FAQs & Additional Resources

 

+What is CII/CPAR?

CII/CPAR is the chosen vehicle to integrate community Electronic Medical Records (EMRs) with two-way data flow. It is a joint project between the AMA, Alberta Health and AHS. Community Information Integration (CII) is a system that transfers select patient information between community (EMRs) and Alberta Netcare. For specialists, CII facilitates sharing of consultation reports with the patient’s family physician and other providers. The Central Patient Attachment Registry (CPAR) is a provincial system that captures the confirmed relationship of a primary provider and their paneled patients. Only primary care providers (i.e., family physicians and pediatricians with a panel) can participate in CPAR.

+What are the benefits of CII/CPAR?

The availability of comprehensive patient information helps clinicians make informed treatment decisions about patients and supports coordination and continuity of care. Participating specialists recognize the benefit of sharing a patient’s consult report with others in the circle of care and informing them that the condition is being managed by a specialist. Specialists that work in both community and AHS will be able to easily access their own consult reports while in AHS, through Alberta Netcare. For complex patients, their consult reports are available to emergency departments.

+What are the requirements to participate?

There are three key pre-requisites for participation in CII/CPAR:

1. Clinic EMR PIA must be up to date 
2. Clinic must be live on Alberta Netcare:
• The clinic must be approved for Netcare
• Users at the site must be authorized for that site
3. The following EMRs are conformed for CII/CPAR:
• Microquest Healthquest
• Med Access
• Wolf
• PS
• Accuro

+Do all the providers in my office need to participate in CII?

No, a clinic can be live on CII with just one physician participating. Other providers can be added at any time.

+What are participating specialists saying about CII?

“Participating in CII has been a time saver for both the ER and the PCN and has resulted in improved quality of care, consistency in treatment plan implementation and improved patient outcomes.”

- Bow Valley PCN Chronic Pain Clinic Team

“The ability to upload consults to Netcare has been invaluable, especially the ability for physicians to have access to consults done in private clinics.”

– Alberta DermaSurgery Centre 

“I believe every Specialist clinic should be a part of this initiative as it can help bridge the communication gap between Specialists, Family Physicians and other healthcare providers within the health system.”

– Dr. Anmol Kapoor, Advanced Cardiology

+How do I get started with CII?

Contact specialists contact cii-specialty@albertadoctors.org to get started. For more information please visit the Get Started Today! page on the CII for Specialists site.

+How long will it take to get on board?

This is a difficult question to answer as there are a number of dependencies that will influence the timeline. For a clinic that has an up to date PIA and reacts quickly to the onboarding requirements (forms, etc.) the onboarding process can be as little as a few weeks. In most cases though onboarding is taking between one and three months. For clinics that require a major amendment to their PIA it may be more. The steps involved in the onboarding process are illustrated below:

+Is there a cost to participate?

There is no monetary cost to participate in CII. That said, signing up for CII is a similar process to signing up for Alberta Netcare; it will require some dedicated time from the clinic team. There are forms to fill out and some back and forth with the implementation team at Alberta Health can be expected. In most cases a team member - often the Clinic Manager - is tasked with these duties. The approximate total time commitment for CII onboarding is 1 hour, not including time potentially required to update the clinic PIA.

+Will my clinic EMR Privacy Impact Assessment (PIA) need to change?

No, as long as your EMR PIA is up to date. Alberta Health has prepared a PIA that covers changes made to your clinic EMR system to accommodate disclosure of health information to Alberta Health. A synopsis of the Alberta Health PIA is provided during the sign-up process. Custodians are asked to sign an endorsement letter for the Alberta Health PIA, which explains that the clinic EMR system has been modified to support the data extraction process. The endorsement letter is signed and submitted by custodians to the Office of Information and Privacy Commissioner.

+What if my PIA is not up to date?

The first step after a confirmation of participation form has been received by the eHealth Support services team is a clinic EMR PIA Assessment with an eHealth privacy and security specialist. The privacy specialist will review the results of the PIA Update Self-Assessment and the clinic PIA with a clinic team member. The eHealth privacy specialist will provide some guidance based on this session. If the PIA requires a minor update, the clinic is recommended to proceed with those updates as they proceed with CII. If a major update is required, it is recommended that the clinic make the recommended changes to update their PIA and inform eHealth when done.

+What privacy and security protections are in place for the data being shared?

Data is being transferred from the EMR vendor’s hosting site to the Alberta Health data centre via a dedicated web service that uses strong encryption. The Alberta Health data centre and Alberta Netcare meets high standards of data security with firewalls, intrusion detection, anti-malware systems and redundancy of power supply and hardware to ensure high availability and data integrity.

+I have concerns about sharing encounter data with Alberta Health. Is there governance over the data in the Healthcare Data Repository?

Through the provincial billing system Alberta Health, already has encounter data from providers providing insured services. The Healthcare Data Repository is new in Alberta and it was designed to support health system planning and quality improvement. Importantly, the repository is governed by the Health Information Data Governance Committee with significant representation of providers such as physicians, nurses and pharmacists. More information can be found in these documents: CII/CPAR Data and Governance and HIDGC Overview Fact Sheet.

