The September 23rd VMDAS quarterly meeting focused on three areas of importance to members. Doctors of BC President Dr. Ahmer Karimuddin addressed attendees. VCH Vice President, Strategy, Innovation & Planetary Health Darcia Pope gave an update on VCH’s strategic plan renewal. Drs. Stephen Van Gaal and David Wilton reviewed the past, present and future of CST/Cerner and took questions from the audience.

Doctors of BC update

Dr. Karimuddin gave an overview of Doctors of BC’s latest strategic plan, which reflects what the association’s members have said are their priorities. Supporting BC’s doctors to be influential leaders driving positive transformation is one of these top concerns. Dr. Karimuddin outlined four directions and priorities the association is taking to achieve this:

• Increase the influence of the physician voice.
• Promote physician health, wellness, and safety.
• Ensure fair compensation and provide business support.
• Engage members on the future of the profession and the culture of medicine.

Dr. Karimuddin emphasized Doctors of BC’s commitment to truth and reconciliation with Indigenous Peoples and to advancing this across our profession. Doctors of BC continues to work with First Nations, Inuit, and Metis communities to advance cultural safety in medicine and is committed to developing a Truth and Reconciliation plan that considers the historical role of the association and profession. Dr. Karimuddin also encouraged attendees to watch CMA President Dr. Joss Reimer’s September 18th apology to Indigenous Peoples.

Physician burnout was highlighted as a significant concern for Doctors of BC, with Dr. Karimuddin noting that we have never been so resilient and yet never so fragile. He discussed the findings of the association’s health authority engagement survey.

Dr. Karimuddin also touched on the Physician Master Agreement. The current PMA has a three-year term. Negotiations are expected to begin in February for a new PMA to take effect on April 1, 2025. He also encouraged physicians to work with the Doctors of BC’s negotiations team.

VCH Strategic Plan update

VCH’s renewed 2024-2029 strategic plan is intended to help the organization move towards the health-care system of the future. The new plan builds on the previous one; the values (we are for everyone; we are always learning; we strive for better results) and vision (healthy lives in healthy communities) remain the same. Four pillars (Indigenous cultural safety; equity, diversity, and inclusion; anti-racism; and planetary health) introduced over the past 18 months also remain.

Exceptional care, research and innovation for impact, and great place to work remain as goals, with a fourth goal added: healthy people. To achieve this new goal, VCH will support optimal health and well-being for all, including addressing the social determinants of health.

To reach its goals, VCH will use advanced data and analytics, technology, healthy facilities and infrastructure, and partnerships.

Ms. Pope drilled down into each of the goals. Areas of focus for the new healthy people goal include investing in prevention and health promotion, specifically programs on substance use, child and youth mental health, and sexual reproductive health, along with monitoring the uptake of screening and vaccination programs at the population level and addressing gaps in access. To determine the social determinants of health, VCH will partner with not-for-profit community organizations at the local level, advocate to provincial and local governments for policies that can improve health and health behaviours, and focus its efforts, in collaboration with other sectors, to create an effective response for people experiencing homelessness.

Ms. Pope concluded her presentation by encouraging members to take VCH’s 10-minute workplace experience survey. Feedback will help VCH better understand what is important to you so it can identify ways to improve. Participation is anonymous. You will need to provide your VCH employee ID or MSP billing number to access the survey.

CST: Looking back, looking ahead, and how to help

Drs. Van Gaal and Wilton thanked attendees for making the CST project a success, while also acknowledging that change has not been easy. There are parts of the system that are easy to use, while others are difficult. Since CST was introduced, we have served 4.1 million patients, trained 42,000 staff and physicians at 45 facilities and 450 clinics. CST gives us the capability if we choose to use it to do some incredible things.

