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Lead Physician’s Monthly Meeting
2016-07-27 8:00 a.m. – 9:30 a.m. The Hall
Meeting Attendees:Monica de Benedetti (chair)
Vanessa Foreman
Terry McCarthy
Mike Pray / Dennis DiValentino
Ruth Morris
Jean Mullens
Laurel Cooke / Desa Bibic
Rob Kerr
Lindsey George
Al Alipio
Chung Dao
Regrets: / Jason Profetto, Anne Marie Crustolo, Jim Williams
1.0 Review of Minutes from June’s meeting
Discussion Summary:
· No comments.
Person / Action: / Timeline
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2.0 Physician Assisted Death (PAD) – Also called Medical Assistance In Dying (MAID)
Discussion Summary:
· The focus is getting the information out to the organization and getting a sense of which practitioners are willing to participate in PAD, and in what sense. An email was sent out yesterday from Monica with more information, including a survey link to ask HFHT physician/IHPs about their ideas about participating in this kind of procedure, picture of an ideal service, etc. If we don’t get enough information via survey response, the Leads are asked to encourage the physicians in their FHO to complete the survey.
· There is not a referral system for PAD yet, however we have made connections with HHS who are willing to mentor and educate.
· It is envisioned that this will be some type of community-based or centralized service that could help to mentor individual physicians and teams along in the process if a patient asks for PAD, and could also help physicians who are not comfortable with performing the procedure. It would be multidisciplinary and could involve other agencies.
· The current model indicates that there need to be two physicians involved in the process. A question was raised as to whether two physicians from the same FHT could be involved in the same procedure. It seems likely that we will have to work with a doctor external to the HFHT.
· An educational component is also important – need to tell physicians what is involved in administering the medications to complete the procedure. It is difficult to ask physicians if they are willing to participate, if they do not know exactly what it is that they will have to do.
· There will be many details to iron out regarding how the process will work, what will be expected of a physician, what other ways a physician could be involved in the process, etc.; the question at this time is to ask individual physicians whether they feel strongly about it one way or another, and to think about what kind of support/needs they will have if a patient asks for PAD.
· Many physicians may not feel comfortable participating in this, but the demand is probably not going to be very high, and there will be ways to refer to other physicians, if not comfortable. A handful of physicians who are willing to participate will be able to service the community.
· There is a complex relationship with palliative care physicians as not all palliative physicians are comfortable with PAD, and HHS does not want to become a referral service to palliative care in relation to PAD.
· Regarding compensation, there are no new codes – use house call, counselling, palliative care codes for compensation.
Person / Action: / Timeline
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3.0 Public Health – TB Immunizations
Discussion Summary:
· Public health has provided a list of who qualifies for publicly funded TB testing. Most people will now have to pay for it for volunteering, schooling, etc. requirements.
· A vial of Tubersol costs about $200 and does 10 tests. A physician will not likely be willing to purchase this because it is not easy to predict whether they will have 10 patients who need a test. There is no way for physicians to recoup the costs or a way for patient to fairly pay for the test. It is also difficult to access Tubersol or other products.
· It also brings to light that public health does not believe that TB is an important health issue.
· Laurel spoke to a rep from Sanofi who said the HFHT could order it centrally at a discounted rate.
· There are other public health units across the province who are setting up clinics for those who are not eligible/able to pay for TB. Laurel is in the process of connecting with the manager of the public health TB unit to see if a clinic could be set up with nursing provided by public health. The group agreed that an ideal arrangement would be that public health sets up a clinic, with a nurse, and to charge patients for their individual doses of TB. The HFHT could provide the space.
· Also noted was that blood tests could also be used to indicate presence of TB, but this will drive up the cost of the system, which will fall back on patients.
Person / Action: / Timeline
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4.0 Palliative Care Early ID Project
Discussion Summary:
· There are three Hamilton physicians in this project that involves identifying patients who WILL need palliative care in future, and looking at the role of CCAC in providing care when the patient qualifies for services.
· It involves coming up with a plan that anticipates what a patient might need when they qualify for CCAC palliative services. The motivation behind this is to reduce ED visits, urgent calls, etc. and facilitate a smooth transition for patients receiving palliative care when the time comes.
· The CCAC already knows who the patients are and their likely needs, which can make for more smooth transition. The goal is to provide continual care with the same CCAC care coordinator as the patient transitions into palliative care (instead of assigning the patient to a CCAC palliative care coordinator as their condition changes).
· There was a discussion about patients who are not receiving enough CCAC services being barred from even being assessed for entry into LTC. Most other physicians have not had this experience.
Person / Action: / Timeline
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5.0 DA VINCI Project
Discussion Summary:
· Many Health Planning projects seek the attachment of a Lead Physician to the project for advisory and championing.
· DA VINCI project is for patients who have depression and alcohol use disorder. The patient regularly attends a counselling group and is provided with anti-depressant and anti-craving medications that are monitored by a physician every two weeks. Right now, a psychiatrist at central office is monitoring patients.
· The plan is to educate family doctors about this program so that physicians can take over management of a patient after the group is over (in order to continue to monitor/adjust medications) and that in future, physicians could manage patients from the very start of their participation in the group.
· Advice is sought from a Lead Physician regarding how to design these physician education sessions. Potential topics include brief CBT model aimed at family doctors, monitoring/management of anti-craving medications.
· Anti-depressants are covered under drug plans, but anti-craving medications are not, and they are expensive. The HFHT has contacted the suppliers of the anti-craving medications and have obtained the medications to provide them to patients. The supplier is interested in providing continuous supply.
· If a Lead Physician is interested in advising this project, email Monica.
