Oct. 8, 2019 – Health Committee Proceedings

Oct. 8, 2019 – Health Committee Proceedings


♪ ♪ THE SPEAKER OF THE NOVA SCOTIA
HOUSE OF ASSEMBLY GRANTS PERMISSION TO RECORD AND USE THE
AUDIO AND VIDEO OF THE PROCEEDINGS OF THE ASSEMBLY AND
ITS COMMITTEES FOR EDUCATIONAL AND RESEARCH PURPOSES AND AS
PROVIDED BELOW. THE VIDEO MAY ONLY BE USED WITH
ITS ORIGINAL AUDIO COMPONENT AND NO OTHER AUDIO OR VIDEO MATERIAL
MAY BE ADDED TO AUDIO OR VIDEO MATERIAL USED.
TELEVISION AND RADIO BROADCASTERS MAY USE RECORDED
EXCERPTS OF THE PROCEEDINGS IN THEIR NEWS OR PUBLIC AFFAIRS
PROGRAMS IN BALANCED, FAIR AND ACCURATE REPORTS OF PROCEEDINGS.
NEITHER THE AUDIO NOR THE VIDEO MAY BE USED FOR POLITICAL PARTY
ADVERTISING, ELECTION CAMPAIGNS OR ANY OTHER POLITICALLY
PARTISAN ACTIVITY EXCEPT THAT MEMBERS OF THE HOUSE OF ASSEMBLY
MAY, FOR THE PURPOSE OF SERVING THEIR CONSTITUENTS, MAKE USE OF
RECORDED EXCERPTS OF THE PROCEEDINGS ON THEIR WEBSITES OR
ON SOCIAL MEDIA IF NOT PRESENTED IN A MISLEADING MANNER AND IF A
LINK IS PROVIDED TO THE FULL PROCEEDING.
NEITHER THE AUDIO NOR THE VIDEO MAY BE USED IN ANY EDITED FORM
THAT COULD MISLEAD OR MISINFORM AN AUDIENCE OR VIEWER OR THAT
DOES NOT PRESENT A BALANCED PORTRAYAL OF THE PROCEEDINGS IN
THE HOUSE. THE AUDIO AND VIDEO MAY NOT BE
USED IN COURT, OR BEFORE A TRIBUNAL OR OTHER BODY, FOR THE
PURPOSE OF QUESTIONING, COMMENTING UPON OR MAKING
JUDGEMENT UPON THE PROCEEDINGS IN THE HOUSE.
ANY OTHER USE OR REBROADCAST OR WEBCAST OF THESE PROCEEDINGS
REQUIRES THE EXPRESS WRITTEN APPROVAL OF THE SPEAKER. >>The Chair: ORDER. CALL THIS
MEETING OF THE PROGRAM 811 STANDING COMMITTEE ON TO HEALTH
I AMORDER. SUZANNE THE CHAIR FROMLOHNES-CROFT, HEAR SCOTIA.
OF THIS MEETING, AND THE TODAY WE TO WILL NOVA MEMBERS
REGARDING THEIRPHONES811 I TURN REMIND PUT OROFF. ON
ACKNOWLEDGE VIBRATERULES THERE IN OF WE CASE NOTEMERGENCY,
ARE BECAUSEAREEMERGENCY, THAT WECHAMBER. AN DID EXIT THERE IS
BEFORE WE IN THE THAT’S IF ANDCOURTYARD DOWNTOGALLERY,
STREET GRANVILLE STREET, GO HOLLIS TO THEGATHER. PEOPLE
OUTSIDE THE ADVISING ART WERE WE WHERE WE
THAT’S COMMITTEE SO PLEASE YOU’RE SO — AND
THAT, WHEN IN THEART EXIT ROOM, REMEMBER THAT WHEN YOU’RE IN
HERE, YOU GO FOR TO THE WILL I THAT LIKE GALLERY. TOMEMBERS
THERE’S NOTE ON BECAUSE AND ABSENT ACCIDENT ONLY WILLTHEY
ARE STUCK IN WEBEDFORD SOTRAFFIC,COMING. BEEN
ANDELAYED. THE HIGHWAY, THEY ARE
THEY WILL BE START INTRODUCTIONS.
>>IRVING, MYCOMING. SOUTH. KEITHFOR
>>KING FOR FOR MLA GOOD THE MORNING, AND THANK YOUMILLER,
AGAIN BEINGHERE. I’M MARGARETEAST. THANK YOU
GOOD HANTS >>GOOD MORNING,NAME’SMORNING,
>>LEBLANC. COLTON ADAMS. >>BARBARA GOOD I’M
>>LEBLANC. GOOD MORNING, SUSAN GOOD MORNING,CAVANAUGH,MORNING.
I’MAND JUDY TAMMYMLA IS CLERK MARTIN,
>>CAPE BRETON LIKE CENTRE. >>OUR
I WOULD IS HEAD.GORDON OUR OUR COUNCILLOR MR. HAVEINTRODUCE
MY TOYOU. GUESTS>>THEMSELVES AND THANK REMARKS.
UMM, DO MY MORNING,HOWLETT. OPENING MANAGETODD GOOD
NATALIA IS NAME THE DR. >>PROGRAM. I’M NAME PRIVACY
IS GALLANT, AND AND TELECARE OF MORNING, QUALITYWITHIN THE
>>GOOD MY NAME IS WENDY BOUTILIER.
I’M THE MANAGER OF OPERATIONS AND CLINICAL SERVICES WITH 811 TELECARE.
>>The Chair: EXCUSE ME. DR. HOWLETT?
THE MIC WILL TURN ON WHEN YOU SAY YOUR NAME.
>>I’LL FIGURE IT OUT EVENTUALLY.
THANK YOU. MY POSITION WITH THE PROGRAM IS
I’M THE MEDICAL DIRECTOR FOR TELETRIAGE 811.
SO I’LL BEGIN, AND THANK YOU FOR THE OPPORTUNITY TO COME BEFORE
YOU AND TALK ABOUT NOVA SCOTIA’S 811 PROGRAM.
WE LOOK FORWARD TODAY TO HAVING A CONVERSATION WITH YOU, AND WE
HOPE TO SHARE WITH YOU WHAT 811 DOES, CLEAR UP WHAT IT DOES NOT
DO, AND SHARE SOME OF THE OPPORTUNITIES THAT LIE AHEAD.
AS YOU MAY KNOW, THIS YEAR MARKS THE 10TH ANNIVERSARY OF THE 811
PROGRAM,ERGO IT BEGAN IN 2009. THE 811 SERVICE HAS A NUMBER OF
FACETS I WOULD LIKE TO TAKE A MOMENT TO OUTLINE BRIEFLY.
FIRST AND PROBABLY BEST KNOWN IS SYMPTOM TELETRIAGE.
FOR MANY OF YOU WHO MAY HAVE USED THE PROGRAM, THIS IS THE
PART OF THE PROGRAM WHEREBY YOU CALL THE PROGRAM, YOU SPEAK TO A
REGISTERED NURSE AND YOU DESCRIBE YOUR SYMPTOMS, AND
THROUGH A SERIES OF EVIDENCE-BASED GUIDELINES AND AN
EXPERIENCED NURSE, A PLAN IS SORTED OUT AS TO WHERE YOU
SHOULD BEST GO TO RECEIVE CARE. UP TO AND INCLUDING IN MANY
CASES THAT YOU DON’T NEED TO GO ANYWHERE AND THAT YOU CAN BE
MANAGED THROUGH SELF-CARE AT HOME.
WE SHARE A LOT OF HEALTH INFORMATION IN ADDITION TO THIS
SERVICE, AND WE HAVE A LARGE NUMBER OF WHAT WE CALL HITS OR
HEALTH INFORMATION TOPICS. THOSE CAN BE FOUND BOTH BY
REACHING US AND ON-LINE. WE DO A LOT OF WHAT WE CALL
PROVIDER REFERRAL. WE HAVE A VERY LARGE COMMUNITY
DATABASE, AND WE SERVE AS A DATABASE FOR THE PROVINCE.
AND DURING THESE TIMES WE REFER PATIENTS TO MENTAL HEALTH LINES,
TO FOOD BANKS, PHARMACIES. WE IDENTIFY WALK-IN CLINICS AND
WE HAVE SOME SERVICES AVAILABLE ALSO FOR OUR FIRST NATIONS.
THERE ARE TWO OTHER IMPORTANT PROGRAMS THAT SOME PEOPLE DON’T
KNOW ARE ASSOCIATED WITH TELETRIAGE.
THOSE INCLUDE TOBACCO FREE NOVA SCOTIA AND TOBACCO FREE NOVA
SCOTIA IS AN ON-LINE AND TELEPHONE CONSULTATION FOR
PEOPLE ATTEMPTING TO QUIT CIGARETTES AND SMOKING.
IN ADDITION TO THAT, WE HAVE GAMBLING SUPPORT NETWORK.
AGAIN, AN ON-LINE AND TELEPHONE CONSULTATION SERVICE WHERE WE
COUNSEL PROBLEM GAMBLERS. IN ADDITION TO ALL THIS, 811
SERVES AS A REPOSITORY FOR THE NEED OF FAMILY PRACTICE LISTS.
IT IS IMPORTANT, HOWEVER, TO NOTE THAT THE CONTENT OF THIS
LIST IS NOT OURS BUT IS MANAGED BY THE NOVA SCOTIA HEALTH
AUTHORITY. A COUPLE OF OTHER IMPORTANT
ITEMS THAT I WISH TO SHARE BEFORE WE START, ONE, AND
PERHAPS A FUN FACT, OUR — (HORN).
NOTHING TO WORRY ABOUT?>>The Chair: NO.
>>LIKE MAYBE I’M DONE? IS OUR NURSES WORK FROM HOME,
AND WE CAN TALK ABOUT THAT MORE LATER.
AND THROUGH A TRIPARTITE AGREEMENT, WE PROVIDE SERVICES
TO ONE OF OUR SISTER PROVINCES, P.E.I.
AND BEFORE I LEAVE, PERHAPS I WILL SAY THE 811 PROGRAM IS
SUPPORTED BY TWO CLINICAL ADVISORY COMMITTEES THAT ARE —
WHOSE MEMBERSHIP ARE OFTEN LOCAL CLINICAL EXPERTS THAT SUPPORT
BOTH OUR MENTAL HEALTH PROGRAMS, GAMBLING SUPPORT NETWORK AND
TOBACCO FREE NOVA SCOTIA AS WELL AS OUR TELETRIAGE PROGRAM, AND
THEY PROVIDE INPUT AS RELATED TO CLINICAL GUIDELINES, QUALITY
METRICS AND OUTREACH, AND THAT’S ALL I HAD TO SAY TO START.
>>The Chair: OKAY. WELL, THANK YOU, DR. HOWLETT.
WE WILL OPEN UP QUESTIONING STARTING WITH THE PC CAUCUS.
MS. ADAMS FOR 20 MINUTES.>>THANK YOU, MADAM CHAIR, AND
THANK YOU, DR. HOWLETT. I’M WONDERING IF YOU COULD START
OFF BY GIVING US SOME NUMBERS. I’M WONDERING WHEN THE LAST TIME
THERE WAS AN 811 REPORT THAT WE COULD ACTUALLY REFER TO AND LOOK
AT. SO FOR THE TEN YEARS THAT THE
811 SYSTEM’S BEEN IN PLACE, WE DON’T HAVE A GOOD UNDERSTANDING
OF THE BREAKDOWN OF THE NUMBER OF CALLS, HOW MANY WERE FOR
MENTAL HEALTH, HOW MANY WERE FOR WHATEVER, SO I’M JUST WONDERING
IF YOU COULD GIVE US A SENSE OF SOME NUMBERS AS TO HOW THE NUMBERS BREAK DOWN.
>>The Chair: DR. HOWLETT?>>SURE.
I’M GOING TO ASK NATALIEIA TO MY RIGHT TO PROVIDE SOME NUMBERS.
SHE MIGHT HAVE SOME DATA THAT IS HELPFUL AND CERTAINLY YOU CAN
ASK MORE QUESTIONS AFTER THAT.>>The Chair: MS. GALLANT.
>>THANK YOU. SO THESE STATISTICS ARE FROM
APRIL 2018 TO JUNE OF 2019. SO IN TERMS OF TOTAL PATIENTS
SERVICED FOR THE PROGRAM WOULD BE 114,000.
THE MAJORITY OF OUR PATIENTS ARE REPEAT PATIENTS.
SO THAT WOULD BE A TOTAL OF 80,000 WHICH WOULD BE
APPROXIMATELY 70%. IN TERMS OF MENTAL HEALTH-TYPE
CALLS TO OUR SERVICE, IT WOULD EQUAL TO ABOUT 2% OF CALLS.
>>The Chair: MS. ADAMS?>>THANK YOU.
THAT’S HELPFUL. GIVEN THAT LAST YEAR THE NUMBER
OF PEOPLE WHO WERE WITHOUT A FAMILY PRACTICE DOCTOR OR
CLINICAL NURSE PRACTITIONER WENT FROM 45,555 TO 51,802, SO THAT’S AN
INCREASE OF ABOUT 13% MORE WITHOUT A FAMILY DOCTOR,
ACCORDING TO THE NOVA SCOTIA HEALTH AUTHORITY STATS, WHAT
PERCENTAGE OF PEOPLE CALLING 811 ARE WITHOUT A FAMILY DOCTOR?
>>The Chair: WHO WOULD LIKE TO TAKE THAT?
MS. GALLANT?>>THAT WOULDN’T BE A STATISTIC THAT I HAVE HERE TODAY.
>>The Chair: MS. ADAMS?>>THANK YOU.
IS THAT A STATISTIC YOU COLLECT?>>The Chair: MS. GALLANT.
>>PART OF OUR CALL PROCESS IS THAT WE DO ASK PATIENTS IF THEY
CURRENTLY HAVE A HEALTH CARE PROVIDER, SO THAT IS A PART OF
THE CALL PROCESS THAT WE FOLLOW.>>The Chair: MS. ADAMS.
>>SO IS IT POSSIBLE FOR YOU TO GET US THAT STATISTIC?
>>The Chair: DR. HOWLETT?>>YES, ABSOLUTELY.
I DON’T SEE ANY REASON WHY WE WOULDN’T PROVIDE THAT STATISTIC.
>>The Chair: MS. ADAMS?>>THANK YOU.
SO I’M SURPRISED THAT ONLY 2% OF THE CALLS WERE FOR MENTAL
HEALTH. SO I’M WONDERING WHEN THOSE
CALLS COME IN, WHAT — YOU KNOW, IF IT’S A PHYSICAL AILMENT
THAT’S CONSIDERED AN EMERGENCY, YOU WOULD DIRECT THEM TO EITHER
A WALK-IN CLINIC, FAMILY DOCTOR OR EMERGE.
WHEN MENTAL HEALTH CALLS COME IN, WHAT’S THE TRIAGE
INSTRUCTION?>>The Chair: DR. GALLANT?
OH, SORRY, DR. HOWLETT.>>THANKS FOR THE QUESTION.
SO WE HAVE A GUIDELINE. IT DEPENDS ON WHAT — SO PERHAPS
I CAN JUST TAKE A MOMENT AND TALK ABOUT OUR EVIDENCE-BASED
GUIDELINES JUST TO EDUCATE THE COMMITTEE A LITTLE BIT, IF I
COULD. SO WE HAVE SOME 300 GUIDELINES
THAT ARE BASED ON VARIOUS SYMPTOMS.
IT MIGHT BE SHORTNESS OF BREATH, IT MIGHT BE WEAKNESS, IT MAY BE
EVEN — AND WE HAVE SOME MENTAL HEALTH GUIDELINES AS WELL THAT
ARE RELATED TO PEOPLE WHO ARE DISTRESSED OR PRESENTING.
THE GUIDELINES WORK IN SUCH A WAY THAT IT’S IMPORTANT TO NOTE
THAT THE SYSTEM IS NOT DIAGNOSING OR TREATING PATIENTS
OTHER THAN WHAT WE CALL SELF-CARE.
SO PEOPLE CALL IN AND THROUGH THE NURSE INTERACTING — AND
IT’S IMPORTANT THAT IT’S A REGISTERED, EXPERIENCED NURSE
INTERACTING USING THE GUIDELINES WE COME UP WITH AN OUTPUT.
SO AS YOU MENTIONED, SO OUR OUTPUTS, BROADLY SPEAKING, AND
I’M GOING TO GET TO THE MENTAL HEALTH ONE, BUT I THINK IT’S
IMPORTANT TO SITUATE IT IF I MAY, WOULD BE 911.
SO THERE ARE SOME SITUATIONS, I’M CALLING IN AND I CALL 811
PERHAPS BY ERROR OR MISTAKE OR IT BECOMES CLEAR THAT WE SHOULD
BE SENDING AN AMBULANCE, GO TO EMERGE.
AND THEN WE HAVE A NUMBER OF DIFFERENT ONES.
SEEING WITHIN 24 HOURS, 48 HOURS, 72 HOURS, A WEEK AND TWO
WEEKS AND HOME CARE. AND THAT’S BASICALLY THE IDEA
THAT WE HOPE YOU WOULD BE ABLE TO SEE YOUR FAMILY DOCTOR WITHIN
TWO WEEKS, AND THAT MAY NOT BE POSSIBLE, AS YOU MENTIONED.
FOR MENTAL HEALTH, IT’S SIMILAR, AND ONE OF THE IMPORTANT OUTPUTS
THAT WE PARTNER TO IS BOTH MOBILE MENTAL CRISIS AND THE
MENTAL CRISIS LINE IN THE REST OF THE PROVINCE.
AND IN THE SAME WAY WE’VE DONE THIS WITH POISON CONTROL AND
OTHER ORGANIZATIONS WITHIN THIS PROVINCE THAT PROVIDE GREAT
CARE, WE’RE NOT HERE TO TAKE OVER THEIR CARE BUT RATHER TO
PARTNER WITH THEM AND TO WORK. SO IN MANY CASES, ONE OF THE
OUTPUTS MAY BE WE THINK YOU NEED TO GO TO MOBILE CRISIS.
NOW, ON THE OTHER EXTREME, IF WE’RE WORRIED ABOUT SOMEBODY, SO
SAY YOU CALLED IN — AND REMEMBER, THIS IS NOT — I WANT
TO BE CLEAR, THIS IS NOT 911. THIS IS 811, SO YOU’RE NOT
CALLING — YOU’RE CALLING 811 BECAUSE YOU MAY NOT KNOW WHAT’S
GOING ON, BUT DURING THAT CONVERSATION, WE HAVE HAD
SCENARIOS WHERE WE HAVE BEEN SIGNIFICANTLY DISTRESSED BY
SOMEBODY TO THE POINT THAT WE’VE ACTUALLY SENT A WELLNESS VISIT
TO THEIR HOUSE. SO WE’VE ACTUALLY CONTACTED THE
POLICE AND SENT SOMEBODY TO CHECK ON THE PERSON.
SO SAY SOMEBODY WAS INCREDIBLY DISTRESSED, THREATENING TO HARM
THEMSELVES AND WE WERE WORRIED ABOUT THEM, WE WOULD ACTUALLY DO
A WELLNESS CHECK AND ACTUALLY SEND SOMEBODY TO THEIR HOUSE, SO
WE DO DO THAT.>>THANK YOU FOR THAT
INFORMATION. THE COST ESTIMATE FOR ONE CALL,
I’VE SEEN DOCUMENTED IT’S AROUND $52 PER CALL.
AND SOME HAVE MENTIONED THAT A PHYSICIAN VISIT COSTS $38.
SO I’M JUST WONDERING IF YOU CAN COMMENT ON WHETHER THOSE TWO NUMBERS ARE ACCURATE AND WHY
YOU THINK THERE’S A DIFFERENCE TO THAT AND
CERTAINLY WHETHER THAT’S A GOOD VALUE.
>>The Chair: DR. HOWLETT?>>YEAH, THANKS VERY MUCH, AND
IT’S A GREAT QUESTION AND I’VE HEARD THAT QUOTE.
IN FACT, ONE OF MY COLLEAGUES, I THINK IT WAS BARBARA O’NEAL, HAD
PUT IT — I KNOW BARB, SHE’S AN EXCELLENT PHYSICIAN.
LET ME SAY THIS, IT COSTS US NET PER CALL, IT’S AN OVERLY
SIMPLISTIC ANALOGY. THERE IS A LOT THAT 811 DOES
JUST BEYOND THE CALLS THAT COULD NOT BE PROVIDED BY A PHYSICIAN,
AS SUCH. FIRST OF ALL, IT’S AVAILABLE
24/7. IT IS AVAILABLE TO EVERY PERSON
IN THIS PROVINCE, ASSUMING YOU HAVE A PHONE.
