Useful resource of policy-relevant documents: Ontario Health Systems Document Portal

The McMaster Health Forum recently announced the launch  of the Ontario Health Systems Document Portal, a continuously  updated repository of policy-relevant syntheses of research evidence about governance, financial and delivery arrangements within health systems, and about implementation strategies that can support change in health systems and address health system transformation in Ontario. It is housed within Health Systems Evidence, a portal is free to access, which provides "one-stop shopping" for documents usefult to health system policymakers and stakeholders in Ontario.

Users need to complete a one-time free registration here to access the database, Content is complementary and automatically available through the home page and advanced search page to all registered users accessing the portal from within the Province of Ontario. Users from outside Ontario need to click on "update my profile" at the top of the screen on the home page, and click the box for Ontario under "enable viewing of complementary content".

Examples of documents currently added include:

• Educational group visits for the management of chronic health conditions: A systematic review
• Impact of e-learning on nurses' and student nurses knowledge, skills, and satisfaction: A systematic review and meta-analysis
• Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications
• The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: A systematic review
• Undetermined impact of patient decision support interventions on healthcare costs and savings: Systematic review

View the video tutorial to know more about searching the database.

Metadata, the NSA....what's all the fuss about? The Guardian explains.

Metadata is data about data.  Every time we use technology, be it a computer, a mobile phone, a camera or the internet, we leave a trail of information about what we do, how we do it, when and from where.   Metadata  that is recorded  in documents created on a computer generally include the name of the author, the time the document was created and when it was modified, a title of the document, keywords etc.; likewise cameras record information about the device, the time a picture is taken; and websites collect visitor IP addresses, web pages visited, user data and login details and so on.  

 The rationale for metadata use is to ensure information is findable, trustworthy, and understandable, and for that reason, there are established standards  for collecting and recording metadata. Many technologies are set up to automatically collect standard transactional and user data.  However, since leaked documents revealed that the US government was collecting such information and was using it, via the NSA's (National Security Agency)  secret surveillance program, to monitor the activities of individuals, it has become the subject of controversy, and seen as intrusive and an invasion of privacy. 

The UK Guardian has made available an interesting l "Guide to your metadata". Click here to access the guide. While the guide mentions that metadata collected from websites records  transactional information about visitors, and generally not personal or content-specific details, it illustrates how, in the case of the Petraeus scandal, even with the use of an anonymous email account, a cross-referencing of data from different sources allowed for identification of an individual. The Guardian guide points out that in some cases a person can limit the information that is collected, by turning off location services on cell phones, for instance,  however, often an individual may not have control over metadata that is collected.  At the very least, we can take the time to educate ourselves and be informed and vigilant. 

Request Survey Participation: Personal Digital Legacy Management

As we increasingly work, communicate and store our records, memorabilia, and creative work online,  how many of us are careful to document what we have and where, to ensure passwords are stored in a format that can be communicated to others, and to appoint an executor who can take charge of our legacy in the event of an emergency or contingency?  This is the focus of a survey that I hope will be responded to by a diverse set of respondents.  It can be located by clicking here: https://www.surveymonkey.com/s/Digital_Legacy_Management_Survey. 

Currently, there is no uniform body of laws governing access to a deceased person's account, and further complications arise when there  are accounts on many different sites, as access is governed by the policies at each site.  If we wish to preserve our digital legacies, we need to take charge of them while we can. 

Important review of social media and clinical care

​Entitled "Social Media as a Tool in Medicine" the review article in the current issue of Circulation, by  authors Katherine Chretien, MD and Terry Kind, MD, MPH, presents a comprehensive overview of the ways social media are being used in clinical care, and  discusses the potential ethical, professional and social implications of such engagement.  

