Doctors Manitoba prescribes urgent upgrade for antiquated patient-referral system

Manitoba doctors say it’s time to speed up the process of patient referrals to specialists by replacing fax machines and snail mail with a co-ordinated electronic system.

This fall, Doctors Manitoba is holding a summit with referring and consulting doctors, government and regulators to discuss making the referral system more efficient and eliminate delays and bottlenecks.

“I have more patients than I can count over my career that have missed specialized appointments or diagnostics because of the vulnerability of that system,” said Doctors Manitoba president Dr. Nichelle Desilets.

There are approximately a half-million specialist consultations in Manitoba annually — almost all of which are initiated by referral sent by fax or mail in a siloed system not designed for effective collaboration, says Desilets’ organization, which advocates for physicians in the province.

A Statistics Canada report this week shows about 60 per cent of Manitobans wait up to three months to see a medical specialist once they’ve been referred by another doctor, and about seven per cent wait a year or longer. It also shows that less than half of Manitoba patients are satisfied with wait times.

Retired FedEx delivery driver Jonathan Green was told last fall that he would have to wait a year for a consultation with a surgeon to look at his torn rotator cuff.

“If it’s going to take at least a year just to see the surgeon, God only knows how long it’s going to take for them to even say, ‘Hey, we’ve got a surgery date for you,’” said Green, who decided to pay out of pocket and had the surgery done in Mexico last April.

“Had I waited to get this done here in Manitoba — and I’m being quite literal when I say this — I’d probably be dead before that happens.”

He said he reached out to former radio announcer and acquaintance Dez Daniels, who faced an excruciating wait for hip-replacement surgery and in 2022 opted to pay for the operation in Mexico.

“Had I waited to get this done here in Manitoba — and I’m being quite literal when I say this — I’d probably be dead before that happens.”–Jonathan Green

She referred Green to that surgeon. He said he paid roughly $13,000 for the surgery, airfare and accommodations and said he hopes to recover some of that from the province.

Modernizing the referral system to make it more efficient and interconnected will give specialists more time to focus on patients, improving health care and reducing waits, Desilets said.

“This sounds like a behind-the-scenes, IT issue but, really, it has the potential to touch so many areas of our health-care system,” she said in an interview earlier this week.

“Specialists tell us that they’re using up to the equivalent of one work week on referral processing per year,” she said. “Any improvements in the referral and requisition processes not only stand to improve the work environment of physicians, patients are going to benefit, as well.”

Having a system that’s easy to navigate and reduces the administrative burden will help with physician recruitment and retention, she said.

Doctors pick up the phone to call a specialist when a patient has an emergent issue, but most cases aren’t emergencies, she said. Most often, a doctor writes a referral to a specialist, “usually old-fashioned fax.”

“There’s definitely people missing appointments and that’s a waste of health-care resources.”–Dr. Nichelle Desilets

 

Once sent, the referral might sit in the fax machine tray or the clinician’s inbox until they get to it, she said, adding machine paper jams and power failures in which the unit’s memory is lost are problems, as well.

When doctors request a CT scan, “there’s thousands of pieces of paper coming through on that other end in the CT department that they have to manage, as well… There’s multiple steps where a small unintentional slip-up could lead to that patient not getting their CT scan in the appropriate, urgent timeline,” she said.

Patient referrals by regular mail can be affected by Canada Post service disruptions and mailings sent to old addresses, Desilets said.

“There’s definitely people missing appointments and that’s a waste of health-care resources,” she said.

“I feel really passionate about the referral and requisition improvements because I’m a family doctor, so I’m often sending the referrals. But, as someone who does colonoscopies and does (caesarean) sections for people who need to deliver their babies that way, I get referrals.

“I see it from both sides. I have been contacted by my colleagues saying, ‘Did you get my note asking for a colonoscopy on this patient?’ And I will go through it and say, ‘nope, never got it.’ And so that person waited unnecessarily.”

Desilets said if she’s referring a patient with a non-life threatening condition, she’ll ask them to let her know if they haven’t received a response from the specialist after three months.

“Until the patient gets that appointment, I don’t know that that referral has been processed yet. It might still be sitting in an inbox. It might have been lost altogether,” she said. “There are opportunities for large, unnecessary time lags just due to the nature of how this work is done.”

carol.sanders@freepress.mb.ca