Ontario health care workers to gain more power

[classA]

I guess I'm just curious about this point. What exactly is wrong with trying to cut costs in the health care system? Current spending is unsustainable, and if it continues, there's no way to maintain our current single-payer public insurance system. Being cost-effective doesn't have to mean a sacrifice in quality or safety of care -- that's pretty narrow-minded. What about introducing an electronic patient record to reduce administrative costs associated with paper-based systems? Is that so bad? Changing the scope of practice of NPs and pharmacists is a long-time coming, and already exists to varying degrees in other provinces. There will continue to be other major changes in health care in the future in an effort to be more efficient, and I think anyone working in the health field has to be flexible and responsive to those changes.

 

Narrow minded?? Well if you can say a physiotherapist is as qualified as a radiologist in reading x-rays then yes it makes sense. But if a radiologist is more qualified then no its cutting costs and cutting quality.

Cost effectiveness is number two, patient safety is number one.

 

Doctors pay for their own administrative costs so I cannot see the relevance of mentioning e-charts.

 

When you try to cut costs by looking at a simple solution you cut quality. We are still dealing and will be dealing with the cost effective measures of decreasing medical school seats that occurred in the 90's.

[tree999]

Narrow minded?? Well if you can say a physiotherapist is as qualified as a radiologist in reading x-rays then yes it makes sense. But if a radiologist is more qualified then no its cutting costs and cutting quality.

Cost effectiveness is number two, patient safety is number one.

 

Doctors pay for their own administrative costs so I cannot see the relevance of mentioning e-charts.

 

When you try to cut costs by looking at a simple solution you cut quality. We are still dealing and will be dealing with the cost effective measures of decreasing medical school seats that occurred in the 90's.

Definitely agree with your point about priorities (patient safety > cost-effectiveness, of course) -- was never arguging this. Just trying to make the point that cost-effectiveness doesn't always mean a negative impact on patient safety. To be honest, I know nothing about physiotherapists' capacity for reading x-rays -- in fairness, the article only says something about a PT ordering the x-ray for an injured knee. But health policy moves at a glacial pace --changes are implemented with painstakingly long consultations and investigations. You're suggesting this might "cut quality", but clearly the expert consensus is that it doesn't (and has been for years).

 

My point about e-health was just an example of a cost-effective intervention which can also improve patient safety and the functioning of the system as a whole. It's cost-effective for many reasons -- reducing administrative costs associated with paper-based charts is only one example. Some docs who work in hospitals don't pay their own admin costs, but I don't know why that matters. There are savings for the system either way.

 

What do those opposed to this change feel is a better approach?

[future_doc]

What exactly is wrong with trying to cut costs in the health care system? Current spending is unsustainable, and if it continues, there's no way to maintain our current single-payer public insurance system. Being cost-effective doesn't have to mean a sacrifice in quality or safety of care -- that's pretty narrow-minded. What about introducing an electronic patient record to reduce administrative costs associated with paper-based systems? Is that so bad? Changing the scope of practice of NPs and pharmacists is a long-time coming, and already exists to varying degrees in other provinces. There will continue to be other major changes in health care in the future in an effort to be more efficient, and I think anyone working in the health field has to be flexible and responsive to those changes.

 

There is nothing wrong with better patient care achieved through technological advances in the electronic error.

 

eHealth, e-Prescriptions – online medication management – will free up doctors’ time, will impact upon reducing wait times in emergency departments, positively impact upon inpatient care, reduce administration, costs, pain and suffering, and deaths due to prescription errors! Patient safety improves, the risk of error decreases, patient lives are saved. This can avoid annually:

394,000 preventable adverse drug reactions,

240,000 physician office visits,

36,000 hospitalizations and

4,000 unnecessary deaths.

 

Ontario’s e-health strategy not only will reduce wait times in emergency departments and the incidence of inpatients in acute care settings waiting for alternate levels of care, it is intended to control and manage diabetes more effectively to reduce complications and costs.

900,000 people in Ontario have diabetes and each year:

350 go blind,

2,300 have a heart attack,

1,100 have a limb amputated,

3,200 die,

23,000 will discover they have diabetes and

165,000 people will visit an emergency department.

Any reduction of these numbers is important to achieve for our citizens.

 

http://www.southwestlhin.on.ca/uploadedFiles/Public_Community/Health_Service_Providers/Webcasts/eHealth_Webcast%20final.ppt#334,26,DiabetesRegistryPreliminaryTimetables

http://www.infoclin.ca/assets/intel%20emr%20white%20paper.pdf

http://www.health.gov.au/internet/main/publishing.nsf/Content/ehealth-furuedirections [see Nos. 5, 7 and 9, Appendix C – Canada]

 

http://www.hisa.org.au/aggrgator/sources/127?pages=3 [Australian Health IT]

[Talon01]

As somebody who is currently finishing my training to be an allied health professional (PT), I have had the opportunity to follow the development of the extended scope proposals for the past couple of years. I know for a fact that several (I don't know the details for all of the professions) of the professional associations and colleges have been pushing for this extended scope for a long time now and have had to plan and re-plan how they will work to educate their clinicians to safely fulfill their responsibilities. New grads will not be able to suddenly do things that they are not trained to do. Rather, some sort of additional courses/qualifications will have to be completed. The associations and colleges are not going to let their members easily screw this up - everybody has worked too hard to finally get their scopes extended.

