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Pan-Canadian Primary Health Care Electronic
Medical Record Content Standard, Version 3.0
Clinician-Friendly Pick-List Guide
Types of Care
Our Vision
Better data. Better decisions.
Healthier Canadians.
Our Mandate
To lead the development and
maintenance of comprehensive
and integrated health information
that enables sound policy and
effective health system management
that improve health and health care.
Our Values
Respect, Integrity, Collaboration,
Excellence, Innovation
Table of Contents
Acknowledgements .....................................................................................................................4
About the Canadian Institute for Health Information ....................................................................6
Introduction .................................................................................................................................7
Background/Purpose ...............................................................................................................7
About This Document ..............................................................................................................7
Value to Stakeholders .............................................................................................................7
Stakeholder Inputs...................................................................................................................8
Clinician-Friendly Pick-Lists ........................................................................................................9
Overview .................................................................................................................................9
CFPL Scope ............................................................................................................................9
PHC EMR CS Use Case Scenario ........................................................................................10
CFPL Licensing .....................................................................................................................13
Adoption, Maintenance and Governance ..................................................................................14
Adoption ................................................................................................................................14
Maintenance ..........................................................................................................................14
Governance ...........................................................................................................................14
Stakeholder Implementation Considerations .............................................................................15
PHC EMR CS Data Elements ................................................................................................15
Additional Data Elements ......................................................................................................15
Data Extraction ......................................................................................................................15
Other Data Sources ...............................................................................................................16
PHC Practice Considerations ................................................................................................16
PHC Reference Sets .............................................................................................................16
Next Steps ................................................................................................................................17
Stakeholder Engagement ......................................................................................................17
EMR Demonstration ..............................................................................................................17
CIHI Contact Information and Companion Products ..............................................................17
Appendix A: PHC EMR CS Data Elements ...............................................................................18
Appendix B: PHC EMR CS Priority Subset—Data Element Matrix ............................................19
Appendix C: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Definitions ........................28
Appendix D: CIHI’s Pan-Canadian PHC EMR–Related Indicators—Relation to the Priority
Subset of Data Elements ......................................................................................38
Appendix E: Glossary of Terms.................................................................................................45
Bibliography ..............................................................................................................................47
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Acknowledgements
The Canadian Institute for Health Information (CIHI) would like to acknowledge and thank the
many individuals and organizations that contributed to the development of this product. In
particular, CIHI would like to acknowledge and express its appreciation to the members of the
Jurisdictional Advisory Group (JAG) who provided invaluable guidance in developing the content
for the Primary Health Care Electronic Medical Record Content Standard Priority Subset.
CIHI would also like to acknowledge the stakeholders who were engaged to validate and
provide input to the Clinician-Friendly Pick-Lists (CFPLs). This included a pan-Canadian mix of
primary care clinicians, nurse practitioners, decision-support specialists, jurisdictional
representatives and Canada Health Infoway.
Jurisdictional Advisory Group
Tom Fogg (Co-Chair)
Consultant, Primary Health Care
Manitoba Health
Jeff Aitken
Director, Conformance and Integration
Services, Health IT Strategy Branch
British Columbia Ministry of Health
Tom Alteen
Project Manager
Newfoundland and Labrador Centre for
Health Information
Claire Bernatchez
Health Information Management Advisor
Treasury Board Secretariat of Canada
Neil Gardner
Strategic Advisor
Saskatchewan Health
Christine Grimm
Acting Chief Health Information Officer
eHealth Nova Scotia
Caroline Heick (Co-Chair)
Executive Director, Ontario, Quebec
and Primary Health Care Information
Canadian Institute for Health Information
Cheryl Hansen
Executive Director, Innovation, eHealth
New Brunswick Department of Health
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Michele Herriot
Chief Information Officer
Northwest Territories Department of Health
and Social Services
Martin Joy
Director, Health Information
Nunavut Department of Health and Social Services
Denise Junek
Vice President, eHealth and Business Relations
eHealth Saskatchewan
Janet Nyberg
Manager, Information Systems
Yukon Department of Health and Social Services
Sylvia Robinson
Director, Primary Care
British Columbia Ministry of Health
Christine Sham
Manager, Strategy, Planning and Alignment
eHealth Liaison Branch
Ontario Ministry of Health and Long-Term Care
Sonya Stasiuk
Director, Data Management Unit
Alberta Health and Wellness
Liam Whitty
Executive Director, Health Information Management
Health PEI
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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CFPL Validation Stakeholders
Dr. Tim Kolotyluk
Family Physician
Alberta
Patsy Smith
Nurse Practitioner
Nova Scotia
Dr. Leo Wong
Family Physician
British Columbia
Cindy Hollister
Clinical Leader, Clinical Adoption
Canada Health Infoway
Gillian Brennan
Project Director
Manitoba
Dr. Ben Chan
Assistant Professor
University of Toronto
Dr. Carol Critchley
Family Physician
Nova Scotia
Dr. Ed Hirvi
Family Physician
Ontario
Dr. Leslie Griffin
Family Physician
Nova Scotia
Dr. Mohamed Alarakhia
Family Physician
Ontario
Dr. John Campbell
Family Physician
Newfoundland and Labrador
Dr. Jennifer Rayner
Family Physician
Ontario
Dr. Avnish Mehta
Family Physician
Ontario
Sara Dalo
Quality Improvement Decision Support
Ontario
Sheri Ross
Senior Clinical Analyst
Alberta
Dr. Wayne Parsons
Family Physician
Ontario
Dr. Leslie Sank
Family Physician
British Columbia
Carol Quinlan
Nurse Practitioner
Ontario
Dr. Robert Oliver
Family Physician
Nova Scotia
Chelsea Good
Quality Improvement Decision Support
Ontario
Pamela Biggs
Business Analyst
Nova Scotia
Ibrahim Omar
Nurse Practitioner
Ontario
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CIHI Project Team
The core CIHI project team responsible for developing the Pan-Canadian Primary Health Care
Electronic Medical Record Content Standard included
• Alison Bidie, Project Lead, Primary Health Care Information Program
• Jing Howard, Senior Coordinator, Primary Health Care Information Program
• Deepak Swain, Analyst, Primary Health Care Information Program
• Mary Byrnes, Manager, Primary Health Care Information Program
• Caroline Heick, Executive Director, Ontario, Quebec and Primary Health Care Information
Significant project contributions were also made by Husam Alqatami, Finnie Flores, Andrew
Goosen, Alana Lane, Shaheena Mukhi, Martin Ortuzar, Isabelle Roberge, Maria Sanchez,
Ginette Therriault, Cristina Tomsa and Jennifer Trebell.
This product could not have been completed without the generous support and assistance of
many other CIHI departments, including Classifications and Terminology, Information
Technology and Services, Publishing and Translation, Communications, and Distribution, and
the CIHI Standards Working Group, who provided ongoing support to the core team.
About the Canadian Institute for
Health Information
The Canadian Institute for Health Information (CIHI) collects and analyzes information on
health and health care in Canada and makes it publicly available. Canada’s federal, provincial
and territorial governments created CIHI in 1994 as a not-for-profit, independent organization
dedicated to forging a common approach to Canadian health information. CIHI’s goal is to
provide timely, accurate and comparable information. CIHI’s data and reports inform health
policies, support the effective delivery of health services and raise awareness among
Canadians of the factors that contribute to good health. The year 2014 marks CIHI’s
20th anniversary of operation.
For more information, visit our website at www.cihi.ca.
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Introduction
Background/Purpose
CIHI has been leading the initiative to improve primary health care (PHC) data and information
across Canada, in alignment with Canada’s federal, provincial and territorial governments and
electronic medical record (EMR) programs. Data and information standards are the foundation
of relevant and useful information. Standards ensure the consistent collection of data that is
comparable and measurable. The Pan-Canadian Primary Health Care Electronic Medical
Record Content Standard (PHC EMR CS) was thus created as a pan-Canadian solution to
facilitate the capture of structured EMR data at the point of care. Environmental scans and
stakeholder consultation recommended a smaller, more focused scope of priority data elements
and highlighted the need for Clinician-Friendly Pick-Lists (CFPLs). In April 2014, CIHI released
a PHC EMR CS Priority Subset (45 of the 106 data elements) to accelerate EMR content
standards adoption across Canada. Refer to Appendix A for the data elements that are in
scope. CIHI also developed CFPLs for 8 priority data elements. For more information, please
refer to Pan-Canadian Primary Health Care Electronic Medical Record Content Standard,
Version 3.0—Business View, available at www.cihi.ca/phc.
About This Document
This guidance document is intended to provide jurisdictions and EMR vendors with information
about the use of PHC EMR CS data elements, CFPLs and PHC reference sets (ref sets).
The guide includes details about the scope and intended use of the standard, the value to
stakeholders and implementation considerations. It is anticipated that the Priority Subset and
associated CFPLs and ref sets will be included in EMR vendor requirements. This document
does not contain technology-specific implementation guidance (e.g., how to extract data from
an EMR, how to design EMR user interfaces to facilitate clinician data capture, how to load
EMR data into a repository to support health system use). Over time, future EMR demonstration
projects and implementation experience will inform version updates of the CS, CFPLs and
associated guidance materials.
The companion products supporting the PHC EMR CS include an information sheet, the
Business View v3.0, Data Models v3.0, Technical Guidance v3.0 and CFPL Spreadsheets v1.0.
These products are available on CIHI’s website at www.cihi.ca/phc.
Value to Stakeholders
When implemented at the point of care, it is anticipated that the Priority Subset and the
associated CFPLs will increase the availability of structured, comparable EMR data to support
priority information needs at the practice and health system levels. The focused scope of the
CFPLs is intended to support priority PHC information needs and CIHI’s pan-Canadian PHC
EMR–related indicators. For PHC clinicians, this means better EMR data to inform
improvements to the quality of care, patient safety and efficiency in their practices.
