Concurrent Sessions

A6 Data to Deployment: Closing the Loop on Preventive Care

Theme 6. Using data to demonstrate value and improve quality of care

Presentation Details

  • Date: Wednesday, October 25, 2017
  • Concurrent Session A
  • Time: 2:30pm-3:15pm
  • Room:
  • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff,

Learning Objectives

It’s time to go beyond collecting and reporting data for measurement sake. This has value, but the ultimate goal is to have a direct impact on population health. We’ve all been making progress on issues like data quality, searches, and reporting. Data itself, however, does not necessarily affect outcomes, as evidenced by the lack of membership-wide improvement to date on D2D indicators. It’s time to close the loop! We need to use our resources to develop systems and workflows that directly improve clinical outcomes. We’re going to go through a practical, real life example to show how this can be done.


At EWFHT, we’ve developed tools to improve cancer screening rates by optimizing data quality, encouraging opportunistic screening, and connecting with patients on a population level.     To improve data quality, we developed a tool to synchronize the monthly CCO Screening Activity Reports with the EMR. We’ve also developed a Preventive Care Toolbar which displays a ‘Prev Care’ button in the middle of the patient’s chart. The button is green if all tests are up to date, yellow if there is a test due within 6 months, and red if a test is overdue.    Clicking the button opens a Preventive Care Summary form which shows the status of each screening test at a glance. It is also colour coded, it allows for individualized screening criteria for each patient, and it provides shortcuts to corresponding forms and requisitions.    The data from the Preventive Care forms is then used by EMR searches to generate lists of patients who are due for screening tests. These lists are linked to personalized letters which are automatically emailed to the patients. Patients can then email back to arrange for the tests to be done.     Screening rates and response rates are monitored on a regular basis to ensure patients actually get the tests done, closing the loop.    We’ve deployed these tools to other FHT’s and we’re measuring increased cancer screening rates.    With the right tools and workflows, data can be used to actually improve clinical outcomes for cancer prevention and many other aspects of health care.


  • Dr. Kevin Samson, Family Physician and IT Lead, East Wellington Family Health Team
  • Hope Latam, QIDS Specialist, East Wellington Family Health Team
  • Michelle Karker, Executive Director, East Wellington Family Health Team

Authors & Contributors

  • Joel Wilson, IT Data Management, East Wellington Family Health Team
  • Michelle Karker, Executive Director, East Wellington Family Health Team
  • Viviana Keir, Integrated Patient-Centred Quality Coordinator, East Wellington Family Health Team
  • Heidi Evans, Conestoga Co-op Student, East Wellington Family Health Team