IT IS — IT PROVIDES CONTINUOUS
SERVICE, DATA AND INFORMATION THAT A FAMILY DOCTOR MAY NOT
HAVE. AND IN ADDITION, ONE OF THE
THINGS WE TALKED ABOUT, AND WE LIKE TO TALK ABOUT IT, IT IS A
BIT OF A SAFETY NET FOR THE COMMUNITY AS WELL.
I WOULD LIKE TO HIGHLIGHT THAT SHORTLY AFTER WE STARTED THIS
PROGRAM, IF I MAY, IN 2009, IF YOU GUYS REMEMBER THE FALL OF
2009, WE WERE HIT BY H1N1. I KNOW, AND WE HAVE SOME VOLUMES
HERE THAT OUR CALL VOLUMES WENT UP — I DON’T KNOW IF YOU CAN
SEE THIS, BUT WE WENT 10 TIMES THE CALL VOLUMES OVERNIGHT
BECAUSE PEOPLE NEEDED TO RESPOND AND GET INFORMATION, AND 811 WAS
THERE TO DO IT. IT WAS EXTRAORDINARILY
CHALLENGING. WE HAD TO HIRE NURSES BEYOND THE
PROVINCE TO ACTUALLY COPE WITH THE CALL VOLUME.
SO THIS IS ONE OF THE SERVICES THAT 811 HAS THAT’S NOT INCLUDED
IN THIS $50 PER CALL BECAUSE THAT’S PART OF WHAT WE’RE DOING,
AND IT’S ALMOST LIKE — I USE THE ANALOGY THAT YOU DON’T KNOW
THAT YOU NEED A SMOKE DETECTOR UNLESS YOU HAVE A SMOKE
DETECTOR. AND WITH THE COST OF THE SMOKE
DETECTOR BECAUSE IT’S THERE. AND WITH THE OTHER THINGS THAT
ARE GOING ON, AND HOPEFULLY WE’LL GET TO IT IN SOME OF THE
QUESTIONS, AND I’LL TRY NOT TO BORE YOU WITH ALL THE THINGS I
WANT TO SAY, BUT I DO WANT TO MENTION THAT WE EVEN HAVE A ROLE
IN MEDICAL SURVEILLANCE IN THE PROVINCE.
YESTERDAY OUR CHIEF MEDICAL OFFICER WAS VISITING, AND AS
PART OF THAT WITH EMERGING ILLNESSES AND THE LIKE, WE’RE
LOOKING AT USING THE CALLS THAT WE’RE DOING AT 811 AS A ROLE FOR
THE MEDICAL SURVEILLANCE OF PUBLIC HEALTH IN THIS PROVINCE.
SO SOMEWHERE HIDDEN IN THAT SOUND BITE OF $50 VERSUS $30,
AND I UNDERSTAND WHAT’S GOING ON WITH THE FAMILY PHYSICIANS AND
THEIR CONCERN ABOUT THEIR PAY AND EVERYTHING ELSE, BUT I THINK
THERE’S SO MUCH MORE WE’RE GETTING OUT OF THAT.
I’M OBVIOUSLY CONVINCED THERE’S VALUE TO THAT, AND I THINK
THERE’S SOME EVIDENCE TO THAT AS WELL.
>>The Chair: MS. ADAMS?>>THANK YOU VERY MUCH, AND
CERTAINLY EVERYBODY THAT I’VE TALKED TO FINDS THE SERVICE OF
TREMENDOUS VALUE, ESPECIALLY AT 3 IN THE MORNING WITH A SICK
CHILD. I WONDER IF YOU COULD TELL ME
HOW MANY OF THE CALLS ARE ABOUT CHILDREN VERSUS ADULTS VERSUS SENIORS.
>>The Chair: WHO? DR. HOWLETT?
>>SO I APOLOGIZE FOR THAT.
WE BROUGHT DATA ON OUR TOP TEN CLINICAL GUIDELINES BOTH ADULT
AND PEDIATRIC, BUT WE DID NOT BRING WHICH PERCENTAGE ARE
PEDIATRICS, BUT WE CAN CERTAINLY MAKE THAT AVAILABLE TO YOU AND
BE HAPPY TO DO THAT. I CAN SHARE WITH YOU THE — YOU
KNOW, IN THE LAST — FROM APRIL OF LAST YEAR TO JUNE OF THIS
YEAR, THE CLINICAL GUIDELINES USED, JUST TO GIVE YOU SOME
INTEREST OF THAT, THE TOP GUIDELINES USED, ONE WAS CHEST
PAIN FOR ADULTS. THE NEXT ONE WAS A MEDICATION
QUESTION CALL AROUND ADULTS, PEOPLE CALLING ABOUT MEDICATION.
MANY OF THOSE MAY, DEPENDING ON WHETHER WE DEAL WITH THEM OR
NOT, MAY ACTUALLY GO THROUGH POISON CONTROL.
THEY DO SOME MEDICATION CONCERNS AND WE WORK BACK AND FORTH.
PEDIATRIC COUGH IS THE THIRD GUIDELINE, PERHAPS NOT
SURPRISINGLY, AND THERE IS SEASONAL VARIABILITY.
WE KNOW WHEN FLU SEASON ARRIVES, WE KNOW WHEN — SEASON ARRIVES
BECAUSE WE START TO SEE SOME OF THESE GUIDELINES GOING
ON AND WE CAN START SEEING THESE CALLS GO UP AND WORKING WITH ROB
WE CAN HELP SOME OF THAT. THE THIRD ONE IS ABDOMINAL PAIN
FEMALE IS THE THIRD ONE. DIARRHEA, ADULT VOMITING, ADULT
COLDS, PEDIATRIC. VOMITING WITHOUT DIARRHEA
PEDIATRIC, HEADACHE ADULT AND BACKPAIN ADULT.
THOSE ARE THE TOP TEN GUIDELINES USED THAT PEOPLE ARE CALLING IN
FOR.>>The Chair: MS. ADAMS?
>>THANK YOU. I’M WONDERING, GIVEN THE FACT
YOU MENTIONED BACK PAIN AND MEDICATIONS WHETHER THERE HAS
BEEN A CONSIDERATION TO HAVING A PHARMACIST CALL A PATIENT BACK
OR A PHYSIOTHERAPIST CALL SOMEBODY WITH BACK PAIN.
I’M JUST WONDERING IF THERE’S ANY OPPORTUNITY TO EXPAND THIS
SERVICE TO OTHER HEALTH PROFESSIONALS
>>The Chair: DR. HOWLETT?>>YES, THANK YOU FOR THE
QUESTION. INTERESTING THAT WE DO HAVE A
PHARMACIST THAT ACTUALLY SITS ON OUR CLINICAL ADVISORY COMMITTEE.
HE’S FROM NORTHERN ZONE AND HE’S FANTASTIC AND WE HAVE
EXPLORED THAT. THE CHALLENGE WITH 811, JUST
LIKE THE CHALLENGE OF — WE HAVE TO BE A GENERALIST.
SO IT’S VERY HARD TO, YOU KNOW, SAY HAVE A DERMATOLOGIST, AND
WE’RE TRYING NOT TO DIAGNOSE BUT TO HAVE A HIGH-LEVEL RESPONSE TO
WHAT WE DO. BUT HAVING A PHARMACIST, FOR
EXAMPLE, ON OUR CLINICAL ADVISORY COMMITTEE AND PROVIDING
INPUT INTO OUR CLINICAL GUIDELINES IS VERY HELPFUL.
AND IF I CAN, I’LL JUST TAKE ONE MORE MOMENT TO SAY OUR CLINICAL
GUIDELINES COME TO US FROM AN OUTSIDE AUTHOR.
WE PARTNER VERY CLEARLY WITH OUR LOCAL HEALTH EXPERTS TO ENSURE
THAT WHAT WE’RE SUGGESTING IS COMPATIBLE.
SO FOR EXAMPLE, BREASTFEEDING, WE HAVE AN ORGANIZATION, SO WE
WOULDN’T PROVIDE ADVICE THAT WASN’T IN ANY WAY DISCONGRUENT
WITH WHAT IS HERE, AND I’LL GIVE YOU AN EXAMPLE THAT HAPPENED
YESTERDAY. WE HAVE A NEW GUIDELINE COMING
AROUND COLONOSCOPY. SOME OF YOU MAY HAVE HAD A
COLONOSCOPY OR ENDOSCOPY. NOBODY WANTS TO TALK ABOUT THOSE
THINGS, BUT AN UNFORTUNATE NECESSITY.
ONE OF THE THINGS WE WERE FINDING, WHICH WAS INCREDIBLE,
IS OFTEN PEOPLE WOULD LOSE THEIR PREPARATION INSTRUCTION.
IT WOULD BE THE WEEKEND. THEY WOULD BE CALLING 811, AND
SAID I’VE WAITED 8 MONTHS FOR MY APPOINTMENT, I DON’T HAVE THE
INSTRUCTIONS. I NEED TO GET THIS PREP RIGHT.
WHAT DO YOU WANT TO DO? SO INTERESTINGLY ENOUGH, WE NOW
HAVE A SENIOR DIRECTOR, TWO PHYSICIANS THAT ARE IN CHARGE OF
ENDOSCOPY IN THE PROVINCE. I CALLED THEM UP AND SAID WHAT’S
THE PLAN? OH, YEAH, WE’RE WORKING ON THAT.
WHAT DO YOU MEAN YOU’RE WORKING ON THAT?
YEAH, THERE’S LIKE 45 DIFFERENT PREPARATIONS THAT EACH PHYSICIAN
HAS. I SAID WELL THAT’S CRAZY.
SORRY. THAT’S NOT THE RIGHT WORD.
THAT DOESN’T MAKE ANY SENSE. SO THEY’VE NOW STANDARDIZED IT
TO TWO, AND I LIKE TO THINK WE WERE PART OF THAT, CHALLENGING
THEM TO STANDARDIZE IT TO TWO. IF YOU HAVE RESIDENTIAL FAILURE,
IF YOU DON’T HAVE RENAL FAILURE, AND WE HAVE THESE GUIDELINES
THAT WE’VE SHARED WITH THEM. THEY’RE GOING TO PROVIDE SOME
INPUT, AND IN THE FUTURE, A COUPLE MONTHS NOW, IF YOU CALL
IN AND FORGOTTEN THE PREPARATION, WE’VE SPURNED THE
PROVINCE TO SAY LET’S STANDARDIZE IT.
THERE’S NOT ENOUGH EVIDENCE TO SAY 42.
WE CAN HAVE TWO STANDARD ONES AND WE CAN PROVIDE THAT TO YOU.
YOU CAN GO TO THE PHARMACY, GET YOUR PREPARATION AND HOPEFULLY
NOT MISS YOUR COLONOSCOPY. YOU MIGHT WANT TO MISS YOUR COLONOSCOPY, BUT YOU SHOULDN’T.
I CAN TALK FOREVER. IN ANSWER TO YOUR QUESTION, WE
ARE VERY IMPORTANT AND NOW LEAH AND WENDY REACH OUT REGULARLY TO
EXPERTS IN THE FIELD TO INFORM OUR GUIDELINES.
>>The Chair: MS. ADAMS?>>THANK YOU.
I’M WONDERING WHEN IF I CALL 811 AND I GET INSTRUCTIONS TO DO ONE
OF SEVERAL THINGS, I’M WONDERING TWO THINGS.
ONE IS: DO YOU TRACK WHETHER I ACTUALLY FOLLOW UP ON THOSE?
SO COULD WE SAY, YOU KNOW, 40% OF ALL SENT TO EMERGE AND WE
KNOW THAT 22% FOLLOW UP ON THAT? AND THE OTHER THING IS: DOES A
PHYSICIAN GET NOTIFIED THAT I’VE CALLED 811?
>>The Chair: DR. HOWLETT?>>BOTH GREAT QUESTIONS.
SO ON THE FIRST QUESTION, WE ARE — WE WOULD LOVE TO DO SOME
OUTCOME RESEARCH ON WHAT WE’RE DOING.
UNFORTUNATELY, THIS IS THE PRIVACY OFFICER NEXT TO ME.
THERE ARE SOME PRIVACY ISSUES FOR US TO ACTUALLY GO AND FIND
OUT IF YOU ATTENDED AT A FACILITY, AND IT IS NOT SIMPLE
FOR US TO — YOU WOULD THINK THAT WE COULD JUST GO AND SAY
DID YOU SHOW UP IN EMERGE, BUT WE CAN’T DO THAT WITHOUT YOUR
PERMISSION. THERE WAS SOME RECENT EXTERNAL
REVIEW THAT LOOKED AT IT, AND IT TALKED IN GENERALLY ABOUT
WHETHER PEOPLE FOLLOWED THE ADVICE OR NOT, AND GENERALLY
THEY DO. WE ALSO TRY AT THE END OF A
CALL, AND IT’S FRAUGHT WITH SOME PROBLEMS, TO SAY THIS IS OUR
ADVICE CAN WE ASK YOU WHAT WOULD YOU HAVE DONE HAD YOU NOT CALLED
811? AND WE HAVE SOME OF THAT DATA.
IF YOU’D LIKE TO SEE THAT, WE’D LOVE TO SHARE IT WITH YOU.
BUT BE AWARE THERE’S A BIAS THERE, RIGHT, BECAUSE WE’VE
ASKED YOU AT THE END OF THE INTERACTION.
WE’VE GIVEN YOU ADVICE AND THEN WE SAY WHAT WOULD YOU HAVE DONE
BEFOREHAND? IT IS VERY DIFFICULT TO SAY,
HEY, BEFORE YOU TELL ME ABOUT YOUR CHEST PAIN, TELL ME WHAT
YOU ARE THINKING OF DOING. IT’S HARD TO DO IT AT THE
BEGINNING OF THE CALL. WE WANT TO GET TO THE CHEST
PAIN. WE DON’T WANT TO ASK YOU TOO
MANY QUESTIONS ABOUT WHAT YOU’RE DOING, AND YOU’RE GOING TO THINK
IT’S A LITTLE CRAZY IF WHAT I WANT TO DO IS CALL YOU SO I DID THAT, YEAH.>>The Chair: MS. ADAMS?
>>THANK YOU FOR THAT. APPARENTLY THERE WAS AN
INDEPENDENT CONSULTANT RETAINED BY THE DEPARTMENT TO REVIEW THE
811 SYSTEM IN 2018, AND I’M WONDERING IF YOU HAVE THAT
REPORT WITH YOU. AND IF SO, WHAT WERE THE MAJOR
CONCLUSIONS?>>The Chair: DR. HOWLETT?
>>THANK YOU. WE DO NOT HAVE THAT REPORT WITH US.
THERE WAS A NUMBER OF — A NUMBER OF VERY POSITIVE THINGS
THAT CAME FROM THAT, AND I CAN SPEAK TO A COUPLE OF THEM, IF
YOU LIKE. ONE OF THE CRITIQUES, AND YOU
KNOW, I’M — IF YOU KNOW ME, I LIKE TO TALK ABOUT THE ELEPHANT
IN THE ROOM. ONE OF THE CRITIQUES ABOUT 811
— I’M AN EMERGENCY DOCTOR, SO YOU KNOW, 1-800-GO TO EMERGENCY
DEPARTMENT. SO I CAN TELL YOU OUR BREAK DOWN
FROM WHAT’S HAPPENED. A LOT OF HEALTH CARE PROVIDERS
WHO ARE IN BUSY EMERGENCY DEPARTMENTS, INCLUDING MYSELF
AND MY COLLEAGUES, SEE THE DENOMINATOR AND NOT THE
NUMERATOR AND NOT DENOMINATOR. WE KNOW THE PEOPLE THAT WERE
SENT IN AND WE REMEMBER THEM, BUT WE DON’T KNOW THE PEOPLE
THAT WEREN’T SENT IN. SO BY OUR VERY NATURE WE HAVE A
BIAS. BUT IN THE LAST YEAR, ALL THE
PEOPLE THAT CALLED IN, APPROXIMATELY 4% OF PEOPLE WERE
SENT TO 911, OF ALL THE CALLS. 1.9% WENT TO POISON CONTROL.
0.3% OF PEOPLE WHO WERE FORWARDED TO THE MENTAL HEALTH
CRISIS LINE, AND I KNOW, I’VE HEARD A NUMBER OF THE MEMBERS,
MENTAL HEALTH IS — AND IN PARTICULAR PARTS OF THIS
PROVINCE IS A SIGNIFICANT CONCERN.
18.7% WERE DIRECTED TO THE EMERGENCY DEPARTMENT.
NOT EVERYBODY. AND THEN THOSE OTHER
DISPOSITIONS, PRIMARY HEALTH CARE PROVIDER AND THE LIKE, WORK
OUT TO BE ABOUT 42%. SELF-AND HOME CARE WORKED OUT TO
BE 30% OVERALL. SO I’M NOT AN EXPERT IN CHEWING
THEORY, BUT LET ME EXPLAIN. IDEALLY, IF EVERYBODY CALLS TO
US AND WE CAN ARRANGE THAT YOU CAN BE SEEN TOMORROW OR THE NEXT
DAY, THEN IT WOULD HELP THE SYSTEM IN SOME WAYS TO DETERMINE
— NOW, THE CHALLENGE IS YOU HAVE TO HAVE AN APPOINTMENT
TOMORROW OR THE NEXT DAY, AND THAT’S WHERE THE WALK-IN CLINICS
SOMETIMES COME IN AND OTHER THINGS.
THOSE RECOMMENDATIONS WE ACTUALLY TALK ABOUT PRIMARY
HEALTH CARE PROVIDER, BUT THE NURSES SPEND A LOT OF TIME IN
EVERY AREA, SO IF THEY ARE UP IN CAPE BRETON OR IF THEY’RE ON THE
SOUTH SHORE AND THE DISPOSITION IS THE NEXT DAY, HOW THAT MAY
LOOK MAY BE VERY DIFFERENT. IF YOU’RE LUCKY ENOUGH TO HAVE A
FAMILY DOCTOR WHO HAS A SAME-DAY APPOINTMENT TOMORROW, GREAT.
IF YOU’RE NOT LUCKY ENOUGH TO HAVE THAT, YOU MAY NEED TO GO TO
THE WALK-IN CLINIC. IF YOU’RE NOT LUCKY ENOUGH TO DO
THAT, YOU MAY HAVE TO GO TO YOUR LOCAL CEC.
THERE ARE A LOT OF PROBLEM SOLVING DONE BY THE NURSES IN
EACH AREA TO FIGURE OUT WHERE THE PERSON NEEDS TO GET THEIR
CARE.>>The Chair: MS. ADAMS?
>>I THINK I HAVE TIME FOR ONE MORE QUESTION, AND IT’S A BIT
OFF-TOPIC, BUT ACCORDING TO THE NOVA SCOTIA
HEALTH AUTHORITIES BY THE MEMBERS, THE NUMBER OF BEDS IN
2017-18 REPORT WAS 3554 AND THE NUMBER OF BEDS IN 18-19 WAS
3150, SO IT’S A LOSS OF 104 BEDS.
I’M WONDERING WHERE THOSE BEDS WENT.
>>?>>I DON’T KNOW, IT’S ACCORDING
TO THE NOVA SCOTIA HEALTH AUTHORITY BEDS.
IT JUST GIVES YOU A LIST OF THE NUMBER OF BEDS IN THE HOSPITALS
AND SAYS THOSE — >>The Chair: ORDER.
TIME HAS EXPIRED FOR THE PC CAUCUS.
WE’LL TURN IT OVER TO MS. MARTIN FOR THE NDP.
>>THANK YOU. SAVED BY THE BELL.
>>THANK YOU VERY MUCH. SO I’D LIKE TO TALK ABOUT THE
NEED FOR FAMILY PRACTICE AND WHO ACTUALLY IS FINDING A DOCTOR AS
OPPOSED TO JUST COMING OFF OF THE LIST.
AND ARE YOU TRACKING THE DEMOGRAPHICS OF THOSE PEOPLE WHO
ARE FINDING DOCTORS?>>The Chair: DR. HOWLETT?
>>YEAH, THANK YOU FOR THE QUESTION.
AS I MENTIONED IN MY OPENING REMARKS, THE CONNECTION TO 811
AND FAMILY PRACTICE IS PURELY THAT AS TO COLLECT THE NUMBERS
AND PASS THOSE ON TO THE NOVA SCOTIA HEALTH AUTHORITY.
