Virtual care needs virtual systems.
We need an organised, virtual healthcare organisation to provide hybrid in-person & virtual care, all supported by central health info repositories to steward patient info & make best use of healthcare🧑⚕️&💰
Future could be this
gregsteer.substack.com/p/primary-ca...
Buy, don’t build. Build takes time, money (development, maintenance), and entails risk. One requirement of the vendor would be application and data hosting in Canada. Only build if requirements can’t be met, which is unlikely.
Ontario has the right idea, sort of. Fix stewardship of primary care medical records, then properly apply technology. Need a project with clear objectives, a plan and funding, especially for a system this big, important and complex.
gregsteer.substack.com/p/improving-...
Close … but first fix stewardship of primary care records, then apply technology. Govt agency administers central info repository for team-based care for everyone, everywhere, anytime.
✅ One Patient
✅ One Record (trusted, complete)
✅ One existing, commercial EMR
One for all, not a “free for all.”
One for all (Globe & Mail, Letters Feb 22). Fix stewardship of primary care medical records, then apply technology
#bcpoli #cdnpoli #bchealth #cdnhealth
www.theglobeandmail.com/opinion/lett...
No amount of tech or money can fix a screwed up, obsolete business model. Instead of duplicating, fragmenting, & exchanging patient information among info silos administered by clinicians, store it in a secure, central repository & give authorised clinicians role-based access.
1 pt, 1 rec, 1 app
Interoperability is not information stewardship. The Tragedy of the Health Information Commons is health information managed by all is managed by none.
❌ health info silo proliferation, duplication & chaos
✅ 1 patient, 1 record, 1 EMR administered by govt agency for pts, doctors & other clinicians
1 EMR. Pt authorises dispensing Rx to access prescription & relevant info in EMR (admin by govt agency, not by doctors & other clinicians) & make any notes in Rx section.
❌ Info Silos, fax
✅ Primary Care (1 pt 1 rec 1 EMR), like Acute Care (1 pt 1 rec 1 EHR)
gregsteer.substack.com/p/stewardshi...
1 EMR. Pt authorises dispensing Rx to access prescription & relevant info in EMR (administered by govt agency, not by doctors & other clinicians) & make any notes in Rx section.
❌ Info Silos
✅ Primary Care (1 pt 1 rec 1 EMR), like Acute Care (1 pt 1 rec 1 EHR)
gregsteer.substack.com/p/stewardshi...
Pt would authorise dispensing Rx to access prescription & relevant info in EMR (administered by govt agency, not by doctors & other clinicians) & make any notes in Rx section.
🛑 Info Silos
🟢 Primary Care (1 pt 1 rec 1 EMR), like Acute Care (1 pt 1 rec 1 EMR)
gregsteer.substack.com/p/stewardshi...
Wasn’t like this in the early 1800s when doctors started keeping clinical records & worked alone. After 200 years, maybe it’s time to modernise stewardship of primary care medical records to reduce admin burden & support team-based care (1 pt 1 record 1 EMR).
gregsteer.substack.com/p/improving-...
No! Interoperability among 70(!) EMRs won’t help much, if at all, if ever. The problem is info mgmt, not info tech. Transfer custody of medical records from physicians to a govt agency. Primary care (1 pt 1 record 1 EMR), like Acute care (1 pt 1 record 1 EHR)
gregsteer.substack.com/p/the-traged...
Interoperability among 70(!) EMRs won’t help much, if at all. The problem is info silos, not tech. Transfer custody of primary care medical records from physicians to a govt agency (1 pt 1 record). Like acute care, physicians do medicine, not IM/IT or admin.
gregsteer.substack.com/p/the-traged...
Rather than treating symptoms, we should address the underlying cause of administrative burden, which is physician responsibilities for primary care information management unchanged since the early 1800s.
Hopefully, MinHlthBC is fixing obsolete roles and resps for healthcare information management, not just streamlining and digitising the fax (goat) paths. Interoperability won’t really help, and physicians can’t wait.
@bccfp.bsky.social @doctorsofbc.bsky.social
Improving stewardship of primary care medical records would reduce admin burden for doctors (& other clinicians), improve patient outcomes, & lower healthcare cost.
The Tragedy of the Health Information Commons: Health information managed by all is managed by none
Improving stewardship of primary care medical records would improve patient outcomes, reduce administrative burden for doctors (and other clinicians), and lower healthcare cost.
open.substack.com/pub/gregstee...
No. Good idea; bad solution (yet another data silo). Today, we can rationalise and centralise health information holdings to support team-based care, inc transfer of custodianship of primary care medical records from doctors (and others!) to a govt agency.
gregsteer.substack.com/p/stewardshi...
Let’s rethink emergency medical services. We can improve patient outcomes by using a hybrid virtual / in-person service model to make better use of 1st responders AND people on-site to provide team-based emergency medical services faster, everywhere.
gregsteer.substack.com/p/rethinking...
We can’t expect 2.8M CDN users to individually protect pt health data. Transfer custodianship of health info from doctors to a govt agency to improve stewardship. Acting on behalf of doctors & pts, it would have the mandate & resources to protect pt info.
gregsteer.substack.com/p/the-traged...
Patients need control over THEIR health info. Proliferation of data silos held by clinicians makes this impossible. Transfer custodianship of health info from docs to a govt agency to improve stewardship of health info, security & pt care.
1 pt, 1 record.
gregsteer.substack.com/p/the-traged...
Canadians deserve and expect an open, transparent and accountable government that delivers services and policies informed by evidence and science, not nonsense and conspiracy. The Canadian Medical Association (CMA) should break ties with the American Medical Association (AMA).
Data interoperability among primary care EMRs won’t really help. It just digitises the fax paths. One EMR federally licensed & provincially administered:
⬇️ admin burden
⬆️ team-based care (primary, acute)
⬇️ cost
⬆️ privacy and security
Faster Better Cheaper
gregsteer.substack.com/p/stewardshi...
No. Patients must own their medical information & authorise its use. Data scattered in an uncharted, expanding universe of silos accessed by 70 EMRs is an info mgmt & security nightmare. One pt, one record, administered by a govt agency for pts & clinicians
gregsteer.substack.com/p/the-traged...
One patient, one record.
No, Canada needs to improve stewardship of health information by transferring custodianship of medical records from physicians to a govt agency so clinicians access trusted, secure, and complete patient info. Interoperability just digitises the fax paths.
gregsteer.substack.com/p/the-traged...
Need an open & transparent accountability fw: common objective, perf measures aligned with objectives, & rewards tied to KPIs.
Political obj is make people (voters) feel good so “measures” are inputs (#EDs, ED hrs).
Emerg Med obj is make pts better, measured by results (e.g. time to diag & treat).
💯 You manage to what is measured. Our healthcare system has budget administrators, rewarded for balancing budgets & ⬇️ political noise. We need service managers, accountable for managing resources to ⬆️ pt outcomes. Coaches work with doctors & other team members to help them achieve this common goal.
“The new policy comes at a time when the health authority is under financial pressure from the province.” 🤔
This policy is about reducing expenditures, not managing Human Resources. “No OT” not the same as “manage OT to maintain service and minimise burnout,” which staff are trying to do w/o OT.
So the Quarterback goes to hand off the 🏈 to the Running Back, who says “Nah, you do it.” QB is pummeled.
The QB isn’t responsible for fixing roles & responsibilities problems. The Coach is. If the RB managed to stay on the team, the O-line might even give the Linebackers some free hits on the RB.