CIHI Indicators: Putting Quality Measurement Into Practice

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Dr. Mark Duerksen is a pioneer of the information age in family practice.

As president of the Steinbach Family Medical Center in Manitoba, he’s been using electronic medical records (EMRs) for 11 years. His facility is also among the first in Canada to build quality measurement directly into physicians’ practices with primary health care (PHC) indicators.

Developed by the Canadian Institute for Health Information, PHC indicators  allow care providers to use EMR data to measure many aspects of their practices.

Prior to incorporating the indicators, Duerksen says his group practice had no systemic approach to preventive screening and management of chronic conditions, such as diabetes and hypertension. Now, each doctors’ screening rates are pulled from the EMR every three months.

"We found that data itself is motivating. You start looking at what processes need to be put in place to improve," he says.

To foster more comprehensive and preventive care, Steinbach’s software features reminders alerting physicians to required tests and exams. Even if a patient visits for a sore ankle, a screen will pop up on Duerksen’s monitor, notifying him that she’s due for a cholesterol test and a Pap smear. He can now track how consistently his patients are getting these tests.

The PHC indicators have been essential road signs on Manitoba’s primary health care renewal journey, specifically its Physician Integrated Network (PIN), of which Duerksen’s group has been a part.

"We can’t demonstrate quality unless we have indicators against which we can measure," says Jeanette Edwards, special advisor to the deputy minister on primary care, Manitoba Health. "We adopted those indicators and we’ve learned a lot." She notes the combination of the EMR and indicators has also led many physicians to better understand their patient population.

"Before this, we treated individual patients. Now we have this overall practice profile, which helps in thinking about where we can make improvements," Duerksen says. "And when we make an intervention, it’s nice to have data to know if it’s worked."

PIN results speak for themselves. At one clinic, colorectal cancer screening increased more than 31% over phase one, while at another, diabetes screening is up 44% and hypertension monitoring increased almost 17%.

"The indicators have been fundamental," says Dr. Alan Katz, associate professor of family medicine and community health sciences at the University of Manitoba. "The process of collecting (data for them) has had a huge impact on how physicians use the EMR to the benefit of the patient. There has been a change in understanding as to the responsibility physicians have for care. We have people thinking on a population-at-risk basis."