SO AS SUCH, WE DO NOT ACTUALLY MANAGE THAT LIST, AND I ACTUALLY
DON’T HAVE THE NUMBERS OF THE LIST BECAUSE IT WAS — THE ROLE
OF 811 WAS WE HAVE A NUMBER, PEOPLE CAN CALL THERE, AND ALL
OF THAT DATA IS THEN PASSED TO THE NOVA SCOTIA HEALTH
AUTHORITY.>>The Chair: MS. MARTIN?
>>THANK YOU. DO ANY DOCTORS ACTUALLY HAVE TO
TAKE PATIENTS OFF THE LIST OR IS IT FULLY OPTIONAL FOR THEM?
AND I UNDERSTAND THAT THERE WAS AN INCENTIVE PROGRAM IN PLACE
THAT OFFERED DOCTORS ADDITIONAL COMPENSATION FOR EVERY PATIENT
THAT THEY WERE ABLE TO ADD TO THEIR ROSTER WHO WAS ON THE 811
LIST. BUT I THINK MANY PEOPLE AREN’T
CLEAR AS TO WHETHER CALLING AND REGISTERING THEMSELVES AS
SOMEONE IN SEARCH OF A FAMILY DOCTOR WILL GIVE THEM PRIORITY
OVER SEARCHING ON THEIR OWN. SO IS THAT A PRIORITY LIST?
BEING ON THE 811?>>The Chair: DR. HOWLETT?
>>THANK YOU FOR THE QUESTION. I’LL REFER TO MY FURTHER
PREVIOUS ANSWER. WE DON’T MANAGE THE LIST, AND
THE WAY THAT PEOPLE ARE TAKEN OFF THE LIST IS MANAGED BY THE
NOVA SCOTIA HEALTH AUTHORITY.>>The Chair: MS. MARTIN.
>>OKAY. IT STRIKES ME THAT THE SERVICE
PRODUCES A TON OF USEFUL DATA BOTH ABOUT THE SERVICE ITSELF
AND ABOUT THE HEALTH ISSUES PEOPLE ARE FACING IN NOVA
SCOTIA. WHAT ARE WE LEARNING FROM THE
811 DATA ABOUT HEALTH ISSUES IN NOVA SCOTIA?
AND IS ANYONE LOOKING AT THE DATA IN A SYSTEMATIC WAY?
AND IS THAT DATA AVAILABLE TO HELP POLICY RESEARCHERS?
>>The Chair: DR. HOWLETT?>>I REALLY APPRECIATE THAT
QUESTION. IT’S A GREAT QUESTION, AND I
THINK WE’RE CHALLENGING OURSELVES TO DO JUST THAT IN TWO
WAYS, IF I MAY. ONE IS THROUGH WORKING CLOSELY
WITH THE NOVA SCOTIA HEALTH AUTHORITY SPECIFICALLY AROUND
THE NEW PROGRAMS OF CARE. SO WE’RE SYSTEMATICALLY MEETING
WITH — YOU MAY KNOW THAT NOVA SCOTIA HEALTH RIGHT NOW HAS
PROGRAMS OF CARE ON CANCER CARE, ON MENTAL HEALTH AND ADDICTIONS, ON EMERGENCY CARE,
ON CRITICAL CARE, AND AS SUCH, THEY HAVE A SENIOR DIRECTOR AND
A SENIOR MEDICAL PHYSICIAN. SO WE’RE MAKING A POINT OF
REACHING OUT TO THEM. LAST YEAR WE SAT DOWN WITH DREW
BETHUNE WHO MANY OF YOU MAY KNOW AND HIS DIRECTOR FOR CANCER AND
TALKED ABOUT WHAT THEIR CHALLENGES ARE AND WHAT WE MIGHT
HELP THEM WITH. SO THIS ISN’T SPECIFICALLY ABOUT
DATA, BUT A SHARED OPPORTUNITY. AND ONE OF THE THINGS THAT CAME
FROM THAT, IT MAY OR MAY NOT WORK OUT, BUT THAT A LOT OF
PEOPLE WHO WERE GETTING IV CHOOEM THERAPY ARE NOW ON ORAL
CHEMOTHERAPY AGENTS, WHICH ARE STILL QUITE EXPENSIVE, STILL
QUITE EFFECTIVE, AND NOW THE ISSUE’S BECOME COMPLIANCE WITH
TAKING THE ORAL MEDICATION. SO THEY WERE EXPLORING WHETHER
THEY SHOULD HAVE A NURSE CALLING OUT TO ENSURE THAT SOMEBODY WHO
NOW LIVES ON THE SOUTH SHORE, SOMEWHERE ELSE, THAT DOESN’T
COME IN FOR IV CHEMO IS ACTUALLY GETTING THE CHEMOTHERAPY AGENT.
AND I SAID TO THE DOCTOR PERHAPS MAYBE WE COULD PARTNER TOGETHER
IF WE HAVE NURSES AND WE PROVIDE THAT SERVICE AND IT MIGHT BE
CHEAPER FOR THE SYSTEM THAN BUILDING ANOTHER SYSTEM ON TOP
OF WHAT WE HAVE. SO THAT WAS — AND THEN WE’RE
TRYING TO DO THAT EACH STEP. ONE OF THE PEOPLE I HOPE TO MEET
IS THE NEW VICE-PRESIDENT FOR RESEARCH THAT THE NOVA SCOTIA
HEALTH AUTHORITY HAS. I’M QUITE PASSIONATE ABOUT DOING
SOME EVIDENCE-BASED AND OUTCOME RESEARCH, AND I THINK THE
PROGRAM IS WELL PLACED FOR THAT TO MEET WITH HER AND FIND OUT
WHAT DATA WE CAN GLEAN FROM THIS.
PRIMARY HEALTH CARE IS ANOTHER EXAMPLE.
I HAVE A MEETING COMING UP WITH DR. RICK GIBSON AND LYNN EDWARDS
TO LOOK AT WHAT WE MIGHT LEARN FROM 811 WHEN IT COMES TO
PRIMARY HEALTH CARE. SO IT’S A GREAT QUESTION.
IT’S CERTAINLY A FOCUS, AND IT’S CERTAINLY SOMETHING WE WANT TO
DO, TO SHARE AND — YOU KNOW, AND THE PROVINCE DESERVES US TO
DO THIS. WE NEED TO GET THIS RIGHT AND WE
NEED TO FIGURE OUT WHAT CAN WE GET FROM THIS SYSTEM TO SHOW THE
NOVA SCOTIA HEALTH AUTHORITY WHAT MIGHT BE NEEDED.
YEAH, ABSOLUTELY.>>The Chair: MS. MARTIN.
>>SO JUST TO FOLLOW UP ON THAT, THEN, IS THE DATA THAT’S BEING
COLLECTED BEING STUDIED AND EVALUATED TO PROVIDE SUGGESTIONS
AND/OR COMMENTS TO THE NSHA?
>>YES.>>The Chair: DR. HOWLETT?
>>THANK YOU. YES, WE ARE DOING SOME OF THAT
THROUGH OUR CLINICAL ADVISORY COMMITTEE.
ONE OF THE PEOPLE THAT JOINED US RECENTLY IS A RESEARCHER AND HAS
AN INTEREST IN THIS FROM THE IWK.
A LARGE NUMBER OF OUR CALLS ARE FROM THE IWK.
AND WE’RE EXPLORING HOW WE MIGHT DO THIS.
WE TALKED ABOUT SOME OUTCOME RESEARCH, TRYING TO FIGURE OUT,
YOU KNOW, WHAT’S ACTUALLY HAPPENING TO PEOPLE.
DO WE HAVE THAT RIGHT YET? NO, I DON’T THINK WE DO, BUT I
DO THINK THAT WE WILL DO THAT. ONE OF THE NEAT PARTNERSHIPS
THAT’S CHANGED RECENTLY IS OUR PROGRAM WAS TAKEN OVER FROM EMCI
FROM McCONTESTEN, SO A THIRD PARTY.
EMCI DOES DO A LOT OF RESEARCH AND WE’RE HAVING SOME MEETINGS
AND COLLABORATING BOTH ON CONTINUOUS QUALITY IMPROVEMENT
PROJECTS AND WE HOPE WITH RESEARCH AS WELL BECAUSE THEY
HAVE MORE RESOURCES AROUND RESOURCES THAN WE HAVE, SO YEAH,
I MEAN, WE’RE IN THE INFANCY OF THAT, BUT IT’S EXACTLY WHAT WE
INTEND TO DO.>>The Chair: MS. MARTIN.
>>SO TO CLARIFY, THEN, IS THE DATA — HAS THE DATA NOT BEEN
USED FOR THE LAST 10 YEARS, AND IT’S A NEW APPROACH?
>>The Chair: DR. HOWLETT?>>NO, I DON’T THINK THAT’S A
FAIR CHARACTERIZATION OF WHAT I SAID.
I THINK THAT WE HAVE ALWAYS SHARED THE DATA.
WE HAVE ALWAYS PASSED THE DATA ON TO OUR PARTNERS.
FORMAL RESEARCH IS NOT BEING DONE ON THIS.
I THINK THAT’S FAIR. BUT WE DID A MICRORESEARCH
PROJECT WITH A FORMER DEAN. THERE’S DIFFERENT LEVELS OF
RESEARCH, PUBLISHABLE RESEARCH AND CQI-TYPE RESEARCH.
WE HAVE CONTINUOUSLY SENT THAT DATA BACK TO VARIOUS
STAKEHOLDERS WITHIN THE ORGANIZATION WHEN WE FOUND
SOMETHING THAT SEEMED TO MISS. SO THERE HAS BEEN A LOT OF
INTERACTION WITH STAKEHOLDERS WITHIN THE PROVINCE.
I THINK WHAT WE’RE SUGGESTING NOW IS WE MIGHT BE ABLE TO TAKE
IT TO ANOTHER LEVEL AND LEVERAGE SOME OF THE RESOURCES THAT EXIST
WITHIN EMCI. I MEAN, I THINK YOU GUYS KNOW
WE’RE ONE OF THE PREMIER HOSPITAL SYSTEMS IN THE
PROVINCE, OUR EHS SYSTEM, AND THEY ARE DOING A LOT OF
RESEARCH, AND WE’RE HOPING TO PARTNER TO DO EVEN MORE WITH
WHAT WE HAVE NOW. WE HAVE DONE THIS.
I THINK WE CAN DO MORE.>>The Chair: MS. MARTIN.
>>THANK YOU FOR THE CLARIFICATION.
SO ASIDE FROM H1N1, WHAT HAS THE TREND BEEN IN THE USAGE OF —
YOU SPOKE ABOUT H1N1 SHOWING A SIGNIFICANT INCREASE, BUT HAS IT
BEEN AN UPWARD OR DOWNWARD TREND?
>>The Chair: DR. HOWLETT?>>I THINK THE LAST CONVERSATION
WE HAD IS OVERALL THE NUMBERS HAVE BEEN SLIGHTLY LESS, AND ONE
OF THE EXTERNAL REVIEWS QUESTIONED AS TO WHY.
THE PREMISE HAD BEEN THAT THE PROGRAM SHOULD — WE SHOULD SEE
AN UPTAKE, AN INCREASE THROUGH THAT.
ONE OF THE CHALLENGES THAT WE HAVE AT 811 IS THAT WE ARE NOT
RESPONSIBLE FOR OUR OWN ADVERTISEMENT.
IT’S ALL DONE THROUGH THE DEPARTMENT OF HEALTH, SO WE’RE
ENCOURAGING THEM TO MAYBE MAKE MORE FRIDGE MAGNETS OR, YOU
KNOW, TO ADVERTISE IT. I THINK THAT’S GETTING BETTER.
DURING SOME OF THE CONVERSATIONS WE HAD, THE HYPOTHESIS THAT 811
NUMBERS SHOULD ALWAYS INCREASE IS SOMETHING THAT PARTICULARLY I
HAVE — I’M NOT SURE ABOUT. I WOULD LIKE TO THINK A LARGE
PART OF WHAT 811 DOES IS EDUCATION.
SO IF YOU’RE A YOUNG MOTHER AND YOU HAVE THREE CHILDREN AND YOU
HAVE A FEVER AND YOU DON’T KNOW HOW TO TREAT IT AND YOU’VE
CALLED 811 AND WE’VE GIVEN YOU ADVICE AND WE’VE EDUCATED YOU,
PERHAPS YOU DON’T NEED TO CALL US THE SECOND TIME BECAUSE WE’VE
DONE THAT. SO I DO THINK — AND A LOT OF
WHAT I DO — WE ALWAYS SAY MORE IS BETTER, AND I THINK WE CAN DO
A BETTER JOB ADVERTISING THE PROGRAM, THERE’S NO QUESTION.
BUT I’M NOT SURE THAT THE SLIGHTLY DECREASED NUMBERS
NECESSARILY IS A BAD THING. IT MAY MEAN THAT WE’RE ACTUALLY
EDUCATING PEOPLE. BUT WE CAN PROVIDE THOSE NUMBERS
AGAIN AND I APOLOGIZE WE DON’T HAVE ALL THESE NUMBERS IN FRONT
OF US, BUT WE CAN CERTAINLY TELL YOU WHAT THE NUMBERS WERE AND
THE CALLS FOR THE TEN YEARS OF THE PROGRAM.
WE’D BE HAPPY TO PROVIDE THAT FOR YOU, IF YOU LIKE.
>>The Chair: MS. MARTIN. >>THANK YOU, AND EARLIER YOU TALK ABOUT
IN 2010 THERE WAS A REPORT ON HEALTH LINK 811 THAT WOULD
INCLUDE ANALYSIS AND TREND. SO WHAT IS SUCCESS FOR 811 AT
THE END OF THE DAY? WHAT ARE THE OUTCOMES THAT 811
NEEDS TO MEET AT THE END OF THE DAY — OR AT THE END OF THE
YEAR, AND HOW DO WE KNOW THAT 811 IS ACTUALLY — IS
SUCCESSFUL?>>The Chair: DR. HOWLETT?
>>THANK YOU. I’M NOT SURE WITH 2010 WAS THE
YEAR. I THINK THE REPORT WAS FROM
2018. MAYBE IT WAS IN THE LAST YEAR.
BUT IT’S A GREAT QUESTION, AND THE EXTERNAL REPORT BROADLY
LOOKED AT WHETHER WE HAD VALUE AND WHETHER THERE WAS VALUE FOR
NOVA SCOTIANS, WHETHER WE WERE — WHETHER PEOPLE THAT
CALLED US WHO WENT TO THE EMERGENCY DEPARTMENT IN A MATCH
CONTROL MIGHT BE SICKER. I’M USING THE SIMPLE TERMS.
THAN PEOPLE THAT WENT ON THEIR OWN.
THERE WAS SOME DATA — THEY GOT SOME PERMISSION TO FOLLOW PEOPLE
THROUGH USING A BILLING NUMBER. THEY SHOWED DURING THAT TIME
THAT FOR MATCHED PATIENTS — I MAY NOT HAVE THIS EXACTLY RIGHT,
BUT FOR MATCHED PATIENTS, THE PEOPLE BEING REFERRED BY 811
WERE AT HIGHER ACUITY LEVELS. SO FOR THOSE OF YOU — AND I
IMAGINE MANY OF YOU ARE AWARE THAT IN THE EMERGENCY
DEPARTMENT, AND I’M AN EMERGENCY PHYSICIAN, WE USE THE CTAS
LEVEL, CANADIAN TRIAGE AND ACUITY SCORE LEVEL OF ONE TO
FIVE WITH ONE BEING SICKEST PATIENT AND FIVE BEING THE LEAST
SICK PATIENT. AND IT’S SORT OF A PROXY FOR
SICKNESS, THE IDEA BEING, YOU KNOW, IF WE’RE DOING CPR ON YOU
YOU’RE A ONE AND IF YOU’VE COME IN BECAUSE YOU’VE RUN OUT OF
YOUR ANT ACIDS YOU’RE A FIVE, AND YOU’RE GOING TO BOSTON THIS
WEEKEND AND YOU REALIZE YOU DON’T WANT HEART BURN, THAT
WOULD BE A FIVE, AND THERE ARE ALL KINDS OF STUFF IN-BETWEEN.
NOW THERE ARE FIVES THAT ARE NOT QUITE THAT FRIVOLOUS, SO IT
LOOKED LIKE THE DATA SUGGESTED THAT THE PEOPLE REFERRED BY 811
WERE HIGHER ACUITY AND DIFFERENT THAN THOSE PEOPLE.
SUCCESS IS AN INTERESTING THING, BECAUSE I SUCCESS IS IN THE EYE
OF THE BEHOLDER. WE HAVE A PERFORMANCE CONTRACT
WITH THE DEPARTMENT OF HEALTH, AND THERE ARE DELIVERABLES AND
CONTRACTS THAT WE HAVE TO DELIVER CERTAIN CALLS.
WE WERE ONE OF THE LAST PROVINCES TO ADOPT AN 811
SYSTEM, FOR WHATEVER THAT’S WORTH.
THE OVERWHELMING RESPONSES FROM THE PEOPLE THAT USE 811 ARE OVERWHELMINGLY POSITIVE.
WE ARE CONSTANTLY STRUGGLING IN — AND IT’S A STRUGGLE IN OUR
CAC TO FIND THE BALANCE BETWEEN MAKING SURE WE DO NOT MISS ANYTHING SERIOUS
AND BEING — CREATING A PROGRAM THAT’S
SENSITIVE ENOUGH NOT TO MISS A SERIOUS CASE.
AT THE SAME TIME, NOT HAVING SUFFICIENT SPECIFICITY SO WE’RE
NOT SENDING EVERYBODY INTO THE TWO — I’LL BE HONEST WITH YOU.
ONE IS IT SEEMED TO BE WE’RE TOO SENSITIVE AND EVERYBODY IS SENT
TO BE SEEN BY SOMEBODY, AND THE OTHER THING IS WE MISS SOMEBODY.
I THINK IT’S UNFAIR TO CHARACTERIZE THE PROGRAM EARLIER
ON THAT THIS WOULD BE A WAY TO DIVERT PATIENTS FROM THE
EMERGENCY DEPARTMENT. I DON’T THINK THERE’S ANY
EVIDENCE, NEVER ANY EVIDENCE THAT’S THE CASE.
WE JUST CHANGE THE PEOPLE THAT GO.
THERE MAY BE PEOPLE THAT, YOU KNOW, WENT TO THE EMERGENCY
DEPARTMENT OR THAT SHOULD GO TO THE EMERGENCY DEPARTMENT THAT
DIDN’T. AS AN EMERGENCY PHYSICIAN,
SOMETIMES WE HEAR ABOUT THE PERSON THAT STAYED HOME, HAD
HEARTBURN AND HAD A HEART ATTACK THREE DAYS AGO AND THEIR HEART’S
IN TROUBLE NOW, RIGHT, AND THOSE PEOPLE WE’RE SENDING IN AND
OTHER PEOPLE WE MAY BE NOT SENDING IN.
>>The Chair: MS. MARTIN?>>THANK YOU.
SO IN 2010 THERE WAS AN ACCOUNTABILITY REPORT DONE, AND
IN 2018 THERE WAS AN EXTERNAL REVIEW.
TYPICALLY THESE ARE MADE PUBLIC AND PUBLISHED ON THE DEPARTMENT
OF HEALTH AND WELLNESS WEBSITE. CAN YOU CONFIRM THAT THESE ARE
PUBLIC DOCUMENTS, AND IF SO, THAT WE COULD ACTUALLY HAVE
COPIES OF THEM? I BELIEVE WE RECEIVED THE 2010
ONE, BUT NOTHING FURTHER.>>The Chair: DR. HOWLETT?
>>THANKS FOR THAT. THANKS FOR CLARIFYING THAT, THAT
THE RECENT REVIEW. THAT WAS DONE BY THE DEPARTMENT
OF HEALTH AND WELLNESS. AS SUCH, IT DOESN’T BELONG TO
US. IT WAS AN EXTERNAL REVIEW, AND
I’LL HAVE TO DEFER TO THEM AS TO HOW THEY MAKE IT PUBLIC, BECAUSE
IT’S NOT — IT’S NOT WITHIN OUR PURVIEW TO ACTUALLY MAKE THAT
PUBLIC.>>The Chair: MS. MARTIN?
>>THANK YOU. SO IS THERE AN ACCOUNTABILITY
REPORT PUBLISHED EVERY YEAR? AND IF NOT, WHY ISN’T THERE?
>>The Chair: DR. HOWLETT?>>SO I’M UNAWARE OF
ACCOUNTABILITY. WE HAVE, JUST LIKE OUR EHS
SYSTEM DOES, WE HAVE A PERFORMANCE REQUIREMENTS THAT
ARE DONE AND ACCOUNTABILITY AS SUCH.