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Similarly, structured EMR data will be an asset at the health system level and will support
monitoring of chronic disease prevention and management, health outcomes, health promotion
and quality of care. EMR vendors will also benefit from a single, usable pan-Canadian standard
that has the potential to lower EMR implementation and maintenance costs in the longer term.
Stakeholder Inputs
The Priority Subset was developed in consultation with the JAG, whose members validated the
data elements with their respective stakeholders. Prince Edward Island, Nova Scotia, Ontario,
Manitoba, Saskatchewan, Alberta, British Columbia and the Northwest Territories provided
input. In addition, stakeholders representing federal organizationsi were engaged to provide
feedback. The final 45 data elements were endorsed by the JAG in December 2013.
Stakeholder input also informed the development of the CFPLs. In March 2014, the draft
clinician-friendly terms were validated by a cross-section of stakeholders, including PHC
clinicians, nurse practitioners, decision-support specialists, jurisdictional representatives and
Canada Health Infoway. Feedback from stakeholders informed the final CFPL scope. In May
2014, the updated CFPLs and a plan to map them to relevant code systems were also reviewed
by the JAG.
i.
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Health Canada, Department of National Defence, Public Health Agency of Canada, Correctional Service Canada.
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Clinician-Friendly Pick-Lists
Overview
The CFPLs are constrained lists of clinician-validated terms commonly used in PHC settings.
CFPLs were developed for 8 Priority Subset data elements: Health Concern, Clinician
Assessment, Social Behaviour, Reason for Visit, Intervention, Diagnostic Imaging Test Ordered,
Referral and Vaccine Administered.
The CFPLs were developed to support aggregate-level reporting and analysis; in order to
facilitate this, the CFPL terms were mapped to recognized code systems. Table 1 summarizes
the CFPLs and the corresponding code system maps.
Table 1: CFPL Mapping to Code Systems
CFPL Description
Code System Maps Available In
Health Concern
ICD-10-CA and ICD-9
Clinician Assessment
ICD-10-CA and ICD-9
Social Behaviour
ICD-10-CA and ICD-9
Reason for Visit
ICD-10-CA and ICD-9
Intervention
CCI
Diagnostic Imaging Test Ordered
CCI
Referral Service
SNOMED CT
Vaccine Administered
SNOMED CT
Note
See Appendix E for descriptions of the code systems.
CFPL Scope
The CFPL terms are intended to be captured as a minimum priority subset of information
to facilitate standardized data capture at the point of care. Terms were identified to support
a variety of needs for aggregate information at the practice level and to support quality
improvement. Consideration was also given to uses such as population health and disease
surveillance. Other scope considerations, such as enabling the use of PHC priority indicators
and jurisdictional PHC information needs, were taken into account. Refer to Table 2 for detailed
scope information.
The CFPLs do not include terms that are typically not critical to priority information needs
expressed by CIHI’s stakeholders. For example, signs and symptoms (e.g., knee pain) as
well as individual problem lists were not included in the Health Concern CFPL. In addition, the
scope is mostly focused on data relevant to the PHC environment. For instance, past surgical
interventions are out of scope, with a few exceptions required to support a PHC priority indicator.
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Table 2: CFPL Scope
CFPL Name
In Scope
Reason for Visit
High-frequency complaints, symptoms, follow-ups,
requests for referral/services/medicine renewals
Health Concern
Chronic conditions, comorbidities, ambulatory care and Signs and symptoms, suspected/
family practice sensitive conditions, special interests of query conditions, past surgeries
population health, major previous medical history
Social Behaviour
Negative social behaviours (e.g., tobacco use, abuse of Occupations, positive social
prescription drugs)
behaviours
Clinician Assessment Diagnoses, comorbidities, chronic conditions,
ambulatory care sensitive conditions
Intervention
Services/procedures relevant to PHC setting (e.g.,
counselling, education, examinations, past surgical
interventions performed outside the PHC setting but
relevant to PHC care)
Diagnostic Imaging
Test Ordered
Diagnostic imaging tests required for priority indicators
such as cancer screening (mammogram) and bone
density screening (bone mineral densitometry), highfrequency and special interest diagnostic imaging tests
Referral
Types of specialty services (e.g., cardiology)
Out of Scope
Signs and symptoms, past history
Activities captured discretely in
other data elements (e.g.,
diagnostic imaging tests,
medications, lab tests, vaccines)
Specialist descriptions (e.g.,
cardiologist), low-frequency
services (e.g., faith healer)
Vaccine Administered High-frequency and mandatory vaccines and those
included by the National Advisory Committee on
Immunization (NACI); supports indicators on influenza,
pneumococcal and childhood immunizations
PHC EMR CS Use Case Scenario
What Is a Use Case?
Use cases provide scenarios that describe the electronic transmission points of a common set
of data elements between an end user and another system to link knowledge and achieve a
specific business goal. For example, the structured capture of patient administrative and clinical
data from a PHC encounter supports the calculation of PHC priority health indicators for
clinicians, health system planners and policy-makers.
A use case includes the following components:
• Narrative: A brief story about people’s interactions with specific aspects of the PHC system.
• Swim lane diagram: A picture of the people, systems and EMR data involved in specific
aspects of PHC systems. Each swim lane represents the action of a person or a system. In
each lane, actions are initiated by an actor and result in data inputs or outputs to the system.
• Flow of events: A sequential flow of actions, derived from the narrative, that corresponds to
key points in the swim lane diagram. Each step in the sequential flow of actions is referenced
in the diagram as a numbered circle.
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Use Case: Narrative
At the onset of an encounter, patient administrative details are captured in the EMR, followed by
the additional clinical data captured by a nurse and then a PHC clinician. Priority data elements
such as Health Concern, Social Behaviour (risk factors) and Intervention are captured in the
EMR in a structured format. Other data elements are captured when applicable, such as
Vaccine Administered and Diagnostic Imaging Test Ordered. The collection of these priority
data elements is supported by underlying CFPLs and PHC ref sets to enable structured EMR
data at the point of care.
Once captured within the EMR, the structured data is used to support improvements to quality
of care and health outcomes. In a standardized format, the EMR data can be aggregated for
comparable reporting to support performance measurement at the practice and health system
levels. The priority data elements can also be used to directly support the calculation of priority
PHC indicators for use by clinicians, health system planners and policy-makers.
Use Case: Swim Lane Diagram
Figure 1 provides an example of a swim lane diagram.
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Patient
1
2
Patient arrives at
PHC clinic based on
his/her appointment
(set up before)
Administrative
details recorded
by receptionist/
nurse
Administrative details
• Patient Identifier
• Patient Date of Birth
• Patient Gender
• Reason for Visit*
• Visit Date
4
Physician
assesses
the patient
based on
the Reason
for Visit
Relevant past and
present medical history
followed by physical
examination (both
general and regional
based on Reason for
Visit and risk factors)
Social Behaviour*
• Smoking
• Physical inactivity
• Obesity
5
•
•
•
•
Health Concerns*
Clinician Assessment*
Intervention*
Diagnostic Imaging
Test Ordered*
• Vaccine Administered†
Electronic medical record
Indicators related to monitoring population health (for
policy-makers)
• Breast cancer screening
• Cervical cancer screening
• Child immunization
• Overweight and obesity rate
Notes
* Data element with an associated CFPL.
† Data element with an associated constrained PHC ref set.
Please refer to Appendix C for indicator definitions.
Indicators related to chronic disease management (for clinicians)
• Blood pressure control for hypertension
• Screening for modifiable risk factors in adults with hypertension
• Screening for modifiable risk factors in adults with diabetes
• Screening for modifiable risk factors in adults with coronary artery disease
Data Use Phase
Health System Use
EMR
Clinician
• Blood pressure
• Height
• Weight
Nurse assesses
the patient
Data Capture Phase
Nurse
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Figure 1: Use Case: Swim Lane Diagram
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Use Case: Flow of Events
1. The patient arrives at a PHC clinic for a scheduled appointment.
2. The receptionist/nurse records administrative details and Reason for Visit of the patient.
3. The nurse assesses the patient and captures systolic blood pressure, diastolic blood
pressure, height, weight, etc., in the EMR.
4. The physician reviews the nurse’s assessment information in the EMR and, based on
Reason for Visit, gathers relevant past and present medical history and performs physical
examination and risk factor assessment.
5. Based on Reason for Visit, medical history and clinical examination, all health concerns are
listed. Finally, the most relevant health concern related to the Reason for Visit is identified
as the Clinician Assessment.
6. The data captured in the EMR at different stages during an encounter is used by clinicians
and health system policy-makers to aggregate information to facilitate quality improvement
and analysis of health system performance.
CFPL Licensing
In order to protect the integrity of the CFPL terms and associated mapping to the relevant
code systems, licence agreements are required for use by stakeholders, including commercial
vendors, governments, non-commercial entities and others.
These agreements provide stakeholders with access to the CFPLs and the code mappings so
they can adopt and implement them. Stakeholders are required to sign and submit an annual
licence agreement before gaining access to the CFPLs.
For additional information about licence agreements, send an email to [email protected].
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Adoption, Maintenance and Governance
Adoption
It will be critical for jurisdictions to include the Priority Subset and associated CFPLs and PHC ref
sets in their EMR vendor requirements to realize the benefits of structured EMR data collection
at the point of care. However, incorporating the PHC EMR CS into an EMR specification does not,
on its own, translate into the collection of meaningful, structured EMR data. Other key enablers
to adoption include jurisdictional and clinician leadership, clear data governance, collaborative
partnerships, change management, capacity-building and policy frameworks.
CIHI’s role in supporting the PHC EMR CS is to provide usable tools and products to
jurisdictional stakeholders that are aligned with their priorities. CIHI will also offer subject matter
expertise and technical guidance to implementers.
It is anticipated that jurisdictions will include the PHC EMR CS and CFPLs in their EMR vendor
requirements. For details on PHC EMR CS data elements, refer to Appendix B. For additional
information about obtaining the CFPLs, send an email to [email protected].
