How 'patient summaries' are connecting physicians to improve care
Posted on January 17, 2020
A new project is strengthening the circle of care around patients to include more communication between family physicians (FP) and hospital physicians in Greater Victoria on Vancouver Island.
The Patient Summary Project—a Shared Care initiative with the Victoria and South Island Divisions of Family Practice—started in 2015 to create a system to easily share a ‘patient summary’ between FP and hospital physicians to inform care when a patient is admitted to hospital. The summary includes information that could be relevant to care but is not typically listed on a patient’s electronic hospital record. It includes, for example, details about past heart attacks or cancer diagnoses, specialist consults, social histories or special care requirements, as well as the existence of allergies or past adverse drug reactions.
“Although PharmaNet can help us piece some of a patient’s story together, it’s often difficult to get a snapshot of their entire medical history,” said Dr. Matt Billinghurst, a Victoria-based locum and hospitalist who works at both Royal Jubilee and Victoria General hospitals. “A patient summary helps bridge this gap.”
A project in patience
Before patient summaries could come to be, physicians first needed a system to alert them when their patients were admitted, discharged or had died in hospital. The task of developing the system, known as e-notification, was no small feat, but was a necessary first step if patient summaries were to be introduced.
“Development of e-notification required a system change,” recalled Dr. Lisa Veres, a Victoria-based FP who led the work with FP, Laura Phillips. “We went through many people and many layers of medical administration. It became apparent that e-notification wasn’t going to happen unless we formed a committee, created a formal project and received major funding (from Shared Care), and had the power to work with the health authority at a different level.”
With e-notification in place and spreading across the region, physicians turned their attention to the next stage of the work – instituting patient summaries.
Building on the successful … and not so successful
At the start of the initiative, the patient summaries project saw 40 FPs provide summaries for their hospitalized patients via a mix of paper and various digital formats. The summaries were faxed into individual hospital wards or the ED to be manually appended to patient charts. While some were used, others were lost or misplaced.
Enough value was realised through this phase that Shared Care provided funding for a second phase of work which saw 100 more physicians participate.
In phase two, Island Health (VIHA) established a central number where summaries could be faxed and ‘tubed’ to the wards in the old fashioned way. While successful in the moment, the summary would eventually be buried within the paper-based chart, with no additional system in place to flag it.
The third phase of work, recently completed, saw another 100 physicians participate. This time, VIHA arranged for health authority staff to scan the faxed summaries into PowerChart so the information could become part of the electronic medical record. The fax number was also written on the e-notification. Through this, and word-of-mouth, this development was so successful that it resulted in physicians, and other health providers across Vancouver Island, sending in their summaries— overwhelming the health authority staff who were scanning and uploading the documents.
As a result, VIHA created a web portal where physicians could upload and export their summaries themselves. Work is now taking place to develop templates for each EMR as well as to address the unpaid time physicians spend completing and uploading summaries into the new system.
Building and maintaining momentum
The value of connecting physicians to share information has resulted in many benefits, including a new sense of teamwork. “Hospital and family physicians are now feeling more like colleagues in the care of their shared patients,” says Dr Veres. It’s been a big success that’s arisen from this project.”
With work ongoing to normalize patient summaries as a part of everyday practice, Dr. Veres added the challenge now facing the project is to maintain its momentum in the physician community. This includes looking for ways to support the work and refining the summary completion process for easier submission through the web portal.
A complete picture
As a physician who has lived both sides of the care-transitions coin, Dr. Billinghurst believes that the project has resulted in a win-win for both patients and physicians, with improved continuity of care and increased communication between physicians.
“I think of the patient summary this way,” Dr. Billinghurst said. “It’s like you’re on a hike. You’re climbing a mountain and as you’re going up, it’s getting foggier and you can hardly see in front of you. And then, close to the top, the fog breaks, and you have this amazing view. At times in the hospital, it feels like we’re in the fog with a patient. Having a patient summary removes the fog, and you’re able to see the patient more completely”.
Resources
For more information and resources visit https://www.divisionsbc.ca/victoria/our-impact/transitions-in-care
Contact
Kristin Atwood, Project Manager