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 | Vol. 13 No. 3, February 10, 2016 |
Canadian Physicians Can Improve Patient Care with Advanced EMR Use
Electronic medical records (EMRs) among Canadian primary care physicians continues to grow, but the use of advanced functions that support improved patient care varies, according to the Commonwealth Fund’s 2015 International Health Policy Survey of Primary Care Physicians.
Initial survey results released in December 2015 revealed that EMR use among Canadian primary care physicians tripled in the past nine years (73% vs. 23%). New analysis released in late January includes provincial EMR adoption rates, benefits being realized and advanced use patterns. Most provinces saw growth in EMR use since the previous survey in 2012. Alberta, British Columbia and Ontario continue to have the highest adoption rates in Canada. Quebec, Manitoba and Saskatchewan experienced the highest increases in EMR uptake by primary care physicians since 2012. Physicians with EMRs report the ability to better manage their patients’ care compared to physicians operating without an EMR:
  • 79% of physicians with EMRs report that they are able to generate a computerized list of patients by diagnosis compared to 20% without an EMR;
  • 70% can generate a list of all medications taken by an individual patient compared to 17% without an EMR;
  • 62% are able to produce a list of patients overdue for tests or preventative care compared to those without an EMR at 11%.
Canadian primary care physicians using EMRs are more likely to use some functionalities that support patient care and less likely to use others, when compared to the 10 country average from the Commonwealth Fund survey. Additionally, the survey also highlighted two areas of digital health that present significant opportunities to provide further value to Canadians:
  • Information exchange: 19% of primary care physicians say they can electronically exchange patient clincial summaries with doctors outside of their practice
  • Consumer services: 15% of primary care physicians say they offer patients the option to email them about medical questions or concerns and 11% offer patients the means to request an appointment or referral online.

EHR System Will Cost Hundreds of Millions, but Is Vital, Government Official Says
An electronic health record (EHR) that connects emergency room physicians with family doctors and Netcare’s lab results will cost hundreds of millions of dollars, but is “critical” to the health of Albertans, the deputy health minister says. Carl Amrhein said Wednesday his department is working with Alberta Health Services on a proposal to roll out a single health information system starting in 2017 in the areas of Edmonton, Calgary and Red Deer. The system will link Alberta’s 97 hospitals with primary care networks of family physicians, as well as the province’s Netcare system so medical specialistists or emergency rooms can find out what medications a person is taking or what diagnostic tests they’ve had.
As of 2014, even though the Alberta government had spent more than $300 million on EHRs — more than $800 million if Netcare is included —  doctors across the province used at least 12 medical record systems that couldn’t communicate with each other. Staff in hospitals had no access. Another 20% of doctors didn’t have EHRs, the auditor general discovered.
Various other  professions, such as pharmacists, optometrists, chiropractors and dentists are working with the health ministry and health authority to see if they can also use such a system while still protecting the privacy and confidentiality of patients.


Microfluidic Chip Mimics Smallest Capillaries to Study How Drugs Affect the Mechanics of Cells
It has been known for a while that some drugs seem to have physical rather than chemical modes of action or associated side effects. Glucocorticoid drugs that are used for asthma or rheumatoid arthritis, for example, increase the white blood cell count but biological explanations for how that happens have been unconvincing. Researchers from Georgia Tech and Emory University have decided to investigate whether physical processes may be at play, and so they built a microfluidic model blood vessel system that can replicate the forces experienced by white blood cells in the smallest of capillaries within our bodies.
The device is a polymer chip that passes real human blood through a very narrow passage, allowing both the drugs tested and natural physical forces to impact the life of white blood cells swimming through. The investigators used an atomic force microscope to analyze the stiffness of the white blood cells before and after they go through the device. What they discovered is that the drugs cause the white blood cells to soften, changing how they flow through vessels. In particular, the softening caused the cells to move away from the vessel walls and flow down the center, effectively increasing their count.
Smartphones and Intelligent Socks to Help Prevent Diabetic Amputations
Diabetic neuropathy strikes a large percentage of the population living with diabetes. The main symptoms being loss of feeling and the development of ulcers on the feet, it’s often diagnosed and treated much later than the ideal. To help prevent the development of ulcers, a student team at the Hebrew University of Jerusalem’s BioDesign course have created sensor-laden socks that can detect unusual forces applied to the feet, thus detecting a loss of feeling and helping the patient adjust the posture, try different shoes, or take other actions.
The socks have dozens of pressure sensors built in throughout the fabric. The data from these is gathered to create a pressure map of the feet, with the red regions showing high levels of force being applied to the feet. Because the socks have Bluetooth wireless capability, the data can be displayed on a paired smartphone where warnings to adjust one’s feet also appear.

