Telehealth in Light of Cloud Computing: Clinical, Technological, Regulatory and Policy Issues

In the health sector, information and communications technologies (ICT) are transforming the modes of practice and service delivery. Telehealth, which is the use of ICT to provide care and health services, is an example of this new model of services. However, telehealth is accompanied by many questions regarding the terms of exchange, archiving, control and security of medical and administrative patient data. These may be very useful but also harmful to patients, healthcare professionals, organizations and even countries. Indeed, with the globalization of information, national data protection policies are being overtaken by this new reality where the "regulatory sovereignty" of a country is challenged. The increasing use of Cloud Computing, as a form of exchange, management and storage of data in the practice of telehealth, is an illustrative example of such challenges

A learning organization in the service of knowledge management among nurses: A case study

AbstractIt becomes critical for health care organizations to develop strategies that aim to design new work practices and to manage knowledge. The introduction of learning organizations is seen as a promising choice for better knowledge management and continuing professional development in health care. This study analyzes the effects of a learning organization on nurses’ continuing professional development, knowledge management, and retention in a health and social services centre in Quebec, Canada. The learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital centre. These changes were particularly pronounced with respect to knowledge transfer, support for nursing practices, and quality of health care, objectives that the learning organization had sought to meet since its inception. However, it seemed to have a limited effect on nurse retention

Some Multidimensional Unintended Consequences of Telehealth Utilization: A Multi-Project Evaluation Synthesis

Background: Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study aims to explore, describe and analyze multidimensional UCs that have been associated with the use of telehealth.Methods: We performed a secondary analysis of the evaluations of 10 telehealth projects conducted over a 22-year period in the province of Quebec (Canada). All material was subjected to a qualitative thematic-pragmatic content analysis with triangulation of methodologies and data sources. We used the conceptual model of the UCs of health information technologies proposed by Bloomrosen et al to structure our analysis.Results: Four major findings emerged from our analysis. First, telehealth utilization requires many adjustments, changes and negotiations often underestimated in the planning and initial phases of the projects. Second, telehealth may result in the emergence of new services corridors that disturb existing ones and involve several adjustments for organizations, such as additional investments and resources, but also the risk of fragmentation of services and the need to balance between standardization of practices and local innovation. Third, telehealth may accentuate power relations between stakeholders. Fourth, it may lead to significant changes in the responsibilities of each actor in the supply chain of services. Finally, current legislative and regulatory frameworks appear ill-adapted to many of the new realities brought by telehealth.Conclusion: This study provides a first attempt for an overview of the UCs associated with the use of telehealth. Future research-evaluation studies should be more sensitive to the multidimensional and interdependent factors that influence telehealth implementation and utilization as well as its impacts, intended or unintended, at all levels. Thus, a consideration of potential UCs should inform telehealth projects, from their planning until their scaling-up

Une enquête : le statut de l'écrivain et la diffusion de la littérature

Pour le sociologue, la littérature, comme les autres formes de l'activité mentale, est à la fois effet et cause des transformations multiples qui caractérisent notre société moderne. La sociologie de la connaissance a depuis longtemps établi une corrélation entre les productions mentales d'une part et le substratum économique, l'organisation sociale et la culture d'autre part. La littérature, comme l'art en général, offre cependant un intérêt particulier pour le sociologue.D'un côté, la société rend possible la création de certaines formes et le développement de certains thèmes. Ainsi, Roland Barthes dans Le degré zéro de L'écriture établit une relation entre le genre d'écriture (formes littéraires) et les sociétés de type bourgeois et de type socialiste. Mais l'écrivain, comme le peintre ou le musicien, n'est pas seulement conditionné globalement par sa société, il est aussi un individu qui vit dans un milieu précis. Sa plus grande sensibilité lui fait percevoir de façon plus aiguë qu'à ses concitoyens les tensions de sa société. Son œuvre est ainsi, de quelque manière, le reflet, le miroir de la vie profonde de son milieu comme aussi de sa société et de son époque. N'étant pas nécessairement philosophe, l'écrivain ne sera pas non plus réflexif dans sa saisie du social. C'est plutôt par transposition au niveau de la sensibilité qu'il transmettra son message. Ce message deviendra pour le sociologue un témoignage, témoignage souvent d'autant plus valable qu'il sera non pas réflexif mais simplement vécu. La journée de demain sera consacrée à l'étude de ces témoignages au niveau des thèmes de notre littérature. Nous avons cependant cru qu'il serait utile de situer ces réflexions dans un cadre plus large. Plutôt que d'apporter des réponses définitives à ce sujet, nous voulons simplement soulever quelques questions qui seront — nous l'espérons — pertinentes et plusieurs personnes — écrivains, éditeurs, libraires, hauts fonctionnaires du ministère des Affaires culturelles du Québec — ont obligeamment accepté de collaborer à cette enquête. Les auteurs tiennent à leur exprimer ici leur gratitude. Ils désirent remercier aussi de leur concours MM. Fernand Grenier, Louis Trotier et Jean Raveneau, professeurs à l'Institut de géographie de l'Université Laval, Mlle Nicole Gagnon et M. Paul Bélanger, assistants de recherche au Département de sociologie et d'anthropologie, et M. Lawrence Ramsay, étudiant en sociologie qui surtout seront susceptibles d'orienter des recherches futures. Les principaux thèmes que nous aborderons seront les suivants : I. la situation de la littérature proprement dite par rapport à la production générale du livre ; II. les problèmes de diffusion (bibliothèques et librairies) ; III. La perception de la littérature et de la société chez les écrivains et les éditeurs

