"MAS provides evidence based analysis as the platform for making policy decisions on the funding, planning, and diffusion of health technologies. We are pleased to work with our international counterparts to further an evidence based agenda."

Lesley Levin MD, FRCP (Lon), FRCPC
Head, Medical Advisory Secretariat and
Senior Medical, Scientific and Health Technology Advisor
Ontario Ministry of Health and Long-Term Care

History and structure
The Medical Advisory Secretariat (MAS) is a Division within the Ontario Ministry of Health and Long-Term Care. MAS provides the Ministry and an advisory committee - the Ontario Health Technology Advisory Committee (OHTAC) - with evidence on the effectiveness, safety, and cost effectiveness of diagnostic and treatment strategies in Ontario. Health Technology Policy Reviews encompass clinical evidence of effectiveness, safety, and legal and policy frameworks in Ontario and report on health and human resource implications, evidence of cost effectiveness, and the diffusion of technology internationally. MAS collaborates with governmental and non-governmental organizations to evaluate promising health technologies for which there is insufficient evidence of effectiveness or of how the technology will function in Ontario. MAS works with external resources to test patient and provider safety for new health technologies and provides evidence based practice guidelines for recommended technologies. Our reviews encompass interventions used at any point in healthcare delivery. However, we do not examine pharmaceutical products or information systems in isolation.

The Secretariat is led by the Senior Medical Advisor and managed by Birthe Jorgensen, Ph.D., Director, who provides liaison with other entities. Ten clinical epidemiologists perform health technology evidence-based reviews. MAS also employs 2 senior policy analysts and 2 administrative staff. We also contract with a medical editor and a medical information science consultant.

Mission
To provide evidence based policy advice to the Ontario health care system and the Ontario Ministry of Health and Long-Term Care on the coordinated uptake of new health interventions. We aim to ensure that residents of Ontario have access to the best available new health technologies that will improve patient outcomes.

How MAS Works
When health care providers or the Ministry request a technology review, MAS prepares a brief description of the technology, current options, scientific literature, current use, and possible research question for the review. In diagnostics, we also determine preliminary evidence of specificity and sensitivity. MAS systematically reviews the scientific literature, collaborates with relevant governmental partners, and consults with clinical and other external experts. We attempt to include all relevant research.

MAS evaluates the methodological quality of each study and identifies biases that might affect validity. Inclusion and exclusion criteria, eg, study design, number of subjects, specific populations, specific comparators, are used in selecting studies. Economic analysis is performed only when there is evidence of effectiveness. An external expert, preferably in Ontario, reviews the draft. The reviewer sees the systematic review, the fundings, and the health system impacts section prior to evidence based recommendations being made by the Ontario Health Technology Advisory Committee. MAS staff peer review presentations of findings by clinical epidemiologists for clarity of presentation subsequently made to Ontario Health Technology Advisory Committee.

Based on the evidence based review, the Ontario Health Technology Advisory Committee makes draft findings and recommendations pertaining to the clinical utility of a technology, and flagging any patient or physician safety concerns with regards to the technology. Where evidence is not available or unclear, OHTAC mey reccommend a field evaluation within the Ontario health care system to evaluate the effectiveness of the technology. OHTAC relieses its draft recommendations along with the draft review for 21 days of public engagement, also circulating the reviews and recommendations directly to those in health care system who work with or might benefit from the technology. Comment is requested which is evidence based and directed at informing OHTAC of any omissions or misinterpretations of evidence as set out in the MAS analysis. After the public and professional engagement period ends, MAS present any feedback which might alter recommendations to OHTAC, which will then finalize its recommendations. Finalized OHTAC recommendations are posted on the OHTAC website. Additionally, there is a formal notice period to appeal OHTAC recommendations of 60 days from posting on the website (see OHTAC Terms of Reference).

Dissemination activities
Summaries and full PDF versions of MAS health technology reports and OHTAC technology recommendations are posted on the web. The public has full access to the materials and may comment to the Secretariat via a dedicated e-mail address.

A periodic E-Bulletin informs healthcare providers and government officials of findings from recent MAS reviews and recommendations from OHTAC. MAS is also a leading participant in the Health Technology Policy Forum, an intergovernmental exchange on policy development in Canadian provinces dealing with pressures to introduce new health technologies. MAS continually shares information with government officials from other Canadian and international jurisdictions as requested. Most recently, the evidence based reviews produced by MAS will be published as the Ontario Health Technology Series (OHTAS). It is hoped that the series will soon become available in PubMed.

Current Projects (a selection)

• Supporting Aging in Community: Falls and Fall Related Injuries; Urinary Incontinence
• Social Isolation; Dementia
• Screening modalities for colecteral cancer
• Monitoring system for long term ant-coagulant use
• Optical Coherence Tomography
• Specialized multi-disciplinary team care for the chronically ill
• Fenestrated Aortic Endografts
• Intastromal Corneal Ring Segments for Corneal Disease

Future Plans

• Continue to integrate individual technologies around disease states (arthritis, cardiac imaging, diabetes, incontinence)
• Expand field evaluation capacity
• Expand capacity for patient safety initiatives