Standardizing Nursing Information in Canada for Inclusion in Electronic Health Records: C-HOBIC

J Am Med Inform Assoc. 2009;16:524–530. DOI 10.1197/jamia.M2974. Affiliations of the authors: C-HOBIC, Canadian Nurses Association (KJH), Ottawa, ON, Canada; C-HOBIC, Ontario Ministry of Health and LongTerm Care (PAW), Toronto, ON, Canada; Nagle & Associates, Inc. (LMN), Toronto, ON, Canada; Health Outcomes for Better Information and Care, Ontario Ministry of Health and Long-Term Care (DMP), Toronto, ON, Canada. CNA is a federation of 11 provincial and territorial registered nurses associations representing Canadian registered nurses. Canada Health Infoway is a Canadian federally funded, independent, not-for-profit organization and is the national-level catalyst for collaborative change to accelerate use of electronic health information systems and EHRs across Canada. The authors thank Canada Health Infoway for its investment in C-HOBIC through its Innovation and Adoption Programme. The authors thank Nora Hammell, Director of Nursing Policy at the Canadian Nurses Association for her commitment and support of the work of C-HOBIC. The authors also thank Dr. M.A. Kennedy for his invaluable assistance in the mapping component of the C-HOBIC project. The authors appreciate the vision and leadership of the Ontario Ministry of Health and Long-Term Care for funding the originating work— Health Outcomes for Better Information and Care (HOBIC). The C-HOBIC project would not have been possible without the commitment of Ministries of Health of Ontario, Prince Edward Island and Saskatchewan and the Winnipeg Regional Health Authority in Manitoba. Correspondence: Kathryn J. Hannah, RN, PhD, C-HOBIC, c/o Canadian Nurses Association, 50 Driveway, Ottawa, ON Canada K2P 1E2; e-mail: [email protected] . Received for review: 08/21/08; Accepted for publication: 02/24/09. Introduction Clinicians, researchers, administrative decision-makers and policy makers all face the critical challenge of how best to measure and improve the quality of healthcare delivery. While many kinds of health data are collected in Canada, information available to support decisions about patient outcomes remains scarce. Furthermore, there is a paucity of information in Canada and elsewhere related to nursingsensitive patient outcomes. Better information is needed to evaluate the effectiveness and efficiency of health care processes and improve people’s health. Standardization of outcome data collection methods and the related terminology facilitates inclusion of such data in electronic health records (EHRs). These improvements facilitate comparison of information across practice settings, thereby promoting quality care. There has been significant investment in EHRs in Canada and around the world. Frequently, the focus in Canada has been on the information needs of physicians. As a result, Canadian funding often has been directed to order entry or results reporting systems that focus on pharmaceuticals or diagnostics. While Canadian nurses use these functions to some extent, such functions provide little support for nurses’ clinical judgments and decision making that are within the scope of nursing practice. Consequently, while nurses are the largest group of providers of care in the Canadian healthcare system, the care that they provide that impacts patients’ clinical outcomes is essentially invisible in most EHRs. Furthermore, including in EHRs the information that is of value to nurses in planning for and evaluating patient care would better Journal of the American Medical Informatics Association Volume 16 Number 4 July / August 2009 525 engage nurses in the use of EHRs. The Canadian Health Outcomes for Better Information and Care project (CHOBIC) is a first step in standardizing nursing-sensitive patient outcome information for inclusion in large jurisdictional EHRs. Canadian Health Outcomes For Better Information and Care In the fall of 2006, the Canadian Nurses Association (CNA) partnered with the Ministries of Health in three Canadian provinces to submit a proposal to Canada Health Infoway, Inc (Infoway) to fund support of inclusion of nursing-sensitive patient information in EHRs. In May 2007, Infoway announced investment from its Innovation and Adoption Program for the Canadian Health Outcomes for Better Information and Care (C-HOBIC) project. C-HOBIC is sponsored by the CNA in partnership with the Ministries of Health of Ontario, Prince Edward Island, and Saskatchewan. In May 2008, the province of Manitoba, represented by Winnipeg Regional Health Authority, joined the C-HOBIC initiative. The C-HOBIC Objectives The C-HOBIC project promotes widespread, systematic use in Canada of standardized patient assessments and standardized related documentation. The project thereby enables feedback to nurses about patient outcomes. The latter is achieved by comparing the same sets of patient assessment data at different points of time. Use of the International Classification for Nursing Practice (ICNP®), the standardized clinical reference terminology of nursing developed by the International Council of Nurses (ICN), facilitates extraction of information into relevant secure jurisdictional EHRs, data repositories, or databases. From those repositories, it is made available to nurses for use in patient care across four sectors—acute care, complex continuing care, long-term care and home care. In participating Canadian provinces, the C-HOBIC project encourages nurses to use EHRs by providing content in the EHR that is of use in nursing practice.