July 2007 Vital Signs.p65 - Calgary & Area Physician's Association

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By: Joanne Anderson, CHR communications Knowledge centres The heart of library services in the region Need to find information on a new piece of equipment? Want to know the results of the latest medication trial? Do you want to provide your patients and their families with trusted information on their treatment? Navigating through information can be complex and time consuming but the health information network (HIN) can help you locate the best and most current evidence to answer all your questions. The HIN — a strategic partnership between the Calgary Health Region and the University of Calgary — provides access and support to health information in practice for physicians, staff, patients and their families. The University’s Health Sciences Library at the Foothills Medical Centre serves as the network’s hub, providing library services across the region. Site knowledge centres are located in the Rockyview General Hospital, Alberta Children’s Hospital, Peter Lougheed Centre, Women’s Health Centre and Tom Baker Cancer Centre. Physicians located in community and rural areas can access services through their desktop and receive personal assistance from HIN staff. “The staff in the knowledge centres offer expert assistance with searching and obtaining health information,” said Taryn Lenders, librarian, Peter Lougheed Knowledge Centre. “We can do literature searches or teach physicians how to find useful information by searching the databases on their own.” Each centre offers 24/7 access for physicians and staff, who can search more than 1,000 online journals through the new web site, hinc.ucalgary.ca, or link through from library services on the region’s i-web. There, individuals will find desktop access to research databases such as Medline, CINAHL, the Cochrane Evidence-based Medicine databases and PsycInfo. The centres can obtain articles and books from around the world, while new online products include: - e-Therapeutics (CPS), a service that provides access to current information on drugs available in Canada - UpToDate, a point-of-care electronic clinical information resource - Natural Standard, evidence- based resources in complementary and alternative medicines - STAT!Ref e-books “We are continually working to add new resources,” said Renee Reaume, manager, health information network. For more information contact a Knowledge Centre through their website at hinc.ucalgary.ca Hybrid charts – SCM and paper By Kathleen Addison, director, health records, and Dr. Peter Jamieson, MAB chair Now that the patient care information system is in use at all three adult sites, the medical staff should be aware that patient information created in Sunrise Clinical Manager (SCM) is now stored in electronic format only and is not printed out at the time of discharge. SCM is now the “source of truth” for this information. Other types of clinical information that is created by other systems (such as lab, DI results, and transcribed reports) will still be printed and filed in the paper chart. Although the region has had clinical applications in use for some time, health record services has previously maintained a completely paper version of the chart. Because of this change in practice, charts in the acute care hospitals will be in a hybrid, or mixed state, with information created both in paper and electronic format. Both of these formats now form the legal health record. To assist health care providers in this transition, paper health records are being flagged as a reminder that additional information exists in SCM. Note that there is a separate label for each site: There are some risks to managing the hybrid health record. When a patient’s health information is contained in more than one format (ie, paper chart and electronic chart), health care providers will need to be aware of this fact in order to locate all the information. On the other hand, the new system offers some benefits. There is now less risk arising from having multiple locations for paper records for the same patient. In addition, this information will be accessible instantly at the point of care, without waiting for the paper records. The long term goal of the region is still to move towards a fully electronic archive system. In the meantime, work will continue to ensure the integrity and availability of the health record. If physicians have any comments, questions, or suggestions, they would be welcome to contact either of us. Vital Signs July 2007 • Page 13
Re: Personal Reflections after ACH/MSA service (Dr. Giuffre, May 2007) I give Michael Giuffre my sincere thanks for his leadership on the ACH MSA executive, especially during so much recent transition. With that in mind, though, I voice my disagreement with his comments in Vital Signs of May, 2007. Dr. Giuffre asserts that the ARP “challenges the concept of putting the patient first” and removes “the incentive to be clinically efficient with high patient throughput.” What a shame that he equates efficiency with quality patient care. The division of paediatric palliative care, of which I am a part, was created through ARP funding. The work would not be sustainable in other models of payment – except maybe by charity on the physician’s part. The work is not efficient in terms of high throughput, but it is extremely valuable to those we treat. Our patient numbers are few compared to other paediatric disciplines or adult palliative care, and the work is