Alarm of Discontinuity of Care.
Attached below is a letter that I addressed to the Medical Officer of Health of Toronto, Dr. Eileen de Villa, regarding the hemorrhaging hours of labour spent processing work that could automated (or deemed obsolete) with a unified, healthcare, operating system. At the hospital I worked at, our code brown meant an internal crisis (or a hazardous spill), and our healthcare system is in crisis. Read below to learn more.
Thank you :)
Date: Friday, April 22, 2022.
To the Medical Officer of Health of Toronto, Dr. Eileen de Villa:
RE: Alarm of Discontinuity of Care in the Healthcare System.
The lack of a unified healthcare operating system is an urgent issue facing the healthcare sector. Dr. Tam's recent report, "A Vision to Transform Canada’s Public Health System" (The Chief …, 2021) discusses how, "the national data landscape is fragmented across jurisdictions, governmental organizations, and community-level data owners” (p. 58, para. 2; in my previous letter dated December 6, 2021, I refer to fragmentation as ‘discontinuity of care’). Moreover, in a statement of the report, Dr. Tam says, "Our pandemic response was hindered in part, by significant gaps in our public health surveillance and data systems" (Public Health Agency of Canada (PHAC), 2021). These gaps in our public health systems lead to huge deficits in efficiency. If I were to hazard a guess - based on my experience working as a case and outbreak investigator from November 2020 to present in the long term care sector – I would say we are currently 80% inefficient. I would even argue that it could be declared a logistical emergency (a type of internal crisis, a ‘code brown’).
Inefficient systems risk burnout of public health workers. Dr. Tam has said: "The pandemic has taken a toll on public health workers … with frequent reports of burnout" (PHAC, 2021). If the healthcare sector is under sustained peaks of workloads, rather than troughs or middle-ground, it may collapse because its workforce will burnout. Action ought to be taken to prevent the occurrence of such a phenomenon by investing in a unified healthcare operating system. Unifying data will likely improve efficiency, reduce workload, and thus, reduce the risk of burnout. This process of stabilization or collapse is typically referred to as homeostasis; and via this process, the healthcare system’s acuity, or intensiveness, can be manipulated to either worsen or promote health.
A simple example of inefficiency is how often I copy/paste data from one place to another. I must perform this action X number of times per day because of our disparate, disconnected systems. If this type of delay occurred in other sectors, like an automotive assembly line, it would cost thousands of dollars per minute. Consequently, when staff are busiest, their efficiency is at its worst because they spend more time processing data from one place to another. It is an inverse relationship: when it is most important to be focusing on real-time data/events, users of the healthcare operating system are processing mundane tasks. Rationally, the healthcare system ought to invest in a single system to recover the costs of an inefficient one – and that means investing in a system that eliminates these mundane tasks with computer algorithms (similar to investing in an automotive assembly line to quickly and cheaply produce more vehicles).
Multiple logons are another example of discontinuity of care that impacts efficiency. I have 10+ logons (letter generator, email, ccm, ccm training logon, OLIS, big-ip, connecting Ontario, OES, webex, covaxon, windows, not to mention excel passwords for facility line lists/epi-curves). As a result, instead of unifying our disparate systems, we are asking a skilled workforce in short supply to manually communicate between them. Per the CNA (2009), registered nurses have shortages of 60,000 full time jobs and Winsa (2021) reports "Hospitals across the province currently have a vacancy rate of 10 to 12 per cent for nurses, according to the Ontario Nurses’ Association". Keep in mind, that shortfall is with the contemporary healthcare operating system. I argue that if we had a more efficient system, we could operate with 20 percent fewer staff and complete 80 percent more work. One of the reasons the automotive sector transitioned to assembly lines was that it required fewer skilled labourers; investing in a computer algorithm that functions as an assembly line ought to produce greater efficiency with fewer professionals.
After reflecting on what I have discussed, are there any questions I could answer from the reader or from our leadership to help initiate the long-term process of transitioning to one, continuous system, for all people involved in the service delivery of healthcare within Ontario, and ideally, within Canada? If I were to ask one, I would reflect on how to consolidate resources to respond to this systemic issue within our sector; and to reflect on how calling a code brown may help raise awareness of the logistical issues the healthcare sector is facing with its disparate, electronic health records. Logistical issues may include how the contemporary healthcare operating system cannot manually cope with the massive spread of viral pathogens, and therefore needs to be unified to be competitive.
In order to be competitive, the healthcare system must overcome its complacency. When healthcare systems were first implemented, they worked in isolation – and at the time that may have been apropos. Present day however, it is neglectful for provincial, federal, and local systems to not integrate their care. By definition, using separate systems for electronic health records is to not be integrated. The healthcare sector needs to change that and it needs to begin with simple steps, like calling a code brown. The larger step is overcoming the complacency of fragmentation which has long been endemic to the healthcare sector.
When the spread of SARS-CoV-2 reached a precipice, the Director-General of the World Health Organization (WHO; 2022), Dr. Ghebreyesus, declared a pandemic and cited alarming levels of spread, severity, and inaction in a situation assessment. Similarly, Dr. Tam has documented discontinuity of care throughout the nation, the acuity of fragmentation and its impact on workload harms public health workers via burnout, and the healthcare sector has complacency with its current function as demonstrated by the stopgap of multiple systems/logons and processes for communicating between them (like copy/pasting data). As a result, the healthcare system is on a precipice and needs to raise awareness of the impossibilities that lay ahead of it by calling a code brown (impossibilities such as being unable to effectively respond to surges or to effectively secure personal health information). Such a message should communicate that homeostasis of the healthcare system is affected by the efficiency of computer algorithms, and that a timeline for correcting it is to be established by the person calling the code.
I look forward to hearing your thoughts and questions.
Thank you.
mk.
*The above is the writer’s personal opinion and does not reflect that of any public health or healthcare institution.
References
CNA. (2009). Tested Solutions for Eliminating Canada’s Registered Nurse Shortage. Retrieved from https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/RN_Highlights_e.pdf
Public Health Agency of Canada. (2021). Statement from the Chief Public Health Officer of Canada on the CPHO Annual Report 2021: A Vision to Transform Canada’s Public Health System. Retrieved from https://www.canada.ca/en/public-health/news/2021/12/statement-from-the-chief-public-health-officer-of-canada-on-the-cpho-annual-report-2021-a-vision-to-transform-canadas-public-health-system.html
The Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada. (2021). A Vision to TRANSFORM Canada’s Public Health System. Retrieved from https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2021/cpho-report-eng.pdf
WHO. (2022). WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Retrieved from https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
Winsa, P. (2021). An Ontario nursing shortage has been predicted for years. Now, it’s turned into a ‘mega crisis’. Retrieved from https://www.thestar.com/news/gta/2021/09/26/an-ontario-nursing-shortage-has-been-predicted-for-years-now-its-turned-into-a-mega-crisis.html