E-Health on Longwoods.com

What Else Does the Box Say?

Fri, 26 Sep 2008 09:21:57 -0400

Have you ever thought about why - if you do - you read the combination of ingredients found in a particular product? Usually, you want to know what makes something good for you or not; what enhances the palatability of the chosen item; or, sometimes, it's sheer curiosity as to whether you have made a good choice. More often than not, you buy something by virtue of its popularity and market penetration or its personal appeal. The successful launch of a product is frequently linked to creative and targeted marketing. But let's face it, there are times when we throw caution to the wind and simply ignore the caloric, saturated fat, sodium and sugar counts of a chosen product. In so doing, we accept the associated potential risks to our well-being.

The British Columbia Alliance on Telehealth Research and Policy

Tue, 23 Sep 2008 14:50:16 -0400

In Canada, the measurement of quality of healthcare has historically focused on specialized hospital-based care. Considerably less is known about the quality of care provided in the offices of primary care physicians. Primary care research has relied on data collected manually from physicians' offices or from administrative databases. Manual data collection from paper-based patient charts in primary care physicians' offices is costly and time consuming, and often only a small portion of the information in the charts is useable due to the lack of uniform documentation. Although data from administrative databases are more readily accessible and encompass the entire population, they are limited in their depth of clinical information.

ICES Report: Using Data from Electronic Medical Records: Theory versus Practice

Tue, 23 Sep 2008 13:09:55 -0400

Yes, Virginia, There Are System Benefits to Be Gained from Providing Patients Access to Their Own Health Information

Tue, 23 Sep 2008 13:06:39 -0400

In the 1960s, Pierre Trudeau popularized the phrase "The Just Society" when he took over as the federal minister of justice. Four decades later, we have evolved into "The Informed Society," where consumers from all types of businesses and industries are playing larger roles in both the purchase and the development of products and services. One has to look no farther than the World Wide Web and the fascinating growth of sites such as YouTube (www.youtube.com) and Facebook (www.facebook.com) for evidence. In healthcare, however, such "grass roots" contributions have been slower to come to the fore, although recently initiatives like Google Health, Microsoft HealthVault and PatientsLikeMe are emerging as alternatives to the status quo. One reason for this latency in healthcare is a lack of familiarity with the system that uses language and jargon that is not accessible to the average consumer. Further, there is a lack of appreciation on behalf of consumers regarding the benefits resulting from the role that empowered patients can play. In addition, there are no "information access" points whereby communication between patients and the system can be affected. Ultimately, patients lack the encouragement, education and means surrounding their potential contribution.

Whose Record is it Anyway? Putting Patients’ Interests at the Heart of EMR Implementation and Use

Tue, 23 Sep 2008 12:59:05 -0400

With the dawn of electronic medical records (EMRs) and patient portals, there is an unprecedented opportunity to provide truly collaborative patient-centred care. These tools can promote communication between healthcare providers and patients, improve chronic disease management and enable patients to become active members in the healthcare delivery system, but only if the tools work for everyone involved - including patients. Without patient consultation and input, there will be limitations in the ways in which physicians and patients are able to capitalize on these tools. Decision-makers must begin to enact their commitment to collaborative patient-centred care by engaging patients in discussions related to EMR design, implementation and use.

Demonstrating the BlackBerry® as a Clinical Communication Tool: A Pilot Study Conducted Through the Centre for Innovation in Complex Care

Tue, 23 Sep 2008 12:58:24 -0400

Canadians are living longer with chronic medical conditions, which have led to an increasing complexity and volume of care for hospitalized patients. Effective in-patient care depends on the effective coordination of care through rapid and efficient communication between various care providers. A delay in coordinating this care has downstream effects on other parts of the system, ultimately contributing to increased emergency department wait times. To address this system-wide issue, the Centre for Innovation in Complex Care at the University Health Network collaborated with Sunnybrook Health Sciences Centre to pilot the use of BlackBerry devices on the general internal medicine wards to improve clinical communication. We describe the implementation process, impact on clinical care and lessons learned from this experience. We observed that residents quickly adopted this new technology and felt that it improved their workflow efficiency and productivity.

Implementation of the Veteran Health Administration (VHA) VistA Clinical Information System Around the World

Tue, 23 Sep 2008 12:58:23 -0400

The success story of the Veterans Health Administration (VHA) within the US Department of Veterans Affairs has been well documented and is generally well known. What is generally not known is that the VHA's clinical information system, known as VistA, and the computerized patient record system clinical user interface front end have been successfully transported and implemented to a number of non-VHA healthcare organizations across the United States. Moreover, VistA software modules have been installed, or are being considered for installation, in healthcare institutions around the world in countries such as Mexico, Finland, Jordan, Germany, Nigeria, Egypt, Malaysia, India, Brazil, Pakistan and Samoa.

Toward a Model of Successful Electronic Health Record Adoption

Fri, 6 Jun 2008 10:04:56 -0400

The Canadian healthcare landscape abounds with pressures to address wait times, chronic disease management, aging at home, information and service integration, health human resource shortages, pandemic planning and most importantly health outcomes of individuals receiving care in our system. Investment in clinical information technologies is often touted as significant to the successful resolution of most if not all of these issues. For example, Baker and Norton (2001) uncovered an alarming rate of preventable adverse events occurring within Canadian hospitals. A particularly high error rate associated with the administration of fluids and medications suggests that there is a dire need to introduce processes and tools to reduce human error in healthcare facilities. The implementation of clinical applications such as computerized physician order entry (CPOE) with integrated electronic medication administration records (MAR) has been identified as a key step to safer care (Bates and Gawande 2003; Leape et al. 2002; Leatt et al. 2006). It has been suggested that the full value of electronic health records (EHR) will only be realized with the implementation of CPOE and that its use (by physicians) is a reasonable proxy for adoption (Ash and Bates 2005). Considering recent surveys of Canadian and American hospitals, those that have fully implemented CPOE remain in the minority (Ash et al. 2004; Davis 2007; Gudbranson 2007); most have yet to tackle the challenges of the change imperative and adoption issues associated with the use of a complete EHR.

New Study Finds One in Four Hospitalizations Is Drug Related

Fri, 6 Jun 2008 10:04:32 -0400

A recent study by Samoy et al. (2006) found that almost 25% of patients admitted to the internal medicine ward of British Columbia's largest hospital are there because of sickness brought on by adverse drug reactions.

Listowel: An Electronic Health Record Success Story

Fri, 6 Jun 2008 10:04:12 -0400

Listowel Memorial Hospital has successfully implemented a community-wide electronic health record with linkages to the community hospital, family health team, laboratories and other regulated health professionals. This case study describes the journey to success along with the factors that were critical in its implementation.

A National Education Strategy to Develop Nursing Informatics Competencies

Fri, 6 Jun 2008 10:03:53 -0400

Advances in the sophistication of information and communication technologies offer nursing practitioners opportunities for better information management, more complete documentation of their work and knowledge development to support evidence-based nursing practice. However, a nursing culture that recognizes and adopts the contributions of technology to practice is required to take advantage of these opportunities. The nature of this change suggests a shift in emphasis from specialists in Nursing Informatics (NI) to NI being integrated into all four domains of nursing practice. The magnitude of change required on individual, organizational and professional levels points to the need for Nursing Informatics education strategies on a national level. Recognizing the role and history of NI specialists, defining NI and the required NI competencies are necessary first steps in developing such a plan. Expanding and adapting the educational infrastructure required to support this initiative follows. A working committee at the national level with representatives from a number of stakeholder groups is currently working on a National Nursing Informatics Project to address these issues. This article summarizes key points of an initial discussion paper.

Clinical Documentation Standards - Promise or Peril?

Fri, 6 Jun 2008 10:03:25 -0400

Imagine a future of integrated clinical information systems that transcend the physical boundaries of clinical units, institutions and community care, providing nurses with comprehensive access to information and knowledge to support the delivery of care to individuals and families. Imagine not having to gather the same information repeatedly, ask the same questions over and over again, or struggle to assimilate information from multiple sources and informants. Better yet, as a person needing the services of the healthcare system, imagine not having to rely on memory for details of family health history or repeatedly provide the same information to numerous caregivers over the course of a single encounter (or multiple encounters) to satisfy the requirements of their specific data collection forms. The future lies in the electronic health record - but are we taking the right steps to get there? In particular, are we sufficiently challenging the status quo of the documentation structures associated with clinical information management?

