Wednesday, 3 August 2016

How far in advance are patients booking online

We recently ran some reports to find out how far in advance of their appointments patients are booking online with their physicians using MyHealthAccess. The full stats graph is below but here are some interesting takeaways:

1 - Approximately 50% of appointments are booked for the upcoming week and 78% are booked for within the next 2 weeks.
2 - More appointments are booked 1 day in advance than any other day.
3 - There is an interesting spike in patients booking exactly 1 week in advance of their appointments.

Thursday, 5 May 2016

There are more Doctors in Canada than ever before.. But why are less Canadians seeing a regular family Doctor?

Canadian MD graduates have increased by 60% over the past 10 years (i.e. 1,757 to 2,804). It would seem that this should mean that less patients would be flooding walk in clinics and emergency rooms with minor ailments.

Contrary to that notion, the percentage of men, women and children who have regular family doctors are not increasing at a sizable rate. Why would that be?

Perhaps it is because a good proportion of clinic have a 'Walk-in' option in their offices. Therefore patients choose to go to the most convenient clinic to their current location.

Or perhaps it is because the methods for remunerating doctors are changing across the country. Ontario for example, is using capitation, i.e., compensation based on the number of patients on a doctor’s roster, regardless of how often a patient sees their doctor. This allows doctors to take their time with each patient, since they are no longer paid per service required and each patient seen. Keep in mind, that there is a cap on the number of patients per doctor’s roster.

In any case, when Canadians need health services they need access to a doctor, and more and more people, are frequenting walk-in clinics.

Walk-in clinics have historically been an emergency resource for after-hours services, or for times when waiting a few days to see your GP would not be reasonable.  But today, with few doctors accepting new patients, there has been a significant increase in the number of people using walk in clinics for matters that would be appropriately dealt with seeing a family doctor(PAP tests, general health check-ups, etc.)

In June 2014, the college of Physicians and Surgeons of BC revised the professional standards for walk-in clinics to reflect this transition. Clinics are now required to keep detailed medical records of the patient, contact the patient regarding labs results, and offer follow-up appointments if patients do not have access to their own GP, as well as have access to Pharmanet BC, the provincial database that tracks current prescriptions and histories. This ensures a proper paper trail of medical records so a doctor can better diagnose each patient.

There is something to be said for the bond developed between a GP and patient. They usually have a rich context of medical history, sometimes going back generations. He/She has time to review your chart before they meet with you, which allows them to diagnose you with confidence.

You are generally able to get in and out of the office relatively quickly and stress free. Walk-in clinics, on the other hand, often have wait times of 15 minutes to 2 hours.  This can make an already uncomfortable situation even worse. Not to mention that without a proper medical history, how can a doctor be expected to properly treat complex concerns..?

In conclusion, as Canadians, we have access to free health care, and we are all responsible to take care of our own health. Wherever we seek treatment we can be sure Canadian doctors will always treat us to the best of their abilities.

Friday, 29 April 2016

When do patients book online?

We've been running our MyHealthAccess online booking program with customers for over a year now and more and more appointments are being booked every month. We gathered some aggregated statistics on online bookings for the past 4 weeks and wanted to share with you some interesting graphs on when patients are using our system to book online in terms of days of the week and hours of the day.

What day of the week are patients bookings online?

  As you can see the busiest day of the week is Monday which drops steadily off until the weekend when online bookings are at their lowest. Interestingly this likely mimics phone system demands in most primary care offices.

What time of day are patients booking online?

As you can see the most popular times are around 8am to around 2pm. The demand spikes early in the morning after 6am, peaks at 9am and then declines slowly to midnight. There is a an interesting spike around 9-10pm which suggests patients are putting off booking an appointment until just before they go to bed... perhaps because up until that point they aren't certain that they need one!

42% of these appointments are being booked outside of normal phone hours of most clinics and many more are being booked on weekends. MyHealthAccess is making a positive difference for patients allowing them to book their healthcare appointments when it is most convenient for them.

Monday, 29 February 2016

The state of Telehealth in Canada

Telehealth services in Canada have been on the rise in recent years to help address the gap between traditional healthcare service demand and capacity. By providing health services through video conference, telephone, online, or accessing information remotely, healthcare workers are able to assist more patients using less resources. The technology gives patients living in remote areas access to health professionals and provides health workers with ways to deliver care outside the traditional confines of clinic and hospital walls.

The potential for Telehealth is enormous and it is slowly catching on in Canada, according to the 2015 Canadian Telehealth Report published by Canada’s Health Informatics Association (COACH). The report looked at Telehealth in 12 provinces and territories (excluding Nunavut). Information for the report was also received from the national First Nations and Inuit Health Branch. In total, 13 jurisdictions provided information from 26 various contributors regarding the state of Telehealth in their regions (a complete list of the program contributors can be found on pg. 8 of the report).

The increase in Canadian Telehealth services

Telehealth endpoints

The amount of hospital-based and community Telehealth endpoints grew in all jurisdictions, expanding by 41.5% from 2012 (7,297) to 2014 (10,351) across the country.

Clinical sessions and clinical service areas

The number of clinical Telehealth sessions have also grown, according to COACH. There is an increase of approximately 195% between 2006 and 2012. From 2012 to 2014, there is an aggregate growth of 47.5%, from 282,529 sessions in 2012 to 411,778 sessions in 2014.

