For nearly 20 years, the OAC has been working to improve cardiac patient care. In 1995, the OAC was the first professional organization in the province to create and publish standards for the performance of echocardiography services. These were ignored until 2009 when a working group came together and subsequently developed standards for echocardiography that were accepted and released by the Cardiac Care Network of Ontario (CCN) in January 2012. OAC members were actively involved in developing these standards (for more information, see Standards for the Provision of Echocardiography in Ontario 2012).A key hallmark of this document is the inclusion of “appropriateness guidelines”.
In 2012, the OAC spearheaded a province-wide advocacy program, without the support of the OMA, to change a hastily-enacted government regulation (a new definition of self referral) that, if fully implemented, would have led to the closure of half of the noninvasive cardiac testing facilities whether they were located in a hospital environment or private office/clinic environment in large and small communities throughout the province. This would have seriously jeopardized access to cardiac care and destroyed the infrastructure for noninvasive testing that the provincial government and cardiologists had worked on together to implement over the previous 15 years. There could have been increased cardiac patient mortality and morbidity had the regulation been implemented unchallenged by the OAC. With the support of cardiologists, community leaders, cardiac patients and their families, the OAC advocacy program was responsible for submitting a petition with 70,000 signatures to Queen’s Park within six weeks. The OAC convened numerous meetings with government officials and through all of this activity convinced the government to change the new definition of self-referral to appropriateness guidelines. The current access to cardiac care for the Ontario patient thus remained unchanged.
A February 2012 independent analysis conducted by the Institute for Clinical Evaluative Sciences (ICES) on the Standards for the Provision of Echocardiography Services in Ontario, which used appropriateness guidelines as the basis for ordering an echocardiography test, concluded that $44 million could be saved annually if the standards were implemented. The Expert Panel on Appropriate Utilization of Diagnostic and Imaging Studies (Rubin Committee) was created in July 2012 to look at the appropriateness guidelines for non invasive cardiac testing and agreed with the OAC that this is the best way to determine who gets a test and when and where and by who. They have gone on to successfully use appropriateness guidelines based principles for other non-invasive cardiac tests and testing outside of cardiology. OAC is proud of its member cardiologists who have had an active role with the Rubin commission.
For the OAC, implementation of appropriateness standards is critical as they ensure that the right test is provided to the right patient at the right time by the right physician in an accredited facility. This leads to improved cardiac patient care, and ensures limited government health care resources are spent appropriately.
We are a strong supporter of the Choosing Wisely Canada campaign, introduced in April 2014, which aims to help physicians and patients engage in conversations to reduce unnecessary tests, treatments and procedures. For more information on CWC, click here.
In 2015, the CCN published updated echocardiography standards, which the OAC supports. The access them, click here
Without OMA approval, the OAC began direct consultations with the government to change the definition of self-referral for noninvasive cardiac testing to appropriateness based guidelines.