Sunday, December 30, 2007

My Team: multidisciplinary care

The New Year will mean more Team-based care for me. A part of it will be the move to the Big Office, but much of it will stem from the on-going development of our Family Health Team: we are now deciding what programs to launch, and how to go about this.

The reason for FHTs is to increase access (more patients rostered, improved access for current patients), to create Teams so that care can be better coordinated, and to increase activities directed at health promotion and disease prevention.

We now have nurses, a RN case coordinator (for tough problems that need system navigation), dietitians, social workers and a clinical pharmacist. We are planning on hiring a clinical psychologist as well. The Social Workers were an immediate hit, and are now so busy that there is a bit of waiting time to see them. We do not have Nurse Practitioners, because there are very few of them, and they’ve all been hired by the other FHTs.

We have a board of directors (mostly family physicians), and an executive director, as well as admin support staff. We have identified several areas that we would like to focus on. Our Allied Health Professionals are getting a full week of in-service training in early January, followed by EMR training the following week.

I’ve been asked to talk about Medical Directives during the in-service training; this is something that we can now start thinking about as a group. Medical Directives allow AHP’s to do delegated act, for patients who fit criteria. For example, I would like to have a directive that will allow my nurse to do a quick strep (or throat swab) for patients who have a positive sore throat score, without asking me for permission first (nurses are not allowed to order diagnostic tests independently). Things like that are easier to do if you use EMR templates; I’ve seen my nurse use the sore throat template correctly several times (it is visible on the EMR Encounter as soon as entered), before I go in to review the history with her; she knows when to do a quick strep, and she has no difficulty in interpreting it correctly. We’ll have to start thinking about what makes sense, and is likely to improve access and quality of care.

There has been some thinking about how to use the EMR; we may go to a centralized booking system for the Allied Health Professionals, accessible remotely. I don’t know how well that will work; I have a feeling several offices will prefer calling rather than logging on to book. We have two EMR systems in our FHT (I heard that in Hamilton they have six!), and some AHPs will work mainly in one system, while others will be assigned to the other. This will be easier for AHPs working inside family practices; I’m not sure how it will work for those assigned to programs.

I have not been actively involved with our FHT board or planning committee, but I am the beneficiary of their work. One physician in particular has been instrumental in bringing this project to fruition, after years of hard work (and lots and lots of meetings for him). It is always like that: there have to be people with vision and dedication to make projects like this happen, and sometimes they are not recognized or rewarded. This is true for some of our EMR pioneers. It is gratifying to see that our provincial government has decided to re-invest in primary care; I think this will pay large dividends.

There will be significant changes related to Team-based care in 2008 for me and my FHT colleagues. I expect that, by the end of the year, my practice will have dramatically changed from what it was as of my first entry in December 2005. Although the upcoming changes may not always be directly related to EMR, IT will be a large component of the final transformation. I am planning to post regular updates on this last part of the journey here.


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