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15 records – page 1 of 1.

Integration of clinical practice guidelines with electronic medical records

https://policybase.cma.ca/en/permalink/policy10458

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health care and patient safety
Health information and e-health
Resolution
GC12-22
The Canadian Medical Association supports the integration of clinical practice guidelines with electronic medical records.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health care and patient safety
Health information and e-health
Resolution
GC12-22
The Canadian Medical Association supports the integration of clinical practice guidelines with electronic medical records.
Text
The Canadian Medical Association supports the integration of clinical practice guidelines with electronic medical records.
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Leadership training

https://policybase.cma.ca/en/permalink/policy10466

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health systems, system funding and performance
Health human resources
Resolution
GC12-37
The Canadian Medical Association will assess the leadership training physicians will find useful to become effective advocates for health care transformation.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health systems, system funding and performance
Health human resources
Resolution
GC12-37
The Canadian Medical Association will assess the leadership training physicians will find useful to become effective advocates for health care transformation.
Text
The Canadian Medical Association will assess the leadership training physicians will find useful to become effective advocates for health care transformation.
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Formal mentoring programs

https://policybase.cma.ca/en/permalink/policy10469

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC12-58
The Canadian Medical Association encourages the ongoing evaluation and enhancement of formal mentoring programs designed to optimize residency training experiences.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC12-58
The Canadian Medical Association encourages the ongoing evaluation and enhancement of formal mentoring programs designed to optimize residency training experiences.
Text
The Canadian Medical Association encourages the ongoing evaluation and enhancement of formal mentoring programs designed to optimize residency training experiences.
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Multiple chronic diseases

https://policybase.cma.ca/en/permalink/policy10470

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Physician practice/ compensation/ forms
Health human resources
Health systems, system funding and performance
Resolution
GC12-56
The Canadian Medical Association supports development of a curriculum to educate physicians and trainees in managing patients with multiple chronic diseases.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Physician practice/ compensation/ forms
Health human resources
Health systems, system funding and performance
Resolution
GC12-56
The Canadian Medical Association supports development of a curriculum to educate physicians and trainees in managing patients with multiple chronic diseases.
Text
The Canadian Medical Association supports development of a curriculum to educate physicians and trainees in managing patients with multiple chronic diseases.
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Transition of resident physicians into practice

https://policybase.cma.ca/en/permalink/policy10477

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC12-67
The Canadian Medical Association supports programs which facilitate the transition of resident physicians into practice.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC12-67
The Canadian Medical Association supports programs which facilitate the transition of resident physicians into practice.
Text
The Canadian Medical Association supports programs which facilitate the transition of resident physicians into practice.
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Disaster medicine

https://policybase.cma.ca/en/permalink/policy10510

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Resolution
GC12-89
The Canadian Medical Association calls for a national education and training strategy on disaster medicine.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Resolution
GC12-89
The Canadian Medical Association calls for a national education and training strategy on disaster medicine.
Text
The Canadian Medical Association calls for a national education and training strategy on disaster medicine.
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In-house duty call

https://policybase.cma.ca/en/permalink/policy10523

Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
GC12-79
The Canadian Medical Association supports the six recommendations pertaining to in-house duty call as put forward in a Canadian Association of Internes and Residents’ position paper, “Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours.”
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-08-15
Topics
Health human resources
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
GC12-79
The Canadian Medical Association supports the six recommendations pertaining to in-house duty call as put forward in a Canadian Association of Internes and Residents’ position paper, “Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours.”
Text
The Canadian Medical Association supports the six recommendations pertaining to in-house duty call as put forward in a Canadian Association of Internes and Residents’ position paper, “Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours.”
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Vision for e-Prescribing: a joint statement by the Canadian Medical Association and the Canadian Pharmacists Association

