Alberta invests 400 M in Clinical Information System

Have you ever been frustrated when a doctor you were seeing didn’t seem to have all the information he/she needed about your history? The Alberta government has committed $400 million over four years towards a new AHS Provincial Clinical Information System (CIS). Currently, patient health information is stored in more than 1,800 disconnected systems across the province. The provincial clinical information system will consolidate this information to create a comprehensive, single health record and care plan.

In our last poll we referenced three types of care continuity: relationship, management and information continuity. The HQCA report Improving Continuity of Care: Key Opportunities and a Status Report on Recommendations from the 2013 Continuity of Patient Care Study describes Information Continuity as:

“The availability and use of information on past events and personal circumstances to support appropriate care for an individual patient. Information may be documented on patient records, or exist as accumulated knowledge in the memories of healthcare providers. Information continuity can be improved through centralized electronic health record systems designed to make information easily but securely available to providers and patients. Moreover, it has been shown that a shared electronic health record and systematic notification methods improve information continuity between providers, which in turn improves co-ordination of care.”

Information is critical to all aspects of patient care but the management of patient information is complex and often confusing. The intent of this post is to share some of the basics of what we have learned about the health information landscape.

You may have heard the terms Electronic Medical Record (EMR), Electronic Health Record (EHR) and Personal Health Record (PHR). Here is an explanation of their differences as defined by Canada Health Infoway:

  • Electronic Health Record: An electronic health record (EHR) refers to the systems that make up the secure and private lifetime record of a person’s health and health care history. These systems store and share such information as lab results, medication profiles, key clinical reports (e.g., hospital discharge summaries), diagnostic images (e.g., X-rays), and immunization history. The information is available electronically to authorized health care providers.

Netcare is an example of a partial electronic health record in Alberta – the system crosses institutional boundaries (between hospitals, clinics diagnostic labs) and includes “key health information

  • Electronic Medical Record: An electronic medical record (EMR) is an office-based system that enables a health care professional, such as a family doctor, to record the information gathered during a patient’s visit. This information might include a person’s weight, blood pressure and clinical information, and would previously have been hand-written and stored in a file folder in a doctor’s office.

An example of an EMR in Alberta would be the program/system that is used by your family doctor.

  • Personal Health Record: A complete or partial health record (PHR) under the custodianship of a person(s) (e.g. a patient or family member) that holds all or a portion of the relevant health information about that person over their lifetime. This is also a person-centric health record, but unlike the EHR, the patient has control or “custodianship” over the record, rather than the health care provider.

We don’t have an example of a system-wide Personal Health Record in Alberta but individuals may complete and maintain their own Personal Health Records independently by tracking and recording their history and journey in the health system themselves.

So how does the provincial CIS fit? Below is a description of the program as outlined on the AHS website:

“The purpose of the AHS Provincial CIS is to improve patient experience, the quality and safety of patient care, by creating common clinical standards and processes to manage and share information across the continuum of health care.

AHS’ goal is to ensure that patients, families and caregivers get the right information, at the right time and place, in order to make the best possible health care choices.

The AHS Provincial CIS will support Albertans to take ownership of their health and care by giving them access to their own health information.”

As mentioned earlier this is a complex issue and it is important for Albertans to be informed, involved and to partner in all aspects of the project. We will continue to follow the progress of the Provincial CIS closely and we will share with you what we learn.

Additional links and resources:

2 Comments for “Alberta invests 400 M in Clinical Information System”

Scott Johnson

says:

My most recent exposure to information breakdown involved a request for a scheduled blood test from Cross Cancer being queried by admitting at my local hospital. Unsigned and without any indication of who to send the results to I was asked who I dealt with. Though I was treated by Cross for over a year, eleven of my twelve chemo infusions were done at the Bonnyville branch clinic where I had no “official” oncologist. Since the oncologist at Cross who started me on chemo quit my case over a misunderstanding after my first infusion I seemed to have been reassigned to another oncologist though I had to request a meeting to confirm this mid-way through. On completion of chemotherapy I saw the replacement oncologist for the second time (for the only time I EVER saw the same oncologist twice). Also at that meeting I was told I should have had my chemo delivery “central line” removed as part of the appointment but it had been overlooked so I’d have to make the three hour each way back to Edmonton again. A second appointment was booked and fortunately I called the day before to confirm as they were ready to remove a different type of line than had been installed and I would have had to come back again.
Back to the initial situation, my blood test was carried out in spite of no oncologist named on the requisition so who knows where it went? Since Cross policy is to NOT call the patient if no further cancer is detected and no one knows where the tests were to go, who would know if the cancer came back? I did call Cross to get the name of the oncologist who covers me now that I’m an outpatient. I’d seen her once for a brief interview. Also, it seemed she had wrong records and was promising a yearly colonoscopy nine months too early and her name escaped me. The receptionist at Cross said there was no record of my seeing anyone in outpatient though she suggested I use the name of my replacement oncologist who has nothing to do with outpatients but one of the two people listed as seeing me at Cross though I’d seen dozens of people. As a further test of who knows what about patients at Cross, I requested a review of my treatments and was told by an oncologist who had nothing to do with my care that my record showed a normal progression of twelve treatments over six months as specified in my entry files. In fact, it took eight months because of delays caused by my platelet counts crashing after almost every infusion. Nor was it mentioned that my first infusion made me so sick I lost over thirty pounds in the first three weeks and when I reported this while still very sick, the doctor at the Bonnyville Hospital made it clear I was a trouble maker, had used up more time than regular agreeable patients used and I was bordering on “abusive” which would them to deny me treatments.
What I’m saying here is there is no medical “system” here in Alberta. Even in the same building in the same department, virtually ever encounter is taken as an isolated, uncoordinated and poorly documented event. Worse, if you point this out, you will either be argued with or treated as if you were delusional; perhaps a professional malcontent or just broken.

Tim Willis

says:

To Scott:

I noticed that you posted at 4:04 am. Either your a morning person, or what i suspect is true. You were up that early because your health condition kept you from sleeping! I’m sorry to hear you have been so sick!
No one likes to spin their wheels. A lack of communication, empathy, and understanding, are evident!
You took the time to post your difficult experience in dealing with the “system”.
I appreciate your comments.
To see a parallel between the health care system, (not all the health care workers) please read 1 JOHN 5:19

I’m convinced that one day everyone will have perfect health and communication!

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