Thursday, October 21, 2010

More hoops for Ontarians seeking bariatric surgery.

I've blogged before about how Ontario's Ministry of Health has chosen to shut the doors for timely access to bariatric surgery for Ontarians.

As part of their much bally-hoo'ed new strategy they decided to create a centralized bariatric registry which involves a website where physicians register so as to apply to have their patients wait for months to years to get an appointment at a bariatric assessment centre.

Well just two weeks ago, after 7 months of "coming soon", the site finally went live and yesterday I had the opportunity to use it.

Want to know what the site does?

It requires physicians to register for access and in return it provides physicians with access to a PDF form.

The form's not fillable - it needs to be filled out by hand (because we doctors are known for our fabulous handwriting I suppose).

Call me crazy, but I would have thought that after 7 months of web development at least I'd be able to actually fill out the form online (whereby submitting online may have privacy concerns).

Or at the very, very least I'd be able to print out the form and photocopy it so that I'd have it available in my form folder rather than have to physically log onto the registry's website each time and go through 4 separate pages before reaching the actual form that I then am required to print, retrieve from my printer, and fill out, but that's not the case because each form has a unique number on it.

And while I'm sure it sounds like I'm whining and being fickle and nitpicky I can tell you that family doctors are a busy bunch and while forms certainly are part of our lives, this 1982-esque, fax machine, hand written, print each time system is only going to slow things down further and is just yet one more example of how the organization of Ontario's bariatric surgical program doesn't seem to reflect a clue.

[Here are the instructions the site provides for filling out the form:

•Always use a ballpoint pen, preferably black. Do not use red or pencil.
•Print all text and numbers legibly, and inside the boxes without any loops or extra strokes.
•Mark all choice fields (e.g. no/yes) with an X.
•If you make a mistake or wish to correct any item on the form, strike through the error with a single horizontal line and write the correction next to it. Never erase or use white-out. Date and initial all corrections and remember to refax if necessary. The original referral form must be used for corrections.
•When faxing, the page must be oriented vertically so that the database can read the barcode at the top.
•Fax all completed referral forms to 1-800-268-2370. Do not send a cover page or any other documentation.
•Check to ensure the fax transmitted successfully

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  1. Wow - that takes government bureaucracy for Dummies to a whole new level. Are you required each time to fill in your postal code in case you can't remember which bariatric center is closest to you for referring your patients?

    Do you think that this new system will triage patients at all so that "healthy" morbidly obese patients will have to wait a little longer whereas a "sickly" obese patient (ie. with multiple serious co-morbidities) will be fast tracked? Or is this just to track referrals?

    And lastly, is there a confirmation that the form is received? I know so many people "in the system" right now just have no idea if they are even in the system/in line for orientation. Their referrals were sent in back in Jan 2010 and still NOTHING. So very frustrating to those waiting to change their lives for the better.

  2. Hi Jennie,

    There are some questions, yes or no style, that could serve to triage folks who have more severe comorbidities and disabilities but not having seen the system in action, I can't comment on whether or not they will serve to effectively triage patients.

    Regarding postal codes, you have to fill in the patient's demographics each time and it's from those that the centre is chosen.

    Despite the fact that I had to register for the system, the form generated for "me" doesn't even pre-fill my name or telephone numbers.

    Regarding confirmations - I certainly didn't see anything on the site suggesting there would be any such courtesy.

  3. What is this "fax" technology they are using? Sounds very leading edge. :-)

  4. One would get fax confirmation from one's own machine.

    But really, you register and your information isn't retained on the form after the first time you fill it in? And why can't you print it? Sounds like after 7 months they had someone (probably a physician who got POed) save a word file as a PDF so they could have something accomplished within a year.

  5. Confirmation that a fax has been received isn't what Jennie was after. What she was after was confirmation that the referral was received, accepted and that a patient was actually on a waiting list.

    With the current system, Ottawa outright refuses to tell patients where they are on a list (and correct me if I'm wrong, but I'm not sure they'll even let you know if you're on a list).

    You can't print the form because the only information that does in fact change on "my" form is the patient # and I suspect that it's possible that were I to simply print the form and change the patient number each time by striking through the number and writing the correction, that in turn that will cause an insurmountable bureaucratic snafu leading to said application being left unentered.

    And yes Holly, this machine - it's amazing.

  6. "Ottawa outright refuses to tell patients where they are on a list (and correct me if I'm wrong, but I'm not sure they'll even let you know if you're on a list)."

    This makes me feel like a lowly peon.

  7. Anonymous11:42 am

    Although I have made it through this not so lovely process here in Canada and am simply waiting for my surgery date to arrive (13 months after my referral from my doctor), I have had to call the assessment center in windsor ontario to set up my follow up appts for after surgery. The machine said that there is this new process where it all goes to a government agency and then this agency then issues the centers the paperwork for which pateients they will b e handling. They also said on the message that it is approximately 4-6 months before you will get your first meeting. This is ridiculous!!! For me it was 3 months before my first meeting and that was ridiculous enough. To add insult to injury, when I was referred to the surgeon in Guelph, I was informed that my surgeon only does 50 of these surgeries PER YEAR!!! She then proceeded to tell me that Guelph only does 250 per year. It's no wonder that there is such a long waiting list. If only 250 are done a year in Guelph (between I believe 4 surgeons) and there are thousands of people waiting its no wonder these waits exist! Yes there are other centers such as Toronto but come on now...50 a year for example is only one surgery per week! RIDICULOUS!!!!!!!!!!!! I do not believe that Canada is completely ready to handle the workload and feel that they should still be sending at least some of us over to the US like they were before until they can come up with a plan to get people through the system a lot faster.

  8. Anonymous8:52 pm

    Would you be able to tell us the questions that are asked on the form so I can ensure my doctor knows all the information I need to tell her. Is there a section where the doctors can request that the patient move ahead on the waiting list due to existing health concerns?
    Thank you for your time.

  9. The questions are very straightforward.

    Single page.

    I think somewhere in the neighbourhood of 10 yes/no tickboxes having to do with weight related comorbidities and whether or not they're well medically well controlled (hypertension, sleep apnea, GERD, hyperlipidemia, diabetes etc)

  10. Anonymous11:37 pm

    Most obese people have weight related comorbidities. Not all but most. I was told at the assessment center in windsor that there is no way to prioritize someone. We all have to go through all the tests and all of the appts with the dr, nurse, social worker, and dietitian, and possibly others and have them all agree that they feel that you are ready to move on with the process. Once you go to the nutrition class, which is after your final drs visit at an assessment center, you will then have your file purolated to the surgeons and you will receive a call to schedule an appt for a consult with the surgeon. The surgeon decides if he/she feels that you are ready for the actual surgery and will then have you buy your Optifast. You will then get a phone call to schedule your actual surgery. For me, that surgery date is 2 months after my consult with the surgeon and has been almost 13 months following my doctors original referral paperwork.

  11. They're making it a lot more difficult and more expensive yet the healthcare system is not even close to be called a system.

  12. Anonymous3:51 pm

    I know that this article was written 14 months ago but I just wanted to share an update. As to the Guelph clinic, the waiting time between referral and first orientation is about 12 months, total time from referral to surgery is about 2 years.
    I was referred in June of this year and expect my orientation in June of 2012 unless there are more delays.

    1. Anonymous7:45 pm

      i'm sorry to hear you have to wait so long...i think the wait time will be shorter...i had to wait 7 months for my orientation (its on thursday- eek) and my family dr was great and we already have all the tests done that the center recommended.