ENVIRONMENTAL SCAN FEBRUARY – APRIL 2010 ANALYSE DU MILIEU FÉVRIER - AVRIL 2010 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques AB Ethics Funding cuts could result in the closure of Alberta's Provincial Health Ethics Network, which has helped patients, health-care workers and health regions with difficult medical ethics questions. Most of the temporary funding from AHS runs out March 31. Supporters say Alberta Health Services should reinstate the funding, or the loss will lessen the province's ability to thoughtfully deal with ethical dilemmas likely to increase with an aging population, new technologies, more experimental drugs and growing chronic health problems. The network -- the first and largest of its kind in North America -- has trained health-care workers how to approach ethical questions such as circumcision, the HPV vaccine, family disagreements over ending lifesupport, or disclosure of medical errors. The network has also helped develop legislation and health policy on issues such as pandemic planning and codes of conduct. Edmonton Journal 2010.03.11 Qmentum standards address various ethical issues, including developing policies and procedures. BC Health Human Resources BC is expanding paramedics’ scope of practice to integrate the ambulance service more closely with the health system, empowering paramedics to make health care decisions to improve patient care. Examples include dealing with people who have chronic diseases in residential care facilities, joining home- and community-care workers in supporting clients in their homes, and providing care in emergency departments. Amendments to the Emergency and Health Services Act pave the way for Qmentum includes standards for Emergency Medical Services. The BC EMS providers were recently integrated into Provincial Health Services Authority (PHSA). They will 2 Topic Matière CDA Health Trends Issue Catégorie Strategic Directions Orientations stratégiques the introduction of “treat and release,” whereby a paramedic called to a scene could assess a patient, provide appropriate treatment, and advise on follow-up care, instead of having to transport the patient to the emergency department. These legislative changes will provide the opportunity for paramedics to play a much greater role in health care delivery, especially in rural and remote areas. BC Ministry of Health Services 2010.04.21 be accredited through PHSA as one of their sequential components. Discussions with PHSA are underway. According to the HealthCast series of reports on health industry trends published by the PricewaterhouseCoopers Health Research Institute, a growing and aging population, more people living with chronic disease, and inconsistent service delivery (due in part to financial and workforce shortages) are placing increased pressure on the health care system in Canada. For information. Key consumer findings include: 42% of Canadians indicated that immediate access to a doctor or health care provider is top-of-mind in their definition of "quality" health care, compared to only 30% globally. When it comes to specialized care, Canadians have a much harder time accessing specialist physicians than the rest of the world. Almost half said it was difficult to see a specialist. Canadians rely heavily on their physicians as a source of medical information. In fact, 72% said they prefer to go to the doctor's office to obtain information about their personal health. 3 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques Consumers also want silos to be broken down in health care. Twothirds of global consumers surveyed said coordinated clinical teams are important to them, similar to 60% of Canadian consumers. NB Council Briefing 2010.04.20 CDA Health Human Resources The Toyota method of using automobile assembly line techniques to improve health care efficiency is “catastrophic” according to a sociologist at the University of Quebec who did a study of the workplace at the local area network in Ahuntsic and Montreal North. Professor Angelo Soares found four of 10 employees posted high levels of psychological stress, and over half felt a disconnect between their values and those of management. Health Edition 2010.03.26 CDA Health Care Sustainability In an opinion-editorial published in the National Post (Mar. 24), Canadian Medical Association President Dr. Anne Doig suggests a number of ways of dealing with the question of sustaining health care spending without crowding out other priorities like education and social programs. First, she says it is important to “explore and agree on the underlying reasons why health spending exceeds economic growth. Part of this exploration must include measuring and appreciating the value of our health system, both realized and unrealized.” Dr. Doig points to a study by the Public Health Agency of Canada that said the cost of premature mortality equaled the direct cost of providing health services in 2000. Second and third, she says “we need to make quality king in health care” and make governments more accountable for their oversight and The quality of employee worklife is an integral component of the Qmentum accreditation program. The Worklife Pulse Survey is part of the Qmentum accreditation program. For information. 