CII/CPAR is the chosen vehicle to integrate community EMRs with two-way data flow. It is a joint project between the AMA, Alberta Health and Alberta Health Services.
Community Information Integration (CII) is a system that transfers select patient information between community Electronic Medical Records (EMRs) and other members of the patient’s care team through Alberta Netcare.
Central Patient Attachment Registry (CPAR) is a provincial system that captures the confirmed relationship of a primary provider and their paneled patients.
Together, CII/CPAR enable health system integration and improved continuity of care that are essential and foundational change elements in the implementation of the Patient’s Medical Home.
CII/CPAR:
- Enables sharing of important health care information between the patient’s primary provider and other providers in the patient’s circle of care
- Facilitates sharing of consultation reports back to the patient’s family physician and other providers
- Identifies relationships between patients and their primary provider
- Allows for family physicians to identify and coordinate when patients are on multiple panels and therefore enables validated patient-family physicians’ information to be available on Alberta Netcare Portal
- Supports notification of primary providers when their patient has a hospitalization or ER visit
CII/CPAR is an important technical enabler to improved patient care because it assists clinics in identifying patients where continuity of care may be sub-optimized. Knowing that a patient is paneled to another provider affords an opportunity to confirm roles and responsibilities in care provision. For PCNs and clinics already investing in panel management, CII/CPAR is the next logical step to promote a coordinated care management approach to service delivery and achieve better patient, provider and system outcomes.
Healthcare providers are already able to access Alberta Netcare Portal to view a ‘snapshot’ of the care the patient has received. CII/CPAR aims to increase value by sharing select Information from family physicians and other community providers (e.g. consultation reports).
CII/CPAR is to improving Albertans’ continuity of care across the health system through better access to primary care and community health information.
To achieve this goal CII/CPAR:
- Collects health data from primary care and community EMRs in Alberta
- Presents this data in Alberta Netcare through clinically relevant reports
- Collects panel data from primary care providers' EMRs
- Alerts CPAR participating providers when their patients have had an event at an AHS facility
- Presents panel conflict information back to providers to encourage continuity for Albertans
- Makes data available to the Alberta Health Healthcare Data Repository for appropriate secondary use, such as quality improvement
Connect Care is a provincial initiative of Alberta Health Services to bridge information, health care teams and patients within sites where AHS is accountable for the record of care.
All physicians seeing patients in the community can contribute encounter information
Information shared through CII to Alberta Netcare and the Healthcare Data Repository at Alberta Health includes data elements in the community physician’s EMR that are set out in the Health Information Standards Committee for Alberta (HISCA) EMR Data Content Standard. This includes patient data (PHN, birthdate, gender), provider data (name, role, expertise, location), observations (health concerns, allergies, blood pressure, clinical assessment), immunizations and referrals. Shared encounter information is presented in Alberta Netcare in the form of a Community Encounter Digest report.
Primary Care Providers that provide longitudinal, comprehensive primary care can contribute panel information
The Central Patient Attachment Registry receives a confirmed patient panel list for each participating primary provider. Information included in the patient panel list: provincial health care number, date of birth, name, gender, last visit date and the date that the patient-provider relationship was last confirmed.
Specialists can also contribute consult reports
Additionally, specialists in the community can make their consult reports available to other care providers through Alberta Netcare. Future phases of the CII project will expand the scope of information sharing, including more data elements and additional clinical reports.
- Community specialists can contribute their consult reports
- Family physicians (and other providers who have panels) can share their panels to CPAR. They can also contribute consult reports to Alberta Netcare if they do that kind of work
- Community specialists and family physicians can both submit encounter information to inform Community Encounter Digests in Alberta Netcare.
