Article Figures & Data
Figures
- Figure 1.
Consensus governance structure for the Canadian Primary Care Sentinel Surveillance Network (CPCSSN).
- Figure 2.
Data repository for regional and central sites at the Queen's University High Performance Virtual Computing Laboratory. System 1, 2, etc represents each regional network site. Connection to the site server will be through a virtual private network.
Tables
- Table 1.
Canadian Primary Care Sentinel Surveillance Network Data Quality Issues Identified During Phase 1 and Our Initial Remediation Strategy
Data Quality Issue Description Remediation Strategy “Dirty data” Misspelled words, extra words in field, inconsistent strings (“ex smoker,” “ex-smoker”), multiple diagnoses in a single field Cleaned by data managers using synonym dictionaries and cleaning algorithms Identifiable Data Names, phone numbers, and other identifying information in diagnosis or reason for visit fields Clean using a de-identification engine Missing data Dosages, dates of onset, occupation, ethnicity Ask and train physicians and/or staff to enter appropriate data Inconsistent data Diagnoses stored in several different places—notes, PMH, problem list, Inconsistent Risk Factors coexisting—smoker, ex-smoker Use physician as “gold standard” for confirming diagnoses; use dates to determine latest status of risk factor Lacking Metadata Referral to “Dr. Jones,” but Dr. Jones’ speciality is not listed Work with EMR vendors to include specialty in address database; encourage staff to enter specialty into address databases Inappropriate Metadata Diagnosis not in problem list, medication in encounter notes Ask physicians to enter “gold standard” diagnosis into Problem List for all patients with an index disease Insufficient Meta Data In 2 EMRs, Problem List, Risk Factors and Procedures appear in the same table with no metadata to distinguish the 3 types of data Work with EMR vendors to separate the 3 different types of data Lacking standardization Multiple, changing, inconsistent names or results for lab tests, eg, HbA1C, glycosylated hemoglobin, hemoglobin A1C; 7% vs 0.07 for test results Work with National standards bodies to encourage uptake of standards Lacking data feeds Lab results not coming in electronically Encourage local labs to provide laboratory results electronically PMH, past medical history; EMR, electronic medical record.
- Appendix 1.
Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Disease Definition Table, © CPCSSN 2008
Disease Diabetes Depression Osteoarthritis Hypertension COPD Case Finding 1. Billing: ICD9- 250.x; Service code: in Ontario K030A or Q040A, in other provinces consult physician and document the code. 1. Billing: ICD9 309.0, 309.1 or 309.81 (Physicians should be asked which code they use before doing this search. Potential codes include: 296, 300, 309, 311, 648) 1. Billing: ICD9 –715.x 1. Billing: ICD9 –401–405 1. Billing: ICD9 –490–492, 496 EMR EMR EMR EMR EMR 2. In Problem List 2. In Problem List 2. In Problem List 2. In Problem List 2. In Problem List Diabetes/NIDDM/DM Depression, post-traumatic stress disorder, 311 Osteoarthritis Hypertension, HTN, Bronchitis 3. In the medication list: 3. In Medication list: 3. In Medication List 3. In Medication List Emphysema Insulin SSRI None identified ACEi/ARB COPD/COLD Glyburide (Sulfonylureas) MAOI Diuretics 3. In Medication List Metformin (Biguanides) Tricyclics (>75 mg/day) Beta Blockers Beta agonists 4. In the lab result: Calcium Channel Blockers Alpha blockers Anticholinergics Xanthines HbA1C > 7% Inhalant corticosteroids Fasting BS > 7 4. Risk Factors Smoker Data Type Data to be extracted Billing Data None identified None identified None identified None identified None identified EMR –Problem List All Diagnoses All Diagnoses All Diagnoses All Diagnoses All Diagnoses EMR –Physiological* BP Weight Weight BP Weight Weight, Joint pain PEFR Height foot ulcer, Waist:hip ratio Waist circumference EMR -Adverse Events Allergies to medication Adverse Events Non-efficacious medication EMR –Medications List† All medications All medications All medications All medications All medications EMR –Risks Smoker Smoker Obesity Smoker Smoker Obesity Alcohol Exercise Exercise Alcohol Diet EMR –Labs F-Glucose, None Identified None Identified None Identified None Identified HbA1c, TG LDL, HDL, TC, Alb:Creat in urine EMR –Referral Ophthalmology, nephrology, PsychiatristPsychologist Orthopedic surgeon Physiotherapy CardiologyNephrology RespirologyThoracic surgery neurology, Occupational therapy endocrinology Exercise program Diabetes Education Dietician EMR –Diagnostic Imaging Not being collected Not being collected Not being collected Not being collected Not being collected EMR –Procedures Revascularization procedure ECT Knee-replacement Angioplasty Spirometry Coronary artery disease investigation Hip-Replacement Coronary artery stent EMR –Other N/A ER Crisis visits ADL/IADL Hospitalization Education Hospitalization * BMI would not be collected as that should be calculated.
† We will use look-up tables to allow conversion of names of meds to particular classes of drugs. This will be done at the central repository level.
EMR, electronic medical record; NIDDM, non-insulin dependent diabetes mellitus; DM, diabetes mellitus; HTN, hypertension; SSRI, selective serotonin reuptake inhibitor; ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease; COLD, chronic obstructive lung disease; MAOI, monoamine oxidase inhibitor (MAOI) antidepressants; HbA1c, hemoglobin A1c levels in diabetic patients; BS, blood sugar; BP, blood pressure; PEFR, peak expiratory flow rate; TG, triglycerides; LDL, low density lipoproteins cholesterol; HDL, high density lipoproteins; TC, total blood cholesterol; Alb:Creat, albumin/creatinine ratio (ACR) urine; ECT, electroconvulsive therapy; ER, emergency room; ADL, activities of daily living; IADL, instrumental activities of daily living.
In this issue
Jump to section
- Article
- Abstract
- The Need for Primary Care Data Sources in Public Health Surveillance
- Chronic Disease Surveillance Objectives
- Initial Development
- Business Planning
- Human Resources
- Privacy and Security
- EMRs
- Disease Definitions
- CPCSSN Database Development
- Recruitment and Retention of Practices
- Stakeholder Development
- Challenges for Future Development
- Acknowledgments
- Notes
- References
- Figures & Data
- References
- Info & Metrics
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