SO WE HAVE REGULAR MEETINGS WITH THE DEPARTMENT OF HEALTH AND
WELLNESS OF WHAT OUR PERFORMANCE CONTRACT OBLIGATIONS ARE.
BUT I’M UNAWARE OF A — AND IT MAY JUST BE I NEED TO GET SOME
MORE INFORMATION ABOUT WHETHER THIS ACTUALLY IS CALLED AN
ACCOUNTABILITY REPORT. WE HAVE A COMPLIANCE REVIEW.
DO YOU WANT TO TALK ABOUT THAT?
>>The Chair: MS. GALLANT. >>THANK YOU.
SO AS DR. HOWLETT STATED, IT IS A PERFORMANCE-BASED CONTRACT.
SO THERE IS A YEARLY COMPLIANCE REVIEW THAT IS COMPLETED,
ENSURING THAT CERTAIN METRICS ARE FOLLOWED WITHIN THE
CONTRACTS THAT ARE COMPLETED ON A YEARLY BASIS.
>>The Chair: MS. MARTIN. >>THANK YOU.
AND ARE THESE PUBLIC DOCUMENTS?>>The Chair: MS. GALLANT.
>>THAT WOULD BE SOMETHING FOR DEPARTMENT OF HEALTH AND
WELLNESS TO SPEAK ABOUT.>>The Chair: MS. MARTIN.
>>THANK YOU FOR THAT. WHEN WE TALK ABOUT DATA, OF
COURSE WE NEED TO TALK ABOUT PRIVACY.
SO I’M WONDERING WITH 811 HOW DO WE ENSURE THAT THE PERSONAL
INFORMATION OF PEOPLE CONTACTING 811 IS NOT AT RISK OR
DISTRIBUTED TO THOSE WHO SHOULDN’T HAVE THAT INFORMATION?
>>The Chair: MS. GALLANT?>>JUST TO CLARIFY, ARE YOU
SPEAKING INTERNALLY OR EXTERNALLY?
IN TERMS OF ACCESS OF INFORMATION?
>>The Chair: MS. MARTIN?>>WELL, I’D LIKE TO KNOW THE
PROCEDURE IF I WAS TO CALL 811, WHAT IS YOUR PRIVACY POLICY
AROUND MY PERSONAL INFORMATION AND WHERE THAT COULD END UP?
>>RIGHT.>>The Chair: MS. GALLANT.
>>SO THANK YOU FOR THE QUESTION.
SO WHEN ANYBODY PHONES INTO 811, THERE’S A CONFIDENTIAL CHART
THAT IS STARTED WITH THEIR INFORMATION SO THAT WE’RE ABLE
TO DOCUMENT THE REASON FOR THEIR CALL.
ANYONE HAVING ACCESS TO THAT CHART IS DELIVERING CARE OR
SERVICE TO THAT PATIENT. SO IT IS ROLE-BASED ACCESS, AND
ANY ACCESS TO ANY CHARTS IS MONITORED ON A REGULAR BASIS.
>>The Chair: MS. MARTIN.>>AND JUST AS A FOLLOW-UP TO
THAT, IS THAT CONNECTED IN ANY WAY THROUGH — WITH THE NSHA
PATIENT INFORMATION?>>The Chair: MS. GALLANT.
>>THANK YOU. SO IT IS SEPARATE ALL TOGETHER.
IT RESTS WITHIN EMCI, THE INFORMATION.
SO WE ARE AN AGENT FOR THE DEPARTMENT OF HEALTH AND
WELLNESS WHO IS THE CUSTODIAN OF THE INFORMATION.
>>The Chair: MS. MARTIN.>>THANK YOU.
BUT IT’S NOT CONNECTED TO MY CHART?
SO I GUESS TO BE CLEAR, IF I HAD A HEART ATTACK, WOULD THERE BE
RECORD OF THAT IN MY — YOU KNOW, IN MY FAMILY DOC’S CHART?
OR IF I WAS SENT TO EMERGE?>>The Chair: MS. GALLANT.
>>SO FOR CONTINUITY OF CARE PURPOSES, IF SOMEONE DOES PHONE
INTO OUR SERVICE AND WE DO RECOMMEND THAT THEY GO TO THE
EMERGENCY DEPARTMENT, WE DO ASK THAT IF WE CAN SEND A REFERRAL
OF THE 811 CHART TO THE EMERGENCY.
AND IF THEY GIVE THEIR CONSENT, THEN WE SEND THAT OVER
IMMEDIATELY.>>The Chair: MS. MARTIN.
>>THANK YOU VERY MUCH. SO I’M WONDERING, TOO, WITH
PEOPLE CALLING IN AND THEIR PERSONAL INFORMATION BEING HELD
BY A THIRD PARTY, IS THAT ON SITE DATA?
HOW IS THAT PHYSICALLY HELD?>>The Chair: MS. GALLANT.
>>IT IS ON SITE, AND THERE WAS AN IN-DEPTH PRIVACY IMPACT
ASSESSMENT COMPLETED AT THE START OF THE PROGRAM AND WITH
EACH CONTRACT, ENSURING THAT PRIVACY STANDARDS ARE MET.
>>The Chair: MS. MARTIN, LESS THAN A MINUTE.
>>SORRY?>>The Chair: LESS THAN A
MINUTE.>>OKAY, THANK YOU.
SO IS THAT SOMETHING THAT’S REVIEWED ANNUALLY, PRIVACY
POLICIES AND CONCERNS? BY THE LOOK ON THE DOC’S FACE,
I’M GUESSING THAT’S A YES, BUT — BECAUSE, I MEAN, WE’VE HEARD
RECENTLY OF BREACHES, YOU KNOW, AND SADLY ACCIDENTS HAPPEN, BUT
IS THIS SOMETHING THAT’S SCRUTINIZED FREQUENTLY?
>>The Chair: MS. GALLANT. >>THANK YOU FOR THE QUESTION.
SO PRIVACY IS OF THE UTMOST IMPORTANCE IN ENSURING THE
SAFETY OF PATIENT RECORDS AND PATIENT INFORMATION.
>>The Chair: ORDER. TIME HAS EXPIRED FOR THE NDP.
WE’LL MOVE IT ON TO THE LIBERAL CAUCUS FOR 20 MINUTES.
MS. DICOSTANZO.
>>THANK YOU, MADAM CHAIR, AND I’M DELIGHTED TO SEE YOU GUYS
HERE. I REMEMBER RECEIVING A CALL TEN
YEARS AGO, AND I THINK IT WAS SIX MONTHS BEFORE 811 WAS TO BE
OPENED TO THE PUBLIC, AND I THOUGHT, WOW, WHAT AN AMAZING
SERVICE THAT WE’RE GONNA HAVE. IT WAS SOMETHING FOR THE FUTURE
THAT WE CAN CALL 24 HOURS, BUT THE CALL I RECEIVED WAS FROM THE
ORGANIZATION IS HOW TO PROVIDE INTERPRETING SERVICES AS I WAS
THE PRESIDENT OF THAT ORGANIZATION.
SO I’M WONDERING, IN 10 YEARS — I KNOW AT THE TIME PRIVACY WAS
THE BIGGEST THING FOR ME TO PROVIDE INTERPRETERS 24 HOURS
AND TO MAKE SURE THEY HAD A ROOM WHERE THEY CAN ANSWER WITH TOTAL
PRIVACY AND OTHER THINGS. SO FIRST MY QUESTION IS: HOW ARE
YOU PROVIDING SERVICES TO NEWCOMERS IN DIFFERENT
LANGUAGES? AND HOW MANY CALLS DO YOU
RECEIVE THAT ARE FROM THE NON-ENGLISH SPEAKING CLIENTS?
>>The Chair: WHO WOULD LIKE TO TAKE THAT?
MS. GALLANT.>>THANK YOU.
SO WE DO PARTNER WITH LANGUAGE MIND SOLUTIONS, WHICH IS AN
INTERPRETIVE LANGUAGE COMPANY. THEY PROVIDE A LANGUAGE WITHIN
240 LANGUAGES. IT’S TYPICALLY IF A PERSON DOES
PHONE IN FOR A SERVICE AND REQUIRING AN INTERPRETER, WITHIN
A ONE-MINUTE TIME FRAME OR LESS WE DO HAVE THAT INTERPRETER ON
THE PHONE. AND IT IS PART OF OUR CONTRACT
WITH LANGUAGE LINE SOLUTIONS THAT THERE’S AN INTERPRETER WITH
MEDICAL TERMINOLOGY, BECAUSE THAT WOULD BE REALLY IMPORTANT
IN PROVIDING OUR SERVICES. AND THEN WE ALSO DO HAVE SOME
BILINGUAL STAFF AS WELL AS PART OF THE 811 SERVICE TO PROVIDE
FRENCH SERVICES AS WELL. AND IF THERE ARE NO BILINGUAL
STAFF ON, THEN WE CAN ESCALATE THOSE CALLS TO LANGUAGE LINE
SOLUTIONS AS WELL.>>The Chair: MS. DICOSTANZO.
>>THANK YOU. DO YOU SEE THE NUMBERS?
ARE THESE NEWCOMERS USING YOUR SERVICE?
I JUST WANT TO KNOW, YOU KNOW, HOW IS IT PROMOTED?
HOW IS IT REACHING THE NEWCOMERS?
BECAUSE IT’S A WONDERFUL SERVICE, ESPECIALLY IF THEY’RE
NEW TO THE COUNTRY, BUT WHAT ARE YOU DOING TO MAKE SURE THAT THEY
KNOW ABOUT YOU?>>The Chair: MS. GALLANT?
OH, SORRY, MS. BOUTILIER. >>THANK YOU.
WE WORK DILIGENTLY TO WORK WITH NEWCOMERS.
WE DO OUTREACH AT THE IMMIGRANT —
PARDON ME? I WORK WITH ISANS AS WELL, BUT
WE ALSO GO TO THE — I’M LOSING THE WORD.
WE DO THE OUTREACH WITH NEWCOMERS IS WHAT I’M TRYING TO
SAY. SO YES, AND WE WORK CLOSELY WITH
ISANS, AND WE’RE BUILDING A PARTNERSHIP SO WE CAN LEARN WHAT
WE CAN DO TO HELP THEM AND WHAT THEIR NEEDS ARE AND WHAT THEY’RE
LOOKING FOR FROM US. SO HOW WE CAN BETTER SERVE THEM,
YEAH. WE’RE WORKING CLOSELY WITH THEM.
>>The Chair: MS. DICOSTANZO. >>I DIDN’T HEAR WHAT ARE THE
PERCENTAGE OF THE CALLS THAT REQUIRE INTERPRETING FROM THE
PATIENTS WHO ARE NOT — I DON’T WANT TO CALL THEM PATIENTS, OR
CLIENTS? AM I ALLOWED TO CALL THEM
PATIENTS? WHO ARE CALLING THAT HAVE
ISSUES, MEDICAL ISSUES.>>The Chair: MS. BOUTILIER?
>>THANK YOU. I WILL REFER THAT TO NATALIA WHO
KEEPS TRACK OF THOSE STATISTICS.>>The Chair: MS. GALLANT?
>>THANK YOU. SO WE DO KEEP TRACK ON A MONTHLY
BASIS IN TERMS OF LANGUAGE IN TERMS OF USAGE WITH LANGUAGE
LINE AND WHAT SPECIFIC LANGUAGES WERE USED.
I DON’T HAVE THOSE SPECIFIC STATS, THOUGH, HERE TODAY.
>>The Chair: MS. DICOSTANZO.>>THANK YOU.
THE OTHER QUESTION I HAD FOR YOU IS FOR THE FUTURE.
WHERE DO YOU SEE 811? WHAT ARE YOUR HOPES?
WHAT ELSE CAN YOU DO TO IMPROVE OR WHAT IS HAPPENING IN OTHER JURISDICTIONS ACROSS THE WORLD?
HAVING A SKYPE METHOD TO ME IS LOOKING AT IT — IF SOMEBODY HAS
A RASH AND IT’S SO HARD FOR SOMEBODY TO DESCRIBE THE RASH
COMPARED TO A DIFFERENT RASH. IS THERE A WAY FOR THE FUTURE
THAT WE CAN HAVE VIDEO TELECONFERENCING?
>>The Chair: DR. HOWLETT?>>YEAH.
THAT’S REALLY EXCITING, AND WE’VE HAD SOME OF THOSE
DISCUSSIONS AT OUR CLINICAL ADVISORY COMMITTEE.
ONE OF THE CHALLENGES WE PRESENTLY HAVE IN THIS PROVINCE
IS TO ENSURE THAT WE PROVIDE A UNIVERSAL SERVICE TO ALL PEOPLE
IN NOVA SCOTIA, AND BECAUSE OF — I KNOW WE’RE LOOKING TO HAVE
INTERNET HIGH-SPEED INTERNET IN ALL AREAS, BUT IT’S NOT
AVAILABLE AT THIS POINT, BUT I DID DEFINITELY THINK NOT
EVERYBODY HAS ACCESS TO IT. I THINK WE HAVE TO BE CAREFUL
JUST TO MAKE SURE WE HAVE A UNIVERSAL SERVICE.
BUT I THINK THE FUTURE OF DOING THAT, AND WE’VE EVEN — YOU
KNOW, I’VE EVEN SAT DOWN WITH SOMEBODY FROM BELL AND SAID, YOU
KNOW, PERHAPS THERE COULD BE A BIOMETRIC DEVICE ON YOUR CABLE
BOX THAT WAS BUILT IN AND YOU GO OVER AND PUT YOUR FINGER ON IT.
WE KNOW WHAT YOUR O2 SATURATION WAS.
IF WE’RE REALLY GOING TO THINK OUTSIDE THE BOX, WE NEED TO
THINK TO SOMETHING LIKE THAT, AND THEN WE CAN LOOK AT A
GUIDELINE BY KNOWING THE PERSON’S SATURATION IS.
THE FUTURE MIGHT BE VISUAL OR EVEN SOME SORT OF BIOMETRIC
DEVICE. SOME OF THESE PEOPLE HAVE THIS
CRAZY THING NOW, YOU KNOW, AND I HAVE ONE OF THESE CRAZY THINGS
HERE, AND YOU CAN NOW GET A EKG, SO TO THINK AHEAD TO WONDER
WHETHER THIS IS SOMETHING WE COULD DO IS THERE.
IT’S THE ART OF THE POSSIBLE. I DON’T KNOW WHAT IT IS YET, BUT
CLEARLY IT WILL CHANGE. THERE’S NO QUESTION.
>>The Chair: MS. DICOSTANZO. >>SO WHAT DO WE KNOW ABOUT WHAT
IS HAPPENING IN OTHER JURISDICTIONS IN THE WORLD THAN
IS MORE ADVANCED THAN WE HAVE HERE IN NOVA SCOTIA THAT WE ARE
ASPIRING TO HAVE. ANYTHING LIKE THAT?
>>The Chair: DR. HOWLETT?>>I’M GOING TO FIGURE THIS OUT
EVENTUALLY. IT IS INTERESTING.
ONE OF THE THINGS I THINK WE NEED TO BE A BIT PROUD ABOUT IN
CANADA, AND SPEAK UP, IS THAT OUR SOCIALIZED MEDICAL SYSTEM IS
VERY DIFFERENT THAN PLACES LIKE THE STATES.
WE OFTEN THINK THE STATES ARE VERY ADVANCED, BUT THEY’RE NOT
ADVANCED IN A SYSTEMS SORT OF WAY.
SO FOR EXAMPLE, AND I JUST — I’M GOING TO LEAP BACK TO THIS
QUESTION, BUT I WANT TO EXPLAIN THIS TO YOU.
I WAS DEALING WITH ONE OF THE GUIDELINES AUTHORS AND WE WERE
TALKING ABOUT THE WORK WE WERE DOING BETWEEN 811 AND 911, WHICH
IS REALLY IMPORTANT TO SAY WHAT IF WE GET SOMETHING THAT GOES TO
811 AND 911, OR MORE IMPORTANTLY 911 TO 811.
SO WE’VE EXPLORED, WHAT IF YOU CALL 911 AND THEY WERE LIKE WE
DON’T REALLY THINK WE NEED TO SEND AN AMBULANCE TO THIS
PERSON. WE’VE HEARD ABOUT SOME OF THE
PROBLEMS THEY HAVE WITH AMBULANCES, BUT MAYBE WE CAN RUN
IT THROUGH 811 AND COME UP WITH A DIFFERENT DISPOSITION WITH THE
UNDERSTANDING THEY COULD BOUNCE BACK TO 911 IF WE COULD COME UP
WITH SOMETHING. SO JUST IMAGINE THAT FOR A
MOMENT. AND HE WAS LIKE, I WOULD LOVE TO
HAVE A SYSTEM LIKE THAT, BUT THEY DON’T RUN THEIR HEALTH
SYSTEM IN THE SAME WAY WE DO AT A PROVINCIAL LEVEL.
THEY DON’T RUN THEIR — AT A STATE LEVEL, SORRY.
SO IT’S VERY CUT UP. SO WE’RE LEADING IN THIS SORT OF
COORDINATION. HAVING SAID THAT, YES, SOME
OTHER AREAS ARE USING THEIR SYSTEM, AND IF THEY’RE IN A
WELL-TO-DO AREA, I IMAGINE SOME OF THESE ARE NOW USING THEIR
APPLE WATCH TO DO ALL OF THAT. AND I WANT TO CONTINUE TO
EXPLORE THOSE, BUT I’M JUST SAYING IN CANADA IT’S A LITTLE
BIT DIFFERENT BECAUSE WE DON’T HAVE EVERYBODY NECESSARILY WITH
AN APPLE WATCH ON THAT. SO NOW, ACROSS CANADA I THINK
WE’RE SIMILAR TO WHAT’S GOING ON.
WE’RE INTERESTED IN — WE’RE BIG FANS OF BENCHMARKING, SO WE’RE
TRYING TO — AND WENDY SITS ON A COMMITTEE, BUT WE’RE TRYING TO
— AND YOU KNOW, IT WOULD BE EVEN HELPFUL, IF I MAY SAY, THAT
IF SOMEHOW IT COULD BE LEGISLATED THAT ALL 811 PROGRAMS HAD TO BE PART OF A NATIONAL
WORKING GROUP, BECAUSE ONE OF THE DOWNSIDES OF HAVING A THIRD
PARTY IS SOMETIMES IT’S PROPRIETARY, BUT THOSE OF US
THAT WORK AT IT WOULD LOVE TO ACTUALLY SAY THERE HAS TO BE A
NATIONAL WORKING GROUP AND THAT EVERY PROVINCE’S GROUP HAS TO BE
PART OF IT, AND THAT WOULD HELP US WITH THE BENCHMARKING.
SO WE’VE CREATED SOME INTERNAL BENCHMARKING.
WE’VE CREATED SOME STANDARDS AROUND OUR CALLBACK TIMES.
WE MONITOR A GREAT LEVEL OF THIS STUFF.
WE HAVEN’T GOT TO THE QUALITY METRICS THAT WE USE, BUT IT
WOULD BE FANTASTIC TO BE PART OF A BENCHMARKING GROUP.
BUT THE VERY NATURE THAT 811, RIGHTLY SO, IS PROVIDED BY THIRD
PARTY IN MANY PROVINCES MEANS THAT IT’S NOT QUITE THE SAME, SO
IT WOULD BE GREAT IF SOMEHOW, YOU KNOW, THERE COULD BE SOME
SUPPORT TO SUGGEST AT SOME SORT OF NATIONAL WORKING GROUP THAT
EVERY 811 PROGRAM, MEDICAL DIRECTOR WOULD HAVE TO BE PART
OF A BENCHMARKING GROUP NATIONALLY.
I THINK THAT WOULD BE A REALLY IMPORTANT THING FOR US TO DO.
AND WOULD HOLD US ACCOUNTABLE AND, YEAH.
DOES THAT MAKE SENSE WHAT I SAID, THE LAST PART?
>>The Chair: MS. DICOSTANZO. >>I THINK SO, AND I DIDN’T EVEN
KNOW IF THE SAME NUMBER IS ACROSS CANADA.
SO EVERY PROVINCE HAS THE SAME NUMBER, 811?
IS THAT SOMETHING THAT YOU’RE REFERRING TO?
>>The Chair: DR. HOWLETT. >>THANK GOODNESS FOR THAT, YES.
