Hospital staff shortages: Immigration backlog leaves professionals on sidelines

2022/08/06 Leave a comment

Of note, appears that the bottleneck more immigration-related than credential recognition delays:

As hospitals across the country struggle under the weight of major staffing shortages, an immigration backlog described by lawyers as the worst they have ever seen is leaving qualified health professionals sitting on the sidelines.

In Februrary 2021, Sharlene Ullani applied for a permanent resident card after years spent working in Canada as a caregiver for children. Eighteen months later, the internationally trained nurse with more than seven years experience hasn’t heard anything from Immigration Canada about her application status.

Online, the government estimates the processing time for new permanent residence cards is 2.6 months, or 81 days, as of Aug. 2.

“I’ve been sending emails two times a month and the answer is always the same: ‘You have to wait, thank you for your patience. We have this pandemic’,” she told CTV National News.

Ullani currently holds a temporary work permit, but it does not allow her to switch jobs — even from a caregiver for children to a caregiver for adults — without losing status. In the months since she filled an application for permanent residency, Ullani has written exams and completed the paperwork necessary to get her foreign credentials translated into a valid licence to work in Ontario as a registered practical nurse.

“It is heartbreaking to see nurses working so hard and we are here, willing to help,” she said. “We are willing to help, but we cannot do so because of our status.”

The Registered Nurses’ Association of Ontario said there are roughly 26,000 nurses “ready and waiting” to work in Ontario, 14,000 of those are registered nurses. CEO Doris Grinspun says the great majority of those people are waiting for their international qualifications to get approved by the college, but thousands have already passed their exams and are waiting for their immigration status to change so they can work.

“The big impact of the backlog for patients is that they are either being short changed in the quality of care or they are not getting care all together,” she said. “If you look at home care, they are likely not getting care all together. If you look at ICU or ER that are closing down or shrinking, even in an emergency, it is desperation.”

Recently, Grinspun worked with the federal government to approve the immigration applications of 26 nurses. Given the health care staffing crisis across the country, Grinspun said the government should prioritize applications filed on behalf of applicants with backgrounds in health care, especially nurses.

“Having internationally trained nurses, RPN … able to join the workforce when they are ready to work in Ontario, and especially those who have already passed their exams and are just waiting on work permits by the feds, move them on. Move them on because nurses and patients need them desperately,” she said.

Speaking at a press conference in Ottawa on Thursday, NDP leader Jagmeet SIngh echoed Grinspun’s calls, saying he has called on Ottawa to implement a fast track immigration system for qualified health-care workers. Singh said he does not know why Ottawa has not yet followed through.

“There is no excuse for this,” Singh said. “I can’t understand why the government is not willing to do this… We need to respond in an urgent way because these are folks who can work here and want to work here.”

In June, the immigration department said more than 2.4 million applications were in the backlog, up from 2.1 million in June. CTV News reached out to the department multiple times for updated figures, but did not hear back at the time of publishing. The department said it usually takes five business days to process and gather statistical data.

Toronto Immigration lawyer Chantal Desloges attributes the backlog to a “perfect storm” of factors related to the early days of the COVID-19 pandemic, when many embassies and consulates closed and immigration staff started working from home.

“When everyone else was doing business online, it wasn’t that easy for the government to pivot,” she said. Desloges added that when offices were closed, applications were still being submitted, but nobody was there to process them.

“All of these things happening at the same time just made a toxic soup of circumstances.”

To speed up the process, Desloges said immigration staff who can’t do 100 per cent of their job from home should be ordered back into the office. She also suggests the government could expedite the approval process by reducing the number and frequency of applicant interviews.

“It is really hard to predict how long it is going to take to sort this mess out, if ever,” she said.

On Tuesday, Immigration, Refugees and Citizenship Canada (IRCC) introduced new measures to speed up the processing of applications for foreign nationals with expired or expiring post-graduation work permits, and for temporary resident to permanent residence pathway applicants. Under the change, individuals in either of those cases will have their current work permits extended while their applications are being processed.

Director of Policy at CanadaVisa.com Kareem El-Assal applauded the change, but said it should have been implemented back in 2020.

“This is a solution that should have been adopted since the start of the pandemic and would have saved applicants a lot of heartache and would have actually saved the canadian government a lot of time as well,” he said.

As delays drag on, applicants like post doctoral researcher Julie Ottoy are left in llimbo, unable to leave the country or attend international conferences for work.

“It is very frustrating,” she said. “It’s been close to five months now not hearing from IRCC and interestingly, last year I submitted this application around the same time and the exact same renewal was approved in two weeks.”

Source: Hospital staff shortages: Immigration backlog leaves professionals on sidelines

Filed under Immigration Tagged with , , , , , ,

Health care researchers need to ask, ‘Who is Black?’ University of Ottawa professor says

2022/07/25 Leave a comment

Why not just use Statistics Canada definitions, both visible minority and ethnic ancestry? Are the various terminologies used really that different or significant?

The real challenge lies more with respect to integrating this data with health card information, to allow this king of analysis and treatment, which of course will likely raise privacy issues.

For immigrants, I understand there is work underway to integrate immigration and health data but anonymized to allow for this kind of analysis in relation to health outcomes, information that could then hopefully be available through CIHI:

The inability to find a common term to describe Black people in Canadian health research can perpetuate inequities, a University of Ottawa professor says.

