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1.08 MRI and CT Scanning Services

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1.08 MRI and CT Scanning Services Chapter 1 Ministry of Health Section 1.08 MRI and CT Scanning Services Follow-Up on VFM Section 3.08, 2018 Annual Report RECOMMENDATION STATUS OVERVIEW Status of Actions Recommended # of Actions Fully In the Process of Little or No Will Not Be No Longer Recommended Implemented Being Implemented Progress Implemented Applicable Recommendation 1 4 4 Recommendation 2 4 4 Recommendation 3 4 2 2 Recommendation 4 4 4 Recommendation 5 3 3 Recommendation 6 2 2 Recommendation 7 2 2 Recommendation 8 2 2 Recommendation 9 2 0.75 1.25 Recommendation 10 1 0.50 0.50 Recommendation 11 1 1 Recommendation 12 2 2 Recommendation 13 2 2 Total 33 1.25 9.75 22 0 0 % 100 4 29 67 0 0 Annual Report. A further 29% of the actions were in Overall Conclusion the process of implementation, and only 4% were fully implemented. The Ministry has made little progress, for According to the information the Ministry of Health example, in analyzing and identifying the reasons (Ministry), formerly part of the Ministry of Health why wait times vary significantly between LHINs and Long-Term Care, and Ontario Health and the or in taking necessary action to reduce the wait- hospitals have provided to us, as of June 30, 2020, time inequities across the province for MRI and little or no progress has been made on the majority, CT scanning services. The Ministry, together with or 67%, of actions we recommended in our 2018 113 114 2020 Follow-Up Report Ontario Health, has established a panel consisting ment and overseeing the funding and performance of clinical, data and service delivery experts to of MRI and CT services in Ontario. Of the 137 evaluate the existing MRI and CT service delivery public hospitals in Ontario, 82 facilities had at model. It expected that by the end of 2021 the least one MRI or CT machine as of May 2020 (79 panel would recommend improvements in areas of them reporting to Ontario Health through the such as scheduling, operational efficiency and Wait Time Information System). The Ministry also patient outcomes. had contracts with seven independent health facili- With respect to our recommendation on redis- ties (IHFs) to provide MRI and/or CT services (the tributing scan referrals among hospitals, we found same number as in April 2018). that the LHINs, now under Ontario Health, were Ontario’s Wait Time Strategy has four priority in the process of expanding the use of centralized levels for MRI and CT scans, with a wait-time target intake of patients waiting for MRI and CT scans. for each: emergency (within 24 hours), urgent For example, the LHINs developed a provincial (within two days), semi-urgent (within 10 days) eReferral strategy, known as the Transitions-in- and non-urgent (within 28 days). These targets Care Strategy, in March 2019, to assist with the fur- were set at the 90th percentile—the time within ther development and integration of eReferral in which 90% of patients in each category should have the province. As well, the Ministry is working with received their scan from the date of referral for the local and provincial delivery partners to develop scan. This means that no more than 10% should and implement a provincial eServices program that have waited longer. integrates and expands eReferral and eConsult, Our audit found that, overall, Ontario’s wait which is expected to be fully implemented by times for MRI and CT scans were the lowest when March 31, 2023. compared to five provinces where 90th-percentile The status of actions taken on each of our rec- wait-time data was available. However, many ommendations is described in this report. Ontarians who needed scans had significantly long waits in comparison to the Ministry targets, particu- larly for semi-urgent and non-urgent cases. Background Among our findings: • Almost two-thirds of semi-urgent and non- urgent MRI patients and one-third of semi- Magnetic resonance imaging (MRI) and computed urgent and non-urgent CT patients waited tomography (CT) scans provide important informa- longer than their targeted wait times. Long tion for diagnosing and monitoring patients’ condi- wait times for these patients delayed diagno- tions. Timely and quality medically necessary scans sis and treatment and could have resulted in help doctors accurately diagnose and treat many deterioration of the patients’ condition. diseases earlier in their course, which can improve • Wait times for MRI and CT scans varied patient health outcomes. depending on where in Ontario the patient In the five years between 2015/16 and 2019/20, lived. The Ministry had not analyzed why the number of MRI scans performed increased by wait times varied significantly among regions. 