Unfortunately, I can't find anything on Health PEI's website to link to. However, Health PEI was presenting its view for the future of primary care in PEI. There were over 100 professionals present at the Stanley Bridge Resort, including family doctors, nurses, other health professionals, and administrators.
Deborah Bradley, Executive Director of Community Hospitals and Primary Health Care, and her colleagues - including Dr Richard Wedge, Executive Director of Medical Affairs, and a brief visit by Keith Dewar, Chief Executive Officer - talked about the type of service they wish to see in PEI.
Health PEI would like to see modern, collaborative health care provided by teams of professionals - doctors, nurses, and other health care workers - working together to provide the best care to the patient. They listed the keys to good health care as being equality, quality, efficiency, and sustainability. If this sounds familiar to our patients, it's because Health PEI's was describing the Phoenix Medical Practice. They even based their key factors on our motto: equality, quality, accessibility, sustainability.
The Phoenix Medical Practice was the only fee-for-service medical team to attend the conference. We were also the largest contingent, with 12 members of the team attending including our management team. Talking to other delegates there, the recurring comments from doctors and nurses present was that they had heard this all before many times but that they were no closer to achieving these ends in reality. Several family doctors commented that there was no mention of how Health PEI was going to implement this model of care.
This is the key problem facing Health PEI: they know what health care should look like, but they don't know how to get there. There was indeed no mention of a blueprint for developing this service, there was no mention of a timetable, and no talk of implementation. It has been at least 10 years since PEI's health managers first started talking about collaborative models of primary care, and to date we have seen almost no progress towards this model.
Another interesting point is that collaborative care, which is what we practice in the Phoenix Medical Practice, involves a team of professionals working together closely in a community medical center. Health PEI's planned primary care networks are actually an example of 'co-operative care' in which professionals work together separately towards a similar goal. Co-operative care is less complex to set up but is also less efficient and less effective than collaborative care.
Finally, the fact that we were the only fee-for-service unit represented is a worrying sign. Half of patients in PEI are served by fee-for-service doctors. If they are not engaged in the modernisation process, then clearly the plan will fail at it's first key test: equality.
So Health PEI has many challenges to face before modern primary care will be widespread in PEI:
1. It has to move from the planning stage of the development cycle to the implementation stage
2. It has to engage its own front line staff in the change process. We noted that the great majority of professionals attending the conference were not engaged and did not think the process of change would happen.
3. It needs to get physicians using a Electronic Medical Record that has the required 'high architecture' features. The current systems - Deltaware's iCore and Cerner - both lack these key features and are not suitable for collaborative care or for quality and outcomes measurement.
4. It has to engage the fee-for-service physicians in the process of change.
5. It has to resist the temptation to re-invent the wheel: PEI is a tiny province and does not have the skills or knowledge base to invent something as complex as this. Far better to take what is already working elsewhere and tweak it so it works here.
The good news is that Health PEI now has a powerful ally in the Phoenix Medical Practice. We are already where Health PEI would like to be, and we have a large team with the training, experience, and skills to implement change. We are also busy building the necessary infrastructure for that change to be possible:
1. We have implemented a high architecture electronic medical record (OSCAR), which is an essential part of quality care delivery and measurement.
2. We have implemented training programs for the key professionals - nurses and receptionists - and we have access to training programs for the other key groups: doctors and managers.
3. We have built a network of guidelines to allow other professionals to safely and effectively work collaboratively with family doctors.
4. We are building links with the other key stakeholders: for example UPEI for RN training, Holland College for LPN and medical receptionist training.
We are therefore offering to use our unique capabilities to help Health PEI implement the changes that it views as essential to the future of health care on PEI. By using the Phoenix Medical Practice as an example of what can be achieved in PEI we can dispel the commonly held view that improving health care delivery in PEI is not possible. By providing tours of our facility to doctors, nurses, politicians, and managers we are able to let them see what their modern health care system will look like. By offering training sessions and clinical placements to doctors, nurses, managers, and office staff we will be able to spread to other parts of PEI the necessary skills and experience which are currently lacking.
The future of health care in Prince Edward Island is already here. We just need to use the skills and training that we already have to spread that future around the province. The success of the Phoenix Medical Practice is therefore central to the success of health care in PEI.
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