https://policybase.cma.ca/en/permalink/policy10670

Last Reviewed
2019-03-03
Date
2012-12-08
Topics
Health information and e-health
Pharmaceuticals/ prescribing/ cannabis/ marijuana/ drugs
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2012-12-08
Topics
Health information and e-health
Pharmaceuticals/ prescribing/ cannabis/ marijuana/ drugs
Text
Vision for e-Prescribing: a joint statement by the Canadian Medical Association and the Canadian Pharmacists Association By 2015, e-prescribing will be the means by which prescriptions are generated for Canadians. Definition e-Prescribing is the secure electronic creation and transmission of a prescription between an authorized prescriber and a patient's pharmacy of choice, using clinical Electronic Medical Record (EMR) and pharmacy management software. Background Health Information Technology (HIT) is an enabler to support clinicians in the delivery of health care services to patients. The Canadian Medical Association (CMA) and the Canadian Pharmacists Association (CPhA) each have identified e-prescribing as a key tool to deliver better value to patients. The integration of HIT into clinics and health care facilities where physicians and pharmacists provide care is a priority for both associations1. As part of its Health Care Transformation initiative, the CMA highlighted the need to accelerate the introduction of e-prescribing in Canada to make it the main method of prescribing. In its policy on optimal prescribing the CMA noted that one of the key elements was the introduction of electronic prescribing. The CPhA, as part of its Blueprint for Pharmacy Implementation Plan, highlights information and communication technology, which includes e-prescribing, as one of five priority areas. We applaud the ongoing efforts of Canada Health Infoway, provinces and territories to establish Drug Information Systems (DIS) and the supporting infrastructure to enable e-prescribing. We urge governments to maintain e-prescribing as a priority and take additional measures to accelerate their investments in this area. It is our joint position that e-prescribing will improve patient care and safety. e-Prescribing, when integrated with DIS, supports enhanced clinical decision-making, prescribing and medication management, and integrates additional information available at the point of care into the clinical workflow. Principles The following principles should guide our collective efforts to build e-prescribing capability in all jurisdictions: * Patient confidentiality and security must be maintained * Patient choice must be protected * Clinicians must have access to best practice information and drug cost and formulary data * Work processes must be streamlined and e-prescribing systems must be able to integrate with clinical and practice management software and DIS * Guidelines must be in place for data sharing among health professionals and for any other use or disclosure of data * The authenticity and accuracy of the prescription must be verifiable * The process must prevent prescription forgeries and diversion * Pan-Canadian standards must be set for electronic signatures Benefits of e-Prescribing A number of these benefits will be realized when e-prescribing is integrated with jurisdictional Drug Information Systems (DIS). * Patients: o Improves patient safety and overall quality of care o Increases convenience for dispensing of new and refill prescriptions o Supports collaborative, team-based care * Providers: o Supports a safer and more efficient method of prescribing and authorizing refills by replacing outdated phone, fax and paper-based prescriptions o Eliminates re-transcription and decreases risk of errors and liability, as a prescription is written only once at the point-of-care o Supports electronic communications between providers and reduces phone calls and call-backs to/from pharmacies for clarification o Provides Warning and Alert systems at the point of prescribing, supporting clinician response to potential contraindications, drug interactions and allergies o Facilitates informed decision-making by making medication history, drug, therapeutic, formulary and cost information available at the point of prescribing * Health Care System: o Improves efficiency and safety of prescribing, dispensing and monitoring of medication therapy o Supports access to a common, comprehensive medication profile, enhancing clinical decision-making and patient adherence o Increases cost-effective medication use, through improved evidence-based prescribing, formulary adherence, awareness of drug costs and medication management o Improves reporting and drug use evaluation Challenges While evidence of the value of e-prescribing is established in the literature, its existence has not fostered broad implementation and adoption. In Canada, there are a number of common and inter-related challenges to e-prescribing's implementation and adoption. These include: * Improving access to relevant and complete information to support decision-making * Increasing the level of the adoption of technology at the point of care * Focusing on systems-based planning to ensure continuum-wide value * Integrating e-prescribing into work processes to gain support from physicians, pharmacists and other prescribers * Increasing leadership commitment to communicate the need for change, remove barriers and ensure progress * Updating legislation and regulation to support e-prescribing Enabling e-Prescribing in Canada CMA and CPhA believe that we can achieve the vision that is set out in this document and address the aforementioned challenges by working collectively on five fronts: * Health care leadership in all jurisdictions and clinical organizations must commit to make e-prescribing a reality by 2015 * Provinces and territories, with Canada Health Infoway, must complete the building blocks to support e-prescribing by increasing Electronic Medical Record (EMR) adoption at the point of care, finishing the work on the Drug Information Systems (DIS) in all jurisdictions and building the connectivity among the points of care and the DIS systems * Pharmacist and medical organizations in conjunction with provinces, territories and Canada Health Infoway must identify clear benefits for clinicians (enhancing the effectiveness of care delivery and in efficiencies in changing workflows) to adopt e-prescribing and focus their efforts on achieving these benefits in the next three years * Provinces, territories and regulatory organizations must create a policy/regulatory environment that supports e-prescribing which facilitates the role of clinicians in providing health care to their patients * Provinces and territories must harmonize the business rules and e-health standards to simplify implementation and conformance by software vendors and allow more investment in innovation. 1 Health Care Transformation in Canada, Canadian Medical Association, June 2010; Blueprint for Pharmacy Implementation Plan, Canadian Pharmacists Association, September 2009

