Don't get swept away by the spin on health care

Public

2016-08-22 Dr Z. Essak, MD - Vancouver, BC

We better be careful not to get swept away by the spin of BC Liberals pre-election buzz.

And when it comes to the spin on health care they're not alone.

The same spin seems to be coming from the leaders of the medical association DoctorsOfBC. Is this the result of being co-managers of BC healthcare for almost a decade through the GPSC and other initiatives?

Is it any surprise they are all so complimenting of each other?

What are we to believe? That they have a plan? That it's going to work, someday, soon?

Yes, the plan to spend tax payer dollars is happening. Billions of dollars and hundreds of millions over budget. So where are the results?

Everyone should have access to their own health record

This is just one of the spins. Terry Lake, Minister of Health, wants everyone to believe it will make health care better.

It may even sound like motherhood, something everyone might want?

It's not really new. It's already being done by some family doctors using open source software, Oscar EMR developed through efforts at McMaster University and individual doctors across Canada including BC.

No, what we are talking about is the BC Liberals continued expenditure of billions of dollars on eHealth Infrastructure and proprietary systems that is not only way beyond budget, but also failed to meet project timelines and has prompted calls for full security and usability reviews.

Yes, healthcare is expensive.

But, why is it this expensive and under-performing?

How is the Province wide EHR project doing?

On December 14, 2015 the Vancouver Sun reported on the BC Auditor General's report for 2014.

B.C. health ministry wants second IT opinion

Planned overhaul of technology projects includes review panel of outside experts

... A scathing report by Auditor General Carol Bellringer this summer prompted Brown and Health Minister Terry Lake to question their IT approach. Why, they asked, can the ministry build a complex hospital within 10 per cent of its original budget but lose control of the purse strings on a computer project?

... The IT troubles in the health care sector are so complex, sensitive and political that many of the users won’t wade into the issue. No physicians would speak about the problems posed by technology reforms through Doctors of B.C., nor would any members of the Health Employees Union or B.C. Nurses’ Union. Yet all represent front-line staff who will likely complain about future IT bungles.

... In the Health Ministry, the deputy minister said, the goal now is to not repeat past failures.

... The B.C. government is in the middle of a series of large-scale IT projects, many that have shot past their deadlines or are riddled with problems. They are, collectively, $350 million over budget and counting.

... The audit found nine of 13 organizations tested by auditors had over-rated their self-assessments for IT security, including lack of monitoring for system weaknesses, security training, risk analysis and data backups.

“We can’t stress enough the importance of these controls,” said Bellringer. “Without strong general computing controls, government risks loss of public trust in its ability to safeguard our most sensitive data and ensuring critical services are always up and running.”

It is now eight months later and where is the review by the panel of outside experts?

Then this spring, 2016, medical usability failures during the system roll out in Naniamo hospitals hit the headlines with calls for another review.

Power, Privilege and Accountability

With power and privilege there comes accountability (PPA) including professional ethics and responsibilities.

As co-managers of BC healthcare the leaders of the DoctorsOfBC are jointly accountable along with the BC Liberal Government for the past decade.

Where are the evaluations?

How is co-management working?

What happened to the $130 million every year since 2006 diverted from payments for direct patient care into co-management initiatives such as the GPSC and Divisions of Family Practice?

"GP for Me" program failed

The "GP for Me" program failed to meet it's targets, there is not a GP for everyone in BC.

Announcements through the summer 2016 by Terry Lake, BC Minister of Health and leaders of the DoctorsOfBC prefer the spin that there is for everyone who wants one, almost. And they claim great strides have been made.

https://doclounge.net/content/future-medicine-and-health-care-bc-and-can...

How are GP Incentive Payments working?

A recent study published in the CMAJ, and reports in the Globe and Mail on August 15, 2016 found that the GP incentive payments, since 2007 cost almost $400 million in direct payments to doctors, while failing to improve primary care access or continuity, or constrain resource use elsewhere in the health care system.

From the program’s inception in 2007 until last year, B.C. had spent more than $397-million paying for the Complex Care Initiative.

Shelley Ross, the co-chair of the General Practice Services Committee, a joint organization with representation from Doctors of B.C. and the province, believes that, contrary to Dr. Lavergne’s findings, there is “absolutely no doubt” that the Complex Care Initiative has improved care for patients in the province.

She says Dr. Lavergne’s research is flawed – that the time period examined was too short and the research was too narrowly focused.  ...

Is the immediate response from Dr Shelley Ross, a Past-President of DoctorsOfBC and co-chair of the GPSC, denying there is any problem and suggesting the research is flawed the best response we can expect?

Rather than pointing to evidence based findings a preference to spin that the research is flawed?

Coming after a warning, more than two years ago, in February 2014 when the BC Auditor General published a report on "Oversight of Physician Services" warning that the GP incentives payment methodology might be failing to deliver improved primary care.

In the Globe and Mail, 2014-06-24

Since 2006, British Columbia has spent more than $1-billion to improve primary health care. So, have B.C. patients benefited from such a massive investment? Sadly, it appears not. ...

In the more than two years since that has there been no effort to apply evidence based analysis that shows benefits?

Where are the evaluations for a program that has been running for almost a decade?

How are the spins doing?

Everyone should have access to their health records. Never mind that the way we are doing it is costing billions, over-spending, and raising security and usability concerns.

Co-management with DoctorsOfBC is great. Co-operation with the medical association is great. Nice to have them on your side. Maybe, even reading from the same page.

The "GP for Me" program failed, GP incentive payments haven't improved primary care.

