Vision 2040

The BC Rural Health Network (the BCRHN) is the healthcare voice for all rural residents of British Columbia. 

BCRHN’s focus is on reaching all rural residents, hearing their needs, celebrating their successes, and assisting them with access to information, programs, and care. The BCRHN is focused on the rural resident and is both located in and connected throughout, rural British Columbia. Through efficient communications, broad provincial reach, volunteer driven community connections, sharing successes and open communications with all governments, it is possible for the BCRHN to reach a specific rural community or the entire province with timely information and responses.

The Network improves: 

  • rural health outcomes in a changing environment through accurate and timely information provision
  • general healthcare information access
  • senior care information and programming
  • creation of community centric care groups
  • interagency communications with other NGOs
  • mental health awareness and programming access
  • access to information from governments and healthcare providers
  • access to programs that benefit the rural resident’s wellness
  • access to science pertinent to the rural resident that is accurate and approved by authorities
  • access to the rural resident generally 
  • access to governments generally
  • assistance to scientists and universities in accessing rural residents to identify determinants of rural healthcare impacts on the rural resident
  • identification of rural health needs specific to rural life
  • support for scholarship and education in rural healthcare fields

The BCRHN inter-connects directly with all member groups and with all governments. Open lines of communication are established and functional within the BCRHN ensuring the resident is receiving accurate information and the governments are aware of the impacts and benefits their decisions have in rural BC. 

The BCRHN has community level memberships throughout BC, made up of municipalities and community healthcare organizations. The BCRHN has Network location hubs in each rural Health Service Delivery region allowing for information provision to specific locations with similar population densities and areas. Eventually, there are 12 BCRHN location hubs, all with similar facilities and office spaces.  Each of these facilities is capable of being a HQ of operations. 

The Board of Directors is a sophisticated, diverse group, who live in and are representative of, rural BC residents. The BCRHN has deep committee representation which includes government representatives, academics, First Nations, medical practitioners, and other community leaders. All committees are active and are included in policy meetings with governments. The BCRHN is the agent for the BC rural residents’ healthcare interests. 

Implementing and evaluating co-design. A step-by-step toolkit

Co-design is when an organisation and its stakeholders work together to design or rethink a service. As an approach it sits midway between consultation and fully user-led projects.

We [New Philantropy Capital] are pleased to offer this toolkit, in which we explore what co-design is and why it matters. Our five-stage process offers a roadmap for planning and implementing your co-design, with tips and tools for each of the five stages. We also explore how you can assess the outcomes of your co-design and the quality of your processes, and how to review and learn from the data.

We have written this with service delivery organisations in mind, but you can apply these principles to any organisation looking to start or improve its co-design.

Michelle Man, Thomas Abrams, Rosie McLeod
July 2019

[Excerpts] What is co-design?
Co-design is when an organisation and its stakeholders are involved in designing or rethinking a service. The central feature of any co-design process is how it recognises the agency of users, who are experts of their own experience. Organisations can provide ways for users to engage with each other as well as with staff, to communicate, be creative, share insights, and test out new ideas.

Co-design sits on a spectrum of ways in which users can be involved in service design and development, as shown in Figure 1.

Co-design is about more than just consultation and feedback. In co-design, your users will
actively identify the issues and potential solutions with you, rather than merely responding to what you have already set out for them.

What are the potential benefits of co-design?
There are many potential benefits to co-designing products and services, which reflect wider benefits to involving users in decisions. For example:
• For the participants involved: Co-design can create intrinsic positive benefits, as explored below.
• For organisations and their users: Co-design can be instrumental in creating better services, and better outcomes for users and organisations. There is widespread recognition that services co-designed with users are more likely to: be responsive to their needs and able to create the right conditions for engagement; facilitate openness and trust; and, ultimately, be effective.
• Morally, there is the argument that users should have a say in the decisions affecting them.
Other benefits will depend on the intended purpose of your co-design, and your reasons for choosing co-design as a way to involve your users.

CO-DESIGN: A FIVE-STAGE PROCESS

When planning and developing your co-design process, it is important to be clear about the purpose. For example, your objective may be to re-think an existing service to better reflect user needs, by their own report. Or a key priority could be achieving positive outcomes for participants, such as encouraging and empowering users to engage with specific activities. You may be seeking to strengthen relationships between staff and volunteers.
Ultimately, you need to know what you are trying to achieve to be able to monitor and understand if you are going in the right direction.


Figure 6 outlines a five-stage roadmap to co-design. In this section, we discuss how to approach and monitor each stage, along with links to useful tools. The five stages build on each other and the advice outlined in each stage applies to each successive stage as well. Remember that each stage relates to the co-design process, not the actual design and delivery of a service.