Documents

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A Vision for Canada: Family Practice, The Patient’s Medical Home

https://policybase.cma.ca/en/permalink/policy10694

Last Reviewed
2019-03-03
Date
2012-12-08
Topics
Health human resources
Health systems, system funding and performance
Resolution
BD13-03-97
The Canadian Medical Association (CMA) endorses the report A Vision for Canada: Family Practice, The Patient’s Medical Home as outlined in Appendix A to BD 13-69.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2012-12-08
Topics
Health human resources
Health systems, system funding and performance
Resolution
BD13-03-97
The Canadian Medical Association (CMA) endorses the report A Vision for Canada: Family Practice, The Patient’s Medical Home as outlined in Appendix A to BD 13-69.
Text
The Canadian Medical Association (CMA) endorses the report A Vision for Canada: Family Practice, The Patient’s Medical Home as outlined in Appendix A to BD 13-69.
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A Collective Vision for Postgraduate Medical Education in Canada

https://policybase.cma.ca/en/permalink/policy10569

Last Reviewed
2018-03-03
Date
2012-05-25
Topics
Health human resources
Ethics and medical professionalism
Resolution
BD12-06-157
The Canadian Medical Association endorses A Collective Vision for Postgraduate Medical Education in Canada, the Future of Medical Education in Canada’s Postgraduate project report as outlined in Appendix A to BD 12-133
Policy Type
Policy resolution
Last Reviewed
2018-03-03
Date
2012-05-25
Topics
Health human resources
Ethics and medical professionalism
Resolution
BD12-06-157
The Canadian Medical Association endorses A Collective Vision for Postgraduate Medical Education in Canada, the Future of Medical Education in Canada’s Postgraduate project report as outlined in Appendix A to BD 12-133
Text
The Canadian Medical Association endorses A Collective Vision for Postgraduate Medical Education in Canada, the Future of Medical Education in Canada’s Postgraduate project report as outlined in Appendix A to BD 12-133
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Best practices for smartphone and smart-device clinical photo taking and sharing

