By: Viji Sundaram in Mountainview, California

A much heralded push toward digital patient portals, commonly integrated with electronic health records, may be exacerbating health disparities between rich and poor, instead of reducing them, as they were intended to.

In fact, for a variety of reasons, “you could argue they increase disparities,” said Suneel Ratan, chief strategy officer of Community Health Center Network and the Alameda Health Consortium, who has researched the use of patient portals in Bay Area community health centers.

Last year, MayView Community Health Center’s three clinics – here in Mountain View, Palo Alto and Sunnyvale -- launched their patient portal tool to meet “meaningful use” requirements in order to receive federal incentive checks, a part of the Electronic Health Records Incentive Program. The program was designed to help health care providers move away from a paper-based system. A few mouse clicks allows a doctor to navigate the entire medical history of a patient.

Patient portals, which have been in use for more than a decade in larger hospitals nationwide, are commonly integrated with electronic health records. They are secure online websites that give patients 24-hour access to their personal health information from anywhere with an Internet connection. It’s a way of patients being engaged with their care team and on their own time, with the hope that it will lead to better health outcomes.

Among other functionalities, patient portals typically include online appointment scheduling, bill pay, prescription renewals and the ability to accept patient-generated data on allergies and other health issues. Patients also have access to lab results.

MayView, a federally qualified health center (FQHC), spent about $30,000 in staff time to build its portal, the clinic’s Executive Director Kelvin Quan said, noting that the tool was not only to meet the federal “meaningful use” standard by tethering it to electronic health records, but also to “meet a standard in adopting the patient care model known as ‘Patient Centered Health Home,’” a kind of one-stop shop for patient care.

Soon after MayView launched the tool, many patients enrolled, but enthusiasm seemed to wane after a few weeks, when the program became something like “white noise,” [a collection of sounds that are a mere distraction] as MayView’s Medical Director Dr. Aarti Gupta described it.

Enrollment figures in MayView’s program show that of the clinic’s approximately 6,600 patients, only 600 are currently enrolled. Of them, only 200 are active users.

Quan believes the tool’s low patient penetration is because “technology doesn’t work for our population,” a good percentage of whom are Hispanic and Asian and Pacific Islanders. That could be the reason why East Palo Alto-based Ravenswood Family Health Center, also an FQHC and with a similar patient demographic, has low usage of its patient portal – 10 to 15 percent -- according to Chief Executive Director Luisa Buada.

"The majority of our patients are Spanish-speaking with lower literacy (including health literacy, reading literacy and computer literacy) rates," said Dr. Justin Wu, Ravenswood's Clinical Informatics Officer. "Add to that the current political climate with mistrust around immigration issues and a general hesitancy to give out information or have health information online, and I think it helps explain some of the problems we've been having with patients in using our patient portal." The two clinics reflect a national usage trend that showed that Asian Americans, Latino Americans and African Americans were 23 percent, 55 percent and 62 percent less likely to register for digital personal health record access, respectively, compared to non-Hispanic whites.

First off, “many of our patients can’t afford computers. If they can, their [technology literacy level] makes it difficult for them to navigate the information,” Quan said.

For those who have the app on their cell phone, the font is so small, they can’t read it, he said.

David Lindeman, director, Center for Innovation and Technology in Public Health and the CITRIS program at UC Berkeley, believes that if some of the text were taken out of patient portals and replaced with images and videos the tool could possibly be embraced by more patients.

A study done two years ago by five academics shows why the patient portal program has been relatively successful at Kaiser Permanente, a large grouping of hospital and practices, as well as the nation’s second-largest insurer. By 2015, Kaiser had registered 70 percent of their 5.2 million patients on their portal, well above the health care industry expectation of 50 percent, according to Quan.

The bulk of Kaiser’s patient portal education material – not entirely simply written -- is geared toward white, middle-class people, who are better educated. Patients with a post-graduate education are more likely to register than adults with a high school education or less on to My Health Manager.

“You have to meet the patients where they are coming from,” said Quan.

My Health Manager enrollees can email their care team members with health questions and expect a response within 48 hours.

