A Thousand Cuts

Initiatives to reduce wait times for surgery generally focus on the interval from when the surgeon submits a booking to when the surgery is completed. It's hard to imagine a less client-centred measurement.

The time from booking to surgery describes the system’s awareness of the client's need. But, that person has been aware of their need since the onset of symptoms, or the finding of an abnormal lab or x-ray result by their primary care practitioner. A common example of this in urologic practice is the man who has an abnormal PSA (prostate-specific antigen) blood test during his annual medical review. This triggers a series of other events (read: waits) that may culminate in the diagnosis and treatment of prostate cancer.

The series of events looks like this:

1. PSA blood test
   
2. Consultation with Urologist
   
3. Prostate biopsy
   
4. Definitive treatment (radiation or surgery), if cancer is diagnosed

That's a pretty high-level view of the man's journey through the system. Of course, I mean that's how the system usually looks at the process. The man may see it like this:

Spoonful of Sugar

I got a big dose of my own medicine last week. And it was bitter.

We've been waiting for our new electronic medical record (EMR) system for several years. We implemented our old EMR over 4 years ago, and I posted previously about some of the benefits. Unfortunately, the EMR program was "orphaned" about 2 years ago when the software company was bought by another company. It changed hands again, this time acquired by one of the companies applying for approval by the Saskatchewan Medical Association (SMA).

While software vendor approval has been drawn-out, it's an important process that helps ensure that vendors will be committed to and capable of providing service in the long-term, as well as expanding the capability of their EMR software to include connectivity with laboratories and between physician offices. We are fortunate that the company that owns our old EMR has received SMA approval, as they have all the necessary codes and knowledge to transfer records between the two systems. As far as we can tell, the transfer of patient information went smoothly. But that was the easy part...