Computerized Physician Order Entry Usage in North America: The Doctor Is In

Fri, 6 Jun 2008 10:02:53 -0400

While computerized physician order entry (CPOE) is still in its infancy as far as adoption goes (<10% of North American hospitals have implemented CPOE), most organizations are planning to utilize CPOE in the future. However, one of the major questions on most hospitals' minds is, "Will physicians accept and use CPOE?"

Community Picture Archiving and Communications Systems: Burgeoning Market

Mon, 24 Mar 2008 12:05:20 -0400

Choosing a Picture Archiving and Communications Systems (PACS) is tougher than it used to be. More and more vendors are offering solutions in the smaller hospital space, and analyzing the sheer number of vendors, the various technology choices and breadth of product offerings is challenging.

Everything I Know About Informatics, I Didn't Learn in Nursing School

Mon, 24 Mar 2008 12:04:50 -0400

To date, efforts to initiate future graduates and nurses currently in practice into the world of information and communication technologies (ICTs) have been provided by relatively few nurse educators. In the past decade, nursing informatics leaders have developed a profile of informatics competencies for nurses, novice to expert - for example, the National Nursing Informatics Project (Hebert 2000) - and have demonstrated actual (Kaminski 2006) and possible informatics integration into curricula (Nagle 2001). Findings from recent studies (Infoway 2007; Nagle and Clarke 2004) suggest that a minority of Canadian schools of nursing have tackled the challenge of integrating informatics throughout their nursing curricula. When asked to respond to a recent survey (Infoway 2007), some schools decided not to participate because there were no faculty members with appropriate expertise in the area, while other schools did not regard informatics as relevant content for their program. Nevertheless, over the years, several schools of nursing have had the foresight to create a single informatics course - usually an elective - at the undergraduate or graduate level. I have held discussions with several deans and directors of schools of nursing over the past two years, and most of them recognize that this is a content area to be reckoned with sooner rather than later. No graduate nursing program has, as yet, created an informatics specialty option, but stay tuned.

The Health Information Bank: Revisiting Bill Dodd's Idea of 10 Years Ago

Mon, 24 Mar 2008 12:04:18 -0400

Ten years ago a Scottish general practitioner, Dr. Bill Dodd wrote a two-page paper in the British Journal of Health Computing titled "An Independent 'Health Information Bank' Could Solve Data Security Issues." It was a groundbreaking piece of thinking and has since been picked up by others over the years. Though some of the terminology used (e.g., Electronic Patient Record) has since been dropped from the English vocabulary, the essence of the paper still resonates with many readers.

The Information Management Strategy Cascade: Strategy-Based Performance Management of a Flu Recall Practice

Mon, 24 Mar 2008 12:03:51 -0400

The Health Results Team for Information Management (HRT-IM) was formed at the Ontario Ministry of Health and Long-Term Care in the fall of 2004 to engage and work collaboratively with the healthcare community to implement change in health system information management. The information management strategy focused on producing better data, supporting accountability and quality improvement through performance measurement and supporting evidence-based decision-making. This paper reviews how an IM strategy framework was applied in a health service provider setting to support linking flu recall practice data to broader organizational strategy and accountability at the Sherbourne Health Centre in Toronto.

US Regional Health Information Organizations and the Nationwide Health Information Network: Any Lessons for Canadians?

Mon, 24 Mar 2008 12:03:24 -0400

The creation of regional clinical data exchanges (usually referred to as RHIOs) is a centrepiece of the US national healthcare information technology strategy. How well are they doing and what lessons can we learn that might be applied here in Canada?

How Consumerist Do People Want to Be? Preferred Role in Decision-Making of Individuals with HIV/AIDS

Wed, 27 Feb 2008 10:21:01 -0500

Most people living with HIV/AIDS seek a relationship with their healthcare providers in which decision-making is a shared task.

REPRINT - Improving Patient Safety through Computerized Drug Management: The Devil Is in the Details

Fri, 18 Jan 2008 10:09:24 -0500

Electronic prescribing and computerized drug management can improve the safety, quality and cost-effectiveness of prescribing. However, if the problems that lead to avoidable adverse events are not addressed by information technology, there is a risk of making considerable investment without the expected return of error reduction and improved patient safety. Improving the safety of prescribing is particularly important in ambulatory care, where most drugs are prescribed. To improve patient safety, IT solutions should be developed that provide: (1) access to the list of all currently active drugs, (2) alerts for relevant prescribing problems (therapeutic duplication, excess dose, dose adjustment for weight [children, elderly] and renal impairment, drug-disease, drug-drug, drug-age and drug-allergy contraindications), (3) the capacity to electronically submit medication stop orders to the dispensing pharmacy and (4) integration of electronic prescriptions (e-rx) into pharmacy software to avoid transcription errors. To improve quality of prescribing, IT solutions should be capable of providing physicians with reminders and alerts for evidence-based preventive care and disease management based on patient-specific drug, disease, therapeutic intent and other relevant clinical information. To improve the cost-effectiveness of prescribing, IT solutions should be developed to provide the cost of medication at the time the prescription is written, and evidence-based alerts for drugs of choice recommendations when appropriate.

Ambulatory EMRs for Large Practices

Fri, 18 Jan 2008 10:08:57 -0500

Recently KLAS studied ambulatory EMR solutions for practices with 100+ physicians. While KLAS has previously studied EMR solutions, this is the first study focused on practices with over 100 physicians. The results provide thought-provoking insight into physician adoption, common obstacles, workflow issues and overall physician satisfaction.

Building a Comprehensive Clinical Database: Collaboration in Stages

Fri, 18 Jan 2008 10:08:30 -0500

The Princess Margaret Hospital Breast Site Group expressed the need for a comprehensive clinical database for breast disease to increase access to detailed high quality clinical data for research and administrative purposes. The database sought to capture patient history, diagnosis, treatment, and follow-up information for over 1,200 new breast disease patients per year. The extensiveness of this information combined with the size of the patient cohort made this a challenging project. The project began with a simple database tool that was flexible and adaptable so that it could be customized to suit the needs of the clinicians in the Breast Site Group. Since the early simplistic implementation, novel data collection techniques have been added to improve quality and completeness of data. This approach facilitated increased confidence in the project on the part of clinicians, which allowed for more constructive input from all parties, and has resulted in a tool that is useful and relevant to members of the Breast Site Group. The success of this project lies in its initial simplicity and gradual development in stages, allowing continual improvement and constant collaboration between all those involved.

Electronic Health Records and Patient Safety: What lessons can Canada learn from the experience of others?

Fri, 18 Jan 2008 10:07:59 -0500

It is recognized that the Electronic Health Record (EHR) has significant potential to improve patient safety in Canada. However, the scientific evidence connecting EHRs to improvements in patient safety is incomplete. Additionally, international experience has demonstrated that EHRs trigger profound cultural and organizational changes in healthcare delivery. Consequently, Canada has a unique opportunity to learn from these experiences.

Data Warehouses in Healthcare: Fundamental Principles

Fri, 18 Jan 2008 10:07:33 -0500

A data warehouse is a centrally managed and easily accessible copy of data collected in the transaction information systems of a corporation. This data is aggregated, organized, cataloged, and structured to facilitate population-based queries, research, and analysis. As healthcare becomes more computerized, particularly the greater adoption of Electronic Health Records, there will be an accompanying and inevitable evolution from workflow automation and data collection to process optimization and data analysis. Data warehouses offer a technological tool to enable data analysis and process optimization and have proven their enormous value in other applications including manufacturing, retail, space exploration, marketing, and e-commerce. However, as these other industries learned in their journey towards data analysis, data warehouse projects are also prone to large and expensive failures. As a result of these failures, data warehousing has evolved in recent years into a subspecialty of information systems. This paper summarizes the key principles and concepts underlying the specialty area of data warehousing, specifically addressing the unique issues in healthcare.

