Nightingale at work in Queens County

There are a lot of advantages to living in rural Nova Scotia, but there is a perception that one of the difficulties has to do with medical care. Caledonia and the villages surrounding it, making up the community of North Queens, have worked hard to tilt that balance in their favour.

Jim Rafferty positioned himself in front of a computer on his desk in his office in the new, well-equipped health centre and said that what he was going to show me took away the inequalities in rural versus urban health care. He made a few clicks with the mouse and rattled the keyboard, and what appeared on the screen were the complete results of diagnostic tests done on a person who had visited the centre. Dr. Rafferty carefully hid the identity of the person.

These results were available to the clinic within minutes of the analysis being completed at laboratories in Halifax. They showed the results of a battery of tests, highlighting those that required more investigation. The results could be portrayed in a variety of ways, including graphically, and with a click of the mouse Dr. Rafferty added them to the patient’s medical record file.

Another click of the mouse would send a message to the reception desk that a patient would be called in for a further visit, and yet another showed Dr. Rafferty’s complete list of appointments for the day, times included (again, Dr. Rafferty hid the identities). Dr. Rafferty said that in 10 minutes at the beginning of the day he could review the results that had come in that day, add the records to each person’s files, send requests for follow-up visits, and organize his day. The time saved, for a busy doctor, was enormous.

What Jim Rafferty was showing me was an electronic medical records system called “myNightingale.” piloted in Lunenburg, with North Queens being next in line. That status was because North Queens was one of the four original clinics in the province involved in an earlier system, itself the result of the health centre’s pioneering work with a nurse practitioner.

The system is expensive, but costs at North Queens were being taken care of under a special health transition fund through the provincial Department of Health. One requirement was high speed internet; another was that a commitment to use the system had to have been made by the end of last September. Dr. Rafferty said the health centre had actually made the “awful” decision of not using the system, because of difficulties with the provision of high speed internet service in the area.

However, the day after that decision was made, the province worked out an arrangement to run half of a T-1 line into the health centre, enabling the high speed internet service at a reasonable rate. The health centre participation was back in business. Dr. Rafferty said this showed how crucial high speed internet is for a rural area, and that you could not attract doctors to rural settings without that capacity.

Unfortunately, using the T-1 system – which is how the North Queens Schools and other schools are hooked up to high speed internet – is too expensive for individual users.

As a result of this system, patient files are now kept not in drawers in Caledonia, but electronically, in Halifax, though Dr. Rafferty assured me that full backups are kept as well. The advantage is that those records are thus available to other authorized medical people helping with a person’s treatment, with confidentiality a prime focus.

Jim Rafferty says that a doctor does not have to be a computer expert to use the system, either. He said that when the first system came along he was computer illiterate, that he couldn’t even turn the computer on. His view, he says, is that if he can learn to use the myNightingale system, anyone can.

The North Queens Health Centre joined the myNightingale system on June 13. The centre is now integrated with Nova Scotia hospitals in terms of patient lab results, radiology reports, and hospital discharge summaries. Both doctors and support staff have more time to focus on patient needs.

Best of all, patient medical history and treatment plans are now instantly available to the doctor, resulting in what the Department calls safer, faster and better treatment decisions. - Tom Sheppard can be reached at twsheppard@gmail.com