BACKGROUND Patients with heart failure (HF) can be affected by disabling symptoms and low quality... more BACKGROUND Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. OBJECTIVE Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. METHODS Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combi...
Introduction The coronavirus disease 2019 (COVID-19) evolved from a rising public health concern ... more Introduction The coronavirus disease 2019 (COVID-19) evolved from a rising public health concern to a pandemic over mere weeks. Before March 11, 2020, the Public Health Agency of Canada had not advised against any mass gatherings. Herein, we highlight practical precautions taken by event organizers to adapt to the rising public health threat from COVID-19 and maintain public safety when conducting a health forum for the Chinese community of Vancouver, British Columbia on February 22, 2020. Materials and Methods In the pre-forum phase, we advertised the availability of virtual conferencing for remote participation in the forum and also had an official communication from the Ministry of Health available regarding COVID-19 on our website. At the forum, we ensured that attendees sanitized their hands at registration and had access to sanitizers throughout the forum. Additionally, we provided translated health literature on COVID-19 to participants and had our health professional speakers address COVID-19-related questions. Results This year, 231 older Chinese adults attended the forum in-person, while 150 participated remotely. The total number of 381 participants compares well to previous iterations of the forum, with twice the amount of participants on average attending online than before. Of the participants who attended the forum, 89% suggested that the forum would be effective in improving their overall health and 87% cited the forum's utility in directing them to access community resources. None of the attendees had COVID-19 or are suspected to have contracted it at the forum. Conclusion Conducting a mass gathering during a crisis required closely following guidance from local public health authorities, constant and clear communication with attendees, and employing practical risk mitigation strategies.
In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly i... more In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using batteryenabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes he...
Natural Language Processing (NLP) is a growing field in data analytics that is increasingly appli... more Natural Language Processing (NLP) is a growing field in data analytics that is increasingly applied in healthcare for assessment of patients’ electronic records or patients’ dialogues to unearth medical issues, emotions, or cognition. Meanwhile, active research is taking place in the use of sensors and wearables in tracking patient phenotypes and physiologic status in diagnosis and management of diseases. This paper’s central purpose is to explore how natural language processing can be combined with wearables in healthcare, and how this approach can advance health service delivery and health system transformation. Our recommendations are to stimulate interest and lower barriers in order to implement this novel combination of solutions in healthcare industries, and to do so in consideration of various technical and ethical concerns.
Background Depression has a profound impact on population health. Although using web-based mental... more Background Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Interventi...
have received personal fees from HealthLink BC for work done as HEiDi virtual physicians during t... more have received personal fees from HealthLink BC for work done as HEiDi virtual physicians during the course of the study. Kendall Ho has also received grants from HealthLink BC and the BC Joint Standing Committee on Rural Issues, Rural Coordination Centre of BC.
Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares t... more Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and ...
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
As generalists, emergency practitioners face challenges in providing state-of-the-art care owing ... more As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Netwo... more Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the…
British Columbia falls short in uptake of recommended clinical prevention services, with even low... more British Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia. We used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results. Sixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or commu...
Introduction: Diabetes mellitus affects over 2.7 million Canadians, with 90% being Type-2 diabete... more Introduction: Diabetes mellitus affects over 2.7 million Canadians, with 90% being Type-2 diabetes (CDA 2010). Complications of diabetes are major causes for emergency department (ED) visits, adversely affecting patients’ health and costing the health system. Improving diabetes self-management can lead to avoidance of ED visits and revisits after discharge. Recent developments in mobile Health (mHealth), such as home health monitoring with sensors, social media, and text messaging, have shown promise in supporting patients in chronic disease self-management. This project tested the feasibility of these tools to support self-management for people with type-2 diabetes. Methods: Forty-three people with type-2 diabetes took part in a three month program that provided: health information via text messages, online access to curated resources and a facilitated discussion board, and access to wireless monitoring devices. Participants were outfitted with a wireless blood pressure monitor and...
Major depression is a prevalent mental disorder and imposes considerable burden on health and pro... more Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs. The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%), and "having access to quality information and resources about work stress issues" (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's…
Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012
Health professionals' use of social media and Web 2.0 technologies are emerging as a new area... more Health professionals' use of social media and Web 2.0 technologies are emerging as a new area of research. We present the experiences of a province-wide network in Canada that was developed using such technologies as a means to increase nurses' capacity in nursing health services research. Our network is based on a model of electronic communities of practice (eCoPs). Network evaluation affirms that nurses do respond to social media, as membership has grown to over 1,400 members in two years. Approaches used for network development and implementation are discussed, and the network's eHealth eCoP is presented as a case of network activities and directions.