Web 2.0 and Chronic Illness: New Horizons, New Opportunities

Fri, 18 Jan 2008 10:06:39 -0500

Web 2.0 heralds a breakthrough opportunity for empowering healthcare consumers of all types, and especially for those suffering from different forms of chronic illness. As I show using some data gathered from a popular social networking website - MySpace.com - this opportunity may be greatest for heavily stigmatized chronic health issues, such as obesity and mental illness. I shall also discuss how hospitals and health regions can benefit from, and contribute to, this fast-growing phenomenon.

How Good Is Good Enough? Standards in Policy Decisions to Cover New Health Technologies

Mon, 19 Nov 2007 11:00:58 -0500

Health technology coverage decisions require reasonable criteria, for example, the requirement that a technology be effective, efficient, legitimate in purpose, acceptable in its effects, safe and so on. The leap from such criteria to decisions requires not only evidence, but also standards. Decision-makers must specify their values, which apply in general, regarding what is "good enough" before they can judge any technology in particular. This paper will do the following: (1) describe the key analytic tasks involved in defining coverage criteria and their standards, (2) identify some of the policy applications of explicit standards to coverage decisions and (3) review the policy uses of such standards, including some challenges they pose. The problem of identifying cost-effectiveness standards will be used to illustrate key issues. It is argued that a precedent-based understanding of standards is relevant in the Canadian policy context, where fairness is crucial. Studies of actual decision-making that seek standards inductively have been misguided in their focus on central tendencies to the neglect of outliers (precedents), while deductive analyses and rules of thumb have been ungrounded in prevailing values.

Performance Measurement in Healthcare: Part II - State of the Science Findings by Stage of the Performance Measurement Process

Tue, 15 Aug 2006 10:42:55 -0400

This paper summarizes findings of a comprehensive, systematic review of the peer-reviewed and grey literature on performance measurement according to each stage of the performance measurement process - conceptualization, selection and development, data collection, and reporting and use. It also outlines implications for practice.

Making Performance Reports Work: It's a Matter of Common Sense

Tue, 15 Nov 2005 10:42:22 -0400

In the paper Making Performance Reports Work by Brown, Bhimani and MacLeod, the authors based their assessment of existing pubic performance reports on the Knowledge, Attitudes and Behaviour (KAB) model, with the addition of performance or actual healthcare outcomes to assess overall impact on the delivery system (i.e., the KAB+performance model). In short, the authors logically conclude that public performance reports about the healthcare delivery system are not effective unless patients ultimately use them, and/or unless providers improve their performance because of them.

Chronic Disease Prevention and Management: Some Uncomfortable Questions

Fri, 15 Jun 2007 10:41:49 -0400

Morgan, Zamora and Hindmarsh make a compelling case for a national strategy on chronic disease prevention and management. The truths raised in the lead paper are not particularly inconvenient, but they do raise a number of uncomfortable questions: (1) Why are physicians not taking a more responsible and active role to prevent and manage chronic diseases on behalf of their patients? (Physicians must recognize that it is their professional responsibility and their job to provide their patients with the appropriate level of care for chronic conditions.) (2) Why are non-physician healthcare providers not playing a larger role to prevent and manage chronic diseases? (3) Why is there a greater focus on managing chronic diseases than on preventing or delaying them from happening? (4) Have we forgotten the profound impact of the social determinants of health on illness, life expectancy and death?

Decoding Mazankowski: A Symphony in Three Movements

Fri, 15 Mar 2002 10:40:57 -0400

The Mazankowski Report is ingenious in design. It is in fact a report in three movements. It begins with a well-modulated analysis of internal reforms needed to improve the system, generally harmonious with the prescriptions of other national and provincial reports. Its financial analyses are composed in a more ominous minor key. Its defining moment is a jarring ideological crescendo that may turn out to be its legacy in the Canadian healthcare debate.

Ontario's Wait Time Strategy: Part 1

Wed, 15 Mar 2006 10:39:52 -0400

This article is the first in a series of articles examining Ontario's Wait Time Strategy. The series begins with the Strategy's key elements, assesses progress made after one year, and identifies the lessons learned thus far.

Commentary: They Must Embrace the Vision

Wed, 15 Nov 2006 10:39:21 -0400

Justifying the expense of health information technology undergoes unparalleled scrutiny. Competing priorities for expenses must be balanced by revenue, all within the confines of the "service" industry. Whether for profit or non-profit, healthcare is ultimately a business.

Speaking with Michael Kirby

Sat, 15 Jun 2002 10:38:46 -0400

Recently, Duncan Sinclair, who chaired Ontario's Health Services Restructuring Commission, interviewed Senator Michael Kirby, Chair of the Senate Standing Committee on Social Affairs, Science and Technology. Since December of 1999, the Committee has examined and reviewed healthcare services in Canada, to date producing a series of five reports with detailed findings and recommendations.

The Effect of a Primary Care Intervention on Management of Patients with Diabetes and Hypertension: A Pre-Post Intervention Chart Audit

Wed, 15 Mar 2006 10:38:13 -0400

A principal goal in enhancing primary care in Canada is to increase emphasis on health promotion, disease prevention and the management of chronic diseases in the primary care setting. To achieve this goal in Nova Scotia, collaborative practice teams with a nurse practitioner and at least one physician were established, and both alternative funding arrangements for physicians and an information system were implemented. This study reports on the impact of this primary healthcare reform initiative on the quality of process-of-care, self-care and proxy measures for specific health outcomes for patients with diabetes and hypertension.

Adverse Events among Winnipeg Home Care Clients

Sun, 15 Oct 2006 10:37:40 -0400

Patient safety research has focused almost exclusively on hospitals, with few studies investigating the safety of other healthcare sectors, including home care. Before measuring patient safety in home care, this study first sought to translate hospital-focused patient safety definitions and concepts to home care. A context-appropriate approach to measuring adverse events (AEs) in home care was developed using chart reviews prompted by a mixed screening process. These methods were then applied to measure the incidence, type, severity, cause, preventability and ameliorability of AEs among Winnipeg Home Care clients.

Current Strategies to Improve Patient Safety in Canada: An Overview of Federal and Provincial Initiatives

Mon, 15 Mar 2004 10:37:03 -0400

In November 2003, senior managers of Sunnybrook and Women's College Healthcare Centre in Toronto announced that lapses in the disinfection of equipment used for prostate biopsies had put more than 800 men at risk of blood-borne diseases (Woods 2003). In the next two months, nine other hospitals in Ontario reported infection control problems with similar diagnostic equipment and the Minister of Health ordered an audit (Greenburg 2004; Woods and Greenburg 2003). Earlier that year, a study of a patient-controlled analgesia (PCA) pump suggested that difficulties in programming such pumps may have contributed to patient deaths (Scully 2003). Stories like these in the past year have created growing attention to adverse events in Canadian healthcare and prompted questions about whether healthcare in Canada is safe and what is being done to improve it. While individual hospitals and regions are mounting patient safety efforts, these problems are systemic and require policy and organizational responses from governments and health regions, not just individual organizations. How are governments and other organizations responding to the calls to improve healthcare safety? This article provides an overview and examples of current initiatives based on reviews of documents and websites, interviews with key informants in several provinces and attendance at patient safety meetings in several cities. As we shall see, although several provinces are beginning to address the patient safety issues, there remain important challenges of leadership, coordination and learning that are essential in gaining public confidence in the safety of our healthcare system.

Current Strategies to Improve Patient Safety in Canada: An Overview of Federal and Provincial Initiatives

Wed, 22 Aug 2007 10:36:38 -0400

This article provides an overview and examples of current initiatives based on reviews of documents and websites, interviews with key informants in several provinces and attendance at patient safety meetings in several cities. As we shall see, although several provinces are beginning to address the patient safety issues, there remain important challenges of leadership, coordination and learning that are essential in gaining public confidence in the safety of our healthcare system.

