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Next #hcsmca chat

Wed. July 23, 2014 at 1pm ET (2pm AT, noon CT, 11am MT, 10am PT)
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The CPSO’s Consultation on Telemedicine: Getting #hcsmca’s feedback on the new draft policy

July 10, 2014

By The College of Physicians and Surgeons of Ontario (@cpso_ca)

The College of Physicians and Surgeons of Ontario (CPSO) recently released a new draft version of its Telemedicine policy for external consultation and is looking to the #hcsmca community to provide feedback on it. The draft policy sets out the CPSO’s expectations of physicians who practise telemedicine. Given the evolution of technology and the increased use of telemedicine in diverse practice settings, the draft policy contains a number of new or revised expectations to ensure it is clear, up-to-date and comprehensive.

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The CPSO is committed to ensuring that the draft policy reflects current practice issues, embodies the values and duties of medical professionalism, and is consistent with the CPSO’s mandate to protect the public. But in order to do this, we need to gather opinions and insights from a wide variety of interested parties. That’s where #hcsmca comes in. Since telemedicine falls under the broader topic of information communications technology, we know it is of particular interest to this community – as was demonstrated by a number of telemedicine-related comments that arose during the June 18 discussion “Online vs. In-Person Patient Support Services.”

We welcome any and all comments on our draft Telemedicine policy. You can read the draft policy online and review our Telemedicine consultation page, which includes information about the consultation and how to submit your long form comments.

On Wednesday, July 16th, let’s examine the following topics during the #hcsmca chat:

  • T1: Do you think the same expectations should apply to telemedicine as they would to care provided in-person?
  • T2: If the doc you are seeing via telemedicine is physically located in another province/country, would you want to know?
  • T3: Would you be concerned about the security of your personal health info being transmitted via telemedicine?

Read the transcript of July 16th #hcsmca chat.

Is it finally time for provincially appointed patient advocates?

July 8, 2014

By Colin Hung (@Colin_Hung)

Colin Hung headshot

Colin Hung

Last month, those of us who live in Ontario went to the polls for our third provincial election in just seven years. The results were surprising – Kathleen Wynne’s Liberal party won a majority which none of the experts were predicting (http://www.theglobeandmail.com/news/politics/ontario-election-day/article19135292/). You could almost hear the collective sigh of relief that there won’t be another election for at least four years.

For me, the timing of the election was horrible. In the previous two years both the Minister for Health (The Honorable Deb Matthews @Deb_Matthews) and the Ontario Ombudsman (André Marin – who tweets under the handle @Ont_Ombudsman) had publicly been talking about finally implementing provincial oversight of Ontario’s healthcare institutions through a third party (Toronto Star article Healthcare check-up: Should the province’s ombudsman have oversight of hospitals?). Ontario is the only province in Canada where the scope of the ombudsman does not include hospitals. This means that in Ontario, should there be a complaint or an issue with a hospital, the escalation process only goes through the Ministry of Health – hardly a neutral third party.

This issue was so important our friends over at HealthyDebate even had a series dedicated to this topic – Expert advice for Ontario Ombudsman on his bid for jurisdiction over hospitals and long term care facilities.

When you read the articles it is clear that Matthews and Marin did not see eye-to-eye on who that third party should be. Marin, obviously, believed that the Ombudsman office was perfectly suited to handle hospitals, but Matthews disagreed. Instead she proposed creating a separate body. In January 2014 Matthews’ publicly proposed the following:

“What we’re talking about is a health-focused patient advocate. I get letters as minister from people who aren’t happy with the care they’ve received. I think it’s really important to turn those complaints into ways to improve quality.”

(Source: http://www.theglobeandmail.com/news/politics/ontario-vows-to-introduce-advocates-office-for-health-care-complaints/article16535059/)

Notice that Matthews didn’t use the word Ombudsman but instead chose patient advocate. Her words got me thinking – is it time that provinces in Canada have a designated person/office that is responsible for advocating on behalf of patients?

Currently, each hospital and healthcare organization in Canada has their own patient advocate – usually an individual or small department that handles patient feedback as well as complaints. These “Patient Relations” teams are fairly effective at helping patients resolve issues involving the organization they represent. [Disclosure: I used to work closely with many Patient Relations teams in Ontario in my role of VP Marketing at RL Solutions].