811 IS THE STANDARD NUMBER ACROSS CANADA.
AND MOST PLACES ARE RUN BY A THIRD-PARTY PROVIDER, AS WE ARE
HERE. THERE IS ONE PROVINCE THAT DOES
IT THEMSELVES, AND WE INTERACT QUITE A BIT WITH THAT PROVINCE
IN ALBERTA, SO WE ARE BIG FANS OF BENCHMARKING WITH OTHER
PROVINCES, RECOGNIZING, TO YOUR POINT, THAT WE MAY NOT KNOW IT
ALL, THERE MAY BE ADVANCES SOMEWHERE ELSE THAT WE SHOULD BE
ADOPTING.>>The Chair: MS. DICOSTANZO.
>>YOU TALKED ABOUT BENCHMARKING.
WHERE ARE WE COMPARED TO CANADA AND MAYBE AUSTRALIA OR ENGLAND
AND HOW DO WE ASPIRE — IS ANYBODY ELSE DOING, GONE FURTHER
OR INVESTED MORE FINANCE INTO THIS SERVICE?
>>The Chair: DR. HOWLETT?
>>THANKS FOR THE QUESTION. IT IS DIFFICULT FOR US TO GET THOSE BENCHMARKS BECAUSE OF THIS
PROPRIETARY SENSE OF IT. THE NATIONAL HEALTH SERVICES, I
HAVEN’T LOOKED AT IT FOR A WHILE.
IT MIGHT BE APPROPRIATE. AUSTRALIA HAS SOME FUNDAMENTAL
DIFFERENCES IN THE WAY THEY APPROACH SOME THINGS.
THERE ARE SOME THINGS TO LEARN, BUT IT’S NOT COMPLETELY THE SAME.
SO YEAH, I THINK THERE NEEDS TO BE MORE BENCHMARKING SO WE CAN
ANSWER THAT QUESTION CLEARER FOR YOU.
I’M HERE TO SAY WE’VE GOT THE BEST PROGRAM AND I THINK WE HAVE
AN EXCELLENT PROGRAM. DO I HAVE BENCHMARKING DATA THAT
CLEARLY SHOWS THAT? NO.
AM I DESPERATE TO GET THAT? YES.
>>The Chair: DR. DICOSTANZO?>>WONDERFUL.
I’VE USED YOUR SERVICE AND I WAS VERY GRATEFUL WHEN THE KIDS WERE
SMALL, SO IT HAS BEEN — IT’S MORE OF A COMFORTING KNOWING
GOING TO BED AND KNOWING THAT YOU DIDN’T HAVE TO GO TO
EMERGENCY THAT NIGHT. IT HAS WORKED AMAZING FOR US.
AND I THINK I’M DONE WITH MY TWO MAIN QUESTIONS.
AND I PASS IT ON TO MY COLLEAGUE.
>>The Chair: MS. MILLER?>>THANK YOU, AGAIN, FOR COMING
IN. THIS IS SUCH A GOOD NEWS STORY
FOR NOVA SCOTIA, I THINK, AND THE WORK THAT YOU’RE DOING HAS
HELPED SO MANY PEOPLE. I’VE BEEN ONE OF THE PEOPLE,
TOO, WHO HAVE CALLED 811 IN A SITUATION WHERE I WASN’T QUITE
SURE. DO I GO TO THE HOSPITAL?
DO I NOT? YOU KNOW, MAYBE A DOCTOR WASN’T
AVAILABLE. I COULDN’T REMEMBER THE EXACT
CIRCUMSTANCES, BUT I KNOW THAT THAT PERSON ON THE END OF THE
LINE GAVE ME THE CONFIDENCE THAT I NEEDED TO BE ABLE TO MAKE A
DECISION OF WHAT I NEEDED TO DO. AND I’M NOT SURE — IT SEEMS TO
ME I REMEMBER THEM CALLING BACK TO FOLLOW UMM, YOU KNOW.
AND MAYBE — IT WAS QUITE A WHILE AGO, YOU KNOW.
IT WAS EVEN MORE IMPRESSIVE THAT THEY EVEN CALLED BACK.
SO ANYWAY, YEAH, THANK YOU FOR THAT.
SO I LOVE HEARING YOU’RE TALKING ABOUT THE FUTURE OF WHERE 811
COULD POSSIBLY GO. DO YOU HAVE ANYTHING ELSE ON
YOUR WISH LIST THAT YOU — YOU KNOW, WHAT DO YOU ENVISION
SEEING HAPPENING IN THE FUTURE OR DO YOU HAVE SOMETHING ON YOUR
WISH LIST THAT YOU’D LIKE TO BE ABLE TO ADD TO THE PROGRAM THAT
YOU THINK WOULD ADD VALUE?>>The Chair: DR. HOWLETT?
>>THANK YOU FOR THE OPPORTUNITY TO ASK ME THAT QUESTION.
YES, I THINK THE BEST WAY TO THINK ABOUT 811 IN A WAY THAT
HELPS ME TO THINK ABOUT 811 IS IT’S A PLATFORM IN WHICH WE CAN
KEBT AND BUILD WITH OTHERS. SO WE ARE VERY INTERESTED IN —
WE HAVE THIS PLATFORM. IT EXISTS.
WE HAVE A NUMBER THAT EVERYBODY KNOWS, AND WE CAN BUILD SERVICES
AROUND THAT. SO IN AN EFFORT, AS THE NOVA
SCOTIA HEALTH AUTHORITY ESTABLISHES STANDARDS ACROSS THE
PROVINCE THROUGH THEIR PROGRAMS OF CARE, WHICH I TALKED TO YOU
ABOUT BEFORE, WE ARE MEETING WITH EACH OF THEM AND SAYING
WHAT CAN WE DO TO HELP? WE ARE EXPLORING WAYS TO WORK
WITH OUR COLLEAGUES IN PRIMARY HEALTH CARE TO MAYBE EVEN HELP
THEM PRIORITIZE WHICH PATIENTS SHOULD BE SEEN THE SAME DAY.
I ALWAYS USE THIS ANALOGY THAT IF YOU CALL YOUR FAMILY DOCTOR,
HOW DOES YOUR — WHO DO YOU SPEAK TO?
AND HOW DO THEY DECIDE WHETHER YOU SHOULD BE SEEN TODAY OR TWO
WEEKS FROM NOW? AND ON WHAT GUIDELINES ARE THEY
USING TO MAKE THAT DECISION? SO IT’S OFTEN THEIR ASSISTANTS,
AND IT MIGHT BE THE NEXT AVAILABLE APPOINTMENT, BUT WHAT
IF WE CAN PARTNER, TRYING TO DO THAT, PARTNER WITH THEM AND HELP
USE THE GUIDELINES TO PERHAPS TRIAGE THE PEOPLE THAT ARE
TRYING TO SEE THEM AND HELP — AND WORK THROUGH THEIR
APPOINTMENTS. SO WE’RE LOOKING TO TRIAL THAT
IN SOME AREAS SO THAT WE MIGHT ACTUALLY BE ABLE TO HELP THE
PRIMARY HEALTH SYSTEM TO BE ABLE TO DO THAT, AND WE DID THAT
SOMETIME AGO WITH THE DAL FAMILY PRACTICE WHERE THE PEOPLE WERE
CALLING IN DURING THE DAY AND THE NURSES WERE QUITE
UNCOMFORTABLE ABOUT NEW COMPLAINTS BECAUSE THEY DIDN’T
KNOW THESE WERE NEW COMPLAINTS AND THERE HAD BEEN A BAD OUTCOME
BECAUSE SOMEBODY HAD CALLED IN WITH BACK PAIN AND THEY DIDN’T
HAVE THE EVIDENCE-BASED GUIDELINES, SO WE HELPED THAT
PRACTICE SO PEOPLE THAT WOULD CALL IN WOULD CALL US AND IF
THEY NEEDED TO BE SENT THAT DAY, WE WOULD SEND THEM TO THE
PRACTICE. SO THAT’S ONE THAT I THINK IS
IMPORTANT. THE IDEA OF CHRONIC DISEASE
MANAGEMENT IS SOMETHING THAT’S VERY APPEALING TO ME, AND THE
FUTURE OF THAT IS QUITE INTERESTING, AND THERE ARE A
NUMBER OF PEOPLE IN THE NOVA SCOTIA HEALTH AUTHORITY RESEARCH
LOOKING AT CHRONIC DISEASE MANAGEMENT.
I THINK THE MODEL PROBABLY NEEDS TO CHANGE AT SOME POINT.
I THINK MOST PEOPLE WHO COME IN WHO HAVE DIABETES ALSO HAVE
HYPERTENSION, ALSO HAVE — THEY MIGHT HAVE COPD AND THEY HAVE
SOMETHING ELSE. AND YET OUR CURRENT MODEL, AS
MANY OF MY GOOD COLLEAGUES HAVE ACKNOWLEDGED THIS, IS THAT WE
DIVIDE THOSE PARTS OF THE PERSON UP.
YOU GO SEE YOUR LUNG DOCTOR, THEN YOU GO SEE YOUR HEART
DOCTOR, THEN YOU GO SEE YOUR DIABETES DOCTOR.
YOU KNOW, YOUR FAMILY DOCTOR IS SORT OF QUARTERBACKING ALL THAT,
BUT TO ACTUALLY HAVE A CHRONIC DISEASE.
AND THEN WHAT COULD WE DO TO SUPPORT THAT.
WE DID DO A TRIAL SOMETIME AGO. IT DIDN’T QUITE TAKE OFF, BUT
PART OF TRYING TO DO SOMETHING DIFFERENT IS YOU HAVE TO FAIL.
YOU KNOW? YOU HAVE TO FAIL, BUT WE LOOKED
AT USING IT FOR DIABETES AND SUPPORTING PEOPLE AS AN
OUTPATIENT IN DIABETES. I THINK THERE IS A ROLE FOR US
AS 811 NOT JUST TO TAKE — BE ON THE RECEIVING END, BUT TO BE ON
THE CALLING END AND HELPING PEOPLE AND DOING THAT.
SO THERE’S A COUPLE OTHER PROGRAMS THAT YOU SHOULD BE VERY
PROUD OF FROM THIS PROVINCE. ONE IS CALLED THE INSPIRE
PROGRAM. SOME OF YOU MAY HAVE HEARD ABOUT
IT. INSPIRED WAS A PROGRAM THAT WAS
DONE BY GRAHAM WALKER. IT’S GONE ACROSS THE COUNTRY,
AND IT HAS TO DO WITH THE TREATMENT OF COPD, AND WE’VE
PARTNERED WITH THEM. THERE ARE A LOT OF GREAT THINGS
HAPPENING IN NOVA SCOTIA. WE JUST SOMETIMES NEED TO TALK
ABOUT THEM A BIT MORE. BUT BACK TO YOUR QUESTION, WHAT
IS IT? I THINK IT IS THIS ABILITY TO
CONNECT AND SERVE AS A PLATFORM WITH ALL THESE OTHER THINGS SO
THAT, LIKE I SAID WITH DREW BETHUNE, THERE WILL BE A
CONNECTION THERE. MENTAL HEALTH WHICH IS A
STRUGGLE, AND WE’RE NOT THE ANSWER TO MENTAL HEALTH IN THE
PROVINCE, BUT WE CAN CONNECT TO THE ANSWER AND WHEN PEOPLE END
UP WITH US, WE CAN CALL AND CONNECT PEOPLE INVOLVED IN
MENTAL CRISIS AND THE LIKE. YES, SO THERE’S A LOT OF
DIFFERENT THINGS LIKE THAT THAT I THINK WE CAN DO.
JUST A MOMENT ON OUR QUALITY. I JUST WANT TO BRAG A LITTLE BIT
ABOUT NATALIA. IT’S A LITTLE BIT DIFFERENT.
AS MANY OF YOU KNOW, I HAVE SOME OTHER LEADERSHIP POSITIONS AND I
OFTEN AS SUCH HAVE TO DEAL WITH POTENTIAL CONCERNS OR
COMPLAINTS, SO I WANTED TO TALK ABOUT THAT IF I COULD FOR A
MOMENT. AND I WOULD ENCOURAGE YOU THAT
PEOPLE DO CALL US BECAUSE THEY ARE UNHAPPY WITH THE SERVICE,
AND LIKE ANY MATURE SERVICE, WE NEED TO WELCOME THOSE CONCERNS
AND RECOGNIZE WHETHER THERE MAY BE SOMETHING THERE THAT NEEDS TO
BE DONE. SO THE PROCESS WHEN YOU CALL 811
AND THERE’S A CONCERN IS NATALIA INVESTIGATED IT.
WE TALK TO THE PERSON. IT MAY BE A PROVIDER.
I CALL THEM. WE FIND OUT WHAT’S GOING ON.
WE REVIEW THE CASE, AND WHEN WE REVIEW THE CASE, IT IS UNLIKE
ANYTHING ELSE I’VE EVER DONE BECAUSE 100% OF THE INTERACTION
IS RECORDED. CAN YOU IMAGINE THAT?
SORT OF LIKE THIS, I GUESS. BUT 100% OF OUR INTERACTION IS
RECORDED, SO IT’S NOT LIKE, YOU KNOW, WHAT DID THE NURSE SAY TO
THE DOCTOR, WHAT DID THE DOCTOR SAY TO THE PATIENT, YOU KNOW,
WHAT IS THE BODY LANGUAGE. IT’S 100% RECORDED.
>>The Chair: ONE MINUTE.>>OH, MAN, I CAN TALK FOREVER.
SO IT’S UNLIKE THAT, AND THEN WE TYPICALLY WILL GET BACK TO THE
PERSON AND FIGURE OUT WHAT’S GOING ON.
THAT’S MY ONE MINUTE LEFT TO YOU.
>>The Chair: MS. MILLER?>>AGAIN, THANK YOU FOR THE
SERVICE. I DON’T KNOW WHICH GOVERNMENT
STARTED THAT, WHETHER IT WAS THE END OF THE CONSERVATIVE
GOVERNMENT OR THE NDP, BUT I CERTAINLY WANT TO GIVE CREDIT
WHERE IT’S DUE. IT’S A GREAT PROGRAM AND THANK
YOU SO MUCH FOR ALL YOUR WORK.>>The Chair: WE WILL THEN TURN
IT OVER TO THE PC CAUCUS, MS. ADAMS?
>>THANK YOU VERY MUCH.>>The Chair: 14 MINUTES.
>>THANK YOU. I’M JUST GOING TO ASK THE ONE
QUESTION WE DIDN’T GET FINISHED. SO THE NOVA SCOTIA HEALTH
AUTHORITY BY THE NUMBERS REPORT FOR 2018-19, THERE’S ONE EVERY
YEAR, AND THIS ONE SPECIFICALLY STATES UNDER CARE DELIVERY IT
SAYS BEDS: STAFFED AND IN OPERATION.
SO 2017-18 THERE WAS 3554 BEDS STAFFED AND IN OPERATION.
AND THE NEXT YEAR WAS 3150, SO THAT’S 400 LESS BEDS.
AND WE HEAR ALL ABOUT THE ESCALATING EMERGENCY ROOM
CLOSURES ACROSS THE PROVINCE OVER THE LAST FEW YEARS, WHICH
IS CAUSING HAVOC. I’M WONDERING IF YOU HAVE ANY
COMMENT ON WHY WE HAVE 400 LESS BEDS IN OPERATION FROM ONE YEAR
TO THE NEXT.>>The Chair: DR. HOWLETT?
>>SO TODAY I’VE COME HERE IN MY ROLE AS THE MEDICAL DIRECTOR FOR
811. AND AS SUCH, I WOULD
RESPECTFULLY LIKE TO ANSWER QUESTIONS RELATED TO 811.
SO THANK YOU.>>The Chair: MR. LEBLANC?
>>THANK YOU, MADAM CHAIR. AGAIN, THANK YOU VERY MUCH FOR
JOINING US HERE THIS MORNING TO DISCUSS THIS IMPORTANT SYSTEM
THAT PLAYS AN INTEGRAL PART OF THE HEALTH CARE SYSTEM HERE IN
NOVA SCOTIA. SO JUST TO BE CLEAR, YOUR ROLE,
WHEN IT COMES TO THE NEED OF DOCTOR REGISTRY IS STRICTLY
COLLECTING NAMES AND DATA?>>The Chair: DR. HOWLETT?
>>YEAH, AND I THINK WE’VE BEEN ASKED TO FORM ANOTHER ROLE, BUT
IS TO CALL THE PEOPLE ON THE LIST AND VERIFY WHETHER THEY
HAVE A DOCTOR OR NOT. BUT AGAIN, THAT DATA IS NOT OUR
DATA. IT IS DATA THAT WE’RE SHARING
BACK TO THE NOVA SCOTIA HEALTH AUTHORITY.
SO YES, SO I THINK I’M STATING THAT CORRECT.
THEY CALL IN, WE TAKE THE INFORMATION, WE PASS THAT ON,
AND THEN MORE RECENTLY I THINK THERE WAS 20,000 PEOPLE THAT WE
CONTACTED JUST TO FIND OUT — I LITERALLY DO NOT REVIEW THE
DATA, DON’T HAVE THE DATA, BUT IT WAS I THINK A BUILDING UPON
SCENARIO THAT 811 WAS A NUMBER THAT EVERYBODY KNEW, THEY COULD
CALL AND IT WAS EASY RATHER THAN CREATE A NEW NUMBER, YEAH.
>>The Chair: MR. LEBLANC?>>THANK YOU, MADAM CHAIR.
THANK YOU FOR THAT ANSWER. IT’S JUST WHEN WE’RE DISCUSSING
QUESTIONS HOW WE’RE DEALING WITH THE REGISTRY AND TAKING PEOPLE
OFF THE REGISTRY, IT WOULD BE NICE TO HAVE SOME GUESTS FROM
THE DEPARTMENT OF HEALTH, NSHA. WHEN IT COMES TO — WHAT’S THE
AVERAGE WAIT TIME WHEN PEOPLE CALL 811?
IS THERE A DELAY WHEN IT COMES TO ANSWERING THE PHONE?
>>The Chair: MS. BOUTILIER?>>THANK YOU FOR THE QUESTION.
WE STRIVE TO ANSWER OUR CALLS WITHIN 30 MINUTES 90% OF THE
TIME, AND FOR THE MOST PART WE’RE VERY SUCCESSFUL IN DOING
THAT. WE DO HAVE NINE CLINICAL STAFF
THAT IF THE NURSES ARE ALL ON CALLS, THAT THE NON-CLINICAL
STAFF WILL ANSWER THE CALL WITHIN 20 SECONDS 80% OF THE
TIME. SO WHAT WE WILL DO IS WE HAVE A
PRIORITIZATION LIST. SO IF THE NON-CLINICAL STAFF
DEEM THAT THE CALL IS AN EMERGENCY, THEY HAVE THE ABILITY
TO TRANSFER DIRECTLY TO 911. OR IF THEY DEEM THE CALL HIGH, OR MORE URGENT THAN A
MEDIUM CALL, IF YOU WILL, THEN THEY COULD TRANSFER THAT PATIENT
DIRECTLY TO A NURSE. SO WE ENSURE THAT THERE IS NO
DELAY IN CARE. IF THE CALL OF AN URGENT MATTER,
WE TAKE CARE OF IT. OTHERWISE WE WILL CALL OUR
PATIENTS BACK WITHIN 30 MINUTES.>>The Chair: MR. LEBLANC?
>>THANK YOU FOR THAT ANSWER. EARLIER YOU NOTED THAT 70% OF
THE CALLS YOU RECEIVE ARE REPEAT CALLS.
THAT’S A VERY LARGE PERCENTAGE. YOU SPOKE ABOUT THE 811 CHART.
IN YOUR SYSTEM, IS THERE A PATIENT DATABASE OR PATIENT
CHARTING DATABASE THAT THERE’S A FOLLOW-UP IF I CALL TODAY WITH
ONE COMPLAINT, I CALL NEXT WEEK, IS THERE A WAY THAT YOUR NURSES
CAN ACTUALLY FOLLOW UP ON THE SAME PATIENT?
>>The Chair: MS. GALLANT.>>THANK YOU FOR THE QUESTION.
SO EACH RECORD OF THE PATIENT IS KEPT, BUT EACH TRANSACTION OR
EACH CALL INTO OUR SERVICE IS KEPT SEPARATE BECAUSE THEY ARE
CALLING IN FOR A DIFFERENT SYMPTOM, PERHAPS SYMPTOMS HAVE
CHANGED OR WORSENED, SO WE DO KEEP THEM A STANDALONE FOR EACH
CALL. THERE ARE CERTAIN SITUATIONS,
DEPENDING ON WHAT RECOMMENDATION THAT WE ARE GIVEN THAT WE WILL
FOLLOW UP WITH THE PATIENT IN AN HOUR TO SEE IF THAT INTERIM CARE
ADVICE THAT WE HAVE GIVEN THEM HAS WORKED.