Experiences of Regionalization: Assessing Multiple Stakeholder Perspectives across Time

Wed, 15 Mar 2006 10:35:56 -0400

This paper constructs a beginning frame for analyzing experiences of regionalizing in healthcare systems. Using Alberta as a case example, it traces the perspectives of multiple stakeholders (government, RHAs, frontline staff and public) on key organizational dimensions to describe the various experiences of organizing healthcare through regionalization. As a team of organizational and health researchers, we have been studying this case together and separately for 10 years. We present the framing and our case example to encourage future discussions, debates and consideration of this structural arrangement for healthcare that has swept across most of Canada. We believe that it is critical to learn more about both the pitfalls and potentials that regionalization produces across time and through change for the delivery of care and the protection and improvement of health. And we believe that perspective matters when assessing the full impacts of regionalizing and re-regionalizing and the multiple change processes embedded within these large structural reconfigurations.

AHSCs: An Indispensable Partner for Governments

Fri, 15 Feb 2002 10:35:21 -0400

A closer relationship between Academic Health Sciences Centres and governments will benefit the overall agenda of health system reform, contribute to the focus and immediacy of the future vision of AHSCs and give governments a deep pool of expertise from which to draw in facing significant policy challenges. Jointly established priorities in health between federal, provincial and territorial governments correspond closely to the interests and expertise of AHSCs. A mutual commitment to evidence as the basis for making decisions in health policy, in education, and in patient care, will find expression in closer interaction between these two institutions.

Changing Roles for Primary-Care Physicians: Addressing Challenges and Opportunities

Sat, 15 Mar 2003 10:18:21 -0400

Direct-to-consumer advertising is but one example of a process called disintermediation that is directly affecting primary-care physicians and their patients. This paper examines the trends and the actors involved in disintermediation, which threatens the traditional patient-physician relationship. The paper outlines the social forces behind these threats and illustrates the resulting challenges and opportunities. A rationale and strategies are presented to rebuild, maintain and strengthen the patient-physician relationship in an era of growing disintermediation and anticipated advancements in cost-effective office-based information systems. Primary care - as we know it - is under siege from a number of trends in healthcare delivery, resulting in loss of physician autonomy, disrupted continuity of care and potential erosion of professional values (Rastegar 2004; Future of Family Medicine Project Leadership Committee 2004). The halcyon days of medicine as a craft guild with a monopoly on (1) technical knowledge and (2) the means of implementation, reached its zenith in the mid-twentieth century and has been under pressure ever since (Starr 1982; Schlesinger 2002). While this is a trend within the US health system, it is likely to affect other delivery systems in the years ahead.

Improving Patient Safety through Computerized Drug Management: The Devil Is in the Details

Fri, 15 Oct 2004 10:17:39 -0400

Making the Best Use of Radiological Resources in Canada

Sat, 15 Oct 2005 10:17:06 -0400

Diagnostic imaging plays a crucial frontline role in healthcare, providing the information some physicians need to make a diagnosis and determine a course of treatment for their patients. However, wait times for access to diagnostic imaging examinations continue to be long. This is due to a number of factors, including the expanding indications for CT and MRI and growing reliance on imaging studies, Canada's lag in purchasing new equipment, an American influence on the Canadian healthcare system and clinicians' requests for inappropriate examinations. A number of strategies need to be implemented to maximize radiology's efficiency and ensure that services are being used appropriately. The author advocates the use of appropriateness guidelines for referring physicians, delisting tests that are completely inappropriate, implementing the use of radiology information systems, enhancing radiologist efficiency and using physician extenders to perform less complex medical work.

The Health Council of Canada: A Speculation on a Constructive Agenda

Sun, 15 Jun 2003 10:16:33 -0400

Mr. Romanow and Senator Kirby each devoted several years and intense effort to studying the Canadian healthcare system. They both came to the view that a national health council is a good idea. Their shared hope was that a health council could bring evidence and reason to bear on health problems that are often buried in the rhetorical avalanche of intergovernmental combat. One suspects that most Canadians also prefer light to heat in health matters.

Pay-for-Performance = Pay for Quality?

Mon, 15 May 2006 10:15:59 -0400

George Pink and colleagues, in this issue of the journal, present an overview of the current status of pay-for-performance programs in other countries and an analysis of the factors that need to be considered in the event that Canada should adopt such a program. While we agree with most of what the authors report in this brief paper, we note that the process is already under way in Canada, challenge a few of the paper's assumptions and provide a few suggestions for and cautions in undertaking next steps. At the same time, we highlight the significant potential pay-for-performance may have in being part of the solution to the great concerns over the sustainability of our much-loved healthcare system.

A Healthcare "Trojan Horse": The Alberta Mazankowski Report; An Analysis of A Framework for Reform: The Report of the Premier's Advisory Council on Health in Alberta

Fri, 15 Mar 2002 10:15:18 -0400

It is a very old political game - prepare people to expect the worst and when it is less than the worst, people are relieved. Well, an old politician, the Honourable Don Mazankowski in cahoots with his close friend Premier Ralph Klein, played that game on us this month.

Acute Care Hospital Strategic Priorities: Perceptions of Challenges, Control, Competition and Collaboration in Ontario's Evolving Healthcare System

Sun, 15 May 2005 10:14:47 -0400

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.

Why Healthcare Renewal Matters: Lessons from Diabetes

Fri, 15 Jun 2007 10:13:55 -0400

In this commentary, we offer evidence about the burden of chronic conditions and use diabetes as a case study to reveal the gap between recommended and actual care in Canada. What we found through our research is cause for concern - namely, that the care that Canadians with diabetes receive is simply not good enough (an inconvenient truth) and that the country has tremendous untapped potential to prevent chronic illness and improve the quality of care (a convenient truth). Our work and the work of others help Canadians understand the benefits that will accrue to them from investments to close the gap between what we know and what we do.

Building on One of the Best Delivery Systems in the World

Wed, 15 Dec 1999 10:13:16 -0400

Rosser and Kasperski build upon and consolidate several earlier reports to put forward a "bottom-up" model for the integration of health services for Ontario that establishes the family physician as the focal point of entry to the healthcare system. The essential features of this model are as follows...

When Leaders Talk to Leaders

Sat, 15 Apr 2006 10:11:58 -0400

Presentations by three Canadian executives who influence healthcare policy and practice were reviewed to identify the kinds of sources these leaders use to draw their conclusions. All three speakers examined policies, practices and outcomes. Presentations were selected to cover activities in three provinces in three different calendar years, to avoid duplication or undue influence of a particular event or release of information. All three speakers drew heavily on data from government sources, especially the Canadian Institute for Health Information (CIHI).

The Evolution of Health System Governance in Canada and Ontario

Wed, 22 Aug 2007 10:11:35 -0400

In general terms, governance refers to the responsibilities of a Board of Directors or trustees to ensure that an organization lives up to its legal responsibilities as a corporation and any other legislation that applies. This includes its financial or fiduciary role, its legal accountabilities and its stewardship or oversight role to ensure that the best interests and objects of the organization are being upheld.

Guaranteeing Accountability for Quality Care

Fri, 15 Jun 2007 10:11:07 -0400

The quality gap in the management of chronic disease is an issue which must be addressed if we are to achieve sustainability of our health system and optimal health outcomes for Canadians. The delivery of quality care needs to be a fundamental expectation of providers, professional regulators, institutional leaders and senior government leaders. Success in the arena of quality improvement comes from clarity of accountability, "obsessive" tracking and action on key performance indicators, and results-based teamwork. Strong leadership, identification of shared priorities across the country, full transparency, and an engaged public are all key to moving ahead in this critical area of Canadian healthcare.

Hippocrates Denied: Why Canada Has Yet to Act on the Patient Safety Imperative

Fri, 15 Oct 2004 10:10:37 -0400

A review of patient safety literature reveals clear documentation of significant patient safety concerns in many countries going back over two decades. However, it was not until the publication of the Institute of Medicine's To Err Is Human about four years ago that widespread attention was at last drawn to this issue. Even with this attention, there has been a very limited response in Canada to the well-documented need for action to address preventable errors. After some reflection, it is clear that a whole series of factors may be conspiring to slow or blunt our response to this issue. This commentary explores these factors and endorses strategies for moving forward.