To assess medical students' self-reported preparedness to provide care to ethnic minorities, ... more To assess medical students' self-reported preparedness to provide care to ethnic minorities, factors that influence preparedness, and attitudes toward cultural competency training. A cross-sectional study, which invited University of British Columbia medical students to participate in a survey on student demographics, knowledge and awareness, preparedness and willingness, and personal attitudes. Of 1024, eligible, 301 students consented to study. Students across all year levels felt significantly less ready to provide care for non-English speaking Chinese patients compared to "any" patients. Proficiency in working with interpreters was correlated with readiness, OR 4.447 (1.606-12.315) along with 3rd and 4th year level in medical school, OR 3.550 (1.378-9.141) and 4.424 (1.577-12.415), respectively. Over 80% of respondents reported interest in learning more about the barriers and possible ways of overcoming them. More opportunities for cultural competency training in t...
Background: Globally, the incidence of sexually transmitted infections (STI) is rising, posing a ... more Background: Globally, the incidence of sexually transmitted infections (STI) is rising, posing a challenge to its control and appropriate management. Text messaging has become the most common mode of communication among almost six billion mobile phone users worldwide. Text messaging can be used to remind patients about clinic appointments, to notify patients that it is time for STI re-testing, and to facilitate patient communication with their health professionals with any questions and concerns they may have about their sexual health. While there are a handful of systematic reviews published on short message service (SMS) interventions in a variety of health settings and issues, none are related to sexual health. We plan to conduct a systematic review to examine the impact text messaging might have on interventions for the prevention and care of patients with STIs. Methods/Design: Eligible studies will include both quantitative and qualitative studies published after 1995 that discuss the efficacy and effectiveness of SMS interventions for STI prevention and management using text messaging. Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Inter-rater reliability scores will be obtained to ensure consistency in the inclusion and data extraction of studies. Heterogeneity will be assessed using the I 2 test and subgroup analyses. A nonhypothesis driven inductive reasoning approach as well as a coding framework will be applied to analyze qualitative studies. A meta-analysis may be conducted if sufficient quantitative studies are found using similar outcomes. Discussion: For this protocol, we identified ten related systematic reviews. The reviews were limited to a particular disease or setting, were not exclusive to SMS interventions, or were out of date. This systematic review will be the first comprehensive examination of studies that discuss the effectiveness of SMS on multiple outcomes that relate to STI prevention and management, covering diverse settings and populations. Findings of the systematic review and any additional meta-analyses will be published and presented to our key knowledge users. This information will provide the evidence that is required to appropriately adopt text messaging into standard practice in STI care.
Proceedings of second ACM SIGMM workshop on Social media - WSM '10, 2010
Social network services are becoming increasingly popular, and people are using these networks to... more Social network services are becoming increasingly popular, and people are using these networks to obtain and share information. The application of social network and social media to the collection, storage and review of personal information presents opportunities for improved personal health management. This paper presents a survey of the literature on the models for the use of online social networks and models for health behavior change. These are then combined to present a framework for health behavior change through social media. This framework is then used to develop a prototype for the system design.