However, the care we receive as citizens of Canada is very rarely handled by a single organization. We have primary care physicians and specialists that we use alongside hospitals. There are also long-term care facilities, CCACs, home-care providers and now telehealth organizations that are also part of the “care team” for many Canadians. In this overlapping, heterogeneous environment it would be very difficult for a patient to know which organization to raise an issue with. Shouldn’t there be someone that patients could escalate issues to who had the ability to see across the entire healthcare continuum?

Furthermore wouldn’t it be nice to have a person (or office) that patients could turn to for help to navigate our increasingly complex healthcare system? To provide the patient perspective whenever and wherever healthcare policies are debated? To fight for patient rights and healthcare privacy? In short, isn’t it time we had a Patient Advocate at the provincial level?

I hope that Ontario’s new incoming Minister for Health – The Honorable Dr. Eric Hoskins (@DrEricHoskins) – carries on the work that Deb Matthews started. Whether or not the Provincial Patient Advocate falls under the Ombudsman or not, it is my personal opinion that this role is needed.

Join us on Wednesday July 9th at 1pm Eastern for the weekly #hcsmca tweetchat where we will be discussing the topic of a Provincial Patient Advocate.

  • T1: Is there a need for a Provincial Patient Advocate? Or is the existing system sufficient?
  • T2: Does patient advocacy and hospital oversight belong in the same place/office?
  • T3: What would a Provincial Patient Advocate be responsible for? What specific duties would they have?
  • T4: What would be the characteristics of a good Provincial Patient Advocate? What background? Knowledge?
  • T5: Do you think we will see a Provincial Patient Advocate in the next 5 years? What’s needed to make this happen?

 

How do people manage without a family doctor?

June 23, 2014

Dr. Wai-Sun “Sunny” Chan is a family physician who recently moved to Canada and set up practice outside of Ottawa. On Wednesday, June 25 at 9 pm ET, Sunny will moderate #hcsmca for the first time to discuss Canada’s shortage of physicians in primary care. What does this have to do with social media? Let’s explore. 

By Dr Wai-Sun Chan (@DrWaiSun)

headshot Dr WaiSun Chan

Dr WaiSun Chan

General practice or family medicine, as it is referred to in North America, is the practice of clinical medicine in the community. Traditionally family physicians are the physicians of first contact for patients, providing primary and continuing care to individuals and families. Family physicians often make the initial decision on medical issues. Sometimes they may take on role of patient advocate and are often key champions in promoting public health and health within the community through their involvement of chronic disease management, cancer screening and vaccination programs. Thus it’s not hard to see why many health systems around the world rely on an effective, organized primary care system with the family physician playing a central role.

It has been estimated that in excess of 4 million people in Canada do not have a family physician. When you consider there are approximately 35 million people living in Canada, then roughly 1 in 10 people are without a family physician. For a highly developed western country this statistic is rather shocking.

People without a family physician are

  • less likely to receive continuity of care
  • less actively to be involved in health promotion activities
  • more likely to receive inadequate care and monitoring of chronic conditions
  • more likely to experience delays in diagnosis

I qualified as a family physician in the United Kingdom over 11 years ago and have worked in both the British National Health Service and Irish health systems. I immigrated to Canada nearly 18 months ago to work as a family physician outside of Ottawa. I had heard much of the problem with the shortages of family physicians prior to my move however seeing the extent of this first hand was quite disturbing. In the first few months of opening my practice I saw elderly patients who had been without a family doctor for many years, families willing to travel over an hour to join my practice and patients residing in another province.

In my experience, family physicians are incredibly busy and patients often have to wait weeks before an appointment becomes available. Wait times to see hospital specialists are amongst the longest in the developed world and emergency departments work under incredible stress and pressure as many people use them as their first port of call for a medical assessment. The situation is far from ideal for everybody.

On Wednesday, June 25 at 9pm ET, I’d like to invite everyone to chat and explore how patients cope without a family physician and what role, if any, social media can play. If so, then how?

