Technology, in the form of online connectivity, is advancing pandemic preparedness and making it easier for doctors to manage their rotating shifts and overlapping schedules.

Traditionally, on-call shifts from multiple locations revolve around paper-based trails that are often confusing –even conflicting. Juggling these rosters resembles the stress loads borne by air-traffic controllers.

Obstetrician Guy-Paul Gagné, M.D., knows firsthand the challenges facing shift schedulers at Montreal’s LaSalle General Hospital. Responsible for the rotating shifts of nine doctors in three hospitals, Gagné explains that it is virtually impossible to create schedules without knowing the interrelated schedules of everyone involved. “My secretary spends half a day locating a doctor,” he said. “That time lost has a huge cost component, not to mention inconvenience to the patient.”

Coordinating schedules and ensuring coverage at every clinic, hospital, nursing home, and prison causes constant confusion. Trading on-call shifts is a nightmare for shift managers. Uncertainty rules when penciled-in changes to schedules are posted in numerous places: Which roster is current?
“I’ve never seen a doctor scheduling system that wasn’t paper based,” reported Steven Rector, M.D., an emergency physician from Atlanta, Ga. “Our schedule is distributed on paper. We make schedule requests on paper and pencil in changes on the master copy in the emergency department.”
A unique solution to this chaos comes in the form of online, real-time software called CHYMA (pronounced “k-eye-ma”). CHYMA was developed by general practitioner Dennis Reich, M.D., from Sudbury, Ontario, who was confronted with creating shift schedules for several clinics. Reich’s software solution enables managers to post shifts live online where they can be accessed and traded anywhere at any time. (See software screenshot for shift schedule trading.)

Pandemic Preparedness

Two key questions confront all pandemic planners: How do we find out where our resources are, and how do we connect with them quickly and easily?
A recent 10-point plan to alleviate pressure on America’s emergency departments in the event of a disaster was proposed by the American College of Emergency Physicians to Congress. ACEP warned that agencies on the federal, state, and local levels could not control medical disaster response and recovery without fully connected and coordinated health resources.

In summary, collection and dissemination of data is vital. ACEP’s proposal (February 2006) emphasized the need for connectivity to “implement protocols to collect and monitor real-time data for syndromic surveillance, hospital inpatient and emergency department capacities, and ambulance diversion status”.
Access to current information and mobilizing key personnel in an outbreak or pandemic emergency requires a shared communications strategy in real time. The U.S. draft proposal of its pandemic flu plan envisions major disruptions in society from an outbreak with about 40 percent of the workforce falling ill, requiring government to work with health officials and the military while they contain the pandemic and maintain order. Coordinating volunteers will play a major role as manpower and movement will be restricted, says the 228-page report.

“Mobilizing ER physicians, front-line healthcare workers, public health units and government agencies, including the police, fire departments, or military, would be crucial for an effective and immediate response,” said Reich. “When key players in healthcare and emergency preparedness want to coordinate cross-institutional communications, CHYMA can help.”
Quarantine Protocols

A central recommendation in reports following Toronto’s Severe Acute Respiratory Syndrome (SARS) crisis emphasized the need for fast, effective, real-time communications with physicians and healthcare workers. During the SARS outbreak, emergency physicians at Scarborough General Hospital were catapulted into an abrupt realization: They urgently needed a better tool to coordinate scheduling and communications while dealing with highly contagious disease and its many isolation-related problems. In CHYMA they found a solution. Doctors can now relay constantly changing isolation protocols among quarantine-exposed physicians as well as trade shifts online in real time, without breaking quarantine barriers.

In Sault Ste. Marie, Ontario, the group health center, 10 regional health facilities, clinics, hospitals, the coroner’s office, and police department are using CHYMA in a citywide strategy. Across Canada, approximately 5,000 physicians are using the software for a variety of applications from shift creation and trading to document sharing, messaging, and providing an audit trail of shifts worked for physician billing purposes. CHYMA also provides online links to medical journals and procedures.

“Now that shift changes are in real time, we have a current up-to-date schedule,” said Mark Fletcher, M.D., director of the Family Focus Medical Clinics’ 65 doctors, in Halifax, Nova Scotia. “This software has solved a lot of problems that can occur when physicians start trading shifts.”
The software’s unique, scalable solution is Web-based and integrates smoothly into existing operations: One clinic manager said the system was up and running in no time because it uses the common intuitive browser functions with which we are all familiar. For shift schedulers, dialing for doctors is now a headache of the past.

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