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Published on: June 11, 2018 The Globe & Mail


Why are fax machines still the norm in 21st-century health care?

Two-thirds of Canadian doctors say their primary means of communication with other physicians is by fax.

Medical clinics in this country, on average, send and receive a mind-boggling 24,000 pages of faxed information annually. Only about one-third of family physicians and specialists e-mail their colleagues for clinical purposes, never mind patients.

These data, from a 2017 survey of clinicians by Telus Health, remind us that, in the digital age, health care continues to cling desperately to the facsimile machine, a clunky technology that most industries have long ago relegated to the scrap heap.

Health care is slow to change. Medicine has an intrinsic (verging on pathological) aversion to risk. If a bank introduces a new technology and it flops, that’s an inconvenience for customers; if a hospital does so, it can be deadly. The stakes are higher.

There is also an obsession with privacy, one that, time and time again, trumps convenience and even common sense.

The notion that paper-based records are somehow safer and more secure than electronic records beggars belief. Yet, rules and regulations still hold that a fax is a secure means of communication while e-mail is often not considered secure.

Then, there are the practical technological impediments to abandoning the fax.

The majority of primary care physicians – 77 per cent, according to Canada Health Infoway – uses electronic medical records to maintain clinical notes. But the systems they use come from a wide variety of vendors and are often unable to communicate with each other.

That means GPs often can’t send files to specialists, share imaging such as MRIs, or e-prescribe. (Almost half of prescriptions are still written by hand.) Sometimes, two departments within the same hospital can’t even communicate electronically.

Because of this lack of interoperability, most everyone falls back to the tried and true (and flawed) method, the fax. When you send a fax, it can lie around in the machine, which is a privacy issue; fax machines run out of paper, and don’t have much memory. To receive information, it has to be fed manually into a machine.

A new movie, Falling Through The Cracks: Greg’s Story, underscores some of these issues.

Greg Price was an Alberta man who was diagnosed with testicular cancer at age 30 and died of a blood clot a year later in May, 2012, after much bureaucratic bungling, including faxed referrals to specialists being lost and ignored.

In the movie, which is designed to teach medical students and practitioners about avoiding medical errors, the camera often zooms in ominously on the fax machine.

It should indeed be looked upon as an object of dread.

One study conducted in Hamilton, Ont., found that one in five faxed requests for consultations – notes sent from doctor to doctor – do not even get a response.

What makes Mr. Price’s story chilling is that it is not at all uncommon. Studies have shown, time and time again, that about half of all medical errors are the result of communication problems.

We owe it to ourselves to use state-of-the-art communication tools if we want to keep patients safe – if we want to avoid having them fall through the cracks.

It is all the more important in an age when many patients have multiple chronic illnesses and a variety of health care providers. Consider that the average frail elderly patient sees two GPs and five specialists in four different clinical settings, and their records are often still paper-based. The fact that their medical files are scattered about like seeds in the wind rather than in one central electronic medical record is unconscionable.

In this country, you can be rushed to the ER, and your family doctor will have no idea you have been there; if the ER wants records from your specialist, they will likely have to get them by fax, during daytime business hours; and, if they want to know your medication history, they likely will have no idea how to contact your pharmacist.

Billions and billions of dollars have been spent creating massive health information systems, but we still don’t have the basics down, such as a single electronic medical record (EMR) with a patient’s medical history, accessible to all appropriate health providers.

The technology exists. It’s affordable, and it’s essential. But to make way for the new, we have to usher out the old. Fax machines belong in a museum, not in 21stcentury medical practice.


Published on: February 18, 2018 The Vancouver Sun

Some facts about B.C.'s PharmaNet as a mother calls for better use of system

VANCOUVER — Some facts about PharmaNet, British Columbia’s unique network that records information about prescription medications:

— PharmaNet was launched by the Health Ministry in 1995 mostly as a billing system, but it became recognized as a valuable tool to access prescription records.