  • T1a How do people manage without a family doctor?
  • T2 Is the doctor–patient relationship (a fundamental strength of family medicine) over-rated?
  • T3 Can social media play a role in helping doctors & patients cope with family physician shortage?

 

Online vs. In-Person Patient Support Services

June 15, 2014

Annette McKinnon (@anetto) and Natrice Rese (@NatriceR) have participated in a variety of online and in-person support services for patients, both to give and receive support. Here Annette outlines the topics they will explore this week on #hcsmca Wed. June 18 at 1 pm ET.

By Annette McKinnon 

Annette McKinnon

Annette McKinnon

There are patient organizations for almost every illness. Their purposes include promoting awareness and providing information about the disease. Many also provide support services and help patients and families connect with other people like them. Many patient organizations also advocate for improvements such as better treatment, access to medications and more research funding.

There are patient-led organizations, such as The Sjogren’s Society of Canada, EmanualsSyndrome.org or FMDchat.org and others that were founded by medical professionals, such as the Canadian Diabetes Association, the Canadian Cancer Society or The Arthritis Society.

A major benefit of this type of organization is that you can self-refer, that is, you don’t need a doctor’s referral to get the benefit of education and help from them. I have been a recipient of in-person services from The Arthritis Society. Meeting others with the same issues as mine in self management courses has been invaluable. The advice and help of physiotherapists and occupational therapists is also irreplaceable.

Later I discovered a self management course offered online which is based on research done at Stanford University. Many self management programs owe a debt to this research from the 80′s. It is still going strong and people with chronic illness can enroll in it here Better Choices, Better Health.

picture of people around a table for an inperson service

In-person Support Services

One thing all of the charities have in common is a need for funding to carry on their good work. In times like this when money is scarce and the organizations have to make hard decisions how do they continue to meet the needs and demands of the patients they serve?

Increasingly patient organizations are augmenting their communication and support services with electronic solutions – eNewsletters, webinars, e-learning, video, online communities, chats and other social media platforms. In some cases, organizations have chosen to replace in-person services with online delivery. The internet offers great opportunity but there are limitations to online means of communication. Obviously, if money were no object, offering both online and in-person services would be the perfect solution.

lego person at comupter

Online Support Services

For rare diseases, online is often the only way to connect with others who have the same health issue, but organizations serving more common conditions may be neglecting some segments of their patient group by moving services to online only. Some patients and families have no computers or ability to use them. There are many people in this category including the poor, those with language difficulty or with low literacy. Some prefer not to use online services because of privacy concerns and/or a fear of social media.

On June 18th, #hcsmca will explore the complexities of choosing between online vs. in-person patient support services when organizations can’t afford both.

  • T1: Is it ethical to opt for online only delivery of patient education and services?
  • T2a: What services are better delivered online and which in person and for whom?
  • T2b: Is online delivery of services actually cheaper?
  • T3: Share example of quality and cost-effective online support systems for patients

Additional Reading

Health Literacy: Is there an app for that?

May 27, 2014

This week May 28, 2014 at 9 pm ET, the Canadian Physiotherapy Association’s Manager of Policy and Government Relations, Kate Rexe (@CPA_Kate) will moderate the #hcsmca discussion. Kate Rexe is an engaged advocate of public health care and has been working in health policy and promoting knowledge exchange for the last 12 years.

By Kate Rexe (@CPA_Kate

head shot Kate Rexe

Kate Rexe


Choosing Wisely

I was excited when the Choosing Wisely Canada campaign launched in April 2014. Modeled after the American Choosing Wisely initiative by the ABIM in 2012, this campaign educates physicians and patients about unnecessary tests and encourages patients to make informed choices. I believe this is a critical step towards improved health literacy because it gives patients and providers the evidence necessary to start conversations about tests and treatments. Why is this important? Because we’ve always been taught to trust the recommendations made by our doctors, surgeons, nurses, and other health care professionals. We often swallow their advice because we are taught to have faith in their education and the healthcare system. However, physicians and patients alike need to understand that more care, more tests, and more treatment doesn’t always equal better care.