Maintenance
CIHI will work with jurisdictions and other key partners to inform the refinement and evolution of
the PHC EMR CS and CFPLs over time. Changes to data elements and clinician-friendly terms
and further mapping to code systems will be driven by jurisdictional priorities and information
needs, as well as the capability and interest of clinicians to collect additional data in a structured
format. A maintenance plan will be developed by CIHI. The plan will include a stakeholder
change request process with input from the JAG. However, the Priority Subset and CFPLs
will remain stable and unchanged until piloting of the CFPLs has been completed. Additional
implementation considerations will be identified at that stage and incorporated into the next
generation of PHC EMR CS products.
Canada Health Infoway will continue to retain accountability for the PHC ref sets associated with
the PHC EMR CS. CIHI will continue to collaborate with Canada Health Infoway in the area of
standards and other opportunities to influence the standardization of EMR data.
Governance
Oversight of the PHC EMR CS and CFPLs will be the responsibility of the Primary Health Care
Information program at CIHI. Governance and endorsement of these products will continue to
be driven through consultation with jurisdictional stakeholders. It should be noted that the use
of the PHC EMR CS and CFPLs by jurisdictions and PHC providers is on a voluntary basis.
Jurisdictions may choose to endorse these products and/or mandate their use by all PHC
providers or by subsets of regional/local providers; they may also choose to encourage their
use through other accountability mechanisms and agreements. CIHI does not have the authority
to mandate the use of these products or the collection of data using these standards.
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Stakeholder Implementation Considerations
PHC EMR CS Data Elements
Stakeholders are encouraged to adopt all Priority Subset data elements in their EMR vendor
requirements. The Data Element Matrix in Appendix B provides a detailed view of the Priority
Subset of 45 data elements, including data element definitions, data types, valid formats,
examples in primary care use and applicable CFPLs or PHC ref sets.
Note that the Priority Subset of data elements supports CIHI’s pan-Canadian PHC indicators.
Information about the EMR-related indicators and how the data elements relate to the specific
indicators can be found in appendices C and D, respectively.
Additional Data Elements
Federal, provincial and territorial stakeholders may choose to define and collect additional EMR
data elements beyond the Priority Subset and/or the original 106 data elements in the PHC
EMR CS. This decision will be driven and supported by individual jurisdictional program needs.
In turn, CIHI will consider including these additional elements in the Priority Subset and/or PHC
EMR CS in the longer term.
When jurisdictional stakeholders consider using additional data elements beyond the Priority
Subset, it is recommended that the core relationships in the underlying data models be retained.
This will facilitate the use of the resulting EMR data for PHC indicator calculations.
Please send an email to [email protected] or visit CIHI online at www.cihi.ca/phc for further guidance
when considering the inclusion of additional data elements. For more information, please refer to
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
Technical Guide (April 2014), available at www.cihi.ca/phc.
Data Extraction
CIHI’s current focus is on providing tools to facilitate the capture of structured EMR data at
the point of care. As such, the previously released pan-Canadian Data Extraction Specification
(DES) v2.1 has not been updated. CIHI will evaluate the need to update the DES, depending
on the needs of jurisdictions choosing to implement the PHC EMR CS.
When stakeholders plan for EMR data extraction, it is important that the solution supports the
data relationship as reflected in the PHC EMR Data Models, v3.0. Jurisdictions are advised to
consider existing jurisdictional data transfer solutions, as well as pan-Canadian directions/trends
in data interoperability.
Please contact CIHI for further guidance when considering EMR data extraction. CIHI is interested
in collaborating with jurisdictions that are implementing the PHC EMR CS, including the CFPLs.
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Other Data Sources
PHC data may also include data that is transferred into the EMR from other external sources,
such as a drug information system (e.g., lab prescriptions, dispenses), a lab system (e.g., lab
results), diagnostic imaging repositories (e.g., diagnostic imaging reports), provincial electronic
health record (EHR) repositories (e.g., clinical documents, allergies) or other EMRs (e.g., clinical
summaries, referrals). Implementers will need to consider how to transform the data transferred
into the EMR from external sources to align with the supported Priority Subset and/or CFPL
code system(s) (e.g., to convert free-text information to coded data).
PHC Practice Considerations
Should there be existing pick-lists in a PHC practice, it is recommended that these local lists be
compared with the CFPL terms for alignment. The CFPL terms are generally broad descriptions
(e.g., depression, asthma) that map to high-level codes to support aggregate-level reporting at
the practice level and for health system use.
In order to maintain a standard approach to data capture, terms in the CFPLs are recommended
as the terms of choice that can be easily viewed in the EMR interface to facilitate standardized
data capture at the point of care. For example, when Alzheimer’s disease is typically captured in
a PHC practice, the standardized description for Alzheimer’s disease from the CFPL should be
adopted, not the local description, to reduce duplication and potential data quality issues.
Additional terms can be implemented as required by PHC clinicians. However, it will be the
responsibility of the implementer to incorporate these additional terms into the EMR and
undertake associated mapping to code systems where needed. In order to align to the CFPL
development process, it is recommended that additional terms remain broad, unless there is a
specific need for added granularity. For example, should additional mental health diseases be
included in the pick-list, include the general description as a starting point and map to a highlevel code category. This approach will facilitate analysis and aggregate-level reporting. Over
time, through implementation experience and stakeholder feedback, the CFPL scope will
evolve, and CIHI may include more granular terms and codes where required. For additional
guidance on the CFPLs, please send an email to [email protected].
PHC Reference Sets
Canada Health Infoway, in collaboration with CIHI, led the development of the PHC ref sets.
The ref sets are intended to support the PHC EMR CS data elements and, when implemented,
will enable structured EMR data at the point of care. For example, Patient Gender, Visit Type
and Patient Identifier Type all have associated ref sets. The Priority Subset data elements are
supported by 15 PHC ref sets in addition to the 8 CFPLs. Refer to Appendix A for details.
In the development of CFPLs, some ref sets were constrained to support the focused scope
(e.g., Vaccine Administered, Referral). For more information about the ref sets, visit Canada
Health Infoway at https://infocentral.infoway-inforoute.ca/2_Standards.
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Next Steps
Stakeholder Engagement
CIHI will engage jurisdictional representatives and vendors to promote the PHC EMR CS and
CFPLs. In turn, jurisdictions and other primary health care stakeholders should consider the
potential implementation of these products via PHC EMR programs and with jurisdictional partners.
EMR Demonstration
CIHI will explore opportunities with ready jurisdictions or partners to engage in EMR demonstration
projects or pilot projects where there is a commitment by the jurisdiction and/or partner to collect
some structured data at the point of care. These local projects will form the basis for larger regional
initiatives leading to a pan-Canadian approach. Future EMR demonstration projects will inform the
evolution of the PHC EMR CS and CFPLs to ensure they continue to support health system use
and priority PHC information needs for clinicians, health system planners and policy-makers.
These projects will also inform CIHI’s approach and timing in considering resuming the collection
of EMR data in a systematic way.
CIHI Contact Information and Companion Products
For more information on the PHC EMR CS or CFPLs, or to learn more about PHC in Canada,
please email the Primary Health Care Information program at [email protected] or visit CIHI’s
website at www.cihi.ca/phc. The website also provides access to the following companion
products: Business View (version 3.0); Technical Guide (version 3.0); Data Models (version 3.0)
and an information sheet. Contact CIHI to learn how to purchase and access the Pan-Canadian
Clinician-Friendly Pick-List Spreadsheets (version 1.0).
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Appendix A: PHC EMR CS Data Elements
DE #
Data Element Name
DE #
Data Element Name
A1
Patient Identifier
E29
Height Unit of Measure*
A2
Patient Identifier Type*
E30
Weight
A3
Patient Identifier Assigning Authority*
E31
Weight Unit of Measure*
A4
Patient Date of Birth
E34
Clinician Assessment
A5
Patient Gender*
F1
Intervention
A9
Patient Status*
F2
Intervention Date
A14
Patient Postal/Zip Code
G1
Lab Test Ordered*
B4
Clinician Identifier
G2
Lab Test Ordered Date
B5
Clinician Identifier Type*
H1
Lab Test Performed Date
B6
Clinician Identifier Assigning Authority*
H2
Lab Test Name*
B7
Clinician Role*
H3
Lab Test Result Value
C1
Service Delivery Identifier
H4
Lab Test Result Unit of Measure*
C4
Service Delivery Postal Code
I1
Diagnostic Imaging Test Ordered
D1
Appointment Creation Date
I2
Diagnostic Imaging Test Ordered Date
D2
Reason for Visit
J1
Diagnostic Imaging Test Performed Date
D3
Visit Date
K1
Referral*
D4
Visit Type*
K2
Referral Requested Date
E11
Health Concern
L1
Referral Occurred Date
E12
Health Concern Date of Onset
M1
Prescribed Medication
E14
Social Behaviour
M2
Prescription Date
E23
Systolic Blood Pressure
O1
Vaccine Administered*
E24
Diastolic Blood Pressure
O2
Vaccine Administered Date
E28
Height
Notes
* Data elements with PHC ref sets.
Data elements highlighted in grey have CFPLs.
18
Appendix B: PHC EMR CS Priority Subset—Data Element Matrix
Data
Data
Element
Element Common
Number Name
Data Element
Standard
Data Element
Name
Definition
Data
Type
Valid
Format
Example
Values
Type of
Permissible
Source for
Values Source Permissible Code
Name
Values
System
Permissible
Values
Source ID
N/A
N/A
Patient
Identifier
Client Identifier Represents a
Identifier
unique identifier
assigned to the
Client.
A2
Patient
Identifier
Type
Client Identifier Represents the Code
Type Code
type of Client
Identifier (e.g.,
jurisdictional
health care
identifier,
passport).
N/A
Jurisdictional ClientIdentifierT PHC
health
ypeCode
Reference
number
Set
SNOMED 2.16.840.1.
Helps differentiate the type
CT®
11388.3.2.20. of identifier used to identify
3.255
the Client. In conjunction
with the Client Identifier,
can be used to associate
administrative information
(e.g., demographic) and
health information (e.g., lab
results) with the Client.