- CII/CPAR is currently in General Rollout with clinics around the province
- CII/CPAR is live with Microquest Healthquest, TELUS Med-Access, Wolf and PS Suite EMRs, and Accuro EMR from QHR
- Specialists are submitting consult reports to Alberta Netcare
- Family physicians and PCN clinics are contributing encounter data to Community Encounter Digest (CED) reports which are a snapshot of recent encounters for each patient
- Primary providers offering comprehensive, longitudinal care are contributing their patient panels to CPAR
- Users of Microquest Healthquest, TELUS Med-Access, Wolf and PS Suite EMRs are receiving eNotifications when their patients have encounters at AHS facilities. This functionality will be available for Accuro EMR in mid-2023.
There are four key pre-requisites for participation in CII/CPAR:
- Clinic EMR PIA must be up to date
- Clinic must be live on Alberta Netcare
- Clinic must be panel ready (for clinics without panels this is not a pre-requisite)
- Panel identification and maintenance processes must be in place
- The CII/CPAR Panel Readiness Checklist can help to see where your clinic stands
- EMR must be on latest version (Healthquest and Accuro users)
If any of these areas need improvement, now is the time to get to work on them.
Supports:
- A PIA Update Self-Assessment.
A recording of a PIA Update Seminar is available here. Alberta Health eHealth Support Services (eHSS) will provide advice; phone (toll free) 1-855-643-8649 between 7 am and 7 pm, Monday to Friday, or email: [email protected] - To receive more information about Alberta Netcare please go to the Alberta Netcare Registration page
- A panel readiness checklist is available here
If your clinic meets the prerequisites some next steps to get ready are:
- Community specialists and primary care clinics may get more information on the ACTT CII/CPAR page to become more familiar with the details of the project. Useful videos are on the Tools and Resources page.
- Primary care clinics should tell their PCN representative that they are interested. Implementation in primary care is being coordinated with PCNs.
- Specialist clinics can express interest to Alberta Health eHealth Support Services by phone (toll free) 1-855-643-8649 between 7 am and 7 pm, Monday to Friday, or email: at [email protected]
No. As the EMRs are configured for each provider, each physician or nurse practitioner may enroll at their own pace. A clinic can go live with one participating provider. There are some specific considerations for partially enrolled clinics.
Yes, providers such as dieticians, nurses, pharmacists, respiratory therapists and other allied health providers working in a clinic with participating physicians may participate. To submit encounters these providers must book appointments in the scheduler with patients. Allied providers can also contribute consult reports. Include these providers on the confirmation of participation form.
Other providers such as social workers and psychologists may participate but their colleges interpret the Health Information Act differently than the College of Physician and Surgeons of Alberta and other healthcare professional colleges. If they choose to participate, these providers need to consider their college standards when contributing.
Not currently. There is a significant cost to conforming a new EMR for CII/CPAR and currently there are not resources to bring on any more. It really comes down to a numbers game: the 5 conformed EMRs account for more than 85% of EMR use in Alberta so it makes sense to make the investment to connect these EMRs. In addition, EPIC (the EMR backbone of Connect Care) and OKAKI, the EMR used by many first nations clinics will also be conformed.
- eNotifications: Sharing AHS admission and discharge notifications directly to community EMRs
- Microquest Healthquest, TELUS Wolf, Med Access and PS Suite are currently live.
- QHR Accuro conformance and testing is anticipated in 2023.
- Patient Summaries: Ability for community physicians to upload patient summaries to Alberta Netcare. Anticipated for 2022. This is meant to be a more comprehensive summary of the patient’s health completed by the primary provider. A copy of the Patient Summary will also be available for the patient in their MyHealth Record.
- CPAR attachments displayed in Alberta Netcare: Family physicians, pediatricians and nurse practitioners participating in CPAR will display as the primary provider for their patients in their Netcare records by 2022.
The CPAR Conflict Report is generated by CPAR on a per panel basis and lists patients on the provider’s panel that are also paneled to another participating provider. It is produced monthly. Click here for a sample report.
The CPAR Demographic Mismatch Report is generated by CPAR on a per panel basis and identifies where there are mismatches between the demographic information in the provider’s EMR and the Alberta Health Provincial Client Registry. It also indicates any deceased patients who have been included in the panel. It is produced monthly. Click here for a sample report.