We need precise, accurate language because research informs public health policies, training for health-care workers and culturally appropriate and antiracist health-care practices, says Dr. Jude Mary Cénat, an associate professor of psychology and the director of University of Ottawa’s Interdisciplinary Centre for Black Health, Canada’s first academic research centre dedicated to studying the biological, social and cultural determinants of health for Black communities.

In Canadian health-care research, the definition of “who is Black” can vary widely. Terms such as “African-Canadian,” “Caribbean” and “African” are inconsistent and make it difficult to compare studies, he says.

The terms may include people who do not identify as Black, such as those who are from North Africa, and people from Caribbean nations including Cuba, the Dominican Republic and Puerto Rico, who consider themselves to be Latin American.

From a health research point of view, that can be a problem, Cénat says. One example: A 2019 review of breast and cervical cancer among “Black Canadian” women included 23 studies, but only seven had unambiguously Black participants. Some studies considered “Africa” as a single block and included participants from North Africa, who may self-identify as Arab.

“Most people from Africa are Black. But you can’t assume they are Black,” Cénat says. “You can’t say Elon Musk (who was born in South Africa) is Black.”

Meanwhile, studies rarely differentiate between Black people whose ancestors have lived in Canada for centuries and those who are recent immigrants, he says. The 2016 census found that the 10th most commonly listed country of origin for people in Canada self-identifying as Black was the United States.

Getting a more precise answer may be as simple as asking people “What is your skin colour?” says Cénat, whose commentary was published this week in the Canadian Medical Association Journal.

Researchers have to ask multiple questions, but the first one is how the subject identifies themselves, he says.

Cénat suggests asking research subjects the basic question: What is your skin colour? From there, it can lead to unraveling other questions about origins and ancestry. It’s also important to give research participants the opportunity to give more than one answer so that multiracial people can self-identify.

Asking questions related to race, ethnicity and region of origin may make some people uncomfortable. “We avoid that question. We ask people about their origin, not their skin colour,” Cénat says.

But health researchers can preface their questions by explaining why the questions are being asked and saying that the answers may help to improve health care for Black people in Canada.

“Researchers don’t have to be afraid of it,” he says.

If Black health research continues to be based on data that are unclear or inaccurate, there’s a risk that policies and programs will not meet the real needs of Black communities, Cénat warns.

Asking the right questions can also tease out more nuanced answers. For example, while the prevalence of diabetes is higher in Black communities than in the general population, some Black communities in Canada may be at more or less risk than others.

Cénat points out that, in Ottawa, racial minorities represent more than 30 per cent of the population.

“We need this because our population is a diverse population. We need to know more about the risk factors and the protective factors,” says Cénat, who studies the role that cultural factors play in vulnerability, trauma and resilience.

“We need to work with racial data that is precise. We need to say 10, 20, 30 years in the future that we have done something for these communities.”

Source: Health care researchers need to ask, ‘Who is Black?’ University of Ottawa professor says

Filed under Multiculturalism Tagged with , , ,

Lost in translation: Patients more likely to die, have serious outcomes when their physicians don’t speak their preferred language

2022/07/12 Leave a comment

Serious study and implications. During my experience as a cancer patient, I often reflected on how hard it must be for patients with weaker language skills, education and income:

Patients treated by physicians who speak their own language are healthier and less likely to die while in hospital, according to a new study led by Ottawa researchers.

The study, published in the Canadian Medical Association Journal, showed significant differences in outcomes among frail, older patients who were treated by a physician in their own language, compared to those who were not.

Francophones treated by a French-speaking physician had a 24 per cent lower chance of death than those who received care from a non-French-speaking doctor, according to the study. They also had shorter hospital stays and had a 36 per cent lower chance of adverse events, such as falls, while in hospital.

For patients whose first language was neither English nor French, known as allophones, the impact was stark. This group had a 54 per cent lower chance of death when treated by a physician in their own language and a 74 per cent lower chance of hospital-related harms, according to the research.

But fewer than two per cent of allophones and fewer than half of the Francophones in the study received physician care in their own language.

Co-author Dr. Peter Tanuseputro, a physician-scientist at The Ottawa Hospital, Institute du Savior Montfort, Bruyere Research Institute and The Ottawa Hospital, called the findings staggering.

“It’s clearly easier to convey important information about your health in your primary language. Regardless, the more than doubling in odds of serious harms, including death, for patients receiving care in a different language is eye-opening.”

Tanuseputro said the research underscores why it is important for hospitals to pay attention to the language patients speak as well as the languages physicians and other health workers speak.

The findings are likely to resonate in Ottawa and Eastern Ontario, where the Franco-Ontarian community rallied to save Montfort hospital after the Ontario government announced plans to close it in 1997. The battle, won after five years of political activism and legal fights, galvanized the community. Today, Montfort is a Francophone university health institution that provides care in both languages and has a research institute.

Still, Tanuseputro noted that the majority of Franco-Ontarians studied did not get health services in French.

The study’s lead author, Emily Seale, a medical student at the University of Ottawa and Institut du Savoir Montfort, said more must be done to make sure patients are heard and understood by referring them to physicians who speak the same language or by using interpreter services.

“This is not only good patient-centred care, but our research shows that there are grave health consequences when it doesn’t happen.”

Dr. Sharon Johnston, scientific director and associate VP research at the Institut du Savoir Montfort said the study is important because: “(it) helps us quantify the risk of greater harm faced by patients who cannot receive medical care in their preferred language. Understanding and addressing this issue, particularly for our francophone community in Eastern Ottawa and Ontario, is a key part of the mission of Hôpital Montfort and l’Institut du Savoir Montfort.”