Most of MayView’s patients are on Medi-Cal (the federal-state health insurance program for low-income people, known as Medicaid in the rest of the nation). Some are undocumented. Care providers at the clinic are already stretched thin, Gupta said, one of the reasons why MayView’s patient portal lacks the e-mail communication functionality.

“If they had to respond to queries from their patients on the computer, it would take time away from attending to patients” who prefer face time with their providers, Gupta said.

Besides, “Medi-Cal will not reimburse them” for computer time, Quan said. 

Ratan said most FQHCs don’t have the resources to implement robust functionality in their patient portals. But at least one he has worked with has deployed a patient portal that includes medical records, in addition to appointment schedules and refills.

Republished in partnership with New America Media.

Published in Health

By H.G. Watson

The Canada Periodical Fund may broaden its horizons in the years to come.

Luc Marchand, the director of the Canada Periodical Fund, told attendees at MagNet, the annual Canadian magazine conference, on June 8 that the results of federal government consultations on media may impact how the fund designs its grants, and for who.

In the years to come, more program dollars may be extended to digital-only outlets, which are currently unable to access some portions of the fund.

The fund currently offers assistance to publishers of paid print magazines, non-daily newspapers and digital periodicals through two programs, one for business development and one for distribution, with a third funding envelope for industry associations. Currently digital periodical publishers can only access the business innovation program, and are excluded from support for distribution.

During the presentation, Mark Jamison, the president of envericom, a project management practice, said that government investment through the Canada Periodical Fund represents about four per cent of value in the industry.

However, the amount of money distributed by the Canada Periodical Fund has been relentlessly dropping since the mid-1990s, a trend dramatically accelerated by the Conservative government. As well, J-Source recently reported on evidence that the program had become politicized, citing a business development grant to Briarpatch that was recommended for approval, but then rejected at the directive of former Heritage minister James Moore without explanation.

Change may come

But change may come. The Liberal government’s push to examine and potentially radically alter Canada’s media laws may impact the fund. A standing committee on local media met throughout the winter, and consultations are coming on digital content creation, according to Marchand.

Marchand said that the switch to digital doesn’t seem to be as prominent in the world of magazines as it is in the newspaper industry. “Print is really strong (in magazines),” he said. But, he noted, more magazines now have a greater online presence. 

No changes will happen without consultation with the Canadian magazine industry, he added, noting that it would be at least a year until the Canada Periodical Fund sees major change, if any.

Until then, there is the recently launched pilot program to fund digital start-ups, which Marchand hopes will help the Fund cover a broader base of the industry.

H.G. Watson can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or on Twitter.

Full disclosure: NCM currently receives funding from the federal Heritage Department's Canada Periodical Fund towards specific editorial and marketing-related projects. This reporting was republished with permission from

Published in Economy

by Shan Qiao in Toronto

Just weeks before its 40th anniversary one of the three major Chinese daily newspapers in North America has ceased printing in Canada.

The World Journal issued its last edition on Dec. 31, 2015, marking yet another setback for the ailing Chinese ethnic media.

From daily newspapers to TV and radio stations, traditional ethnic media outlets have been fighting to survive under the irrevocable challenges brought on by the rise of social media.

Like other traditional Chinese media, World Journal has been struggling with declining readership and advertising revenues, coupled with increasing labour costs.

Founded by the United Daily News Group in Taiwan on Feb. 12, 1976, World Journal mainly targets readers from the island whose political perspectives are not aligned with Beijing. 

Announcement not a surprise to some 

The closure of the newspaper’s Vancouver and Toronto offices resulted in more than 20 full-time jobs in editorial, translation, graphic design and printing being slashed on New Year’s Day.

The World Journal will keep publishing in the United States; its North American headquarters in New York, along with its west coast bureaus in Los Angeles and San Francisco will remain in tact.

[quote align="center" color="#999999"]“It’s obvious that traditional media is a dying business, giving up the market to new media and free pickup weekly newspapers.”[/quote]
Jiansheng Ge, a senior reporter who has been working for the newspaper in Toronto for over eight years after emigrating from Taiwan, was not shocked by the abrupt announcement the newspaper’s CEO made earlier in December.  