IF IT HAS, THAT’S GREAT, THEN WE’LL CONTINUE TO PROVIDE THEM
MORE ADVICE AT THAT POINT IN TIME.
IF NOT, THEN WE MAY RECOMMEND FOR THEM TO GO AND BE SEEN, JUST
DEPENDING ON THE SEVERITY OF THEIR SYMPTOMS.
SO THERE ARE TIMES THAT WE DO TELEPHONE CALL BACKS WITHIN AN
HOUR. DEPENDING ON THE SITUATION.
>>The Chair: MR. LEBLANC.>>THANK YOU VERY MUCH FOR THAT
ANSWER. EARLIER YOU ALLUDED TO TIME
FRAMES THAT ARE ACCEPTABLE FOR DIFFERENT PATIENT OUTCOMES.
IF I HAVE ONE AILMENT, A TARGETED TIME TO SEE MY DOCTOR,
THE NEXT DAY OR TWO DAYS OR WITHIN THE WEEK.
DOES 811 COLLECT INFORMATION TO SEE ACTUALLY IF THAT TIMELINE OR
THOSE TIMELINES WERE ACTUALLY ACHIEVED?>>The Chair: DR. HOWLETT?
>>NO. THOUGH THAT’S NOT COMPLETELY
TRUE. WE DO DO A CALLOUT TO OTHER —
WE DO DO ON A PERCENTAGE OF OUR PATIENTS A CALLOUT TO FIND OUT
WHAT ACTUALLY HAPPENED. IDEALLY THIS IS THE
OUTCOME-BASED RESEARCH TRYING TO SORT OUT WHAT’S GOING ON, TO SAY
WE MADE THIS RECOMMENDATION, WHAT DID YOU ACTUALLY DO AND HOW
DID YOU ACTUALLY, YOU KNOW, GET IN?
THAT ISSUE IS USUALLY DEALT WITH AT THE FRONT END, I.E., IF WE
SAY TO THE PATIENT YOU SHOULD SEE YOUR FAMILY DOCTOR IN TWO
DAYS AND LET’S SAY IT TAKES SIX WEEKS TO GET INTO MY FAMILY
DOCTOR, THE NURSES WILL TYPICALLY PROBLEM SOLVE AT THAT
POINT. THEY WON’T SAY GOOD LUCK.
THEY WILL SAY, OKAY, WHERE ELSE COULD YOU GO SEE SOMEBODY?
AND ONE OF THE — SO ONE OF THE CONCERNS SOMETIMES IS PEOPLE END
UP IN THE EMERGE BECAUSE THERE’S NO OTHER OPTION OTHER THAN TO GO
TO THE EMERGE, BUT IT WAS NOT OUR INTENTION TO SEND THEM TO
THE EMERGENCY DEPARTMENT, PER SE.
AND IT’S INTERESTING, IT SORT OF WORKS OUT, AND I’LL EXPLAIN WHY
IT SORT OF WORKS OUT. IN THE MAJOR AREAS WHERE THE
EMERGENCY DEPARTMENTS ARE — I WORK IN AN MAJOR EMERGENCY DEPARTMENT AT DARTMOUTH GENERAL,
THERE ARE OTHERS AS WELL. AS YOU GET OUT OF THE CITY, THE
EMERGENCY DEPARTMENTS TEND TO BE LESS HIGH ACUITY, JUST BY THE
NATURE OF THE POPULATION THERE. IN THE MAJOR CITIES THERE’S A
LOT OF WALK-IN CLINIC. AGAIN, IT’S NUMBERS.
YOU CAN MOVE THEM TO WALK-IN CLINICS.
IF YOU GO TO SMALLER PLACES, IT MAY NOT BE THE SAME.
CAPE BRETON MAY BE DIFFERENT. IT SORT OF WORKS OUT.
AND JUST SO THAT EVERYBODY’S CLEAR, WHEN YOU CALL 811, THE
FIRST THING THAT — PICK UP THE PHONE, BUT IT IS OUR TELEHEALTH
ASSOCIATES WHO TAKE YOUR CALL, AND THEN WE HAVE CREATED A
CLINICAL CATEGORIES OF HIGH, MEDIUM AND LOW, URGENT THINGS,
AND THEN THE NURSES CALL BACK. AND THEN THAT — WE MEASURE BOTH
— AND THE CALL TO PICK UP THE PHONE IS LESS THAN A COUPLE
MINUTES, 20 SECONDS. THE CALLBACKS ARE DONE WITHIN 30
MINUTES. AND OCCASIONALLY WE STRUGGLE
WITH THAT. LIKE ANYTHING, IF THERE’S A
MANPOWER CRISIS, I MEAN, WE DO THAT VERY WELL, BUT THERE ARE
OCCASIONAL TIMES WHEN WE DON’T DO THAT.
>>The Chair: MR. LEBLANC. >>EARLIER YOU STATED STATISTICS
BASED ON THE OUTCOMES IN OUR PROVINCE, 8% AND 911, POISON
CONTROL AND ET CETERA. ARE THERE REGIONAL BREAKDOWNS OF
THESE OUTCOMES? IS THAT SOMETHING THAT’S
AVAILABLE?>>The Chair: DR. HOWLETT.
>>I’M A MR. AS WELL.
FATHER AS WELL. WE HAVE NOT LOOKED AT — THAT’S
A GREAT QUESTION. WE COULD PROBABLY LOOK AT IT
LIKE THAT. THERE’S NO REASON WE CAN’T.
WE DO, INTERESTING ENOUGH, BECAUSE AS I MENTIONED EARLIER,
WE HAVE P.E.I. SO WE ACTUALLY BREAK OUT P.E.I.
FROM US. WE HAVE PRESENTED PREVIOUSLY TO
THE ZONES, THE FOUR ZONES. SO THERE’S NO REASON WE CAN’T DO
THAT. WE COULD CREATE THAT DATA AND
JUST SAY IS THERE SOMETHING SPECIFIC AROUND ONE AREA WHERE
WE SEND MORE PEOPLE, AND THAT WOULD BE SOMETHING REALLY
INTERESTING TO LOOK AT, BUT I DON’T THINK WE HAVE A THESIS OR
A HYPOTHESIS THAT IT WOULD BE DIFFERENT IN AN AREA, BUT IT
WOULD BE WORTH LOOKING AT FOR SURE.
>>The Chair: MR. LEBLANC. >>EXAMINING ISSUES OF POSSIBLE
CLOSURES AND OVER-BURDENED EMERGENCY ROOMS IT WOULD BE
CERTAINLY NICE TO HAVE A REGIONAL APPROACH TO EXAMINING THESE DIFFERENT PERCENTAGES.
YOU SPOKE EARLIER ABOUT TALKING ABOUT OUTCOME RESEARCH, AND DATA
AND INFORMATION AND THOSE REPORTS.
SO 811 OPERATED BY EMCI, THE AMBULANCE SERVICE IS OPERATED BY
EMCI. THERE’S AN OPPORTUNITY TO SHARE
INFORMATION THERE AND CONDUCT INTERNAL RESEARCH.
SO I GUESS JUST BECAUSE A PATIENT’S FORWARDED, THOSE 4% OF
YOUR CALLS ARE SENT TO 911, DOESN’T NECESSARILY MEAN THAT
IT’S ACTUALLY A PATIENT TRANSPORT OUT OF THAT.
INTERNALLY ARE YOU GUYS PERFORMING OUTCOME RESEARCH?
>>The Chair: DR. HOWLETT?>>ALMOST LIKE YOU SET THAT
QUESTION UP. THANK YOU.
I DON’T THINK YOU KNEW THAT. YEAH, WE ACTUALLY HAVE A MEETING
SET UP TO LOOK JUST AS A CONTINUING QUALITY — WITH
MYSELF, DR. TRAVERSE, NATALIA AND THE EQUIVALENT OF THE
NATALIA TO THE EMCI TO REVIEW ALL THE PATIENTS THAT GET SENT
FROM 811 TO 911 AND HOW WE’RE DOING IT.
SO YEAH, WE’RE IN THE PROCESS OF LOOKING AT THAT.
SO YEAH.>>The Chair: MR. LEBLANC?
>>THANK YOU. AND JUST TO BE CLEAR, I THINK MY
COLLEAGUE ASKED THE QUESTION EARLIER, SO IF A PATIENT DOES
CALL YOUR SERVICE, THEIR FAMILY PHYSICIAN, IF THEIR LUCKY TO
HAVE A FAMILY PHYSICIAN, ARE THEY NOTIFIED OF THE CALL IN ANY
MANNER?>>THEY’RE NOT AT THIS POINT.
IT CERTAINLY COULD BE SOMETHING WE DO.
WE’D HAVE TO FIGURE OUT HOW TO DO THAT, BUT WE ARE MEETING OUR
— THIS FALL HOPEFULLY IN THE NEXT MONTH WITH THE GP COUNCIL
AT DOCTORS NOVA SCOTIA. AND I DON’T THINK THAT I’VE EVER
HAD ANYBODY COME AND SAY I WISH YOU TOLD US THAT THEY CALLED
811, BUT I’LL BRING IT UP DURING THAT CONVERSATION.
IT’S A GREAT THOUGHT, ACTUALLY.>>The Chair: MR. LEBLANC?
>>THANK YOU. SO 811 OPERATED FOR P.E.I. AND
NOVA SCOTIA AT THE SAME TIME. IS IT THE SAME NURSES THAT ARE
OPERATING FOR BOTH PROVINCES AT THE SAME TIME?
>>The Chair: MS. BOUTILIER?>>YES, IT IS THE SAME NURSES.
>>The Chair: MR. LEBLANC. >>AND ARE THOSE NURSES FROM
P.E.I. OR ARE THEY FROM NOVA SCOTIA?
>>The Chair: MS. BOUTILIER?>>THE NURSES ACTUALLY WORK ALL
THROUGH NOVA SCOTIA AND P.E.I.>>The Chair: MR. LEBLANC?
>>DO WE KNOW PERCENTAGES OF NOVA SCOTIANS VERSUS P.E.I.?
>>The Chair: MS. BOUTILIER?>>I DON’T HAVE THOSE EXACT
NUMBERS. WE DO PROMOTE THE NURSES TO WORK
FROM P.E.I. IT’S A MATTER OF RECRUITING
THEM, AND WE DO OUR BEST TO RECRUIT NURSES ALL THROUGH NOVA
SCOTIA AND P.E.I.
>>The Chair: MR. LEBLANC? YOU HAVE TWO MINUTES.
>>TWO MINUTES? THANK YOU.
A LITTLE BIT ABOUT THE LIST, IF MY GRANDMOTHER WHO IS 70 PLUS
YEARS OLD GETS A PHONE CALL SAYING WE HAVE A FAMILY DOCTOR
FOR YOU AND THAT DOCTOR IS GREATER THAN AN HOUR AWAY AND
SHE’S NOT COMFORTABLE DRIVING MORE THAN AN HOUR, AND SHE
DECLINES THAT OPPORTUNITY FOR THAT FAMILY PHYSICIAN AT THAT
TIME, WHAT HAPPENS TO HER PRIORITY ON THE REGISTRY, IF
YOU’RE ABLE TO ANSWER THAT?>>The Chair: DR. HOWLETT?
>>YEAH, I CAN’T. I’M NOT READY — I’M NOT READY?
I’M NOT ABLE TO ANSWER THAT BECAUSE I DON’T HAVE THAT DATA
AND WE DON’T MANAGE THAT LIST. JUST BACK TO YOUR QUESTION,
THERE IS ONE NURSE ON P.E.I. THE REST ARE FROM NOVA SCOTIA.
OH, AND THERE’S ONE IN NEW BRUNSWICK TOO.
>>The Chair: MR. LEBLANC?>>AND I ASSUME THAT YOU GO
THROUGH CLINICAL AUDITING, QUALITY CONTROL FOR YOUR CALLS?
>>The Chair: MS. GALLANT?>>THANK YOU.
YES, WE DO HAVE A RIGOROUS PROGRAM IN TERMS OF CALL
AUDITING AND MONITORING, AND THAT’S BASED ON THEIR
PERFORMANCE AND ALSO ON THEIR EXPERIENCE AS A TELEHEALTH
NURSE. SO WE DO WORK CLOSELY.
WE MONITOR THAT ON A MONTHLY BASIS.
>>The Chair: MR. LEBLANC?>>HOW MUCH TIME DO I HAVE,
MADAM CHAIR?>>The Chair: LESS THAN A
MINUTE.>>I JUST WANT TO MAKE SURE FOR
THE RECORD, ARE YOU GUYS PRIVATE WITH EMCI OR DEPARTMENT OF
WEALTH? DR. HOWLETT?
>>The Chair: DR. HOWLETT.
>>PRIVATE.>>The Chair: MR. LEBLANC?
>>I GUESS ARE THERE PLANS TO EXAMINE IMPROVED PATIENT OUTCOME
OR NOT NECESSARILY PATIENT OUTCOME, SORRY, THE TRACKING OF
THE PATIENT OUTCOME?>>The Chair: DR. HOWLETT?
>>YEAH, ABSOLUTELY. SO THE —
>>The Chair: ORDER. TIME HAS LAPSED.
WE’LL TURN IT OVER TO THE NDP FOR 14 MINUTES.
MS. LEBLANC?>>THANK YOU VERY MUCH.
BEFORE I ASK MY QUESTIONS, I ALSO JUST WANT TO GIVE THREE
CHEERS TO 811. I WAS AS A MOTHER OF TWO HAVE
DONE MANY A CALLS IN THE MIDDLE OF THE NIGHT.
AND I HAVE TO — THAT’S ACTUALLY PART OF MY FIRST QUESTION.
BECAUSE IN MY EXPERIENCE, I THINK MOSTLY I THINK BACK TO THE
TIMES I’VE CALLED 811 IT’S MOSTLY BEEN LITERALLY IN THE
MIDDLE OF THE NIGHT, 11:00, SOMETIME WHEN A WALK-IN CLINIC
IS NOT AN OPTION OR IT WOULD BE A REAL PAIN TO GET UP AND GET
OUT OF THE HOUSE KIND OF THING. SO I CALL 811 FIRST.
AND SO I’M WONDERING IF YOU HAVE ANY STATISTICS ON, LIKE, HOW THE
VOLUME OF CALLS AT DIFFERENT TIMES OF DAY.
>>The Chair: MS. BOUTILIER?>>THANK YOU.
SO YEAH, OUR CALL VOLUMES DO VARY.
GENERALLY IN THE MORNING WE’RE NOT — CALL VOLUMES ARE QUITE
LOW, AND AS THE AFTERNOON GOES INTO THE EVENING, AROUND
SUPPERTIME WHEN EVERYBODY STARTS GETTING HOME FROM WORK AND
SCHOOL, OUR CALL VOLUMES DO INCREASE, AND THEY DO DECREASE
OVERNIGHT. THEY DECREASE FROM MIDNIGHT ON
IT’S A LOWER CALL VOLUME.>>The Chair: MS. LEBLANC?
>>AND SO I GUESS I JUST WANTED TO CONNECT THAT WITH SOMETHING
DR. HOWLETT SAID EARLIER, WHICH IS — WELL, THIS IS — AND THIS
IS ALSO GONNA GO INTO ANOTHER QUESTION, BUT DR. HOWLETT
EARLIER MENTIONED SOMETHING AROUND SAYING THAT THE 811
SYSTEM HASN’T LESSENED THE PEOPLE WHO GO TO THE ER BUT HAS
CHANGED THE PEOPLE WHO GO. IS THAT AN ACCURATE — NUMBER
ONE, IS THAT AN ACCURATE RE-TELLING OF WHAT YOU SAID?
>>The Chair: DR. HOWLETT?>>YEAH, I THINK THAT WOULD BE A
FAIR REPRESENTATION OF WHAT I SAID AND IT WOULD BE ACCURATE.
AND SO JUST, IF I COULD EXPAND ON THAT, THERE THERE ARE SOME
PEOPLE THAT COULD MANAGE AT HOME AND SOME STAYING AT HOME THAT
SHOULD GO TO THE EMERGE. I GET A LOT OF FLAK FOR BEING
THE EMERGENCY DOCTOR ASSOCIATED WITH 811, AS YOU CAN IMAGINE,
BECAUSE MY COLLEAGUES, BUSY EMERGE, BUT IT IS ALSO QUITE
HUMBLING TO BUMP INTO SOMEBODY THAT LITERALLY SAYS, HEY, YOU —
THE PROGRAM SAVED MY KID’S LIFE, RIGHT?
LIKE I CALLED, AND IT’S HAPPENED TO ME WHEN I WAS AT CAPITAL
HEALTH, WHEN I WAS — JUST SAID, LOOK, I WAS CALLING IN, I WAS IN
CHARGE OF THE KIDS. MOM WAS AWAY AND I SAID HOW MUCH
TYLENOL SHOULD MY 5-MONTH-OLD AND THEY SAID YOUR 5-MONTH-OLD
SHOULDN’T HAVE TYLENOL. IT SHOULDN’T HAVE A FEVER.
YOU SHOULD GET TO THE IWK. THEY HAD A SERIOUS BACTERIAL
INFECTION, DID WELL AND SAID THANK GOODNESS YOU SHOWED UP.
THOSE ARE SOME OF THE THINGS THAT ARE REWARDING ABOUT THIS
PROGRAM.>>The Chair: MS. LEBLANC?
>>RIGHT, AND EARLIER YOU — I MEAN, LISTEN, I THINK THE
PROGRAM’S AWESOME. EARLIER YOU ALSO MENTIONED AT
THE VERY BEGINNING YOU SAID, YOU KNOW, ASSUMING YOU DO HAVE A
PHONE, THIS SERVICE IS AVAILABLE TO ALL NOVA SCOTIANS, ASSUMING
YOU DO HAVE A PHONE. THAT’S KIND OF A BIG POINT, A
BIG IMPORTANT POINT HERE, BECAUSE IN TERMS OF PEOPLE WHO
DON’T HAVE PHONES, OBVIOUSLY THEY ARE PEOPLE WHO CAN’T AFFORD
A PHONE. AND SO I’M WONDERING IF YOU CAN
COMMENT ON THAT. LIKE, DO YOU SEE IN TERMS OF
BEING ALSO AN ER DOCTOR, WOULD YOU SAY IT’S FAIR THAT THE
PEOPLE WHO THEN, YOU KNOW, PRESENT AT EMERGENCY ARE PEOPLE
WHO DON’T HAVE ACCESS TO THE 811 SYSTEM FIRST?
LIKE, THAT THEY HAVEN’T HAD THAT SORT OF FIRST LINE OF TRIAGE, OR
WOULD YOU — AND I GUESS SECONDLY, WOULD YOU SUGGEST OR
WOULD YOU AGREE WITH ME WHEN I SAY THAT EVERY NOVA SCOTIAN
SHOULD HAVE A PHONE?>>The Chair: DR. HOWLETT?
>>SO A LOT OF QUESTIONS IN THERE.
AND THANK YOU FOR THAT, SUSAN. FAIR, I LOOK AFTER DARTMOUTH
GENERAL. A LOT OF MY FAVOURITE PEOPLE
COME FROM SUSAN’S RIDING. AND THEY ARE SOME OF OUR MORE
HARDSCRABBLE PEOPLE IN OUR SOCIETY, BUT MOST OF THEM HAVE
PHONES, INTERESTINGLY ENOUGH. I DON’T SEE VERY MANY PEOPLE WHO
DON’T HAVE PHONES. I CAN COUNT ON ONE HAND THE LAST
MONTH PEOPLE WHO DON’T HAVE PHONES.
IN SHORT ANSWER, YES, I THINK THE PHONE SHOULD BE — I THINK
811 IS HELPFUL AND IT’S A MATTER OF CONTINUING TO EDUCATE PEOPLE
TO CALL IT WHEN THEY DO AND SO, YEAH.
I WAS TRYING TO MAKE THE DIFFERENTIATION BETWEEN THE
INTERNET AND THE PHONE. THAT SOMETIMES WE THINK WHY IS
IT SO INTERNET-BASED. I THINK VERY FEW OF THESE PEOPLE
MAY NOT HAVE ACCESS TO RELIABLE INTERNET.
I THINK THAT IS REALLY WHERE I SEE THE DIFFERENCE IN MANY OF
THE PEOPLE I SEE, BUT MOST OF THEM SEEM TO HAVE ACCESS TO A
PHONE.>>The Chair: MS. LEBLANC?
>>WELL, I’M GLAD THAT’S YOUR STANCE.
I HAVE TO SAY THAT I HAVE MANY PEOPLE COME INTO MY OFFICE WHO
DON’T, WHO COME IN TO USE MY PHONE.
