Provincial health authorities counter municipal 311 plans with their own

A Part VII application submitted to the CRTC to establish 311 as a national standard for non-urgent telephone health triage services should win out over a competing application by five cities seeking the same number for municipal services, according to an official at Alberta Health and Wellness. The Alberta provincial health ministry filed the application on behalf of Canada’s 13 provinces and territories last month (NL Update, Sept. 7/04), nine months after the cities of Calgary, Toronto, Halifax, Gatineau PQ and Halton ON submitted their own Part VII application for the use of the 311 number. "We would hope that on the evidence our application would stand a better chance than theirs, but that is something the CRTC is going to have to decide. The benefit to the public for 311 as a part of the primary care system should have more appeal to the CRTC," says Paul Childs, manager of business planning of the business intelligence program in the health accountability program at Alberta Health and Wellness. "But it’s a CRTC decision and we leave it in their hands."If either of the applications are accepted it could result in a financial outlay by telcos to get the 311 system up and running. The Alberta application, like that of the cities, proposes that the incremental costs of implementing the 311 system be borne by the telecommunications carriers. Talks between Alberta Health and Wellness and the telcos are not progressing rapidly on the matter. "We’ve had some initial discussions with TELUS (Corp.), but we expect that we will be having more," says Childs, who wouldn’t release any more details. "I really don’t want to comment on them at this point. It’s difficult." Alberta’s Part VII application asks the CRTC to issue a decision that assigns the 311 code for non-commercial use across Canada for first-level health care telephone triage services, that the right to use the number be given to provincial ministries of health and local health authorities across Canada, that the number be assigned only for that purpose, and that all telcos be required to route 311 calls. The provincial and territorial health ministries also call on the regulator to initiate a public proceeding to address the matter within 30 days, and to make a determination within six months of the date on which a process for the examination of the application is established. "The application recognizes that telephone triage is becoming an important part of primary care reform, and that most provinces either have or are in the process of developing a telephone triage service. We were looking for a number that would make it like 911 - an easily remembered convenient number nationwide," says Childs.The cities want the 311 number designated for access to information about non-emergency municipal government services exclusively. The cities note that adoption of the single three-digit code will help ease the situation of number exhaust (NL, Nov. 10/03). Alberta Health and Wellness outlines in its August 24 application how its application complies with CRTC criteria. The first stipulates that there must be a compelling need for three-digit access that cannot be satisfied by other dialing arrangements. "Currently, the availability of dialing arrangements for services that are in place vary from province to province and even within provinces and territories. Having a dedicated three-digit number will reduce public frustration and avoid the increased cost that results when health problems worsen because they are unattended, or when non-emergency cases are handled though emergency rooms," states the Alberta application. The application further notes that the use of 311 would allow jurisdictions to tailor the use of the number to whatever services they choose to provide at a particular point in time, and it would serve the broad public interest as the universal number would significantly assist all Canadians in accessing non-emergency health triage services. The use of 311 for this purpose would also not confer a competitive advantage on the service providers, which will be the provinces and the territories, and the telephone triage service would eventually be available 24-hours-a-day, seven-days-a-week anywhere in Canada, notes the application. Seven of 10 provinces currently have telephone health triage services in place (with access via seven or ten digit numbers), and several more provinces and territories are in the process of investigating the possibility of implementing such services. It is anticipated each province would join the 311 scheme on its own timetable. The application also states that allocation and adoption of 311 for health triage services in Canada will maintain the integrity of the North American Numbering Plan and is in agreement with the Canadian Steering Committee on Numbering policy for the use of N11 numbers.The telecommunications companies would be expected to route 311 calls to a seven or ten digit number as appropriate for the particular location, but Childs notes that the 311 infrastructure changes needed to make the number work would not be as extensive as for 911.There would be a cost to implement such a system, but Childs says it would be less than that needed to run the 911 system. "…The switch re-programming can be scheduled along with other necessary switch work. This will help to reduce the costs of switch reprogramming," states the Alberta application. "Unlike 911, which requires extensive network security measures, 311 would not require high performance redundant trunking or caller ID." The implementation of a health information and advice service using the 311 number links to three key primary health care reform objectives: expand 24/7 access to primary health care services, increase the emphasis on health promotion, disease prevention and chronic disease management, and facilitate improved coordination and integration with other health services, the provinces tell the CRTC. Some of the advantages resulting from the availability of a telephone health triage service, according to the provinces are a reduced number of visits to emergency rooms, more appropriate use of emergency room services, reduction in public calls to front-line medical staff, reduction in the requirement for "on-call" availability by medical staff, ability for patients to provide "self-care," and attention to problems that may have gone unattended or worsened without proper medical attention. The application also points out that a systematic review of ten studies from the United States and the United Kingdom conclude that telephone triage for health problems decreases immediate visits to physicians without increasing adverse outcomes such as subsequent hospitalizations, visits to emergency department, or deaths.

Provincial health authorities counter municipal 311 plans with their own

News | 09/15/2004 4:00 am EDT

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