Better Primary Healthcare Information for Canada: A Goal within Reach

Primary healthcare (PHC) is recognized as an integral component of healthcare systems and is fundamental to achieving health goals for populations (Government of Canada 2001; WHO 1978). Nations with well-developed primary care systems have been shown to have lower per capita healthcare costs and better health outcomes (Starfield 2004). In spite of the importance of PHC in the healthcare system, current data sources are inadequate to support policy development, system management and planning (Broemeling, Watson et al. 2009).

Fully developed and well-designed PHC information systems are required if Canadians are to benefit from the “value proposition” offered by effective PHC – better outcomes and integrated care for populations in a cost-effective manner. But can Canadian jurisdictions achieve better PHC information than they have today? Yes – by learning from the studies in this special issue and select Canadian models, as well as by collectively improving PHC information system models such as those found in Australia, the Netherlands, the United States and the United Kingdom. To provide maximum benefits, improved PHC information systems should be designed to be accessible and relevant to health professionals, health system decision-makers and policy makers in a privacy-sensitive manner.

This special issue of Healthcare Policy/Politiques de Santé gives readers important new information on what can be done with existing PHC data sources and the requirements for additional data sources and systems to support health system management and policy development. While the title of this special issue, and the papers within it, indicate an emphasis on British Columbia, the majority of the research findings and recommendations are applicable and highly relevant across Canada. With this in mind, individuals and organizations that play a role in PHC delivery, management and policy can learn from and build on the new knowledge put forth by the contributing researchers.

Specifically, this special issue provides a “roadmap” (Watson 2009b) and a results-based logic model (Watson, Broemeling et al. 2009a), both of which can be applied in designing better PHC information systems. These papers are complemented by others focusing on the limited availability of data across Canada for use in PHC performance measurement (Broemeling, Watson et al. 2009) and methods for leveraging existing sources to develop patient (Broemeling, Kerluke et al. 2009) and provider registries (Watson, Peterson et al. 2009). Wong and colleagues (2009) provide an insightful analysis on the supply and distribution of PHC registered nurses in British Columbia. Watson's (2009b) preface gives additional details about each paper and an integrated perspective on developing population-based PHC information systems.

The Canadian Institute for Health Information (CIHI) is currently working on a multi-pronged strategy, in collaboration with a broad range of stakeholders and experts, to develop better PHC data sources. Based on information gathered during stakeholder consultations and PHC projects, the following two high-level PHC information needs have been identified:

• How does PHC performance (e.g., access, quality and outcomes) vary across practice models, regions and jurisdictions, and is it changing over time?

• What are the interrelationships between the various elements of PHC (e.g., access and quality), and how do these relationships influence the desired outcomes (e.g., fewer complications among people with diabetes)?

The PHC data required to address these questions need to be collected from the following four domains: (a) patients/populations, (b) clinical information sources (e.g., electronic medical records, chart abstraction, clinical encounter forms), (c) providers and (d) PHC clinics. A comprehensive PHC information system requires data from all four domains, preferably with some data to produce representative estimates for populations and some that are linkable for use in the interrelationships analyses.

When developing PHC data sources and information requirements, it is important to keep in mind that there are several commonalities that can be leveraged to ensure that data sources are useful for multiple users while also minimizing the data-collection burden.

The first commonality is that data and information needs across jurisdictions are quite similar. For example, CIHI's Pan-Canadian PHC Indicator Development Project, which included input from experts and decision-makers from multiple levels across the country, identified a common set of PHC indicators believed to be applicable and important across all jurisdictions (CIHI 2006). When deconstructed, these indicators reveal a set of common data elements that are required across the country to support the information needs of jurisdictions and others. This finding is supported by Watson's (2009a) recommendation for a pan-Canadian approach to PHC data development.

The second commonality is that a single, well-designed source of data or information can be used by many different stakeholders for a variety of purposes. For example, data on technical quality-of-care measures, such as HbA1c screening rates for people with diabetes, would be useful to PHC providers wishing to maximize these rates for their patient populations, for health region planners of chronic disease management and for ministries of health interested in knowing the impact of recent policy changes intended to increase these rates.

The third commonality is that the burden of PHC data collection must be minimized. Arguably, one of the reasons that PHC data sources have not developed at the same pace as institution-based information sources is the way in which PHC is delivered and the limited PHC resources available for data collection. The limitations of time and resources to support new or additional PHC data collection are unlikely to change; however, technology and better electronic medical record (EMR) design do offer opportunities to minimize the data-collection burden. A well-designed PHC data-collection system could make use of data already captured for clinical and administrative purposes in PHC settings. For example, as PHC EMRs and related systems (e.g., laboratory data systems) evolve to become more interoperable and broadly used, they also have the potential to become a valuable and efficient new source of relevant PHC data – provided the limited data collected conform to data standards and are accessed and used in an agreed-upon and privacy-sensitive manner. Data from the other three domains require the completion of periodic surveys, but this can also be done using an approach that minimizes the data-collection burden on a sample of health professionals and populations/patients.

This special issue of Healthcare Policy/Politiques de Santé contains many relevant research findings that will help inform PHC data development initiatives across Canada. As Canada embraces the transition to an interoperable PHC EMR environment, the goal of more and better PHC information for Canada is definitely within reach. This is an opportunity to be seized, not missed.