Next Steps for Patient Safety in Canadian Healthcare

Fri, 15 Oct 2004 10:10:08 -0400

Morgan outlines some important elements necessary for improving patient safety in Canadian healthcare. But these steps are likely to require considerable time and resources and may be difficult to implement. In the light of the evidence of adverse events in Canadian hospitals, all Canadian healthcare organizations need to begin to measure the numbers and types of adverse events experienced by their patients and clients. Staff need to learn new skills for investigating and improving care. A variety of tools and resources are available for these tasks. Leadership both in senior management and on the front lines must learn to shift the focus from blaming individuals to improving systems of care. Leaders must also acknowledge that most healthcare organizations have failed to gather the necessary information on adverse events, and they must invest in building knowledge and implementing practices that reduce the current levels of injury.

Grasping the Opportunity to Improve the Safety of Care

Fri, 15 Oct 2004 10:09:36 -0400

Clearly a wakeup call for the healthcare industry, the IOM report of 2000 To Err Is Human now appears to have been a sentinel event, at least in the United States (Institute of Medicine 1999). Given that the practice of medicine in the United States is, in many ways, very similar to that in Canada - for example, our physician trainees are educated and evaluated using similar models - it is unfortunate that the IOM report was not also a wakeup call for Canada. Four years have passed, and apparently Canadians have only recently woke up to front-page newspaper headlines that point out that Canadians, like Americans, are being harmed and killed as a result of medical errors.

Chronic Disease Prevention and Management: Some Uncomfortable Questions

Fri, 15 Jun 2007 10:09:09 -0400

The VHA's Commitment to Accountability: A "Third Way" for Medicare?

Sun, 15 May 2005 10:08:39 -0400

Albertans are seeking a "Third Way" for Medicare; Canadians generally are struggling with the issue of "sustainability."The transformation of the Veterans Health Administration suggests that the key to sustainability is not levels of spending per se but public confidence that a system delivers value for money. The VHA regained confidence by defining its value ("Quality") and being accountable for delivering it. The US health system is no model for Canada, but Quality and Accountability should be part of a Third Way, incorporating the best ideas from the US into a renewed public system.

Primary Healthcare: The All-Too-Quiet Revolution in Waiting

Sat, 15 Jan 2005 10:07:36 -0400

Remodelling the kitchen won't help the house with a weak foundation. The same holds truth in healthcare. We cannot solve quality and access problems or deal effectively with wait times unless primary healthcare - the foundation of the system - is solid. That is why the First Ministers' 2003 Healthcare Renewal Accord identifies it as the cornerstone of tomorrow's healthcare system. But progress is slow, and the foundation is creaking under the strain of even greater pressures.

Telephone Contact Centre Links to Primary Healthcare Reform

Sun, 15 Dec 2002 10:07:05 -0400

A new telephone health advice service implemented in September 2000 is integral to the Capital Health (Edmonton) Region's strategy to build a comprehensive approach to primary healthcare. Capital Health Link operates 24 hours a day, seven days a week and was the first comprehensive nurse-based health advice phone line in Alberta. Callers to Capital Health Link ("Link") can talk to experienced and specially trained registered nurses for health advice, information about programs and services, and to register in selected Capital Health programs. Satisfaction ratings have been high from the outset as Link supports people to manage their health through informed choice and decision-making. Evaluation results indicate the service is helping the public access the most appropriate level of care. This has led to a reduction in the number of visits to emergency departments, drop-in medical clinics and family physicians' offices. Innovations for the future include linkages with a new electronic health record system and an expanded role in chronic disease management that will further support an integrated primary care strategy for the region.

A Framework for Reform; Highlights from the Report of the Premier's Advisory Council on Health

Fri, 15 Mar 2002 10:06:27 -0400

In August 2000, Alberta Premier Ralph Klein announced the appointment of 12 healthcare leaders who would provide his government with council and recommendations for reform through the Premier's Advisory Council on Health. The Council released its final report and recommendations in January 2002.

An Inconvenient Truth: A Sustainable Healthcare System Requires Chronic Disease Prevention and Management Transformation

Fri, 15 Jun 2007 10:05:47 -0400

We begin this paper by highlighting some of the facts behind this inconvenient truth. We then review and provide examples of several best practices in CDPM. We suggest that these best practices provide the foundation for a national CDPM strategy and argue that the FPT mandate for wait times be expanded to encompass CDPM and result in "care guarantees." We conclude with a high-level preliminary analysis of costs and benefits of this strategy to transform CDPM in Canada.

Chronic Disease Management: The Authors Respond

Fri, 15 Jun 2007 10:05:06 -0400

We want to thank the authors for their thoughtful and passionate commentaries. Each commentary stands on its own, and collectively they make a convincing and eloquent case for greater awareness and action for a "made in Canada" chronic disease prevention and management (CDPM) strategy that will not only transform our healthcare system but also help ensure its sustainability.

The Human Factor: Unexpected Benefits of a CPOE and Electronic Medication Management Implementation at the University Health Network

Sat, 15 Oct 2005 10:04:33 -0400

For the most part, literature and research around the benefits of computerized physician order entry (CPOE) and electronic medication management (EMM) have focused on the reduction of adverse events and medication errors. While these are major anticipated benefits relating to patient safety, the University Health Network (UHN) discovered that there are other unexpected benefits to be gained, related to human factors, from implementing CPOE and EMM. And they, too, can improve patient safety.

In Pursuit of a Safe Canadian Healthcare System

Fri, 15 Oct 2004 10:03:54 -0400

This paper provides evidence that Canada's healthcare system is not as safe as it needs to be, and suggests ways to make it safer. Healthcare leaders must recognize that patient safety is indistinguishable from the delivery of high quality, affordable healthcare, and they must become more knowledgeable about the extent of the patient safety problem in Canada. The creation of a Patient Safety Board, modelled after Canada's Transportation Safety Board, will provide the authority healthcare leaders require to reduce medical errors. Without a national Patient Safety Board we cannot efficiently and effectively identify, quantify and address medical errors in Canada. This paper also urges healthcare leaders to recognize that a fundamental tool in improving patient safety is the electronic health record (EHR). Return on investment data for a national EHR strategy are presented. The author focuses on three EHR initiatives: outpatient electronic prescribing; in-patient computerized physician order entry; and home-based diabetes disease management. Potential net savings to Canada from these three EHR initiatives alone approach $2 billion annually. We must accelerate our EHR investment. Coordinated national EHR initiatives will cost less, save lives and prevent harm when compared to the status quo. These initiatives will also provide the foundation for transforming our healthcare system and will assist in building a better-educated, healthier and therefore more economically competitive nation.

Lessons Learned from the Veterans Health Administration

Sun, 15 May 2005 10:03:13 -0400

Veteran Affairs (VA) Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, treating close to five million patients annually through its 163 hospitals and 15,000 physicians (Kolonder 2003). Comparable in operational size to the province of Ontario, it is an efficient and innovative system for Canadians to learn from. In particular, the VHA is an excellent example of healthcare transformation through the use of information technology (IT) (see Table 1).

Can a Healthcare System Be Transformed? Lessons from the Past Decade at the Veterans Health Administration

Sun, 15 May 2005 10:02:25 -0400

The Veterans Health Administration in the United States has wrought a miracle. After 10 years of transformation and strategic reinvestment, their healthcare system has become more community-oriented, provides more services overall and costs less per patient. In this commentary, the systems of the Veterans Health Administration and of Canada are compared and contrasted with regard to three key issues: community orientation, patient-centredness and the role of information technology.

The Impact of the Electronic Health Record on Patient Safety: An Alberta Perspective

Fri, 15 Oct 2004 10:01:50 -0400

Alberta is at the leading edge in developing its electronic health record (EHR), a provincial initiative to provide healthcare providers with immediate access to a patient's medication history and laboratory test results, regardless of where they are in the province, or where the patient's drugs or other treatments were ordered. The Alberta EHR was launched in October 2003. So far 6,000 healthcare providers have voluntarily signed on to use it, and benefits to patient safety have been reported. The EHR is an important part of healthcare renewal that is required to improve patient safety; however, it must not be viewed as a stand alone cure-all solution to Canada's patient safety challenge. The EHR will only reach its full potential if it is part of an integrated approach to health renewal that stresses consistency of healthcare, practice and information standards, and consistency and standardization of healthcare data. Without a sector-wide EHR like Alberta's, the proliferation of computerized electronic medical records (EMRs) in hospitals, clinics and pharmacies might create "islands of information" that are not widely compatible. A national EHR approach must acknowledge the importance of improving broadly accepted practice standards and data consistency in order to reduce the islands of information and protect patients from medical errors as they move between them.