If a patient has been paneled to more than one provider, the patient should be asked to choose who they identify as their primary provider for comprehensive care. The CII/CPAR Team Toolkit has suggestions for practice teams on developing an approach and customizing their process to their clinic.
This does not preclude the patient seeing the other providers episodically. What it should do is identify for both the patient and the providers which provider is responsible for the patient's comprehensive, longitudinal care including screening, periodic health exams, complex care, following up on eNotifications, guiding the patient's journey's in the health care system etc.
If the information in the clinic EMR is incorrect then it can simply be corrected to resolve the mismatch. If, on the other hand, the information is wrong in the Alberta Health Provincial Client Registry the clinic should advise the patient to go to https://www.alberta.ca/ahcip-update-status.aspx, fill out the appropriate form and drop it off at a registry agent office. Some clinics are trying to be more hands on with this – helping patients print and fill out the correct form; doing outreach to patients and sending forms, etc. See the Demographic Mismatch section of the CII/CPAR Team Toolkit for more information.
CPAR is set up to identify panels by provider and location. It is also set up to receive panel lists that have been generated from an EMR. If a provider has panels in multiple locations, there are two possible solutions for setting up CPAR panels depending on the EMR setup. In the situation where each location has a different EMR instance then it would be appropriate to set up a CPAR panel for each location/instance. If the provider practices at multiple locations that use the same EMR instance, then it would make more sense to create a single panel for ease of uploading because the EMR will most likely produce a single panel list for all locations.
Panels are submitted on a per provider basis to recognize the unique attachment between an individual and their primary provider for longitudinal care. Ideally this relationship exists on a one-to-one basis - evidence shows how important this is for continuity of care. Recognizing that some providers work in a team structure, CPAR can accept shared panels. An example of a shared panel scenario is where one physician works 3 days a week and their partner works 2 days a week and they care for a common group of patients. When a panel is first created during the registration process there is the ability to associate the panel with multiple physicians. Once the panel is established the Panel Administrator can add or remove responsible physicians.
Wow, over 5,000 is a very large panel size. The average panel size for a primary provider in CPAR is much smaller. Panel readiness is a requirement to participate in CPAR. Each participant needs to use the panel readiness checklist and each box must be checked. If all boxes cannot be checked, the clinic needs to go back to develop and act on their panel processes before participating. Panel maintenance is a very important process.
When a physician participates in the central patient attachment registry that NOT panel ready and loads a panel that is known to have many panel conflicts, each panel conflict appears on the report for another participating primary provider causing a cascade effect for those providers and teams. The other impact is that the system now knows that this physician is the primary provider and eNotifications will be generated for each of the CPAR paneled patient when they have a hospital admission, hospital discharge, emergency discharge and day surgery. The average number of eNotifications are 11.7 per week for each 1,000 patients on the panel. A panel of 5,000 would generate close to 60 notices a week! Also, later in 2021, Alberta Netcare will display the name of the primary provider in each Albertan’s record where the primary provider is participating in CPAR.
Participants must be panel ready. In a sense, the primary provider is declaring to the system that they have a validated the care relationship with the patient.
Participation in CII/CPAR is voluntary. Any participant can stop at any time. If a provider is moving practice or leaving practice, contact eHealth Support Services to inform them and receive the forms to be off-boarded. Contact eHealth Support Services at [email protected] or 1-855-643-8649 for assistance.
As participation is voluntary, participants should know that they may off-board in a little as 24 hours if they saw an urgent need. Two actions in control of the provider are that they can reverse the steps they took in their EMR to be configured for CII/CPAR and they can contact their EMR vendor to request that data flow be stopped.
The CED report is created in Alberta Netcare by CII and summarizes the care the patient received over the past 12 months from all community-based clinics in Alberta that participate in the CII program. This includes details on the following:
- Service providers
- Service delivery location
- Encounter (details)
- Observations (measurements and others)
- Interventions and treatment
- Referral requests
- Immunizations
Click here to see a sample report and information sheet.
