Getting the word out

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A novel outreach program is just one way Nova Scotia Health is leading in healthcare information technology

When it comes to test results, sometimes the waiting really is the hardest part. Worry itches at the back of our minds no matter how much we distract ourselves, a persistent drumbeat we can quell but not quite silence until we hear the news. Until we know.

In the age of COVID-19 the agony of that wait is more far reaching than ever before. In Atlantic Canada, Nova Scotia Health leaders realized early on that post-testing outreach could waste precious time for patients and stretch staffing to its very limit. With a million Bluenosers relying on the agency, clear and rapid communication became a priority as urgent as the hands-on care provided by its hospitals and health centres across the province.

As COVID testing accelerated with the spread of the virus, roughly 60 public health staffers were tasked with informing people of their test results. At the time that meant reaching 40,000 individuals by phone. Despite a Herculean effort by the staff, most results took 48 to 72 hours to be communicated. The furious pace at which the staff worked couldn’t be sustained for any length of time, especially given the raft of unknowns at the time, which included the virus’s transmissibility and potential spread.

Enter Nova Scotia Health’s CIO, Andrew Nemirovsky, RN. A nurse who’d spent years at bedsides and on hospital floors, he brings a passion for IT, informatics, and healthcare fused to create a career focused on bridging information management and technology with clinical care. Working in concert with the Nova Scotia Health Information Management and Technology and provincial public health teams, as well as partners, including Nova Scotia’s Department of Health and Wellness and other provincial agencies, he directed his team to come up with innovative ideas to manage what was apt to become a logistical and public health nightmare.

Nemirovsky and his team went to work building a secure, in-house notification system designed to ease the burden on staff as well as the hefty loads carried by those anxiously awaiting to hear their status. Their focus: how to get the message out to people who tested negative, giving staff plenty of time to continue telephone outreach to patients who tested positive.

“Our team figured out a way to implement a system that was relatively low tech, easy to implement, easy to maintain, and easy for the citizen to consume,” he explained. “They came up with this relatively unique system where when your result came in you’d get an email back with a unique link so it couldn’t be hacked, and it required that the person enter the last four digits of their healthcare number to validate who they were, and then they would see the result.”

The system they devised sliced the two- to three-day waiting time to within 24 hours in the majority of cases. As soon as a negative test result is established it goes into the system, which generates an email to the patient in just 10 minutes.

Along with the result, the email outlines how to get answers to additional questions, and offers guidance on what to do if other family members test positive for the virus.

“It’s huge from a public health perspective. It’s been well received by citizens because they get their results much quicker,” he said. “It’s a great system, and it's continuing to be used. To date we’ve sent out 114,000 emails to Nova Scotia residents to go to the website and 95,300 have gone through and accessed that link. ... That’s 95,000 phone calls we didn’t have to make,” he said.

Nova Scotia Health and its partners received a 2020 UNIVANTS of Healthcare Excellence Award in recognition of the groundbreaking system. The global awards program, created by Abbott and a host of marquee healthcare organizations, celebrates and inspires healthcare excellence.

“Since the initial implementation, Nova Scotia Health has adapted the application to be used for mandatory post-secondary student testing and the organization continues to work with its partners on other testing scenarios that the application could be used for to deliver negative test results,” according to the award entry abstract.

Nursing informatics as a platform for clinical excellence

Nemirovsky’s background in nursing brings a special perspective to his work as an information management pro, especially since informatics, or information science, is part of his expertise.

“Where nursing becomes really important is in the provision of care and management of patients. A lot of informatics focused on physicians in the past, and people have come to realize that nursing is as important because nurses do a lot of data entry in IT systems, and all of that information feeds into the electronic and paper-based systems, depending on where you are in the continuum, and helps form the decisions that the care team and physicians make when looking after those patients,” he said.

“From a nursing perspective, having access to that system and information is hugely beneficial because it does affect the way they care for patients. When I was at the bedside we would look up lab values before we would administer medications to make sure there were no contraindications. Now I would look for electronic notes on patients; it all contributes to what I would call more holistic and patient-centered care because we are armed with the knowledge that we need to provide the most effective care as easily as possible.”

Nova Scotia Health maintains a number of nurses on their IT team to ensure a clinical perspective on IM and IT support. “It's very easy for us to get stuck in technology and the bells and whistles of a new tool, computer, or system and forget as a clinician what it's like to actually use the system so we make sure we hire a number of nurses and continue to do that as we move forward and introduce more digital technology.”

Building a multidisciplinary team has been central to the IM/IT unit’s efforts. “We have a very broad mix of staff as opposed to one skill set. When I look at our informatician roles, we have nurses, dietitians, pharmacy techs, and hardcore IT people who have a keen interest in healthcare.

“We have a really diverse team, which I think is quite helpful because sometimes it takes a couple of different perspectives to solve some of the problems we come up against. It’s nice to have that strong technical background, overlay it with a strong clinical background, and merge the two together. That’s what we look for in those informaticist-type roles.”

At heart, informaticists are translators. “A lot of the time these two are speaking different languages so they really need that strong intermediary that can translate and explain the risks and benefits to both groups and help them to make compromises and changes in scope and what we’re doing work-wise. We’re moving more from business and system analysts to clinical informatics-type roles because we’re seeing more value in those roles.

“We are totally patient-focused, making sure that the IM/IT program is an integral partner with our clinical peers, working closely with our physicians and nurses to make sure that we’re giving the best possible experience to them and our patients, and making sure that patients are cared for as safely and as efficiently as possible,” he concluded.