https://policybase.cma.ca/en/permalink/policy13860

Date
2018-03-03
Topics
Health information and e-health
Ethics and medical professionalism
  1 document  
Policy Type
Policy document
Date
2018-03-03
Topics
Health information and e-health
Ethics and medical professionalism
Text
Clinical photography is a valuable tool for physicians. Smartphones, as well as other devices supporting network connectivity, offer a convenient, efficient method to take and share images. However, due to the private nature of the information contained in clinical photographs there are concerns as to the appropriate storage, dissemination, and documentation of clinical images. Confidentiality of image data must be considered and the dissemination of these images onto servers must respect the privacy and rights of the patient. Importantly, patient information should be considered as any information deriving from a patient, and the concepts outlined therefore apply to any media that can be collected on, or transmitted with, a smart-device. Clinical photography can aid in documenting form and function, in tracking conditions and wound healing, in planning surgical operations, and in clinical decision-making. Additionally, clinical photographs can provide physicians with a valuable tool for patient communication and education. Due to the convenience of this type of technology it is not appropriate to expect physicians to forego their use in providing their patients with the best care available. The technology and software required for secure transfer, communication, and storage of clinical media is presently available, but many devices have non-secure storage/dissemination options enabled and lack user-control for permanently deleting digital files. In addition, data uploaded onto server systems commonly cross legal jurisdictions. Many physicians are not comfortable with the practice, citing security, privacy, and confidentiality concerns as well as uncertainty in regards to regional regulations governing this practice.1 Due to concern for patient privacy and confidentiality it is therefore incredibly important to limit the unsecure or undocumented acquisition or dissemination of clinical photographs. To assess the current state of this topic, Heyns et al. have reviewed the accessibility and completeness of provincial and territorial medical regulatory college guidelines.2 Categories identified as vital and explored in this review included: Consent; Storage; Retention; Audit; Transmission; and Breach. While each regulatory body has addressed limited aspects of the overall issue, the authors found a general lack of available information and call for a unified document outlining pertinent instructions for conducting clinical photography using a smartphone and the electronic transmission of patient information.2 The discussion of this topic will need to be ongoing and it is important that physicians are aware of applicable regulations, both at the federal and provincial levels, and how these regulations may impact the use of personal devices. The best practices supported here aim to provide physicians and healthcare providers with an understanding of the scope and gravity of the current environment, as well as the information needed to ensure patient privacy and confidentiality is assessed and protected while physicians utilize accessible clinical photography to advance patient care. Importantly, this document only focusses on medical use (clinical, academic, and educational) of clinical photography and, while discussing many core concepts of patient privacy and confidentiality of information, should not be perceived as a complete or binding framework. Additionally, it is recommended that physicians understand the core competencies of clinical photography, which are not described here. The Canadian Medical Association (CMA) suggests that the following recommendations be implemented, as thoroughly as possible, to best align with the CMA policy on the Principles for the Protection of Patient Privacy (CMA Policy PD2018-02). These key recommendations represent a non-exhaustive set of best practices - physicians should seek additional information as needed to gain a thorough understanding and to stay current in this rapidly changing field. KEY RECOMMENDATIONS 1. CONSENT * Informed consent must be obtained, preferably prior, to photography with a mobile device. This applies for each and any such encounter and the purpose made clear (i.e. clinical, research, education, publication, etc.). Patients should also be made aware that they may request a copy of a picture or for a picture to be deleted. * A patient's consent to use electronic transmission does not relieve a physician of their duty to protect the confidentiality of patient information. Also, a patient's consent cannot override other jurisdictionally mandated security requirements. * All patient consents (including verbal) should be documented. The acquisition and recording of patient consent for medical photography/dissemination may be held to a high standard of accountability due to the patient privacy and confidentiality issues inherent in the use of this technology. Written and signed consent is encouraged. * Consent should be considered as necessary for any and all photography involving a patient, whether or not that patient can be directly recognized, due to the possibility of linked information and the potential for breach of privacy. The definition of non-identifiable photos must be carefully considered. Current technologies such as face recognition and pattern matching (e.g. skin markers, physical structure, etc.), especially in combination with identifying information, have the potential to create a privacy breach. * Unsecure text and email messaging requires explicit patient consent and should not be used unless the current gold standards of security are not accessible. For a patient-initiated unsecure transmission, consent should be clarified and not assumed. 