No, just diagnosis codes (ICD9).
No. CII only gathers information from encounters that happen after the clinic/physician goes live. CII does not pull any information that was entered in the EMR before the go-live date.
Is sharing of encounters limited to physicians or nurse practitioners? If a patient is diabetic and seeing a pharmacist and physician has not done a diagnostic code will the physician still need to check?
In order for information to be shared to Alberta Netcare, the provider must be a registered CII/CPAR participant. In this scenario, if the pharmacist is registered with CII/CPAR then the information could get pulled. Allied Health Professionals participating in CII/CPAR is certainly possible but gets a little complicated. Your clinic might want to get all the docs up and running first and then think about Allied Health.
No, the CED is not intended to be a complete record of the patient’s chart. It’s intended to provide a snapshot of care the patient has received in the last 12 months. If a patient has a new diagnosis entered into the profile during their visit it will show in the “Health Concern History” but is not intended to be there indefinitely. The future Patient Summary feature will serve the purpose of sharing a more comprehensive record with Alberta Netcare and the patient’s MyHealth Record.
Only new entries made during the visit are pulled to Alberta Netcare.
Unfortunately no, immunization records that populate the CED do not also populate the patient’s Alberta Netcare immunization record or forward to Alberta health to satisfy the new requirements.
eNotifications are intended to be an alert about the patient’s visit to an AHS facility only. They contain very basic information about the visit. Ideally teams will use eNotifications as a trigger to look in Netcare for details of the visit including lab results. A list of the data elements included in an eNotification can be found here.
Consult requests made during an AHS visit are not included in eNotifications. They may be included in the discharge summary in Alberta Netcare. Ideally teams will use eNotifications as a trigger to look in Netcare for details of the visit including consult requests. A list of the data elements included in an eNotification can be found here.
No, if you are participating in CPAR and your EMR is enabled you will receive e-Notifications automatically.
As clinics have not necessarily had a reliable process in the past to receive this information, receiving eNotification is a new opportunity to develop reliable workflow around them. It is advised that the clinic work with their PCN facilitator to develop protocol and process. Guidance can be found in the 'eNotifications' section of the CII/CPAR Team Toolkit and in a webinar produced to help teams.
I’m a rural doc who works in the local hospital. I often receive e-Notifications to my EMR for patient visits I’ve had with my patients in the hospital. Is there a way to turn these notifications off?
Unfortunately, not at this time. It is recognized that the eNotification experience of rural physicians will be different than that of urban. Not only for the reason mentioned, but also because it’s possible rural physicians may receive a higher percentage of eNotifications for minor problems that don’t require follow up. Future upgrades may be able to resolve these issues.
For a detailed explanation see below, but if you’d like to change how the tasks are classified in your EMR there is a simple way to do so at the site level. There are instructions in the 'Selecting task category for eNotification delivery' section of the Med Access CII/CPAR User Guide. Someone with admin permissions who is reasonably comfortable with Med Access shouldn’t have any trouble.
Med-Access originally built the eNotification solution with the notifications coming in as “Lab” tasks. The developers reasoned that since they were coming in via e-delivery the same way that Labs do, then they should be Lab tasks. They were asked to change the category to “Investigations”. The reasoning was as follows:
- It was understood that providers would probably not care to have e-notifications mixed up with their labs
- A decision was made that it was important that they come into the EMR as a category of task that has its own tab in the chart so they would be more visible. That left “Care Coordination” or “Attention” out.
- The “Investigations” tab was chosen with the reasoning that a variety of different kinds of things come into the investigations tab whereas the Consults tab is more specific (we freely admit that this is debatable).
It was understood that this wasn’t a perfect solution but also recognized that there wouldn’t be 100% agreement among users about how they would like to categorize these tasks. Expectations were that most clinics would re-categorize the tasks as they come in according to their personal preference. As it turns out, many clinics don’t mind that they come in as “Investigation” tasks, a few clinics have chosen to have them come in as “Care Co-ordination” tasks, others have chosen “Attention” tasks. Fortunately, Med Access is flexible this way.