4 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques management of the health care system. That begins with producing comparable data and health indicators.” Then, she says Canadians need to be encouraged to take increased personal responsibility for health and health care. Finally, “we must stop looking at health spending in isolation. Once we get a better understanding of the likely future path and size of health spending we must determine what the subsequent implications are for other government programs like education, social services, public security and infrastructure.” Health Edition 2010.03.26 CDA CDA Health Human Resources Infection Prevention and Control According to a recently released report, three-quarters of Canadian family doctors have experienced at least one incident of major abuse at the hands of patients. Close to 40 per cent had been subjected to severe abuse including assault. The findings were released in the journal Canadian Family Physician. It was the first national examination of violence in doctors' offices. The study's author would like to see Canada develop a national policy on how doctors should deal with such abuse, while ensuring the patient in question still gets the medical treatment he or she needs. CBC 2010.03.17 Qmentum standards address safety issues affecting both clients and staff. Linguists at Xerox Corporation have teamed up with medical researchers in France to explore how "language technology" can help curtail hospitalacquired infections (HAI). Researchers will use a "text mining" tool developed by Xerox to analyze For information. An ROP on workplace violence prevention was released in February. It will apply to surveys starting in 2011. 5 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques medical records, automatically identifying patients who could be at risk of contracting an HAI. The mining software identifies specific terms that indicate a patient may have contracted an HAI, making the link between patient symptoms, drugs and names of bacteria. When these links identify potential risk of an HAI, the system automatically alerts the staff. The project, titled “Assistant de Lutte Automatisée et de Detection des Infections (ALADIN),” is being sponsored by the French government in an effort to help detect HAIs more quickly and reduce infections. NB Council Briefing 2010.03.25 CDA Infection Prevention and Control A study by the Canadian Nosocomial Surveillance Program shows a dramatic increase in the number of cases of Canadians becoming infected or colonized by MRSA since 1995, both in hospitals and within the community. Researchers found that between 1995 and 2007, the incidence of MRSA - methicillin-resistant Staphylococcus aureus - soared 17-fold at Canadian hospitals. Over the 13-year period, there was also a three-fold jump in the number of MRSA infections associated with more virulent strains from the community. According to lead author Dr. Andrew Simor, chief of microbiology and infectious diseases at Sunnybrook Health Sciences Centre in Toronto, Canadian hospitals have had a measure of success in dealing with MRSA, but more still needs to be done. "There are things we can do to lower the risk of MRSA spread in hospitals, including increased screening of highrisk patients, better compliance with hand hygiene, appropriate cleaning of the hospital environments, and other infection prevention and control In addition to the standards on Infection, Prevention and Control (IPC), there are seven ROPs that address IPC and apply to all clients. Two ROPs are specific to hand hygiene: Education/Training on hand-hygiene Hand-hygiene audit 6 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques measures." The Canadian Press 2010.03.10 NL Accountability Significant progress has been made in implementing the recommendations of the Cameron Report into faulty breast cancer receptor testing, Newfoundland and Labrador Health Minister Jerome Kennedy said in releasing a one-year update on the government’s work. Of the 60 recommendations, 39 have been fully or substantially completed. The remaining 21 are partially complete with some, such as continuing education for staff, an ongoing activity. Some 425 patients received the wrong results from testing conducted between 1997 and 2005. The Accreditation Canada laboratory standards are included in all four NL health authority surveys being conducted during 2010. Health Edition 2010.03.26 NS OTDT Nova Scotia’s approach to organ donation is a "hit-and-miss" affair that requires new rules to ensure doctors follow through on the wishes of potential donors, the province’s health minister said. Maureen MacDonald said she is seeking public input on proposed legislation aimed at increasing the number of life-saving donations. The wishes of potential donors are often ignored by doctors who "don’t feel comfortable" following up on the matter. As well, distraught family members sometimes overrule the wishes of potential donors, even though the current law says that’s not supposed to happen. The Organ Donation and Transplant Association of Canada says one organ donor can save the lives of eight people and assist the lives of 50 more. NB Council Briefing 2010.04.22 OTDT standards address the roles of the various health care providers, and how to communicate with family members. Deceased Donor Standards and Transplant Standards were released in February 2010. Living Donor Standards will be released this September. 