8% and CT scans by 24% (17% and 31% respect- • MRI and CT machines could have been ively, between 2013/14 and 2017/18), excluding operating more hours per day to reduce wait emergency scans. times, but the hospitals were unable to fund The Ministry of Health (Ministry), formerly part increased operating hours. The 108 MRI of the Ministry of Health and Long-Term Care, is machines in Ontario’s hospitals were used at responsible for capacity planning, policy develop- only 56% capacity in 2017/18. If all 108 MRI Section 1.08: MRI and CT Scanning Services 115 machines operated for 16 hours, seven days agency that assumes centralized responsibilities for a week, hospitals would have outperformed most of the functions of at least 20 health agencies. the Ministry’s wait-time targets. In addition, As of April 31, 2020, the following organizations the province’s 165 CT machines were used at had been transferred to become part of Ontario approximately 37% capacity in 2017/18. Health: • The Ministry had not reviewed its funding • Cancer Care Ontario; method for either MRI or CT services for • Health Quality Ontario (now Quality); more than a decade, and it had not incorpor- • Health Shared Services Ontario (now Shared ated into its funding method the actual cost- Services); per-scan information, hospitals’ demand and • eHealth Ontario (now Digital Services); capacity, and the complexity of scans required • HealthForceOntario Marketing and Recruit- by patients. ing Agency; and • Hospitals lacked user-friendly communication • Ontario Telemedicine Network. systems (such as email and text messaging) The 14 Local Health Integration Networks that would allow patients to confirm their (LHINs) have been clustered into five interim and appointments, contributing to patient no- transitional geographic regions—West, Central, shows. This resulted in scanning machines Toronto, East and North. However, due to the sitting idle unless hospitals were able to fill COVID-19 pandemic, the transfer of the health the time slots quickly. None of the four hospi- system funding, planning and co-ordination func- tals we audited routinely tracked reasons for tions of these LHINs to Ontario Health has been no-shows. postponed to a later date. • Province-wide peer review of MRI and CT scan results was not mandatory across Ontario hospitals. Lack of a peer review program exposed patients and hospitals to Status of Actions Taken the risk of misinterpretation of MRI and CT on Recommendations images and/or misdiagnosis of a patient’s condition. We conducted assurance work between May 2020 We made 13 recommendations, consisting of 33 and June 2020. We obtained written representation action items, to address our audit findings. from the Ministry of Health, Ontario Health and the We received a commitment from the then hospitals that effective October 2, 2020, they have Ministry of Health and Long-Term Care, Local provided us with a complete update of the status of Health Integration Networks (LHINs) and hos- the recommendations we made in the original audit pitals that they would take action to address our two years ago. recommendations. 65% of MRI Patients and 33% Event Subsequent to Our of CT Patients Had Long Waits 2018 Audit for Their Scans, in Excess of the The existing Ministry of Health (Ministry) was part Ministry’s Targets for Semi-urgent of the Ministry of Health and Long-Term Care when and Non-urgent Priority Patients we conducted our audit in 2018. Recommendation 1 In June 2019, Ontario Health was created under To help ensure patients have equitable access to MRI the Connecting Care Act, 2019, as a provincial and CT services across the province, we recommend 116 2020 Follow-Up Report that the Ministry of Health and Long-Term Care work urgent CT scan for the same year ranged from 27 with Local Health Integration Networks (LHINs) and days in the Central East LHIN to 135 days in North hospitals to: East LHIN. • analyze and identify the reasons why wait times We also found that, overall, wait times for both vary significantly between LHINs: MRI and CT scans in 2019/20 have not improved • for MRI services; and since 2017/18: • for CT services; and • MRI scans: For emergency patients, only • take necessary actions to reduce the wait-time 5% (the same as in 2017/18) waited longer inequities across the province: than 24 hours. For urgent patients, 16% • for MRI services; and (17% in 2017/18) waited longer than two • for CT services. days (up to five days). Semi-urgent and non- Status: Little or no progress. urgent patients accounted for 90% (91% in 2017/18) of the total MRI scans in 2019/20. Details Overall, only 33% (slightly worse than 35% in In our 2018 audit, we found that while Ontario hos- 2017/18), not 90%, of semi-urgent and non- pitals were mostly able to provide timely services urgent patients received MRI scans within to patients who required either an emergency or the Ministry’s targets of 10 days and 28 days, urgent MRI or CT scan, they were unable to do so respectively.
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