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Doctor warns poor hospital communication likely to worsen

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The head of the Bermuda Hospitals Board has appealed to doctors to help fix healthcare (File photograph by Akil Simmons)

The chief executive of the Bermuda Hospitals Board has appealed to physicians to collaborate in “fixing healthcare in Bermuda”.

However, a veteran doctor has warned that basic communications between with the hospital and physicians have grown dangerously flawed, with patient care placed at risk.

R, Scott Pearman spoke as the first non-physician to address the recent quarterly Docs for Dinner gathering hosted by Ewart Brown with Bermuda Healthcare Services and the Brown Darrell Clinic, saying alignment between “the hospital and all of the physician providers is essential for the effective and efficient management of our population’s health”.

A general practitioner at the event challenged Mr Pearman that physicians frequently found accessing the hospital’s new communications system “impossible”.

R. Scott Pearman, BHB chief executive, on communications issues with doctors

“As I said in my speech, technology offers new opportunities for the hospital and community physicians to communicate through secure channels that ensure patient confidentiality and adherence to Bermuda’s personal information privacy act requirements while optimising patient care, but it is a just tool that connects us and the hospital and local physicians still have to do their part.

“It is critical to patient care and the improvement of the healthcare system for us to communicate as effectively and efficiently as we can, but equally vital that all shared information is appropriately protected and secure.”

“Do not tell me to use a system that I cannot access,” the doctor said, citing a case in which repeated attempts to learn of a patient’s status were frustrated.

The GP finally discovered from the client’s family that the patient was dead.

R. Scott Pearman, the chief executive of the Bermuda Hospitals Board, addresses a gathering of the island’s physicians (Photograph by Jonathan Bell)

Mr Pearman, whose appointment was announced last December, responded at the dinner by acknowledging that “communication has absolutely been a struggle” and that the BHB “have had challenges”.

He said that with the implementation in 2022 of the hospital’s patient electronic and administrative records log, known as Pearl, the BHB had taken “a grand step”.

However, the physician responded that the upcoming requirements of the Personal Information Protection Act — Pipa — would only worsen ineffective communication channels.

“We are absolutely having to look at Pipa,” Mr Pearman conceded, adding that the BHB had faced its own challenges contacting physicians in return.

Healthcare in Bermuda has stood out as one of the last industries where the use of fax has persisted in an otherwise disjointed system — and the implementation of Pearl has been hailed as a vital upgrade.

The doctor at the Docs for Dinner night, who highlighted the discovery that a patient who had been in the hospital was now in a funeral home, said the problem was far from a one-off event.

The GP said that the BHB no longer uses regular e-mails or points of contact such as WhatsApp because of security concerns — with the impending implementation of Pipa next year due to set an even more rigorous legal framework around how doctors communicate with the hospital regarding their patients.

But the physician in question told The Royal Gazette on Friday that while personal data was subject to better security under the new regime, accessing the BHB’s internal system was a major hurdle.

“Getting into the BHB system can be a huge struggle. I try to do it early in the morning and half the time I can’t. When they tell patients that their doctors have been notified, the doctors are not actually being notified in a way that they can access.”

The doctor recounted the shock of learning that a patient who had been undergoing treatment was dead, adding: “The same thing happened to me this week. I got it from the family that the patient died in hospital. I hate to say this, but it happens a lot.”

The physician said continuing problems with the BHB system had shut out its own remote workers at times.

The GP added: “It endangers healthcare. We are working in the dark now, much more than we used to.

“I don’t say this in a critical manner. It’s a concern, and it’s been very frustrating for the medical community. The increasing privacy around our communications is making it much more difficult. If we cannot address it, it potentially threatens welfare.”

Stricter health information legislation in North America began the elimination of fax communications in Bermuda — but the doctor said faxes, an information-sharing technology more than a century old, remained in use within the island’s medical system.

“Fax is archaic, but it’s actually safer. It goes directly from end to end. E-mails have a long trajectory, and they can be hacked.

“I was encouraged to hear at Docs for Dinner that they are trying to sort this out. We need it.”

Mr Pearman’s speech touched on the disjoint between the BHB and doctors since the 2008 introduction of a hospitalist programme, which he said “displaced primary-care physicians as the most responsible physician for inpatient care”.

“Although the change in programme resulted in reducing length of stay, the disruption in relations with primary care and resultant confusion for our mutual patients was a failure in execution.”

Mr Pearman added: “How do we close this wound? I believe the answer lies in leveraging Pearl to improve communication and co-ordination of care between you and BHB when your patients are in the hospital.”

The physician who flagged up the communications hurdle told the Gazette: “I am optimistic that they are working on it.

“I can’t comment on Pearl from outside. I’m a GP in the community, not an inside user. But this is a big problem, and not just for me. It needs to be addressed.”

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Published April 01, 2024 at 8:00 am (Updated April 01, 2024 at 8:55 am)

Doctor warns poor hospital communication likely to worsen

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