Health Literacy
Not so long ago, I think ELB asked for a new topic.....was it on "prospective" payment for physicians a la New England Journal of Medicine article? Let me know ELB and we can fit that one in somewhere along our conversation route.
But it gets me to thinking, that we are in a new world of health literacy not only for physicians just to understand what prospective payment means but for the public and patients to understand their role in their own health care.
Granted, not everyone will be able to become literate in their own health care but I hazard an educated guess that the majority will. Trouble is, many physicians, politicians, health policy types and administrators tend to see patients as illiterate or pretty close. This is all very unfortunate since people are going to need to become more aware of how to manage their health care.
This starts with health literacy.
Empowering and educating patients in their own care will require an understanding of health terms and how to use the system including medical social networking sites and mhealth. Forget Michael Decter's book on how to navigate the Canadian health care system-that was obsolete before it was published. Just look at the ease with which anybody under the age of 75 manages a mobile phone, sends photos electronically and surfs the internet.
The majority of the public can do this and those who can't will need government support. Fine, but to think that government can spend billions and billions on failed eHealth strategies because of the government centralized one-size-fits-all-especially-the-consultants approach, well, we would be doomed to fall and fail endlessly.
Social networking sites are likely to take on a significant new role in health care but establishing reliable sites guided by the medical profession or another respected source will be the real catch.
How long will it take for the health care leadership in Ontario or Canada to figure this one out.
By the way, I hear that an auditor's report on the federal version of Ontario's eHealth, Canada Health Infoway, will be out in early November. It should be interesting.
I'll post some links in the comment section and don't forget to visit the twitter link if this sort of thing interests you.
Welcome to our newcomers and thanks for the fascinating contributions from all of you.
Merrilee Fullerton
88 Comments
Reader Comments (88)
Saskatchewan health system review released
A Patient First Review of Saskatchewan’s health system, released Thursday, has called for more convenient, comprehensive and coordinated care, but the costs of implementing its recommendations will likely depend on savings identified in a companion review of system administration.
The review was undertaken by Commissioner Tony Dagnone, a former hospital executive, at the behest of Health Minister Don McMorris. Since the launch of the review last November, Mr. Dagnone’s team has consulted with some 4,000 citizens as well as health care providers and health system leaders.
Guiding the review have been two principal questions: is the health system putting the patient first, and is it achieving best value in care delivery and administration. Commissioner Dagnone had the services of consulting firm KPMG to help answer the first question, and Deloitte Inc. for the second.
“The research findings make clear that those associated with health care must renew their commitment to putting the patient first,” Mr. Dagnone says in the introduction to his report. “Patients ask that health care workers and their respective leadership see beyond their declared interests so that the interest of patients takes precedence at every care interaction, every future contract negotiation and every policy debate.”
One of his recommendations is the creation of a Charter of Patient Rights and Responsibilities.
The KPMG research found that while 73 per cent of people in the province feel the health care system puts people first, only 19 per cent strongly agree this is the case. Furthermore, almost a third has experienced unacceptable behaviour from health care workers – a disturbing 45 per cent among First Nations and Métis people.
Access to care was a pervasive concern, and one of Mr. Dagnone’s recommendations is to establish an “aggressive” strategy to improve patients’ surgical experiences accompanied with “clear targets and regular updates.”
The Deloitte administrative review focused on business functions in general administration, finance, human resources, information technology, telehealth, nursing management and supply chain management (especially purchasing).
It found that while expenditures on general administration were lower relative to other Canadian jurisdictions, spending on board and executive costs was greater.
The Deloitte report says economies of scale are “challenged” by duplication of effort across 14 service provider organizations: 12 health regions, the Athabasca health authority in the far north, and the Saskatchewan Cancer Agency.
While it was outside of the scope of the administrative review to look at the regional health governance structure, the Deloitte report says this configuration undermines the effort to improve efficiency. “All of this points to a strong need to reconsider the current regional structure.”
One of its main cost-saving ideas is the formation of Provincial Shared Services Organization to handle functions that currently exist separately in each region. The report estimates savings in the range of 14 to 20 per cent over four to five years.
The main and ancillary reports can be found at www.health.gov.sk.ca/patient-first-review. HE
http://healthedition.com/
As reported in the Medical Post October 6.