Emergency medicine departments within several organizations are now advocating the adoption of ea... more Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and national level to establish a template for policy makers from other jurisdictions to translate knowledge into action for EDs. This research study will employ the IHI model for improvement, incorporate the principles of participatory action research, and use the E2E online CoP to engage ED practitioners (eg, physicians, nurses, and administrators, exchanging ideas, engaging in discussions, sharing resources, and
Revista panamericana de salud pública = Pan American journal of public health
The health of people living in the Region of the Americas has experienced noteworthy improvements... more The health of people living in the Region of the Americas has experienced noteworthy improvements over the past several decades. However, several critical goals remain unmet. Considerable challenges persist in both communicable and non-communicable diseases; in particular, marked increases in obesity, diabetes, cardiovascular diseases, and cancer, and the continued impact of diseases such as tuberculosis, dengue, and malaria. Suboptimal levels of maternal and child health, insufficient human and infrastructure resources, and wide geographical and cultural differences add further complexity to the situation in the Region. The availability of health services and health-related information varies greatly across communities, geographic areas, and countries, impeding universal access to health services and decreasing the quality of care. These differences are determined by a combination of geographical barriers and other social determinants of health, as well as policy processes and decisions. Viewing the glass as half-full, the spread and uptake of information and communications technologies (ICT) have the potential to level the playing field by reducing some of these barriers and enabling information-sharing that will assist in equalizing these differences. Many ICT systems and devices, initially expensive and of limited dissemination, have become affordable and are widely used across many levels of society. The World Health Organization (WHO) defines eHealth as "cost-effective and secure use of information and communication technologies in support of health and health-related fields" (1). Today, ICT are present in arguably all aspects of health and healthcare, making it of critical importance to gain a deeper understanding of how they can transform health services and the broader health systems in which they are embedded. The Pan American Health Organization (PAHO), through its Strategy and Plan of Action on eHealth (2), promotes improving public health in the Region through innovative ICT tools and methodologies that favor the extension of universal health coverage and help to build societies that are more informed, equitable, competitive, and democratic. There are multiple examples of how using eHealth in health systems can address the growing demand for better quality and more accessible and affordable health services. eHealth can facilitate access to services and to health information in remote areas through telehealth; it can enhance the exchange of information and health data among systems through standards and interoperability; it can capture medical information in a health record to improve efficiency and continuity of care; it can allow secure, remote access to patients' electronic health records; it can help monitor and report diseases more frequently and with reduced latency in the system through the use of mobile devices; it can address challenges in the skilled health workforce by offering continuing education through virtual education platforms; and it can promote the search for and sharing of information among different individuals and groups through forums and other social networks accessible via the Internet and other communication channels. Considering the importance of the aforementioned trends and the potential of eHealth to strengthen health systems, this special issue of the Pan American Journal of Public Health on "eHealth in the Americas" aims to reflect the range of enabling factors, practical applications, and outcomes related to using ICT in health. The diverse collection of contributions shows how a variety of eHealth interventions and policies address specific diseases, such as cancer, obesity, diabetes, depression, and lupus, among others, in addition to showing the important role that governments and other actors play in this process of change.
BACKGROUND Patients with heart failure (HF) can be affected by disabling symptoms and low quality... more BACKGROUND Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. OBJECTIVE Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. METHODS Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combi...
Introduction The coronavirus disease 2019 (COVID-19) evolved from a rising public health concern ... more Introduction The coronavirus disease 2019 (COVID-19) evolved from a rising public health concern to a pandemic over mere weeks. Before March 11, 2020, the Public Health Agency of Canada had not advised against any mass gatherings. Herein, we highlight practical precautions taken by event organizers to adapt to the rising public health threat from COVID-19 and maintain public safety when conducting a health forum for the Chinese community of Vancouver, British Columbia on February 22, 2020. Materials and Methods In the pre-forum phase, we advertised the availability of virtual conferencing for remote participation in the forum and also had an official communication from the Ministry of Health available regarding COVID-19 on our website. At the forum, we ensured that attendees sanitized their hands at registration and had access to sanitizers throughout the forum. Additionally, we provided translated health literature on COVID-19 to participants and had our health professional speakers address COVID-19-related questions. Results This year, 231 older Chinese adults attended the forum in-person, while 150 participated remotely. The total number of 381 participants compares well to previous iterations of the forum, with twice the amount of participants on average attending online than before. Of the participants who attended the forum, 89% suggested that the forum would be effective in improving their overall health and 87% cited the forum's utility in directing them to access community resources. None of the attendees had COVID-19 or are suspected to have contracted it at the forum. Conclusion Conducting a mass gathering during a crisis required closely following guidance from local public health authorities, constant and clear communication with attendees, and employing practical risk mitigation strategies.
In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly i... more In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using batteryenabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes he...
Natural Language Processing (NLP) is a growing field in data analytics that is increasingly appli... more Natural Language Processing (NLP) is a growing field in data analytics that is increasingly applied in healthcare for assessment of patients’ electronic records or patients’ dialogues to unearth medical issues, emotions, or cognition. Meanwhile, active research is taking place in the use of sensors and wearables in tracking patient phenotypes and physiologic status in diagnosis and management of diseases. This paper’s central purpose is to explore how natural language processing can be combined with wearables in healthcare, and how this approach can advance health service delivery and health system transformation. Our recommendations are to stimulate interest and lower barriers in order to implement this novel combination of solutions in healthcare industries, and to do so in consideration of various technical and ethical concerns.