BUT I WANTED TO ASK A BIT ABOUT THE NURSES WORKING FROM HOME
TOO, WHICH IS SOMETHING THAT I — AS SOMEONE WHO CALLS 811, I
HAD — YOU KNOW, WHEN YOU SEE SOMEONE ON THE RADIO, RADIO
PERSONALITY IN PERSON FOR THE FIRST TIME, THIS IS LIKE, THIS
IS NOT AT ALL WHO I THOUGHT YOU WERE.
I HAD THIS IMAGE OF ALL THESE NURSES WORKING TOGETHER IN ALL
THESE COSY OFFICES AND EVERYONE ON THE PHONE TOGETHER.
THE NURSES WORK FROM HOME. CAN YOU TALK ABOUT THAT?
BECAUSE THEY’RE NOT CONNECTED WITH A SITE, ARE THEY UNIONIZED?
ARE THEY PAID IN THE SAME WAY AS, YOU KNOW, NSHA NURSES OR
PEOPLE WHO ARE WORKING, YOU KNOW, IN SORT OF MORE
CONVENTIONAL NURSING SITUATIONS? AND IS THIS EMCI, WHICH I’M
ASSUMING A COMPANY, LIKE, WHO’S PAYING THE NURSES?
>>The Chair: WHO WANTS TO TAKE THAT?
OKAY, MS. BOUTILIER. >>THANK YOU.
SO YES, ALL THE NURSES WORK FROM HOME.
THEY ARE NON-UNION NURSES. THEY HAVE VARIOUS BACKGROUNDS
AND EXPERIENCES THAT WE’RE LOOKING FOR.
AND SO YOU HAD A LOT OF QUESTIONS THERE.
WHAT’S ANOTHER QUESTION THAT I COULD ANSWER THERE?
>>The Chair: MS. LEBLANC?>>WHO PAYS THEM?
>>The Chair: MS. BOUTILIER. >>THANK YOU.
WELL, EMCI PAYS THEM. WE WORK FOR EMCI.
I MEAN, WE ARE REGULATED THROUGH THE DEPARTMENT OF HEALTH AND
WELLNESS, BUT WE WORK FOR EMCI.>>The Chair: MS. LEBLANC?
>>SO JUST TO BE CLEAR, EMCI IS A COMPANY THAT RUNS THIS SYSTEM
THAT THE DEPARTMENT CONTRACTS TO RUN 811 FOR THE CITIZENS OF NOVA
SCOTIA, AND YOU FOLKS ARE PAID BY EMCI AND THE NURSES ARE PAID
BY EMCI?>>The Chair: MS. BOUTILIER?
>>CORRECT.>>The Chair: DR. HOWLETT?
>>SO THE SAME THING HAPPENS WITH EHS, RIGHT?
IT’S A VERY SIMILAR AGREEMENT IN THAT SYSTEM.
I WANTED TO TALK A LITTLE BIT ABOUT THE NURSES, IF I COULD.
IT’S NOT INTUITIVE WHAT THESE NURSES ARE, AND WHAT THEY DO,
AND I SPENT A LOT OF TIME — WE HAVE THIS SESSION REGULARLY, BUT
WE SPEND A LOT OF TIME DOING SOME EDUCATION, BUT WHAT THE
NURSES DO IS VERY DIFFICULT. IT IS AS MUCH OF A NURSING —
YOU KNOW, I’M AN EMERGENCY PHYSICIAN.
I WORK WITH A NUMBER OF PEOPLE, BUT WHAT THEY DO IS VERY
DIFFICULT. I WANT TO BRAG ABOUT WHAT THEY
DO. IT IS VERY HARD TO
OVER-THE-PHONE ASSESS A SICK PERSON AND DECIDE WHAT’S WRONG
WITH THEM. IT IS AS MUCH AS A SPECIALTY
SKILL AS BEING AN I2 NURSE, BEING AN EMERGE NURSE, AND IT IS
NOT FOR ALL NURSES. SOME OF THEM THINK, HEY, I’M
GOING TO GO HOME AND I DON’T HAVE TO GO ANYWHERE ELSE, A THEN
THEY TRY IT AND THEY’RE LIKE, WHOA, THIS IS WAY MORE
DIFFICULT. A LOT OF THE NURSES THAT WORK
WHERE I WORK, MANY TIMES THEY’RE THE FINAL WORD ON THE PATIENT.
THEY’VE SEEN THE PATIENT AND THEY’RE LEAVING THE PATIENT AT
HOME. AND THAT IS VERY DIFFERENT THAN
WHAT MANY OF THEM HAVE DONE. BECAUSE OFTEN IT’S BECAUSE
THERE’S A PHYSICIAN. TYPICALLY NURSES WORK IN A TEAM
WHERE THIS CASE THEY MAY ACTUALLY BE USING A GUIDELINE
AND RECOMMENDING SELF-CARE. SO THEY SPEND A LOT OF TIME
DOING THAT, AND LOTS OF TIME TO FIGURE THAT OUT.
WE HAVE SOME EXCELLENT WELL-TRAINED NURSES, AND THIS
SKILL IS VERY DIFFICULT TO DO. THERE ARE SOME ADVANTAGES.
WE HAVE NURSES THAT — AND THEY HAVE TO BE IN AN OFFICE.
THEY CANNOT BE IN THE KITCHEN. THEY ARE SET UP SPECIFICALLY.
THEY DO HOME VISITS. IT ALL HAS TO BE DONE VERY
PROFESSIONALLY. THEY ARE EXPECTED TO DRESS
PROPERLY. YOU CAN’T ROLL OUT OF BED,
PAJAMAS ON, START TAKING CALLS. IT DOESN’T WORK LIKE THAT.
IT’S IMPORTANT AND IT’S DIFFICULT.
IT DOES ALLOW A GROUP OF NURSES THAT MAY NOT BE WORKING
SOMEWHERE ELSE, FOR WHATEVER REASON, OR IF THEY HAVE INTERNET
CONNECTION, THEY MAY BE ABLE TO STAY WITH THEIR FAMILY SOMEWHERE
IN A RURAL AREA AND DO THIS. AS LONG AS — THE REAL CHALLENGE
IS WE HAVE TO HAVE HIGH-SPEED INTERNET CONNECTION TO ALLOW
THEM TO DO THIS, YEAH.>>The Chair: MS. LEBLANC?
>>YEAH, SO GIVEN THOSE SPECIAL SKILLS AND THAT SORT OF
PARTICULAR WAY OF WORKING, CAN YOU TALK ABOUT THE — LIKE, THE
COMPARATIVE SALARY OF AN 811 NURSE TO, SAY, A NURSE WORKING AT A
HOSPITAL?>>The Chair: MS. BOUTILIER?
>>THANK YOU. WE DO STRIVE TO DO COMPARATIVE
SALARIES WITH OUR NURSES BASED ON THE HOSPITAL WAGES.
>>The Chair: MS. LEBLANC?>>SO THE NURSES WHO WORK AT 811
ARE PAID THE SAME AS NURSES AT THE HOSPITAL?
>>The Chair: MS. BOUTILIER?>>AGAIN, WE STRIVE TO MATCH
WHAT THE WAGES ARE IN THE HOSPITAL.
>>The Chair: MS. LEBLANC.>>SO I’M SORRY, YOU’RE SAYING
YOU STRIVE TO MATCH THE WAGES OF THE HOSPITAL, WHICH SUGGESTS TO
ME THAT THEY DON’T MAKE THE SAME.
I’M JUST ASKING THE QUESTION. THERE’S NO JUDGMENT.
I JUST WANT TO KNOW, AND ALSO I’D BE CURIOUS TO KNOW IF THEY
HAVE HEALTH BENEFITS.>>The Chair: MS. BOUTILIER.
>>WE ABSOLUTELY DO HAVE HEALTH BENEFITS.
SO WE STRIVE — AGAIN, WE STRIVE TO MATCH, AND IT’S
PERFORMANCE-BASED. SO WE DO YEARLY PERFORMANCE
REVIEWS WITH OUR NURSES, AND SO ON A YEARLY BASIS WE DO
INCREASES BASED ON PERFORMANCE. SO IT’S PERFORMANCE-BASED
PAYMENTS OR SALARIES.>>The Chair: MS. LEBLANC.
>>CAN YOU TALK ABOUT WHAT THE BASE SALARY IS?
LIKE THE STARTING SALARY?>>The Chair: MS. BOUTILIER?
>>I THINK I’LL PASS ON THAT QUESTION AT THIS TIME.
>>The Chair: MS. LEBLANC.>>WELL, I THINK IT’S IMPORTANT
FOR NOVA SCOTIANS TO UNDERSTAND WHAT PEOPLE WHO ARE SERVING THEM
ARE MAKING.>>The Chair: MS. BOUTILIER.
>>SORRY, SO I JUST WANTED TO BE SURE I WAS ALLOWED TO REVEAL
THAT STARTING WAGE IS $36.78 AN HOUR WE START OUR NURSES WITH.
>>The Chair: MS. LEBLANC. >>AND THAT GOES UP ANNUALLY OR
WHATEVER BASED ON PERFORMANCE.>>The Chair: MS. BOUTILIER?
>>THAT IS CORRECT.>>The Chair: DR. HOWLETT.
>>SORRY, I THINK WE’RE ALL A BIT UNCOMFORTABLE WITH THIS.
WE’VE NEVER BEEN HERE BEFORE AND WANT TO MAKE SURE WE GET THIS
RIGHT. I DON’T KNOW EXACTLY THE —
BECAUSE I HAVEN’T BEEN INVOLVED IN THE WAGES, AND I UNDERSTAND
WHY YOU’RE ASKING THE QUESTION. IT MAKES A LOT OF SENSE TO ME.
ONE OF THE THINGS THAT WE KNOW ABOUT THE NURSING HERE IS WE
SEEM TO HAVE FOUND AN OPPORTUNITY TO FIND NURSES THAT
WANT TO WORK IN THIS ENVIRONMENT, RIGHT?
AND THE OTHER THING IS, THERE’S A LOT LESS EXPENSES IF YOU DON’T
HAVE TO TRAVEL TO WORK AND THERE’S A BUNCH OF OTHER THINGS
THAT SPECIFICALLY AROUND PARKING OR TRAVELLING OR CARS AND
EVERYTHING ELSE. SO IT DOES PROVIDE A CERTAIN
ECONOMIC ADVANTAGE IF YOU CAN ACTUALLY FIND A JOB WHERE YOU
WORK FROM HOME.>>The Chair: MS. LEBLANC.
>>YEAH, I TOTALLY GET IT. OBVIOUSLY THERE’S MANY DIFFERENT
WORKING SITUATIONS FOR MANY PEOPLE AND THINGS WORK WELL FOR
PEOPLE. I KNOW THAT I HAVE A
SISTER-IN-LAW WHO WORKED AT HOME FOR MANY REASONS, AND IT WAS
REALLY PERFECT FOR HER, AND SHE LIVED OUTSIDE THE CITY.
DIDN’T HAVE TO DEAL WITH ANY OF THAT STUFF.
BUT I’M WONDERING IF YOU COULD — WE DON’T HAVE TO DISCUSS IT
FURTHER NOW, BUT IF YOU COULD TABLE OR SEND US WITH THE OTHER
DATA THAT YOU’RE SENDING US THE INFORMATION AROUND HOW THOSE
PERFORMANCES WORK. SO YOU KNOW, WHAT WOULD THE
ANNUAL REVIEW ENTAIL AND WHAT HAPPENS IF THE NURSE IS NOT
MEETING THEIR PERFORMANCE TARGETS?
YOU KNOW, DOES THEIR SALARY GO DOWN, DOES IT STAY THE SAME IN
THAT KIND OF INFORMATION, THAT WOULD BE GREAT.
I’M JUST GOING TO MOVE ON TO TALK A LITTLE BIT ABOUT THE
INTEGRATION OF THE 811 SYSTEM WITH — LIKE, IN THE FUTURE,
WITH THE ELECTRONIC ONE PERSON ONE RECORD.
ARE YOU SITTING LIKE THAT BECAUSE MY TIME’S UP?
>>The Chair: NOT YET.>>CAN YOU TALK ABOUT IS THERE A
FUTURE OF INTEGRATING 811 WITH ONE PATIENT ONE RECORD SO THAT A
NOVA SCOTIAN HAS ONE CHART WHICH 811 WOULD ALSO BE INCLUDED IN?
>>The Chair: DR. HOWLETT?>>YES, IT’S TOTALLY MY
EXPECTATION THAT WE WILL BE INCLUDED IN THAT, FROM MY
UNDERSTANDING. I DON’T THINK — WE’VE NOT HAD
THOSE CONVERSATIONS NOW, BUT IT IS MY UNDERSTANDING, SUSAN, THAT
WE WOULD BE INCLUDED IN THE OPOR, YES.
>>The Chair: MS. LEBLANC?>>HOW MUCH TIME DO I HAVE?
>>The Chair: JUST ABOUT 20 SECONDS.
>>WONDERING IF THERE’S ANY WAY TO CURRENTLY LOOK UNTIL WE GET
ONE PATIENT ONE RECORD, IF THERE’S A WAY TO — YOU KNOW, TO
MAYBE IMPLEMENT THIS IDEA OF HAVING RECORDS OR THE 811 CALL
BE TRANSFERRED TO — >>The Chair: ORDER.
TIME HAS LAPSED FOR THE NDP. WE’RE MOVING OVER TO THE LIBERAL
CAUCUS. 14 MINUTES.
MR. IRVING.>>THANK YOU, MADAM CHAIR, AND
THANK YOU ALL FOR BEING HERE TODAY.
I JUST WANTED TO GO BACK TO TRENDS OF USAGE.
YOU MENTIONED THERE WERE 114,000 I GUESS INDIVIDUAL CALLS AND
80,000 — I THINK I UNDERSTOOD 80,000 INDIVIDUAL CLIENTS IN THE
COURSE OF A YEAR. BUT YOU ALSO INFERRED THAT
NUMBERS HAD DROPPED A BIT. SO I’M JUST WONDERING, OVER THE
TEN YEARS, REMOVING THE BLIP OF — IT WASN’T SARS, BUT ANYWAY,
THE H1N1, IS THERE A GENERAL DOWNWARD TREND OVER A NUMBER OF YEARS
WITH RESPECT TO THE USE?>>The Chair: DR. HOWLETT?
>>SO I DON’T HAVE IT IN FRONT OF ME, SO I — I’M HAPPY TO GET
IT TO YOU, AND YOU CAN LOOK AT IT.
IT IS MY MEMORY THAT IT HAS COME DOWN A BIT.
ONE OF THE THINGS THAT WE DO KNOW IS THAT EVERY TIME WE
EMBARK ON AN ADVERTISING WE DO HAVE AN UPSURGE, AND I THINK
THERE IS AN OPPORTUNITY THERE THAT WE HAVE.
IT HAS GOTTEN MUCH BETTER. WE INITIALLY THE COORDINATION
BETWEEN ADVERTISING AND — WASN’T ALWAYS PERFECT, AND SO
YOU KNOW, WE SUDDENLY ADVERTISE AND OUR VOLUMES JUMP 30%
OVERNIGHT AND THEN IT COMES OFF, BUT WE’RE MUCH BETTER AT KNOWING
THAT BECAUSE SOMETIMES IT HAS STAFFING IMPLICATIONS, IF WE’RE
NOT READY FOR THAT. BUT YEAH, SO I THINK — I’LL GET
THAT DATA FOR YOU. I DO THINK ADVERTISING IS PART OF IT.
AND SO I’LL LEAVE IT AT THAT.>>The Chair: MR. IRVING?
>>THANK YOU. AND TO THAT POINT OF
ADVERTISING, IN TERMS OF ADVERTISING YOUR OWN SERVICES,
WHEN WE HAVE PEOPLE CALLING UP TO BE PUT ON THE FAMILY
PRACTITIONER LIST, I ASSUME THAT YOU DO — I MEAN, IT WOULD BE
THE PERFECT TO SAY YOU CAN ALWAYS CALL BACK IF YOU DON’T
HAVE A FAMILY DOCTOR WE’RE HERE TO HELP FILL THAT GAP DURING
THIS WAITING PERIOD. DOES THAT ACTUALLY HAPPEN?
>>The Chair: MS. BOUTILIER?>>THANK YOU.
YES, THAT DOES HAPPEN. SO IF THEY DO CALL THE NEED A
FAMILY PRACTICE LINE AND THEY ARE EXHIBITING SYMPTOMS OR
REQUESTING HEALTH INFORMATION, THE TELEHEALTH ASSOCIATE WILL
REFER THEM BACK TO 811. TO CALL 811 BACK TO SPEAK TO A
REGISTERED NURSE.>>The Chair: MR. IRVING?
OH, SORRY, DR. HOWLETT?>>SO ONE OF THE OTHER THINGS
WE’RE WORKING WITH SOME OF OUR PRIMARY HEALTH CARE COLLEAGUES
IT’S ON THEIR ANSWERING SERVICE. YOU’VE REACHED DR. JONES’S
OFFICE, AFTER-HOURS, IT’S AN EMERGENCY, PLEASE GO TO — IF
YOU’RE UNSURE WHAT TO DO, PLEASE CALL 811.
THERE’S AN EDUCATION THAT’S HAPPENING IN THERE AS WELL.
RICK GIBSON, WHO YOU MAY HAVE MET, WHO’S THE SENIOR PHYSICIAN
FOR PRIMARY HEALTH CARE HAS BEEN VERY GOOD ABOUT PUTTING THAT
OUT. THE WHOLE ADAGE, IF IT’S AN
EMERGENCY, GO TO EMERGENCY. IF YOU NEED TO SEE YOUR FAMILY
DOCTOR, GO TO YOUR FAMILY DOCTOR.
YOU’RE NOT SURE, CALL 811.>>The Chair: MR. IRVING?
>>THANK YOU. NOW THE HIGH NUMBER OF REPEAT
CALLS, AND I’M SURE MANY, MANY OF THEM, YOU KNOW, LIKE MS.
LEBLANC, WITH THREE KIDS, ARE, YOU KNOW, USE IT — USE THE
SERVICE OVER AND OVER AND IT’S PROVIDING GREAT VALUE.
I’M JUST CURIOUS WHETHER THERE’S ANY KIND OF VERY MUCH LOW-NEED
USE, YOU KNOW, SENIORS THAT ARE LONELY.
I MEAN, THAT’S KIND OF A MENTAL HEALTH THING AS MUCH AS
ANYTHING, BUT YOU KNOW, AS ANY POLITICIAN WHO KNOCKS ON DOORS
EVERY ONCE IN A WHILE YOU MEET A SENIOR THAT WANTS YOU TO SIT
DOWN AND HAVE A LONG CONVERSATION.
AND I’M WONDERING IF THAT IS SOMETHING THAT HAPPENS IN THIS
SERVICE AND WHETHER NURSES ARE TRAINED TO TRY AND WEED THROUGH
THE LONELINESS CALLS, I GUESS.>>The Chair: DR. HOWLETT?
>>SO FIRST OF ALL, I JUST WANT TO SAY I THINK SUSAN ONLY HAS
TWO KIDS, BUT JUST WANTED TO MAKE SURE THAT WAS UNDERSTOOD.
BUT THANK YOU. NOT SO MUCH.
I THINK OUR EXPERIENCE WITH THE ELDERLY IS THEY DON’T CALL THIS
LINE FOR — YOU KNOW, JUST FOR LONELINESS.
I’M NOT SURE WHY. IT MAY JUST BE BECAUSE THEY
RESPECT IT AND DON’T WANT TO DO IT.
WE DO HAVE A GROUP THAT IN EMERGE WE WOULD CALL FAMILIAR
FACES THAT NOW USE THE LINE. WE CALL THEM MULTI-CALLER OR
MULTI-VISIT PATIENTS THAT ARE SOMETIMES DIFFICULT TO MANAGE,
AND THEY MAY CALL FOR ALL KINDS OF INTERESTING REASONS, SOME OF
WHICH WE HAVE TO ACTUALLY CREATE CARE PLANS AROUND WHAT — THEY
ARE CALLING TO INTERACT WITH NURSES IN AN UNUSUAL WAY.
SO THAT’S THE REALITY. BUT THAT’S THE REALITY IN
ANYTHING. WE SEE THAT IN EMERGENCY
DEPARTMENT, AND NOT SURPRISINGLY TO SEE IT ON THIS.
