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Stat! Better communication needed among physicians

By Jerry Zeidenberg

CALGARY – To improve the coordination of patient-care among general practitioners, radiologists, surgeons and other specialists, the Health Quality Council of Alberta is calling for greater investment in electronic communications networks.

That may sound paradoxical, as Alberta is often cited as the Canadian province that has invested most in electronic systems for healthcare, and is a national leader in the use of electronic charting.

But the HQCA is calling in particular for networks that connect one doctor to another, so that each can inform the other of what he or she is doing with patients.

Such networks would include electronic referrals and notifications that messages have been received and dealt with. They would also include alerting systems that convey urgent messages such as critical test results.

They differ from most of the regional electronic networks that have been created so far, which upload patient data to central repositories and allow physicians to access information at their discretion. The systems being called for are much more proactive, and would replace the phone calls and faxes that still predominate among doctors’ offices.

The HQCA report has caught the attention of Alberta’s minister of health, Fred Horne, who is demanding that provincial medical organizations, including the Alberta Medical Association, take note of this call for action on electronic networks that link physicians, as well as the report’s nine other recommendations. (For the full list, with details, see www.hqca.ca.)

“The minister has asked many of the organizations for their plans to implement the recommendations,” said Patricia Pelton, acting chief executive officer of the HQCA. “He wants to hear their plans within the next few months.”

The HQCA attracted a good deal of publicity by focusing on the case of 31-year-old Greg Price, who died three days after undergoing surgery for testicular cancer in May 2012.

While this form of cancer has high rates of survival if caught early and treated quickly, Mr. Price had to wait months for appointments with specialists (the first surgeon he was referred to didn’t respond for 93 days), received few call-backs for subsequent appointments and tests when he needed them, had to wait nearly three weeks for an ‘urgent’ CT scan, and essentially dropped through the cracks of the system.

As his father, David, said at a Calgary press conference late last year, “Greg died prematurely. We believe he died prematurely because of multiple gaps and failures in the so-called system of healthcare in Alberta.”

Problems with ‘continuity of care’ have dogged healthcare systems across Canada for years, and the issue of communication breakdown was recently examined in depth by the Health Quality Council of Alberta. The council produced a 92-page report last December that analyzed the dilemma in general, and focused on the case of Greg Price in particular.

“We know that in any study of sentinel events [unexpected events that lead to severe injury or the death of patients], communication breakdowns are always among the top factors,” said Dr. Ward Flemons, author of the study and an HQCA medical advisor.

In addition to peer-to-peer networks linking medical professionals, the HQCA is calling for the use of a patient portal that allows patients not only to view their health records and test results, but also lets them see what has happened with referrals to specialists.

In this way, patients can keep tabs on their appointments and prod the system, when necessary.

“Gone are the days when a doctor can manage his patient’s health completely, 100 percent of the time,” said Dr. Flemons. “Patients often have five or six different chronic conditions. Every member of the team has to be active, and has to be monitoring the same information – and that team includes the patient himself.”

As it happens, Alberta Health has been working on a patient portal for some time, and the plan is to go live with it this year.

In addition, the province will start testing e-referrals in 2014.

Dr. Flemons concedes there are many challenges ahead when it comes to building physician networks to improve the continuity of care. Firstly, it requires that all physicians use computerized health record systems. While the province is at the top of the list when it comes to physician usage of EMRs, not all doctors in Alberta are fans of the systems. That means there will still be gaps in the proposed solution.

As well, a network that securely connects thousands of doctors to each other would need to be devised. That, too, is a missing link.

“We agree, it’s going to be a considerable project,” said Dr. Flemons. “But if you make it easy for people to do the right things, they will do the right things.”

Some commentators in Alberta praised the HQCA report, but were skeptical of its recommendations ever coming to pass – or at least in the near future. In response, Dr. Flemons noted that families of patients who have suffered from gaps in continuity of care, including the Price family, will pressure politicians and medical organizations to keep their promises. For its part, the Price family has created a web site to highlight the issue: See http://healtharrows.ca. “The families are going to hold people accountable,” said Dr. Flemons.

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