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Artificial intelligence governance framework for healthcare. 医疗保健领域的人工智能治理框架。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-29 DOI: 10.1177/08404704241291226
Masooma Hassan, Elizabeth M Borycki, Andre W Kushniruk

Recent advancements in the field of Artificial Intelligence (AI) provide promising applications of this technology with the aim of solving complex healthcare challenges. These include optimizing operational efficiencies, supporting clinical administrative functions, and improving care outcomes. Numerous AI models are validated in research settings but few make their way into useful applications due to challenges associated with implementation and adoption. In this article, we describe some of these challenges, along with the need for a facilitating entity to safely translate AI systems into practical use. The authors propose a new AI governance framework to enable healthcare organizations with a mechanism to implement and adopt AI systems.

人工智能(AI)领域的最新进展为这项技术的应用提供了广阔的前景,其目的是解决复杂的医疗保健挑战。这些挑战包括优化运营效率、支持临床管理职能和改善护理效果。许多人工智能模型已在研究环境中得到验证,但由于实施和采用方面的挑战,很少有人工智能模型能得到有用的应用。在本文中,我们描述了其中的一些挑战,以及需要一个促进实体来安全地将人工智能系统转化为实际应用。作者提出了一个新的人工智能治理框架,为医疗机构提供了一个实施和采用人工智能系统的机制。
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引用次数: 0
Considerations for emergency department virtual triage. 急诊科虚拟分诊的注意事项。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-11-08 DOI: 10.1177/08404704241298643
Laila Nasser, Emily Morris, Irene Mathias, Justin N Hall

Health leaders are increasingly interested in harnessing Artificial Intelligence (AI) to remotely conduct virtual triage for Emergency Department (ED) patients. This study explores equity considerations and patient attitudes to virtual triage in a Canadian ED. A cross-sectional study surveyed 150 ED patients, with 32 additional patients interviewed in-depth. Descriptive statistics and qualitative descriptive methodology were employed: 84.7% of patients would consider virtual triage, 71.3% were comfortable following advice to seek alternate care, including their General Practitioner or virtual ED. Approximately 38.2% of patients >60 years would require assistance using virtual triage, with confidence in using technology to direct care decreasing with age. Thematic analysis revealed five key themes: value of decision support; care access expectations; technological literacy demographics; trust in AI; and confidentiality. In conclusion, virtual triage is a viable and promising tool if barriers to technological literacy are addressed, and tools are endorsed by health providers and patients.

医疗领导者对利用人工智能(AI)远程对急诊科(ED)患者进行虚拟分诊越来越感兴趣。本研究探讨了加拿大一家急诊室对虚拟分诊的公平性考虑和患者态度。这项横断面研究调查了 150 名急诊室患者,并对另外 32 名患者进行了深入访谈。研究采用了描述性统计和定性描述方法。84.7%的患者会考虑使用虚拟分诊。71.3%的患者愿意听从建议寻求其他医疗服务,包括全科医生或虚拟急诊室。年龄大于 60 岁的患者中约有 38.2% 需要虚拟分诊的帮助,使用技术指导护理的信心随年龄增长而降低。主题分析揭示了五个关键主题:决策支持的价值;获得护理的期望;技术知识人口统计学;对人工智能的信任;保密性。总之,如果能解决技术素养方面的障碍,并得到医疗服务提供者和患者的认可,虚拟分诊是一种可行且前景广阔的工具。
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引用次数: 0
From fragmentation to functionality: Enhancing coherence of digital health integration in health systems. 从分散到功能:加强卫生系统数字卫生整合的一致性。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-28 DOI: 10.1177/08404704241294255
Samuel Petrie, Shelley McLeod, Kendall Ho

Digital health programs continue to be implemented within Canadian health systems at a steady pace. The effectiveness of digital health initiatives has been rigorously analyzed, with both benefits and drawbacks extensively commented on. While the discussion about digital health continues, both positive and negative perspectives of it are approaching saturation in their themes. Accepting that digital health is here to stay post-pandemic, the focus should shift to strategies and supports needed to avoid the fragmentation of care through digital health implementation. This short article poses three questions which policy-makers and decision-makers should explore as part of a level-setting exercise with involved stakeholders at the outset of a digital health program's consideration. An implementation team should design the digital health program to have equity as its foundational focus, conduct value-based evaluations, and position the program in a learning health system framework to guard against the fragmentation of care.