2. TRANSMISSION * Transmission of photos and patient information should be encrypted as per current-day gold standards (presently, end-to-end encryption (E2EE)) and use only secure servers that are subject to Canadian laws. Explicit, informed consent is required otherwise due to privacy concerns or standards for servers in other jurisdictions. Generally, free internet-based communication services and public internet access are unsecure technologies and often operate on servers outside of Canadian jurisdiction. * Efforts should be made to use the most secure transmission method possible. For data security purposes, identifying information should never be included in the image, any frame of a video, the file name, or linked messages. * The sender should always ensure that each recipient is intended and appropriate and, if possible, receipt of transmission should be confirmed by the recipient. 3. STORAGE * Storing images and data on a smart-device should be limited as much as possible for data protection purposes. * Clinical photos, as well as messages or other patient-related information, should be completely segregated from the device's personal storage. This can be accomplished by using an app that creates a secure, password-protected folder on the device. * All information stored (on internal memory or cloud) must be strongly encrypted and password protected. The security measures must be more substantial than the general password unlock feature on mobile devices. * Efforts should be made to dissociate identifying information from images when images are exported from a secure server. Media should not be uploaded to platforms without an option for securely deleting information without consent from the patient, and only if there are no better options. Automatic back-up of photos to unsecure cloud servers should be deactivated. Further, other back-up or syncing options that could lead to unsecure server involvement should be ascertained and the risks mitigated. 4. Cloud storage should be on a Canadian and SOCII certified server. Explicit, informed consent is required otherwise due to privacy concerns for servers in other jurisdictions. 5. AUDIT & RETENTION * It is important to create an audit trail for the purposes of transparency and medical best practice. Key information includes patient and health information, consent type and details, pertinent information regarding the photography (date, circumstance, photographer), and any other important facts such as access granted/deletion requests. * Access to the stored information must be by the authorized physician or health care provider and for the intended purpose, as per the consent given. Records should be stored such that it is possible to print/transfer as necessary. * Original photos should be retained and not overwritten. * All photos and associated messages may be considered part of the patient's clinical records and should be maintained for at least 10 years or 10 years after the age of majority, whichever is longer. When possible, patient information (including photos and message histories between health professionals) should be retained and amalgamated with a patient's medical record. Provincial regulations regarding retention of clinical records may vary and other regulations may apply to other entities - e.g. 90 years from date of birth applies to records at the federal level. * It may not be allowable to erase a picture if it is integral to a clinical decision or provincial, federal, or other applicable regulations require their retention. 6. BREACH * Any breach should be taken seriously and should be reviewed. All reasonable efforts must be made to prevent a breach before one occurs. A breach occurs when personal information, communication, or photos of patients are stolen, lost, or mistakenly disclosed. This includes loss or theft of one's mobile device, texting to the wrong number or emailing/messaging to the wrong person(s), or accidentally showing a clinical photo that exists in the phone's personal photo album. * It should be noted that non-identifying information, when combined with other available information (e.g. a text message with identifiers or another image with identifiers), can lead to highly accurate re-identification. * At present, apps downloaded to a smart-device for personal use may be capable of collecting and sharing information - the rapidly changing nature of this technology and the inherent privacy concerns requires regular attention. Use of specialized apps designed for health-information sharing that help safeguard patient information in this context is worth careful consideration. * Having remote wipe (i.e. device reformatting) capabilities is an asset and can help contain a breach. However, inappropriate access may take place before reformatting occurs. * If a smartphone is strongly encrypted and has no clinical photos stored locally then its loss may not be considered a breach. * In the event of a breach any patient potentially involved must be notified as soon as possible. The CMPA, the organization/hospital, and the Provincial licensing College should also be contacted immediately. Provincial regulations regarding notification of breach may vary. Approved by the CMA Board of Directors March 2018 References i Heyns M†, Steve A‡, Dumestre DO‡, Fraulin FO‡, Yeung JK‡ † University of Calgary, Canada ‡ Section of Plastic Surgery, Department of Surgery, University of Calgary, Canada 1 Chan N, Charette J, Dumestre DO, Fraulin FO. Should 'smart phones' be used for patient photography? Plast Surg (Oakv). 2016;24(1):32-4. 2 Unpublished - Heyns M, Steve A, Dumestre DO, Fraulin FO, Yeung J. Canadian Guidelines on Smartphone Clinical Photography.

