Sick Kids and TAHSN implement new online system for physicians and researchers to disclose affiliations with the medical industry
Photo Caption: Ross DeBoni, Director, Legal, Leah Daniels, Director, Legal and Compliance, Wendy Lawrence, Director of Compliance, Privacy and Risk Management, Sarah Lowy, Director, Corporate Legal Services & Corporate Counsel, Tamara Birkenheier, Director, Legal and Compliance and Sara Gottlieb, Legal Counsel.
Conflict of interest is a familiar concept to lawyers and compliance officers. Relationship management is a much broader and more vague term that is applied to a wide range of business situations and applications. It’s also the approach the Hospital for Sick Children and the Toronto Academic Health Science Network have adopted to replace their conflict of interest reporting procedures.
As part of its compliance policy and as a means of transparency, SickKids required physicians and researchers who worked at the hospital to disclose any affiliations they had with the medical industry. This could include situations such as sitting on a scientific advisory board of a pharmaceutical company or working as a funded research partner with a medical device manufacturer.
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It’s not that the hospital wanted to discourage doctors and scientists from taking those positions. According to Wendy Lawrence, director of compliance, privacy and risk management at SickKids, the research hospital wanted to “encourage [people] looking for those opportunities and to make them more effective,” while at the same time improving their compliance reporting system.
“We were saying relationships are a good thing. They’re key to the innovation mandate of all of our academic hospitals and we're going to focus on managing that,” she says.
In order to manage those relationships effectively, the hospital decided to implement an online system that would allow the roughly 900 scientists and physicians who are part of the medical team to submit information about their relationships, for the legal and compliance team to review, manage and store.
Since many of the medical experts who worked out of SickKids or who had privileges at the hospital also had similar arrangements with other health-care facilities in the Toronto area, Lawrence reached out to her colleagues at the University of Toronto and the hospitals that are members of TAHSN (Baycrest Health Sciences, Holland Bloorview Kids Rehabilitation Hospital, the Centre for Addiction and Mental Health, Sinai Health System, Unity Health Toronto, Sunnybrook Health Sciences Centre, University Health Network and Women’s College Hospital) to see if they wanted to work together on a common solution that would allow the medical expert to submit a single relationship disclosure form that would be available across the network.
Lawrence says she consulted with experts at U.S. hospitals who work in relationship management and disclosure software (U.S. laws mandate that physicians disclose their industry relationships), but since TAHSN already had one common IT platform in place (known as CMaRS) designed to handle physician reappointments to the members hospitals, it made sense to build the relationship disclosures and management system on that same platform.
“We looked at systems that [American hospitals] bought off the shelf, and we decided to make our own because we thought there would be a value in a built-in-Canada system that really reflected our unique needs. In particular, in Toronto our medical academic community is very interconnected, and there would be much more appetite for hospitals and the medical community to be grouped together, as opposed to the U.S., which seemed a bit more siloed,” says Lawrence.
Between getting the TAHSN members to agree to common requirements and policies regarding relationship management disclosure and coding the application, the project took two years. But even though it is up and running and medical professionals are using it to disclose their industry relationships, it still isn’t completed. Now, Lawrence says, there is interest in adding additional automated management and reporting functions to the system.
But even at the stage it’s at, it is making a difference in how Lawrence and her team are doing their jobs. She says feedback from medical staff is that the system is user friendly, even in light of them being required to submit more detailed information about their industry relationships. Because the users are finding the system easy to use, Lawrence says, disclosure and compliance rates are better. The extra information is also useful to the compliance team, which is able to better understand the relationships and better able to assist the medical personnel in managing those relationships.
It has also changed the way the legal and compliance team works.
“We had staff who were spending their time processing the data and doing manual workflows. Now, we are spending time advising on relationship management and having the system do all of the manual workflow so we can really focus on providing advice and helping people comply and helping them manage their relationships, which is how we want to focus our attention,” she says, adding that turnaround times have improved as manual processes have been eliminated.
Working on the project has been a satisfying experience due to its collaborative nature. Taking the opportunity to work with other in-house counsel at different organizations is definitely something Lawrence recommends, as is coming to see first-hand the value of collaboration.
“You can learn to take a broader lens to collaboration. You can collaborate with colleagues in your organization as in-house counsel — you can often collaborate with other legal compliance professionals, you can collaborate with other business units. But in our instance, we actually collaborated with other organizations in the same sector, and I think the value of collaboration is invaluable. You can get efficiencies, you can pool resources.
“As a compliance professional, when you’re instituting a policy, you are looking for ways to help your organization do the right thing. And when you do it together, in this instance, with a number of organizations, you're actually helping the sector do the right thing. You’re improving the standard for the whole sector, not just for your own organization.”
While there are no definitive plans to offer the relationship and disclosure management system for sale to other organizations, Lawrence is open to the idea.
“There are two parts of it: our policy and our best practice, as well as their system. I think they go hand in hand. I think the Toronto hospital community has decided to take on this relationship management journey. We've definitely learned from U.S. institutions that do the same thing, and I think it'd be something we want to share with other Canadian academic health communities and encourage them to do that, and share our best practices, both the policy and the system we developed to enable us to meet that policy standard."
