Primary Care in Lake Cowichan
Healthcare in BC
Helen Day, a Community Paramedic, brought up her patient’s Electronic Medical Record (EMR) to prepare for her first appointment, an obstetrics consult, at the BC Community Health Clinic in Lake Cowichan. Marianna (37F) is 7 months pregnant with her first child and a virtual family physician had requested an obstetrics consult to address rising blood pressure in a patient of Advanced Maternal Age (AMA). Helen would be on a video call with Dr Mary Cameron, the obstetrician. The EMR had noted that language may be an issue so a foreign-trained health professional was available for translation services if required.
The only family physicians in Lake Cowichan had retired or departed in June, 2025 so responsibility for primary care is provided by onsite first-line healthcare providers working with virtual family physicians and other specialists. To ensure continuity of primary care, BC Health assigned responsibility for patients’ longitudinal care to the virtual family physician team, and assumed the lease for the clinic vacated by the departing doctors. Since patient health information was in a centralised information repository accessed through the provincial standard EMR, transfer of responsiblity was a simple administrative matter for BC Health. Additional continuity is provided by one of the physicians agreeing to semi-retire and work part-time as part of the virtual family physician team, and the other had moved within province and is available for virtual consults. Onsite care is provided by paramedics, who are rotated through clinic and emergency shifts. If the clinic premises had not been available, the ambulance station would have been renovated to add a small reception area and an examining room configured for virtual care. There is no need for a receptionist or a filing area. Patients schedule and manage their appointments online using Virtual Visit, a “virtual waiting room” application developed by eHealth Saskatchewan. The clinic does not keep paper records since all patient information is accessible to authorised clinicians and securely stored in the EMR.
Helen welcomed the patient into the examining room, and initiated the videoconference. Both Helen and Dr Cameron viewed the same patient record in the EMR, which was linked to data in other systems (e.g. Electronic Health Record, laboratory, imaging, Pharmanet). An automated scribe would record notes in the EMR for review by Dr Cameron. Helen led the appointment and added the translator since the patient’s English was limited. The EMR showed all vaccinations up to date. To simplify clinician access and reduce cost, Medical Information Management Services (MIMS) had consolidated vaccination data into the EMR and retired the provincial vaccination information system. Marianna was concerned about the safety of her chronic pain medications during pregnancy and breastfeeding. Helen and Dr Cameron performed the examination. Dr Cameron entered a request in the EMR for a Community Clinical Pharmacy consult, which would trigger a medication review. She also entered a prescription renewal for amitriptyline, should Marianna decide to have it filled. The prescription could be filled at any pharmacy by a Dispensing Pharmacist who would pull the prescription from the patient’s EMR, fill it, and record the dispensing transaction in Pharmanet.
Helen ended the appointment, and printed a prescription reminder for the patient. Dr Cameron edited the notes prepared by the scribe, and closed the patient record. While the patient prepared to leave, Helen greeted her next patient and prepared for the appointment.
Helen liked having both community and emergency paramedicine roles, which meant full-time employment that was challenging and rewarding. Lake Cowichan no longer had any problem recruiting or retaining healthcare workers. She was optimistic that Lake Cowichan would recruit a family physician who also would find living in Lake Cowichan and working in a modern, team-based healthcare system very rewarding
How do we get here? Check out Team-based Healthcare for Everyone, Everywhere for the latest step in a BC Health System transformation project that can bring this story to life.
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