With the notion of “choosing wisely” in mind, I recently decided to question a diagnostic test ordered for my 3-year old daughter. This decision fell outside of the Choosing Wisely resources, but was in keeping with the spirit of the campaign. Based on the evidence and previous conversations with the team of specialists that have cared for her since birth, I asked if we could forego the invasive procedure as I didn’t believe it would offer any new insight into her development. The doctor agreed, but my anxiety related to questioning and cancelling the test remains. While logic reassures me I made the right decision, I feel like I have interfered with a system designed to provide the best quality care for my daughter.

I am not a health professional, but a professional working in health policy. With over a decade of experience, including seven years on a hospital research ethics board, I would argue I have a high level of health literacy. So I can’t help but wonder: if I am feeling like I’ve made a mistake in questioning the physician and the system, how do other healthcare consumers feel? And, more pointedly, is access to information leading to more informed consumers, or more troublesome patients?

Interprofessional health team_700wide

Moving beyond the medical model
There are solutions to common health challenges that both improve quality of life and reduced reliance on diagnostic imaging, unnecessary tests and treatments. These solutions are often based on interprofessional collaboration, which promote the engagement of the right professional at the right time to provide the right care. For example, in 2013 the Canadian Physiotherapy Association (@PhysioCan) released a series of fact sheets highlighting the Value of Physiotherapy in many areas from cardiovascular rehabilitation, to musculoskeletal conditions, to managing chronic disease. The reality is physiotherapy has a significant long-term impact on health because it focuses on a patient’s function and quality of life. The result is not only improved patient outcomes, but a broader impact on population health because physiotherapists promote the adoption of healthy behaviours, work to prevent chronic disability and support self-management strategies to prevent the occurrence of acute events over time. Unfortunately, primary health care is organized in such a way that physiotherapists are not often the first point of access for a patient. This is why it is critical to balance health literacy and consumer choice with system change.

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Is social media the answer?
Social media can be a great equalizer for the consumers of health care. The rising use of information technology, regardless of socioeconomic status and even for the aging population, demonstrates the possibilities and solutions for sharing information for the prevention and promotion of health, as well as mechanisms for managing complex chronic disease.

But, does the availability of information lead to more informed choice? Dr. Google opens up a world of diagnoses and access to health information that drives consumer demand, but is not always based on sound evidence. Targeted social media campaigns can help raise awareness and ask important questions to increase health literacy. But, one could argue the proliferation of health information can cause confusion for the average consumer. If health professionals are providing information, how do we increase the confidence of patients to question the prescription of tests and treatments?

mobile tech and health_700wide

How do we better support consumers of health care?
If social media is an opportunity to engage citizens in more informed choice about healthcare, tests and treatment, there must be a way to evaluate the differences in the evidence that is circulated to consumers. Expanding health literacy to include access to other health professionals in the diagnosis and treatment of common problems would be a logical next step for the Choosing Wisely Canada campaign. While the campaign provides an excellent example of guidelines for ordering tests, it needs to go one step further to identify how a range of solutions are available to improve a patient’s quality of life.

For the #hcsmca chat on May 28, 2014 at 9 pm ET, we will be discussing the following topics exploring the role of social media in helping patients and clinicians make wise choices when it comes to diagnostic tests and images.

  • T1: Can social media help patients and clinicians choose wisely when it comes to diagnostic imaging? #CWC 
  • T2: Are patients ready to question doctor’s orders when it comes to prescribed tests?
  • T3: Can social media help promote access to the right professional at the right time?
  • T4: Is access to information leading to more informed consumers, or uncooperative patients?

Read the May 28th transcript.

Nurses and social media in 2014 (and beyond)

May 19, 2014

Nurses Kartini Mistry and Richard Booth both work in the field of clinical informatics and they leverage Twitter. This week they will lead #hcsmca to explore the use of social media as it relates to nursing. 

By Richard Booth (@rbooth5) and Kartini Mistry (@KartiniRN)

headshot Richard Booth

Richard Booth

head shot Kartini Mistry

Kartini Mistry

Last week, Canada celebrated its National Nursing Week. Each year from May 12th to 18th, an opportunity is generated for all of us to reflect upon the nursing profession and recognize the hard work and commitment of Canadian nurses.

