Scheduling physicians into the workflow of multiple healthcare sites is a major administrative headache, as most of these institutions use outdated or even paper-based systems. The problem is particularly acute in small municipalities and rural communities, where doctors are in short supply.
A home-grown Web-based application called Chyma has been adopted by many Canadian communities to tackle scheduling and communications of doctors. About 5,000 physicians use the system across Canada to connect with major hospitals and related healthcare facilities in places such as Sudbury, North Bay, Brantford and Scarborough.
In Ottawa and Vancouver, the system is being considered as a pandemic communications tool, as it can also be used to marshal resources for medical emergencies.
Developed by Dr. Dennis Reich, a general practitioner (GP) based in Sudbury, Ont., Chyma was designed by an insider to work as an add-on to existing communications systems via the Web. A key feature is that it allows physicians to manage their on-call schedules at different sites within one unifying system.
"It's difficult for us to get involved in hospital communications systems," says Reich, pointing out that disparate systems such as Novell, Office or Lotus Notes each require separate system set-up and logon IDs. "So we created a system that allows healthcare professionals to have the same system no matter where they are."
In Sault Ste Marie, Ont., Chyma is used in a citywide strategy by ten regional health facilities, hospitals and clinics as well as the police and coroner's office to serve a population of 80,000. There are so few physicians in the region that having a central mechanism to track and coordinate who needs to be where and when is imperative.
"It's a crisis situation here – our area is significantly deprived of primary care physicians," says Julian Piwowarski, manager of ICT at the Sault Ste. Marie Hospital (SSMH). "Most people uses hospital emergency for primary care, that's how bad it is."
About 1800 users across the Sault use the system as a comprehensive one-stop platform for all parties that might be involved in reacting to an emergency. Piwowarski says most off-the-shelf products are too general, largely because it's difficult to discriminate information access and dispersal between groups.
The SSMH was the first customer to adopt Chyma in 2003 and was involved in the beta-testing needed to customize the application. Developers started by creating an electronic directory, controlled by IT staff, to replace the paper phone book.
Electronic on-call schedules were then created with the calendaring feature, managed by the same people who previously looked after paper records. A knowledge base containing policies and procedures for 50 categories was assembled, with the capability to issue alerts to the right people for high-priority matters.
By linking these three main components and adding an audit trail to ensure accountability, developers created a flexible system that provides the latest information in real time.
The system is so easy to use that even elderly volunteers use it daily. "A lot of them had never seen a computer, and you wouldn't believe how they've taken to it," says Piwowarski, adding that the system has evolved over the past three years so it is now used for a range of other purposes such as scheduling physicians' rounds, administrative meetings and social events.
He believes there is more community potential in the software, but there is a trade-off between efficiency and respecting physicians' privacy and time. There are some limitations and restrictions – for example, home phone numbers are not given out.
This is one of several security and privacy areas that he believes would need to be refined to make Chyma a robust pandemic communications tool.
Dr. Reich says he didn't set out to create the system for pandemic purposes, but it could prove very useful in filling this communications void.
Notwithstanding Canada's direct experience with Severe Acute Respiratory Syndrome (SARS), there is no clear policy mandate to ensure proper pandemic communications tools are in place, says Wayne Foster, a senior advisor at Chyma.
Most hospital communities are still using ad hoc e-mail and phone systems. "It is embarrassing," he says. "It's so rudimentary to have an information portal and an online collaboration tool."
An array of provincial and federal entities are planning the development of full-blown pandemic communications systems that link to patient e-health records, but progress to date has been slow, says Dr. Reich. "There is no online tool right now that people are used to using," says Foster. "People won't know how to proceed if another pandemic hits." 066706