Stage 1: Set-up
The aim of this stage is to get your co-design off to a solid start:
• Engage participants. They should reflect your intended user groups and broader community.
• Be clear and collaborative in agreeing the intended aims and outcomes of the process, different levels of involvement, the scope of influence for participants, and how decisions will be made.
• Think about where participants may be able to take on new roles to develop skills or contribute beyond their “day job”.


Tips and things to monitor:
• Define your scope and approach: What do you want your co-design to achieve? Are there limitations? Discuss potential disagreements, seek common ground, and try to agree both with your participants.
• Set clear aims for the co-design process: Agree what your priorities are and how you’re going to assess progress. Choose simple metrics to review your performance against.
• Involve participants early in the co-design process: Don’t wait until you have a set of polished options. Involve participants in the development of ideas and approaches.
• Involve participants in decisions about what and how to evaluate. You could involve participants in deciding what it is you most need to learn, and what the intended outcomes should be. You could offer training to enable them to contribute to peer-to-peer research, such as facilitating group discussions. You could consider holding a session with users and participants to reflect on what the findings are saying.
• Consider how to support participation, particularly for those with special needs. Co-design is about encouraging and supporting people to engage and enabling them to participate in a way that suits them. Consider whether target participants have the information, skills, and confidence to participate, and whether there is anything you can do to improve this. It may be helpful to define clear boundaries and set realistic parameters, so all participants understand what is or isn’t possible within the context of the partnership.
• Ensure diversity and inclusivity: Seek a mix of participants with different kinds of knowledge (lived
experience, professional and specialist expertise). Try to recruit participants who reflect your target audience, not just those you currently support. Consider how to accommodate people’s availability and needs, for example by holding workshops on a weekend, and ensure venues are accessible to all. Monitor inclusivity and representativeness by tracking outputs such as: number of users and staff involved; range of participants (age/ethnicity/disability/gender); whether users are invited or volunteer to participate; and the percentage of users with access to training to develop their skills.
• Don’t focus too much on the long term at this stage. It’s challenging and resource-intensive to evaluate long-term impact. Instead, focus on the relationships and quality of setting you create for participants.

To access the toolkit, click on:  Implementing and evaluating co-design DOWNLOAD 

Genuine involvement requires a re-balance of decision-making power

New Philanthropy Capital

By Charlotte Lamb – 

November 22, 2021

[Excerpts from New Philanthropy Capital (NPC)] As we explore building back better after the pandemic, we are thinking a lot about readdressing power imbalances and about diversity, equity, and inclusion. If we are to do this well, centring the voices of those with lived experience in our work is vital.

1. Lived expertise and professional expertise are valued equally and are used alongside impact data and  
    information about the wider system to inform strategic and operational decisions, at all levels.

2. Genuine co-creation and co-production is facilitated by true power sharing within and between
    organisations and supported by effective decision-making and governance processes.

3. There is a good understanding of the purpose and benefits of including those with lived experience in
    decision-making, and consequently, there is a desire to do this well across charities and funders.

4. Organisations have a strong understanding of what good involvement practice looks like for their
    organisation and are committed to implementing this to a high standard.

5. Boards take an evidence-led approach to decision-making—which includes lived experience, alongside
    professional expertise, impact data and information about the external environment.

We know that it can be hard to picture what genuine influence should look like in your organisation and the practicalities of it, and so it’s easy to feel stuck on how to take it forward. Often power imbalances and unclear accountability prevent meaningful user involvement—this is where it’s easy to fall into the practice of involving people in a tokenistic way. What’s more, having an outcome fixed before beginning the involvement process prevents any decision-making power from genuinely being shared. Re-balancing decision-making power requires a deep culture shift. 

Good co-production requires relationships and trust building, and this take time.

Good involvement practices are reinforced by better evidence of their efficacy and impact.

[….. ] for the voices of people with lived experience to be truly reflected, they must have a genuine influence on decisions and not just be giving feedback on your choices.

Read more at: https://www.thinknpc.org/blog/genuine-involvement-requires-a-re-balance-of-decision-making-power/

Canadian-developed screening test aims to detect early-stage cancer using blood samples

Tom Yun CTVNews.ca writer

Published November 28, 2021

TORONTO — The COVID-19 pandemic led to a surge in late-stage cancer diagnoses, with restrictions preventing or discouraging many from getting screened early. But a new screening technology developed by a Canadian company could make it easier to detect cancers earlier.

