Putting the Pieces Together
Healthcare in BC
Dr Karen Spector, an internal medicine physician at Lions Gate Hospital, logged into the hospital system, which managed workflow and served as a portal to correct, complete, and current medical histories for all residents of BC. Her patient was a 72 y o male admitted for shortness of breath. She pulled up his chart in the hospital Electronic Health Records (EHR) and then the patient’s medical history in the provincial standard Electronic Medical Records (EMR) system. The patient had authorised role-based access to his EMR records as part of the admission process.
She quickly scanned the problem list in the EMR, which is a synopsis of the patient’s health and a roadmap to the information in the patient’s history. The EMR contained a 2011 discharge summary from Royal Alexandra Hospital in Edmonton that noted a small, stage 3a lymphocytic lymphoma confirmed on biopsy, and no abnormal lymph nodes above or below the diaphragm. The patient had moved from Alberta to BC 5 years ago. As part of enrollment in the BC Medical Plan, the provincial Medical Information Management Services (MIMS) had transferred the patient’s history from the EMRs used by his physicians in Alberta to the standard EMR used in BC. The patient’s EHR contained an admission to Royal Inland Hospital in Kamloops for a CT scan that confirmed the lymphoma was stable. Karen remembered the days when she and other members of the clinical team wasted valuable time and resources searching for information, and repeating tests and treatments. She now had a time-series of comprehensive and correct information with which to start her diagnosis and treatment, and build on the work of other clinicians.
In the past, diagnosing a complex patient was like solving a jigsaw puzzle where clinicians weren’t given the pieces. They had to find them. This took time. Time the patient might not have. Pieces were missing. Some were wrong. Often, the partially completed puzzles were inaccessible or discarded. Pieces had to be found and the puzzle reassembled every time the patient sought care.
Adam Ho, a clinical pharmacist working from home in Comox, had the tools and information he needed to assess and manage patient medications, and could work with clinical teams anywhere in BC. All hospitals had the same processes, and BC had standardised its EHR and EMR systems. He reviewed the patient’s information in the hospital EHR and medical history in the EMR. Adam reconciled dispensing records in Pharmanet with prescriptions and diagnoses in the EMR. He left a note in the EHR that per the EMR the patient was taking all prescribed medications, and they were all first line treatments for the diagnoses. One of the diagnoses was preliminary, and the primary care physician was prescribing according to the standard treatment protocal.
Before healthcare transformation and consolidation, clinical pharmacists worked with incomplete and potentially incorrect information in a complex system. They inferred diagnoses from dispensing records, and relied on patients for the history of diagnoses and treatments, including prescriptions. When Adam worked casual in the Lower Mainland, he had to remember different passwords, software, processes, and policies depending on the hospital. This was frustrating, and fortunately he had not made any dispensing errors.
Adam had played hockey in university, and thought of the parallels between the healthcare system and a hockey team. Before consolidation of the health authorities, healthcare in BC was like having players from 6 different teams on the ice and 6 head coaches on the bench, each with a slightly different playbook. The team on the ice couldn’t play together very well, and the excess number of coaches, and their assistants, left little room on the bench for players. BC Health now ices one team, with one coach and one playbook. Players play their positions anywhere on the ice as required. Systems, processes, and policies are built around the needs of practitioners and patients, not those of bureaucracies.
Karen successfully diagnosed and treated the patient, and handed him off from acute care back to primary care. The patient’s medication had been adjusted so Adam had written the new prescription and a requisition for follow-up lab tests in the EMR, counselled the patient, and wrote a note in the discharge summary. Karen exported the discharge summary from the hospital EHR directly into the patient’s EMR to complete the hand-off. If the primary care physician needed more information, they could view the patient’s chart in the EHR.
Karen and Adam had added a few pieces to the health puzzle for their 72 y o patient, and BC Health made it available to the next clinician.
How do we get here? Check out Streamlining the Health Organisation for the latest step in a BC Health System transformation project that can bring this story to life.
greg steer
Enterprise Coach
