Please Share with Us the Highlights of Your Career in Radiology.
As a first year medical student I participated in a B.Sc. in medicine research project using ultrasound to compare the pulsations of the third ventricle in the brain intracranial pressure. When a local neurosurgery resident introduced a clinical ultrasound service I worked as an on-call technologist. Three years later he left. I started in radiology as a first year resident and the ultrasound section chief. My third year of residency involved a year of research in obstetrical ultrasound in Glasgow. After, I returned to the University of Manitoba, completed the radiology residency and embarked on a practice of academic radiology with a primary focus on ultrasound.
In 1990 I assumed the position of professor and chairman of the department of radiology at the University of Manitoba and the Health Sciences Centre in Winnipeg. After a term of seven years as department head I moved back to spend my time in ultrasound seeing patients and expanding the knowledge base in pelvic ultrasound and pelvic pain in particular. In 2008 I was inducted into the Order of Canada as an Officer for my work in ultrasound and contributions to healthcare in Canada.
How Far has Canada Advanced in Terms of Developing a Nationwide EPR?
Canada Health Infoway began a programme about eight years ago to foster and develop a nationwide interoperable electronic health record (EHR) for Canadians connected with a radiology information management and PACS system. They provided a national framework and some matching funds for provinces. This was a stimulus for each institution and province to begin the process of digitisation of radiology. In Manitoba the process involved all of the province's hospitals and that has just been completed. Because the process was province wide, single software vendors were chosen to ensure access of images and information across the province. Of our 10 provinces and three territories, all are at different stages of progress towards EHRs. Infoway's vision for 2015 includes having EHR infostructure in place across the country and implementing standardised electronic records in physician offices and physician order entry systems in hospitals, and including some degree of decision support for physicians such as clinical practice guidelines.
How are Radiologists from Abroad Integrated into the Healthcare System?
To practice in Canada, a radiologist must have passed the examinations of the College of Physicians and Surgeons of Canada. Exceptions are made for some with foreign certification especially the American Board of Radiology. During the 90s, when there was an acute shortage of radiologists, there was an influx of South African and British trained radiologists who were given temporary privileges if they practiced in underserviced areas. These temporary foreign workers were later given full registration, allowing those interested to move within Canada on a more permanent status. The rules have changed since then, and with few exceptions, all foreign graduates have to pass the Canadian radiology exams. Basic English language requirements are present in all provinces with the exception of Québec, which requires everyone who wants to work in Québec to pass a French written and oral test of proficiency.
What Sort of Audit/Accreditation Systems are in Place in Your Department?
Healthcare is under the jurisdictions of each of our provinces and territories. Regulations in Canada legislated by the provincial Colleges of Physicians and Surgeons require yearly checking and reporting of radiation emitting imaging equipment in hospitals and offices. There is also checking of the processes and protocols in the imaging department. Audits are required by hospital standards departments but are not done in clinics. System accreditation is spotty now. Quality of care protocols are now starting to appear in hospitals across Canada. This has been a serious gap in the past. The best assessment of the necessity of exam referrals is using an electronic order entry system with appropriateness criteria or imaging referral guidelines in place as decision support. The CAR would like to see province-wide adoption of guidelines in this format. Our association plays a role in the area of accreditation too.
Do You Consider Yourself to be a Handson Manager?
Yes, very much so. I believe that the radiologist is an integral member of the healthcare team and as such, must be the problem solver of the team. This is also the vision of the CAR and a vision that as president I have shared with all Canadian radiologists and hope they take it to heart so that the future of the profession will be secure. The best part of my day is when I am called upon by a clinician to help them and their patients with a problem. Being available, accessible and willing to assist is what the service component of radiology is all about.