The researchers relied partly on data from home care services, which keeps track of patients’ first languages.

They studied more than 189,000 adult home care recipients who had been admitted to hospital between April 2010 and March 2018. They compared patients who received care from a physician in their primary language and those who received care in a different language.

Most of the home care recipients in the study spoke English. Thirteen per cent spoke French and 2.7 per cent spoke another language.

Just over half of the physicians in the study spoke only English and the remainder were multilingual. While 44 per cent of Francophones received care primarily from French-speaking physicians, only 1.6 per cent of allophones received most of their care from physicians who spoke their primary language or one they could understand.

Tanuseputro said, in his own experience, making attempts to find a physician who can provide care in a patient’s language, or translation services, is not always a priority in a busy hospital.

“I am guilty of this too. What our study shows is that there are risks and consequences if you don’t do that.”

Among other suggestions, Tanuseputro said teams of physicians should consider a patient’s language and find someone better able to communicate with the patient. And translation services should be used, even if it takes time.

He also said hospitals should assess patients to understand how well they understand English. If they can’t, hospitals should have interpretive services or multi-lingual family available.

While the study looked at home care patients who were in hospital between 2010 and 2018, Tanuseputro said the situation may well have worsened during periods of the pandemic when family members were generally kept out of the hospital and unable to help interpret.

The study can be found at: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.212155

Source: Lost in translation: Patients more likely to die, have serious outcomes when their physicians don’t speak their preferred language

Filed under Multiculturalism Tagged with , ,

Delaware is shrinking racial gaps in cancer death. Its secret? Patient navigators

2022/03/08 Leave a comment

Of interest:

Sussex County, in the heart of southern Delaware’s poultry-farm country, is home to many people like Michelaine Estimable, a 62-year-old native of Haiti who came to work on the factory lines of a chicken-processing plant.

But Estimable hasn’t worked in two years, because of a leg injury that made it impossible for her to drive. Now, she relies on family members she lives with to get rides to medical appointments — one of the logistical headaches that’s kept her from scheduling her mammogram for the past year.

Luckily for her, she’s getting some help this year accessing preventative care from the state of Delaware. At the clinic where she gets primary care, she meets with Margarette Osias, a patient navigator for the Delaware Breast Cancer Coalition, who sets up shop here every Tuesday, hoping to find people in the community due for mammograms or other cancer screenings.

Osias schedules exams for patients, sends them reminders, and arranges rides for them to get there. A bilingual Haitian Creole speaker herself, Osias also deals with insurance — or even goes with patients to appointments to serve as a translator.

Whatever obstacles the patient faces, “I am basically the connection between that individual and receiving that care,” Osias says.

Patient navigators like Osias play a critical role in how the state of Delaware has reduced its cancer death rates, and narrowed — even eliminated — racial disparities in some forms of cancer. Both are high priorities for the Biden administration, which last month relaunched the Cancer Moonshot initiative, pledging to cut cancer deaths in half in 25 years and address persistent disparities in screening and treatment among people of color. Nationally, cancer kills Black people at higher rates than other groups.

Delaware’s approach to cancer care stands out in the U.S. Two decades ago, the state had one of the highest cancer death rates in the country, so it used funds from the 1998 tobacco settlement to set up universal cancer screening and treatment for its residents. Its Screening for Life program will pay for all cancer screenings and, if cancer is found, will also cover up to two years of treatment — even for residents who are undocumented, have no insurance, or earn up to 6.5 times the federal poverty rate.

Now, that program is a model for addressing racial inequity in health care.

But access to screening and treatment can only help if residents like Estimable, who’s lost a sister and a cousin to cancer, know about it — which is where patient navigators like Osias come in.

Osias schedules exams for patients, sends them reminders, and arranges rides for them to get there. She also helps patients with insurance and translates for them at medical appointments.

Every five years, the state identifies zip codes where screening rates run lowest. Navigators then fan out across grocery stores and laundromats in those communities, dropping flyers, setting up booths, and meeting with religious leaders. They arrange mobile screening vans to factories and other workplaces during work hours.

The process is neither quick, nor easy; it takes time to be seen and develop a rapport with people who have a distant or skeptical view of the medical system, says Mary Jo Vasquez, another patient navigator.

People will often approach only after seeing her multiple times, at their church, or where they shop. “They need to trust you,” she says. “They have to learn that we’re there for them, that we want to help them and that we’re not going to abandon them.”

Having patient navigators on the front line is essential, says family nurse practitioner Nadya Julien.

Julien opened Tabitha Medical Care three years ago, and started working with navigators like Osias. The clinic serves mostly her fellow Haitians, as well as some Latino immigrants. She says many are illiterate and didn’t grow up with preventative medicine back home, which puts them at especially high risk of getting late-stage cancers.

The role of navigators isn’t just logistical, she says, they also reduce fears and help people feel supported through a scary and unfamiliar journey, whether it’s screening or treatment.

“When you have the navigator that speak the language that’s can schedule the appointment, that can go to the house and pick them up and also be there with them to translate it gives comfort,” Julien says.

Delaware’s progress against cancer inequities has been slow and steady, and not without its challenges. The state’s overall cancer death rate has gradually fallen from the 2nd highest among states in the 1990s to the 15th highest. Black men’s improvements stand out: From the period of 2003-2007 to that of 2013-2017, the death rate from all cancers declined 26% for non-Hispanic Black men in Delaware, compared to a 15% decline for white men.

