联盟签署了一项正式的数据共享协议，该协议使联盟的75个社区卫生中心（CHC）与CIHI能够共享可链接的结构化EMR数据。通过利用联盟的商业智能报告工具，CIHI共享了包含患者水平临床数据的3年EMR数据。CIHI使用其数据源评估工具评估了EMR数据质量，以确保适合分析用途。通过将患者级别的EMR记录与医院记录（CIHI的出院摘要数据库（DAD）和国家门诊报告系统（NACRS））相链接，我们研究了COPD患者在基层医疗管理中的各个方面，并跟踪了他们在整个医疗保健体系中的经历，包括出院后的初级保健随访。

结果

2015年4月1日至2018年3月31日期间，Alliance EMR数据代表了大约570,000名患者和850万例初级保健，与CIHI共享。以完整性和一致性为中心的数据质量评估证实，该数据适合用于分析目的。总体而言，确定有13023名已登记的初级保健患者患有COPD，占总体原油患病率8.7％。COPD患者的平均年龄为64岁，男女患病率相同。患者最有可能完成高中学历或同等学历，说英语，独自生活，家庭收入低于$ 15,000。他们最常见的情况是每年与一系列医疗服务提供者之间进行10-19次基本医疗服务，他们最常寻求健康咨询/指导服务，讨论他们的治疗计划和药物更新。通过将EMR数据与CIHI的NACRS和DAD链接，我们发现研究期间74.1％的COPD患者至少有1次ED就诊，34.4％的COPD患者至少有1次急诊住院。此外，急诊就诊的16.2％导致急诊医院入院。在所有住院患者中，大多数COPD患者已出院（81.6％）并接受了及时的初级保健随访（30天内为81.0％）。

结论

结构化且可链接的EMR数据提供了以创新方式检查患者在整个护理过程中经历的机会。使用来自联盟的结构化EMR数据，并与CIHI的NACRS和DAD数据库链接，我们能够生成一组COPD患者，探索其初级保健遭遇的复杂性，并通过连续的护理（即急诊就诊和住院。希望联盟与CIHI之间的伙伴关系将有助于推动未来的工作，以解决加拿大和国际上可比的EMR数据中的差距。