 

As for comments such as "I would not trust a pharmacist, nurse, physiotherapist or anyone else over a doctor", please consider that a physician's knowledge is not all-encompassing. As a quick example, family docs get a total of somewhere around 10 weeks of mandatory training in musculoskeletal education during med school/residency. Physiotherapists receive between 16 and 20 months of MSK education. If I have a MSK injury there are only 3 people I would consider seeing: a physio - who can assess me in 24-72 hours, or an orthopedic surgeon - who can assess me in 3-6 months, or a physiatrist - if anybody actually knew where I could find one.

 

Edit: One more comment from the physio perspective. I don't really understand the concern about physios interpreting xrays. While it is obviously a good idea to be able to interpret the tests that you are ordering, ultimately they will be doing the exact same thing that a GP will be doing - namely, reading the radiologist's interpretation. There is one major difference though - a physio can actually perform a proper physical exam to decide whether the imaging matches the clinical presentation.

 

I agree with the last bit. After doing PT before medicine, it would be better to see a PT directly with a MSK related injury. Their MSK knowledge and examination skills are better than most FP.

[future_doc]

I agree with the last bit. After doing PT before medicine, it would be better to see a PT directly with a MSK related injury. Their MSK knowledge and examination skills are better than most FP.

 

Talon01, you are a breath of fresh air with this open minded attitude and perspective as you are about to move forward on the front lines in medicine! You recognize this is a collaborative process and not a competition amongst health care professional.

[Talon01]

Talon01, you are a breath of fresh air with this open minded attitude and perspective as you are about to move forward on the front lines in medicine! You recognize this is a collaborative process and not a competition amongst health care professional.

 

The only down side is you have to pay out of pocket now. Sure, it would be great to see someone with a fellowship in sports med or an orthopod but the waitlists are too long. And most 'simple' MSK injuries don't require an MD. Within the PT education curriculum (at least in Ontario) they're taught the red flags and what require an urgent referral to an MD anyhow.

[future_doc]

The only down side is you have to pay out of pocket now. Sure, it would be great to see someone with a fellowship in sports med or an orthopod but the waitlists are too long. And most 'simple' MSK injuries don't require an MD. Within the PT education curriculum (at least in Ontario) they're taught the red flags and what require an urgent referral to an MD anyhow.

 

So much for cost effectiveness. This is a drawback that needs to be addressed and dealt with by OHIP and the political powers that be. Giving (improving the system theroretically) with one hand while taking away the practical benefits in the real world is not much of a gain at all.

[A-Stark]

Ontario’s e-health strategy not only will reduce wait times in emergency departments and the incidence of inpatients in acute care settings waiting for alternate levels of care...

 

I don't really buy this for a second. Without providing more long-term care beds, this problem will not be alleviated, regardless of what gimmicky "e-health" systems are put in place.

[tree999]

I don't really buy this for a second. Without providing more long-term care beds, this problem will not be alleviated, regardless of what gimmicky "e-health" systems are put in place.

It's pretty simple. When patients are transferring from an acute care bed to a long-term care bed, there is a bunch of paperwork that has to be filled out. This takes time on the acute care side, and then the paperwork has to be processed on the LTC side. So even if there is a LTC bed free, there are admin-related delays because of paper-based transfer forms + paper patient charts. During this time, a LTC patient is using an $$ acute care bed. E-health can eliminate those delays. Doesn't sound "gimmicky" to me, buddy.

[A-Stark]

Give me a break, paper forms/charts are at best a minor part of this. Just last week I was talking to a patient who was waiting to move to LTC, and the delay was solely due to waiting for a bed. Note that the LTC facility in question is attached to the hospital.

[Satsuma]

Give me a break, paper forms/charts are at best a minor part of this. Just last week I was talking to a patient who was waiting to move to LTC, and the delay was solely due to waiting for a bed. Note that the LTC facility in question is attached to the hospital.

 

Agreed. I have never seen a delay in getting a patient transfered because of paperwork.

 

I have never really heard much talk about this "e-health" initiative. If it is just about patient records, I am not sure how it would alleviate wait times in the emerg, or wait times to get into long term care facilities. There simply need to be more beds. More beds in LTC - so pts aren`t taking up beds as inpatients in hospitals. And more inpatient beds so pts aren`t waiting in the emerg to get admitted for hours to days.

 

There also needs to be more family physicians so pts don`t come to the emerg for non-emergencies because they have no primary doctor.

 

If ehealth is about centralizing pt records, that definitely has advantages. But I am not sure how it would deal with the above problems.