— PharmaNet has been available in emergency departments since the 1990s.

— The College of Physicians and Surgeons of British Columbia made its use compulsory in walk-in clinics and methadone clinics in 2016 after the province declared a public health emergency in response to increasing overdose deaths.

— Doctors say PharmaNet has great potential but an installation fee, monthly charges of about $10, and its time-consuming process are disincentives.

— The college says it is committed to making PharmaNet use mandatory for all doctors but the government must first enhance the system to allow for quick access.

— The Ministry of Mental Health and Addiction says as of December 2017, about 6,500 physicians working in private community practice were eligible for PharmaNet, but only 3,918 have access to the system. It says work is underway to develop an improved prescription monitoring program.

— Beth Sproule, a pharmacist and clinician scientist at the Centre for Addiction and Mental Health, says many provinces now have drug information systems but unlike PharmaNet, they do not provide real-time data to doctors: “The provinces are talking to each other, looking at best practices. There’s a lot of work going on, looking at the prescription monitoring side of things.”


Top 10 tips to protect your inbox, computer and mobile device

To some people, spam messages are simply a nuisance cluttering up their inboxes, but, spam messages can actually pose a real threat to your privacy. They can spread spyware and other types of malware, which can compromise your computer and mobile devices, and collect your personal information without your knowledge.  However, there are measures you can take to reduce the risk of:

  • Your email address being collected and targeted by spammers in the first place;
  • Inadvertently launching malicious software from a spam message in your inbox; and
  • Your computer or device being compromised. 

Protect your e-mail address from being harvested: Spam starts with a practice called “address harvesting,” where computer programs indiscriminately collect email addresses that are sold to spammers. And so, your first line of defence is protecting your email address.  Here are some ways to do this: 

  1. If posting your email address to a website, do not use the “@” or “.” symbols. Instead, use a format such as "jane at myDomain dot com". This can help prevent "spambot" software, often used to seek out and extract email addresses online, from recognizing it. 
  2. Use a primary email address for your trusted contacts and consider creating additional addresses for use in online activities, such as filling out forms or joining communities. These addresses can be easily changed if they are harvested and you start receiving spam.

Protect your inbox from being a launchpad for spyware and other types of malware: While address harvesting leads to spam, spam may spread spyware, which can transmit your personal information to unauthorized parties. In some cases, your key strokes can be monitored, revealing sensitive information like account passwords.  To help avoid this:

  1. First and foremost, don’t open e-mails from an unfamiliar person or organization. Deleting mail from unknown senders can avoid a host of future problems.
  2. But, if you do, don't reply to spam as that can confirm your address as being active and cause you to receive more spam.  For the same reason, never click on a "remove" or "unsubscribe" link in a suspicious spam message.  You may be unwittingly “subscribing” to receiving even more spam.
  3. And don’t click on links or attachments in an e-mail if the message is suspicious. They may be harbouring malware, which, if unleashed from your inbox, can jeopardize your privacy or compromise your device.
  4. Malware can even come from the accounts of your friends or other known sources if their computers have been hijacked. So, if you are in doubt about an attachment, don’t reply to the email itself and before opening it check with the sender by phone or in person. In other words, if an email from a trusted source seems out of character it may indeed be from an altogether different character.
  5. Report unsolicited e-mail containing suspicious attachments or content to the Spam Reporting Centre at  By analyzing accumulated reports and identifying trends gathered by the Centre, the Office of the Privacy Commissioner of Canada is working with its enforcement partners to identify address harvesters and sources of spyware for investigation. 

Protect your device or computer: Think of these next steps as a sort of insurance policy for your device in the event your first two lines of defence fail:

  1. Install security software from a reliable company on your computer. Security software should include features like anti-spam, anti-virus, anti-malware and a firewall.  
  2. Ensure your operating system and other software suites, including security software, are set to automatically update.  If you’re not sure how, use your “Help” function and search for “Automatic Updates.”
  3. Don’t acquire security software in response to unexpected calls, messages or pop-ups.  This type of marketing is commonly used for malicious purposes.  Instead, only download security software from web sites you know and trust.  Free software might sound appealing but can hide malware. In the same vein, apps for your mobile device should only be downloaded from reputable marketplaces.