7 ON Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques Long Term Care Ontario is providing $30 million in one-time funding to help long term care facilities meet new patient care standards contained in the Long Term Care Homes Act which comes into force July 1. The Act includes enhanced inspection, compliance and enforcement provisions and more stringent provisions concerning staff who provide direct resident services. Among other things, the Act also institutes a policy of zero tolerance on resident abuse and neglect, and minimal use of restraints. Health Edition Qmentum includes standards for long term care. 2010.04.30 PEI Health System Restructuring Prince Edward Island’s 2010-11 budget provides new funding for its “One Island Health System” program — an initiative for improving the integration of health services as recommended by a major consulting report for the government in 2008. Focusing on health care renewal, the government is moving forward with creating five Primary Care Networks throughout the island. “This model will ensure that no Islander is more than a 30-kilometre radius from a family physician and a wide variety of primary health services and programs,” says Finance Minister Wesley Sheridan. The government is putting $500,000 into the development of these Networks this year. Home care was another issue identified in the consulting report - PEI was spending far less of its health budget on home care than other provinces. The government increased home care spending by $2.2 million last year A presentation on the Ministry of Health and Long Term Care’s new compliance program will be given to Accreditation Canada on May 13. Following this meeting, mapping of the two programs will be conducted. Update on the restructuring in PEI. As requested, feedback was provided to senior government officials regarding their governance model at the time of their previous survey. 8 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques and is increasing the amount again this year to a total of $13 million. Another recommendation of the report was to improve the governance model for health care. A new agency — Health PEI — came into existence April 1 to take over the running of health-care services. Health Edition 2010.04.30 Leo Steven, former CEO of Sunnybrook Health Sciences Centre, has been appointed chair of Health PEI; he will head an 11-member board. Health Edition 2010.04.23 QC New Standards The Montreal Gazette (Feb. 15) comments on the case of a 25-year-old woman who died two years ago in the recovery room of a private clinic after having cosmetic surgery. Her family has recently announced that it will sue the clinic after the coroner concluded it did not have proper treatment standards. The Gazette notes that the government will be implementing new accreditation standards on April 1 for private clinics to perform some 50 designated procedures. The start date had been put off, as the Gazette observes, “on the regrettable grounds that too few of the province's 60 private clinics were ready to put the rules into effect.” It says no further delay should be permitted. “Medical clinics, whether they're publicly funded or run privately, should all adhere to the same high standards of professionalism. Those standards must be spelled out – and enforced – by government.” Health Edition 2010.02.19 Quebec abortion clinics will be exempt from licensing standards being applied to private clinics as of March 31. These standards, some of which Accreditation Canada is developing Independent Medical or Surgical Facilities Standards. 9 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques are comparable to what exists in a public hospital operating room, have to be met in order for clinics to perform any of some 50 procedures. Last fall, abortion clinics said it was unrealistic and inappropriate for them to be subject to the same criteria. Some threatened to close, and they received the backing of the medical community in their stand. The government made it official this week that abortion clinics will be exempt from the new rules. Health Edition 2010.03.26 QC Nouvelles normes Le quotidien The Gazette (15 février) a commenté le décès d'une femme de 25 ans survenu il y a deux ans dans la salle de réveil d’une clinique privée après qu’elle ait subi une chirurgie esthétique. La famille de la défunte a récemment annoncé qu’elle engagera une poursuite contre la clinique, le coroner ayant conclu que cette dernière n’avait pas respecté les normes appropriées liées au traitement. The Gazette fait remarquer que le gouvernement instaurera de nouvelles normes d’agrément le 1er avril de manière à ce que les cliniques privées puissent effectuer quelque 50 interventions désignées. Comme le souligne The Gazette, la date d’entrée en vigueur a été reportée « en raison du fait déplorable qu’un trop petit nombre des 60 cliniques privées de la province est prêt à satisfaire aux normes ». Le quotidien soutient qu’aucun délai supplémentaire ne devrait être permis. « Les cliniques médicales, qu’elles soient subventionnées par l’État ou privées, devraient toutes adhérer aux mêmes normes élevées en matière de professionnalisme. Ces normes doivent être clairement énoncées et appliquées par le gouvernement. » Health Edition, 19 février 2010. Au Québec, les cliniques d’avortement seront exemptées des conditions Agrément Canada élabore actuellement des normes pour les établissements médicaux ou chirurgicaux indépendants. 