Patient Safety: Is the Evidence Strong Enough That Information Technology Can Help?

Fri, 15 Oct 2004 10:01:04 -0400

It is not difficult to prepare a commentary on Dr. Morgan's invited essay "In Pursuit of a Safe Canadian Healthcare System" if one agrees with almost everything he reveals and postulates. When a respected young practising physician candidly and forcibly makes a case for the need for significant healthcare system reform, one must sit up and take notice. If nothing else, his statement "outpatient medical errors are the bread and butter of internal medicine hospital admissions" should cause us to be deeply concerned. Dr. Morgan pleads for a number of reforms, such as the creation of a Patient Safety Board akin to Canada's Transportation Safety Board, the demonstration of an ROI for the electronic health record, the introduction of computerized physician order entry, and a number of other suggestions. Due to limitations of time and space, we will react to only a few of his views, mildly disagreeing with some while strongly reinforcing others.

The Electronic Health Record: A Leap Forward in Patient Safety

Fri, 15 Oct 2004 09:57:40 -0400

In his review of patient safety issues in the Canadian healthcare system, Dr. Matthew Morgan states that "coordinated national EHR initiatives will cost less, save lives and prevent harm when compared to the status quo." Canada Health Infoway is spearheading this initiative in Canada. Infoway's No. 1 guiding principle for investment is that projects undertaken must "enhance the quality of patient care, healthcare services and patient safety." They must also support the development and adoption of pan-Canadian interoperable EHR solutions. Infoway is working in seven major areas to improve electronic access to accurate and timely health information in order to reduce errors, facilitate accurate diagnoses and speed treatment. These areas include the building blocks of the EHR: infostructure, registries, digital imaging systems, and drug and laboratory information systems. Infoway is also developing and expanding telehealth networks to increase the scope of the Canadian healthcare system. Infoway was recently mandated to develop a public health surveillance system for infectious diseases to give healthcare providers a tool for tracking and managing disease outbreaks in the Canadian population. These systems will improve safety, quality, accessibility, cost-efficiency and the sustainability of the healthcare system. Patient safety is a cornerstone of Infoway's activities.

Stark Laws and the Electronic Health Record: An Unintended Paradox

Wed, 22 Aug 2007 09:57:18 -0400

The federal government currently limits what technology hospitals may provide associated practices, but loosening these rules may not help the spread of healthcare information technology.

Identifying and Preventing Technology-Induced Error Using Simulations: Application of Usability Engineering Techniques

Sat, 15 Oct 2005 09:56:38 -0400

In this paper, we describe a framework for the analysis of technology-induced errors, extending approaches from the emerging area of usability engineering. The approach involves collection of a rich set of data consisting of audio and video recordings of interactions of healthcare workers with health information systems under simulated conditions. The application of the approach is discussed, along with methodological considerations and issues in conducting such studies. The steps involved in carrying out such studies are described along with a discussion of our current work. It is argued that health care information systems will need to undergo more rigorous evaluation under simulated conditions in order to detect and prevent technology-induced errors before they are deployed in real healthcare settings

A Collaborative Evidence-Based Approach To Making Healthcare a Healthier Place to Work

Sat, 15 Mar 2003 09:55:47 -0400

Difficulties in recruitment and retention, high rates of work injuries, illnesses and absences from work, and escalating costs plague Canada's healthcare system. The well-being of the healthcare workforce merits serious consideration by healthcare decision-makers.

Cancer Care Ontario's Computerized Physician Order Entry System: A Province-wide Patient Safety Innovation

Sun, 15 Oct 2006 09:47:43 -0400

This paper describes the critical success factors in the design and implementation of CCO's CPOE system, including Web-based training and ease of administration to maximize physician adoption, incorporating point-of-care access to clinical practice guidelines into the tool, and the use of CPOE data to monitor and increase access to anti-cancer drugs and patient safety.

Can Medicare Be Saved? Reflections from Alberta

Thu, 15 Jun 2000 09:47:07 -0400

Most Canadians would consider the very question of saving medicare as a threatening prospect. Even more threatening should be the growing consensus that the above question is no longer relevant, that medicare in its current form cannot be saved and that the debate must turn to how our healthcare system should evolve in order to remain sustainable.

"Change Is Inevitable and Desirable": An Interview with Ontario's Minister of Health and Long-Term Care

Sat, 15 Sep 2001 09:46:10 -0400

Peggy Leatt, our Editor-in-Chief, caught up with The Hon. Tony Clement, Minister of Health and Long Term Care, as he was driving between engagements. Between launching Arthritis Month by presenting a $5oo,ooo cheque and heading to the Ontario Hospital Association's sixth annual forum for CEOs, he spoke to us on a cell phone (but not driving) from somewhere on an Ontario highway.

"We Are All in This Together": Integrated Health Service Plans in Ontario

Tue, 15 May 2007 09:45:13 -0400

Fourteen recently created local health integration networks (LHINs) are Ontario's approach to planning, coordinating, integrating and funding healthcare on a regional basis. Governed by appointed boards, LHINs are crown corporations that will move decision-making and accountability for health services closer to consumers and health service providers and that will also assist with system performance management. The mandate of LHINs is outlined in Ontario's Local Health System Integration Act, 2006 (Government of Ontario 2006), which forms the basis for creating LHINs to help ensure the delivery of stronger, locally planned healthcare.

Telepsychiatry: Implications for Licensing and Credentialing

Wed, 22 Aug 2007 09:44:45 -0400

Telepsychiatry can be defined in many ways. In the following discussion, it is defined as the live, interactive audio and visual communication that is attained through videoconferencing and that appears to offer a reasonable alternative to the traditional face-to-face psychiatrist-patient encounter.

Telehealth: Risk Management in the Re-Tooling of Health Care

Wed, 22 Aug 2007 09:44:13 -0400

This article is an attempt to outline a conservative, yet proactive, approach to risk management in healthcare delivery through telehealth. Although many of us do not feel prepared to make decisions regarding risk management without more information, the developers of technology march on - faster than we can adapt. In many cases, we clearly need to move ahead and adopt some technology, despite a limited amount of information regarding the full impact of technological change. This is the dilemma: either we become part of the development of these new systems, tools, protocols and guidelines for their use - or others will do it for us. Meanwhile, our risk only increases because we are on new terrain. As Cepelewicz states when discussing telehealth liability, "it's only a matter of time before we see a dramatic increase in the number of malpractice cases" (1998, p. 3).

Patients in a Globalized World: Keeping Hospitals in Perspective

Sat, 15 Nov 2003 09:43:41 -0400

The challenge of globalization could be the burning platform on which Canadian health providers finally learn that there is more to gain from collaboration than competition. Change in this globalized world cannot mean morphing into (publicly funded) entrepreneurial organizations and competing among other Canadian institutions prospecting for their global market share. Hospitals must understand that if they are firstly integrated into a proper, seamless healthcare system, they could then have extraordinary power in a globalized world. The VISA model should be examined as an example of the collaboration and co-operation that has allowed thousands of highly competitive financial institutions to come together with a common governance structure and an IT system that benefits everyone. VISA is doing very well in a globalized world.

E-Nursing: Electronic Nursing Resources on Your Desktop

Thu, 15 May 2003 09:43:03 -0400

E-Nursing represents an innovative approach to nursing education that has the potential to support professional practice throughout the institution. This paper details the benefits, design and promotion of an electronic nursing resource collection. How to divide responsibility, cost and expertise in such a project is also discussed. Preliminary usage statistics validate E-Nursing as a point-of-care education tool for nurses at Mount Sinai Hospital. A planned approach to implementation has been an effective means of introducing E-Nursing in an institution that previously relied on traditional hard-copy resources housed in the hospital's library.

