Measuring the System’s Fault Lines

Contributed by Dr. Joshua Tepper, President and CEO of Health Quality Ontario

A quality health care system seamlessly delivers care across a broad spectrum of care settings and patient populations. Unfortunately, even a good health care system can have fault lines into which patients can fall and where quality care is deficient.

Measuring Up, Health Quality Ontario’s newly released 11th annual report on the performance of the province’s health system and on the health of Ontarians, documents those fault lines as well as other areas where the provincial system can improve.  It takes the pulse of the system through measurement and through narratives from people like Gordon, Lilac and Elgin who share their experiences as patients and that of Shawn Dookie, a nurse practitioner.

Starting with initial entry into the system, Measuring Up this year identifies areas of concern. Compared to 10 other developed countries, Ontario scores as one of the worst when it comes to having access to a primary care provider the same or next day when someone is sick. More than half of Ontarians surveyed reported having this problem.

Then, when patients have to go to the emergency department they are spending on average of an hour-and-a-half longer in the emergency department before being admitted to a hospital bed than they were the previous year. This can, at least partially, be attributed to the fact that an average of 3,961 beds daily were occupied by patients waiting for care elsewhere in 2015/16 (known as Alternate Level of Care). For those of you who want to see a good Rick Mercer-type rant about Alternate Level of Care and its impact on the system, this video was filmed by the chair of Health Quality Ontario’s Quality Standards Committee, Dr. Chris Simpson, two years ago when he was president of the Canadian Medical Association.

Little progress was documented in reducing the number of people with a mental health or substance use issue who went to the emergency department without seeing a psychiatrist or other physician first (33.1% in 2015).

Some wait times also continue to be an issue in Ontario. Hip and knee replacements are increasingly common yet fewer patients are receiving surgery within the target time. For example, 5% fewer of those awaiting Priority 4 knee surgery in 2016/17 had their procedure within the target time, compared to in 2014/15

Furthermore, only 56.7% of home care patients felt strongly involved in the development of their own care plan. And caregiver distress among those caring informally for patients needing home care has increased from 21.2% in 2012/13 to 24.3% in the first part of 2016/17.

Health Quality Ontario always brings an equity lens to the delivery of care and here again Measuring Up identifies areas of concern.

  •  About 1 in 12 people in Ontario reported having trouble paying their medical bills
  •  Variations exist by region and by rural vs. urban in reported having ongoing consistent care over time with the same physician. For example, the proportion of people who had high continuity of care ranged from 66.5% in the South-East Local Health Integrated Health Network (LHIN) LHIN region to 49.8% in the Central West LHIN region.
  • The premature mortality rate shows striking variations across the province with the rate of potential years of life lost being 2.5 times higher in the North West LIHN region) at 7,647 potential years of life lost per 100,000 people compared with 3,026 potential years of life lost per 100,000 people in the Central LHIN region over the same time period.
  • Colorectal cancer screening has inequities by income. Urban residents in the lowest income neighbourhoods had the highest rate of being overdue for screening in 2015 at 46.5% compared to 32.7% of these in the highest income neighbourhoods.

The measures of involvement in home care and continuity of care referenced above are two of four new indicators added to Measuring Up this year. The other two indicators are:

  • The wait time from when a patient is assessed or registered in the emergency department to the time they are first seen by a physician. The average time patients waited to see a physician increased slightly this year from last year to 1.5 hours from 1.4 hours.
  • The wait time between when a cancer patients is referred by a primary care physician to a surgeon to the time of their first appointment with the surgeon. About 6 out of 7 Ontario patients who had cancer surgery had their first surgical appointment within target wait times in 2016/17.

In addition, findings are now available on the delivery of primary care in the LHIN sub-regions, smaller geographic planning areas within Local Health Integration Networks.

In Quality Matters: Realizing Excellent Care For All, our report on how to improve quality in the system, it is noted that measurement gaps exist in documenting transitions in care and that “safer and more efficient transitions for patients require appropriate accountabilities and hard data rather than anecdotes.”Measuring Up this year is an example of where we are bridging those gaps in knowledge, by producing numbers that shine a light on where we can do better.

The report also documents where Ontario is doing well and these findings are not insignificant as they show that overall Ontarians are living longer and losing fewer years of their lives to premature death. Measuring Up also shows long-term care residents are receiving better care on a number of parameters and more people are receiving colorectal cancer screening in a timely manner.

These statistics are also useful as they show improvement is possible and guidance on how that improvement might occur.


Toronto EMR: Every Step Conference Recap

Contributed by Revin Samuel



Thank you to all the attendees, speakers, exhibitors, peer leaders and staff who participating in the 2017 EMR: Every Step Conference this past September 28 in Toronto. The conference was a tremendous success!

If you’d liked to provide any feedback on the conference, feel free to do so by emailing

Stay tuned to for details on future EMR: Every Step Conference and our brand new series, On the Road with OntarioMD.

We hope to see you again soon!


Small Changes Can Have a Big Impact With EPEP


Contributed by Marsha Foster, OntarioMD Practice Enhancement Consultant

Does this sound familiar?  Your clinic has had an electronic medical record (EMR) for some time now. Things seem to be running OK… but maybe you expected everything to be a little easier by now.  Some questions linger in the back of your mind: Is my data truly sound? Could I use my EMR to better understand my diabetic population? Is there an easier way to keep tabs on my preventive care?

OntarioMD’s EMR Practice Enhancement Program (EPEP) is aimed at helping physicians answer these types of questions to optimize their EMR data and functionality. EPEP is a service available to all Ontario primary care providers and community specialists using a certified EMR. A typical EPEP engagement will start with a meeting between you and your Practice Enhancement Consultant (PEC), held at your office at a time that’s convenient for you. Together, you’ll discuss your areas of interest and practice priorities. Your PEC may also ask you to demonstrate some of your favourite ways to document information in your EMR. Your PEC will then perform an in-depth analysis of your EMR data.

After all this initial work is done, your PEC will present their findings and recommend steps you can take to streamline your workflow and use your EMR to achieve your practice objectives. The choice is always yours as to how closely you follow your PEC’s recommendations.

An EPEP success story

The services of a PEC were requested by a family health organization in the Greater Toronto Area that was concerned about the inaccurate data they saw in their EMR around preventive care and cancer screening. They knew their team of five physicians was providing good care, but this was not being reflected in their ministry reports. Instead of documenting their work in an easily trackable manner, they relied on detailed documents sent from the ministry, and spent many hours manually updating patient charts.

The PEC’s data analysis uncovered an issue with the clinic’s roster status process. This process gap was the cause of the poor preventive care reports being produced.

The PEC demonstrated a best practice that could be used to correct the roster status within the EMR. The clinicians and staff agreed to implement the changes suggested by the PEC, and the data gap was closed within a short amount of time. The roster clean-up dramatically improved the clinic’s preventive care reports, and eliminated the hours needed for manual updates. That was time the clinic could start dedicating to other activities and services.

This is just one story of how small changes can have big impact! To meet with a PEC and see how EPEP can improve your practice efficiency, please contact