10 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques requises pour la délivrance d’un permis imposées aux autres cliniques privées à compter du 31 mars. Les cliniques doivent respecter ces conditions, comparables à celles pour les salles de chirurgie en milieu hospitalier, afin de pouvoir pratiquer l’une de quelque 50 interventions. L’automne dernier, les cliniques d’avortement ont soutenu qu’il n’était pas réaliste ni approprié qu'elles soient assujetties aux mêmes critères que les cliniques privées. Certaines ont menacé de fermer et ont reçu l’appui de la communauté médicale. Le gouvernement a annoncé cette semaine que les cliniques d'avortement seront exemptées des nouvelles règles. Health Edition, 26 mars 2010 QC Communication The McGill University Health Centre (MUHC) has launched a free personal electronic health record (PEHR) service at www.unani.ca that allows people to aggregate, track and share health and lifestyle information. Anyone with an Internet access can subscribe to Unani.ca. Co-developed with Quebec-owned Medical.MD, Unani.ca is the first consumer-minded personal electronic health record (PEHR) in the Canadian marketplace. PEHR service is the outgrowth of a successful test conducted last July with the Montreal company Medical.MD, and is now poised to be part of the “health space” offering from Telus so subscribers can update their health records electronically including via their mobile phones. Information can also flow in the other direction, so a person’s cell phone may ring when it is time to take medication. Within a year or so the PEHR system should be connected with physicians, hospitals and clinics. The Canadian Press 2010.03.15 For information. MUHC is a client organization. 11 QC Topic Matière Issue Catégorie Communication Le Centre universitaire de santé McGill (CUSM) a lancé un service gratuit de dossier de santé électronique au www.unani.ca qui permet aux utilisateurs de se regrouper, de faire le suivi et d’échanger de l’information sur la santé et le style de vie. Quiconque disposant d’un accès Internet peut s’inscrire au Unani.ca. Mis au point conjointement avec Medical.MD, une entreprise québécoise, Unani.ca est le premier service de dossier médical personnel à l’intention des consommateurs sur le marché canadien. Mis à l’essai en juillet dernier en collaboration avec Medical.MD, ce service est maintenant prêt à être intégré à la plateforme TELUS espace santé. Les abonnés pourront donc mettre à jour leur dossier de santé électronique, notamment à l'aide de leur téléphone mobile. L’information peut aussi circuler dans l’autre sens : par exemple, une sonnerie de téléphone mobile pourrait aviser son propriétaire qu’il est temps de prendre son médicament. D’ici environ un an, la connexion au système de dossier de santé électronique devrait être établie pour les médecins, les hôpitaux et les cliniques. La Presse canadienne, 15 mars 2010. QC OTDT Quebec posted an average of more than 3.6 transplanted organs per deceased donor in 2009 despite a slight decrease in the number of donors, Québec-Transplant announced this week. The sharing of best clinical practices has been a determining factor in increasing the supply of organs available for transplantation in the last five years, and this has resulted in an almost 15 per cent increase in the number of organs transplanted. Health Edition 2010.02.12 Strategic Directions Orientations stratégiques À titre indicatif. Le CUSM est un organisme client. Québec-Transplant was participated in the focus group discussion of panCanadian stakeholders during the development of the Organ and Tissue Donation and Transplant Standards. 12 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques Deceased Donor Standards and Transplant Standards were released in February 2010. Living Donor Standards will be released this September. DOTT Québec-Transplant a annoncé cette semaine que la province a affiché une moyenne de plus de 3,6 organes transplantés par donneur décédé en 2009 et ce, malgré une légère diminution du nombre de donneurs. La communication des meilleures pratiques cliniques s’est avérée un facteur déterminant dans la réserve d’organes disponibles aux fins de transplantation au cours des cinq dernières années, ce qui a entraîné une augmentation de près de 15 pour cent du nombre d'organes transplantés. Health Edition, 12 février 2010. Québec-Transplant a pris part au groupe de discussion réunissant des intervenants de partout au Canada dans le cadre de l’élaboration des normes en matière de dons d’organes et de tissus, et de transplantation. Les normes en matière de dons d’organes et de tissus (donneurs décédés) et les normes en matière de transplantation d’organes et de tissus ont été publiées en février 2010. Quant aux normes en matière de dons 13 Topic Matière Issue Catégorie Strategic Directions Orientations stratégiques d’organes et de tissus (donneurs vivants), elles seront publiées en septembre prochain. Items have been compiled from Health Edition, Canada’s Health Newsweekly; The Canadian Press; Edmonton Journal; NB Council Briefing; CBC; and BC Ministry of Health Services. Les éléments proviennent du Health Edition, Canada’s Health Newsweekly, de la Presse canadienne, du Edmonton Journal, du NB Council Briefing, de la CBC et du ministère des Services de santé de la Colombie-Britannique.