To find out more about the Office of the Privacy Commissioner of Canada’s responsibilities under Canada’s anti-spam legislation or “CASL”, Canada’s law against spam and other electronic threats, visit  

For information about CASL overall, visit


April 3, 2017

Man arrested in relation to PharmaNet privacy breach

One man has been arrested in connection to a series of PharmaNet breaches that may have compromised the personal medical information of about 20,500 British Columbians. 

Vancouver police executed a search warrant at a home in Richmond on March 23 and arrested a suspect. Investigators believe the man gained unauthorized access to the provincial online prescription-medication information system and used patients’ personal data for fraudulent purposes. 

The man, who hasn’t been identified, faces a number of identity-theft-related charges, said police. Charges haven’t been laid. 

The Health Ministry characterized the breach as a product of “cybercrime” that targeted doctor and medical clinic offices and PharmaNet service vendors.

“Through forensic analysis, we have learned that several breaches, which have occurred since July 2016, are connected,” said spokeswoman Lori Cascaden.

“This inappropriate access to PharmaNet is not because of a direct hack into the system. It is suspected that access was obtained through impersonation of physicians and other methods.”

In February, the Health Ministry sent out letters to about 7,500 people affected by the breach, which officials became aware about after users and vendors reported incidents of “suspicious access.”

Since then, another 13,000 people may have had their PharmaNet information accessed, said the ministry Monday.

In the majority of cases, the suspect is believed to have accessed patients’ profiles, which contain their name, address, gender, date of birth and personal health number. In some cases, information such as the patient’s medication history for the last 14 months was also viewed. 

To mitigate the risk of identity theft, the government said it will provide free credit monitoring to affected individuals. People who had their personal information compromised should expect a letter on how to access this service.

The ministries of Health, Finance, and Technology, Innovation and Citizens’ Services have launched an investigation and taken immediate steps to stop the breaches, and is working to implement “more robust security measures” with PharmaNet vendors, said the health ministry. 

An independent security review of PharmaNet and an overall modernization of the system, which would include security enhancements, are also underway.


Read the full Vancouver Sun story


February, 2017

BCCLA says government should tell all PharmaNet patients how to avoid data breaches.

“You go into your pharmacy and say you want to lock down your records with a key word,” BCCLA policy director Micheal Vonn said Thursday. “With a key word, you have to give it to them every time you fill a prescription, but you know that only the people who are attending to your health care have access to your records.”

The PharmaNet system links all B.C. pharmacies to a central set of data systems and logs every prescription dispensed in the province.

Read the full Media Release


February, 2017

Your password: The key to your personal information.

Think of your password as a guard that stands between your personal information and potential online risks. Given the best protective armour, the chances of anything getting through are greatly minimized.

When you create passwords with combinations of letters and numbers that are unique for every one of your online accounts, you'll make it more difficult to unlock your identity – keeping your information safe and secure. You should password-protect all your devices: computer, laptop, tablet, smartphone, etc.

What makes a strong password

Many people choose a password that's easy to remember – like an address, pet's name or special date – and use it over and over again. The thing is, attackers try these first because they're pieces of information that are easy to obtain.

To protect your passwords online, follow these tips:

  • Make sure it's a minimum length of eight characters.
  • Use a combination of upper and lower case letters and at least one number.
  • Include at least one character that isn't a letter or number.
  • Be creative. Use the first letter of each word of a memorable sentence or phrase, then make it even tougher by changing some of the letters to numbers (e.g. use a "3" to replace an "e").
  • Try a mix of your pet's name, your favourite numbers, the street you grew up on or other combinations.

Read the full Media Release


June, 2016

College of Physicians and Surgeons of BC adopt new professional standard on safe prescribing.