I'll see if I can post either the link to the Medpost article or to the Ontario Medical Review from the summer where this was published.
http://www.medicalpost.com/opinions/columns/article.jsp?content=20091006_122718_5808
http://www.oma.org/pcomm/omr/jul/09accountability_paper.pdf
http://www.medicexchange.com/EMR/global-market-for-ehr-to-show-a-growth-rate-of-24-by-2012.html
Providing better education/more options is not what the plan is. Providing options provides choices and central doesn't want choices.
We need to data mine and force guidelines that restrict options, and allows to control the budget. EMRs/EHRs are controllers of costs - not enablers for options.
EHealth - nothing will chnage - same people advising, same advice, just slowed down a bit. EHR is despertaely needed by the hospital sector to allow more intense rationing - with its delay (?2018), the hospitals are screaming harder about shortfalls. Sadly even the AG report, which pointed out no plan, privacy issues, and the concern about the purpose of data mining, can't stop this process - too much money and too much political pressure behind the scenes.
As for patient literacy - this is last thing wanted - imagine informed patients requesting reasonable services - we couldn't ration!!
H1N1 - we keep pushing this federally - looks like none of the promises will be delivered on vaccine deadlines. All smiley faces in the public, but behind the scenes, the yelling has started.
LHINs - heads down barrelling to the wall - no money in sight. What a brilliant move - distance the MOHLTC from the public by having another funding level that has no funding but must handle the compliants.
Deficits - running at 22-24 billion by year end.
I would agree with Realist in that a decade from now having spent a few more billion we will be busy toiling away on some outdated eHealth project meanwhile new technology will permit the finally completed eHealth technology to be leap-frogged altogether.
The silver lining in all of this is the longer the eHealth project is delayed the more obvious it will appear that what they are trying to accomplish is the wrong approach technologically.
Kind of like trying to install antiquated expensive satellite technology for high speed internet service to rural Ontario meanwhile 3G wireless just came on stream.
http://www.cbc.ca/canada/toronto/story/2009/10/09/mcmaster-medical-records-oscar674.html?ref=rss
One hears figures of 14% to 24% to 40%.
No one is more elated by the delays in implementing E Health, the supposed panacea for the health care system---in particular where it impinges on my office---I dread the day that I have to communicate/write notes etc., on the computer, facing a screen and not the patient...but it would be an excellent way of slowing everybody down, in particular the older doctors---I've calculated that I would only manage some 10 patients per day---less if I had to do all the flow sheets that my pointy headed colleagues expect these days---from a flow sheet for diabetes to the number of bowel movements per day etc.,.
Thank god for the corrupt and venal incompetents running the IT system these days; I'm relieved that the main culpable characters remain at their posts---may they remain long in their posts in sheer befuddlement, so that I might reach retirement in relative peace and tranquility.
Sorry for being off topic but the government H1N1 vaccine advice has become so confusing it is farcical. I really think the fact that PHAC and the provinces can't seem to speak from the same page has lead most Canadians to just tune out, and now reflected in the polls showing only 30 percent will get vaccinated.
The office today was flooded with cases and by closing our volumes were double the normal for this time of year.
http://www.digitaljournal.com/article/280611
http://www.ottawacitizen.com/health/Failure+eHealth+option/2116442/story.html
If I hear someone else say "we can't afford not to do this" I am going to have to bite my tongue until it bleeds....
Sheesh...it costs 75 million or so a year just to keep the relatively empty tech highway running.....Expect that maintenance to grow as more docs go online....and when it comes to adverse reactions from medications, those will STILL happen because there is no genetic analysis to tell whether patients will react to a certain medication or not. There will still be a cost to the system because of adverse reactions albeit maybe not as much as there would have been without an electronic record but they will still occur. I argue that the cost of building and maintaining an eHealth infrastructure will be more than the cost savings.
In the UK the cost is estimated now to be about 60 billion.
Educate patients...I show them Epocrates on my iPhone...it's free and they can check their drugs and interactions themselves for goodness sake. I do it in front of them and those individuals who are on a slew of medications because of rare disease or common disease such as diabetes, hypercholesterolemia seem motivated to access the same. So not all patients will do this but many can.