Background Depression has a profound impact on population health. Although using web-based mental... more Background Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e–mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Interventi...
have received personal fees from HealthLink BC for work done as HEiDi virtual physicians during t... more have received personal fees from HealthLink BC for work done as HEiDi virtual physicians during the course of the study. Kendall Ho has also received grants from HealthLink BC and the BC Joint Standing Committee on Rural Issues, Rural Coordination Centre of BC.
Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares t... more Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and ...
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
As generalists, emergency practitioners face challenges in providing state-of-the-art care owing ... more As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Netwo... more Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the…
British Columbia falls short in uptake of recommended clinical prevention services, with even low... more British Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia. We used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results. Sixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or commu...
Introduction: Diabetes mellitus affects over 2.7 million Canadians, with 90% being Type-2 diabete... more Introduction: Diabetes mellitus affects over 2.7 million Canadians, with 90% being Type-2 diabetes (CDA 2010). Complications of diabetes are major causes for emergency department (ED) visits, adversely affecting patients’ health and costing the health system. Improving diabetes self-management can lead to avoidance of ED visits and revisits after discharge. Recent developments in mobile Health (mHealth), such as home health monitoring with sensors, social media, and text messaging, have shown promise in supporting patients in chronic disease self-management. This project tested the feasibility of these tools to support self-management for people with type-2 diabetes. Methods: Forty-three people with type-2 diabetes took part in a three month program that provided: health information via text messages, online access to curated resources and a facilitated discussion board, and access to wireless monitoring devices. Participants were outfitted with a wireless blood pressure monitor and...
Major depression is a prevalent mental disorder and imposes considerable burden on health and pro... more Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs. The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%), and "having access to quality information and resources about work stress issues" (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's…
Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012
Health professionals' use of social media and Web 2.0 technologies are emerging as a new area... more Health professionals' use of social media and Web 2.0 technologies are emerging as a new area of research. We present the experiences of a province-wide network in Canada that was developed using such technologies as a means to increase nurses' capacity in nursing health services research. Our network is based on a model of electronic communities of practice (eCoPs). Network evaluation affirms that nurses do respond to social media, as membership has grown to over 1,400 members in two years. Approaches used for network development and implementation are discussed, and the network's eHealth eCoP is presented as a case of network activities and directions.
To assess medical students' self-reported preparedness to provide care to ethnic minorities, ... more To assess medical students' self-reported preparedness to provide care to ethnic minorities, factors that influence preparedness, and attitudes toward cultural competency training. A cross-sectional study, which invited University of British Columbia medical students to participate in a survey on student demographics, knowledge and awareness, preparedness and willingness, and personal attitudes. Of 1024, eligible, 301 students consented to study. Students across all year levels felt significantly less ready to provide care for non-English speaking Chinese patients compared to "any" patients. Proficiency in working with interpreters was correlated with readiness, OR 4.447 (1.606-12.315) along with 3rd and 4th year level in medical school, OR 3.550 (1.378-9.141) and 4.424 (1.577-12.415), respectively. Over 80% of respondents reported interest in learning more about the barriers and possible ways of overcoming them. More opportunities for cultural competency training in t...
Background: Globally, the incidence of sexually transmitted infections (STI) is rising, posing a ... more Background: Globally, the incidence of sexually transmitted infections (STI) is rising, posing a challenge to its control and appropriate management. Text messaging has become the most common mode of communication among almost six billion mobile phone users worldwide. Text messaging can be used to remind patients about clinic appointments, to notify patients that it is time for STI re-testing, and to facilitate patient communication with their health professionals with any questions and concerns they may have about their sexual health. While there are a handful of systematic reviews published on short message service (SMS) interventions in a variety of health settings and issues, none are related to sexual health. We plan to conduct a systematic review to examine the impact text messaging might have on interventions for the prevention and care of patients with STIs. Methods/Design: Eligible studies will include both quantitative and qualitative studies published after 1995 that discuss the efficacy and effectiveness of SMS interventions for STI prevention and management using text messaging. Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Inter-rater reliability scores will be obtained to ensure consistency in the inclusion and data extraction of studies. Heterogeneity will be assessed using the I 2 test and subgroup analyses. A nonhypothesis driven inductive reasoning approach as well as a coding framework will be applied to analyze qualitative studies. A meta-analysis may be conducted if sufficient quantitative studies are found using similar outcomes. Discussion: For this protocol, we identified ten related systematic reviews. The reviews were limited to a particular disease or setting, were not exclusive to SMS interventions, or were out of date. This systematic review will be the first comprehensive examination of studies that discuss the effectiveness of SMS on multiple outcomes that relate to STI prevention and management, covering diverse settings and populations. Findings of the systematic review and any additional meta-analyses will be published and presented to our key knowledge users. This information will provide the evidence that is required to appropriately adopt text messaging into standard practice in STI care.