“Currently, physicians are required to have PharmaNet access in methadone clinics, and walk-in and urgent care settings. The College Board endorses the concept of mandatory use of PharmaNet for BC physicians at all points of clinical care.”

Read the full Media Release


June 2, 2016

Vancouver Sun, Health Issues Reporter, Pamela Fayerman

B.C. doctors have become the first in Canada to be legally bound by strict new standards for prescribing opioids and other addictive drugs.

The mandatory prescribing program of the College of Physicians and Surgeons of B.C., which took effect Wednesday, comes about because of an epidemic of narcotic addictions and deaths. Doctors who don’t follow the mandatory, professional standards could face complaint hearings and disciplinary actions like fines and licence suspensions.

The standards replace guidelines that were only recommendations on proper and safe prescribing of pain medications, sedatives, stimulants and other addictive medications. The guidelines allowed for some discretion; the new standards do not.

“It’s not a matter of if, when or maybe,” said Dr. Ailve McNestry, deputy registrar of the College, referring to the new standards.

“Unsafe prescribing needs to stop,” said Dr. Gerry Vaughan, president of the College’s board. “The new document clearly states what our registrants must and must not do when prescribing certain classes of drugs, especially if there is a risk of misuse or diversion.”

Last year, up to 200 doctors were ordered by the College to take educational programs to learn how to properly prescribe opioids and other addictive drugs. 

Under the standards, doctors must now have discussions with patients about alternatives to opioids, especially for conditions like low back pain, headaches and other ailments that don’t require such medications. Doctors must take careful patient histories and do a risk-benefit analysis to consider if opioid therapy is safe.

McNestry said some mental health patients may be vulnerable to addiction, as are patients who have abused alcohol or come from families where addiction is a problem. Doctors must review PharmaNet records to see if a patient has taken such medications, because some individuals doctor-shop in order to collect more pills to either use themselves, give to others or sell on the street. If doctors do end up prescribing such medications, they are now required to start with the lowest dose, for a short time period, and monitor patients frequently.

While some opioids like fentanyl are illegally imported into B.C. or manufactured here by organized crime networks, the College says doctors have also had a role through inappropriate prescribing of opioids and other medications.

Dr. Perry Kendall, the provincial health officer, said a few months ago that B.C. has “a public health emergency” and as many as 800 people may die from opioids in 2016, almost double the number in 2015.

McNestry said B.C. is unique in introducing standards. Provinces have historically taken only an educational approach to prescribing recommendations.

“We are now calling these legally enforceable standards. Our mandate is public protection and if education doesn’t (achieve) that, then we need to do something more,” she said. While chronic pain doctors and their patients may have “valid”concerns about how the changes will affect them, McNestry said the College must do more to stop the overuse of such medications.

“There’s just too many people suffering from the side effects of high dose opioid therapy. There are people who are being prescribed dangerous combinations of drugs (opioids and sedatives), leading to people stopping to breathe.”

According to IMS Brogan, which monitors pharmaceutical sales, Canadian doctors have been heavy prescribers of opioids, writing 53 prescriptions for every 100 people. McNestry said one doctor who came to the attention of the College recently had prescribed 80,000 opioid tablets in a three-month period.

The new standards are based on a set published in March by the U.S. Centers for Disease Control and Prevention. The B.C. College and its board adopted them because they didn’t want to wait any longer for proposed new Canadian standards. The current national guidelines are six years old.

McNestry said coroner’s reports, which are reviewed by College officials, showed that a disturbing number of people who died of overdoses were never prescribed the medication that killed them, which means they had obtained drugs illegally. A Vancouver Sun series earlier this year showed that some health professionals steal opioids from hospitals for their personal use or sell them on the streets.


