Quality

Ontario healthcare suffers from lack of electronic records

TORONTO – Significant improvements have been made in shrinking waits for some types of surgery and high-tech imaging, but many Ontarians still wait too long for urgent cancer surgery, MRI scans, specialists or a space in a nursing home, according to the fourth annual report of the Ontario Health Quality Council (OHQC).

Moreover, for the fourth straight year, the report pointed to the lack of system-wide information technology tools, such as electronic medical records, as one of the biggest roadblocks to a more efficient system with high-quality care. In 2007, just 25 percent of family-practice doctors in Ontario had electronic medical records, compared to 50 percent in Alberta, 98 percent in the Netherlands and 89 percent in the United Kingdom.

“Ontarians are more likely than people in these countries to feel that their time was wasted because of poorly organized care or that they’ve been given an unnecessary test,” said Dr. Ben Chan (pictured above), CEO of the Ontario Health Quality Council. “Ontario needs to continue to focus on implementing electronic health records for all.”

Other report findings include:
• Ontario is doing twice as many MRI scans as it did before the introduction of the Wait Time Strategy, but waits for low urgency MRI scans have fluctuated between 90 to 120 days for almost four years, well over the target of 28 days.
• Although Ontario is producing more doctors and nurse practitioners than ever, access to family doctors hasn’t improved since 2006 – 7.4 percent of adults in Ontario don’t have a family doctor and about half that number, or 400,000 people, are looking for a doctor, but can’t find one.
• More than half of “sicker adults” – people who described their health as “fair” or “poor” – surveyed in Ontario said they waited more than a month to see a specialist after being referred, compared to only one-quarter in Germany, the Netherlands and the US.
• Only one-third of people in Ontario (and across Canada) can see their doctor the same or next day when sick and needing care, while two-thirds could do so in the Netherlands.
• Waits for places in long-term care homes have doubled in the last two years, from 49 days to 106 days.

“Thanks to Ontario’s Wait Time Strategy, waits have been greatly shortened for cataract surgeries, hip and knee replacements, and some cardiac procedures,” said Lyn McLeod, OHQC Chair. “But when half of cancer patients who need urgent surgery have to wait longer than is medically acceptable, when waits for MRI scans are three to four times longer than the target, and when waits for nursing home spaces have doubled in just two years, it’s pretty clear that everyone involved in delivering healthcare has to take action.”

Patients needing cancer surgery are prioritized into four categories according to the urgency of their need. This ranges from Priority 1, which calls for “immediate surgery” to Priority 4 where the target is 12 weeks. The OHQC report shows that in Priority 2 or the “urgent surgery” category, half of patients did not get their surgery within the medically acceptable two-week timeframe, including some who waited twice as long.

“Long waits for surgery cause needless anxiety and may result in a patient’s condition getting worse,” said Dr. Chan. “This is a serious problem, but solving it doesn’t require large-scale restructuring or great expense.” The OHQC report notes that North York General Hospital has consistently met wait time cancer surgery targets through better coordinated cancer care. “We strongly encourage all hospitals that do urgent cancer surgery to take a close look at their numbers and commit to aggressive targets to bring down their wait times to match the best in the province.”

On the positive side, the independent agency’s report also notes that cancer survival has improved substantially for breast and colon cancer, the large majority of patients who need cardiac procedures are now being treated within the target time and the use of telemedicine is growing rapidly, which greatly reduces travel and inconvenience for people who need a specialist.

“Overall, there have been real improvements in the quality of Ontario’s health system, but the pace of change must be accelerated,” said Dr. Chan. “Our report spotlights specific examples of higher performance from Ontario and elsewhere that show that better results are possible. We encourage healthcare providers, planners and policy-makers to learn from proven practices and apply the lessons.”

About the OHQC
The Ontario Health Quality Council (OHQC) is an independent agency, created by the Government of Ontario in September 2005 and funded through the Ministry of Health and Long-Term Care. The Council reports directly to Ontarians on access to publicly funded health services, human resources in healthcare, consumer and population health status, and outcomes of the health system. The Council also has a mandate to support quality improvement in the healthcare system – by promoting the use of best practices and quality improvement methods among health care leaders and managers.