 

Also, if it is anything like telehealth...it will probably increase pts going to emerg. Telehealth ends up telling most people, to go to the emerg.

[tree999]

Agreed. I have never seen a delay in getting a patient transfered because of paperwork.

 

I have never really heard much talk about this "e-health" initiative. If it is just about patient records, I am not sure how it would alleviate wait times in the emerg, or wait times to get into long term care facilities. There simply need to be more beds. More beds in LTC - so pts aren`t taking up beds as inpatients in hospitals. And more inpatient beds so pts aren`t waiting in the emerg to get admitted for hours to days.

 

There also needs to be more family physicians so pts don`t come to the emerg for non-emergencies because they have no primary doctor.

 

If ehealth is about centralizing pt records, that definitely has advantages. But I am not sure how it would deal with the above problems.

 

Also, if it is anything like telehealth...it will probably increase pts going to emerg. Telehealth ends up telling most people, to go to the emerg.

Wait times is a complicated issue. There are obviously many reasons why a patient transfer might be delayed. In an ideal world, there would be glorious amounts of beds and doctors! Unfortunately this isn't the case. So we should at the very least avoid a situation where a bed IS available somewhere, but the patient is not promptly transferred to it (trust me, this happens in Toronto all the time). E-health isn't going to solve all the problems, but if it can make even a small difference with wait times, then great!

 

PS. ehealth is nothing like telehealth in that respect. Yes, it ultimately culminates in a centralized electronic patient record. There is consensus that ehealth initiatives can reduce wait times in emerg, for example, by creating automated referral processes to community partners.

[ploughboy]

So we should at the very least avoid a situation where a bed IS available somewhere, but the patient is not promptly transferred to it (trust me, this happens in Toronto all the time). E-health isn't going to solve all the problems, but if it can make even a small difference with wait times, then great!

 

Really? I don't start working in Toronto until July, so I guess I'll know better then. Certainly when I was doing medicine as a clerk, if there was even an outside chance that one of our patients would be transferred to LTC we were all over that. Paperwork done, I's crossed, T's dotted...I don't think we ever actually wheeled one of our ALC patients to the front door but we might as well have.

[tree999]

Really? I don't start working in Toronto until July, so I guess I'll know better then. Certainly when I was doing medicine as a clerk, if there was even an outside chance that one of our patients would be transferred to LTC we were all over that. Paperwork done, I's crossed, T's dotted...I don't think we ever actually wheeled one of our ALC patients to the front door but we might as well have.

Sounds like you had a good team, ploughboy

 

A lot of this is about discharge planning too -- sometimes the conversation about where a patient is going, be it home, or some form of LTC, doesn't happen far enough in advance. I've seen some great results when multi-disciplinary rounds happen each morning to discuss all upcoming discharges, and then one point person deals with all the referrals.

 

On that note, I'm going to make one last comment about e-health being great (sorry)! It allows for continuously updated queuing information. Referring physicians can then pick providers/facilities with shorter queues, optimizing the distribution of patients.

[A-Stark]

Wait times is a complicated issue. There are obviously many reasons why a patient transfer might be delayed. In an ideal world, there would be glorious amounts of beds and doctors! Unfortunately this isn't the case. So we should at the very least avoid a situation where a bed IS available somewhere, but the patient is not promptly transferred to it (trust me, this happens in Toronto all the time). E-health isn't going to solve all the problems, but if it can make even a small difference with wait times, then great!

 

PS. ehealth is nothing like telehealth in that respect. Yes, it ultimately culminates in a centralized electronic patient record. There is consensus that ehealth initiatives can reduce wait times in emerg, for example, by creating automated referral processes to community partners.

 

It doesn't take weeks to fill out a few forms or scan some charts. I don't know what first-hand experience you have with this, but I was around for things like like this. Moving to electronic charting is a good idea... bed capacity has little to nothing to do with it.

[ploughboy]

A lot of this is about discharge planning too -- sometimes the conversation about where a patient is going, be it home, or some form of LTC, doesn't happen far enough in advance. I've seen some great results when multi-disciplinary rounds happen each morning to discuss all upcoming discharges, and then one point person deals with all the referrals.

 

On that note, I'm going to make one last comment about e-health being great (sorry)! It allows for continuously updated queuing information. Referring physicians can then pick providers/facilities with shorter queues, optimizing the distribution of patients.

 

Absolutely. I'm a firm believer that the patient's disposition should be considered right from the get-go, both in the emerg and on the wards. As much as it pains me to admit it, one of the things I'm thinking about from the moment I pick up the patient chart in the ER is "Is (s)he staying or going?"

 

I think the good thing about e-medical records is that as a physician seeing this patient for the first time, I can (theoretically) see his/her whole medical history and get a sense of what's already been done and what needs to be done.

 

If I can see that buddy with the sore knee had an x-ray done yesterday at St. Elsewhere and it was benign except for a bit of osteoarthritis, there's not a lot of point in me repeating that today. Go home, take some Advil...