Canada: BC Invests Talent and Funds into International Data Sharing Effort
DNA sequencing is revolutionizing healthcare and with the advancement of technology it has become more affordable to accumulate vast amounts of genomic data. These large and complex datasets – often called “Big Data” – provide an essential platform that inform the provision of healthcare and help patients in Canada and around the world. This can happen only if data is accessible and widely shared in a manner that fully protects patient privacy. To address barriers that exist in sharing this data both in Canada and internationally, Genome British Columbia (Genome BC) and TELUS Health are supporting a pan-Canadian program called Can-SHARE. This program will create the policies and tools for Canadian clinicians and researchers to share genomic and clinical datasets across Canada and with international partners in a more effective manner without compromising confidentiality.
In the Can-SHARE Project, University of British Columbia researcher, Dr. Jan Friedman is leading an effort to develop standards to enhance newborn screening by using genomic approaches while maintaining the widespread public support for this important public health program. Newborn screening tests babies for conditions that can cause serious life-long disabilities or chronic disease if not treated shortly after birth. Can-SHARE co-applicant, Dr. Anne Junker based at BC Children’s Hospital, leads the Maternal Infant Child & Youth Research Network of Canada (MICYRN) which is hosted at the Child & Family Research Institute. MICYRN links 20 maternal-child research institutes across the country and will provide practical tests of a number of innovative policies and procedures developed by Can-SHARE.
UK: Hunt announces £4.2 billion for NHS IT
The government will invest £4.2 billion in NHS technology over the next five years, health secretary Jeremy Hunt has said. The money will be invested in advancing Hunt’s ‘paperless’ ambitions, first outlined in a speech to the Policy Exchange think-tank almost exactly three years ago. Money will also be invested in newer pledges to encourage patients to use online services and apps, as outlined in the digital inclusion report commissioned from IT entrepreneur Martha Lane-Fox, and in cyber security.
The NHS is now supposed to be paperless at the point of care by 2018, and to be using fully digital, interoperable health and social care records by 2020. The Treasury Spending Review, which committed the government to finding £8 billion towards the Forward View, some of it frontloaded, indicated that £1 billion would be spent on technology over the five years of this Parliament.
Quebec's New e-Health Records May Spur Change
Quebec's adoption of a single system of electronic health records (EHR) across its 34 hospitals is prompting calls for a reassessment of Ottawa's eHealth strategy. The Government of Quebec wants to rationalize the many competing electronic health record systems purchased by hospitals, which are often partly funded by Canada Health Infoway, the federal agency that has invested $2.1 billion since 2001 in often-incompatible systems. Rationalizing will help overcome longstanding problems with the lack of "interoperability" between competing and intentionally incompatible commercial EHR systems.
To help break the information logjam, Quebec Health Minister Dr. Gaétan Barrette announced on Dec. 17 that all hospitals will now be required to implement Cristal-Net, a homegrown system developed on a not-for-profit basis by clinician–scientists in Québec City and Grenoble, France. Cristal-Net, which has been tested in the five Québec City hospitals, will reduce costs while improving the movement of records between hospitals throughout the province, says Jean Boulanger, who leads the system's development as director of information technology at the Centre hospitalier universitaire de Québec– Université Laval in Québec City.

HL7 Canada Election: Call for Nominations for next Affiliate Chair
Canada Health Infoway is delighted to host the election for the HL7 Canada Affiliate Chair position, representing the HL7 Canada Constituency internationally for the term of the agreement (2016-2017). We invite you to nominate the next HL7 Canada Affiliate Chair. If you know of someone interested in: representing HL7 Canada at HL7 International, leading the HL7 Community engagement and continuing to shape HL7 standards work in Canada.
The nomination period takes place January 25 to February 12, 2016 via HL7 Community. For full details on the HL7 Canada Election, including nomination process and schedule visit InfoCentral News.
Smartphones May Decrease Sedentary Time, Increase Activity
Evidence has linked sedentary time to increased risk of breast, colorectal, ovarian, endometrial, and prostate cancers as well as weight gain, higher BMI, and obesity. Nevertheless, adults in the U.S. spend an average of about 8 waking hours per day being sedentary. Few interventions have specifically focused on decreasing and interrupting sedentary time and even less is known about the role of mobile phone technology.
A pilot study finds that using smartphone reminders to prompt people to get moving may help reduce sedentary behaviour. The study appears in the Journal of Medical Internet Research. Researchers Darla E. Kendzor, PhD of the University of Oklahoma Health Sciences Center and Kerem Shuval, PhD of the American Cancer Society explored whether smartphone interventions have the potential to influence sedentary behaviour.
Participants wore accelerometers, to measure movement, and carried smartphones for seven consecutive days. Participants who reported more than two hours of sitting during the previous day or replied that they were sitting during any random smartphone assessment received a message emphasizing that long uninterrupted sitting is bad for health, and encouraging them to stand up and move around more, and to sit less.
Over the seven-day study period, participants had significantly fewer minutes of daily sedentary time and more daily minutes of active time than controls. Accelerometers recorded three percent less sedentary time than control participants, equaling about 25 minutes of time spent engaged in activity rather than in sedentary behavior on any given day.


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