SPECIAL REPORT with Sina Jahankhani

Coastal Forest Care Centre WELCOME TO NEW PATIENTS WELCOME! This is Sina Jahankhani reporting live from BBC. Today’s special report will be a visit to the Coastal Forest Care Clinic, a remote health clinic in Southern BC, where many new health informatics systems are being introduced to In order to manage the growing patient database.

We turn now to Dr. Pang, the dental professional at the CFCC, for his thoughts on the changes that are about to be implemented.

Changing the CFCC Growing number of patients Desire to reach remote patients in Southern BC Desire to improve patient care and communication between clinicians The need for access to specialists outside the clinic 1. Dr. Pang, can you tell us a little bit about the changes that are happening, as well as some of reasons behind them?

1. DATA MANAGEMENT Transitioning from a paper-based system to an electronic one Organized, accurate, and up-to-date 2. There must be a lot of things to consider with this process. What is one of the biggest issues you are having to deal with at the moment in light of the growing number of patients?

The EHR Electronic Health Record (Canada Health Infoway) 6 Components 3. And how exactly has it been proposed that the clinic moves from a paper-based to an electronic system?

The EHR: the benefits Reduce errors of handwriting Increase distribution Organized storage of data Reduced wait times Improved patient care 4. Can you tell us some of the benefits of this ‘EHR’?

The EHR: for the dentist EDR Improved primary diagnosis Record of patient dental history (eg. X-rays) 5. I’m curious to know how the HER will affect you professionally as dentist?

The EHR: for other clinicians Integration and compilation of data Prevention of drug adverse effects Financial records and prospective research 6. Given that this is a multi-professional clinic, how will the EHR be an advantage to the workplace?

The EHR: the issues The transfer from paper to computer Security and technological maintenance Training of clinicians Accepted standards 7. So you’ve talked a lot about the benefits behind having an EHR, but are there any risks involved with implementing something like this?

Standards Controlled data input Universal terminology 8. What do you mean by ‘standards’?

Standards: LOINC Rhymes with “oink”! Logical Observation Names and Codes Linked to other standards (eg. SNOMED) Understanding electronic clinical data Efficient exchange of information 9. I can see how that would be important to implementing something like an EHR. What kinds of standards are in place already in Canada that you can see the clinic aligning with?

Standards: the benefits Reduce language barriers Confidence in understanding distributed info Promote patient understanding and research Reduce errors Improved automatic referencing to nomenclature (anthony continues to talk)

Standards: the issues Training the users (time and $$) Difficulty deciding on a standard terminology 10. And the risks? (anthony needs to see a patient, and sends Sina to Alex) Ok, Dr. Pang, Thanks so much for your time!

2. Clinical Decision Support Lack of decision support tools Prone to errors of omission and comission Integration of computers for efficiency and memory support CDSS: Knowledge systems that interpret data to assist health professionals 1. So I’ve just talked to Dr.Pang about one of the biggest issues at the clinic right now, data management. I’m wondering if you could enlighten us on any other big changes that the clinic is undergoing?

CDSS: the benefits Allow offloading of memory Updated with new medical research Provide suggestions, reminders, and alerts 2. That sounds like it could cost a lot of money! There must be many benefits to bringing a systems like this into the CFCC!

CDSS: for the nutritionist Thorough primary diagnosis Provides suggestions for additional lab tests, etc. Gives reminders based on patient history, medications, and allergies Offers recommendations for diet/exercise regimens 3. As a nutritionist, how would CDS tools affect your job? And from a multi-professional perspective, how might they improve the way the other clinicians work?

CDSS: for other clinicians Improve patient-practitioner relationship Increase efficiency with routine tasks Allows administrative organization of clinical facilities and costs Provides guidance on important decisions (alex continues to talk)

CDSS CDSS assist trained health professionals; they do not make decisions for them! 2 types of CDSS Clinicians’ preferred type of CDSS But there are risks involved! 4. This almost sounds like you wouldn’t need professionals around to make decisions anymore!

CDSS: the issues Disruption of workflow due to improper integration Interference with decisions of trained health professionals Poor user interface design (eg. fonts, colours, etc) (alex continues to talk)

CDSS: design and usability Human-computer interface needs to be: useful, usable, and likeable Minimize interface flaws and increase flexibility of human-computer interface Designing integrable software: time, effort, $$ (sina interrupts alex rambling about colours): 5. But what about colour-blind users? (when alex is finished discussing all points): Thanks so much for your time, Dr. Little. (begins to head for the exit)

(sina still walking off stage) (brett interjects) Brett: Aren’t you going to interview me??? Sina: I’m just interviewing clinicians who work here…

3. Databases and technology Brett: Well I am a social worker.... it  is a clinical profession … we use databases a lot etc

Health Informatics and Social Workers: Databases Storage and backup of data Confidentiality and ethics Advanced encryption standards Relative levels of access 1. I thought that these types of databases only help clinicians, how will it affect you?

Databases: for the patients PHR Allow patients to be active in the care of their own health 2. How will patients benefit from this technology? Will they have access to the database?

Telehealth Remote nursing Teleconferencing Desktop sharing 3. I’m aware that patients in your database may live a great distance from the clinic. Are there any considerations as to how technology might be able to help the CFCC assist these patients?

Telehealth: for other caregivers Nurses Physicians and nutritionists Caregivers at home 4. Will these application be helpful to the other professionals at this clinic?

Telehealth: the issues Unauthorized access Comfort with technology Implementation Patients and unfamiliar terminology 5. With the patients accessing these technologies from home, I imagine there would be several risks involved. Can you tell us about a few the issues you are considering?

Telehealth: in, around, and across clinics Remote-area patients Patient-centered care 6. Given the motivations and the risks involved with this technology, do you think all these changes will actually be able to solve the problems involved with the growing list of patients at the CFCC? (let brett talk) 7. Do you see other similar clinics across Canada adopting these systems of data management, clinical decision support systems, and telehealth?

THANKS FOR VISITING OUR CLINIC We hope to see you soon! THANKS FOR VISITING OUR CLINIC (BUT MAYBE NOT REALLY)