数字医疗计划继续在加拿大医疗系统内稳步实施。人们对数字医疗计划的有效性进行了严格的分析,并对其优点和缺点进行了广泛的评论。虽然有关数字医疗的讨论仍在继续,但其正面和负面观点的主题都已接近饱和。既然数字医疗在大流行后会继续存在,那么重点就应该转移到通过实施数字医疗来避免医疗服务碎片化所需的战略和支持上。这篇短文提出了三个问题,政策制定者和决策者在开始考虑数字医疗项目时,应与相关利益方共同探讨这些问题。实施团队在设计数字医疗项目时,应将公平性作为其基础重点,开展基于价值的评估,并将项目定位在学习型医疗系统框架内,以防止医疗服务碎片化。
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引用次数: 0
Unlocking the potential: Responsibly embracing artificial intelligence to advance the use of health data and analytics at the Canadian Institute for Health Information. 释放潜能:加拿大健康信息研究所(Canadian Institute for Health Information)以负责任的方式利用人工智能推进健康数据和分析的使用。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-10 DOI: 10.1177/08404704241271196
Shez Daya, Babita Gupta, Nasir Kenea

Canadian Institute for Health Information (CIHI) is looking to modernize and adopt new ways of working. This incudes the use of new technology, including the application of Artificial Intelligence (AI). To begin in a purposeful manner, the organization developed an AI strategy which was informed through feedback from key stakeholders and partners, from its staff and from a review of international research. The research informed several ways AI could add value to CIHI's internal operations and to the external role CIHI could play in advancing responsible AI adoption in health systems across Canada. This article describes the strategy development process and the areas of focus within the strategy.

加拿大卫生信息研究所(CIHI)正在寻求现代化和采用新的工作方式。这包括使用新技术,包括应用人工智能(AI)。为了以一种有目的的方式开始,该组织制定了一项人工智能战略,该战略是通过主要利益相关者和合作伙伴、其员工的反馈以及对国际研究的审查而得出的。这项研究为人工智能如何为 CIHI 的内部运营以及 CIHI 在推动加拿大各地医疗系统负责任地采用人工智能方面所能发挥的外部作用增添价值提供了依据。本文介绍了该战略的制定过程和重点领域。
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引用次数: 0
Mapping the landscape of front door frailty in the United Kingdom: Lessons for further afield. 绘制英国前门虚弱状况图:为更远的地方提供借鉴。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-28 DOI: 10.1177/08404704241293317
Elinor Burn, Amy Armstrong, Natalie Offord

The ageing global population is posing a significant challenge to healthcare systems worldwide. Healthcare needs have become more complex and the demand for services is ever increasing. Identification of frailty at the front door of hospitals can prompt comprehensive geriatric assessment and streamline patients to the most suitable clinical area. The United Kingdom has set a priority to develop front door services given the pressure on the National Health Service. A British Geriatrics Society survey has demonstrated that the majority of frailty assessments occur in the emergency department using the Clinical Frailty Scale. This survey prompted the creation of the setting up services guide and its key principles using a collaboration of experience from across the country. Understanding the systems that already exist and creating a network to enable a flow of care towards community teams is crucial to the successful provision of modern frailty attuned care.

全球人口老龄化正在给全世界的医疗保健系统带来巨大挑战。医疗保健需求变得更加复杂,对服务的需求也与日俱增。在医院前门识别虚弱状态可以促使进行全面的老年病学评估,并将病人分流到最合适的临床区域。鉴于国民健康服务的压力,英国已将发展前门服务列为优先事项。英国老年医学会的一项调查显示,大多数虚弱评估都是在急诊科使用临床虚弱量表进行的。这项调查促使我们利用全国各地的合作经验,制定了服务设立指南及其主要原则。了解现有的系统并创建一个网络,使医疗服务流向社区团队,是成功提供现代体弱护理的关键。
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引用次数: 0
Medical silos, social identity, and duty of care: A call for health leaders to improve transitions of care. 医疗孤岛、社会身份和护理责任:呼吁医疗领导者改善护理过渡。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-18 DOI: 10.1177/08404704241290689
Francis Bakewell

