Good morning.
Thank you very much for inviting me to this meeting.
Diagnostic imaging plays a very important role in the diagnosis of clinical conditions in many clinical areas, and we know that you cannot treat patients properly without having an accurate diagnosis. Therefore, wait times in diagnostic imaging create major bottlenecks in many other areas of clinical care.
I just want to share a few figures with you to give you some idea of the problem. In 2003, there were 35 million diagnostic imaging studies performed in Canada. That's 17,000 exams per radiologist, about 2,000 more than we feel are optimum, and more than one diagnostic imaging exam per Canadian.
In 2004, there were approximately 2,000 radiologists in Canada. This was, we feel, about 500 short of the number of radiologists we actually needed, and that situation has not changed substantially a year or two later.
If current trends continue, we expect that diagnostic imaging volumes will increase by 30% over the next six years, whereas the net supply of radiologists will increase by less than 5%. So the situation is not going to get better; it's going to get worse unless we can do something about it.
In the past we have advocated for more diagnostic imaging equipment, and we certainly appreciate the response of the federal and provincial governments in providing money for more equipment. But we also know that the solution does not lie just in providing more equipment. We have to become more efficient and more productive.
The Canadian Association of Radiologists is working on four projects that we feel will increase our efficiency and productivity. The first of these is advocating for more PACS and RIS systems in Canada. PACS are picture archiving and communications systems. RIS refers to radiology information management systems. These are electronic systems, and you can view these as the diagnostic imaging part of an electronic health record. These will increase our efficiency, and we appreciate the support of Infoway in helping to fund PACS and RIS systems across Canada.
We're also working with the Canadian Association of Medical Radiation Technologists on developing physician extenders. This means training technologists to do some of the procedures that radiologists do, under the radiologist's supervision, thus freeing radiologists to do other things and to become more efficient in other areas.
We're also advocating with the Canadian Interventional Radiology Association the increased use of interventional radiology. These techniques, we believe, can move patients out of operating rooms into interventional radiology suites, where procedures can be done in less costly and invasive fashions, and free operating room time for more complicated procedures.
The fourth project is the guidelines project, and that's a project I want to spend a little time on. I'm the chair of the guidelines committee, and we believe that guidelines have the potential to make a substantial impact on diagnostic imaging wait times.
Just to give you a little background and to share a few more figures, based on a pilot project we did in New Brunswick and based on studies and the literature, we believe that at least 10% of diagnostic imaging studies performed in Canada are unnecessary. That equates, this year, to about four million examinations. That's the workload of 250 radiologists, half our shortfall. It's also the workload of about 200 average-sized hospitals. So it's a substantial number of exams, and if we could stop doing those we feel it could make a significant difference to wait lists in radiology.
So you may ask, why are all these unnecessary exams done?There are three basic reasons. One is that exams are repeated because the original study is unavailable or inaccessible, and PACS will go a long way to ameliorating this problem. There are two other reasons, though.
You have to understand that the amount of information that is being provided to physicians daily, weekly, and yearly is overwhelming, and no physician can keep up completely. So physicians often are not sure what is the most appropriate diagnostic imaging study to do. They are not always sure whether diagnostic imaging will help their patient, but they do the best they can and they order a diagnostic imaging study.
In some cases those diagnostic imaging studies are not the most appropriate studies to answer the clinical question the physician has. What happens is they then have to go on and do another study that is more appropriate.
In other situations they order studies believing that they can help them, when in fact the diagnostic imaging study will not help them in their clinical situation, or at that time.
Guidelines are designed to prevent as much as possible these inappropriate examination orders. Because of this, the CAR decided that we should develop guidelines for imaging procedures. We looked at what was available and we decided that those of the Royal College of Radiologists in England, which had developed an excellent set of evidence-based guidelines, were the most suitable for our purposes. With their permission we adopted these guidelines. We modified them slightly for the Canadian situation, and we published them in booklet form at the end of last year. The first printing has already been distributed and we're now into a second printing. I may add that they were published in both English and French.
However, we also believe that printed guidelines are not the most effective way of implementing guidelines. Busy physicians don't often have time to look things up when they're seeing patients. We believe the best way to implement guidelines and have them be effective is to provide them at the point of care.
The CAR is partnering with Medicalis, which is a Canadian medical software company based in Waterloo. They have developed an electronic diagnostic imaging order entry software called Percipio, and they have integrated the CAR guidelines into this software. When a physician orders a diagnostic imaging study, he provides clinical information. If the study does not meet with the guidelines, he immediately gets an electronic prompt suggesting to him what would be a more appropriate study or suggesting that diagnostic imaging would not help him.
We are currently about to start a demonstration project of this software at my hospital, the Children's Hospital of Winnipeg. This project has been jointly funded by Health Canada and Manitoba Health, and has the support of the Winnipeg Regional Health Authority. I may add that it also has the enthusiastic support of our pediatricians.
We're going to have an independent research team assessing the effectiveness of this software, using both quantitative and qualitative methods.
We believe it will be important to do other demonstration projects in other clinical settings, such as testing it with family practitioners in rural and remote areas and testing it in busy emergency departments, and we would very much like the support of the committee in getting funding for these demonstration projects.
In conclusion, as an association we believe that ongoing cooperation and communication between all parties--governments, physicians, and patients--is essential to initiating and sustaining change. We are committed, as a national organization of radiologists, to working cooperatively with all parties to create positive change.
Thank you for your attention.
Thank you for your interest.