February 2016

From ISMP Canada

ISMP website

Five Questions to Ask About Your Medications

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:

  • doctor's appointment (e.g. family physician or specialist, dentist)
  • interaction with a community pharmacist
  • discharge from hospital to home
  • visit by home care services


November 2015

Drug safety tool being ignored by B.C. doctors

Make PharmaNet check mandatory, report urges

Forcing doctors to register with B.C.’s prescription database would help ensure patients are not receiving too many of the dangerous opioids behind fatal overdoses, addiction and other serious problems, according to a new report.

Less than a third of British Columbia’s physicians are using PharmaNet, the provincial system that records all prescriptions, according to a report released

Tuesday by the B.C. Centre for Excellence in HIV/AIDS and endorsed by 73 addictions and public health experts from around the province.

PharmaNet records data such as the drug name, dose, quantity, prescribing doctor and duration for all prescriptions dispensed in B.C.’s pharmacies. All pharmacists can access it and physicians working in B.C.’s methadone clinics or transient-care settings, such as hospital emergency departments or walk-in clinics, must be able to use it. But many other physicians have been reluctant to sign up and pay the $8 monthly fee to access PharmaNet, according to Evan Wood, co-director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.

That’s a huge problem, he said, because more than 70 per cent of the province’s doctors may be writing opioid prescriptions without knowing their patient’s history with the drugs or whether they are already being prescribed the dangerous form of pain medication from another doctor.

Without access to PharmaNet, doctors may also be unsure whether someone is receiving benzodiazepines, the risky pharmaceutical class of tranquilizers like valium or ativan that are often linked to opioid-related deaths in B.C., Dr. Wood added.

Globally, Canadians are the second-largest per capita consumer of opioids, a family of pain medications that includes oxycodone, hydromorphone, morphine and fentanyl. Deaths tied to the synthetic opioid fentanyl have spiked across the four largest provinces in recent years, with fatal overdoses increasing nearly seven times in B.C. from 13 in 2012 to 90 last year, according to a national network of drug researchers.

Dr. Ailve McNestry, deputy registrar for the College of Physicians and Surgeons of B.C., said her agency’s board will likely review and approve new guidelines this January mandating all clinicians use PharmaNet, and it could take up to a year for doctors to make the technological change.

“Most younger physicians, who have no technological challenges, would just say ‘Of course [I use PharmaNet],’” Dr. McNestry said. “It’s mostly about the hassle factor: so it would be physicians who are more of my generation who would have to read the instruction manual and figure out how to connect with PharmaNet through their electronic medical records.

“We’re the only province in Canada, I think, that has access to such an informative database and not using it is not justifiable any more.”

The experts’ report also called on the college to impose a maximum dose for opioid prescriptions, to cut down on supplying of the black market and abuse of the drugs, and for more investment in addiction care and education.

In 2013, more deaths in British Columbia were linked to opioids other than heroin (about 3.5 deaths per 100,000 people) than to motor vehicle accidents involving alcohol (just over 1 death per 100,000 people), according to Tuesday’s report.

Charles Webb, president of the association representing B.C.’s doctors, was unavailable for an interview before press time, but said in an e-mailed statement that his organization supports the use of PharmaNet “to ensure the safe prescription of opioids, particularly for patients unfamiliar to physicians at the point of prescription.”

Provincial Health Minister Terry Lake said he was surprised so few doctors reported using the database. He said he was committed to talking with the provincial medical association and college to increase participation in the system – something he said might be inevitable in coming years as all patient records are digitized.

Mr. Lake welcomed the new report, stating the province has made significant progress on the issue, through cracking down on pharmacies dispensing methadone illegally, and investing $3-million last year into new ways of treating substance addiction and Dr. Wood’s research at the centre.

“There’s a lot of blame going on in terms of prescribing practices, but I remember distinctly in the late ’80s, early ’90s, people said that physicians weren’t treating pain well enough, that people were going without good pain medication because of physicians’ fear or antipathy toward using opioids,” said Mr. Lake. “What we saw was the pendulum swung and it swung too far, so we’re seeing a lot of prescription opioid abuse and dependence.