What is a GP anyway these days?

Seriously, is it the same doctor you have seen and developed trust in that make themselves available when needed? Granted, possibly not 100% of the time, but consistently and with coverage after hours or does a clinic or the ER become the place to go?

Is it just whoever at a clinic or centre you can see?

When you ask patients, it seems, there are few who say they have a family doctor.

Fewer still who say they have sufficient time when seeing the doctor.

Some say the physician time has been taken by compelling them to complete complex disease forms for incentive payments and other administrative requirements.

Studies are showing that the young, new generation of doctors see their professional and personal time and lifestyle balance differently. Are medical schools doing enough to nurture professional virtues above customer and client service perspectives in this technological age?

Does it even matter if you see a doctor?

The medical home team-based care initiative.

Another of the BC Liberal spins gearing up for the spring election next year, 2017, is the medical home team-based care initiative.

Now you don't have to worry about seeing a GP you'll have the medical home and team-based care instead.

You'll always have someone to see you, doesn't matter if it's not a doctor or a nurse but someone will be there.

How much will this cost and what will it achieve?

It's not a new idea, it's been tried elsewhere, yet where is the evidence it is a cost efficient and effective way to deliver primary medical care?

Here again the spins comes from both Terry Lake, BC Liberal Health Minister and the leaders of DoctorsOfBC President Dr. Alan Ruddiman and division leaders.

It's the wave of the future or will it be a tsunami?

Who are our leaders?

Who are the leaders in our government, professional organizations and other associations?

Are these leaders of merit or an orchestrated procession through the halls of the establishment? Past-Presidents of the DoctorsOfBC automatically get a seat on the Physician Services Committee. Look who's on the CMA Board and committees.

Do we have thought leaders or are they just cheering the ideas of others?

Dr. Brian Brodie, Chair of CMA Board, at the CMA General Council meeting in Vancouver today said, we should tackle the hard questions.

Is that what the leaders in politics and professional medical organizations are doing?

Or are they schmoozing?

Weblinks:

https://doclounge.net/content/future-medicine-and-health-care-bc-and-can...

2016-08-15

http://www.cmaj.ca/site/press/cmaj.150858.pdf

M.Ruth Lavergne: A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease.

http://www.theglobeandmail.com/news/british-columbia/british-columbias-d...

From the program’s inception in 2007 until last year, B.C. had spent more than $397-million paying for the Complex Care Initiative.  ...

Shelley Ross, the co-chair of the General Practice Services Committee, a joint organization with representation from Doctors of B.C. and the province, believes that, contrary to Dr. Lavergne’s findings, there is “absolutely no doubt” that the Complex Care Initiative has improved care for patients in the province.

She says Dr. Lavergne’s research is flawed – that the time period examined was too short and the research was too narrowly focused.  ...

2015-12-14 Vancouver Sun,

B.C. health ministry wants second IT opinion

http://www.vancouversun.com/health/health+ministry+wants+second+opinion/...

B.C. not alone in bungling computer projects

http://www.vancouversun.com/health/alone+bungling+computer+projects/1158...

... The B.C. government is in the middle of a series of large-scale IT projects, many that have shot past their deadlines or are riddled with problems. They are, collectively, $350 million over budget and counting.

2015-12-15 BC Auditor General:
The Status Of Government's General Computing Controls 2014.

http://www.bcauditor.com/sites/default/files/publications/reports/OAGBC%...

http://www.bcauditor.com/sites/default/files/publications/news-releases/...

Similar to the report released in 2013, all 148 government organizations were asked to rate their general computing controls on a scale of 1 to 5, known as maturity level. Compared to 2013, organizations assessed themselves at a higher level. However, of the 13 organizations whose self-assessments were audited this year, 69% over-rated their level of achievement. Many organizations lacked documented policies and procedures hallmarks of strong general computing controls.

2015-12-15 B.C. Auditor general faults province for lax computer security

http://www.vancouversun.com/technology/auditor+general+faults+province+c...

... The audit found nine of 13 organizations tested by auditors had over-rated their self-assessments for IT security, including lack of monitoring for system weaknesses, security training, risk analysis and data backups.

“We can’t stress enough the importance of these controls,” said Bellringer. “Without strong general computing controls, government risks loss of public trust in its ability to safeguard our most sensitive data and ensuring critical services are always up and running.”

2014-02-15 BC Auditor General report - Oversight of Physician Services

https://www.bcauditor.com/sites/default/files/publications/2014/report_1...

This report contains six recommendations to improve the oversight of physician services and assist Government with demonstrating that physician services are high-quality and providing value for British Columbians. Although Government has taken some steps to address the issues presented in this report, significant work is still needed.

http://www.theglobeandmail.com/opinion/was-bcs-push-for-better-primary-h...

Since 2006, British Columbia has spent more than $1-billion to improve primary health care. So, have B.C. patients benefited from such a massive investment? Sadly, it appears not. ...

Access to care after hours, and in settings other than the office (home, hospital, and long-term care), declined in the period leading up to investments, and then continued to fall at the same rate after. In 1991, 96 per cent of family physicians saw patients outside of office hours. This fell to 79 per cent by 2001, and after investing in reform, reached 59 per cent in 2010. In 1991, 92 per cent of B.C. doctors saw patients at home, falling to 76 per cent in 2001. In 2010, only 55 per cent made a home visit. ...

BC Auditor General (other links)

http://www.bcauditor.com/healthfundingexplained

http://www.bcauditor.com/pubs