Sunday, November 19, 2006

Managing waiting times, managing data

We now have a Joint assessment centre to expedite assessments for hip and knee surgery, run in common by the surgery departments of 3 local hospitals. Because the surgery depends on how functionally impaired people are, the assessments are done by a physiotherapist or orthopedic nurse practitioner. This frees up the surgeon's time. The patient can choose the first available surgeon (from 3 hospitals) or a surgeon of their choice--but then they have to wait longer. The Centre opened November 1st.

When I received the announcement, the referral form and letter were scanned into my network. I saw a patient who fit their criteria last week. I printed the letter of introduction and a blank referral for my patient, and a referral for me to fill out. I sent this the same day (with very little hand-written data, it is mostly check-boxes), along with the CPP and a printed copy of my clinical notes indicating what the problem is (which saves having to rewrite the whole thing).

I wish more specialists took this approach, rather than continue to use individual waiting lists.

I am continuing to use the on-line waiting times sites to refer my patients for MRIs, and this has made a difference.

I have to think carefully about what happens to my data. It continues to bother me that so much data needs to be scanned in because it is not integrated with the EMR; this can be a real problem for shared care with a specialist. A local internist sees one of my patients for mild hypertension (I am not sure why). Periodically, he orders blood tests, DI such as bone densities, and changes her meds. In the past, on the paper chart, this was just irritating. In the EMR, it is more of a problem. The blood tests he orders have to be scanned in, and do not show up on electronic summaries (he does not use one of the electronic labs). The changes in meds have to be entered in the CPP instead of just flowing in from my encounter. I have to enter his BP values so they show up on my graphs. It is no longer just irritating, it is now more work (for no better care).

I finally called the specialist and explained why I no longer wanted my patient to see him. I explained that I am using an EMR, and that it is important that the data flow in electronically. He agreed to stop seeing the patient.

I think the primary care EMR will be the core of the eventual Electronic Health Record (EHR) for most patients. When a patient comes back from a hospital, I ask them to tell the institution to send me a report. I show them their EMR, and explain that records get scattered all over the place in our health care system; the only way to ensure information is not lost is to get their data into the EMR.

There are 4 large labs in my area. 3 are electronic and flow into the EMR, and 1 is not. If I get a result from the non-electronic lab, that chart is flagged, so that the patient can be told not to use that lab in the future.

I have now been told that my hospital's software and my EMR will be able to share data, in mid 2007.

I think we can have a say into how the data is managed. We can sometimes direct patients where their data is more likely to follow them.

My group continues to have problems with SSHA (Smart Systems for Health), which is the government agency that provides Internet access for doctors and hospitals. Their lines have been slow at times, and are sometimes unreliable. I had my SSHA internet access cut off on Friday, and I switched to my back-up internet line, which is actually faster. I am not sure government should be in the business of providing Internet access; I may just stay on the back-up line.


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