Standard Operating Procedure: Primary Care Place of Service and Alternate Place of Service – Profile EMR User Help

Site Applicability
Purpose
Scope
Responsibilities
Procedures
A New Client at a Primary Care Clinic
A New Client at a Non-Primary Care Clinic
Change a Client’s PC POS
Change a Client’s Alt POS
Removing a Client’s PC POS
Removing a Client’s Alt POS
Inactivating a Client
Approvals
Revision History
Appendix A –Profile EMR Clinics
Appendix B – Screenshots
Additional Resources
References/Associated Documents

Site Applicability

All sites using Profile EMR. This includes clinics that are part of various programs: Primary Care (PC), Home Health, Mental Health & Substance Use, Public Health, and Prevention. (See Appendix A for a list of clinics).

Purpose

To ensure Profile EMR users enter, change, and remove Primary Care Place of Service (PC POS) or Alternate Place of Service (Alt POS) in the client record in a standardized way. This is required to ensure Profile EMR accurately reflects which sites and providers are currently involved in a client’s care. This will support Primary Care empanelment (see References), and ensure Profile EMR data used for decision making are valid and reliable.

Scope

Staff designated to make changes to PC POS or Alt POS by their clinic leadership.

Responsibilities

Clinic leadership will ensure that all clinic staff are aware of this Standard Operating Procedure.

Clinic leadership will designate which staff roles (1-2 maximum) will make updates to the PC POS or Alt POS for their clinic.

Designated staff will follow this SOP.

Procedures

Definitions:

Primary Care Place of Service (PC POS): the clinic which provides the client’s day-to-day primary health care, acting as the first point of contact for the health care system and coordinating other specialist care that the client may need. In the VCH/PHC context, all PC clinics have a mandate to serve clients with complex clinical and psychosocial needs who are currently not able to access a fee for service provider.

Includes a family physician or nurse practitioner (NP) who is the Most Responsible Provider (MRP) for the client. The MRP is assigned at the client’s first visit and provides the majority of the client’s care. The client’s MRP may change based upon client needs and capacity across MRPs.

Alternate Place of Service (Alt POS): a clinic which provides specialized service for a specific client need, usually for a limited (even if extended) period of time. May or may not include a physician or nurse practitioner who acts as an Alternate Provider. There are limited circumstances where an alternate clinic assigns a MRP. The Residential Care NP and Satellite NP clinics have NPs who act as MRPs. Additionally there are situations where a client has no other primary care provider (MRP) and the non-primary care clinic is the only ongoing care that the client accesses.

A New Client at a Primary Care Clinic

If the client meets the PC mandate, and will be seen for primary care:
- add the clinic to the PC POS field and add the MRP
If the client is only seen for specialty care and not primary care:
- add the clinic to the Alt POS field and add an Alternate Provider

A New Client at a Non-Primary Care Clinic

If the client meets the clinic’s mandate and will be seen on an on-going basis:
- Add the clinic to the Alt POS field and add an Alternate Provider (or MRP in limited circumstances)

Change a Client’s PC POS

PC POS is the clinic that provides the majority of the client’s care in the past 12 months
Changing the PC POS requires changing the MRP
If the client visits more than one clinic, discussion will take place between the client and all MRPs providing care. PC POS will be mutually agreed upon
Both the new and former MRP approve the change (via tasks or other means of communication)
Once approved, the change of POS can be tasked to the designated staff member who performs this responsibility
Clinical Coordinators (CCs) can facilitate the process of changing the PC POS (and MRP)
- MRPs may designate CCs the ability to add clients to their panel in certain circumstances, but remain responsible for the overall approval

Change a Client’s Alt POS

Multiple Alt POSs can be added for a client
Only clinic members can add or remove their clinic from the Alt POS field
It is not possible for a clinic to remove another clinic (other than their own) from the Alt POS field
- If the client no longer intends to visit a clinic in the Alt POS field, contact that clinic to inform them and ask them to remove their clinic from the Alt POS

Removing a Client’s PC POS

Remove a client’s PC POS if any of the following conditions are met:
- The client has not visited the clinic in at least 12 months, clinic process to re-engage the client has been followed, and the client remains lost to contact
- The client is receiving PC at a non-VCH/PHC PC site (i.e., Fee-for-service GP)
- The client has moved out of the service area and does not intend to continue visiting the clinic
- The client no longer meets the PC mandate and has been transitioned to appropriate care in the community (i.e., FFS physician)
Remove the clinic from the PC POS field and remove the MRP from the MRP field
As of November 2023, PC POS and ALT POS and MRP (if one exists) will remain in the yellow bar following client death. As workflows included removal of PC POS and ALT POS and MRP from client records following death prior to November 2023, Profile EMR will be re-entering this information into these records

Removing a Client’s Alt POS

Remove a client’s Alt POS if any of the following conditions are met:
- The client has not visited the clinic in at least 12 months, clinic process to re-engage the client has been followed, and the client remains lost to contact
- The client has moved out of the service area and does not intend to continue visiting the clinic
- The client no longer meets the clinic’s mandate and any applicable transition or discharge steps have been completed
As of November 2023, PC POS and ALT POS and MRP (if one exists) will remain in the yellow bar following client death. As workflows included removal of ALT POS and MRP from client records following death prior to November 2023, Profile EMR will be re-entering this information into these records

Inactivating a Client (when not within the context of client death)

A client's record is inactivated when clinics/POSs are no longer involved in the client’s care. In this case, be sure that:
- PC POS, ALT POS, and MRP fields are empty
- There are no tasks, appointments, interventions, referrals, or recalls outstanding for other clinics
  - A warning will appear on inactivation if any of these items exist

Inactivating a Client (when within the context of client death)

