Friday, April 3, 2009

Hidden Treasure

Last week, I attended 2 meetings that were goldmines. IHI’s Redesigning the Clinical Office Practice Summit and Taming of the Queue were high-yield for great ideas, both at the formal presentations and through informal discussions. While I was pleased to find out about some exciting quality improvement work being done across North America, I was a little annoyed that I only made these discoveries by virtue of attending the meetings.

For example, I’m interested in improving how information is shared between family doctors and specialists when a referral is made. At various meetings, I’ve happened on projects that are directly related to this area:

  • Our hematuria referral information letter has improved the amount of information we receive, but a web-based referral system would be better. It turns out that Manitoba is already developing an electronic referral system that guides family doctors through the referral process.
  • A Winnipeg radiologist reported on an electronic system to manage x-ray requests. Because of concerns that some x-rays may be ordered inappropriately, and not contribute significantly to patient care, the system provides decision support, based on clinical information entered by the physician. This is a potential educational tool that would give immediate feedback to a referring physician. Demand for consultation may be reduced if this feedback assists the physician in managing the patient’s condition in the primary care setting.
  • A British Columbia physician showed me a template for specialists to list the appropriate investigations and information that should accompany a referral request. Specialists can indicate what tests should or should not (reducing unnecessary testing) be done.

It made me wonder how much other relevant QI work is going on under the radar. Are we missing opportunities for collaboration and reducing wasteful duplication? We need a central clearinghouse for quality improvement work being done across the country.

Here’s what I’d like to see:

  • The Internet seems popular; let’s make our quality repository web-based.
  • Forget passwords and restricted access. Let anyone browse the site. Embrace comment and collaboration, in the wiki fashion. Worried that “the public” will be upset to find out that the healthcare system has quality problems? Don’t worry - “they” already know, and will likely be pleased to find out about efforts to fix the problems.
  • Assign each of the projects searchable tags for its location, discipline, category, etc. Pushpin them on a map. Let users filter search by tags.
  • Include blogs, bulletin boards, chatrooms, podcasts, etc. Share!

Breakthrough idea? Hardly. It’s social networking – Facebook already has this nailed.

Now, which national healthcare organization is going to mine this vein?


  1. Originally posted by Trish Paton (AHS Medicine Hat) 04/03/09 5:00 PM

    Kishore, you are so right! Not just in clinical settings, either...there are so many great things happening that are so hard to find out about. It's partly, I think, an issue of how to get info out but also how to make it "findable". If you don't have the exact place, and have to start googling (we don't hunt any more, we just google)...well, who has time to sort it all out? I'm not sure how to handle it, but I do think we need to look at models like Health Promotion Clearinghouse in Nova Scotia and Health Nexus in Ontario. Keep up the good work! Always enjoyable reading.

  2. Originally posted by Julie Gilbert (Cancer Care Ontario) 04/06/09 8:40 AM

    Glad you asked about better use of using social networking media! Cancer Care Ontario is pilot testing a web-based community focused on process improvement in the cancer system. The site is used for blogging, sharing tools and discussion around how to improve the way things are done for better efficiency and effectiveness. It's also an attempt to test whether these interactive web 2.0 tools are useful for sharing and collaboration, and if we're ready for them! Check it out at

  3. Originally posted by Joanne Stewart (IHA British Columbia-Practice Support Program) 04/08/09 2:00 PM

    It was nice to meet you at the IHI conference in Vancouver recently. I really enjoyed your talk too! Very down to earth. Thanks for voicing what so many of us seem afraid to.... Let's try to share and not reinvent the wheel on things. I have been working in health care 20+ years, and am amazed how protective we are of our work. Here's to the power of technology/email/internet/blogs/thinking outside the box.