He says he knew the end was coming, he just didn’t know when.
“It’s obvious that traditional media is a dying business, giving up the market to new media and free pickup weekly newspapers,” he laments.

According to Ge people are joining the battlefield to publish free weekly newspapers without paying enough attention to quality because it’s a legitimate and easy investment for them. 

Examining why the newspaper folded
Joseph Lau, the founding president of Toronto’s Chinese Media Professionals Association, appealed on WeChat, a popular Chinese social media app with over one billion users, to buy the World Journal’s last edition on Dec. 31 to show support. 

[quote align="center" color="#999999"]“Traditional media has a weakness, from my perspective, which is a ‘one-way’ communication."[/quote]

“Media colleagues should examine why the business is not doing well,” he says. “Traditional media has a weakness, from my perspective, which is a ‘one-way’ communication. You won’t be able to trace back your readers’ data, not like new media that grabs users’ information for its marketing purpose.”  

He adds that World Journal publishing electronically online for some time was also part of its downfall. 

“This is suicidal and it kills the hardcopy edition, but it’s the trend nobody in the business can avoid,” Lau says. 

“I believe news always needs content regardless what the carrier is, either on paper or on a smart phone. Paper media’s readership will be less and less, losing to other carriers. However, we are not a fully digital age yet. In the coming 10 years, paper media still has some space to survive.” 

He adds, with a laugh, that his own online TV news channel,, has been operating since 2003 and is still “surviving”. 

Finding work for former ethnic media 

After losing their jobs in ethnic media, reporters can find it difficult to find work. They often find themselves using transferable skills to land work in other fields. 

A popular career alternative is working as a politician’s constituency assistant. 

[quote align="center" color="#999999"]“Media professionals often make great hires for both public and private sectors."[/quote]

Two reporters, who preferred to remain unnamed, who previously worked at OMNI TV found jobs at the riding offices of Conservative member of Parliament (MP) Bob Saroya and Liberal MP Shaun Chen after Rogers cut most of its ethnic programming last year, while a former reporter for the World Journal started working for Liberal MP Arnold Chan months before the newspaper announced its closure. 

Miriam Ku, a former World Journal reporter who left journalism several years ago in pursuit of a career in politics has since worked as an assistant for a municipal councillor and is now an outreach adviser for Ontario’s Conservative party leader, Patrick Brown. 

Wilson Chan, who is Ontario Premier Kathleen Wynne’s communication adviser, previously worked as Editor-in-Chief of a Chinese daily newspaper called Today Daily News that was rebranded to Today Commercial News after he left. 

“Media professionals often make great hires for both public and private sectors, whether it could be working for a politician, an NGO (non-governmental organization) or a public relation firm,” says Ku, adding that media professionals’ vast knowledge on current affairs, strong community networks and effective audience-focused writing talents are useful when seeking jobs.

Some reporters work as licenced interpreters in the community, hospitals or courtrooms. Others become part-time realtors serving the particularly property-hungry Chinese community, and often, their part-time income easily supersedes their humble reporter’s salary. 

As for Ge, he had already planned something years before the closure announcement was made. 

He is a seasonal Chinese language teacher working at the elementary school level for the Toronto District School Board. Although his working hours are not enough right now, he is confident and wants to pursue this path, getting more training to become a full-time teacher in a more stable and sustainable job environment.

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Published in Arts & Culture

by Marco Campana in Toronto

When it comes to technology use, immigrants to Canada are well ahead of settlement agencies. It’s a reality the sector needs to face. Organizations can and need to incorporate technology more effectively to serve their clients.

In 2007, Statistics Canada reported that 78 per cent of immigrants who arrived in Canada during the last 10 years used the Internet - a higher percentage than the 75 per cent of people born in Canada who used it.

Yahoo! Canada confirms that trend in its 2014 Digital Acculturation study, which found that, “When it comes to media preferences, new Canadians are digital first, with a particular focus on mobile devices.”

[quote align="center" color="#999999"]They’re mobile, actively using niche social networks, apps and services that are not necessarily mainstream in Canada.[/quote]

New Canadians are actively using niche social networks, apps and services that are not necessarily mainstream in Canada. They’re coming from countries where Internet growth is explosive, faster, cheaper and where online learning is becoming popular.

