A New Day in Primary Care
Healthcare in British Columbia
Dr. Mary McMurphy opens her laptop and fires up the Electronic Medical Records (EMR) system to start her day in her clinic in North Vancouver.
As the application loads, she recalls the path to this new world. With the help of the provincial Medical Information Management Services (MIMS) a few years ago, Mary migrated her patient information to the provincial standard EMR paid for by the Province and used by all primary care physicians in British Columbia. MIMS is responsible for procuring and administering the system, which is a cloud-based Commercial-off-the-Shelf (COTS) application developed, maintained and supported by a private company. Having MIMS responsible for managing patient information means “One Patient, One Record.” Physicians update one complete, accurate, and authoritative record. MIMS is responsible for stewarding patient data, not individual doctors. Doctors spend more time on prevention, diagnosis and treatment, and less time on compiling and managing patient information.
The EMR alerts her of a new lab result for a dangerously elevated INR for one of her patients. Mary had configured the EMR to notify her of any items requiring her immediate attention. She tells her MOA to set up an urgent telehealth appointment with the patient. There are no other notifications.
She pulls up her first patient, Tony Gamble, and reviews his record in the EMR. The purpose of his telehealth appointment is a review of his medications for high cholesterol and hypertension. Mary notes that Tony recently had day surgery for a broken arm. She reviews the initial diagnosis entered in the EMR by the Nurse Practitioner at Urgent Care, the imaging from Lions Gate Hospital, and the discharge note entered by the Surgeon at Lions Gate Hospital. Gone are the days when discharge notes disappeared into “the abyss.” She’d follow up treatment during the call.
Mary’s second patient is Grace Shepherd, a new patient in for a physical exam. Prior to MIMS, a new patient meant receiving a massive PDF on paper or a USB drive, often created by a different EMR, which then had to be transformed and entered into the clinic EMR. Or worse, Mary would have to take an incomplete and sometimes inaccurate history from the patient. Now, the patient contacts MIMS, authorises Mary for physician level access to their charts, and deauthorises their previous physician.
Mary’s third patient is Charles Long, who recently had urgent coronary bypass surgery at St. Paul’s Hospital. She reviews the labs, treatment plan, and discharge notes entered into the EMR by the Cardiologist. Hospitals are for “care and repair” so follow-up primary care is often essential for patients to achieve the full benefits of acute care. Cardiology had requested primary care follow-up in the EMR, which triggered the in-person appointment. In the past, patients discharged without access to primary care:
didn’t receive the care they needed to fully recover,
might remain under the care of the specialist, which meant highly specialised and limited resources delivered less specialised treatment and care, or
could deteriorate and be readmitted to acute care.
Mary can’t remember how to access the pharmacist notes in the EMR so she asks Tracy, her medical student from UBC, for assistance. All medical students and health care workers are trained on the standard EMR.
Mary’s day is a mix of in-clinic and telehealth appointments. At the end of the day, she completes her charting. Her days are shorter now because she doesn’t have to rechart information from other physicians. They’re more satisfying because she can focus on improving the health of her patients, not compiling and managing information. She now has time to coach her daughter’s soccer team.
This scenario is based on Improving Primary Care with Improved Information Management.
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