A3
Patient
Identifier
Assigning
Authority
Client Identifier Represents the Code
Assigning
legal entity/
Authority Code organization
responsible for
assigning the
Client Identifier.
N/A
Ministry of
Health
Alberta
(qualifier
value)
ClientIdentifier PHC
AssigningAutho Reference
rityCode
Set
SNOMED 2.16.840.1.113 Helps identify the
CT®
883.2.20.3.256 organization that issued the
identifier when a Client can
have multiple identifiers. In
conjunction with the Client
Identifier, can be used to
associate administrative
information (e.g.,
demographic) and health
information (e.g., lab
results) with the Client.
A4
Patient Date Client Birth
of Birth
Date
N/A
N/A
YYYYMMDD 20101001
N/A
N/A
N/A
Used in the provision and
administration of care. Can
be used to associate
administrative information
(e.g., demographic) and
health information (e.g., lab
results) with the Client.
Birthdate is used to
validate the identity of the
Client. It is also used to
ensure that the right drug
and lab reference ranges
are used for the Client.
(cont’d on next page)
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Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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A1
Represents the Date
Client’s date of
birth.
N/A
Example of Primary Care
Use
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
HL7
Example of Primary Care
Use
A5
Patient
Gender
Client
Administrative
Gender Code
Represents the Code
reported gender
category of
the Client at a
given time.
N/A
Male
A9
Patient
Status
Client Status
Code
Represents
Code
whether or not
the PHC
Provider
considers the
Client to be
actively seeking
PHC services
through him or
her.
N/A
Patient active ClientStatusC PHC
(finding)
ode
Reference
Set
SNOMED 2.16.840.1.113 Ensures that inappropriate
CT®
883.2.20.3.191 reminders are not sent to
Clients who have a status of
inactive with the Provider.
A14
Patient
Postal/Zip
Code
Client
Residence
Postal Code
Represents the String
postal code of
the Client’s
primary
residence.
ANA NAN
K0K 3R0
N/A
N/A
N/A
N/A
Provides a part of the Client’s
address, which can be used
to help find Service Delivery
Locations that are close to
the Client’s home.
B4
Clinician
Identifier
Provider
Identifier
Represents a
Identifier N/A
unique identifier
assigned to the
Provider.
82356743
N/A
N/A
N/A
N/A
Can be used to link Client
records and billing
information to a specific
Provider. Can be used to
support authorization to
access sensitive records.
B5
Clinician
Identifier
Type
Provider
Represents the Code
Identifier Type type of Provider
Code
Identifier.
N/A
Provider
ProviderIdentif PHC
billing number ierTypeCode Reference
(qualifier
Set
value)
SNOMED 2.16.840.1.113 In conjunction with the
CT®
883.2.20.3.257 Provider Identifier, can be
used to link Client records
and billing information to a
specific Provider. Can be
used to support authorization
to access sensitive records.
B6
Clinician
Identifier
Assigning
Authority
Provider
Identifier
Assigning
Authority Code
N/A
Health
ProviderIdentif PHC
regulatory
ierAssigningA Reference
body for
uthorityCode Set
physicians
and surgeons
(qualifier
value)
SNOMED 2.16.840.1.113 In conjunction with the
CT®
883.2.20.3.252 Provider Identifier, can be
used to link Client records
and billing information to a
specific Provider. Can be
used to support authorization
to access sensitive records.
Represents the Code
legal entity
responsible for
assigning the
unique identifier
to the Provider.
Administrative PHC
Gender
Reference
Set
Permissible
Values
Source ID
2.16.840.1.113 Used for administrative
883.2.20.3.308 purposes. Can be used
for identification matching
and confirmation.
(cont’d on next page)
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20
Data
Data
Element
Element Common
Number Name
Data
Data
Element
Element Common
Number Name
Data Element
Standard
Data Element
Name
Definition
Data
Type
Clinician Role Provider Role
Type Code
Represents the Code
role of the
Provider in
relation to his or
her participation
in a specific
health care
event.
C1
Service
Delivery
Identifier
Service
Delivery
Location
Identifier
C4
Service
Delivery
Postal Code
Service
Delivery
Location Postal
Code
D1
N/A
Permissible
Values
Source ID
Example of Primary Care
Use
Primary care
physician
(occupation)
ProviderRoleC PHC
ode
Reference
Set
SNOMED 2.16.840.1.113 Used to distinguish roles
CT®
883.2.20.3.265 within a health care setting.
Can be used to restrict
access to Client data by
role type.
Represents the Identifier N/A
unique identifier
of the practice
(Service
Delivery
Location) where
the Client
received care.
897564RT
N/A
N/A
N/A
N/A
Name of the Service Delivery
Location is referenced on
letters sent to Clients.
Represents the String
postal code
where the Client
received the
PHC service.
ANA NAN
K0K 3R0
N/A
N/A
N/A
N/A
Provides a part of the Service
Delivery Location address,
which helps Clients know
where to go for service.
Appointment Encounter
Creation
Request Date
Date
Represents the Date
date on which
an appointment
was created for
the Client by the
Provider (or his
or her staff).
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Helps identify wait times for
specific Providers.
D2
Reason for
Visit
Client
Encounter
Reason Code
Represents the Code
reason for the
encounter as
conveyed by the
Client.
N/A
Reason for
Visit CFPL
CFPL
ICD-10CA
2.16.840.1.113 Can be used to give the
883.3.1780.5.1 Provider advance notice of
2.2.3
information that may need to
be addressed with the Client
during the encounter. Can
assist in scheduling the
amount of time a Client may
need with the Provider.
D3
Visit Date
Encounter
Date
Represents the Date
date the Client
had an
encounter with
the Provider.
YYYYMMDD 20101001
N/A
N/A
N/A
N/A
R51
Can report on Client wait
times for scheduled Clients
and track the continuum of
care provided to Clients.
(cont’d on next page)
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B7
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Permissible
Values
Source ID
Example of Primary Care
Use
D4
Visit Type
Encounter
Mode Code
Represents the Code
type of contact
between the
Provider and the
Client.
N/A
Direct
Encounter
Client Alone
(procedure)
EncounterTyp PHC
eCode
Reference
Set
SNOMED 2.16.840.1.113 Can be used to track services
CT®
883.2.20.3.207 provided that may require
special billing processes. Can
be used to track percentage
of Clients treated through
various modes of visits.
E11
Health
Concern
Observation
Represents the Code
Health
Client’s relevant
Concern Code conditions,
diagnoses and
major past
medical history.
N/A
J44.9
Health
Concern
CFPL
CFPL
ICD-10CA
2.16.840.1.113 Provides a longitudinal record
883.3.1780.5.1 of health problems for a
2.2.1
Client. Clinicians can use this
information to monitor the
health of their Clients,
recommend treatments and
assist in the formation of
diagnoses.
E12
Health
Concern
Date of
Onset
Observation
Health
Concern Start
Date
Represents the Date
date on which
the Client’s
health concern
started.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
E14
Social
Behaviour
Observation
Social
Behaviour
Code
Represents a
Code
type of Client
social behaviour
that increases
the possibility of
disease or injury
for the Client.
This can include
risk factors such
as tobacco use,
alcohol use and
abuse of illicit or
prescription
drugs.
N/A
Social
Behaviour
CFPL
CFPL
ICD-10CA
2.16.840.1.113 Can be used to identify Client
883.3.1780.5.1 behaviours or risk factors
2.2.4
that, if treated, could lead to
improvements in the Client’s
health and wellness.
Z72.0
Provides a longitudinal record
of health problems for a
Client. Clinicians can use this
information to monitor the
health of their Clients.
(cont’d on next page)
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Data
Data
Element
Element Common
Number Name
Data
Data
Element
Element Common
Number Name
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Permissible
Values
Source ID
Example of Primary Care
Use
Systolic
Blood
Pressure
Observation
Systolic Blood
Pressure
Number
Represents the Number
Client’s systolic
blood pressure
value (in mmHg)
as measured.
The unit of
measure
(mmHg) is
implied when
representing
the value.
N/A
120
N/A
N/A
N/A
N/A
A discrete value provides the
ability to graph and trend
values over time. The
measurement supports
clinical decisions.
E24
Diastolic
Blood
Pressure
Observation
Diastolic Blood
Pressure
Number
Represents the Number
Client’s diastolic
blood pressure
value (in mmHg)
as measured.
The unit of
measure
(mmHg) is
implied when
representing
the value.
N/A
120
N/A
N/A
N/A
N/A
A discrete value provides the
ability to graph and trend
values over time. The
measurement supports
clinical decisions.
E28
Height
Observation
Represents the Number
Height Number height of the
Client as
measured.
N/A
3.25
N/A
N/A
N/A
N/A
A decrease in female height
could be an early sign of
osteoporosis and trigger a
need for a bone mineral
density test.
E29
Height Unit of Observation
Represents the Code
Measure
Height Unit of unit of measure
Measure Code used to capture
the Client’s
height.
N/A
Centimetre
HeightUnitofM PHC
easureCode Reference
Set
UCUM
2.16.840.1.113 A decrease in female height
883.2.20.3.194 could be an early sign of
osteoporosis and trigger a
need for a bone mineral
density test.
E30
Weight
Observation
Weight
Number
N/A
75.6
N/A
N/A
N/A
E31
Weight Unit
of Measure
Observation
Represents the Code
Weight Unit of unit of measure
Measure Code used to capture
the Client’s
weight.
N/A
Kilogram
WeightUnitofM PHC
easureCode Reference
Set
UCUM
2.16.840.1.113 Weight is used to calculate
883.2.20.3.195 BMI.
Represents the Number
weight of the
Client as
measured.
N/A
Weight is used to calculate
body mass index (BMI).
(cont’d on next page)
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Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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E23
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Permissible
Values
Source ID
Example of Primary Care
Use
E34
Clinician
Assessment
Observation
Encounter
Clinical
Assessment
Code
Represents the Code
Provider’s
professional
opinion of the
most significant
condition related
to the Client’s
current
encounter
following clinical
assessment.