BUT FOR ELDERLY, NO, I DON’T THINK WE’VE SEEN THAT AS AN
ISSUE. WE DO DO SOME OUTREACH, OF
COURSE, FROM PROVIDER REFERRAL TO VARIOUS THINGS THAT WE CAN
HELP PEOPLE. I CAN IMAGINE, THOUGH, THAT ONCE
YOU SIT DOWN FOR TEA YOU’RE THERE FOR A WHILE.
>>The Chair: MR. IRVING?>>THAT’S RIGHT, AND I DO AGREE
WITH YOU. I MEAN, WE’RE IN PUBLIC SERVICE
AND WE’RE SERVING THE PUBLIC, SO I APPRECIATE YOUR COMMENTS
THERE. I UNDERSTAND YOU ALSO HAVE A
WEBSITE AND ON-LINE SERVICES THERE.
DO YOU HAVE ANY SENSE OF WHETHER THAT IS
PROVIDING, YOU KNOW, THROUGH — PROVIDING SERVICE THAT ARE
FOREGOING CALLS AND PROVIDING ADVICE WITHOUT TALKING TO A
NURSE BUT HELPING FOLKS NAVIGATE TO THE MOST APPROPRIATE
HEALTH PROFESSIONAL TO DEAL WITH NEEDS?
COULD YOU TELL ME IF — TELL THE COMMITTEE A BIT MORE ABOUT THE
ON-LINE SERVICES OR YOUR WEBSITE?
>>The Chair: DR. HOWLETT?>>THANK YOU.
YEAH, I’M NOT AWARE — I WAS ASKING IF WE HAD ANY DATA ON HIT
RATES. I THINK — SORRY, THE ANSWER IS
I DON’T KNOW. AND I’LL BE HONEST WITH YOU, I
DON’T KNOW WHETHER THAT — LIKE, WE’RE EXPLORING WHETHER WE CAN
PUT SYMPTOM TRIAGE ON-LINE, SO WE ARE EXPLORING THAT.
IT’S FRAUGHT WITH SOME OTHER AREAS HAVE DONE THAT, AND WE’RE
LOOKING AT PERHAPS LOOKING AT DOING IT.
HAVE SOME — HAD A CONVERSATION YESTERDAY WITH A COMMITTEE ABOUT
THE PROS AND CONS OF DOING THAT, LETTING SOMEBODY JUST GO THROUGH
A LIST AND SEEING THE SYMPTOMS AND NOT HAVING A NURSE ASSIST IN
THAT PROCESS, YOU KNOW. I THINK IT’S REALLY IMPORTANT, A
LOT OF PEOPLE ASK WHY CAN’T YOU — IF IT’S JUST A PICK LIST, WHY
DO YOU NEED NURSES? WELL, THAT’S KIND OF A SILLY
QUESTION. THERE IS AN ART TO IT.
YOU NEED TO HAVE SOMEBODY, YOU NEED TO CLARIFY A QUESTION, YOU
NEED TO HAVE A HEALTH CARE PROVIDER TO BASICALLY SAY, YOU
KNOW, IT SOUNDS LIKE THIS, OR THE PERSON MIGHT MINIMIZE THE
SYMPTOMS. FOR THOSE OF US WHO WORK ON THE
FRONT LINE, WE KNOW SOME PEOPLE MINIMIZE SYMPTOMS.
SOME PEOPLE ARE ON THE OTHER END OF THAT SPECTRUM, AND WE’RE
ALWAYS TRYING TO SORT OUT WHERE AND HELP THE PERSON UNDERSTAND
WHAT’S THE MOST ACCURATE SYMPTOM AND WHAT’S THE MOST ACCURATE
DISPOSITION FOR THEM. NOT SURE — STILL STRUGGLING A
LITTLE BIT AND TRYING TO GET SOME DATA FROM SOME OTHER AREAS
ABOUT HOW SUCCESSFUL THEY ARE USING AN ON-LINE ONE, AND WHAT
ARE THE RESULTS OF THAT. SO THAT WAS ACTUALLY ON OUR
ACTION ITEM FROM YESTERDAY TO FIGURE THAT OUT.
SO WE ARE LOOKING AT THAT, YEAH.>>The Chair: MR. IRVING.
>>THANK YOU. I GUESS I JUST HAVE ONE MORE
QUESTION BEFORE I TURN IT OVER TO MY COLLEAGUE TO THE RIGHT
HERE. AND IT GOES BACK TO DATA.
JUST CURIOUS WHETHER YOU HAD ANY KIND OF REGIONAL DATA THAT
INDICATED ANY TRENDS REGIONALLY THAT ARE HELPFUL FOR HEALTH CARE
PLANNING.>>The Chair: DR. HOWLETT.
>>YEAH. I KNOW SOMETIMES WHEN WE PRESENTED THE REGIONAL DATA
AROUND ZONES, SO MAYBE I CAN PUT IT BACK TO THE COMMITTEE.
BECAUSE WE’RE PLANNING TO MEET WITH THE NOVA SCOTIA HEALTH
AUTHORITY AGAIN, AND WE’LL PROBABLY BREAK IT OUT BY ZONE.
I GUESS THE QUESTION FOR THE COMMITTEE, IF I MAY, IS HOW
GRANULAR WOULD YOU LIKE THE DATA?
AND WOULD YOU LIKE IT BASED ON THE PEOPLE WHO VOTE FOR YOU OR
WHAT ARE YOU LOOKING FOR?>>The Chair: WE DON’T NORMALLY
DO ANSWER AND QUESTIONS, BUT IT’S INTERESTING.
YOU CAN GIVE US THOUGHTS TO PONDER FOR SURE.
AND PEOPLE MAY WANT TO SUBMIT FROM THEIR CAUCUS IF THEY HAVE
SUGGESTIONS TO YOU. BUT NORMALLY IT’S NOT OUR
PROCESS.>>SORRY ABOUT THAT.
>>The Chair: MR. IRVING?>>THANK YOU.
I MEAN, I THINK THE PURPOSE OF MY QUESTION AND OTHER MEMBERS ON
THE COMMITTEE IS IT REALLY DOES SEEM LIKE THERE IS VALUABLE DATA
WITHIN THIS SERVICE, AND I JUST ENCOURAGE US TO FIND WAYS TO
INVESTIGATE THAT AND GARNER THE BENEFITS OF THAT DATA BECAUSE IT
IS — I THINK IT DOES HAVE VALUE TO THE SYSTEM AND OUR HOSPITAL
PLANNING OR HEALTH SERVICES PLANNING.
SO WITH THAT, I’LL TURN IT OVER TO MY COLLEAGUE TO THE RIGHT.
THANK YOU.>>The Chair: MR. JESSOME.
>>THANK YOU, MADAM CHAIR. THROUGH YOU TO OUR WITNESSES, AS
THE INTAKE MECHANISM FOR NOVA SCOTIANS IS ATTEMPTING TO FIND
PRIMARY HEALTH CARE, FIND A FAMILY DOCTOR, DOES YOUR SHOP
HAVE THE CAPACITY TO TRIAGE CALLS BASED ON WHO HASPATIENTS
AS THEY ARE MAKING A HIGHER NEED THAN PERHAPS THE NEXT
PATIENT?>>The Chair: DR. HOWLETT?
>>THANK YOU. SO IF I UNDERSTAND THE QUESTION
CORRECTLY, ARE YOU SPECIFICALLY TALKING ABOUT THE SYMPTOM OF THE
PATIENT OR YOU’RE TAUBZ ABOUT WHETHER THE PATIENT HAS A FAMILY
DOCTOR?>>The Chair: MR. JESSOME?
>>THROUGH YOU, MADAM CHAIR, I’M ASKING — I’M REFERRING TO THE
GROUP OF NOVA SCOTIANS THAT DO NOT HAVE A FAMILY DOCTOR.
DOES YOUR SHOP HAVE THE CAPACITY TO TRIAGE, YOU KNOW, ONE TO TEN
WHO IS IN HIGHEST NEED, WHO HAS THE HIGHEST URGENCY TO BE
MATCHED TO A FAMILY DOCTOR?>>The Chair: DR. HOWLETT.
>>AGAIN, THANK YOU. SO AGAIN, JUST ON THE NEED A
FAMILY PRACTICE REGISTRY, WE DON’T — OTHER THAN COLLECT THE
DATA AND PASS THAT TO THE NOVA SCOTIA HEALTH AUTHORITY, WE’RE
NOT INVOLVED IN TAKING PEOPLE OFF THE LIST, CALLING THEM BACK,
GIVING THEM A FAMILY DOCTOR. THAT RESIDES COMPLETELY WITH THE
NOVA SCOTIA HEALTH AUTHORITY.>>The Chair: MR. JESSOME?
>>SO MY QUESTION IS WOULD YOUR SHOP HAVE THE CAPACITY —
>>The Chair: THEY DON’T DO THAT.
HE’S — >>I APPRECIATE, MADAM CHAIR,
THAT THEY DO NOT DO THAT. I’M ASKING DO THEY HAVE THE
CAPACITY TO DO THAT.>>The Chair: DR. HOWLETT.
>>I BELIEVE I UNDERSTAND YOUR QUESTION NOW.
WE HAVE NEVER BEEN ASKED TO DO THAT AT THIS POINT.
I’M — I WOULD HAVE TO TALK TO SOME PEOPLE AND SEE WHETHER THAT
WOULD BE — YOU KNOW, WHETHER WE COULD DO THAT.
IT’S AN INTERESTING PROPOSAL. IT’S NEVER BEEN ASKED, SO YOU
KNOW, THERE WOULD CLEARLY HAVE TO BE CRITERIA, SO THERE’S A
BUNCH MORE — I JUST DON’T HAVE — I HAVEN’T PUT ENOUGH THOUGHT
TO ACTUALLY ANSWER THAT QUESTION IN A MEANINGFUL FASHION, IF
THAT’S HELPFUL.>>The Chair: MR. JESSOME?
>>DO YOU THINK THAT — I GUESS I’M TRYING TO UNDERSTAND, WOULD
IT REQUIRE THE — I GUESS THE INTAKE PERSONNEL TO HAVE I GUESS
A CERTAIN BACKGROUND, OR WOULD IT BE SOMETHING THAT I GUESS A
QUESTIONNAIRE OR SOMETHING ALONG THOSE LINES THAT ANY INTAKE
PERSON COULD ADMINISTER?>>The Chair: DR. HOWLETT?
>>YEAH, I MEAN, THERE ARE SOME CONVERSATIONS WITH MY POSITIONS
OUTSIDE OF THIS ABOUT THEY HAD SOMEBODY WHO HAS, YOU KNOW,
THREE CHRONIC DISEASES AND PERHAPS THEY ARE A PRIORITY FOR
A FAMILY DOCTOR. I’M SURE THERE COULD BE CRITERIA
ESTABLISHED. WHETHER THAT WOULD NEED A
CLINICAL PERSON OR NON-CLINICAL PERSON TO ADMINISTER IT TO THE
PATIENT, I’D HAVE TO GIVE IT SOME MORE THOUGHT AND INVOLVE
SOME PEOPLE MAYBE SMARTER THAN ME RIGHT NOW TO MAYBE FIGURE IT
OUT. I THINK THAT WOULD BE AN
APPROACH THAT WOULD MAKE SENSE SOMEHOW, YEAH.
>>The Chair: MR. JESSOME?>>FOR THOSE PEOPLE WHO CALL IN
WITHOUT A FAMILY DOCTOR, ARE YOU INFORMING THEM AUTOMATICALLY
ABOUT 811 AS A SERVICE?>>The Chair: MS. GALLANT?
>>THANKS FOR THE QUESTION? YES, THAT IS PART OF OUR
PROCESS, THAT WE WILL ADVISE THEM THAT IF THEY HAVE SYMPTOMS
THEY CAN CALL 811 24 HOURS A DAY.
>>The Chair: MR. JESSOME. >>AND OPPOSITELY, WOULD THOSE
WHO CALL IN WITHOUT A FAMILY DOCTOR AUTOMATICALLY BE ADDED TO
THE 811 LIST?>>The Chair: MS. GALLANT?
>>IT’S NOT AN AUTOMATIC PART OF THE PROCESS, BUT IF THEY ASK
THEN WE CAN DEFINITELY TRANSFER THEM OVER TO THE NEED A FAMILY
PRACTICE PROGRAM. IF IT’S DURING REGULAR BUSINESS
HOURS. IF IT’S AFTER HOURS, THEN WE
WOULD ADVISE THEM TO PHONE BACK AND BE ADDED TO THE LIST FOR
SURE.>>The Chair: MR. JESSOME?
>>THANK YOU FOR YOUR TIME.>>The Chair: ANYMORE QUESTIONS
FROM THE CAUCUS? OKAY.
WE WILL NOW ASK OUR — TIME HAS ELAPSED.
DR. HOWLETT, WOULD YOU GIVE SOME CLOSING REMARKS?
>>YES. THANK YOU.
I’D HOPED THAT WE WOULD HAVE A MEANINGFUL CONVERSATION, AND I’D
LIKE TO THINK THAT WE HAVE. I’VE ALSO BEEN VERY IMPRESSED BY
A NUMBER OF THE SPEAKERS AND SOME REALLY INTERESTING TOUGH
QUESTIONS AND SOME IDEAS, AND SO, YOU KNOW, I CAME HERE WITH
AN IDEA THAT I WOULD — HOPEFULLY WE WERE TO EDUCATE
YOU, BUT I’VE HEARD SOME GREAT STUFF FROM YOU, AND SO THANK YOU
FOR THAT. AND WE’LL TAKE SOME OF THOSE
IDEAS BACK AND CHALLENGE OURSELVES TO CONTINUE TO DO
BETTER TO SERVE THE POPULOUS. I DO BELIEVE STRONGLY THAT 811
HAS A ROLE TO PLAY IN OUR HEALTH CARE SYSTEM HELPING COORDINATE
IT. I DON’T THINK IT’S WRONG TO
STRESS WE HAVE SOME WORK TO DO STILL.
AND I THINK 811 CAN BE A PART OF THAT.
THE ONE PLEA THAT I ASKED ABOUT IS IF THERE’S SOME WAY THAT WE
CAN MANDATE A FEDERAL — I THINK YOU HEARD THAT FROM ME, BUT A
FEDERAL MANDATORY WORKING GROUP BY ALL THIRD PARTIES, I THINK
THAT WOULD BE VERY HELPFUL. I THINK IT WOULD CHALLENGE US
AND ALLOW US TO BENCHMARK AND IMPROVE THAT WE CAN DO THINGS IN
CANADA. IT’S THE CANADIAN WAY, BUT
SOMETIMES WHEN WE PUT THE THIRD PARTY IN, THERE’S A LOT OF GOOD
THINGS, BY THE WAY, OF HAVING A THIRD PARTY RUN THIS
ORGANIZATION. THERE’S AN ACCOUNTABILITY AND
RIGOUR THAT I’VE SEEN THAT I DON’T ALWAYS SEE IN MY OTHER
JOB. NO, THERE IS SOME REALLY GOOD
THINGS TO THAT. BUT LIKE ANYTHING, THERE’S A
NEGATIVE SIDE TO THAT, SO I JUST WANTED TO, AGAIN, EXPRESS MY
APPRECIATION AND THANK YOU FOR COMING HERE AND YEAH.
>>The Chair: THANK YOU, DR. HOWLETT, MS. GALLANT AND MS.
BOUTILIER. YOU MAY LEAVE.
I’M SURE THERE ARE PEOPLE OUT IN THE MEDIA GALLERY THERE WAITING
TO INTERVIEW YOU. WE HAVE A SHORT BUSINESS
MEETING. WE STARTED THE MEETING A LITTLE
LATE TODAY, SO I’M — WE CAN’T STAY HERE FOREVER BECAUSE LEG TV
NEEDS TO GET IN AND USE THE ROOM, BUT CAN WE HAVE LIKE A
FIVE-MINUTE EXTENSION IN CASE WE NEED IT?
DO I HAVE CONSENSUS FROM THE ENTIRE COMMITTEE?
THANK YOU. WE WILL MOVE ON.
WE HAVE A BIT OF BUSINESS. THE NDP HAD ASKED FOR
REPRESENTATIVES FROM THE COLLEGE OF DENTAL HYGIENISTS AND FOR THE
DEPUTY MINISTER OF HEALTH AND WELLNESS.
THE COMMITTEE APPROVED, ALONG WITH A LIBERAL AMENDMENT, THAT
ADDED ANGELA PURCELL, THE DENTAL ASSOCIATION EXECUTIVE DIRECTOR
OR DESIGNATE. BUT IT SHOULD BE CLARIFIED THAT
MS. PURCELL DOES NOT WORK FOR THE CANADIAN DENTAL ASSOCIATION.
SHE IS THE EXECUTIVE DIRECTOR OF THE PHARMACEUTICAL SERVICES AND
EXTENDED HEALTH BENEFITS WITH THE DEPARTMENT OF HEALTH AND
WELLNESS. GIVEN THAT NEW INFORMATION, DOES
THE COMMITTEE STILL WISH TO INVITE MS. PURCELL TO ATTEND THE
MEETING? DO WE HAVE CONSENSUS ON THAT?
>>[INDISCERNIBLE]. >>The Chair: YOU ASKED, BUT HER
POSITION WAS DIFFERENT THAN WHAT YOU — FROM WHAT I UNDERSTAND.
SHE IS THE EXECUTIVE DIRECTOR OF PHARMACEUTICAL SERVICES AND
EXTENDED HEALTH BENEFITS WITH THE DEPARTMENT OF HEALTH AND WELLNESS.
MS. LEBLANC?>>MY UNDERSTANDING IS THAT THIS
WAS THE PERSON THAT THE LIBERAL CAUCUS WANTED TO ADD TO THE
ROSTER OF WITNESSES.>>The Chair: YES.
SO YOU’RE FINE WITH THAT? YES?
SO WE HAVE CONSENSUS FROM THE COMMITTEE?
OKAY, GREAT. THE 2019 ANNUAL REPORT, WE’D
LIKE TO HAVE APPROVAL. YOU WERE ALL SENT IT BY EMAIL.
DO WE HAVE — CAN WE HAVE A MOTION TO APPROVE AND HAVE IT
SENT TO THE LEGISLATURE? MR. JESSOME?
>>SO MOVED.>>The Chair: OKAY, ALL THOSE IN
FAVOUR?>>AYE.
>>The Chair: OPPOSED? MOTION IS CARRIED.
SO MS. CALENA, YOU WILL GET THAT READY AND I WILL SIGN IT I GUESS
TODAY AFTER THE MEETING. WE ALSO HAVE A CORRESPONDENCE
FROM DR. DAVID ANDERSON, DEAN OF FACULTY OF MEDICINE.
YOU RECEIVED THAT. IT WAS A REQUEST FROM THE AUGUST
14 MEETING. YOU RECEIVED IT BY EMAIL FROM
THE CLERK. ARE THERE ANY COMMENTS OR
QUESTIONS? OKAY.
OUR NEXT MEETING DATE WILL BE TUESDAY, NOVEMBER 12, 2019.
WE ARE HOPING IT WILL BE 1 O’CLOCK TO 3.
IT MAY BE — IF THE HOUSE IS STILL SITTING, IT WILL BE IN THE
MORNING. MS. ADAMS?
>>THANK YOU. AT A PREVIOUS HEALTH COMMITTEE
MEETING I HAD ASKED FOR HIERARCHY CHARTS FOR THE
DEPARTMENT OF HEALTH AND WELLNESS AND THE NOVA SCOTIA
HEALTH AUTHORITY. AND TO DATE I HAVEN’T RECEIVED
THAT.>>The Chair: THAT THE
ORGANIZATIONAL CHARTS? I DO REMEMBER THAT, YES.
>>I HAVE WRITTEN TO THE DEPARTMENT AND ASKED FOR THAT.
IT NORMALLY TAKES A WEEK OR SO TO SEND THESE LETTERS OUT TO
WITNESSES BECAUSE WE HAVE TO WAIT FOR THE HANSARD TRANSCRIPT
TO BE AVAILABLE, SO I MAKE A LIST OF ALL THE REQUESTS THAT
WERE MADE IN THE MEETING, SEND IT TO THE DEPARTMENTS.
THEY HAVE RECEIVED IT. SO WE’RE JUST WAITING NOW.
>>The Chair: MS. ADAMS?>>THANK YOU, AND THAT WAS FOR
THE DEPARTMENT OF HEALTH AND WELLNESS AND THE NOVA SCOTIA
HEALTH AUTHORITY.>>The Chair: MS. CAVANAUGH?
>>YES, I WROTE TO BOTH ORGANIZATIONS.
>>The Chair: THANK YOU. ANY OTHER QUESTIONS?
I WILL ADJOURN THIS

Related Posts

Leave a Reply

Your email address will not be published. Required fields are marked *