The project was organized around five key goals: patient safety first; strengthen our core; best way, every day; draw on data; and, face time, not chase time. CST allows us to include allergies and alerts across encounters, closed loop and barcoded medications, and direct physician order entry (the latter, Dr. Van Gaal commented, is important although it can be hard). Strengthening the core was perhaps the most important part of the project. We were able to retire decades old infrastructure that was no longer supported. And there is now single sign on for security. Best practices are embedded in standard order sets and there is decision support to guide appropriate testing. There is now a single patient record from cradle to grave and automated data collection from monitors and devices. We have dashboards for clinical services and operations.

Dr. Van Gaal and other members of the CST leadership team are keen for us to invest on top of the foundation we have laid. All the hard work has been done: we have digitized documentation, learned new technologies, have rich and comprehensive data, a secure and reliable core, and an AI-capable technology stack. In Dr. Van Gaal’s words, it is a foundation upon which we can do great things. The options include maintaining the system as is or take it to the next level by investing in AI scribes, usability improvements, better prediction tools, and a patient portal.

Physicians need to build the case for more investment. One way to do this is by demonstrating results in five areas: population outcomes, patient experience, clinician well-being, health equity, and resource sustainability (which align with VCH’s strategic plan). To help embed the provider voice within VCH’s structures, a digital health committee as well as a medical analytics group will launch soon.

Dr. Van Gaal suggested that we need new goals to push CST forward. The initial goal of face time, not chase time can become face time, not screen time. Next is to deliver insights from data to make better decisions for patient care and service organization. Those goals will be augmented by ones that physicians tell CST leadership are important. To assist, Dr. Van Gaal encourages you to ask for your data and use it to derive insights and generate results as well as propose and refine high return on investment proposals.

There are three ways to contact CST leadership. Reach out to your team’s clinical informatics specialist. You can also submit change ideas using a webform or email Dr. Van Gaal and/or Dr. Wilton.

CST Q&A

CST Task Group Chair Dr. Raheem Kherani led the question-and-answer portion of the session, taking questions from both within the venue and from members who had joined the meeting online.

Q: There needs to be an urgent method for access for someone when they can’t log in. If they can’t log in and it’s after hours, what do they do?

A: The best place to start is phoning the service desk. That should resolve any access issues.

Q: What is the timeline for GF Strong? There is an impact on patient care between VGH and GF Strong.

A: There is no timeline yet for GF Strong activation. Multiple sites (e.g., Powell River and Bella Bella) are yet to go live. It’s a matter of budget and timing.

Q: CST is poor for out-patient clinics; far too slow. What are the supports for out-patient clinics?

A: We are starting an ambulatory clinic project. It will visit individual clinics to observe what is happening to identify where we can help clinics save time and how we can improve the overall ambulatory experience.

Q: Is there a plan to expand the scope of Cerner to include the lab? We have antiquated systems. I use six separate systems daily.

A: To my knowledge there is no plan to change our current integration between Cerner and the systems used there.

Q: One of the problems trauma surgery is facing at the provincial level is accessing everybody’s Cerner meta tech from all the health authorities. Interoperability is a big problem. Extracting data locked in free text piles is a problem for our data and analytics. Panda has laid out a roadmap to the future but when will our Cerner be integrated into that?

A: Uncertain about the specifics for Panda. Part of this has to do with the operation of multiple data warehouses within the province. Your point about trying to harmonize data extracts from multiple environments into a single analytic working space is heard. The QI program is working on improving our data infrastructure. That is outside of the CST project.

Q: What do we do when we’re on call and on provincial call for things around the province? Currently you can’t document in CST Cerner. Where are we going with that?

A: For patients who are currently registered, we can create an encounter for that phone call. We will soon launch the ability to add any patient so long as they have a PHN. A communication about that will be sent once the option is available.  

Q: I am part of a group at Doctors of BC that is trying out three AI scribes and evaluating them. I have been using them for nine months and am never going back.

A: We are excited to hear about experiences of people using AI scribes. We are working on it as an organization. It is a top priority for us.

Questions that were asked via Slido and that were not gotten to will be answered at a future time. 

Next meeting

The next VMDAS quarterly meeting is Monday, December 16. This will also be the VMDAS and VPSA annual general meetings. Watch for details in upcoming issues of your weekly Checkup e-newsletter.