The success varies by cancer. The state’s colorectal cancer mortality rates declined 37% among Black men in that time, and compared to 20% for white men. On the other hand, death from breast cancer only decreased by 3% among Black women compared to 15% for white women in that same period.

And a new challenge emerged in the pandemic: screening rates dropped off, temporarily hampering outreach efforts, so — like many other places — the state is now focusing on making up for lost ground.

But solving shifting challenges has always been a big part of navigators’ work. Through trial and error, they’ve discovered they get fewer no-shows if they conduct free screening events on Thursdays, instead of Fridays, for example. They’ve learned to confirm appointments by text instead of by phone, after noting texting helped cut back on confusion and missed appointments.

Learning and tweaking the program like that has helped remove more roadblocks to care, says Stephen Grubbs, a medical oncologist and a founding member of the advisory council of the Delaware Cancer Consortium, which developed the state’s approach.

“This program has been so successful I think because it’s built on data and evidence,” Grubbs says. The state didn’t just screen more people, it also got them into earlier treatment, which ultimately saved lives, he says: “The final end point was, did we change mortality? And the answer was yes. And that’s where you’ve got to get to. If you don’t get there, the other stuff really doesn’t matter, does it?”

Grubbs says it helps that the economics of the program work, too. Catching cancers earlier means less invasive, less costly treatment with better outcomes which, in turn, helps reduce overall cancer costs. All that is possible, he says, because of patient navigators.

“We took the barriers down, the navigators grease the system and made sure it all flowed through — that’s exactly what it was,” he says.

The state now hopes to build on its success, getting more funds to hire more navigators to target other cancers.

Delaware benefitted from having a unified approach, with support from politicians, physicians, community health centers and patient advocates, says Karen Knudsen, CEO of the American Cancer Society. “Having a state cancer plan is something they embrace, and that 20 years of work is starting to bear fruit,” she says.

The state demonstrated the importance of patient navigators, who now play big role in cancer care nationally.

“Everybody knows it’s the right thing to do,” Knudsen says. “And I think there’s a good, strong business case for it as well because of the lower cost of care for patients who are navigated.”

The problem, she says, is insurance doesn’t cover navigation services, which means cancer treatment centers or nonprofits like hers have to fund the cost.

She says she hopes that will change, especially after she spoke to President Biden last month at the White House’s Cancer Moonshot announcement.

“He did not specifically talk about navigators using that word, but he did talk about eliminating disparities and increasing access,” she says. “What I hear when I hear that, I hear “navigation.”

Back at Tabitha Medical Care, after patient navigator Margarette Osias completes scheduling her mammogram, she tells Michelaine Estimable she will call her and send her a text message to remind her.

Then, as she does with every patient she sees, Osias turns to Estimable to ask her to help spread the word: “If she goes to a church or if she’s in the community, if she can share that information with maybe other women that she can let them know that they can come.”

Will she do that?

“Yes,” Estimable answers emphatically. “Yes.”

Source: Delaware is shrinking racial gaps in cancer death. Its secret? Patient navigators

Filed under Multiculturalism Tagged with , , ,

Wolfson: In pursuit of a world-class health data system

2022/02/19 Leave a comment

Good arguments, challenge given complexity and jurisdictional issues. Some progress through programs like MyChart which makes managing my hospital-based visits and tests so much easier:

Canadians see new and increasingly powerful computerization in almost every facet of their day-to-day lives—everywhere, that is, except for something as fundamental as health care, where systems are too often stuck in the past.

Canadian governments have invested heavily to advance the use of health data, most often without a clear national vision. An incoherent approach for health data is hurting health outcomes, escalating sector costs and expanding inequities.

The health sector relies on data to guide almost every decision, from the choice of an antibiotic for treating an individual’s simple urinary tract infection, to national pandemic policies that affect millions of Canadians.  The challenge is that health and health-related data are so poorly organized and managed in Canada.

While health-care providers create and have responsibility for safe management of records of health care encounters, personal health information in Canada should be available to patients as well.

The reality is that patients continue to have limited access to or insight about data about them, as that remains under the de facto control of myriad and siloed health-service providers. The inevitable result of this scattered provider-centric rather than patient-centric approach is that patient data are typically spread among their various health care providers’ uncoordinated and unstandardized data systems. The result: both providers and patients have to work with incomplete and incoherent information.

The health sector has invested for years in digital technology in the mistaken belief it would immediately solve our health data woes. We have failed to realize the true obstacle to effective health data collection and use is not mainly technological, but a matter of policy and governance.

To realize its tremendous promise, health data in Canada must become centred around the individual. Services would be designed around people and by people. The “life flows” of patients and families would mesh with the “work flows” of providers and institutions. There would be one centrally accessible virtual digital record for each of us.

As patients move from home to care setting, and from provider to provider, data would remain seamlessly accessible for those in the patient’s “circle of care”; no need to repeat your health history for each new provider. Data flows about a person—who sees what—would be transparent to the person involved or to their proxy.

Health-care providers would continue to access personal information for the purposes of individual care, while a new role—health-data stewards—would be mandated to curate population-based data for public good while ensuring privacy and confidentiality.

How can we make this vision a reality in Canada?

This will only happen with a fundamentally reimagined approach to health data policy and governance for the digital age, grounded in mutual trust. Governments need to trust the public by providing clear and complete information, with people in Canada trusted to act for the good of the community. The public would be involved in policies regarding health data collection, sharing, use and communication. And governments need to make real their commitments to respect Indigenous data governance.

