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Wait list management

Sarah Kramer outlines Ontario’s wait time reduction strategy

By H. Dominic Covvey and Shirley Fenton

WATERLOO, Ont. – Long wait times for key health services have long frustrated Canadians. Ontarians are no exception, but a major provincial government initiative is aimed at changing what we kvetch about.

The first component of this initiative is increased funding for specific procedures. The second is establishing accountability for actually reducing wait times, and the third is a system to measure what happens and monitor achievements. The system is called the Wait Time Information System (WTIS) and Sarah Kramer is the one making it happen.

Sarah is a VP and CIO at Cancer Care Ontario (CCO), focusing on implementing CCO’s ambitious Information Management Strategy. Recently, Sarah took on a leadership role in developing and implementing the information architecture to support the Ministry of Health and Long Term Care’s Access to Services and Wait Times Strategy.

In late September, Sarah was the kick-off speaker for the 2005-2006 Smarter Health Seminar series, hosted by the Waterloo Institute for Health Informatics Research at the University of Waterloo. She entitled her talk, “Standing on a Burning Platform: Implementing a Province Wide Wait-time Information System.”

There are quite a few aspects of WTIS that easily generate concern. First of all, it is a big undertaking, starting with five “pilot” hospitals and then incorporating all 77 that received funding to increase their volumes and hopefully reduce wait times.

Five specific services will be monitored: hip/knee replacement, cataract surgery, cardiac surgery, cancer surgery, CT/MRI. The system addresses only “Wait-2”, which is the time from when the care provider decides to order one of these services and when the patient actually receives the service.

The wait to get an appointment with a specialist is not captured. Care providers will be expected to enter data, including the scheduled date for the service, through a web-based interface, although the data is intended to be obtained eventually from the institution’s scheduling system.

One concern here is ensuring that the date of the service request is accurate. Later dates would give the appearance of shorter wait times. Another issue is the tool used to compute a patient’s priority in the wait list for a service.

It was pleasing to hear that the final specification of the priority is in the hands of the care provider, although the priority system does suggest a priority based on assessment tools being constructed for each service. Finally, many are already aware that the WTIS depends on the existence of an Enterprise Master Patient Index (EMPI) system that has only recently been put on a fast track.

If you would like to see Sarah Kramer’s presentation, go to and select WIHIR Online Presentation Archive.