This article explores the concept of medical silos, particularly within hospital systems, and examines their deeper roots in social identity and the fiduciary duty of care of healthcare providers. While traditional perspectives focus on informational and communication barriers, this analysis highlights how professional identity and moral obligations contribute to the persistence of silos. Social identity theory reveals that strong in-group affiliations, formed during medical training and specialization, fosters collaboration within groups but also create divisions between them. Similarly, the fiduciary duty of care, central to ethical medical practice, may inadvertently reinforce silo boundaries in resource-limited environments. By emphasizing the role of centralized leadership, the article proposes that health system managers and leaders, with the broadest possible duty of care, must take action to dismantle these barriers. Recommendations include re-evaluating policies for patient transitions and fostering integrated care pathways to improve overall system flow, rather than simply balancing the agendas of stakeholders within their silos.

本文探讨了医疗孤岛的概念,尤其是医院系统内的医疗孤岛,并研究了医疗孤岛在社会认同和医疗服务提供者的信托责任中的深层根源。传统观点侧重于信息和沟通障碍,而本文的分析则强调了职业认同和道德义务是如何导致医疗孤岛持续存在的。社会认同理论揭示了在医疗培训和专业化过程中形成的强烈的群体内从属关系,这种从属关系促进了群体内部的合作,但也造成了群体之间的分裂。同样,在资源有限的环境中,作为医疗实践道德核心的受托照护责任可能会无意中强化孤岛界限。文章通过强调集中领导的作用,提出医疗系统的管理者和领导者必须承担起最广泛的关怀责任,采取行动消除这些障碍。建议包括重新评估病人转院政策和促进综合护理路径,以改善整个系统的流程,而不是简单地平衡各利益相关方在各自筒仓内的议程。
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引用次数: 0
The power of partnership: Strategies for pan-Canadian spread and scale of paramedics providing palliative care. 伙伴关系的力量:在全加拿大推广和扩大提供姑息关怀的辅助医务人员的战略。
Q3 Medicine Pub Date : 2025-03-01 Epub Date: 2024-10-28 DOI: 10.1177/08404704241293299
Alix Carter, Cheryl Cameron, Danielle Stennett, Marianne Arab, Shaw-Moxam Raquel, Andrea C Coronado, Charlotte Pooler

Paramedics and Palliative Care is an example of a promising practice ("pilot") that underwent successful spread and scale across Canada. Through the support of two pan-Canadian health organizations and concurrent evolution of the profession of paramedicine, this innovation has become integrated into practice. Evaluation of the innovation sites showed positive impact in all elements of the Quintuple Aim, and data from the expansion sites mirrors this success. Paramedic comfort and confidence is improved. Patient and family satisfaction is high. Quality indicators such as time spent at home, and home deaths, improved after program launch. There are time and cost savings with the program in place. The framework that enabled this spread and scale is presented and elaborated, to support further uptake of this innovation and provide a blueprint for successful expansion of other promising practices to support healthcare improvement across Canada.

辅助医务人员和姑息关怀是一个很有前途的实践("试点")范例,它在加拿大各地成功推广并扩大了规模。通过两个泛加拿大卫生组织的支持和辅助医疗专业的同步发展,这一创新已融入实践。对创新点的评估显示,五重目标的所有要素都产生了积极影响,扩展点的数据也反映了这一成功。辅助医务人员的舒适度和信心得到提高。病人和家属的满意度很高。计划启动后,在家中度过的时间和家中死亡人数等质量指标都有所改善。该计划的实施节省了时间和成本。本报告介绍并详细阐述了促成这一推广和规模化的框架,以支持进一步采用这一创新方法,并为成功推广其他有前途的做法提供蓝图,从而支持在加拿大全国范围内改善医疗保健服务。
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引用次数: 0
Trust, technocracy, and the public servant's bargain: The evolving role of Canadian health leaders post-COVID.
Q3 Medicine Pub Date : 2025-02-21 DOI: 10.1177/08404704251320301
Jared Wesley, Samuel Goertz