Governments must also trust each other and recognize the over-riding importance of coherent pan-Canadian data.  At present, each province and territory has its own health data policies, standards and governance, with very little active coordination across borders. Even in the area of death certification, where the vital statistics registrars have worked together for many decades, we have the current failure to agree on and report COVID-related causes of death in a standardized manner.

Accessing the routinely collected data that do exist is a marathon for fully authorized researchers, for example to study post-marketing drug safety and effectiveness. Even with all the available approval processes in place, it has still proven impossible to analyze these kinds of data for the country as a whole.

These pervasive blockages to generating coherent and timely pan-Canadian information seriously impairs our ability to respond to public health threats and generate insights that could improve health outcomes for all.

Ultimately, we need to rethink—not rejig—how we manage and use health data. The Pan-Canadian Health Data Strategy report, authored by an Expert Advisory group, points out the need for a culture shift in health data use. Public input has to be part of the transformation to person-centred health care and health data systems.

Of course, updating health data systems has costs. But given the tens of billions of health-care dollars the federal government is providing to the provinces through fiscal transfers, it is long past time the federal government leveraged this clout—using both carrots and sticks—so that people in Canada can finally have informed, accessible health data when and where they need it most.

Michael Wolfson is a former assistant chief statistician at Statistics Canada, and a current member of the University of Ottawa’s Centre for Health Law, Policy and Ethics. Vivek Goel is president and vice-chancellor of the University of Waterloo. Both are members of the Expert Advisory Group on the Development of the Pan-Canadian Health Data Strategy.

Source: In pursuit of a world-class health data system

Filed under Other Tagged with , ,

Kaplan-Myrth: Health-care workers have your backs. Please protect us too

2022/02/09 Leave a comment

From our family doctor:
Those of us who have been the recipients of harassment and intimidation over the last two years — who have experienced the overlap between antivax/antimask rhetoric and anti-semitism, racism, homophobia and misogyny — were overcome by a sense of foreboding as trucks rolled into downtown Ottawa more than a week ago. These events, now spreading to the rest of Canada, are a warning to us all.By now everyone has seen the photos of Nazi and confederate flags on the backs of trucks. Residents of downtown Ottawa are powerless against trucks honking their horns all night, diesel fumes wafting into their windows. Food was taken from the Shepherds of Good Hope shelter. Women survivors of violence, traumatized, cried out for help, unable to safely walk outside the Cornerstone shelter. An employee at a local business was physically assaulted. LGBTQ community members were confronted with transphobic placards; a shop window with a rainbow flag was broken. In a virtual townhall meeting led by Ottawa Centre MPP Joel Harden, the chat was disrupted at one point because of anti-Black, racist comments.

The mayor has declared that downtown Ottawa is “under siege,” in a state of “emergency.” As the hate spreads across the country, health-care workers in Toronto and Vancouver were warned not to dress in scrubs in the streets, to avoid being a target for hate. In response, Dr. Lisa Salamon-Switzman, an emergency room physician in Toronto, posted on Twitter that she would wear her scrubs, that as a granddaughter of Holocaust survivors, she would not cower from those espousing hate.

Source: Kaplan-Myrth: Health-care workers have your backs. Please protect us too

Filed under Other Tagged with , , ,

Canadians’ health data are in a shambles

2021/12/10 2 Comments

Unfortunately, all too true, with too few exceptions, based upon my admittedly anecdotal experience in Ottawa:

Canadians see new and increasingly powerful computerization in almost every facet of their day-to-day lives – everywhere, that is, except for something as fundamental as our health care, where systems are too often stuck in the past.

When we go to the doctor, we get prescriptions printed on paper; lab results are sent via fax; and typically, medical offices have no direct links to any patient hospitalization data. And while the pandemic sparked a mad scramble to set up many new data systems – to track who was infected, where there were ventilators, who has been vaccinated and with which vaccine – this has happened in a largely unco-ordinated way, with Ottawa and provincial governments each developing systems separately.

As a result, even these newest computer systems are duplicative, and they do not communicate across provincial boundaries, or even within some provinces – not even, for example, to connect vaccinations, infections, the genotype of the virus, hospitalizations, other diseases and deaths so they are centrally accessible. And so Canada’s recent health-data efforts have wasted millions of dollars while failing to provide the evidence base needed for real-time effective responses to the fluctuating waves of COVID-19 infections..

This kind of failure is not new. Even before the pandemic, key kinds of data have long been imprisoned by data custodians who are excessively fearful of privacy breaches, even though the data are generally collected and stored in secure computer databases. A broad range of critical health care data remains unavailable – not only for patients’ direct clinical care, research and quality control, but also for tracking adverse drug reactions, showing unnecessary diagnostic imaging and drug over-prescribing. The result is that major inefficiencies in the systems remain hidden – and may actually cause health problems, and even deaths by medical misadventure.

There are many directions one could point the finger of blame, but as a new report from the Expert Advisory Committee to the Public Health Agency of Canada found, the root cause is a failure of governance. Federal and provincial governments have failed to agree on strong enforcement of common data standards and interoperability, though this is not only a problem of federalism. Health-data governance problems are also evident within provinces where one health agency’s data system is not connected to others within the same province.

What Canada and the provinces have now is essentially provider-centric health-data systems – not just one but many kinds for hospitals, others for primary care, and yet others still for public health. What Canadians want and need is patient- or person-centric health data. That way, no matter where you are in the country, your allergies, chronic diseases and prescriptions can be known instantly by care providers.