N/A
J45.9
Clinician
Assessment
CFPL
CFPL
ICD-10CA
2.16.840.1.113 The clinical assessment of
883.3.1780.5.1 the encounter can be used to
2.2.6
help track episodes of care.
Can also support the
automatic creation of billing
information.
F1
Intervention
(Treatment)
Intervention
Code
Represents
Code
the services
or activities
performed for
the Client within
the PHC setting
as well as
relevant
intervention
history that
occurred
beyond the PHC
setting.
N/A
7.SP.10.VK
Intervention
CFPL
CFPL
CCI
2.16.840.1.113 Tracked interventions
883.3.1780.5.1 performed on a Client can
2.2.2
help guide future
interventions. Used to track
Client’s progressive
improvement on the
continuum of care timeline
(e.g., counselling for smoking
cessation delivered in 2012).
F2
Intervention
(Treatment)
Date
Intervention
Date
Represents the Date
date the
intervention was
performed.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
G1
Lab Test
Ordered
Laboratory
Represents the Code
Test Name
lab test ordered
Ordered Code by the Provider
for the Client.
N/A
ObservationOr PHC
derableLabTy Reference
pe
Set
LOINC®, 2.16.840.1.113 Used in the provision of care
pCLOCD 883.2.20.3.164 (e.g., confirmation of
suspected diagnoses). The
lab test name is required to
know what test is being
ordered.
G2
Lab Test
Laboratory
Ordered Date Test Order
Date
N/A
N/A
Represents the Date
date the lab test
was ordered by
the Provider.
Hemoglobin
A1c in Blood
YYYYMMDD 20100430
N/A
N/A
Used in the provision of care
to track the date a particular
intervention was performed
by the Provider.
Supports scheduling of future
appointments based on the
tracked turnaround time of
lab tests.
(cont’d on next page)
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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24
Data
Data
Element
Element Common
Number Name
Data
Data
Element
Element Common
Number Name
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Permissible
Values
Source ID
N/A
Lab Test
Performed
Date
Laboratory
Represents the Date
Test Performed date the lab test
was performed.
Date
YYYYMMDD 20100430
N/A
H2
Lab Test
Name
Laboratory
Test Result
Name Code
N/A
Hemoglobin
(Mass/
Volume) in
Blood
ObservationR PHC
esultableLabT Reference
ype
Set
LOINC®, 2.16.840.1.113 Used to ensure that the name
pCLOCD 883.2.20.3.105 of the test performed is
understood by the Provider,
researcher, etc.
H3
Lab Test
Laboratory
Result Value Test Result
Value Text
(Number,
Code)
Represents
String
N/A
the result of the (Number,
lab test.
Text)
Sickle cell
trait
N/A
N/A
N/A
H4
Lab Test
Laboratory
Result Unit of Test Result
Value Unit of
Measure
Measure Code
Represents the Code
unit of measure
of the lab result
for the lab test
performed.
N/A
mg/mmol
LaboratoryOb PHC
(milligram per servationUnit Reference
millimole)
OfMeasureCo Set
de
UCUM
2.16.840.1.113 Ensures that the unit of
883.2.20.3.152 measure associated with the
value is provided.
I1
Diagnostic
Diagnostic
Represents the Code
Imaging Test Imaging Test
type of
Ordered
Ordered Code diagnostic
imaging test
ordered by the
Provider for the
Client.
N/A
3.GY.10
Diagnostic
CFPL
Imaging Test
Ordered CFPL
CCI
2.16.840.1.113 Diagnostic images can
883.3.1780.5.1 be used to assist in
2.2.5
the confirmation of
suspected diagnoses.
I2
Diagnostic
Diagnostic
Imaging Test Imaging Test
Ordered Date Ordered Date
Represents the Date
date the
diagnostic
imaging test
was ordered by
the Provider.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Schedule future
appointments based on the
tracked turnaround time of
diagnostic imaging tests.
J1
DI Test
Performed
Date
Represents the Date
date the
diagnostic
imaging test
was performed.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Schedule future
appointments based on the
tracked turnaround time of
diagnostic imaging tests.
Diagnostic
Imaging Test
Performed
Date
Code
N/A
N/A
Schedule future
appointments based on the
tracked turnaround time of
lab tests.
Used in the provision of care
(e.g., confirmation of
suspected diagnoses). For
instance, blood sugar
monitoring (Accu-Chek)
values are tracked over time
and compared with yearly
HbA1c test results at a
central lab.
(cont’d on next page)
25
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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H1
Represents
the lab test
performed.
N/A
Example of Primary Care
Use
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
K1
Referral
Referral
Service Code
Represents the Code
type of service
required for the
Client.
N/A
K2
Referral
Requested
Date
Referral
Requested
Date
Represents the Date
date the referral
request was
created by the
PHC Provider.
L1
Referral
Occurred
Date
M1
M2
310063007
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
Permissible
Values
Source ID
Example of Primary Care
Use
ReferralServic PHC
eCode
Reference
Set
SNOMED 2.16.840.1.113 Identifies the general type of
CT®
883.2.20.3.197 care or category of referral
services requested.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Assists Providers in tracking
when a request to obtain a
consult was first requested.
Referral
Represents the Date
Occurred Date actual date the
Client had the
encounter with
the referred-to
Provider.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Assists Providers in
understanding which referral
services have longer wait
times.
Prescribed
Medication
Medication
Prescribed
Name Code
Represents the Code
medications
prescribed to
the Client.
N/A
N/A
N/A
TBD
N/A
Can be used to create a
longitudinal medication
record to support the
provision of care.
Prescription
Date
Medication
Prescribed
Date
Represents
Date
the date the
prescription for
the medication
was created for
the Client.
YYYYMMDD 20100430
N/A
N/A
N/A
N/A
Can be used to create a
longitudinal medication
record to support the
provision of care.
Amoxicillin
(cont’d on next page)
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26
Data
Data
Element
Element Common
Number Name
Data
Data
Element
Element Common
Number Name
Data Element
Standard
Data Element
Name
Definition
Data
Type
Example
Valid Format Values
Vaccine
Vaccine
Administered Administered
Name Code
Represents
the vaccine
administered to
the Client within
and beyond the
PHC setting,
including current
and past
vaccination
history.
N/A
Influenza
VaccineAdmin PHC
virus vaccine isteredNameC Reference
(product)
ode:
Set
•
VaccineAdmin
isteredTradeN
ameCode
•
VaccineHistori
calNameCode
•
PassiveAdmini
steredImmuniz
ingAgentCode
•
PassiveHistori
calImmunizing
AgentCode
O2
Vaccine
Vaccine
Administered Administered
Date
Date
Represents the Date
date the vaccine
was
administered to
the Client.
YYYYMMDD 20100430
N/A
N/A
Permissible
Values
Source ID
Example of Primary Care
Use
SNOMED •
CT®
2.16.840.1.113
883.2.20.3.281
•
2.16.840.1.113
883.2.20.3.282
•
2.16.840.1.113
883.2.20.3.279
•
2.16.840.1.113
883.2.20.3.262
Can be used to create
reminders about vaccines to
be administered and track
past history of vaccinations.
N/A
Can be used to support
vaccine reminders to relevant
Clients or to flag that a
vaccine has already been
given and is not required until
a future date.
N/A
27
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O1
Type of
Permissible Source for
Values
Permissible Code
Source Name Values
System
This information comes from the Pan-Canadian Primary Health Care Indicator Update Report, which is available from
www.cihi.ca/phc. The following is a subset of EMR-related indicators.
Indicator Name
Indicator Definition
Numerator
Denominator
Child Immunization
Percentage of patient population,
currently age 7, who have received
recommended childhood
immunizations.
Number of individuals in the denominator who
have received childhood immunizations in
accordance with the recommended schedule.
Number of primary health care (PHC)
clients/patients currently age 7.
Inclusions
• Individual is in the denominator
• Individual has received all immunizations listed
in the National Advisory Committee on
Immunizations (NACI) recommended schedule,
or had a contraindication for immunizations that
were not received
Inclusions
• PHC client/patient
• Age of individual is 7 years
Exclusions
None
Exclusions
None
Colon Cancer Screening
Percentage of patient population,
age 50 to 74, who had a screening
test ordered for colon cancer.
Number of individuals in the denominator who
had a screening test for colon cancer ordered
within an appropriate time frame.
Inclusions
• Individual is in the denominator
• Individual who had at least one of the following
screening tests ordered:
− Fecal occult blood test (FOBT) within the past
24 months
− Sigmoidoscopy within the past 5 years
− Colonoscopy within the past 10 years
Number of primary health care (PHC)
clients/patients, age 50 to 74.
Inclusions
• PHC client/patient
• Age of individual is between 50 and
74 years
Exclusions
None
Exclusions
None
(cont’d on next page)
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Appendix C: CIHI’s Pan-Canadian PHC EMR–Related
Indicators—Definitions
Indicator Name
Indicator Definition
Numerator
Denominator
Breast Cancer Screening
Percentage of female population,
age 50 to 74, who reported having
had a mammogram.
Number of individuals in the denominator who
had a mammogram ordered within the past
36 months.
Number of female primary health care
(PHC) clients/patients age 50 to 74.
Inclusions
• Individual is in the denominator
• Individual had a mammogram ordered within
the past 36 months
Cervical Cancer Screening
Smoking Cessation Advice
in PHC
Percentage of female patient
Number of individuals in the denominator
population, age 18 to 69, who had a who had a Papanicolaou test within the past
Papanicolaou test.
36 months.
Exclusions
• Individual has had a bilateral
mastectomy
Number of female primary health care
(PHC) clients/patients, age 18 to 69.
Inclusions
• Individual is in the denominator
• Individual had a Papanicolaou test within the
past 36 months
Inclusions
• PHC client/patient
• Sex of individual is female
• Age of individual is between 18 and
69 years
Exclusions
None
Exclusions
• Individual had a hysterectomy
Percentage of patient population
Number of individuals in the denominator who
who are smokers, age 12 and older, were offered specific help or information to quit
who were offered specific help or
smoking within the past 15 months.
information to quit smoking.
