Linking primary care EMR data and administrative data in Alberta, Canada: experiences, challenges, and potential solutions

Introduction Administrative data are commonly used for a variety of secondary purposes. Although they lack clinical detail and risk factor information, linkage to primary care electronic medical records (EMR) could fill this gap. Primary care EMRs are a relatively new data source available in Alberta and thus, EMR-administrative linkages are novel. Objectives and Approach To describe the process undertaken for linking de-identified primary care EMR data from two regional Alberta networks of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) with administrative data (hospital admissions, emergency department visits, pharmacy information) from Alberta Health Services Analytics, specifically as it relates to a study on patients with complex, chronic diseases. As this linkage process is new in Alberta, we will describe the challenges encountered and possible solutions to inform future data linkage for research studies. Results Linkage steps: 1) approval from research ethics board and individual CPCSSN providers as data custodians; 2) notify Privacy Commissioner on behalf of custodian; 3) send linking key (CPCSSN patient ID, EMR ID) from regional database to Analytics; 4) send linking files (patient personal health number [PHN], EMR ID) from custodian’s EMR system to Analytics; 5) match unique EMR ID from linking key and clinic linking files; 6) PHN from clinic linking file mapped to administrative data; 7) data de-identified before transferring to secure repository; administrative data matched to EMR data using CPCSSN ID. Challenges: obtaining individual provider consent for each study; sampling bias; delays/issues generating clinic linkage file; mismatch between patients in clinic \& regional linking files. Current and potential solutions will be discussed during the presentation. Conclusion/Implications As primary care EMR and administrative data become more routinely linked and accepted, the process will become more efficient and streamlined. These data will contribute to a better understanding of patients and their care in Alberta

Documenting cannabis use in primary care: a descriptive cross-sectional study using electronic medical record data in Alberta, Canada

Abstract Objective Documenting cannabis use is important for patient care, but no formal requirements for consistent reporting exist in primary care. The objective of this study was to understand how cannabis use is documented in primary care electronic medical record (EMR) data. Results This was a cross-sectional study using de-identified EMR data from over 398,000 patients and 333 primary care providers in Alberta, Canada. An automated pattern-matching algorithm was developed to identify text and ICD-9 diagnostic codes indicating cannabis use in the EMR. There was a total of 11,724 records indicating cannabis use from 4652 patients, representing approximately 1.2% of the patient sample. Commonly used terms and ICD-9 codes included cannabis, marijuana/marihuana, THC, 304.3 and 305.2. Nabilone was the most frequently prescribed cannabinoid medication. Slightly more males and those with a chronic condition had cannabis use recorded more often. Overall, very few patients have cannabis use recorded in primary care EMR data and this is not captured in a systematic way. We propose several strategies to improve the documentation of cannabis use to facilitate more effective clinical care, research, and surveillance

Death is not always a failure: outcomes from implementing an online virtual patient clinical case in palliative care for family medicine clerkship

Background: The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care. Aims: To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010–2011 Year Three Family Medicine Clerkship rotation curriculum. Methods: A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students’ educational experience of using this case. Results: Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students’ self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as ‘Good to Excellent’, 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate. Conclusions: The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs