That word again at #HIMSS21Europe

It was the word that highlighted discussions at last year’s virtual HIMSS Europe conference and trust was also the word heard again and again during the main presentations at this year’s #HIMSS21Europe meeting that has just concluded.

The big difference this year was that trust was used primarily in the context of encouraging COVID-19 vaccination to help end the pandemic and only secondarily with sharing of patient data.

This year’s HIMSS Europe meeting continued with the usual major topic areas showcasing advances in European countries and the UK with respect to digital health and virtual care. However, the keynote sessions focused to a greater degree on COVID-19 and the steps needed for Europe to adapt successfully to a post-pandemic era.

At last fall’s conference delegates and the health IT world in general were still basking in total transformation of health care delivery from in-person to a virtual basis because of the COVID-19 pandemic – a goal many had been working on fruitlessly for decades. Now as Dr. Ran Balicer, chief innovation officer at Clalit Health Services in Israel said on the conference’s first day “providing care at a distance is how you provide care”.  He added that the whole concept of telehealth has become some redundant as health systems have adapted to hybrid models of care delivery that combine in-person and virtual care.

Back to trust.

“The key to every vaccination program is trust,” said the World Health Organization’s Dr. Hans Kluge during the opening plenary session. This point was hammered home during a session of dealing with COVID-19 misinformation and fake news in which data was presented from surveys in several European countries indicating where trust in government was highest, people were also supportive of COVID-19 vaccines.

The importance of promoting digital trust in developing an inclusive society in the post-COVID-19 world was referenced during the main closing plenary session on global inequities by Dr. Ahmed ElSaaed, Focus Area Lead for Innovation Scaling at the United Nations Global Pulse Finland.

In the same session, Dr. Deborah Maufi, chief medical officer for Babymoon Care B.V. in The Netherlands, said trust was needed to build “key and targetted campaigns” aimed at specific communities to encourage vaccination.

Trust also surfaced in a sessions dealing with the use of patient data. Such trust is the key to sharing patient data for secondary use, said Seamus O’Neill, Chief Executive at the Northern Health Alliance in the UK.

People have been more trusting in sharing their personal health data during the COVID-19 pandemic, he said, because this was being done on an emergency basis to deal with an immediate, threat to personal health. However, he said, one should be wary in assuming people will continue to maintain the same high degree of trust over the longer term after the pandemic. “The volume of health-related data is increasing exponentially … and patients have to be convinced their data is being shared responsibly” said Dr. Rowland Illing, a radiologist and chief medical officer at Affidea in the UK, at the same session.

(Photo of Helsinki – where once again we are not meeting (but should have been) for HIMSS Europe because of COVID-19)

Virtual care use ignited by #COVID19 pandemic

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The COVID-19 pandemic has provided the opportunity for Canada to go from “worst to first” in using virtual care and assessing its impact.

That’s according to Dr. Sacha Bhatia (@sacha_bhatia), FM Hill Chair in Health Systems Solutions and the Chief Medical Innovation Officer at Women’s College Hospital in Toronto and currently one of the country’s more eloquent advocates for virtual care.

Dr. Bhatia made the comment during his participation in a virtual discussion hosted by Massey College. The Massey Dialogues session was hosted by Principal Nathalie Des Rosiers and also featured former University of Toronto medical school dean Dr. Catherine Whiteside and Massey fellow and medical student Krish Bilimoria (@KHBilimoria).

In addition to virtual care, the wide-ranging discussion also touched on changing attitudes towards sharing patient data and the need to adjust medical education to prepare new physicians to practise in a virtual environment.

Dr. Bhatia noted the approach and attitude of physicians towards virtual care has changed significantly in the last couple of months because COVID-19 introduced new risks to physical contact for both physicians and patients. “In some ways the COVID pandemic was the match that lit the fire around this revolution in virtual care,” he said.

When it was announced that half of all patients visits in China would be conducted virtually when the pandemic was at its peak in that country, many viewed this as being unattainable. But now, he said, 70% of patient consults in some areas of Canada are occurring virtually and in some instances the use of virtual visits has grown by 780%.

The paradox that Canada has been a pioneer and is admired globally for developing telemedicine to service remote and isolated communities but lags other countries in integrating virtual care into routine practice was touched on.

Dr. Bhatia said “tremendous inertia” against using virtual care in most physician practices in Canada was coupled with concerns about patient privacy, quality of care issues and “the elephant in the room” – adequate remuneration for virtual consults.

With the significant growth in virtual care, Dr. Bhatia said an important issue now is determining the impact of this on the quality of care and outcomes. “This has happened very fast and we don’t know what the impact of that is going to be,” he said.

“There was a rush for us to do this to protect our patients and providers … but now if we’re going to make it sustainable we need to do the research to begin to understand what the impact of that has been. Canada has an opportunity here to be a real leader internationally in understanding the impact of virtual care and changing the care model.”

Many standards of practice for virtual care have not yet been fully developed, Dr. Bhatia acknowledged.

“There are a lot of conditions for which we are making up as we go to be perfectly honest”

As a medical student, Bilimoria said questions now have to be asked about how clinical skills and evaluation will have to change to adapt to virtual care models. “How do you evaluate and assess patients virtually?”

(The importance of adapting medical education to deal with virtual care is a key but underappreciated part of the Virtual Care Task Force report released earlier this year by the Canadian Medical Association, Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada)

“I think medical student involvement at all levels from education to research is going to be absolutely critical,” said Dr. Bhatia.

Dr. Whiteside said another component of the current reshaping of care delivery is digital care and the challenge of allowing patients to have access their own medical records while at the same time allowing those involved in their circle of care to also share the information. She noted that privacy legislation in various jurisdictions across the country is being opened up so access to data can be more patient-centric.

With the COVID-19 pandemic, Dr. Bhatia noted “research and practise are effectively occurring in real time” and this makes it even more important that new models for collecting and sharing data are put in place.  “Using research will actively help develop new treatments and new approaches that will potentially help save lives not in six or seven years from now but literally next month.”

He said there needs to be a much more pragmatic approach to how we think of data and privacy and that the public must be engaged in that conversation.

All participants in the discussion raised the issue of equity and concerns that virtual care is not necessarily being provided in an equitable fashion. Dr. Bhatia said this is of special concern given data that marginalized groups are already being impacted to a greater degree by COVID-19.

However, Dr. Whiteside said “COVID is enabling us to actually get closer to that kind of productive and positive relationship that we need to really move the agenda forward for access to data (and) engagement of patients and their caregivers in decision making”

The full Massey Dialogues session can be accessed here.

Help for the helpers: #Covidwellness tips

Emily

Last Thursday evening, a small but dedicated group participated in a #COVIDWellness tweetchat and shared tips and advice for supporting healthcare providers during the current COVID19 pandemic.

Organized by @ChildHealthCan, the chat was co-hosted by @BrucePSquires, president of McMaster Children’s Hospital, @DrGigiOsler, past-president of @CMA_DOCS, and @KathyReid5, nursing leader at Stollery Children’s Hospital.

The hosts and others shared not only useful information on dealing with today’s situation but also for one hour created a positive community

Much of the information provided reinforced what other credible individuals have been saying about maintaining good mental and physical health during this time while striving to stay safe but connected.

A small sampling from the chat follows:

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Twitter in the Age of #COVID19

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In this the year of Our Lord 2020 we truly are seeing the power of Twitter and social media.

As individuals around the world struggle to cope with physical distancing and social isolation, Twitter and other mainstream social media channels have become major conduits for information and networking and are arguably strengthening many people’s mental health by helping ward off isolation.

Just as the spread of COVID-19 has been enabled by our global culture and ability to span the world in hours, so the global reach of social media has enabled people to stay in contact and informed even as they are confined to their homes. And COVID-19 is very definitely where it is at right now. Ninety-five percent if not more of the tweets now appearing in my feed from the 4,000 plus people I follow (admittedly mainly health-care related), deal with COVID-19 issues.

However, it is well worth remembering that Twitter and the like are just media platforms and are neither inherently good nor bad. And so, along with enabling better communications and interactions, social media platforms are once again showing with the COVID-19 pandemic how easy it is to transmit and amplify erroneous and downright dangerous information.

Another challenge is the asynchronous, ominpresent, yet selective nature of social media. Tweets are appearing in my feed that first appeared 3-4, if not more days ago – not a good thing given the fast-moving nature of what we understand about this pandemic. Information about outbreaks, number of cases, and availability of badly needed health care supplies needs to be timely to be useful and that is often not the case with what is appearing on social media.

Also, tweets are appearing from around the world – another challenge for those of us in countries such as Canada where public health measures and other badly needed information is determined at the provincial level. Much of what we are seeing is not relevant to our own situation and can be misleading.

Social media such as Twitter allow us to choose who we follow. This selection bias means we are not getting the whole picture and can be misled about what is going on in the world around us – another critical failing if we are isolated at home. The good news is that in a stream such as mine which is so heavily health-care focused, many good people are retweeting solid scientific evidence or opinion from others I am not following directly. Unfortunately, I am sure people in other echo chambers are having poor or inaccurate information amplified. And for those of us who spend their time predominately on social media and dealing with health care in Canada we need to remember the vast majority of physicians and other health care professionals have neither the time nor interest in social media, thereby limiting our ability to view what they are contributing.

Yet, I believe my Twitter worldview to be fairly balanced. For every picture of people ignoring social distancing and filling the beaches of Sydney, Australia or Clearwater, Florida there are pictures of dedicated health care workers going about their work.

Unfortunately the unprecedented situation we find ourselves facing this pandemic have caused some to forget the basic principles of being on social media – being transparent, accurate and respectful: And in the case of health care, respecting patient privacy and confidentiality especially if that person is a physician or healthcare worker infected as a result of their work.

With social media potentially being the window on the world for many of us for some time to come those principles of human conduct which have served us so well in other avenues of life should remain top of mind.

(Image from the CDC)