Inclusions
• Individual is in the denominator
• Individual was offered smoking cessation
education within the past 15 months
Exclusions
None
Number of primary health care (PHC)
clients/patients, age 12 and older, who
are smokers.
Inclusions
• PHC client/patient
• Age of individual is at least 12 years
• Individual is a smoker
• Individual visited his or her PHC
provider within the past 15 months
Exclusions
• Individual uses tobacco only for a
purpose other than smoking
(cont’d on next page)
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Exclusions
None
Inclusions
• PHC client/patient
• Sex of individual is female
• Age of individual is between 50 and
74 years
Indicator Definition
Numerator
Denominator
Influenza Immunization, 65+
Percentage of patient population,
age 65 and older, who received an
influenza immunization.
Number of individuals in the denominator who
received an influenza immunization within the
past 12 months.
Number of primary health care (PHC)
clients/patients, age 65 and older.
Inclusions
• Individual is in the denominator
• Individual received an influenza immunization
within the past 12 months
Inclusions
• PHC client/patient
• Age of individual is at least 65 years
Exclusions
None
Exclusions
None
Well Baby Screening
Percentage of patient population,
currently age 3, who received
screenings for congenital hip
displacement, eye and hearing
problems.
Number of individuals in the denominator who
received screening for congenital hip
displacement, eye and hearing problems.
Inclusions
• Individual is in the denominator
• Individual received screening for congenital
hip displacement
• Individual received screening for eye problems
• Individual received screening for
hearing problems
Number of primary health care (PHC)
clients/patients, currently age 3.
Inclusions
• PHC client/patient
• Age of individual is 3 years
Exclusions
None
Exclusions
None
Blood Pressure Testing
Percentage of patient population,
age 18 and older, who have had
their blood pressure measured
by their primary health care
(PHC) provider.
Number of individuals in the denominator who
Number of PHC clients/patients, age
had their blood pressure measured by their PHC 18 and older.
provider in the past 15 months.
Inclusions
Inclusions
• PHC client/patient
• Individual is in the denominator
• Age of individual is at least 18 years
• Individual had a blood pressure measurement
Exclusions
taken by his or her PHC provider within the
None
past 15 months
Exclusions
None
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Indicator Name
Indicator Name
Indicator Definition
Numerator
Denominator
Screening for Modifiable Risk
Factors in Adults With
Coronary Artery Disease
Percentage of patient population,
age 18 and older, with coronary
artery disease (CAD) who received
testing for all of the following:
• Full fasting lipid profile screening;
• Blood pressure measurement; and
• Obesity/overweight screening.
Number of primary health care (PHC)
clients/patients who received testing within the
past 12 months for all of the following:
• Full fasting lipid profile screening;
• Blood pressure measurement; and
• Obesity/overweight screening.
Number of PHC clients/patients, age
18 and older, with CAD.
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has a diagnosis of CAD
Exclusions
None
(cont’d on next page)
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Inclusions
Exclusions
• Individual is in the denominator
None
• Individual had a lipid profile screening
performed within the past 12 months
• Individual had a blood pressure measurement
taken by his or her PHC provider within the
past 12 months
• Individual had at least one of the following:
− Weight measured by his or her PHC provider
within the past 12 months
− Waist circumference measured by his or her
PHC provider within the past 12 months
Indicator Definition
Numerator
Denominator
Screening in Adults With
Diabetes
Percentage of patient population,
age 18 and older, with diabetes
mellitus who received testing for all
of the following:
• Hemoglobin A1c (HbA1c);
• Full fasting lipid profile screening;
• Nephropathy screening
(e.g., albumin/creatinine ratio,
microalbuminuria);
• Foot examination;
• Blood pressure measurement; and
• Obesity/overweight screening.
Number of individuals in the denominator who
received testing for all of the following:
• At least two HbA1c tests within the past
12 months;
• Full fasting lipid profile screening within the
past 36 months;
• Nephropathy screening (e.g., albumin/
creatinine ratio, microalbuminuria) within the
past 12 months;
• Foot examination within the past 12 months;
• Blood pressure measurement within the past
12 months; and
• Obesity/overweight screening within the past
12 months.
Number of PHC clients/patients, age
18 and older, with diabetes mellitus
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has a diagnosis of
diabetes mellitus
Exclusions
None
Inclusions
• Individual is in the denominator
• Individual had at least two HbA1c tests within
the past 12 months
• Individual had a lipid profile screening within
the past 36 months
• Individual had a nephropathy screening test
within the past 12 months
• Individual had a foot examination from his or
her primary health care (PHC) provider within
the past 12 months
• Individual had a blood pressure measurement
taken by his or her PHC provider within the
past 12 months
• Individual had at least one of the following:
− Weight measured by his or her PHC provider
within the past 12 months
− Waist circumference measured by his or her
PHC provider within the past 12 months
Exclusions
None
(cont’d on next page)
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Indicator Name
Indicator Name
Indicator Definition
Numerator
Denominator
Screening for Modifiable Risk
Factors in Adults With
Hypertension
Percentage of patient population,
age 18 and older, with hypertension
who received testing for all of the
following:
• Fasting blood sugar;
• Blood pressure measurement; and
• Obesity/overweight screening.
Number of individuals in the denominator who
received testing, within the past 12 months, for
all of the following:
• Fasting blood sugar;
• Blood pressure measurement; and
• Obesity/overweight screening.
Number of PHC clients/patients, age
18 and older with hypertension
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has a diagnosis of
hypertension
Exclusions
None
Treatment of Dyslipidemia
Percentage of patient population,
age 18 and older, with established
coronary artery disease (CAD) and
elevated low-density lipoprotein
cholesterol (LDL-C) who were
offered lifestyle advice and lipidlowering medication.
Number of individuals in the denominator who
were offered lifestyle advice and lipid-lowering
medication within the past 12 months.
Inclusions
• Individual is in the denominator
• Individual was offered lifestyle advice within the
past 12 months
• Individuals who have one or both of
the following:
− Individual was prescribed lipid-lowering
medication within the past 12 months
− Individual has a documented contraindication
to lipid-lowering medication
Number of primary health care (PHC)
clients/patients, age 18 and older, with
established CAD and elevated LDL-C
(i.e., greater than 2.0 mmol/L).
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has a diagnosis of
coronary artery disease
• Individual has an LDL-C value
greater than 2.0 mmol/L
Exclusions
None
Exclusions
None
(cont’d on next page)
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Inclusions
• Individual is in the denominator
Exclusions
• Individual had a blood pressure measurement • Individual is pregnant
taken by his or her primary health care (PHC)
provider within the past 12 months
• Individual had at least one of the following:
− Weight measured by his or her PHC provider
within the past 12 months
− Waist circumference measured by his or her
PHC provider within the past 12 months
• Individual had at least one of the following:
− A blood sugar test within the past 12 months
− A diagnosis of diabetes mellitus
Indicator Definition
Treatment of Acute Myocardial Percentage of patient population
Infarction
who have had an acute myocardial
infarction (AMI) and are currently
prescribed a beta-blocking drug.
Numerator
Denominator
Number of individuals in the denominator who
are currently prescribed a beta-blocking drug.
Number of primary health care (PHC)
clients/patients who had an AMI
between 12 and 24 months ago.
Inclusions
• Individual is in the denominator
• Individuals who had one or both of
the following:
− Individual was prescribed a beta-blocking
drug within the past 12 months
− Individual has a contraindication to betablocking drugs
Inclusions
• PHC client/patient
• Individual had an AMI between 12
and 24 months ago
Exclusions
None
Exclusions
None
Treatment of Anxiety
Percentage of patient population,
age 18 and older, with a diagnosis
of panic disorder or generalized
anxiety disorder who were offered
treatment or referral to a mental
health provider.
Number of individuals in the denominator who
were offered treatment or referral to a mental
health provider within the past 12 months.
Inclusions
• Individual is in the denominator
• Individual received at least one of the following
from his or her primary health care (PHC)
provider within the past 12 months:
− A prescription for anti-anxiety medication
− A referral to a mental health provider
− An offer for non-pharmacological treatment
(psychological interventions: individual nonfacilitated self-help, individual guided selfhelp and psychoeducational groups)
Number of PHC clients/patients,
age 18 and older, with a diagnosis
of panic disorder or generalized
anxiety disorder.
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has a diagnosis of at least
one of the following conditions:
− Panic disorder
− Generalized anxiety disorder
Exclusions
None
Exclusions
None
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Indicator Name
Indicator Definition
Numerator
Denominator
Blood Pressure Control for
Hypertension
Percentage of patient population,
age 18 and older, with hypertension
for a duration of at least 12 months,
who have blood pressure
measurement control.
Number of individuals in the denominator who
have had blood pressure measurement control
within the past 12 months.
Number of PHC clients/patients, age
18 and older, with hypertension for
duration of at least 12 months.
Inclusions
• Individual is in the denominator
• Individual had a blood pressure measurement
taken by his or her primary health care (PHC)
provider within the past 12 months
• If patient does not have a diagnosis of
diabetes mellitus:
− The latest blood pressure reading is less
than 140/90
• If patient does have a diagnosis of
diabetes mellitus:
− The latest blood pressure reading is less
than 130/80
Inclusions
• PHC client/patient
• Age of individual is at least 18 years
• Individual has had a diagnosis of
hypertension for at least 12 months
Exclusions
• Individual is currently pregnant
Exclusions
None
Overweight and Obesity Rate
Percentage of patient population,
age 2 and older, who are currently
overweight or obese.
Number of individuals in the denominator who
have a height and weight corresponding to a
body mass index (BMI) in the overweight or
obese range.
Inclusions
• Individual is in the denominator
• Individual has a height and weight
corresponding to a BMI in the overweight or
obese range
Exclusions
None
Number of primary health care (PHC)
clients/patients age 2 and older.