Bluntly, sinec its inception in the MOHLTC the use of EHR has had no plan. It was started because of the federal dump of cash, and the desire of the vested interests to get at the cash. In the end, it got stolen by Ontario vested interests (lead by some of the advisors to the Feds), so they could get at the assured entitlements which would lead to lifetime access to funds. The funds are still flowing, just in deeper and better hidden rivers. All the "experts" now claiming it should move ahead still, have already advised the MOHLTC for years, and, again bluntly, if reviewed individually have all got documented conflict of interests.
As the AG report objectively stated:
1. No plan.
2. No purpose
3. No agreement
4. No privacy.
A responsible government would stop and:
1. Hold public discussions and goals and mission.
2. Regroup fundinmg flow with a clearcut reporting and accountability structure
3. Set and meet deadlines.
There are easier and cheaper ways to move ahead than what we are doing BUT, we have agendas that must be met and we will not change the course set.
The plan is good.
Meanwhile, H1N1 seems to be rising rapidly and we have no vaccine, and the budget is out of control. Such great leadership we've had for the last 20 years.
They've built an expensive 407 IT type highway with no on or off ramps---it gets better and better.
Who is Epocrates?
What does he look like?
On my cell phone I have pictures of my grand children that I show to patients [when they're interested?
Kidding aside, does any one have to memorise anything any more?
If their electronic paraphernalia cease functioning, do our younger colleagues simply go home?
http://www.google.com/hostednews/canadianpress/article/ALeqM5huZ61rwt1q3UHryG-vFdM2xpMulQ
1.6 billion plus 1 billion from eHealth
and I've said before....this kind if IT system will be billions and billions in the making...the UK's system was to cost less than 2 billion....and now it is somewhere around 60 billion in costs.....
and some would have us believe that this kind of thing will save us money...fat chance.
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That seems simply "keeping up with the neighbours".
Perhaps a goal, not a rationalization is required. The goal might be meaningful, achievable and preferably both cost saving and health improving. Self indulgent spending on political targets, like rocket fuel on the space race, is irrational.
... cut ...
"The best the premier's brain trust can offer, after presiding over an agency that broke the rules and wasted a billion tax dollars, is the promise of more rules. Pitiful.
All political careers end. The question isn't how many bruises you can avoid while in office. The question is whether you can be proud of the things you fought for.
The object is not to avoid being removed from office; it's avoiding being removed having accomplished nothing.
This is the fate that seems to await McGuinty. He has wasted time, tax dollars and the reputations of some good people, but he has failed to deliver a better health system.
Shifting salaries from government to hospital boards. Consultants hiring consultants. Liberal supporters receiving untendered contracts. The direct responsibility for the eHealth fiasco lands squarely on McGuinty's shoulders. This is the work of the premier's office, not the bureaucracy or any minister's office.
snip
All political careers end. The question isn't how many bruises you can avoid while in office. The question is whether you can be proud of the things you fought for.
The object is not to avoid being removed from office; it's avoiding being removed having accomplished nothing.
This is the fate that seems to await McGuinty. He has wasted time, tax dollars and the reputations of some good people, but he has failed to deliver a better health system.
It's not a record to be proud of."
http://www.thewhig.com/ArticleDisplay.aspx?e=2135813
You forgot the part about no helmet. Sounds like an ideal time to restructure....
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Quick question: if one where to run away from the mess in Ontario, what would be a good employment destination?
Outside Canada, Obamacare will open up lots of opportunity for individulas from Ontario. There are about 10 years behind in the public abuse of funding in health care so lots of options for abuse exist.
http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/4000/bul4499.pdf
More on empowering patients:
http://hcplive.com/rheumatology/acr_2009_ra/connected_technology
Perhaps the Ministry is looking to recoup the eHealth losses from practitioners. Did the NB docs settle their issues with the government when it reneged on its agreement? I think so...maybe Ontario is trying a different approach.....but not much different.
I'm guessing a lot of practices are not going to do this.
I'm guessing the Health Unit won't be able to manage all the immunizations very well either. And I saw my first two cases yesterday
We have been riding bareback (mask free) for 4 weeks now and not one of our staff has become ill, however we are obsessive with the hand sanitizer, Calvicide surface sanitization 3x a day, and all coughing patients get a mask and are put in a separate room. I was quite surprised last night to see sick coughing patients coming in with their own masks which means some fo the messaging has gotten through. People are coughing into their sleeves and many decide to wait in their cars rather than in a room full of virus. All the chronics were told to stay away until the vaccine is available.
