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The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project has begun implementation of the collection of standardized patient outcome data related to nursing care in electronic health records (EHRs) in Canada.

C-HOBIC introduces a systematic, structured language to admission and discharge assessments of patients receiving acute care, complex continuing care, long-term care or home care. This language can be abstracted into provincial databases or EHRs. C-HOBIC builds on the Ontario HOBIC program (Health Outcomes for Better Information and Care).


The objectives of the C-HOBIC project were to:

  • standardize the language concepts used by HOBIC to the International Classification for Nursing Practice (ICNP) and SNOMED CT;
  • capture patient outcome data related to nursing care across four sectors of the health system: acute care, complex continuing care, long-term care and home care;
  • share the captured data as patients transition across the various sectors of the health system; and
  • store the captured and standardized data in relevant, secure jurisdictional data repositories or databases in preparation for entry into provincial EHRs and the Canadian Institute for Health Information Discharge Abstract Database for acute care.

Methodology and deliverables

C-HOBIC used the methodology developed in Ontario through the Nursing and Health Outcomes Project and the HOBIC program The outcomes have a concept definition, a valid and reliable measure, and empirical evidence linking them to nursing inputs or interventions. They are:

  • functional status
  • therapeutic self-care (readiness for discharge)
  • symptom management (pain, nausea, fatigue, dyspnea)
  • safety (falls, pressure ulcers)

With the goals of introducing standardization and avoiding additional documentation burden for nurses, components of the interRAI instruments1 are utilized to collect information about functional status, continence, symptoms (fatigue, nausea, dyspnea), falls and pressure ulcers. A numeric rating scale is used to collect information about the intensity of pain for acute care and home care settings. Therapeutic self-care (i.e., patients’ self-care ability related to the disease/medical condition and its treatment) is assessed with an instrument developed by Sidani and Doran.2


In addition to providing real-time information to nurses about how patients are benefiting from care, the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organization is managing clinical outcomes – in other words, how well they are preparing patients for discharge. Furthermore, at an aggregate level, this information will be useful to researchers and policy-makers in examining how well the system is performing in meeting the health-care needs of people.

This project contributes to many of the priorities for health-care renewal in Canada:

  • patient safety
  • outcomes related to home care
  • increased use of information technology
  • accountability


Phase 1: May 2007 to June 2009 — Final Report

In Ontario, C-HOBIC was implemented in acute, long-term care, complex continuing care and home care; in Manitoba, in long-term and home care; and in Saskatchewan, in long-term care. The evaluation findings are most positive in care sectors that have been involved in the initiative for the longest time and have focused resources on assisting clinicians to use the C-HOBIC information to improve their practice.

User feedback during the project illustrates that, while adoption of EHRs is not complete and the incorporation of C-HOBIC data and reports into nurses’ practice could take up to a year after implementation, the use of C-HOBIC data and reports is seen to be beneficial and will foster adoption of EHRs among non-users.

Phase 2: February 2012 to January 2015 — Final Report

In the second phase, the C-HOBIC measures were captured in acute care within the Allscripts system at St. Boniface Hospital in the Winnipeg Regional Health Authority (WRHA). A summary report of the information was printed and included in the discharge package to facilitate sharing of information as the patient transitions from one sector to another within the health-care system.

In Ontario, C-HOBIC data in the form of a synoptic report was made available via the Clinical Connect portal, so that clinicians in the Hamilton Niagara Haldimand Brant Local Health Integration Network and the Waterloo Wellington Local Health Integration Network all have access to clinical information as patients transition from one sector of the health-care system to another.

 “[C-HOBIC] allows the nurse to understand patients’ ‘ways of knowing’ with regard to medical history and medications. It is a quick way for the nurse to assess the patient’s educational needs and lets the nurse know about family/friends the patient relies on.”

“C-HOBIC can elicit information not normally attained. It keeps the nursing unit updated regarding recent treatments, etc., prior to the patient’s admission.”

“Have a meeting where you’ve actually seen a result and then everybody believes it; you use a report at a meeting and the family says, ‘Wow,’ [because] they’ve seen the progress made. [The nurses say] this is great.”

[1] interRAI instruments. Available at http://www.interrai.org/instruments.html Accessed on July 4, 2015.
[2] Irvine Doran, D., Sidani, S., Keatings, M., & Doidge, D. An empirical test of the Nursing Role Effectiveness Model. Journal of Advanced Nursing: 2002 38(1): 29–39.