Inclusions
• PHC client/patient
• Age of individual is at least 2 years
Exclusions
• Individual is currently pregnant
• Individuals who are
− Age 18 and older; and
− Shorter than 0.914 metres
• Individuals who are
− Age 18 and older; and
− Taller than 2.108 metres
(cont’d on next page)
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Indicator Name
Indicator Definition
Numerator
Denominator
Complications of Diabetes
Percentage of population, age
50 to 74, with established diabetes
mellitus who had an acute
myocardial infarction, had an aboveor below-knee amputation or began
chronic dialysis.
Number of individuals, age 50 to 74, with
diabetes mellitus who had an acute myocardial
infarction, had an above- or below-knee
amputation or began chronic dialysis within the
past 12 months.
Number of individuals, age 50 to 74,
with diabetes mellitus who had an
acute myocardial infarction, had an
above- or below-knee amputation or
began chronic dialysis within the past
12 months.
Inclusions
• Age of individual is between 50 and 74 years
• Individual has a diagnosis of diabetes mellitus
• Individual had one or more of the following
within the past 12 months:
− Acute myocardial infarction
− Amputation above or below the knee
− Initiation of chronic dialysis
Exclusions
None
Inclusions
• Age of individual is between 50 and
74 years
• Individual has a diagnosis of
diabetes mellitus
• Individual had one or more of the
following within the past 12 months:
− Acute myocardial infarction
− Amputation above or below
the knee
− Initiation of chronic dialysis
Exclusions
None
Health Risk Screening in PHC
Percentage of PHC clients/patients, Number of PHC clients/patients who report being Total number of PHC clients/patients,
age 12 and older, who were
screened by their PHC provider for common
12 years and over
screened by their PHC provider for health risks over the past 12 months
the following common health risks
over the past 12 months:
• Tobacco use;
• Unhealthy eating habits;
• Problem drug use;
• Physical inactivity;
• Overweight status;
• Problem alcohol drinking;
• Unintentional injuries (home
risk factors);
• Unsafe sexual practices; and
• Unmanaged psychosocial stress
and/or depression.
(cont’d on next page)
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Indicator Name
Indicator Name
Indicator Definition
Glycemic Control for Diabetes Percentage of PHC clients/patients,
age 18 and older, with diabetes
mellitus in whom the last HbA1c
was 7.0% or less (or equivalent
test/reference range depending
on local laboratory) in the last
15 months.
Numerator
Denominator
Number of PHC clients/patients with diabetes
mellitus in whom the last HbA1c was 7.0% or
less (or equivalent test/reference range
depending on local laboratory) in the past
15 months
Total number of PHC clients/patients,
18 years and over with diabetes
mellitus within the past 15 months
Percentage of PHC women
clients/patients, age 55 and
older, who had a full fasting lipid
profile measured within the past
24 months.
Number of PHC women clients/patients who had Total number of PHC women
a full fasting lipid profile measured within the past clients/patients, age 55 years and
24 months
older, within the past 24 months
Dyslipidemia Screening
for Men
Percentage of PHC men clients/
Number of PHC men clients/patients who had
patients, age 40 and older, who had a fasting lipid profile measured within the past
a full fasting lipid profile measured
24 months
within the past 24 months.
Total number of PHC men clients/
patients age 40 years and older
Screening for Visual
Impairment in Adults With
Diabetes
Percentage of PHC clients/patients, Number of PHC clients/patients with diabetes
age 18 to 75, with diabetes
mellitus who saw an optometrist or
mellitus who saw an optometrist
ophthalmologist within the past 24 months
or ophthalmologist within the past
24 months.
Total number of PHC clients/patients,
age 18 to 75 years, with diabetes
mellitus within the past 24 months
Bone Density Screening
Percentage of women PHC
clients/patients, age 65 and older,
who received screening for low
bone mineral density at least once.
Number of women PHC clients/patients who
received screening for low bone mineral density
at least once
Total number of women PHC clients/
patients age 65 years and older
Pneumococcal Immunization,
65+
Percentage of PHC clients/patients, Number of PHC clients/patients who received a
age 65 and older, who have
pneumococcal immunization
received a pneumococcal
immunization.
Total number of PHC clients/patients
age 65 years and older
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Dyslipidemia Screening
for Women
Child Immunization
Pneumococcal Immunization, 65+
Health Risk Screening in PHC
Well Baby Screening
Blood Pressure Testing
Colon Cancer Screening
Cervical Cancer Screening
Breast Cancer Screening
Dyslipidemia Screening (Men and Women)
Screening in Adults With Diabetes
Screening for Visual Impairment in Adults With Diabetes
Bone Density Screening
Treatment of Dyslipidemia
Treatment of Anxiety
Treatment of Acute Myocardial Infarction
Smoking Cessation Advice in PHC
Blood Pressure Control for Hypertension
Complications of Diabetes
A1
Patient Identifier
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
A4
Patient Date of
Birth
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
A5
Patient Gender
X
X
X
A9
Patient Status
X
X
X
X
X
X
X
X
X
X
D1
Appointment
Creation Date
D3
Visit Date
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Referrals for Patients With Chronic Conditions
Treatment and
Education
Wait Times for Specialist Referral
Screening
Wait Times for PHC Provider
Immunization
Glycemic Control for Diabetes
Health
Status
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Influenza Immunization, 65+
Data
Element
DE # Name
Overweight and Obesity Rate
PHC
Indicator
Appropriateness
Other Quality
Measures
Effectiveness
X
Wait
Times
X
Referral
X
X
X
X
X
X
X
X
X
(cont’d on next page)
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Appendix D: CIHI’s Pan-Canadian PHC EMR–Related
Indicators—Relation to the Priority Subset of Data Elements
Data
Element
DE # Name
E11
Health Concern
E12
Health Concern
Date of Onset
E14
Social
Behaviour
E23
Systolic Blood
Pressure
X
X
X
X
X
E24
Diastolic Blood
Pressure
X
X
X
X
X
E28
Height
X
X
E29
Height Unit of
Measure
X
X
E30
Weight
X
X
X
X
X
X
X
X
X
X
X
Treatment of Acute Myocardial Infarction
X
X
X
X
X
X
X
X
X
Effectiveness
Wait
Times
X
X
(cont’d on next page)
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Referrals for Patients With Chronic Conditions
Treatment and
Education
Wait Times for Specialist Referral
Appropriateness
Wait Times for PHC Provider
Smoking Cessation Advice in PHC
Glycemic Control for Diabetes
Treatment of Anxiety
X
Complications of Diabetes
Treatment of Dyslipidemia
Screening
Blood Pressure Control for Hypertension
X
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
X
Screening in Adults With Diabetes
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Immunization
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Health
Status
Influenza Immunization, 65+
Overweight and Obesity Rate
PHC
Indicator
Other Quality
Measures
Referral
X
X
X
X
X
E34
Clinician
Assessment
X
X
X
X
X
F1
Intervention
X
X
X
X
F2
Intervention
(Treatment)
Date
X
X
X
X
G1
Lab Test
Ordered
X
G2
Lab Test
Ordered Date
X
H1
Lab Test
Performed Date
X
X
H2
Lab Test Name
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Wait
Times
Referrals for Patients With Chronic Conditions
Wait Times for Specialist Referral
Effectiveness
Wait Times for PHC Provider
Glycemic Control for Diabetes
Treatment and
Education
Complications of Diabetes
Smoking Cessation Advice in PHC
Screening
Blood Pressure Control for Hypertension
X
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
Screening in Adults With Diabetes
Treatment of Acute Myocardial Infarction
Weight Unit of
Measure
Treatment of Anxiety
E31
Treatment of Dyslipidemia
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Immunization
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Health
Status
Influenza Immunization, 65+
Overweight and Obesity Rate
Data
Element
DE # Name
Appropriateness
Other Quality
Measures
Referral
X
(cont’d on next page)
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PHC
Indicator
Data
Element
DE # Name
H3
Lab Test Result
Value
X
X
H4
Lab Test Result
Unit of Measure
X
X
I1
Diagnostic
Imaging Test
Ordered
X
I2
Diagnostic
Imaging Test
Ordered Date
X
K1
Referral
K2
Referral
Requested Date
L1
Referral
Occurred Date
X
X
X
Wait
Times
X
X
X
X
X
X
(cont’d on next page)
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Referrals for Patients With Chronic Conditions
Effectiveness
Wait Times for Specialist Referral
Appropriateness
Wait Times for PHC Provider
Glycemic Control for Diabetes
Complications of Diabetes
Treatment and
Education
Blood Pressure Control for Hypertension
Smoking Cessation Advice in PHC
Treatment of Acute Myocardial Infarction
Treatment of Anxiety
Screening
Treatment of Dyslipidemia
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
Screening in Adults With Diabetes
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Immunization
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Health
Status
Influenza Immunization, 65+
Overweight and Obesity Rate
PHC
Indicator
Other Quality
Measures
Referral
Treatment of Anxiety
Treatment of Acute Myocardial Infarction
M1
Prescribed
Medication
X
X
X
M2
Prescription
Date
X
X
X
O1
Vaccine
Administered
X
X
X
O2
Vaccine
Administered
Date
X
X
X
A2
Patient Identifier Used for administrative purposes
Type
A3
Patient Identifier Used for administrative purposes
Assigning
Authority
A14
Patient Postal/
Zip Code
Wait
Times
Referrals for Patients With Chronic Conditions
Wait Times for Specialist Referral
Effectiveness
Wait Times for PHC Provider
Glycemic Control for Diabetes
Complications of Diabetes
Treatment and
Education
Blood Pressure Control for Hypertension
Screening
Smoking Cessation Advice in PHC
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
Screening in Adults With Diabetes
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Immunization
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Health
Status
Influenza Immunization, 65+
Overweight and Obesity Rate
Treatment of Dyslipidemia
Data
Element
DE # Name
Appropriateness
Other Quality
Measures
Referral
Used to distinguish urban and rural patient populations or to stratify quality indicators by geographic region; can also be used to calculate travel distance to
PHC clinic to inform equity of care
(cont’d on next page)
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PHC
Indicator
Referral
Referrals for Patients With Chronic Conditions
Wait
Times
Wait Times for Specialist Referral