We don't have time to be filling out any kind of spreadsheet paper or otherwise and the best I can offer is the diagnostic code 079 for all the flu cases seen.
Looks like the disease will peak in and around Halloween in Ontario as predicted earlier well before even the first dose of vaccine is administered in what has become a massive failure on the part of PHAC.
http://www.google.org/flutrends/ca/
http://www.theglobeandmail.com/news/opinions/editorials/upside-down-priorities/article1330235/
Suzanne Strasberg at a District meeting touched on the subject, it seems that even after a years lead time, the pointy headed had not geared their computers for the October increase, it seems that they are waiting from some kind of OK from the hierarchy and are using the departure of the previous health minister as an excuse for their delay.
We have learned never overestimate the intelligence and wisdom of the politico-bureacratic class---they introduced the Barer Stoddard Report policies to decimate our profession just before the ageing demographic tsunami struck---they had a vet restructure our hospitals so that there is no spare capacity left to cope with a health care tsunami---and just as we are girding our loins to face the H1N1 pandemic they are either about to reneg on our contract or are fumbling matters badly.
Nothing demoralises troops more before the battle than evidence of incompetence at HQ and word that their supplies and wages are being delayed or even cancelled.
The pointy headed can stuff their spread sheets and flow charts---when one is up to one's arse in alligators it's hard to remember that one's here to drain the swamp
It isn't quiet behind the scences, it is a mess.
1. The budget is broken (hint - think 23 billion off right now). In addition, the future is not perking up. There is now a permanent structural deficit in Ontario.
2. Health Central is demoralized. The public revelation of eHealth and al. merely confirmed to all in the MOHLTC that the wink wink nudge nudge we all saw, is rampant. Seniors who draw salaries "off line" to avoid caps, bonuses to some and not others, silo protection of budgets to maintain power - the list is not ignorable any more.
3. New Minister - always slow things down. In addition, advice still is coming from "compromised" advisors - both in Queen's Park and the hospitals and agencies.
4. LHINs have no capacity to act and hospitals are fighting back to maintain control as the deficit rises.
5. We have a "lame duck" government for 2 years - with all the scandal, there is no capacity to mover quickly or make good decsions.
Look for at least two years of this.
So very sorry to hear this, Hayseeds.
My sincerest sympathy goes out to your colleague and his family.
Thanks for the laugh. We have a morally bankrupt government that is in office for 2 more years. The only exit strategy is more Fiberal appointees.
Parliamentary paralysis during an economic collapse is the indirect benefit since at least now the governemt wil not be able to make it worse.
While I am a big proponent of vaccination the constantly changing recommendations with many actually conflicting (i.e Feds saying give adjuvant vaccine to pregnant women and Ontario saying no) has created an atmosphere in the office where we cannot offer any sound advice.
And it appears that at least in Ontario, based on an update received last night, that the government has reneged on offering unadjuvanted vaccine to children under 3 years old. Now the recommendation says adjuvant vaccine for all children and two doses three weeks apart are required for all kids under 9 years old.
After looking at the reporting requirements for administration of the pH1N1 vaccine and the measly fee in return for this service I suspect very few offices will get involved leaving the province and municipalities to vaccinate the population at designated clinics.
What a complete and utter mess.
"We won't be able to supply the infantry much in the front trenches, we're cutting back on the ammo and food and wages for budgetary reasons...and if you kick the bucket from incoming fire, tough faeces, off to the poor house with your loved ones"---yep, morale will be greatly boosted by the actions and inactions of those brilliant pointy headed at HQ.
We're going to give this H1N1 vaccination business a try, but if the paper work becomes too onerous we'll simply hand them of the the Public Health facilities.
Alas, I am afraid I cannot agree with Canary - this is WELL BEYOND a complete and utter mess. We have seen this coming in slow motion for quite some time and yet we cannot seem - even with all of our collective wisdom, intelligence and technology - to be able to plan a Sunday-after-church-luncheon-social.
For anyone to even think about unilaterally delaying a negotiated fee increase to a group that is absolutely instrumental with delivering the solution.
Bewildering.
Please pardon my language, but holy shit, it is a sad day indeed when the United Church Women can outperform the entire Government of Ontario and in particular, the Ministry of Health and Long Term Care!