One of the things we’ve heard from community providers from the beginning of the CII/CPAR project was that they want a way to get their personal input about their patients into Netcare. Particularly for more complex patients: for example; patients who have unusual or rare conditions, patients who take off book medications, patients who have a history of failed medication, patients with multiple complexities that have a very specific care regimen, etc. Primary providers have a wealth of information about these kinds of patients. Currently there’s no easy way for them to share that information with the rest of the health care system.
The Patient Summary would be designed to fill that gap. Providers would be able to create a document in their EMR that “tells the patient’s story” and submit it to Alberta Netcare so other providers have access to the information. When it is submitted to Alberta Netcare a copy will also be available in MyHealth Record for the patient to access. This was always envisioned as a companion to the CED. There would be not only a record of the patient’s recent encounters, but also a record of the key health care issues as identified by the patient’s primary provider, giving other providers a better overall picture of the patient.
Patient Summary functionality is anticipated in 2021. Actual availability will vary by EMR.
Patients absolutely have the option to not share some or all of their information to Netcare. The easiest way to handle this is to not chart confidential information in fields that flow to the Community Encounter Digest but depending on what the patient (or the provider) wants kept confidential this can also be handled by making the whole chart, or parts of a chart confidential. Physicians should be familiar with the mapping and confidentiality functions in their EMRs, different EMRs have different capabilities.
Providers do not need to have a specific conversation with their patients about information sharing to Netcare. Obviously, it would be prudent to do so with any patients who have specific concerns about confidentiality.
Under the HIA, CII/CPAR is under the ‘Netcare Umbrella’ and providers are obligated to notify patients that they participate in information sharing for the purposes of providing better care. Most are already doing this as a requirement for Alberta Netcare. Many accomplish this by having a “Health Collection Notice Poster” posted in conspicuous areas in their clinics, often exam rooms. Some include it in a package that they give to patients when they first join the clinic. When a clinic joins CII/CPAR the wording of their notice should change slightly.
Clinics with PIAs that need updating can still move forward with CII. As part of the onboarding process eHealth Support Services will review your EMR PIA and advise if there are areas that need attention. Most clinics require only a minor update and can move forward with CII participation while working on the PIA. If eHealth Support Services should advise that a major update is required, then CII participation will advance when the update is submitted to the OIPC. For more information please see the EMR PIA Information for Clinics.
The Health Care Data Repository is a database of aggregated health care information intended for system analysis and quality improvement. It is not intended for health care delivery. Alberta Netcare is an Electronic Health Record that gathers patient specific information for the purpose of providing health care.
Through the provincial billing system Alberta Health, already has encounter data from providers providing insured services. The Healthcare Data Repository is new in Alberta and it was designed to support health system planning and quality improvement. Importantly, the repository is governed by the Health Information Data Governance Committee with significant representation of providers such as physicians, nurses and pharmacists. More information can be found in these documents: CII/CPAR Data and Governance and HIDGC Overview Fact Sheet.
Fee codes are already sent to AH as part of billing, but the billing system is older technology and cannot share data with other systems. Having health service codes in the Healthcare Data Repository will be important for doing data analysis on usage, delivery etc.
Alberta Health Services has well established Advance Care Planning/Goals of Care processes. Within that protocol EMS are to look for the Green Sleeve in the patient’s home, but EMS do not have access to Netcare. There will be an opportunity to re-visit it when there are more community providers using CII/CPAR and it will be a provincial effort involving AHS and community physicians to establish what the new protocol will be. Another dependency may be EMS access to Netcare.
A community provider may choose to indicate on the Community Encounter Digest that they have had Goals of Care discussions with the patient by the documented appointment reason, assessment, or profile/problem added to the visit. Consider that this is only a prompt for another provider accessing the patient’s record to possibly ask for the resulting Green Sleeve.