In light of this, we’d like to expand upon the celebrations in this week’s #HCSMCA chat, and discuss social media as it relates to the nursing profession.

It is likely that many of you know nurses who have embraced social media and regularly use it as a tool to enhance and improve their practice. For instance, a quick scrub of the twittersphere resulted in over 1700 tweets using the #NursingWeek hashtag alone since May 8 (until May 16), and we collectively have noticed an increase presence of nurses on Twitter during Nursing Week 2014. However, the open and public nature of social media can sometimes make nurses and their respective professional organizations hesitant to fully utilize this form of social communication technology.

In this week’s #HCSMCA chat, we would you all to think about social media and its relationship to nurses and the nursing profession. We want to explore some of the benefits and possible barriers, as well as think of ways we can promote the use of social media for this unique clinician population.

Please join #hcsmca on Wednesday May 21st at 1pm Eastern (2pm AT, 11am MT and 10am PT) as we discuss these important topics:

  • T1: Why should (or not) nurses get involved w/ social media? What are +/- within the nursing community & to using these types of tools?
  • T2: What can be done to support/encourage the use of social media by nurses & organizations that employ them?
  • T3: What should schools of nursing teach and encourage the new generation of nursing students in regards to social media?

Here is the transcript of the chat.

Patient Education and Behaviour Change?

April 27, 2014

This week on April 30th at 9pm ET, Colin Hung,#hcsmca member and co-founder of#hcldr chat will lead a discussion on patient education and opportunities to influence behaviour change or not. Colin explains.

By Colin Hung (@Colin_Hung)

Colin Hung headshot

Colin Hung

Over the past couple of weeks I have been reminded how important patient education is and how it is often a precursor to behaviour change. I have also been reminded how difficult it is to find good health information online and the role that technology can play in changing behaviours.

My journey down the path of patient education started with disbelief.

I have been fascinated by the Measles “outbreak” in the US and in BC. The sharp rise in Measles cases once again put vaccinations in the spotlight. What I found interesting (and depressing) was the lack of knowledge people had about the pros and cons of vaccines. Often the people being interviewed seemed to be basing their decision on whether or not get vaccinated on urban myth and folklore versus evidence. Frankly I was shocked that people couldn’t be bothered to look up vaccines on the Internet.

More disbelief followed when I read an eye-opening post from Dr. Brian Goldman (aka @NightShiftMD) about how many prescriptions go unfilled in Canada. In his post, Unfilled Prescriptions, Dr. Goldman quotes a study by McGill University that revealed that 31% of prescriptions went unfilled. Dr. Goldman stopped short of making recommendations, but he did ask a very poignant question: “how do we encourage more Canadians to fill their prescriptions?” In other words, how do we get people to change their healthcare behaviour?

Last week I had a business meeting with some great folks from a US non-profit organization called Healthwise (www.healthwise.org) whose sole goal is to “help people make better  health decisions.” They achieve this goal by producing education materials for both patients and providers (brochures, booklets, online tools, videos, etc.) I never imagined that an organization can be successful supplying education to patients. Clearly there was a need for it. I just never saw how significant it was.

Finally I participated in last week’s #HealthXPh tweetchat where a family physician from the Philippines talked about how his staff spend a lot of time with patients teaching them about the medication or treatment that was just prescribed before they leave the clinic – and how this reduces the need for repeat visits. Unfortunately he lacked the time and resources to do anything outside of the clinic though he wished he could.

The common thread here is that patient education can lead to behaviour change, better outcomes and less burden on the healthcare system. But what forms of patient education are effective? What is practical given the case load on already stretched physicians? What role can technology and social media play? Other than physicians and patients who else should be involved in raising the level of health literacy?

Join #hcsmca on Wednesday April 30th at 9pm Eastern (6pm Pacific) as we discuss this important topic.

  • T1. What forms of patient education have you found effective? Online text? Booklets? Videos? 1-on-1 with your doc?
  • T2. Does social media have a role in patient education? If so, what is/could be effective?
  • T3. What role can technology (apps?) play in patient education? How do you know a good one from bad one?
  • T4. Other than patients & physicians who else should be involved in raising healthcare literacy in Canada?
Resources