time-consuming and unpredictable. The ARP allows flexibility for visits in a number of settings including home visits; outreach clinics in other regions; education for staff; and dedicated time for the planning of the new children’s hospice. These initiatives have all enhanced the care that we provide to children and families. Other divisions have similarly been able to improve ways that they provide care by considering what works best for families, not how it can be billed. Despite the challenges that remain with ARPs, I support the principle that they enhance quality family-centred care rather than, as Dr. Giuffre states, “change [the] emphasis away from patient care.” Sharron Spicer, division chief, paediatric palliative and respite care Past president response I would like to thank Dr. Spicer for the compliment and for her comments on ARP’s. Dr. Spicer is, of course, correct. The true luxury of the ARP in the tertiary care setting is the ability to have outstanding programs such as palliative care, eating disorders, developmental pediatrics to name but a few of the many. Indeed, we and our patients are privileged to have these types of care models and colleagues that can provide this needed care. In fact, these low volume patient programs are indeed very “patient focused” and have contributed to quality care. Yet one cannot avoid at least some concerning fundamentals. The waiting lists for outpatient care in the clinics have never been longer. The funneling of patients to our emergencies continues to be a problem. Patients and families are waiting for an inpatient bed or a procedure for too long. There remains a shortage of physicians across all fields of medicine. There is often too little or no differentiation, in the hospital outpatient setting, for the time and support staff allotted to see the complex and less complex patient. Yet our academic complement of staff, almost all ARP, has increased with each working very hard, seeing patients, teaching, administrating and researching. But it does seem that our patient throughputs have not kept pace with the gains in personal, and in addition, our system, “cost per patient,” must be going up. The ARP Vital Signs July 2007 • Page 14 Letters does nicely succeed as a recruitment tool, and it does seem to be an excellent way to acknowledge and reward clinicians for education, teaching, and research to advance medicine and our faculty’s stature. It does seem to be a strange approach or emphasis if the overall or primary objective is truly “patients first.” How to meet the need of so many patients, in a growing population, in a setting of scarce resources, is, in my view, still a problem. The community offices, that see the majority of patients in need of health care, have family docs, pediatricians and specialists completely burdened with overheads and these overheads are contributing to many docs closing their doors. Do these affected patients now seek care in the hospital outpatient settings? We all like to think that when our patients do get care, it is reassuringly with quality. This may be especially true with the timely expanse within the region, of designated safety and quality measures and personnel. I do not blame the ARP’s for all our system problems. They have their place in our complex care model. They are not the panacea, they are costly, and they may, in my view, contribute in the short run to physician shortages, in spite of their recruitment potential. In an ideal world, I think we would be better off rewarding and differentialting patient care from all the other duties and services performed by physicians. The health care system needs to move the pendulum back toward promoting and rewarding the providers of clinical patient care. Michael Giuffre Residents excluded I am writing this letter in response to Dr. Robin Cox’s article “New ACH MSA executive” in the May 2007 issue to share the pediatric residents’ view of the physicians’ lounge. The Dr. William Cochrane Physicians’ Lounge is a large, well designed, nicely furnished, bright escape from the rest of the hospital. Complete with marble countertops, a large flat-screen TV, a fireplace and a waterfall it is a great place for the physicians from various fields to be collegial with one another. However, one large group of physicians at the Alberta Children’s Hospital was, and continues to be, excluded from this lounge. For those who don’t know, it is the policy of the physicians’ lounge that residents are not allowed unless accompanied by a staff physician. Occasionally, even when accompanied by a staff physician, residents have been made to feel unwelcome and uncomfortable. At other physician lounges in Calgary, residents are welcome at any time. Currently there are 65 pediatric residents and fellows based at the Alberta Children’s Hospital. With anticipated growth in the pediatrics program this number will continue to rise. At any give time our numbers are increased by residents from other programs including anesthesia, emergency medicine, diagnostic imaging, psychiatry, community medicine, family practice, general surgery, orthopedic surgery, neurosurgery, otolaryngology and neurology. Some would argue that the residents have their own lounge. Let me paint that picture for you. There is a small, dark residents’ lounge on the fourth floor. It is roughly 10 feet by 15 feet, has no windows to the
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July 2007 Vital Signs.p65 - Calgary & Area Physician's Association

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