doctor on computerbaby boy

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Dr. Beth Gamulka

Dr. Beth Gamulka is a Staff Paediatrician at The Scarborough Hospital and at The Hospital for Sick Children, with a focus on Acute Care. She is also Adjunct Clinical Assistant Professor in the Department of Paediatrics at the University of Toronto.

I’m a hospital-based paediatrician so that means I don’t have my own files on patients, only the records from their previous hospital visits. The patients I see are a mix of: healthy babies that are new-born, or being seen in follow-up in the hospital clinic to make sure they’re doing okay; premature babies in the NICU; some children with a variety of acute illnesses who come to the emergency room, or who are sent in by their family doctors to be seen in our paediatric clinics; and then the children that we admit to the hospital, who usually have common paediatric illnesses like pneumonia, dehydration, fever, asthma.

Some of the kids we see are very complex patients who are followed closely at SickKids but then they have an illness and go to the nearest hospital and show up in the emergency room or clinics. And they may be quite unwell and have a very long medical history. So with children who have been seen elsewhere in the past, I will always check to see if I can get that information on eCHN. And it’s a very easy thing to check, it’s very easy to access.

On a typical 24-hour shift, I might use eCHN maybe half-a-dozen times - and some of that may not be necessarily because of the child in front of me but it’s to follow-up on a child that I’ve sent down to Sick Kids. You can make a personal list on eCHN of patients that you want to follow. We’re often seeing kids with a new illness and we might make the diagnosis or we might send them down to Sick Kids for the diagnosis. But you know, I was the first person to see them and so I’d like to know what happened – partly because of my interest in the patients and partly because I want to learn something.

Also, I deal with a huge immigrant population at Scarborough General. I might see 30 to 40 families on one of my 24-hour shifts and I always joke, I could probably go into room after room and there’s a different language being spoken in each room – so it’s a really multi-cultural operation. With eCHN, I can get the information I need without worrying about some of the potential obstacles like the language barrier or different cultural expectations for health care givers. And so I always try to get all the information that’s available so I don’t have to ask the family every question all over again.

With children who have complex chronic conditions, no parent will want to go through their entire history every time. And so I can clarify things. The parents appreciate it and I think sometimes it’s a cross-check against the information you are getting.

I have a perfect example of how useful eCHN can be. Recently, a seven-day-old baby came to the clinic who had a respiratory problem and it was unclear what the cause was. His parents told me they had had a previous child who died several years ago, but they were unable to verbalize the diagnosis. However, the child had been treated at Sick Kids and when I looked on eCHN, I was able to get medical information on that child - and that made it so much easier to diagnose the newborn in front of me.

It was a congenital chylothorax – which is rare. Without eCHN, I would not have been able to make that diagnosis within my community hospital setting. It wasn’t clear initially whether his difficulty breathing was related to his heart or lungs or infection so he really needed to get downtown as quickly as possible. This way I was able to literally in two minutes get the information off the computer, make the diagnosis, and then transfer him to Sick Kids with the diagnosis – rather than with an unknown mysterious symptom that would have required a lot more investigation. It made the transfer downtown much smoother because the more information I could give the team that was taking over, the easier it was for them to do their job too.

I think eCHN was life-saving in this case in the sense that the newborn was able to get the treatment he needed very quickly because the diagnosis was gleaned from his sister’s – and the only way you would have been able to get that was through eCHN. The parents certainly couldn’t have provided it and it would have taken longer to get the paper information faxed to me than it would have to get him transferred down. And then we could easily have missed the information anyway because the first child and this one had different last names on account of name changes. It was only because we had the eCHN digital record based on the health card number that the pieces all fit together so well.

So it was amazing! It was a perfect example of eCHN working really well for us.

I think eCHN certainly does improve outcomes for individual patients. It makes it easier to streamline the care you’re giving and makes it easier to get to the heart of the diagnosis. It allows you to avoid duplicating tests and to be able to share information with the right specialists, if that’s what you need to do. And particularly with that newborn - don’t forget, it’s a big mystery. You have a child in front of you, he doesn’t have a history, he doesn’t have a past record, a story. You don’t know why he’s doing what he’s doing right in front of you. So to have that extra information is huge - it was unbelievable. It made my life so much easier – and I think we were able to save that particular infant from going through a whole lot more before he received the treatment that he needed.

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