Person / Action: / Timeline
All / Contact Monica if interested in advising this project. / Pending
6.0 CBT for Insomnia Initiative Proposal
Discussion Summary:
· This project was also discussed at Health Planning. The purpose of this project is to provide a five-week CBT program for insomnia to help patients taper off of benzodiazepenes. It is a collaborative practice team effort.
· It is currently being trialed at King West.
· Some noted that recent trial information has shown that CBT for insomnia is not beneficial and that reduced time in bed is helpful.
· A rigorous evaluation of this pilot will determine whether we continue with this project or not.
Person / Action: / Timeline
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7.0 Privacy Audit
Discussion Summary:
· We recently offered some more training workshops which have been well attended with positive feedback. Online training will be available in the future, and the workshops will be offered yearly.
· There are some next steps to do now that we have developed policies, and are providing ongoing training. On an annual basis, we need to review our policies to make sure they are aligned with provincial policy, we need to provide a yearly summary to the Board regarding privacy breaches that have happened in the practices (practices should complete the Privacy Breach reporting form), and all practices need to conduct a yearly privacy audit in their EMRs to detect snooping.
· Doing a privacy audit will involve having the practice team identify patients who are at risk of being snooped (family members, friends, people who work in practice or are prominent in the community) and then check the EMR logs to monitor snooping.
· Snooping is a problem in Ontario and the consequences of doing so are increasingly serious, including a $50 000 fine. Physicians are the custodians of their patients’ information, and so are responsible to ensure snooping and other breaches are not occurring.
· Practices will be instructed to do a privacy audit in the fall. The HFHT will provide support to practices to do the audit. The HFHT lawyer will help us determine what to do if there is a breach through snooping, particularly if through a paid employee. There are levels of snooping and levels of consequence. Draft policies will be brought to this group for review.
· It was also communicated from the Commissioner earlier this year that an employee’s regulatory body should be notified if they are sanctioned.
· It was noted that Telus PS does not show how long a user has been in the chart; QIDSS will determine if there is a way to track this.
· Carlisle Medical has some wording about snooping in their privacy policy; Lindsey will share it with other practices.
· HFHT Privacy Policies can be found on this link to the HFHT Intranet (please contact Vanessa if you do not know your login information).
· There were some questions about reporting breaches to patients when it involves misdirected faxes. If faxes are mistakenly sent to another health care provider, then we feel it is safe to assume that the health care provider will also be aware of privacy compliance and will shred the information, and the patient does not need to be notified. If a fax goes to a non-health care provider, the patient should be notified.
· This brought to light a conversation about having the central office create a list of pharmacies and specialists with verified contact information, and making this available to practices. Physicians would also like to have a database that tells them more about the specialties or sub specialties of specialists in the City.
Person / Action: / Timeline
Lindsey / Share Carlisle’s privacy policy so that other practices may see the standard paragraph about snooping. / Pending
Vanessa / Tell Sabrena/Gilles? about need for centralized list of pharmacy contact information, specialties, etc. / Pending
8.0 Choosing Wisely (CW)
Discussion Summary:
· A communication to practice teams about what CW is, is in progress. Practice Facilitators have been distributing posters to practices with patient information re CW.
· It will be important to educate practice teams. There will be an educational afternoon in future, that will be accredited (will happen early in new year – some delays due to accreditation process). CW has designed the training and it should be relatively low cost. We will be able to host it at the HFHT central office, and it will be 3 hours long.
· In the meantime, it would be helpful to have champion physicians (Rob, Mike, Monica) spread messaging about what CW is by coming to FHO meetings to discuss.
· There are many CW resources for patients that are helpful in having conversations about what tests or treatments are really needed. Most patients are receptive.
· It is important that whole practice teams are educated about CW.
· Laurel will help to organize nursing/IHP inservices, and will make sure it is part of the NPs’ problem based learning group.
Person / Action: / Timeline
Mike / Continue to craft CW communication / Pending
Laurel / Incorporate CW topic into inservices, NP learning group / Pending
Monica/
Rob/
Mike / Discuss plan for disseminating message about CW more broadly to FHOs / Pending
9.0 E-Consults
Discussion Summary:
· Mike shared some information about his experiences with e-consult. There are two different programs he is aware of.
· One program is through OTN/telemedicine and is based on the telederm model. It is a pilot. It is used for a variety of specialties. There is a list of specialists available for e-consults. It is simpler than telederm was. Users can cut and paste clinical notes, attach pictures, ECGs, etc.
· It has some training requirements and IDs are needed.
· They are interested in piloting the program more broadly the with the HFHT.
· Another project is run through Champlain LHIN and has minimal set up. One of our physicians has used it before and loves it.
· By September, our physicians will have had more experience using both, and may be able to recommend one for more broad piloting to the HFHT.
· There may be an e-consult option for psychiatry and mental health; Mike will look into it.
Person / Action: / Timeline
Mike / Find out if there is e-consult services for psychiatry/mental health. / Pending
10.0 E-Consults
Discussion Summary:
· The latest update to Telus PS shows an opt in or opt out feature for the Innovi cards. It is a short, two paragraph agreement.
· There is also an option to opt in or out of sending aggregated prescription data to insurance companies.
Person / Action: / Timeline
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9.0 Updates from Internal/External groups (IT, FMAH, LHIN, OMA, etc.)
Discussion Summary:
· The LHIN is still holding webinars with physicians to further discuss Patients First.
· This email will be passed on to physicians from HFHT Communications.
· With respect to the OMA contract, there will no longer be a referendum. There will be a general meeting (date/location TBD), and there will likely be proxy and/or online voting. No further information seems to be available at this time.
Person / Action: / Timeline
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10.0 Board/OCFP Update
Discussion Summary:
· None.
Person / Action: / Timeline
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Next Meeting: August 24, 2016, The Hall, Third Floor