Ontario Auditor General Report Highlights Virtual Care

Ontario’s Auditor General Bonnie Lysyk has released the 2020 Annual Report, two weeks after releasing a highly critical special report that found Ontario was slower to respond to COVID-19 and more reactive compared to other provinces.

Today’s report, however, details 13 value for money audits in a wide-range of areas from IT at Metrolinx to condominium oversight. For health care, the report focuses on three key areas: virtual care, blood management and safety, and retirement homes.

Virtual patient care

Summary:

“While there is a growing need for virtual patient care, especially due to the COVID-19 pandemic, Ontario does not yet have targets or goals for this service. The province should ensure better integration and co-ordination of the Ontario Telemedicine Network and Telehealth Ontario while developing more effective oversight processes for physician billings for virtual care.”

Key findings from the report:

  • The Ministry of Health working with the Telemedicine Network, does not have effective strategies, systems and procedures in place to offer patient-focused virtual care services in a cost-effective manner to meet Ontarians’ needs.

  • Expenditures on physician billing for virtual care increased almost 400% between 2014/15 and 2019/20, not including temporary billing due to the COVID-19 pandemic.

  • The Ministry’s oversight of physician billings for virtual care services is limited with little ability to confirm that physicians are providing quality virtual care services.

  • The report also acknowledged the quick implementation of temporary billing codes for virtual care services as a result of the pandemic, but did flag the concerns raised around data security and privacy for non-Telemedicine platforms.

  • Lastly, the Auditor General urged the Telemedicine Network and Telehealth Ontario to work collaboratively to coordinate and integrate services, while evaluating the impact of virtual care on patient outcomes.

Blood management and safety

Summary:

“The audit found that neither the Ministry of Health nor Canadian Blood Services (CBS) gathers important information about the supply and demand for blood components and products used by hospitals. Hospitals are not required to report what they use to CBS, and CBS does not collect information about how physicians use them. Information about supply and demand is important, as short-term shortages have occurred twice in the past five years.”

Key findings from the report:

  • While the supply of blood products has been reasonably reliable, the COVID-19 pandemic has magnified existing weaknesses in the reliability of Ontario’s blood product supply.

  • The province heavily relies on US-based suppliers. This presents a risk to the health of people in Ontario who need these products, should the supply chain be disrupted.

  • Hospital use and waste of blood is not well reported and tracked. Although CBS encourages hospitals to report their use through the Blood Component and Product Disposition Database, some hospitals either do not report or report inconsistently.

 Retirement Homes Regulatory Authority (RHRA)

Summary:

“This audit found that an increasing number of people living in retirement homes require a higher level of care suitable to that provided by long-term-care homes. The RHRA, however, does not collect the data needed to assess the impacts of the increasing level of care needed by residents. Also, the RHRA does not oversee all beds in retirement homes, and some potentially vulnerable residents may not receive the care and protection of the RHRA.” 

Key findings from the report:

  • The care and accommodation of thousands of former hospital patients in retirement homes are not subject to RHRA oversight or Ministry of Health inspections. For context, in 2019/20, 4,201 patients designated as alternate level of care (ALC) were discharged from hospitals to retirement homes.

  • Neither the Ministry for Seniors and Accessibility or the RHRA track the number of patients designated as ALC in retirement homes.

  • COVID-19 has resulted in 185 COVID-19 outbreaks at 171 licensed retirement homes, affecting 989 residents and 491 staff as of August 31, 2020. A total of 209 residents from 48 retirement homes have died as a result of the pandemic.

  • Five retirement home operators have still not installed required sprinkler systems.

Reactions and what to expect next

Late last month, the Auditor General released a special report on the government’s COVID-19 preparedness and management. The now contentious report concluded that Ontario’s response was disorganized and slow due to outdated provincial emergency plans, insufficient staff and changeover in leadership at Ontario’s Provincial Emergency Management Office. Health Minister Christine Elliott responded to the November 25 report, noting that it is “a disappointment, and in many respects a mischaracterization of the province’s pandemic response.”

With Ontario reporting a record high 1,925 COVID-19 cases today, Queen’s Park is in a precarious position with the challenges of the holiday season and vaccine deployment ahead. Although the Premier has not yet commented on today’s report, we can expect this to be a topic of conversation at this afternoon’s daily press conference.

Additional reading

Read the summaries of value-for-money audits here.

Read the Auditor General’s news release here.