Documents

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Prelicensure clinical training programs

https://policybase.cma.ca/en/permalink/policy565

Last Reviewed
2017-03-04
Date
1987-08-25
Topics
Health human resources
Resolution
GC87-67
That provision should be made for enough flexibility within prelicensure clinical training programs to prepare physicians for a variety of practice situations in Canada (eg. rural, isolated, urban) without undue prolongation of the training period.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1987-08-25
Topics
Health human resources
Resolution
GC87-67
That provision should be made for enough flexibility within prelicensure clinical training programs to prepare physicians for a variety of practice situations in Canada (eg. rural, isolated, urban) without undue prolongation of the training period.
Text
That provision should be made for enough flexibility within prelicensure clinical training programs to prepare physicians for a variety of practice situations in Canada (eg. rural, isolated, urban) without undue prolongation of the training period.
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Specialty training for family medicine residents

https://policybase.cma.ca/en/permalink/policy572

Last Reviewed
2017-03-04
Date
1987-08-25
Topics
Health human resources
Resolution
GC87-66
That appropriate training in speciality areas of medicine be provided to family medicine residents within the existing two years of the residency training program where possible.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1987-08-25
Topics
Health human resources
Resolution
GC87-66
That appropriate training in speciality areas of medicine be provided to family medicine residents within the existing two years of the residency training program where possible.
Text
That appropriate training in speciality areas of medicine be provided to family medicine residents within the existing two years of the residency training program where possible.
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Confidentiality of medical records