StageZero Life Sciences is a Richmond Hill, Ont.-based health care company that has developed a way to simultaneously screen for a wide variety of cancers using a single blood sample. Some of the cancers that StageZero can detect include breast, cervical, endometrial, prostate, liver, stomach, bladder and colorectal.

“We’re adding a whole series of additional ones. And as we continue to build out, we’ll continue to add to them,” StageZero Chairman and CEO James Howard-Tripp told CTV News Channel on Saturday.

The test uses mRNA technology to analyze gene signatures in the patient’s blood sample and cross-reference them with genetic profiles of individuals who have had cancer.

“We’ll take a sample of your blood and we then measure it to see whether it matches. Clearly, if it does that, we’re going to say with very high probability that you have (cancer),” said Howard-Tripp.

If mRNA sounds familiar, that’s because it’s the same technology that’s been used to develop the COVID-19 vaccines made by Pfizer and Moderna.

Howard-Tripp says the blood tests can detect cancers with 98 to 99 per cent accuracy at any stage, even in very early stages. If the blood test comes up as positive for a cancer, the patient would be advised to see a pathologist for a traditional lab test to confirm the diagnosis.

“We will always tell you that we’re not the definitive test. The definitive test is always a piece of tissue in front of the pathologist,” Howard-Tripp said.

Cancer is the leading cause of death in Canada. According to the Canadian Cancer Society, an estimated 229,200 new cancer cases and 84,600 cancer deaths are expected in 2021.

But being able to detect cancers in the earlier stages can significantly increase the likelihood of survival. For example, patients with colorectal cancers detected in stage one or two have a five-year survival rate of around 90 per cent, Howard-Tripp says.

“If you find it late, at stages three and four, you’ve got a 10 to 14 per cent chance of being alive in five year’s time. More than two-thirds of the time, colorectal cancer is found late,” he said.

Howard-Tripp says the pandemic has resulted in a “tsunami” of late-stage cancer diagnoses.

“COVID has had an absolutely massive impact on healthcare, because you don’t go and see your physician because of all the difficulties with it, unless you’re really ill. And at that point, you’re by and large symptomatic. If you are symptomatic, you’re by and large late stage,” he explained.

So far, StageZero’s blood tests have been made available in clinics in the Greater Toronto Area and parts of the United States. Howard-Tripp says anyone who is worried that they’re at a heightened risk of cancer due to age, heritage, family history or any other factors can get screened.

“It really is simply available to anyone that might have a concern,” he said.

Click on: Canadian-developed screening test aims to detect early-stage cancer using blood samples

Stigma Free Society

Overdose prevention sites provide wide range of health benefits: new research

[Excerpts] Published on December 2, 2021. 
The scaling-up of overdose prevention sites (OPS) in Vancouver beginning in December 2016 was associated with a range of health benefits, including an increase in engagement in addiction treatment, as well decreases in public injection and syringe sharing.

The findings from researchers with the BC Centre on Substance Use (BCCSU) and University of British Columbia (UBC) were published today [December 2, 2021] in the peer-reviewed journal Addiction.

They found that following the establishment and expansion of OPS:

  • Use of supervised consumption services immediately increased by more than 6% (from about 41% to 47%)
  • Addiction treatment participation immediately increased by nearly 5% (from about 65% to 70%)
  • Public injection immediately decreased by approximately 6% (from about 36% to 30%)
  • Syringe sharing immediately decreased by nearly 3% (from about 5% to 2%)

The findings build upon evidence that has shown that OPS and supervised consumption sites can reduce fatal overdose, reduce other causes of premature death, reduce transmission of infectious diseases like HIV and hepatitis C, support access to other health services, and improve the well-being of neighbourhoods by reducing public disorder.

“Overdose prevention sites are low-barrier settings that not only prevent overdose deaths, but also have the added benefit of bringing people into a supportive environment where they can get the help they need,” says lead author Dr. Mary Clare Kennedy, research scientist at the BCCSU. “Given the worsening of the drug poisoning crisis across the country, access to these services should be expanded.”

OPS provide access to a clean, safe space where drug consumption is witnessed and overdoses are responded to by teams of trained staff and peers.

“This research shows exactly what we are seeing on the frontline – that OPS save lives in so many ways,” says Sarah Blyth, a co-founder of the Overdose Prevention Society. “I hope this information helps guide government officials.”

The need for these services can be especially acute in more rural and remote communities, which lack many substance use services but still experience high rates of overdose.

Read more:

Source: https://www.bccsu.ca/blog/news-release/overdose-prevention-sites-provide-wide-range-of-health-benefits-new-research/

Is Apple Going Into Healthcare?


