Guide
What a primary care attachment registry has to get right.
A province that wants every resident attached to a family doctor or nurse practitioner needs two lists that agree with each other: the unattached patients waiting for a provider, and a practitioner panel registry (sometimes called a provider panel registry) of who is already attached and who has room. This guide covers what that software has to do, and how Astam does it.
One waitlist for the whole province
People should register once, however they arrive: online for themselves or someone else, by phone, at a hospital or cancer care intake, through a community navigator, or carried over from an older list. Each route is recorded so the program can see where people come from.
The registration date is the person's place in line. It should never move because of a declined offer, a data clean-up or a removal that turns out to be wrong. In Astam the original date is locked by a server rule.
Priority that people can understand
Most provinces rank people by health need as well as time waited. The rules should be written down, versioned and applied the same way to everyone. Astam computes priority from listed factors, such as a recent hospital admission or chronic conditions on medication, and records the source of each factor. A navigator can override the result, and the override is kept with its reason.
Each priority has a wait target, so the program can report how long people wait against the target, not just in total.
Practitioner panels and capacity
The registry also has to know who is already attached. That means each practitioner's panel, usually loaded from clinic EMRs, and how many new patients each clinic or team can take this month.
Capacity goes stale quickly. Astam stamps every capacity update with its date and treats anything older than 14 days as stale: it is flagged for staff and left off the public list of clinics taking patients. When a clinic's panel feed fails, the last good panel is kept and the failure is shown on the integration screen.
Matching people to openings
For each opening, staff need a ranked list they can explain to the clinic and the patient. Astam ranks the people who could take a place by priority, time waited against the target, distance from the clinic and stated preferences, such as a language or a female practitioner. It shows the reason beside every rank, and lists who was left out and why, for example because the clinic is beyond their travel limit.
The offer is saved with its reasons, so the decision can be reviewed later.
Counting an attachment honestly
An attachment should count only when both sides have confirmed it: the clinic accepted the person and the person confirmed they now have that provider. Counting clinic acceptance alone inflates the numbers. In Astam, an attachment stays pending until the patient confirms.
When the same person turns up on two panels, the registry needs a way to settle it with the patient. See duplicate attachments and panel conflicts.
Reporting the program can stand behind
A program dashboard should show people waiting by region, wait against target by priority, attachments confirmed in the last 30 days and how fresh each clinic's data is. Astam also includes a fairness check: the median wait for groups such as the Far North, or people who self-identify as First Nations, Métis or Inuit, compared with everyone waiting. A gap over 30 days flags the priority rules for review. Indigenous identity is self-identified and optional.
Questions to ask any vendor
- When does your system count someone as attached?
- What happens to a person's registration date if they decline an offer?
- How are people on two panels found, and who decides which attachment stays?
- How old can capacity be before it leaves the public list?
- Can you show why each person was ranked where they were for an opening?
- Which EMRs can load panels today, and on what terms?
Updated