Private vendor-centric health-data software also pose a threat, as do data collected by powerful tech companies from new wearable technologies that offer to collect your health data for you. If Canada does not act swiftly and decisively to establish the needed governance, competing vendor software and individual data will continue the rapidly growing cacophony of proprietary standards. This trend is raising new concerns about privacy, along with untracked increases in health care costs.

The fundamental importance of standardized, interoperable, securely protected health data has been known for decades. There have been repeated efforts to achieve a modern effective health-data system for Canada. But federal cajoling and even financial incentives have failed. Much stronger governance mechanisms are required, and urgently, as the global pandemic has revealed.

The federal government has the constitutional authority to play a much stronger role, given its powers in spending, public health, statistics, as well as “peace, order and good government.” It also has readily available regulatory powers under the Canada Health Act.

Of course, high-quality data collection and data software have costs. But given the tens of billions of health care dollars the federal government is providing to the provinces through fiscal transfers, it is long past time they leveraged this clout – using both carrots and sticks – so Canadians can finally have informed, accessible health data when and where they need it most.

Michael Wolfson is a former assistant chief statistician at Statistics Canada, and a current member of the University of Ottawa’s Centre for Health Law, Policy and Ethics. Bartha Maria Knoppers is a professor, the Canada Research Chair in Law and Medicine, and director of the Centre of Genomics and Policy at McGill University’s Faculty of Medicine. They are both members of the Expert Advisory Group for the Pan-Canadian Health Data Strategy.

Source: https://www.theglobeandmail.com/opinion/article-canadians-health-data-are-in-a-shambles/

Filed under Data, Government Tagged with , , ,

Ottawa, provinces must create agency to reform how health data is collected and used, report says

2021/12/01 Leave a comment

East to agree, hard to implement given provincial agreement needed. Even integration within a province is far from being implemented in a comprehensive manner:

The federal and provincial governments must create a national agency to set standards for the collection and sharing of health data to respond more quickly to threats such as pandemics and to improve patient care, a new report says.

The report, from a federal advisory group to be released on Tuesday, says governments across the country also need to change privacy laws to allow health records and data to be more easily shared – with patients, medical providers and public-health officials. That would require a significant culture shift away from a system that focuses solely on keeping data secure and private, and toward one that ensures health records and data can be used and shared safely.

The report says the systems across the country that aren’t standardized and can’t talk to each other have limited Canada’s ability to respond to COVID-19, including managing vaccines and tracking variants. More broadly, that reality is also hurting patient care, and could hamper the response to other health crises, the report says.

“We haven’t had this concept that people holding this data should be promoting its appropriate use, its timely use for the benefit of the individuals or for the entire population of Canada,” Vivek Goel, a public-health expert who chaired the review and is also president of the University of Waterloo, said in an interview.

The report is the second of three from the Pan-Canadian Health Data Strategy Expert Advisory Group, which the federal government launched last year to examine data problems exposed by COVID-19. While the group’s work was spurred by the pandemic, its recommendations are far broader, and call for dramatic changes to how Canadians’ health data are stored and managed.

The report says the systems for managing health records, and the privacy laws that oversee them, were designed and created for paper records and haven’t sufficiently been updated for a primarily digital system.

Most people can’t access their own health records, which also aren’t readily available to health care providers as patients move through the system, the report says. The document calls for a “person-centric approach” that would give patients control of their records and allow all of their health care providers to access them easily and securely.

“An integrated, person-centric health data structure ensures that all health data follows an individual through the course of their life-long care,” the report says.

It adds that creating a national system would require governments to agree on standards to ensure those records can be accessed regardless of where a patient is or which doctor they see.

While the report does not make detailed recommendations about managing such a system, Dr. Goel said it should be overseen by a body controlled by Ottawa, the provinces and the territories that would recognize – and address – the reality that health care falls under provincial and territorial jurisdiction.

“We need an entity that is co-owned, co-managed, co-supervised by the federal, provincial and territorial governments together in setting those standards,” he said.

It would also require changes to privacy laws. The report says current privacy laws turn health care providers into “custodians” of data, which, in turn, creates a “privacy chill” that prompts them to restrict access even if not required. Instead, the report proposes a model of “data stewardship” that “champions data sharing, access, use and protection.”

Dr. Goel said a system that standardizes health data and facilitates sharing with officials and experts in other jurisdictions would help governments identify and track public-health threats such as infectious diseases including COVID-19. He said the pandemic revealed how ill-equipped federal, provincial and local health agencies were to gather and share data.

For example, he said as new variants of COVID-19 emerge, such as the Omicron variant that is dominating headlines, it is crucial to track who is getting sick and how transmission and patient outcomes are affected.

To do that effectively, health officials need access to information not just from their own provincial or local health unit, but the entire country. That doesn’t require the same system for everyone, just systems designed to communicate.

He compared it to the Interac network, which allows transactions to be tracked between banks even if they are all using different systems. “There are models that we can learn from the private sector.”

Dr. Goel said governments would need the public’s buy-in to increase data sharing in this way, but he thinks they can be persuaded. He says patients may actually be surprised to learn how little information is shared for wider public-health surveillance, such as the details they provide to COVID-19 contact tracers.

Ewan Affleck, a doctor and an expert in health informatics who sits on the advisory group, said he routinely runs into problems accessing his patients’ records from other providers or jurisdictions.