“Now it’s time to bring it back into balance and use opioids appropriately.”

© Copyright (c) The Globe & Mail

July/August 2015

Walk-in clinics in B.C. told to offer continuing care to patients

Under new rules, clinic doctors must offer to be primary-care physician for patients who do not have a family doctor

The walk-in or urgent care clinic that you visited just once is obliged to be your “medical home” if that’s what you need and want, according to new standards set by the College of Physicians and Surgeons of BC.

Formerly, there was an expectation that such clinics became your primary care clinic of record after three visits.

Under beefed-up guidelines, walk-in clinics will be held to the same high standard as those where patients book appointments. That means doctors at walk-in clinics must keep excellent medical records, contact patients with lab or other diagnostic test results, send copies of reports to other doctors who need them, offer to be the primary-care clinic for patients who need a regular place to go, and schedule periodic screening and prevention checkups.

Dr. Heidi Oetter, CEO and registrar of the College, said professional standards and guidelines were updated with stronger language to let doctors and patients know there aren’t different standards of care for traditional medical clinics and walk-in clinics.

If patients have no other place to go, then walk-in clinic doctors must offer to be the patient’s primary care physician through a “verbal invitation.” They can no longer consider a patient’s visit as a one-off, she said,.

Oetter said the College hears regular complaints from the public that walk in clinics “cherry pick” the easiest cases. But even patients with complex or chronic illnesses should be able to depend on walk-in clinics for continuing care, she said. If it’s not offered, patients should feel comfortable demanding “what they need.”

The College also expects every walk-in clinic to have a medical director who is a doctor, not a business person, so the College can communicate “doctor to doctor.” The medical director must ensure compliance with College standards. Doctors at such clinics can’t delegate followup of medical care and lab tests to staff who are non-physicians.

The College is also insisting walk-in clinics provide after-hours coverage and have access to PharmaNet so they know what prescriptions patients are taking. Oetter said the latter rule arose after investigations which found evidence of prescription fraud throughout the Lower Mainland. One person got more than 250 prescriptions, from multiple physicians, and filled them at 34 different pharmacies from 2007 to 2013. The College found fault with 46 physicians who had deficient prescribing practices.

“This case serves to remind physicians of the important role they play in mitigating this public health problem, which starts with prescribing medication to patients according to current prescribing standards and principles. This includes taking the time to conduct an appropriate exam, asking the right questions, and checking the patient’s PharmaNet profile before issuing a prescription — especially for a narcotic.”

Read the full story.

January 2015

BC Law Firms get caught with a ransom virus, stemming from bad healthcare next?

We find it interesting that the authorities quoted in the article, and not the software experts, seem to think that no damage was done—even though the hackers obviously had full access to the client machines.There seems to be a strong wish to deny the danger that comes from email hacking.

Here's the litmus test:  Would you be okay sending your personal VISA number, expiry date and CRC code by email?

Read the full story.

November 2014

New Research

The New York Times on November 12, 2014 reported that a Pew Research Center study released the same day indicates a majority of adults feel that their privacy is being challenged along such core dimensions as the security of their personal information and their ability to retain confidentiality.

Read the White Paper.

September 2014

BC Women's Hospital celebrates one year communicating with patients by secure email and eForms.

The Comprehensive Abortion and Reproductive Education (CARE) program at BC Women’s Hospital & Health Centre offers counseling and abortion services to women who are experiencing unplanned pregnancies or to those who require an abortion for genetic or medical reasons.

The CARE clinic takes its appointments by telephone. Concerns included significant time on hold, averaging up to 45 minutes, patients desiring to make appointment outside of regular office hours and on weekends, and patients’ desire to use Internet services for appointments and medical information.

Read More.

September 2014

Medinet Launches Rejection Management Service for Medical Billing.

Service takes off as doctors realize the thousands of dollars of income lost in rejected claims. Doctors are busy, and our Rejection Management package recovers lost income and helps keep the practice accounting up to date.

Read More.