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Cancer Care Ontario
Wait Time Information System
Putting Healthcare Delivery on the Clock
Cancer Care Ontario (CCO) is an umbrella organization that steers and coordinates Ontario's cancer services and prevention efforts. CCO has 300 employees and directs more than $500 million in public funding for cancer prevention, detection and care. The agency also operates screening and prevention programs; collects, monitors and reports information about cancer system performance; develops evidence-based standards and guidelines and works with regional providers to plan and improve services for patients.
Challenge
Reducing wait times for key health services is one of the Ontario government's top priorities. Excessive wait time - the length of time patients must wait from the decision to have a medical procedure to when they actually receive the procedure - is a symptom of a broader problem: managing how patients get access to care.
On November 17, 2004, the Minister of Health and Long-Term Care, George Smitherman, announced Ontario's Wait Time Strategy. The strategy was designed to reduce wait times by improving access to healthcare services for adult Ontarians in five areas: cancer surgery, selected cardiac procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans.
The key challenge, however, was that there was precious little information available with which to establish evidence-based benchmarks for medically acceptable wait times, and no mechanism in place for the subsequent monitoring and management of wait times. Surgeons were managing their individual wait lists on paper; hospitals were unaware of who was waiting for what; system managers had no data to understand provincial and local trends and issues; government had no timely data to address a pressing public issue and the public had no reliable data with which to hold their government accountable.
Solution
CCO was asked by the health ministry to manage the development and deployment of a system to capture and report wait time data in Ontario. Led by CCO, a team of partners and vendors developed and deployed the Wait Time Information System (WTIS) in healthcare facilities to support the collecting and reporting of a standard set of wait-time-related data gathered from physicians and hospitals.
WTIS is a custom built .NET application that uses a full suite of Microsoft products. An SQL server serves as the database and stores all required wait-time data. WTIS captures wait times electronically in near-real time from surgeons' offices, diagnostic imaging departments and hospital information systems. Users can enter information online using Internet Explorer 6.0 or Netscape 7.0, or hospitals can submit data through their hospital interface.
With 81 hospitals and more than 1,700 surgeons using the system, information is available for 255,000 surgical procedures and 1.2 million MRI/CT scans annually. The scope of WTIS is being expanded to include wait-time information captured for all types of surgery in Ontario by 2009.
Results
WTIS has transformed the way key healthcare services are delivered in Ontario and transformed the relationship between patients and the health system.
Wait-time data is available in just two days. With data being captured quickly, consistently and acurately across the province, comparisons can be made and wait-time targets have been established where none existed previously. Administrators and government are better able to allocate healthcare resources where they are needed most and ensure that patients with the highest-priority need are cared for first. For 2007, for example, the government invested in an additional 127,266 procedures to help reduce wait times, including 3,000 more hip and knee joint replacements and 6,100 more cataract surgeries.
Measuring and tracking progress in wait time reduction is, for the first time, a transparent process for patients, clinicians, hospitals and government. A public Web site established to report wait times, www.ontariowaittimes.com, has had more than four million visits to date. Physicians, too, are making use of WTIS, and more than 450 new Internet connections have been set up so surgeons can access wait-time information to help them improve clinical practice and reduce their workload.
Wait times are decreasing, with cataract surgery leading the way with a 41 per-cent reduction in wait time between September 2005 and January 2007.
Innovative Use of Technology
Healthcare lags other industries in using technology to improve operational efficiency and deliver high-quality service. WTIS proves that an information technology system can be used to transform clinical practice. Today 1,700 surgeons across the province are accessing near-real-time data directly from their offices. Before this project, approximately 50 per cent of these surgeons couldn't even launch Internet Explorer.
WTIS was deployed concurrently with another province-wide system. During development, a need was identified to be able to link patient records. As a result, a provincial Enterprise Master Patient Index (EMPI), a registry of patient demographic information, was approved to be delivered concurrently with WTIS.
EMPI, a product developed by Initiate Systems, is the largest client registry in Canada, with more than 48 million records and 62 sources. It is a cornerstone for delivering an electronic health record in Ontario and will be used by other e-Health initiatives in the future. With distinctly different purposes, the WTIS and EMPI systems were built using different technology that resulted in the complex integration of the two systems.
In less than two years, these two provincial systems, comprising the largest installation of its kind in Canada, were deployed throughout the province, transforming the way surgery and diagnostic imaging are delivered in Ontario.
A 2007 CIPA Winner!
For its exceptional application of information technology to transform processes and bring benefits to the healthcare sector and society, Cancer Care Ontario has been awarded the 2007 CIPA Diamond Award of Excellence in the not-for-profit sector.
Technology partners
Accenture Canada
Anzen Consulting Inc.
Canada Health Infoway
Cardiac Care Network of Ontario
Courtyard Group Ltd.
Initiate Systems Inc.
Microsoft Canada Co.
Smart Systems for Health Agency
xwave division of Bell Aliant
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