19011 Community Information Integration and the Central Patient Attachment Registry were actually created at the request of physicians. The Section of General Practice (now the Section of Family Medicine) requested a panel registry in the 2016 Amending Agreement with Alberta Health. That same year at an AMA representative forum, the motion advanced for a means to share consult reports from community clinics with Alberta Netcare. This was advanced with Alberta Health through CII. The intent was not to drive forward blended capitation.
Physician leaders at the Alberta Medical Association agree with the benefits of CII and CPAR to improve continuity of care for Albertans.
For more information about how CII and CPAR are enablers for continuity of care please visit the CII/CPAR page.
For more information of Alternate Relationship Plans, refer to this page on the AMA website.
CPAR has two areas of the application, one for Blended Capitation Model (BCM) clinic funding or “rostering” and another for panels. They are linked by the patient identity in the background but are two separate functional areas. CPAR for rosters enables the clinic to manage their rosters in order that Alberta Health may accurately fund a program.
CPAR for panels receives the provider panel that is automatically uploaded from the EMR monthly. It validates patient identity and looks for a date of death or demographic mismatch in the provincial registry and if the patient is paneled to another primary provider participating in CPAR (for panels). The clinic panel administrator can login to CPAR to download the demographic mismatch and panel conflict reports. Because the panels are uploaded automatically, there is little work involved in using CPAR for panels, the value comes in the information received back at the clinic and informing the health system of the established primary care relationship.
For rostering, CPAR records the relationship is between a patient and the program (clinic organization). The initial load of the patients into CPAR is manual and then the program Roster Administrator manages it in the CPAR web portal on a regular basis.
For paneling, CPAR records the relationship between a primary provider (physician or nurse practitioner) and the patient. The provider is identified by their practitioner ID and the facility in which they are providing care for the panel. This relationship is submitted monthly from the panel lists in the clinic EMR through the Community Information integration data hub to CPAR. All physicians or nurse practitioners must register in CII/CPAR to participate in in the panel component.
While a BCM clinic who rosters patients cannot be funded to care for a patient with an invalid PHN ULI; CPAR for panel accepts PHNs/ULIs for patients with out-of-province PHNs, RCMP, and NIHB insured individuals.
As the number of providers and clinics participating in the panel component of CPAR grows there are advantages for the BCM clinic. Through the panel conflict reports the BCM clinic would be aware of a provider that paneled one of their rostered patients in the past and has maintained them on the panel. The BCM clinic could inform the other provider to remove the patient from their panel as they are a signed roster program patient. The CPAR initiative is looking to add the functionality to enhance this in the CPAR panel conflict reports.
When a physician or nurse practitioner participates in CII/CPAR they are declaring an established primary provider-patient relationship to the health system. Through eNotifications the primary provider will be notified in their EMR when their CPAR paneled patient has a hospital admission, hospital discharge, ED visit or day surgery at an AHS facility in the province. In June 2021 the patient-provider relationship in CPAR will display the name of the CPAR primary providers in the patient’s Netcare record. This will be another advantage for relational continuity.
Through participation in CII/CPAR, the primary provider will contribute to their patient’s Netcare record through daily encounter upload to Netcare enhancing informational continuity through the Community Encounter Digest.
CPAR has two areas of the application, one for the Blended Capitation Model (BCM) clinic funding, known as “rostering” and another for panels. They are linked by the patient identity in the background but are two separate functional areas. CPAR for rosters enables the clinic to manage their rosters in order for Alberta Health to accurately fund a BCM clinic.
CPAR for panels receives the provider panel that is automatically uploaded from the EMR on a monthly basis. It validates patient identity and looks for a date of death or demographic mismatch in the provincial registry and if the patient is paneled to another primary provider participating in CPAR (for panels). The clinic panel administrator can login to CPAR to download the demographic mismatch and panel conflict reports. Because the panels are uploaded automatically, there is little work involved in using CPAR for panels. The value comes in the information received back at the clinic and informing the health system of the established primary care relationship.
Refer to this FAQ for Blended Capitation Clinics.
For EMR-specific information, please see the EMR articles in the Resources Centre.