The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) stakeholder communication release May 4, 2015 read more ….
The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) stakeholder communication release May 4, 2015 read more ….
As CPCSSN zeros in on the end of it’s Phase III operations it has released it’s first PROSPECTUS. The PROSPECTUS has been developed to focus on making a difference where health matters and move forward in three (3) major research arenas: sentinel EMR surveillance, research and knowledge development, and practice transformation. To download or open a pdf copy of the document click here CPCSSN_ProspectusVersion_Jan14-2015
— Anita LambertLanning (@cpcssn) November 28, 2014
check out free full text at PMC http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+25485260
The Health Council of Canada closed its doors on the 31st March of this year. I wonder what, if any, difference the termination of the Council will make for health care reform?
The Council was a national, independent, public reporting agency established in 2003 to monitor policy and program commitments related to the First Ministers’ Accord on Health Care Renewal. It gathered and shared information on health care innovation across the country – the practices, policies, programs and services that are improving health outcomes and the way health care is delivered. I used its reports and Health Innovation Portal for some of my own work over the years. And I guess it fair to say that some aspects of its work supports the strategic direction of CPCSSN.
For example, in November 2012 one of the Council’s senior policy analysts wrote, “Government-led initiatives are promoting changes like greater use of electronic medical records (EMRs), inter-professional team-based care, and innovations in practice management to help primary care physicians see more patients, more effectively.”
CPCSSN has been working with sentinel physicians and other stakeholders across the country to help support such change. Our sentinel feedback tool is designed to provide the information practitioners need to better affect the health of their patient population. A January 2013 news release on the Council’s website announces that the use of information technology means better communication with patients and improved safety, quality and coordinated care. I was somewhat relieved to see a more patient-centered proclamation, an appreciation of the patient experience.
My eyes fell upon a familiar bit of information; “57% [of Canadians] have at least one chronic condition and 31% have two or more.” The conditions of this study included arthritis, asthma, and other lung diseases, cancer, mental health problems such as depression or anxiety, diabetes, heart disease, high blood pressure, and high cholesterol.” (2013 Commonwealth Fund International Health Policy Survey of the General Public published in the Health Council’s January 2014, Bulletin 8.) CPCSSN developed and rigorously validated case definitions for eight chronic diseases for surveillance activities and primary care and public health research.
And while there is much work to do in chronic disease prevention, management and intervention practice, I believe this translates to be much more than learning about the prevalence of chronic disease. It is about improving overall health outcomes for individuals and communities through evidence-based best practices. How best to do this using electronic medical record-based data?
My considerations lead me to the Conference of Deputy Ministers of Health’s vision for the secondary use of health data; “ … health system use of electronic health data that will both protect the privacy and confidentiality of patients and serve Canadians and Canada’s health care system well into the future.” (Better Information for Improved Health: A Vision for Health System Use of Data in Canada, June 2013)
This all strikes a chord for me. I can easily see the role of CPCSSN is comprised of innovators in the capture and use of electronic health data. We have created a surveillance system, an information technology platform using new sources of health care data. We have an award-winning privacy and information security system.
As a national network of sentinel surveillance and research collaborators and coordinators, CPCSSN is placed to serve a greater purpose. I am convinced that our work can influence primary care and public health downstream at the practitioner and best practices level, and upstream at the policy and program levels with research and knowledge development. We are creating intelligence from primary care data. We are the bridge between health research, policy and primary care practice. We are becoming a part of the system for change. CPCSSN is part of the solution.
Dr. Richard Birtwhistle
It seems like we have been trying to improve our health care system forever. We know there are problems: access, wait times and the ‘grey tsunami’ to name a few. We also know that in Canada health care is consuming over 40% of provincial budgets and increasing. We have an expensive and under performing system.
I recently attended the 2nd of 3 annual conferences hosted by the Monieson Centre of Queen’s University School of Business. The invited speakers came from a variety of backgrounds and from Sweden, Denmark, Germany and Australia. This conference is focused on ‘Creating Strategic Change in Health Care’. The 3 questions posed by the Conference organizers were:
I sat on a panel discussing the electronic health record. It became clear that like so many other sectors trying to develop a coherent policy that could be adopted by all the health care sectors was very unclear. Politics and competition were things that often got in the way. What we heard repeatedly was that we cannot wait for politicians to solve these important health care issues for us. The system must rely on some ‘bottom up’ evolution of workable ideas that will improve health care in Canada.
CPCSSN is one of these ideas. In order to drive change in primary care, physicians have to see themselves differently. We can no longer be ‘free agents’ when it comes to care provision and dismiss our responsibilities for the population for which we serve. CPCSSN provides the power of information to primary care practitioners about their practice population, their peers and an opportunity to consider their role in improving healthcare in the community.
Health care system change is a big chunk to bite off all at once but if each one of us figure out how we might do it better in our context and our local community, good things can happen.
CPCSSN data are appropriate for use in public health surveillance, primary care, and health services research, as well as to inform policy for these diseases. The full details on CPCSSN case validation work can be found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096475/
– The full reference for this CPCSSN published has been added to the ENDNOTE cloud part of the CPCSSN website also at http://cpcssn.ca/research-resources/resources-2/
Williamson T, Birtwhistle R, Khan S, Garies S, Wong S, Natarajan N, et al. Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records. Annals of Family Medicine. 2014 July 14;12(4) July/August):367-72.Methodology. Epub July 14, 2014. English.