Settlement agencies need to explore technology use in source countries like China, India and the Phillipines, to understand the technology profile of newcomers to Canada. In many cases, agencies can start with their own staff members – certainly, they should be asking their clients.

Opportunity for settlement agencies, ethnic media

With the pre-eminence of social media, word of mouth information about immigration and settlement is increasingly shared online. Tens of thousands of newcomers share information and orientation on social networking sites like:

These websites are in English, but there are many more in other languages.

We already know that a relatively small percentage of newcomers access mainstream in-person government and community services. Online social networking sites mean they’re potentially bypassing these services even more.

[quote align="center" color="#999999"]If newcomers continue to bypass settlement agencies, how informed will they be when it comes to their settlement needs?[/quote]

If newcomers continue to bypass settlement agencies, how informed will they be when it comes to their settlement needs? How effective are newcomer networks and word of mouth? The results are mixed.

In 2010, the Toronto Immigrant Employment Data Initiative found that “immigrants who found their current job through personal initiative, family or friends, and Canada employment centres had the lowest average hourly wages.”

This is not to say that the newcomer networks are not without value or importance. Far from it.

But, it makes me wonder how we can better ensure newcomers’ digital literacy results in better access to settlement information and resources.

There is a role here for settlement agencies. There is also a role for ethnic media. Research has shown that ethnic media can do a much better job informing and orienting newcomers to life in Canada.

Private immigrant-serving businesses and organizations are also looking at how to best use technology and social media to provide services.

In a recent article, Vancouver-based Will Tao wrote about his impressions of how technology is impacting services provided by Canadian immigration lawyers. He notes a few specific trends that should be examined:

  1. Increased use of technology to gather information from potential clients in advance of serving them
  2. Increased use of technology and applications to manage communication
  3. Increased use of technology as a means of establishing communication with, and serving, clients in other cities/countries around the world (i.e. pre-arrival services) 

Use of technology

While online service is still in its infancy in the settlement sector, there are great examples of innovative agencies offering online and hybrid services across the country.

Organizations like Immigrant Services Association of Nova Scotia, COSTI Immigrant Services, Ontario Council of Agencies Serving Immigrants, CultureLink, South Okanagan Immigrant and Community Services, Canadian Immigrant Integration Program, North York Community House and Catholic Crosscultural Services have been offering online services and courses in recent years with much success.

[quote align="center" color="#999999"]We’re certainly not effectively mining and sharing their learning and knowledge across the sector.[/quote]

In fact, CultureLink recently completed its first Massive Open Online Course (MOOC) for newcomers: Create an Expert LinkedIn Profile for Job Search. The pilot course had 2,000 participants.

Last week, ISANS launched its Settlement Online Pre-Arrival service. It’s an important step forward in providing settlement resources online, before newcomers arrive.

The more I speak to individual settlement workers, the more pockets of service innovation I find.

They’re using this tech to serve their clients. They want to do more. However, we’re not harnessing their knowledge and experience to create better organizational systems, or to create policies to drive innovation around the possibilities technology offers as a means of providing service.

We’re certainly not effectively mining and sharing their learning and knowledge across the sector.

As we imagine the settlement agency of the future, we first need to better understand the digital and settlement literacy of immigrants to Canada. It’s time to start asking them how they’re using technology, how they want to interact with us, and where technology fits into this.

For immigrant-serving agencies, the future is right in front of them. The answers lie with their clients.

Marco Campana does freelance communications work with organizations that serve immigrants, refugees and promote diversity. He provides social media support, writing, editing and internal website consultation and strategy. In particular, he helps settlement agencies harness and implement social media and technology in their community service work.

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Published in Commentary

New Canadian Media provides nonpartisan news and views representing all Canadian immigrant communities. As part of this endeavour, we re-publish aggregated content from various ethnic media publishers in Canada in an effort to raise the profile of news and commentary from an immigrant perspective. New Canadian Media, however, does not guarantee the accuracy of or endorse the views and opinions contained in content from such other sites. The views expressed on this site are those of the individual writers and commentators, and not necessarily those of New Canadian Media. Copyright © 2019 All rights reserved