A client's record is inactivated following client death. In this case, be sure that:
- There are no tasks, appointments, interventions, referrals, or recalls outstanding for other clinics
  - A warning will appear on inactivation if any of these items exist

Approvals

Director, Clinical Informatics Community (Jeb Dykema, January 6, 2020)

Director, Primary Care (Andrew Day, January 6, 2020)

Medical Director, Primary Care (Dr. Michael Norbury, January 6, 2020)

Community Analytics & Reporting Working Group (Michael Li, Chair, January 6, 2020)

Revision History

Revision#	Description of Changes	Prepared by	Effective Date
00	Initial Release	Sandra Pettman, Senior Specialist, Primary Care, Clinical Informatics Community	January 2020
01	Instructions for client death added	Sandra Pettman, Senior Specialist, Primary Care & MHSU, Clinical Informatics Community	December 2020
02	Updated CMPA Article link	Serina Jorgensen, CSSE Profile EMR	July 2021
03	MRP clarifications added for Alt clinics providing ongoing care	Sandra Pettman, Senior Specialist, Primary Care & MHSU, Clinical Informatics Community	August 2021
04	Updated clinic names	Serina Jorgensen, CSSE Profile EMR	January 2022
05	Updated clinic names	Janet Nordhagen, CSSE, Profile EMR	May 2022
06	Updated clinic names	Janet Nordhagen, CSSE, Profile EMR	July 2022
07	Updated clinic names	Janet Nordhagen, CSSE, Profile EMR	December 2022
08	Adding PC POS to Ann Vogel	Serina Jorgensen, CSSE, Profile EMR
09	Change in workflow following client death	Irvin Sandstra, CIS, Profile EMR	November 2023

Appendix A –Profile EMR Clinics

Clinic (in Profile EMR)	Clinic Name	PC POS	Alt POS
Anne Vogel	Anne Vogel Clinic	√	√
Assisted Dying Program	Assisted Dying Program		√
BCCDC CPS	BCCDC STI Clinic		√
Boulevard Youth	Boulevard Youth Clinic		√
COVID Assessment Centre - 3B	COVID Assessment Centre -3B		√
Crosstown	Providence Crosstown Clinic		√
Downtown CHC	Downtown Community Health Centre	√	√
DTES Connections	Downtown Eastside Connections Clinic		√
E.Hastings (Insite)	Insite Supervised Injection Site		√
East Van Youth	East Van Youth Clinic		√
Foundry N Shore	Foundry North Shore	√	√
Foundry Richmond	Foundry Richmond	√	√
Grdvw\Wlnd SubUse	Grandview Woodland Substance Use Service		√
Gilwest	Gilwest Clinic		√
Heatley	Heatley Community Health Centre	√	√
Heatley ICMT/Womens ICMT	Heatley Intensive Case Management Team		√
HIM Health Centre	Health Initiative for Men Health Centre		√
Inner City Youth	Foundry Vancouver Granville	√	√
Intensive Housing Outreach	Intensive Housing Outreach Team		√
Knight Street Youth	Knight Street Youth Clinic		√
John Ruedy	John Ruedy Clinic (JRC)	√	√
Migrant Worker	Migrant worker		√
Mountainside Yth	Mountainside Youth Clinic		√
NS Diabetes Ed Centre	North Shore Diabetes Education Centre		√
NS HlthConnection	North Shore Health Connection Clinic	√	√
NS PCN MH Support Team	North Shore PCN Mental Health Support Team		√
Overdose Outreach Team	Overdose Outreach Team		√
Parkgate Youth	Parkgate Youth Clinic		√
Pender CHC	Pender Community Health Centre	√	√
Powell River Youth	Powell River Youth Clinic		√
Primary Care Network	Primary Care Network		√
qathet Diabetes Ed. Ctr	qathet Diabetes Education Centre		√
RAAC	Rapid Access Addiction Clinic		√
Raven Song PC BLU	Raven Song Community Health Centre	√	√
Raven Song PC GRN	Raven Song Community Health Centre	√	√
Raven Song PC YLW	Raven Song Community Health Centre	√	√
Raven Song Youth	Raven Song Primary Care Youth Clinic		√
RavenSong SubUse	Raven Song Substance Use Services		√
Rchmnd Diabetes Ed Ctr	Richmond Diabetes Education Centre		√
Residential Care NP	Residential Care Nurse Practitioners		√
Richmond Community Geriatric Services	Richmond Community Geriatric Services		√
Satellite NPs	Satellite Nurse Practitioners		√
Sechelt ORC	Sechelt Opioid Replacement Clinic		√
Sheway	Sheway	√	√
South SubUse	South Substance Use Services		√
STOP Outreach	Seek and Treat for Optimal Prevention of HIV/AIDS		√
Stepping Stones	Stepping Stones		√
Steps Services	Steps Services		√
Strathcona Mental Health	Strathcona Mental Health		√
Substance Use Withdrawal Management & Recovery	Substance Use Withdrawal Management & Recovery		√
Sunshine Coast Youth	Sunshine Coast Youth Clinic		√
TCB	Trans Care BC		√
Three Bridges	Three Bridges Community Health Centre	√	√
UBC Alzheimer's	UBC Alzheimer's Clinic		√
UBC MS Clinic	UBC Multiple Sclerosis Clinic		√
Vancouver Community Youth Concurrent Disorders Services	Vancouver Community Youth Concurrent Disorders Services		√
Van COVID Team	Vancouver COVID Team		√
VCH TSC	VCH Trans Specialty Care		√
Youth Preg/Parenting	Youth Pregnancy & Parenting Program (YPPP)		√

Appendix B – Screenshots

The user may add or remove a PC POS or Alt POS on the Yellow Bar or through the EMR Registration Form. Note: the user can only update the POS they are logged into.