A 2021 Update

[Excerpts] “I do think there will be a day when people looking back will say Apple’s greatest contribution to the world was healthcare.” Tim Cook surprised most of his audience when he said this during the Time 100 Summit in 2019.

This article is a supplement to the content of our e-book, Tech Giants in Healthcare. It’s also the second entry to our new series that provides a snapshot of what a given tech giant is working on its way to disrupt healthcare. We first looked at the recent healthcare developments around Amazon which indicate the company’s bet on remote care and an aim to overhaul the pharmaceutical industry. 
For its part, Apple entered the healthcare market later than its competitors but is working on acquiring a significant share of the market. Are the recent developments indicative of Tim Cook’s statement? Let’s see the steps that the company is taking to reach that vision.

The Apple Watch phenomenon

According to Statista, Apple holds the largest share of the global smartwatch shipment market. In the first quarter of 2020, that accounted for a substantial 47.9% share of the market. The company has been heavily leveraging the popularity of its smartwatch for its healthcare plans.
Healthcare? There’s an app for that!
Source: https://www.apple.com/

Apple’s Health app aims to bridge patients and doctors, and all the data in-between. In early June, new features were announced for the app that further hammered in this aim. It already gathers health data from a user’s iPhone, Apple Watch and other apps to make them accessible in one place.

Healthcare? There’s an app for that!

Apple’s Health app aims to bridge patients and doctors, and all the data in-between. In early June, new features were announced for the app that further hammered in this aim. It already gathers health data from a user’s iPhone, Apple Watch and other apps to make them accessible in one place. 

Healthcare designed by Apple

Mid-June 2021, we [The Medical Futurist] got more details about Apple’s healthcare plans. It turns out that the tech giant does not plan to limit itself to smartwatches and apps; but also wants to provide a full-blown primary-care medical service of its own. The news came from an exclusive report by the Wall Street Journal that had access to insider contacts and documents.
Their medical service would be fully run by Apple with Apple-employed doctors working at Apple-owned clinics. To test this bold plan, the WSJ says the company took over employee health clinics near its headquarters that were previously run by a startup. It built a team of clinicians, engineers and product designers to test out its new health services in those clinics.

While the effort is ongoing and is at a preliminary stage according to the report, this would signify a radical move by a tech giant. And Apple has the resources to make such a move.

Click on: READ MORE or IS APPLE GOING INTO HEALTHCARE? to view the article.

What Does Synthetic Data Mean In Healthcare’s Artificial Intelligence Revolution?

[Excerpts] Data is the foundation of artificial intelligence. As the importance of A.I. grows in modern medicine, there’s a huge need for data (as well as data annotation) – the latter being one of the most important aspects of the work in building an algorithm. In healthcare, collecting data means utilising existing databases and using images, radiology results, samples, CT or MR scans, patient records and more. The more data you feed the system, the better the results can become.

It’s easy to guess that this data includes your own health-related data: EMRs, smartwatches, genetic reports, wearables and so on are all means to feed the A.I. with datasets. But what if we would never be able to obtain enough data to contribute to the progress of A.I. in healthcare? 

Why is data important in healthcare A.I.?

The biggest obstacle to A.I. is the inadequacy of the available data. Without patient data, there is no A.I. in healthcare. On one hand, the amount of data needed for effective algorithms in healthcare is crucial as a huge amount of data is needed to feed the algorithms. On the other hand, data needs to be annotated, drawing lines around tumours, pinpointing cells or designating ECG rhythm strips – that’s why the altruistic role of data annotators is so important.

Above all that, privacy concerns limit the amount of available data in medicine. Working with sensitive patient data is a tricky issue. It seems we cannot keep our privacy intact AND also benefit from A.I.’s advantages in our care. We saw in many cases how sensitive information can get leaked even unintentionally – and we are not even talking about hacking or privacy, just a poorly protected database. New methods like federated learning might make it possible to do this without breaching patients’ privacy, but its scope is limited.

That is where synthetic data could be of help. It can fill in the missing data, making it possible to produce entirely fabricated patient datasets that are just as useful for training A.I. as the real thing, while keeping patient data protected.

Hands-on use

Synthetic data already has a number of practical use cases. A group of researchers in Michigan have developed a computer vision model to help improve pathologist decision support to more accurately diagnose brain tumours. Their challenge was that if they wanted to use brain scans from other institutions, the algorithm’s efficiency dropped as it could not compare the different types of scans. 

Click on Synthetic Data if you would like to read more about privacy, quality and bias.