He treats patients in the Northwest Territories, which sends many people to Alberta for surgery and other procedures, but he often can’t access their information easily – or at all.

“I have no means of getting it because of jurisdictional legislation laws, privacy concerns, and this impairs my capacity to provide care,” Dr. Affleck said in an interview.

“So we make mistakes, and those mistakes damage Canadians. This is happening all the time.”

Dr. Affleck said the same issues hamper Canada’s ability to track and respond to population-level health issues such as pandemics.

“Whether it is guiding our response to COVID or whether we’re treating a patient for a urinary tract infection, this is all based on our adjudication of information,” he said.

“Digital health in Canada is legislated to fail. We have to change that model, because it’s an antiquated model from the age of paper-based information, which worked well then, but it works terribly now. And it is actually damaging Canadians.”

Source: https://www.theglobeandmail.com/canada/article-ottawa-provinces-must-create-agency-to-reform-how-health-data-is/

Filed under Government Tagged with ,

Refugee, undocumented health-care workers demand access to permanent resident program

2021/10/22 Leave a comment

Of note given unsubscribed slots in the permanent resident pathway program for the healthcare stream:

Refugees and undocumented health-care workers are demanding they be allowed to apply for a government program that would grant them permanent status in Canada.

The temporary resident to permanent resident pathway program was announced in April as a way to keep skilled essential workers in the country, with a focus on retaining 20,000 hospital and long-term care workers.

While the government has already received the maximum number of applications for recent university graduates and other essential workers, there have been few applicants accepted to the health-care stream.

The program is set to close on Nov. 5 and has so far accepted only 5,421 applications.

The Migrant Workers Alliance for Change says that’s because refugees and undocumented people are barred from applying and many health-care occupations are excluded.

“I felt humiliated when the eligibility requirement excluded me,” said Fasanya Kolade, a Nigerian refugee and developmental support worker in Newfoundland and Labrador.

Kolade works primarily with seniors and adults with physical, developmental and intellectual disabilities, and said he pulled 65-hour weeks throughout the pandemic to care for his patients.

Despite meeting most of the criteria, he could not apply.

“The only criteria that excluded me was just that I am a refugee claimant,” he said in an online press conference Wednesday.

The program is only open to workers with temporary status in Canada, so even undocumented people with work permits cannot apply.

The program also requires applicants to meet language requirements, and have recent experience in an approved health-care occupation.

Those requirements can also limit eligibility for people who don’t have time to take the proper language tests, the Migrant Workers Alliance said.

The federal government launched a similar pathway program specifically for health-care workers with pending or failed refugee claims late last year, which closed to applications on Aug. 31.

Now with nearly 15,000 spots for temporary residents set to expire in just two weeks, the alliance is calling for the criteria to be expanded.

“Changing these rules, ensuring access for migrants, refugee claimants, undocumented people without economic, occupational restrictions and language restrictions is a no-brainer,” said Syed Hussan, executive director of Migrant Workers Alliance for Change.

“Otherwise these spots will just evaporate.”

Several people have applied, hoping the criteria would be amended, but have been denied.

“When I first heard of the health worker pathway I knew God had finally heard, not only my cries, but also other people in my situation,” said Jane, a Ugandan refugee and personal support worker in Hamilton, Ont. Her full name has been protected because of her lack of immigration status.

She fled her country after leaving an abusive and homophobic relationship and was disowned by her family when they learned she was a lesbian.

She applied for the pathway program with the help of a lawyer and waited, hoping the criteria would be expanded to include people with failed refugee claims, but she was denied.

There are many people with similar stories said Florence, a Ugandan asylum seeker who works in a Toronto residential home for young adults with complex developmental and physical disabilities. Her full name has also been protected.

She was denied because she had filed an asylum claim in the United States.

“Our hands are tied up. I cannot get a steady permit to pursue my dreams,” Florence said Wednesday. “I know there are very many of us like me who need papers.”

Immigration, Refugees and Citizenship Canada did not immediately respond to a request for comment.

Source: Refugee, undocumented health-care workers demand access to permanent resident program

Filed under Immigration Tagged with , ,

Les agences privées écartées du recrutement à l’étranger

2021/10/16 Leave a comment

Of note (processing delays and impact on regions):

Des régions en pénurie de personnel auraient pu compter sur plus d’une centaine d’infirmières provenant de l’étranger, mais le réseau de la santé a tourné le dos à plusieurs offres de recrutement provenant d’agences privées, a appris Le Devoir.

Parmi elles, l’agence de placement Serenis, qui n’a pas ménagé ses efforts pour présenter un « projet clés en main » afin de faire venir au Québec une vingtaine d’infirmiers et d’infirmières originaires de la France et du Maghreb. « En ce moment, j’ai 20 infirmières et infirmiers hautement qualifiés qui sont en stand-by », affirme Jackie Lamothe, présidente de trois franchises de l’agence de placement Serenis, pour les régions de la Mauricie, du Centre-du-Québec et de la Montérégie Est.

Selon elle, ces professionnels de la santé ont été choisis par l’agence parce qu’ils sont prêts à aller travailler dans les régions éloignées où les besoins sont criants, comme à La Tuque. Et ils ont tous en poche l’évaluation comparative du ministère de l’Immigration qui indique l’équivalent québécois de leur diplôme.