Glycemic Control for Diabetes
Complications of Diabetes
Effectiveness
Blood Pressure Control for Hypertension
Smoking Cessation Advice in PHC
Treatment of Acute Myocardial Infarction
Treatment of Anxiety
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
Screening in Adults With Diabetes
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Treatment of Dyslipidemia
Treatment and
Education
Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Influenza Immunization, 65+
Immunization
B4
Clinician
Identifier
For Provider-level analysis and reporting; required to calculate which patients will be aggregated into which provider’s report
B5
Clinician
Identifier Type
Used for administrative purposes
B6
Clinician
Identifier
Assigning
Authority
Used for administrative purposes
B7
Clinician Role
Used to restrict indicator calculations to appropriate provider types (e.g., access information on a specific type of PHC provider); can also inform
coordination of care within a PHC setting
C1
Service Delivery For practice-level analysis and reporting; required to identify the PHC practice where the patient received care in order to generate practice-level statistics
Identifier
C4
Service Delivery Used to distinguish urban and rural clinics; paired with A14 to calculate travel distance to clinic to inform equity of care
Postal Code
D2
Reason for Visit Used to inform how often patients come to PHC clinic for a specific chronic health condition
(cont’d on next page)
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Overweight and Obesity Rate
Health
Status
Data
Element
DE # Name
Other Quality
Measures
Appropriateness
Wait Times for PHC Provider
PHC
Indicator
D4
Visit Type
J1
DI Test
Used to calculate diagnostic imaging wait times
Performed Date
Used for administrative purposes
Wait
Times
Referrals for Patients With Chronic Conditions
Wait Times for Specialist Referral
Effectiveness
Wait Times for PHC Provider
Glycemic Control for Diabetes
Complications of Diabetes
Treatment and
Education
Blood Pressure Control for Hypertension
Smoking Cessation Advice in PHC
Treatment of Acute Myocardial Infarction
Treatment of Anxiety
Screening
Treatment of Dyslipidemia
Bone Density Screening
Screening for Visual Impairment in Adults With Diabetes
Screening in Adults With Diabetes
Screening for Modifiable Risk Factors in Adults With
Coronary Artery Disease
Screening for Modifiable Risk Factors in Adults With
Hypertension
Dyslipidemia Screening (Men and Women)
Immunization
Breast Cancer Screening
Cervical Cancer Screening
Colon Cancer Screening
Blood Pressure Testing
Well Baby Screening
Health Risk Screening in PHC
Pneumococcal Immunization, 65+
Child Immunization
Health
Status
Influenza Immunization, 65+
Overweight and Obesity Rate
Data
Element
DE # Name
Appropriateness
Other Quality
Measures
Referral
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PHC
Indicator
Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Appendix E: Glossary of Terms
Term
Canadian
Classification of
Health
Interventions
Acronym
(if Applicable)
CCI
Canadian Institute CIHI
for Health
Information
Description
The Canadian Classification of Health Interventions (CCI) is the new
Canadian national standard for classifying health care procedures. CCI is
the companion classification system to ICD-10-CA. CCI replaces the
Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures
(CCP) and the intervention portion of ICD-9-CM in Canada. It is designed to
be provider and location neutral so that it may be used across the
continuum of health care settings in Canada.
CIHI is an independent, not-for-profit organization that provides essential
data and analysis on Canada’s health system and the health of Canadians.
Clinician-Friendly
Pick-Lists
CFPLs
The CFPLs are constrained lists of clinician-friendly terms mapped to 1
appropriate code system, aimed at supporting adoption of the PHC EMR CS
Priority Subset. The scope of the CFPLs is focused on supporting PHC
indicators for clinicians and jurisdictions.
Content Standard
Working Group
CSWG
The CSWG provides input and expert advice on the adoption,
implementation and maintenance of the PHC EMR CS to ensure that it
remains clinically and technically relevant and aligned with existing
standards, where applicable. The group includes jurisdictional standards
experts, PHC providers, researchers and Canada Health Infoway.
Electronic Medical EMR
Record
An EMR is a computer-based patient medical record used by physicians,
nurses and administrative staff. EMRs contain patient information that
authorized health professionals can access electronically rather than
through a traditional paper chart.
Health System Use HSU
HSU of information refers to the use of health information to monitor,
manage and improve the health of Canadians and the health care system.
International
Statistical
Classification of
Diseases and
Related Health
Problems, Ninth
Revision
ICD-9
ICD-9 is a publication from the World Health Organization comprising a set
of codes that are used worldwide to classify diseases and injuries. The
ICD-9 is split into several sections that correspond to a type of disease or
injury. Each section is assigned to a range of numbers, each of which
denotes a medical condition.
International
Statistical
Classification of
Diseases and
Related Health
Problems, Tenth
Revision, Canada
ICD-10-CA
ICD-10-CA is an enhanced version of ICD-10 developed by CIHI for
morbidity classification in Canada. ICD-10-CA represents the broadest
scope of any previous ICD revision to date. Unlike ICD-9, ICD-10-CA
applies beyond acute hospital care. ICD-10-CA also includes conditions and
situations that are not diseases but represent risk factors to health, such as
occupational and environmental factors, lifestyle and psycho-social
circumstances.
Jurisdictional
Advisory Group
JAG
The JAG is a pan-Canadian working group that supports adoption and
implementation of the PHC EMR CS by providing approval, advice and
strategic guidance on adoption, implementation, stakeholder engagement
and ongoing governance. The group consists of senior-level representatives
from jurisdictions across Canada.
Primary Health
Care
PHC
PHC refers to first-contact care that deals with the majority of health
problems. It is the foundation of any health care system, and countries with
strong primary care seem to have better health than those without.
(cont’d on next page)
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Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Term
Acronym
(if Applicable)
Description
Primary Health
Care Electronic
Medical Record
Content Standard
PHC EMR CS
The PHC EMR CS is composed of priority data elements that are commonly
captured in EMRs in a PHC setting and that support both primary and health
system use of EMR data.
Primary Health
Care Reference
Sets
PHC Ref Sets
PHC ref sets are effectively constrained lists of allowable values from the
source code system(s) that are applicable to the delivery and administration
of PHC. They support the implementation of the PHC EMR CS by facilitating
standardization of PHC data for primary and health system use.
Primary Health
Care Voluntary
Reporting System
PHC VRS
The PHC VRS is a pan-Canadian PHC data source to support PHC
performance measurement and health system improvement. It collects a
minimum data set of patient data extracted from the PHC EMR systems of
PHC VRS participants.
Systematized
SNOMED CT
Nomenclature of
Medicine—Clinical
Terms
SNOMED CT is a comprehensive clinical terminology that contains more
than 300,000 active concepts with unique meanings, ranging from
diagnoses and therapies, to medications, results and orders.
For more information on SNOMED CT, please visit Canada Health
Infoway’s website: https://infocentral.infoway-inforoute.ca/2_Standards.
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Pan-Canadian Primary Health Care Electronic Medical Record Content Standard, Version 3.0—
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Bibliography
American College of Cardiology Foundation, American Heart Association. ACC/AHA 2002
Guideline Update for the Management of Patients With Chronic Stable Angina. Bethesda,
US: ACC/AHA; 2002. http://www.cardiosource.org/~/media/Images/ACC/Science%20and
%20Quality/Practice%20Guidelines/s/stable_clean.ashx. Accessed September 10, 2014.
Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer
Statistics 2013. Toronto, ON: CCS; 2013.
Canadian Institute for Health Information. The Burden of Neurological Diseases, Disorders and
Injuries in Canada. Ottawa, ON: CIHI; 2007.
Canadian Institute for Health Information. Insights and Lessons Learned From the PHC VRS
Prototype. Ottawa, ON: CIHI; 2013. http://www.cihi.ca/cihi-ext-portal/pdf/internet/
lessons_phc_vrs_proto_en. Accessed September 10, 2014.
Canadian Institute for Health Information. Pan-Canadian Primary Health Care Indicator
Update Report. Ottawa, ON: CIHI; 2012. https://secure.cihi.ca/estore/productFamily.htm?
locale=en&pf=PFC2000&lang=en. Accessed September 10, 2014.
Canadian Institute for Health Information, Canadian Emergency Department Information Systems
(CEDIS). The Canadian Emergency Department Diagnoses Shortlist (CED-DxS), version 3.0.
Ottawa, ON: CIHI; 2012. https://secure.cihi.ca/estore/productSeries.htm?pc=PCC515.
Accessed September 10, 2014.
INSightful Information TEchnologies for Family Medicine. Electronic Nomenclature and
Classification of Disorders and Encounters for Family Medicine, Version 5.0. Ottawa, ON:
INSITE-Family Medicine Inc.; 2009. http://www.insite-fm.com/Products/ENCODE-FMver5.0.pdf.
Accessed September 10, 2014.
Public Health Agency of Canada. Chronic diseases. http://www.phac-aspc.gc.ca/cd-mc/
index-eng.php. Accessed September 10, 2014.
Public Health Agency of Canada. Diseases under national surveillance (as of January 2009).
http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/duns-eng.php. Accessed September 10, 2014.
Public Health Agency of Canada. Publicly funded immunization programs in Canada—routine
schedule for infants and children including special programs and catch-up programs
(as of June 2014). http://www.phac-aspc.gc.ca/im/ptimprog-progimpt/table-1-eng.php.
Accessed September 10, 2014.
Wait Time Alliance. Wait time benchmarks for sight restoration. http://www.waittimealliance.ca/
waittimes/sight_restoration.htm. Accessed September 10, 2014.
47
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For permission or information, please contact CIHI:
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495 Richmond Road, Suite 600
Ottawa, Ontario K2A 4H6
Phone: 613-241-7860
Fax: 613-241-8120
www.cihi.ca
[email protected]
© 2014 Canadian Institute for Health Information
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