Internet will expand patient, physician options

Project aims to keep all involved informed

Patients and their physicians in southeastern Ontario, Canada, will soon be able to check an Internet site to find out how long they will have to wait to see a specialist, have elective surgery, or receive outpatient services.

Kingston (Ontario) General Hospital, in partnership with Hotel Dieu Hospital and the Queen’s University Health Policy Research Unit, is developing a public Web site to help physicians and patients find out about and access referral services that require the least amount of waiting, says John Marshall, MD, Kingston’s general chief of staff.

Kingston General is an academic health science center with regional responsibility for tertiary care services in southeastern Ontario.

The Web site will include information from 200 physician offices affiliated with Kingston General, listing the procedures they perform, the number of patients on the waiting list, the average monthly throughput, and the earliest time for an appointment.

Voluntary waiting times will be included. For example, some patients may wait for several months because they want to go to Florida for the winter before having the procedure performed.

"This will allow the referring physician and the patient to understand what the alternatives are," says Marshall. "For instance, the patient will know that he could see Dr. X in three months but could see Dr. Y the next week. They would be able to make an informed decision."

The Canadian medical system often has situations where patients are waiting for one physician practice and are not aware they could get services if they went to another practice.

"It is completely unfair for referring physicians to have to go shopping to find the shortest waiting time for their patients. They should be able to get it with today’s technology," he says.

So far the project is more conceptual than operational but the Web site should be up and running by fall, Marshall says

"It is more problematic than we originally thought, not because the technology is difficult and not because we have the wrong ideas but because we have to deal with 200 separate physician offices. That is the big challenge," he states.

The first step is lining up the data to construct the backbone of the Web site. "The biggest challenge is ensuring that we can and do get reliable data," Marshall says.

For instance, all 200 physician office sites use the same scheduling system for their clinics but most don’t put the patients on the scheduling system until one week before the patient is due for the appointment.

"We have to change that habit. We are educating my colleagues and their secretaries to do what they need to do," he says.

The hospital is working with Atlanta-based Per-Se Technology to create a template and a waiting list module for the patient care system that will automatically create the information necessary for the Web site.

"If I’m going to get my colleagues to do this, it is realistic to expect that we mustn’t impose extra work. The issue is to automate it. If we are going to have a meaningful Web site, it should be updated automatically. We are putting in place the infrastructure at present," he says

The project is not entirely altruistic, Marshall says. "Part of my purpose is to have the leverage to impress upon the ministry people who fund our hospital that we need more staff and more hospital resources."

For the past six years, the hospital has been on a global budget for physician services. The hospital gets a lump sum based on what the physicians were billing when the plan started.

"Those who are responsible for the limitation of resources need to be aware of what we are doing and not doing. The waiting list shows what we are not doing. If we are coding as much as we are paid to do and we still can’t serve the population, we probably need to get more funds," he says.

The project is funded by a $95,000 grant from The Change Foundation, a charitable organization incorporated by the Ontario Hospital Association. The hospital is matching the grant funds.