Through social media,  patients, caregivers and family members find health information and support, and share experiences.  For researchers, such communication has fuelled new ways of gathering health data (through sites like Patientslikeme and qualitative analysis of posts and discussions on Twitter, or on Facebook groups, for example).  Likewise, physicians are using social networking to answer clinical questions, to access patient information to aid clinical care, and to connect with patients.  As telemedicine has grown with the use of new technologies, there has been a growth of virtual clinics. 

​Ethical and professional implications pf physician use of social media for clinical care are discussed using the American Medical Association principles of medical ethics as a framework for discussion of the key issues. The article also briefly touches on legal implications of social media use in clinical care, beyond HIPAA and privacy law.  

Social media offers many benefits for clinical practice and will increasingly be incorporated into health care. It is thus important that these issues be acknowledged, discussed, and understood by physicians and by patients and caregivers, as advocates and as participants in their care.  

Continuing Education Possibilities (MOOCs)

Today's information culture requires a commitment to continuous learning.  In the last four years, the availability of Massive Open Online Courses (MOOCs)​ has made this possible, as course offerings from Universities around the world have burgeoned. It is exciting to behold the possibilities.  I have just added a web page to this site explaining what MOOCs are, listing the main MOOC platforms with a bit of information about each that may help in deciding how to go about finding and registering for courses that fit particular needs.  You can find that here.

The changing landscape of public health surveillance

Today, public health surveillance takes into account not just officially reported data and statistics, but also data collected from informal channels such as twitter, blogs, social networking sites, chat rooms and crowdsourcing platforms. Likewise, dissemination of outbreak data is now made through multiple channels.

To get a flavour of the changing landscape of international disease surveillance, visit the website of the International Conference on Digital Disease Detection, held in February 2012, at the Joseph B. Martin Conference Centre, Harvard Medical School, and access the archived presentations and panel discussions.  Scroll down the page and click on the adjacent graphic to explore the presentation topic or panel discussion  of interest, and discover the amazing research underway or locate tools to further explore ideas.

While there are many improvements to the way public health can be practiced within this new surveillance landscape: decreasing time between an outbreak and formal recognition of an outbreak, which allows a faster response to containing the outbreak, for example, there are also many challenges to managing, using, and making sense of the vast flows of data.  The presentations touch on techniques, analysis, applications and challenges. 

Patient-Centred Care

Among resources I consulted for a recent project on “Patient-Centred Care” was a policy paper by the Ontario Medical Association (OMA).  According to the OMA: “A patient-centred care system is one where patients can move freely along a care pathway without regard to which physician, other health-care provider, institution or community resource they need at that moment in time. The system is one that considers the individual needs of patients and treats them with respect and dignity”.  In many systems, it says in the review, the patient faces challenges of access to services, continuity in care, long waiting times, involvement in decision-making about their care, having to “adapt to the system and to navigate through its many intersections”. The problems identified relate to funding priorities, lack of sufficient integration and co-ordination of care, and policy and practices at the system and institutional level, and inadequate communication and shared-decision making between health care providers and patients.  Many practical and useful solutions are presented in the paper, which, as a researcher, patient and care advocate for elderly family members, I heartily endorse.

On March 5th, 2013, a few weeks ago, I attended a talk given by London, Ontario physician Dr. Ramona Coelho entitled "Suffering and Medicine".  She spoke of the need to go beyond solving medical problems, to helping patients cope with an unsettling diagnosis or an incurable illness through acknowledging accompanying fears, validating feelings, and providing a sympathetic ear.  In focussing on suffering rather than on medical problems, her discussion focussed squarely on the patient. This, I thought, is what patient-centred care is all about.  Evidence based care, though highly effective for solving medical problems, is surely less than effective if applied without a sympathetic and empathetic approach to understanding the patient's feelings of inadequacy, fears of not being in control, financial worries, depression, loneliness, anger and many conflicting emotions that in themselves can negatively affect health outcomes.  One may worry that this approach requires doctors to spend a bit more time in consultation, but ultimately, if it helps patients understand and better manage their own care, it should result in a lower burden of care within the health system.