+What if a patient does not want his/her information shared?

Patients have the right to ask their physician to limit the amount of health information that they disclose. The provider must apply their professional judgment and weigh the patient’s concern with any other important factors, such as patient safety, the potential importance of that information to another health care provider, legal requirements, professional college standards and other factors. The provider can choose whether to submit the consult report to Alberta Netcare or not. Best practice would be to inform the patient about their decision and if the patient has concerns to document the decision in the EMR.

If the provider has opted to also share encounters, encounter data (e.g. visit date and reason) is shared unless the provider chooses to use the confidentiality features of the EMR.

+Do I need to tell my patients?

Providers do not need to have a specific conversation with their patients about information sharing to Netcare. Obviously, it would be prudent to do so with any patients who have specific concerns about confidentiality.

Under the HIA, CII/CPAR is under the ‘Netcare Umbrella’ and providers are obligated to notify patients that they participate in information sharing for the purposes of providing better care. Most are already doing this as a requirement for Alberta Netcare. Many accomplish this by having a “Health Collection Notice Poster” posted in conspicuous areas in their clinics, often exam rooms. Some include it in a package that they give to patients when they first join the clinic. When a clinic joins CII/CPAR the wording of their notice should change slightly. There is a sample “Health Collection Notice Poster” on the ACTT website that contains specific wording about CII/CPAR. It’s in the Privacy Tools and Information section and it’s available in English, Punjabi, Arabic and Spanish.

+Will historical data flow?

No, only data entered into the EMR from go-live date forward will be shared to Alberta Netcare. If the provider has opted to also share encounters, encounter data (e.g. visit date and reason) is shared unless the provider chooses to use the confidentiality features of the EMR.

+Can I choose which consult reports go to Netcare?

Yes, absolutely. Each EMR gives users the option of choosing which consult reports are shared to Alberta Netcare and which are not.

+Will my clinic EMR workflow need to change?

In most EMRs there is no change to workflow, as data is transmitted automatically in the background when you save and close your consult report, or you may have to click ‘send to Netcare’. For specifics, see the EMR Resources for Specialists webpage.

+Will my MOA be able to upload my consult reports?

The answer to this depends on which EMR you use:

• TELUS Wolf: Consult reports must be uploaded by the registered provider who created them.
• TELUS PS Suite: Team members can upload with correct setup.
• TELUS Med-Access: Team members can upload with correct setup.
• MQ Healthquest: Team members can upload, no additional setup required.
  
• QHR Accuro: Team members can upload, no additional setup required.

For further information please contact your EMR provider.

+Can I upload attachment results with my consult?

The answer to this depends on which EMR you use:

• QHR Accuro: you can select attachments to the consult letter as you normally would, and they will be included in the report shared to Alberta Netcare.
• MQ Healthquest: doesn’t have the ability to attach investigations or results from the EMR. The consult letter is fully editable though, meaning that anything that can be cut and pasted can be included. Some clinics run optical character recognition on all files before they’re imported into the EMR so that the text can then be cut and pasted within the EMR.
• TELUS Med-Access: you can select attachments to the consult letter as you normally would, and they will be included in the report shared to Alberta Netcare.
• TELUS Wolf: doesn’t have the ability to attach investigations or results from the EMR. The consult letter is fully editable though, meaning that anything that can be cut and pasted can be included. Some clinics run optical character recognition on all files before they’re imported into the EMR so that the text can then be cut and pasted within the EMR.
• TELUS PS Suite: you can select attachments to the consult letter as you normally would, and they will be included in the report shared to Alberta Netcare.

+Will I be able to proofread my consult report before sending to Alberta Netcare?

Yes, you will be able to proofread your report prior to uploading to Alberta Netcare. The workflows vary slightly by EMR and in each case the provider has a choice of which consult reports to submit. Details are provided in each EMR guide.

+Will I still need to fax my consult report to the referring provider when my consult is in Alberta Netcare?

You will still be required to follow the CPSA standard of practice for referral consultation. The benefit of automatically sharing your consult report to Alberta Netcare is that it is now available to all health care providers, without the need to ‘refax’ or mail additional copies and signals to other providers that you are managing that given condition.

More valuable and informative information can be found on the ACTT CII for Specialists and Alberta Netcare CII pages.

+When will my consult report be available in Netcare?

Eligible consult reports are batched daily and sent to Alberta Netcare overnight. They should be available in Alberta Netcare the next day.

+Do we still have to fax/send the consult back to the referring physician if the consult report is available on Netcare?

Yes, you still need to fax/send the consult report back to the referring physician as it remains Standard with the College of Physicians and Surgeons of Alberta.

+Where can I find information specific to my EMR?

For EMR-specific information, please see the EMR Resources for Specialists webpage.

• Clinic Journey Checklist for Specialists - 3 pages [August 2020]
• CII Glossary and Abbreviations - 5 pages [November 2020]
  
• Considerations When only Some Providers are Live on CII/CPAR - 8 pages [July 2021]
  
• Alberta Netcare Learning Centre's CII Quick Reference Documents & CII FAQs