Public servants are central in helping Canadians navigate public health crises. Before, during, and after the COVID-19 pandemic, these professionals have been essential to implementing widespread government interventions, sometimes amid significant public scrutiny. These experiences highlight the delicate balance public health officials maintain in a democracy: providing expert advice to cabinet to define the public good and implementing decisions to help preserve public health. Notwithstanding varying scopes for autonomous decision-making, chief medical officers of health aid elected officials in weighing tradeoffs in the pursuit of communal objectives, not by dictating them but by enabling informed decision-making. In recent years, there have been calls for public health officials to substitute their judgement for that of elected officials in issuing directives. This article explores the role of public health officials as public servants and the perils of these officials misunderstanding their roles which may undermine the effectiveness and legitimacy of policy decisions.

公务员是帮助加拿大人应对公共卫生危机的核心力量。在 COVID-19 大流行之前、期间和之后,这些专业人员在实施广泛的政府干预措施方面发挥了至关重要的作用,有时还受到公众的高度关注。这些经历凸显了公共卫生官员在民主社会中保持的微妙平衡:既要向内阁提供专家建议以确定公共利益,又要执行决策以帮助维护公众健康。尽管自主决策的范围不尽相同,但卫生部门的首席医疗官帮助民选官员在追求公共目标的过程中权衡利弊,而不是对其发号施令,而是促成知情决策。近年来,有人呼吁公共卫生官员在发布指令时用自己的判断取代民选官员的判断。本文探讨了公共卫生官员作为公仆的角色,以及这些官员误解自己角色的危险性,这可能会损害政策决定的有效性和合法性。
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引用次数: 0
Improving patient engagement in mental health: Exploring the potential of pre-visit notes in Canadian care settings. 提高患者对心理健康的参与度:探索加拿大医疗机构中就诊前记录的潜力。
Q3 Medicine Pub Date : 2025-02-10 DOI: 10.1177/08404704251316424
Karishini Ramamoorthi, Iman Kassam, Brian Lo, Sarah Kimball, Gillian Strudwick

OurNotes is a movement that advocates for patient engagement by encouraging patients to contribute to their care through a pre-visit note, where they can comment on their health progress and prioritize topics for discussion with their clinicians. To date, pre-visit notes have been implemented in primary and acute care settings internationally, and their reception has generally been positive. However, their use in Canada and in mental health settings is limited. To address this gap, we conducted semi-structured interviews with 26 mental health clinicians, patients, and care partners. Barriers, facilitators, and recommendations to implementing pre-visit notes in Canadian mental health settings were identified. Overall, clinicians, patients, and care partners had positive perceptions towards pre-visit notes, indicating that they may serve as an innovative model for improving patient engagement and satisfaction in mental health settings. The barriers and facilitators identified, provide guidance for mental health organizations considering the implementation of pre-visit notes.

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引用次数: 0
Implementing the pillars of value-based care: Leadership lessons from the CIUSSS Centre Ouest de l'Ile de Montreal.
Q3 Medicine Pub Date : 2025-02-07 DOI: 10.1177/08404704251317872
Jennifer Gutberg, Erin Cook, Lawrence Rosenberg

The Canadian healthcare landscape is characterized by its ambitious pursuit of innovation in response to challenges such as resource limitations and system restructuring. However, meaningful innovations cannot be sustained without leadership that empowers a patient-first integrated model of care. This article will explore the transformative changes of CIUSSS Centre Ouest de l'Île de Montréal directed to implanting the pillars of a value-based health system. We showcase our "Hospital-at-Home" program as an example to highlight the critical role of leadership in setting our vision of "Care Everywhere," empowering our healthcare workforce, and in ensuring successful implementation and sustainment. Our manuscript aims to provide insights into the leadership strategies that have underpinned these achievements, focusing on how these innovations have anticipated emerging healthcare demands, and highlighting a sustainable model for health leaders and policy-makers who are addressing similar challenges.

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引用次数: 0
期刊
Healthcare Management Forum
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