– Check out the CPCSSN case definitions list at http://cpcssn.ca/research-resources/case-definitions/
Published online today; this study describes care patterns for 25,000 people with diabetes: http://www.canadianjournalofdiabetes.com/article/S1499-2671%2814%2900097-5/abstract. Vancouver style reference to this “in press” citation for your reference:
Greiver M, Williamson T, Barber D, Birtwhistle R, Aliarzadeh B, Khan S, Morkem R, Halas G, Harris S, Katz A. Prevalence and Epidemiology of Diabetes in Canadian Primary Care Practices: A Report from the Canadian Primary Care Sentinel Surveillance Network. Canadian Journal of Diabetes 16 May 2014 (in-press 10.1016/j.jcjd.2014.02.030)
I was recently asked to give a short presentation about CPCSSN. This is not an unusual request, a number of us within CPCSSN give talks, present posters, conduct technical workshops, even webinars.
So what makes this request unique?
It is to be 12 minutes and my audience is the general public. This means no research, technical or medical jargon, and no acronyms. You can be sure however, I will make an exception when referring to CPCSSN. Saying “Canadian Primary Care Sentinel Surveillance Network” takes 5 seconds, “CPCSSN” less than 1!
I need to fit a complex topic into as few words as possible. Capturing years of work and investment in a short time slot is not without its challenges and on top of that I had to grab their attention and keep it.
In pursuit of finding an angle I find myself revisiting CPCSSN’s roots, its beginnings.
Eight years ago a group of 30, most of us family medicine researchers, gathered at a workshop in Kingston. The goal was to evolve the concept of establishing a national network of primary care practice-based research networks or PC PBRNs. [An acronym!] Together we would support each others’ work and the work of other primary care and public health researchers.
This national network would have the capacity to respond to information needs about the provision of primary care across Canada. It would be positioned to assist health care practitioners.
We envisioned the coordination of primary care research groups to answer questions that require large sample sizes or assessment of regional variation. We pictured a data system to support this, a system for disease surveillance and health care practice improvement.
We believed in the possibility of influencing the prevention and management of chronic disease for populations across the country. We wanted to influence the optimization of primary care across the service delivery spectrum. We wanted to make a difference for the overall health of Canadians.
A small team of us worked to find funding for our initiative. In 2008, we received a grant for a two-year feasibility study to test our ideas, our vision. We became known as CPCSSN. The feasibility study’s success lead to a 5-year, multi-million dollar project that has supported the creation of an award-winning infrastructure. Four years later we have defined and are building our niche, our value and our capacity. We are attracting international attention along the way!
Today CPCSSN is a national network of primary care and public health researchers, health care providers, and talented staff working together to make a difference in health care practice and policy through surveillance and research. CPCSSN is an innovator, creating a surveillance system with a new source of data. We are generating knowledge for improved health care for patients at the practice level and for policy makers at the system level.
In a nutshell, we use information technology and a privacy architecture to extract, transform and translate patient health data from the electronic medical records of practitioners who are dotted across the country. These care providers make up CPCSSN’s most valued sentinel surveillance network.
CPCSSN is scrupulously careful with the data. We protect the confidential information provided by individuals to their physician in the context of care. It is de-identified and housed in a secure, central location. It is analyzed for information about chronic diseases, their prevention or delay, and management. The data is also used to create reports that go back to the participating sentinel physicians. The feedback reports serve as a practice improvement tool.
I can say that we have built a strong foundation. Our vision is becoming a reality. We have accomplished much but have only scratched the surface of possibilities.
This report was prepared primarily for CPCSSN stakeholders and partners in order to share what has been accomplished to date in the realm of governance, IT, Privacy and Ethics, as well as surveillance and research. The contents includes a few highlights of information about each of the eight (8) CPCSSN chronic conditions* for which data validation was conducted plus obesity.
*Alzheimer’s including dementia
Each of the eight conditions will also have their own expanded publication being released in a Canadian healthcare research journal during 2014-2015. Notice of these and other publications / presentations / posters are updated on the new CPCSSN website at http://cpcssn.ca / http://rcsssp.ca but we will also let you know as each publication is released via another CPCSSN ALERT. CPCSSN_PrimaryHealthcareIntelligence2013report_EN
Dr. Michelle Greiver provided a summary of the successful implementation of a Health Service Use (HSU) EMR feedback tool to Canada Health Infoway Regional Staff Meeting in Toronto – Tuesday Dec. 10, 2013. This project was supported by Canada Health Infoway’s HSU funding for enhanced testing in Ontario of a sentinel feedback tool developed primarily by CPCSSN data managers Dave Jackson and Bryan Forst based in Alberta.
Registries benefit from standardized data to indicate the presence of conditions. Standardized coding for chronic diseases may not be present in Electronic Medical Records (EMRs). This can impede quality improvement efforts that rely on registries for denominators. We implemented team-based methods to standardize chronic disease coding in primary care EMRs.
Outcomes from this successful demonstration project include:
1. Return of cleaned data and DPT implementation is feasible in primary care
2. Data quality can be improved at the practice level
3. Free text in EMRs can be mapped to standardized SNOMED CT terms demonstrated in the large NYFHT which is part of the UTOPIAN practice based research network
4. Patients can be safely re-identified within the circle of care for tracking and follow-up
5. Scalable processes can be implemented to enable the active use of data for QI projects
click here to have a look at the full presentation by Dr. Greiver to the CHInfoway regional meeting.