Implementation of a new clinical and organisational practice to improve access to primary care services : a protocol for an effectiveness-implementation hybrid study

Introduction In Canada, as in most Organisation for Economic Co-operation and Development countries, healthcare systems face significant challenges in ensuring better access to primary care. A regional healthcare organisation in Quebec (Canada) serving a population of approximately 755 459 citizens has implemented a standardised access approach to primary care services for this population. The objective of this new clinical and organisational practice is to ensure that users benefit from the same referral process, regardless of the entry point, in order to be directed to the right services. This new practice integrates a shared decision-making process between the user and the professional, and a collaborative process between different health professionals within and between services. The objective of our research is to identify and characterise the conditions of implementation of this practice. Methods This effectiveness-implementation hybrid investigation will use an embedded single-case study, defined in this case as the process of implementing a clinical and organisational practice within a healthcare organisation. Further to an evaluation conducted during a preliminary phase of the project, this study consists of evaluating the implementation of this new practice in four medical clinics (family medicine groups). A qualitative analysis of the data and a quantitative preimplementation and postimplementation analysis based on performance indicators will be conducted. This study is ultimately situated within a participatory organisational approach that involves various stakeholders and users at each step of the implementation and evaluation process

Implementation of an electronic medical record in family practice: a case study

Background Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge. Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Qu_bec, Canada. Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Qu_bec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants. Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace. Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy

Toxicity report of once weekly radiation therapy for low-risk prostate adenocarcinoma: preliminary results of a phase I/II trial

<p>Abstract</p> <p>Background</p> <p>Increasing clinical data supports a low α/β ratio for prostate adenocarcinoma, potentially lower than that of surrounding normal tissues. A hypofractionated, weekly radiation therapy (RT) schedule should result in improved tumour control, reduced acute toxicity, and similar or decreased late effects. We report the toxicity profile of such treatment.</p> <p>Materials and Methods</p> <p>We conducted a multi-institution phase I/II trial of three-dimensional conformal radiation therapy (3D-CRT) for favourable-risk prostate cancer (T1a-T2a, Gleason ≤ 6 and PSA < 10 ng/ml). RT consisted of 45 Gy in nine 5 Gy fractions, once weekly. Primary end-points were feasibility and late gastrointestinal (GI) toxicity (RTOG scale), while secondary end-points included acute GI toxicity, acute and late genitourinary (GU) toxicity, biochemical control, and survival.</p> <p>Results</p> <p>Between 2006 and 2008, 80 patients were treated. No treatment interruptions occurred. The median follow-up is 33 months (range: 20-51). Maximal grade 1, 2, and 3 acute (< 3 months) GU toxicity was 29%, 31% and 5% respectively (no grade 4). Acute GI grade 1 toxicity was reported in 30% while grade 2 occurred in 14% (no grade 3 or 4). Crude late grade ≥ 3 toxicity rates at 31 months were 2% for both GU and GI toxicity. Cumulative late grade ≥ 3 GI toxicity at 3 years was 11%. Two patients had PSA failure according to the Phoenix definition. The three-year actuarial biochemical control rate is 97%.</p> <p>Conclusions</p> <p>Weekly RT with 45 Gy in 9 fractions is feasible and results in comparable toxicity. Long term tumour control and survival remain to be assessed.</p

The acceptance of the clinical photographic posture assessment tool (CPPAT)

Abstract Background There is a lack of evidence-based quantitative clinical methods to adequately assess posture. Our team developed a clinical photographic posture assessment tool (CPPAT) and implemented this tool in clinical practice to standardize posture assessment. The objectives were to determine the level of acceptance of the CPPAT and to document predictors as well as facilitators of and barriers to the acceptance of this tool by clinicians doing posture re-education. Methods This is a prospective study focussing on technology acceptance. Thirty-two clinician participants (physical therapists and sport therapists) received a 3–5 h training workshop explaining how to use the CPPAT. Over a three-month trial, they recorded time-on-task for a complete posture evaluation (photo - and photo-processing). Subsequently, participants rated their acceptance of the tool and commented on facilitators and barriers of the clinical method. Results Twenty-three clinician participants completed the trial. They took 22 (mean) ± 10 min (SD) for photo acquisition and 36 min ± 19 min for photo-processing. Acceptance of the CPPAT was high. Perceived ease of use was an indirect predictor of intention to use, mediated by perceived usefulness. Analysis time was an indirect predictor, mediated by perceived usefulness, and a marginally significant direct predictor. Principal facilitators were objective measurements, visualization, utility, and ease of use. Barriers were time to do a complete analysis of posture, quality of human-computer interaction, non-automation of posture index calculation and photo transfer, and lack of versatility. Conclusion The CPPAT is perceived as useful and easy to use by clinicians and may facilitate the quantitative analysis of posture. Adapting the user-interface and functionality to quantify posture may facilitate a wider adoption of the tool

The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network

Abstract Background: The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Methods: Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. Results: The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). Conclusion: The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations

How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada)

The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics