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Tuesday, June 6, 2023

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An Ontario doctor’s wait-list database is saving patient lives. It’s madness a doctor had to do it himself

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As wait times worsened over the course of the pandemic, referral-related problems were a constant hot topic among health-care workers. Finding a specialist isn’t based on what your family doctor knows, but who they know, a networking process that can take years of practice. Nathan Denette / THE CANADIAN PRESS file photo

The first time Niagara family physician Ali Qamar looked at the database he and his team created to improve patient care, “I had this feeling that a blindfold had been removed,” he says.

There’s nothing fancy about RelayMD. It’s a searchable database of specialists and procedures, by location and wait times. Yet by simply showing the full extent of available specialists in his community, this young family doctor vividly saw how access could be speeded up, reducing patient anguish and hardship.

While it hasn’t added supply to the system, it has made the supply visible, shortening wait times for patients lucky enough to know what their options are, Armine Yalnizyan writes.

One patient with blood in their urine — a possible sign of cancer, which later proved to be the case — waited eight months to see a specialist. Had the RelayMD database existed, Qamar would have seen there was another specialist who could see the patient in half the time. Every passing week impacted the prognosis.

Another patient, with nerve compression in the neck requiring spinal surgery to prevent further deterioration of motor control, has already been in a queue for a consultation for more than a year. Today, Qamar’s database can locate a specialist with a four-month wait time, with a fraction of the effort.

Finding a specialist isn’t based on what your family doctor knows, but who they know, a networking process that can take years of practice. “It was like looking at a system through a keyhole,” says Qamar.

Given the number of new family doctors and nurse practitioners who will come on stream in the coming years, lack of an integrated province-wide or even countrywide database is madness. It guarantees wasted time and suboptimal results.

As wait times worsened over the course of the pandemic, and as more specialists retired, Qamar commiserated with a Facebook group of thousands of early-career family doctors. Referral-related problems were a constant hot topic, with crowdsourcing a recurring solution.

Comprehensive information was needed. Qamar embraced the glamour of a bootstrap operation: endless excel sheets, lots of hand-filled surveys, and hundreds of hours of zoom calls at odd hours. It paid off.

RelayMD was born in March 2022, with an emergency physician and a University of Waterloo engineer. The three founders worked with about a hundred doctors to improve user interface, documentation and tracking, then hired an assistant to help, at $17 an hour. Wait times are updated regularly, and subspecialities are noted (the types of cases that will and won’t be seen), which reduces the number of declined referrals.

This simple yet miraculous system is brought to you courtesy of four people on a shoestring budget. It has delivered surprising results, surprisingly quickly.

RelayMD now lists 5,500 specialists who work through referrals from family doctors to provide care in the province’s most densely populous region, the Toronto-Hamilton-Niagara corridor. This week, specialists in Kitchener-Waterloo will be added. Next up, London or Ottawa.

By summer, at least 8,000 specialists will be listed — roughly two-thirds of all specialists to whom family docs can refer patients in Ontario — as well as hundreds of allied health professionals, such as psychologists or physiotherapists.

A family doctor can search wait times by location/distance, specialty (say, cardiology), subspecialty (say, pediatric endocrinology), or specific procedure (surgery, or a diagnostic test). They can search by gender (want a female doctor for a gynecological exam?) or language (especially helpful to reduce barriers to care for recent immigrants, migrant workers and refugees).

In Ontario many specialists have their own referral form. The website has downloadable versions of them all, making it one-stop shopping for family physicians and administrative staff.

Within a year, Qamar’s team has created a resource that is, quite literally, a lifesaver. It has made workflows more efficient, reducing time spent by doctors and receptionists trying to secure a referral, and reduced the time patients spend in agonizing limbo.

It hasn’t added supply to the system. It has made the supply visible, shortening wait times for patients lucky enough to know what their options are. It’s a mystery to me that any doctor in Canada in 2023 had to DIY a fix for that.

I wrote about centralized wait-lists in February, which is why Qamar got in touch with me. B.C. has a government-funded platform, free for all doctors. While different approaches have been tried in Ontario, it’s beyond frustrating we still don’t have an integrated, up-to-date, physician-friendly database of wait times for all specialists.

That’s the ultimate goal of RelayMD, which charges a $19.99 monthly subscription per physician, with bulk deals for clinics and family health-care teams. It’s a fast-growing business, with every month bringing in new subscribers; but Qamar says he and his co-founders would rather this information not be behind a paywall.

“The alternative for many doctors is nothing,” says Qamar. “When you order something from Amazon, you can track its progress to your door. Our expectations are so skewed for total transparency on the consumer side, but when it comes to getting care, there’s none of that.”

Qamar and his partners hope the province will see the database’s value and step in to fund the minimal costs of updating it. They want to ensure all doctors have the information they need to improve patient care and health outcomes.

That’s why they got into this business in the first place.

Armine Yalnizyan is a leading voice in Canada’s economic scene and Atkinson Fellow on the Future of Workers. She is a freelance contributing columnist for the Star’s Business section. Follow her on Twitter: @ArmineYalnizyan. You can write to her at ayalnizyan@atkinsonfoundation.ca

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