https://policybase.cma.ca/en/permalink/policy598

Last Reviewed
2017-03-04
Date
1979-06-20
Topics
Health information and e-health
Ethics and medical professionalism
Resolution
GC79-2
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1979-06-20
Topics
Health information and e-health
Ethics and medical professionalism
Resolution
GC79-2
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
Text
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
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A Doctor for Every Canadian - Better Planning for Canada's Health Human Resources: The Canadian Medical Association's brief to the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities - Addressing Existing Labour Shortages in High-Demand Occupations

https://policybase.cma.ca/en/permalink/policy10387

Date
2012-05-09
Topics
Health human resources
  1 document  
Policy Type
Parliamentary submission
Date
2012-05-09
Topics
Health human resources
Text
The Canadian Medical Association (CMA) is pleased to present this brief for consideration by the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities as part of its current study, Fixing the Skills Gap: Addressing Existing Labour Shortages in High Demand Occupations. The health sector provides essential services and high value jobs supporting communities across Canada. Statistics Canada reports that employment in the health sector accounts for 10 per cent of the Canadian labour force.i Beyond the renewed commitment for the long-term fiscal arrangement for health care, Canada requires a pan-Canadian approach to health human resources planning to achieve self-sufficiency in health human resources. This submission focuses on physicians and proposes action at the federal level to begin to address specific shortages and ensure a needs-based specialty mix distribution and self-sufficiency for our country. Health Care Transformation In 2010, the CMA initiated a cross-country consultation with Canadians on the future of the health care system. Based on that input, the CMA, together with the Canadian Nurses Association, developed six principles to guide health care transformation. These principles have since been endorsed by over 100 medical, health and patient organizations. One of the principles is sustainability. Sustainable health care requires universal access to quality health services that are adequately resourced and delivered along the full continuum in a timely and cost-effective manner. Addressing health human resource shortages is critical to ensuring a sustainable, accessible and patient-centred health care system. The principles outline a vision to ensure adequate health human resources: health care will be delivered within collaborative practice models; pan-Canadian eligibility for licensure will support inter-provincial portability of all health care providers; and health human resource planning will align with communities in the short, medium and long term. In fulfillment of this vision, this submission will focus on: * Ensuring a needs-based specialty mix; * Targeting health infrastructure investment to optimize the supply of health human resources; and * Foreign credential recognition. Physician Shortages Canada's experience with physician shortages dates back to the mid-1990s following significant cuts to first-year medical school enrolment. While there have been substantial increases since then, it took a decade to rebound. In 2010, first-year enrolment stood at 2,830 - 80 per cent higher than the mid-1990s.ii Despite these significant gains, Canada's supply of physicians relative to our population is well below the Organization for Economic Co-operation and Development (OECD) average.iii Indeed, with the seventh-lowest supply of physicians per capita among OECD nations, Canada ranks below the European Union nations and the United States. Currently, between four million and five million Canadians do not have a family physician. Over one-third of all Canadian physicians are over the age of 55. Many will either retire soon or reduce their practice workload. Many physician practices are at capacity and unable to take on new patients. Findings from the CMA's 2012 survey of provincial-territorial medical associations (PTMAs) with respect to physician resources underscore the pressing need for a pan-Canadian approach to health human resources planning.iv While all jurisdictions in Canada are experiencing challenges, shortages by type of practice vary by jurisdiction. Issue 1: Needs-based Specialty Mix A sustainable health care system requires health human resource planning to ensure an appropriate specialty mix. At present, there is no pan-Canadian system to monitor or manage the specialty mix. The findings from the 2012 CMA survey of PTMAs revealed that only three jurisdictions have a long-term physician resource plan in place, while only one jurisdiction employs a supply and needs-based projection model. To illustrate the consequences of the lack of monitoring and management of the physician specialty mix, from 1988 to 2010, the numbers of post-graduate trainee positions in geriatric medicine were essentially constant at only 18 positions, while the number of trainees in pediatric medicine increased by 58 per cent.v It has been almost four decades since the federal government has completed a needs-based projection of physician requirements in Canada. The last federally commissioned study, the Report of the Requirements Committee on Physician Manpower to the National Committee on Physician Manpower, was published by the Minister of National Health and Welfare in 1975. Recommendation 1 The CMA recommends that the federal government, in collaboration with medical organizations, lead a benchmark study on the current specialty mix in Canada, as well as a supply and needs-based projection to support health human resources planning. Issue 2: Targeted Health Infrastructure Adequate health infrastructure is an important element in optimizing the capacity of health human resources. Health infrastructure shortages have been reported as a limiting factor on physician resources. For example, the recruitment of specialists and sub-specialists is being affected not by a lack of demand for their services, but, rather, by the limitations of existing hospital infrastructure, such as operating rooms. This too has been revealed by the CMA's 2012 survey of PTMAs. Ensuring there is sufficient health infrastructure to optimize the current capacity of health human resources would no doubt help address Canada's persistent problems with wait times. Recommendation 2 The CMA recommends that a targeted health infrastructure fund be established to address infrastructure shortages that prevent the optimization of health human resources and exacerbate wait times. Issue 3: Foreign Credential Recognition The CMA recognizes the federal government's commitment to address foreign credential recognition and that physicians are among the target group for 2012. The medical profession is well positioned to support the federal government's objective. Under the auspices of the National Assessment Collaboration, a group of federal, provincial and other stakeholders, the medical profession is currently working to streamline the evaluation process for international medical graduates (IMGs) licensure in Canada. Related to this effort, the pan-Canadian portable eligibility for licensure is an important issue in health human resources, especially for physicians. The CMA and the medical professional have been active in this important issue for many years. In 1992, the Federation of Medical Licensing Authorities of Canadavi adopted a national standard for portable eligibility for licensure. In 2009, the Federation of Medical Regulatory Authorities adopted an agreement on national standards for medical registration in Canada that reflects the revised labour mobility chapter of the Agreement on Internal Trade. FMRAC and the Medical Council of Canada are working on a one-stop process for IMGs to apply for licensure in Canada (with support from Human Resources and Skills Development Canada). The CMA fully supports bringing into practice qualified IMGs already in Canada. Canada has historically benefited from a steady flow of IMGs to our country. In fact, close to one-quarter of all physicians in Canada are IMGs. While IMGs may be seen as a key strategy to addressing shortages in Canada, actively recruiting from developing countries is not an acceptable solution to our physician shortage. Canada must strive for greater self-sufficiency in the education and training of physicians. In fact, self-sufficiency is a key principle of the Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources' Framework for Collaborative Pan-Canadian Health Human Resources Planning.vii Recommendation 3 The CMA recommends that the federal government continue to support the efforts of medical organizations to promote the pan-Canadian portable eligibility of licensure. Recommendation 4 The CMA recommends that the federal government continue to support efforts of medical organizations to streamline the process of credential verification and assessment of eligibility of licensure for IMGs. Conclusion Despite progress in addressing the shortage of physicians in Canada, serious challenges in health human resources persist. At present, few jurisdictions engage in health human resources planning. Further, despite changing shifting demographics, it has been almost four decades since the federal government has completed a study of physician requirements. Canada requires a pan-Canadian approach to ensure adequate health human resources in support of a sustainable health care system. Summary of Recommendations Recommendation 1 CMA recommends that the federal government, in collaboration with medical organizations, lead a benchmark study on the current specialty mix in Canada, as well as a supply and needs-based projection to support health human resources planning. Recommendation 2 The CMA recommends that a targeted health infrastructure fund be established to address infrastructure shortages that prevent the optimization of health human resources and exacerbate wait times. Recommendation 3 The CMA recommends that the federal government continue to support the efforts of medical organizations to promote the pan-Canadian portable eligibility of licensure. Recommendation 4 The CMA recommends that the federal government continue to support efforts of medical organizations to streamline the process of credential verification and assessment of eligibility of licensure for IMGs. i 2006 Census data ii Association of Faculties of Medicine of Canada. 2010. First Time Enrolment in Canadian Faculties of Medicine by Faculty of Medicine, 1994/95-2010/11. iii OECD. OECD Health Data 2011. Available at: http://www.oecd.org/document/60/0,3746,en_2649_33929_2085200_1_1_1_1,00.html iv CMA. Results of PTMA Physician Resource Interviews. v vi Since renamed the Federation of Medical Regulatory Authorities of Canada. vii Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources. 2009. How Many Are Enough? Redefining Self-Sufficiency for the Health Workforce A Discussion Paper.

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