The First 200 Days: Cancer Leadership in Ontario

Sun, 15 Dec 2002 09:42:27 -0400

In Ontario, each cancer centre is attached to a host hospital. If a cancer patient straddles the line separating the cancer centre from the host hospital and lifts one foot, that patient is receiving services governed by the board of the hospital. If that same person lifts the other foot, the patient is receiving services governed by the board of Cancer Care Ontario (CCO), with a head office on University Avenue in Toronto. In every other clinical program the emphasis is on the patient receiving the appropriate service in the appropriate setting (inpatient or outpatient) within a single program, under single governance. Why is it that places like Windsor and Thunder Bay have part of a major clinical cancer program managed and governed from Toronto, a huge distance away, while the respective boards of the hospitals govern the other part? This scenario, strange but true, is far from the ideal coordinated plan in which regional cancer centres, host and community hospitals, community care access centres, home-care services, nurses, physicians and surgeons, oncologists and other providers of cancer care align services in a way that can help patients and families seamlessly navigate the corridors of cancer care.

CIHI Survey: Canada's Health System: Transitions in Leadership

Sat, 15 Jan 2005 09:41:43 -0400

Canadian hospital CEOs are at least twice as likely as those in the UK, Australia, US and New Zealand to say that they face serious shortages of trained managerial staff, according to a 2003 survey by the Commonwealth Fund. More generally, many decision-makers and policy-makers cite identifying, supporting and nurturing health leaders as a key challenge in the years ahead (Dault et al. 2004). Those who shoulder these leadership responsibilities operate within the complex, multilevel environment of health policy and healthcare delivery. Their ranks include federal/provincial/territorial Ministers and Deputy Ministers of Health; senior managers in health regions, hospitals and other healthcare organizations; and clinical leaders. This article presents the first results of a profile of Canada's health leadership cadre and how it is changing.

Rethinking Medicare: The Author Responds

Thu, 15 Jun 2000 09:39:36 -0400

The greatest challenge of rethinking medicare is to find ways to bridge between the domains of policymaking and politics to achieve the changes we all know are essential... Comments from the author about the ten commentaries.

Insight: Bernie Blais, Deputy Minister of Health and Social Services, Nunavut

Sun, 15 Jan 2006 09:38:59 -0400

In the Fall of 2005, Consulting Editor Ken Tremblay interviewed Bernie Blais, Nunavut's Deputy Minister of Health and Social Services - a position he had held since July of 2002. In addition to his duties as Deputy Minister, Mr. Blais's portfolio included people with disabilities and the status of women. Since the interview, Mr. Blais has announced he has accepted the position of CEO of Alberta's Northern Lights Health Region.

Guidelines for professional accountability in e-health services needed

Fri, 15 Sep 2006 09:38:23 -0400

Advances in the use of technology in health care delivery raise unique questions with regard to standards of professional practice and research ethics that have not yet been well addressed. Although health professionals have well-defined ethical codes of conduct, most have not adapted or developed specific codes of professional conduct that apply when providing services using technology. The results of this study suggest that additional caution is needed when professional health services are transmitted through technological devices.

Home-telehealth initially costs more, but may save more in the long-run

Wed, 15 Jun 2005 09:37:41 -0400

Home-telehealth can decrease costs by preventing unnecessary clinic visits, hospitalizations and trips to the emergency room. This study followed frail elderly veterans with coronary heart failure, chronic obstructed pulmonary disease, and/or diabetes mellitus using home-telehealth versus the usual care plus nurse case management for six months. Even though there were added costs to implement the hometelehealth system, the subsequent decrease in unnecessary nursing home visits, urgent care visits, emergency room visits, and hospitalizations more than justified the costs when compared with usual care plus nurse case management in veteran male patients.

Insight: In Conversation with Will Falk, Partner, Accenture Health and Life Sciences

Tue, 15 May 2007 09:37:12 -0400

William Falk has walked the back halls of power and has managed projects and teams that have set directions, shifted public policy and made headlines. No stranger to the complexities of the healthcare system, academic medicine and the drivers of change, Will has formed strong ideas and possible solutions from his observations in Canada and the US. Armed with these experiences, a passion to improve system performance, the promise of information technology and Canada's recent emphasis on wait times and chronic disease management, Will Falk, now with Accenture's Health and Life Sciences practice, has become a proponent of the enabled patient - participants who can better navigate the system and its providers. Ken Tremblay spoke with him at his Toronto office.

Home care services of the future? A home-telehealth demonstration project

Wed, 15 Jun 2005 09:36:32 -0400

The fastest growing segment in the US health care market is home health services. The use of hometelehealth technologies could provide alternative approaches to providing home care services. At the end of this study, participants who received some form of home-telehealth showed significant improvement in their functional and cognitive outcome measures.

Applying a Prism: The Spectrum of a Sustainable Healthcare System

Fri, 15 Jun 2007 09:36:03 -0400

Initiatives aimed at reducing wait times for surgical and diagnostic procedures and comprehensive chronic disease management programs focus, respectively, on the supply and demand aspects of access to healthcare. Addressing either in isolation can have a salutary health effect for segments of the population and produce system improvement. Approaching healthcare access issues even more broadly, in the context of population health and with a patient-centred perspective, carries the promise of sustainability, the potential for superior health outcomes across a continuum of patient care and the possibility of enhanced system competency through true integration of multiple sectors. A model for comprehensive access to health services includes a plan for a network of primary care providers, appropriate capacity and flow efficiency for the provision of unplanned (emergency) services, operationalization of wait times initiatives to sustain planned services (most surgeries and diagnostic procedures) and a strategy for decreasing demand for care by engaging primary and community care capabilities and a robust chronic disease management strategy.

Bridging from Paper Charts to an EHR at Hamilton Health Sciences

Wed, 22 Aug 2007 09:35:34 -0400

Hamilton Health Sciences (HHS) implemented a centralized document management system so that all patient records are now scanned and stored as electronic documents accessible online anytime, anywhere by authorized staff. In addition to solving administrative and clinical problems created by the hospital's growing mountain of paper patient records, the new system is facilitating the hospital's transition to a full Electronic Health Record (EHR). In addition to helping HHS optimize its forms environment, and giving clinicians a taste of personal productivity benefits yet to come, the system is part of a solid technology platform being built to support the coming EHR.

Project Profile: New Computing Model Helps Hamilton Health Sciences Address Changing Business Requirements

Fri, 15 Sep 2006 09:34:55 -0400

This case study presents the impetus, business case, chronology and benefits of implementing a new server-based computing model at Hamilton Health Sciences that solved a critical desktop management problem while reducing IT costs. The new approach also provided a robust, flexible and scalable technology platform that is helping the hospital address business requirements driven by the emerging virtual healthcare community.

E-Health Consumer: A Diminishing Tolerance of Hospitals

Wed, 22 Aug 2007 09:34:22 -0400

Increasing consumer sophistication and comfort with the Internet will lead to less tolerance for hospitals and health systems that have not employed the technology in a consumer-friendly manner.

The Tragedy of the Medicare Commons?

Sun, 15 Jul 2001 09:33:44 -0400

Peter Ubel's main conclusion is that physician participation in bedside rationing is essential to controlling healthcare costs. This conclusion is out of step with the current focus of thinking and policy debate within Canada and other countries with universal public healthcare systems. In the Canadian context, collectively we need to better understand the limits and choices in defining the "medicare commons," which occurs at the intersection of the overall level of funding, the range of services provided (comprehensiveness) and the level of access that we are able to provide. This will require a deliberative process that must engage patients/the public at all levels of decision-making. Physicians must accept responsibility to use scarce resources prudently, but this is a collective responsibility and must be exercised in a transparent manner.