« J’en ai parlé à des chefs de service des établissements de santé, qui en ont ensuite parlé à leurs supérieurs, et ils étaient tous intéressés. Mais ça finissait toujours par bloquer en haut, comme au niveau du ministère. On a vécu ça partout où on a essayé, même en régions éloignées comme la Gaspésie, le Bas-Saint-Laurent et dans le Nord, comme la Baie-James… »

C’est au début de l’année 2021 que, devant la détresse de plusieurs employés en lien avec la pénurie de personnel, Mme Lamothe a commencé ses propres démarches de recrutement à l’étranger. Neuf mois plus tard et après avoir investi 20 000 $, notamment en analyses de CV, en entrevues et en frais de consultant en immigration, cette ancienne infirmière a été en mesure de dresser une liste de travailleurs francophones « surqualifiés » avec de l’expérience à l’urgence et en pédiatrie, dont la formation allait être facilement reconnue par l’Ordre des infirmières et infirmiers du Québec (OIIQ). « Pour être membre de l’OIIQ, il faut faire un stage de 75 jours dans le réseau public et j’offrais même aux établissements de santé de le prendre sur mon bras », soutient Mme Lamothe. Son agence allait également s’occuper de l’accueil et de l’intégration des travailleurs, comme le logement et la première épicerie. « Je pouvais même signer un papier pour confirmer que ces personnes-là allaient rester dans le public. C’était gagnant-gagnant ! »

Alors que Radio-Canada a rapporté que le gouvernement Legault mène actuellement une opération sans précédent avec Recrutement santé Québec pour faire venir 4000 travailleurs de la santé hors du Québec — dont 3500 infirmières —, des agences privées s’étonnent que leurs offres de recrutement n’aient pas été retenues. « J’ai trouvé ça très dommage. Si le gouvernement avait pris nos services, on aurait déjà une soixantaine d’infirmières pratiquant en Abitibi, ça n’aurait coûté que quelques centaines de milliers de dollars et on aurait pu économiser plusieurs millions en location de personnel », a déclaré Marc Blais, président de l’Agence de placement et de développement internationale (APDI), qui a près de 2000 CV d’infirmiers et d’infirmières de l’Afrique subsaharienne dans sa base de données. « Il y a eu un manque total de vision là-dessus. »

En 2019, son entreprise, qui fait uniquement du recrutement, avait proposé un projet pilote en collaboration avec le Cégep et le Centre intégré de santé et services sociaux de l’Abitibi-Témiscamingue (CISSS-AT) pour offrir une formation de mise à niveau reconnue par l’OIIQ à quelque 400 des Africains de l’Ouest qui avaient été présélectionnés. La force de cette initiative était la promesse que les gens recrutés allaient vouloir s’installer durablement en région, puisqu’ils viennent eux-mêmes de l’extérieur des grands centres. « On a sollicité le ministère de la Santé pour avoir des fonds, et ça a été refusé. [Le gouvernement] préférait travailler à l’interne avec Recrutement santé Québec », a soutenu M. Blais, qui se sent comme s’il s’était fait un peu voler son idée. « Ce programme-là, au fond, c’est nous qui l’avions mis en place. »

Le président de l’APDI constate que les agences privées de placement ou de recrutement sont boudées par le gouvernement. « On dirait que le [ministère] n’est pas très à l’aise avec les agences privées. Lorsque les solutions viennent du privé, il ne les retient pas. On nous met tous dans le même bassin. »

Jackie Lamothe déplore aussi que les efforts de son agence semblent être mal perçus. « Le gouvernement a peur qu’on vole du personnel du réseau, mais ce n’est tellement pas ça ! » lance-t-elle. « C’est le contraire. On prend du sang neuf qu’on met dans le réseau. On évite le [recours au] TSO [temps supplémentaire obligatoire], qui force les infirmières épuisées à partir. »

Longs délais à l’OIIQ

Entreprises privées de personnel soignant du Québec (EPPSQ) dit recevoir une trentaine d’appels par jour de professionnels de la santé de la France et du Maghreb prêts à venir travailler dès maintenant au Québec. « Nous, on pourrait se porter garant, comme agence, de les faire travailler, après validation des acquis et d’un cours accéléré. Mais ce pont-là ne se fait pas », dit Hélène Gravel, la présidente de cette association. EPPSQ a d’ailleurs intenté une poursuite contre le gouvernement, qui veut limiter le recours aux agences privées. Selon elle, le nœud du problème ne se situe pas uniquement dans l’administration du réseau de la santé, mais surtout au sein de l’Ordre des infirmières et celui des infirmières auxiliaires.

« Même pour une personne qui vient de France, c’est très long avant qu’elle puisse venir et gagner sa vie. […] Les délais à l’OIIQ sont encore trop longs. Il va falloir qu’ils s’amenuisent », a-t-elle ajouté.

Selon les données fournies par l’OIIQ, il faut de deux à trois mois pour obtenir une réponse à une demande d’admission par équivalence d’un dossier une fois que celui-ci est complet. À cela s’ajoute un programme de formation de 10 à 14 mois que doivent normalement suivre l’ensemble des infirmières diplômées à l’étranger, sauf les Françaises, qui bénéficient d’une voie rapide en vertu d’une entente France-Québec. S’ajoutent aussi les délais d’obtention des permis d’étude et de travail auprès des autorités en immigration.

À l’heure actuelle, environ 90 dossiers sont en traitement, selon l’OIIQ, qui précise que, généralement, seulement 40 à 50 dossiers parviennent à être complets et sont présentés à son Comité d’admission.

Source: Les agences privées écartées du recrutement à l’étranger

Filed under Immigration Tagged with , ,

← Older posts

Newer posts →