The fish stinks from the head: we need wholesale change at all levels starting at the top. The current structure has long-outlived its shelf life. We need someone with the courage and fortitude to carry the hammer AND use it with alacrity when faced with pea-brained resistance regardless of its source.
I am just concerned that we won't find someone to do this among us. BC and Alberta have tried with Australians. Heck, Ontario even took down our highly-respected but retrodorsally despised South African.
My biggest fear is that someone will come up with the bright idea to hire a consultant to cure everything.
It must be killing many of us - as it is me - that we have no opportunity, role or little say in any of this.
Most of the questions surrounded the vaccine program which admittedly keep evolving as more information and understanding of the vaccine emerges.
It is confusing with info from PHAC, MOHLTC and local public health groups not to mention media from the US and elsewhere.
Ultimately, locally is where the care will be provided so locally is where the final decisions need to be made and physicians' judgment calls will be needed.
Messages were...25 million people in Europe have received the same adjuvant that is in our H1N1 vaccine
-safety of the vaccine seems fairly certain
-pregnant women should get vaccinated...adjuvant or non-adjuvant
-prioritizing patients will be important since vaccine supply is going to be small at first..the term "trickle" was used
-only about a third of the physicians in attendance were interested in providing the vaccine through their offices
-the pre-qualification requirements to provide the vaccine in a physician's office are loosening...perhaps because of the testing results of the vaccine or perhaps the realization by MOHLTC that it needs primary care providers to be a source of vaccine delivery
-predominant strain in Ottawa area of influenza is H1N1 but there are other common respiratory viruses present accounting for significant numbers of usual cold symptoms...
-seasonal flu does not seem to be here in great amounts at all
-some concern about wasting some of the vaccine if used in primary care provider offices because of volume of patients or timing of vaccination (must be used within 24 hours of reconstitution and large batches of 500 doses will have to be overcome)
-many doctors offices aren't equipped to report to the ministry at noon on Mondays with all the details they are asking for...would have needed emr to provide this...so some doctors in other areas are receiving paper records that will be used.
-overall it appears better to get the vaccine than not and now that the safety of the vaccine has been tested it looks like the stringent measures around vaccine reporting and documentation is loosening up
I agree. What can I say...at a time when our health providers are working with increased intensity and risk, there is government delay in funding its agreement with physicians.
Not much will change until Bill 8 is canned in Ontario and Ontario's Chaouilli case wins....then things will change. That would definitely be a catalyst.
Let me add my condolences and best wishes to those previously expressed by others.
I hope you and all other health care professionals tasked with assisting flu victims (and their loved ones)take all the precaution needed to stay safe.
It is indeed disrespectful of MOHLTC officials to, for any reason, fail to keep a financial committment made to physicians regardless of current demands. Given the rest of the chaos and scandal picture however, no surprise.
Had a T-Con today at noon with all six practices in this FHO trying to figure out the logistics of dealing with all this crapola from Public Health. Our PH contacts are also tearing their hair out; who is going to do what and how and with what changes daily. Hard for them to give solid advice.
All clinics agreed to be "delivery agents". Difficult to anticipate the uptake. Clinics will be done in the usual way, that is, dedicated clinics on specified days. Any FHO patient can go to any FHO clinic. Service delivery itself is not so much a problem as the sh*tload of paperwork PH wants. Lucky, though, the second shot has been done away with except for the little tykes.
By the way, PH wants us to start "shooting" on Monday. No way, Jose. It will be the first week of November before we can build the critical mass for the clinics to make all this worthwhile. Maybe the adjuvant will be available by that time...
or not...
Do I sound cynical? Gotta work on that attitude adjustment.
btw, Ottawa Public Health to launch flu clinics next week.
and you are right about that.....but I think it is mostly the Ministry that wants this...not so much the public health departments...it is a trickle down effect.
The right to good government is limited when a vote of confidence is disallowed.
iron law of oligarchy
It states that all forms of organization, regardless of how democratic or autocratic they may be at the start, will eventually and inevitably develop into oligarchies. The reasons for this are the technical indispensability of leadership, the tendency of the leaders to organize themselves and to consolidate their interests; the gratitude of the led towards the leaders, and the general immobility and passivity of the masses.
Wikipedia 2009