Guidelines for professional accountability in e-health services needed

Fri, 15 Sep 2006 09:32:45 -0400

Diane Beattie, Chief Information Officer, London Health Sciences Centre

Sun, 15 Dec 2002 09:32:11 -0400

Diane Beattie is Integrated Vice President and Chief Information Officer, Health Information and Health Alliances - with the Strategic Alliances and Networks senior leadership role added in January 2003 - for London Health Sciences Centre (LHSC) and St. Joseph's Health Care (SJHC) London. She is responsible for strategic leadership in all aspects of health information management and information technology, focusing on the development of an IT strategic plan to support London hospitals. LHSC and SJHC employ more than 12,000 employees, and combined, their budgets total more than $800 million.

e-Health Consumer: A Diminishing Tolerance of Hospitals

Fri, 15 Dec 2000 09:31:35 -0400

Though the news was expected, it still came as somewhat of a shock. Mary had suspected for some time now that "something just wasn't quite right." During the past several months, her father had been complaining about a variety of ailments and had made several trips to the doctor and hospital for various tests and consultations. During that time, her dad's symptoms became more frequent, pronounced and extensive. In the end, it was almost a relief to finally hear the news; at least she now knew what they were dealing with.

Infostructure and the Revitalization of Public Health in Canada

Thu, 15 Mar 2007 09:31:01 -0400

Similar to the United States, Canada's overarching challenge is to build a core public health infrastructure for the 21st century. Assessing the informational reputation of Web-based providers demonstrates the centrality of federal government departments and agencies in the Canadian public health infostructure. The federal government's substantial investment in government online projects has helped bring public health information and services to Canadians, and continuing to build on that infostructure will be critical to revitalizing public health in the future.

Safe: A Status Update on Information Security and the Hospital Community

Sat, 15 Nov 2003 09:30:24 -0400

IT Security and Privacy are becoming increasingly visible "hot topics" across the full spectrum of industry and service sectors. Legislation and global "best practices" are working hard to defend organizations and individuals against escalating, rapidly evolving cyber-threats. Predictably, the threat landscape is having an impact on all levels to varying degrees: governmental, organizational and individual. This article introduces the basic context for information security and offers insight into how a number of hospitals are addressing the situation, what barriers they currently face and what opportunities they see unfolding.

The Future of the Internet in Healthcare: A Five-year Forecast

Thu, 15 Jun 2000 09:29:43 -0400

Why is the use of the Internet in healthcare growing so quickly? How sustainable is that growth? What kinds of health-related applications will develop over the next five years? How will the Internet affect healthcare delivery and health outcomes? In all the excitement about the Internet, there inevitably will be unrealistic expectations about its impact on the healthcare industry. This forecast sorts through the current hype to give a realistic assessment of the pace and direction of change for the next five years.

Hospitals in a Globalized World: A View from Canada

Sat, 15 Nov 2003 09:29:08 -0400

Globalization is a complex, multidimensional phenomenon that has already influenced the way hospitals operate and will increasingly impact the healthcare landscape and patients' experience worldwide. This paper briefly analyzes the direct and indirect effects of globalization on healthcare systems and services, mainly focusing on the experience of academic health sciences centres. Building their analysis on the belief that globalization is neither negative nor positive in itself, the authors compare alternative definitions of globalization, suggest possible ways in which it could impact health systems, examine how the role of large teaching and research institutions could evolve over the next decade or so, and put forward some fundamental questions faced by healthcare institutions.

The Business Case for Patient Safety

Wed, 15 Nov 2006 09:28:31 -0400

Conventional wisdom dictates that hospitals are institutions in which ailing or injured people go for a temporary visit, their discharge ultimately dependent upon either a partial or complete recovery. Unfortunately, the most well-intended acts sometimes result in tragedy. Depending upon the severity of a patient's condition, sometimes a visit to the hospital is a one-way excursion. And in some cases (most would argue in too many cases), the reason a patient dies within the confines of a hospital is due to the lack of a systems approach to patient safety.

The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care

Sun, 15 May 2005 09:27:49 -0400

The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators.Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.

Towards the Virtual Hospital: An Ecological Approach to Network Development in Health Services

Wed, 15 Mar 2000 09:27:00 -0400

While the last decade held much rhetoric and debate on the issue of healthcare reform across Canada, little actually resulted in substantive innovations at the integrated service delivery level. Preoccupation with governance and management structural changes, mergers (not always for the better) and funding reform has unfortunately left the system struggling to find new solutions to the "Gordian knot" of access, waiting lists, human resource scarcity, systems integration and continuity of care, to name just a few issues. And it's ironic that the biggest single factor mitigating against new designs for models of service delivery may very well be our collective old mindset still struggling with the challenges of uncertainty, complexity, ambiguity and paradox brought on by new times and ever-increasing expectations. Unfortunately, this often results in resistance to change when, in fact, what is needed is tolerance for and embracing of these challenges to move forward.

Hospitals in a Globalized World: A View from Canada

Sat, 15 Nov 2003 09:25:54 -0400

In the first part of the paper, the complex and multidimensional nature of globalization is analyzed and the highly polarized debate on the nature of this phenomenon briefly summarized. The second part focuses on the effects of globalization on health and healthcare. A pre-existing conceptual framework is used to analyze the complex linkages between globalization and health, and alternative scenarios are presented to illustrate the current and potential effects of international trade policies and regulations on health systems. In the third part, changes in hospitals' structure, organization and functions triggered by globalization and the introduction of new information and communication technologies are examined. The analysis is built around five main elements: patients, human resources, capital, information and funding. Finally, the paper highlights some of the most fundamental challenges, both practical and ethical, that healthcare institutions have to face in the transition to a new era of globalized health services.

Project Profile: New Document Management System Delivers Immediate Administrative and Clinical Benefits at Hamilton Health Sciences

Tue, 15 May 2007 09:25:21 -0400

Hamilton Health Sciences (HHS) operates five hospitals and a cancer centre that serve the 468,000 citizens of the city of Hamilton and the more than two million residents of Central-South Ontario. As with many hospitals, the bulk of patient records at HHS are still being generated in paper form - 10 million pages per year, in fact, and climbing! In response to significant administrative and clinical problems caused by the growing mountain of patient records, HHS decided to implement an electronic document management system.

Taking the Next Step to Privacy Compliance for Hospitals: Implementing the OHA Guidelines

Sat, 15 Nov 2003 09:23:35 -0400

The recently released July 2003 "Guidelines for Managing Privacy, Data Protection and Security for Ontario Hospitals," prepared by the Ontario Hospital eHealth Council Privacy and Security Working Group (the "Guidelines") are useful in that they provide a comprehensive overview of the types of issues raised for hospitals by existing and pending privacy legislation, and a very high-level framework for addressing same. However, the Guidelines are, as stated high-level guidelines only - leaving hospital management to grapple with the next big step towards privacy compliance: how to operationalize the Guidelines within their particular hospital. This article summarizes the basis principles of the Guidelines, and seeks to provide some initial guidance as to the role of legal counsel in addressing some of the practical, legal and operational issues hospitals will face in endeavouring to implement the Guidelines. We note that while the Guidelines have been drafted specifically for the Ontario context, where no personal health information omnibus legislation has yet been enacted - in contrast to the Health Information Act in Alberta and the Personal Health Information Act in Manitoba - the personal health information issues raised by the Guidelines are universal to hospitals in general; as a result, the Guidelines should also be of interest to hospital management in other provinces.

Focus on Leaders: Dr. Lynn Nagle and the Case for Nursing Informatics

Tue, 15 Mar 2005 09:22:05 -0400

Lynn Nagle, RN, PhD, is Senior Vice President, Technology & Knowledge Management at Mount Sinai Hospital in Toronto, where she is responsible for information and communication technology, and information management. She is also Assistant Professor in the University of Toronto's Faculty of Nursing. Dr. Nagle's research is directed towards evaluating the impact of technologies in clinical practice settings. She is the Canadian nursing representative to the International Medical Informatics Association Nursing Work Group, and is the current and founding President of the Canadian Nursing Informatics Association.

Accelerating the E-health Connectivity Imperative: Implementing Short-term Value against Long-term Goals when Building Private-sector Relationships

Tue, 15 May 2001 10:57:40 -0400

The role of the private sector in the e-health equation, whether it be a pure business transaction (e-commerce), information transaction (e-health) or a patient care transaction (e-care), is to encourage, build and foster connectivity. The key to building successful connectivity projects that link groups together electronically is to demonstrate value to all parties. Framing this is an over-arching understanding by all participants in the system of the necessity to implement projects with short-term value, while keeping in mind the long-term goals of sustainability and increased care in the Canadian healthcare system.