Proceedings of second ACM SIGMM workshop on Social media - WSM '10, 2010
Social network services are becoming increasingly popular, and people are using these networks to... more Social network services are becoming increasingly popular, and people are using these networks to obtain and share information. The application of social network and social media to the collection, storage and review of personal information presents opportunities for improved personal health management. This paper presents a survey of the literature on the models for the use of online social networks and models for health behavior change. These are then combined to present a framework for health behavior change through social media. This framework is then used to develop a prototype for the system design.
Emergency medicine departments within several organizations are now advocating the adoption of ea... more Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and national level to establish a template for policy makers from other jurisdictions to translate knowledge into action for EDs. This research study will employ the IHI model for improvement, incorporate the principles of participatory action research, and use the E2E online CoP to engage ED practitioners (eg, physicians, nurses, and administrators, exchanging ideas, engaging in discussions, sharing resources, and
Revista panamericana de salud pública = Pan American journal of public health
The health of people living in the Region of the Americas has experienced noteworthy improvements... more The health of people living in the Region of the Americas has experienced noteworthy improvements over the past several decades. However, several critical goals remain unmet. Considerable challenges persist in both communicable and non-communicable diseases; in particular, marked increases in obesity, diabetes, cardiovascular diseases, and cancer, and the continued impact of diseases such as tuberculosis, dengue, and malaria. Suboptimal levels of maternal and child health, insufficient human and infrastructure resources, and wide geographical and cultural differences add further complexity to the situation in the Region. The availability of health services and health-related information varies greatly across communities, geographic areas, and countries, impeding universal access to health services and decreasing the quality of care. These differences are determined by a combination of geographical barriers and other social determinants of health, as well as policy processes and decisions. Viewing the glass as half-full, the spread and uptake of information and communications technologies (ICT) have the potential to level the playing field by reducing some of these barriers and enabling information-sharing that will assist in equalizing these differences. Many ICT systems and devices, initially expensive and of limited dissemination, have become affordable and are widely used across many levels of society. The World Health Organization (WHO) defines eHealth as "cost-effective and secure use of information and communication technologies in support of health and health-related fields" (1). Today, ICT are present in arguably all aspects of health and healthcare, making it of critical importance to gain a deeper understanding of how they can transform health services and the broader health systems in which they are embedded. The Pan American Health Organization (PAHO), through its Strategy and Plan of Action on eHealth (2), promotes improving public health in the Region through innovative ICT tools and methodologies that favor the extension of universal health coverage and help to build societies that are more informed, equitable, competitive, and democratic. There are multiple examples of how using eHealth in health systems can address the growing demand for better quality and more accessible and affordable health services. eHealth can facilitate access to services and to health information in remote areas through telehealth; it can enhance the exchange of information and health data among systems through standards and interoperability; it can capture medical information in a health record to improve efficiency and continuity of care; it can allow secure, remote access to patients' electronic health records; it can help monitor and report diseases more frequently and with reduced latency in the system through the use of mobile devices; it can address challenges in the skilled health workforce by offering continuing education through virtual education platforms; and it can promote the search for and sharing of information among different individuals and groups through forums and other social networks accessible via the Internet and other communication channels. Considering the importance of the aforementioned trends and the potential of eHealth to strengthen health systems, this special issue of the Pan American Journal of Public Health on "eHealth in the Americas" aims to reflect the range of enabling factors, practical applications, and outcomes related to using ICT in health. The diverse collection of contributions shows how a variety of eHealth interventions and policies address specific diseases, such as cancer, obesity, diabetes, depression, and lupus, among others, in addition to showing the important role that governments and other actors play in this process of change.
Uploads
Papers by Kendall Ho