An increase in clinical service areas is seen across the jurisdictions as well, with 393 operating in 2010 and an 123 being added by 2012, a 31% increase, according to the 2013 Canadian Telehealth Report. The most common services being delivered by Telehealth are in psychiatry and psychology, cardiology, diabetes, genetics, oncology, and chronic pain, neurology, pediatrics, occupational therapy, and physiotherapy specialties.

Telehomecare and remote patient monitoring

Home Telehealth monitoring endpoints also saw an increase in British Columbia, Ontario, New Brunswick, Quebec, and the Yukon, rising by 18% from 2010 (2,095) to 2012 (2,465). An increase of 54% in patient numbers occurred between 2012 and 2014 (3,802). The most monitored conditions are congestive heart failure and chronic obstructive pulmonary disease.

Although there has been an increase in home Telehealth monitoring, the growth rate is lower than expected, potentially due to inconsistent research results and the amount of capital required to establish remote patient monitoring services.

Educational service areas

Educational service areas are areas in which distance education regarding health care is provided via Telehealth. In the 2015 report, the distinction was made between provider educational services and patient educational services. The report’s glossary defines the two as:

Patient Educational Service: A Telehealth service where distance education is provided to the patient (or the patient’s family) towards their care or wellness. (Appendix A: Glossary, pg. 69)

Provider Educational Service: A Telehealth service where distance education is provided to a clinician or related Telehealth staff, e.g. continuing medical education (CME), clinical rounds, technology in-services etc. (Appendix A: Glossary, pg. 69)

In 2012, there were 90 distinct educational service areas in Canada for clinicians, patients, and families. The jurisdictions reported an aggregate increase of 28% between 2010 (208) and 2012 (266), providing education services in more areas. Ontario’s Telemedicine Network (OTN) provided all 90 identified educational areas via Telehealth.

In 2014, the 90 distinct educational services remain for healthcare providers, with 64 services being available for patients and families. Oncology, pediatrics, and pharmacy are the top educational services, available for providers in 10 jurisdictions. Dietetics is the leading area of education for patients and their families, with 8 jurisdictions offering services.

Medical peripherals

A variety of medical peripheral devices are used across the jurisdictions to conduct clinical assessments using Telehealth. These peripherals include exam cameras, digital stethoscopes, digital ophthalmoscopes, digital otoscopes, ocular and retinal cameras, dermatology cameras, and ultrasound scanners. There has been an overall increase in the number of these devices used across the jurisdictions.

Desktop and mobile videoconferencing

Out of 12 reporting jurisdictions in 2014, 10 reported to have some form of desktop or mobile video conferencing technology available. All 10 of these use the technology for administrative purposes and clinical consultations, while 9 of them also use it for patient education.

Electronic scheduling services

All 13 jurisdictions used electronic scheduling in 2012, an increase from the 10 that reported to be using e-scheduling in 2010.


The increase in Canadian Telehealth services suggest that Canada’s health care providers and patients are starting to adopt these new technologies at a faster pace, providing better access to health care services across the country. Another positive benefit of the expansion in Telehealth services come from the increase in engagement and education on the part of the patient in their own care and well-being.

By providing healthcare services to patients across the country in both urban and rural areas, Telehealth has the potential to revolutionize the healthcare industry by facilitating the evolution of a more patient-centric model of healthcare access.

Thursday, 4 February 2016

Family Physician Growth in Canada

I recently saw this graph while checking out the CMA Physician Data Centre Research regarding Family Physician Growth in Canada and figured it was interesting enough to share.

If interested, you can find the full report on Family medicine physicians here

The main takeaway for me is that in the last 10 years Canada's number of GPs per unit of population has grown by 15% and its still trending up.

Thursday, 7 January 2016

INFOGRAPHIC! Canadian Healthcare Spending

Canadian Healthcare Spending

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Estimated 2015 Canadian Healthcare Spending

In 2015, it is estimated that Canada’s health expenditures will reach $219.1 billion, or an equivalent of $6,105 per Canadian. This amount would represent 10.9% of the country’s gross domestic product (GDP).

About 71% of the total health expenditure this year is estimated to come from public-sector funding, 66% of which will be provincial and territorial government spending. Another 5% will come from other parts of the public sector, such as the federal government, municipal governments, and social security funds.

The remaining 29% of health spending for the year will comprise of private funding, made up of out-of-pocket spending (14%), private health insurance (12%), and other sources (3%).

Health spending in Canada, compared to other countries
According to the 2013 data on spending, Canada was in the top quarter of the Organisation for Economic Co-operation and Development (OECD) countries when it came to health expenditures. Only the United States ($9,086USD), Germany ($4,920USD), and Denmark ($4,847USD) spent more than Canada ($4,569USD) per person on health in 2013.

France ($4,361USD), Australia ($4,115USD), Japan ($3,713USD), Finland ($3,645USD), and the United Kingdom ($3,364USD) completed the list of the top 9 spenders out of the 29 countries in the OECD that have comparable accounting systems. The OECD average spending per person was $3,566USD.

What Canada spends its health dollars on
Three main categories, hospitals, drugs, and physicians, make up over 60% of health expenditures in Canada. In 2015, it is forecasted that hospitals will account for 29.5% of spending, drugs will reach 15.7%, and physician services will be at 15.5%. A growth of 0.9%, 0.7%, and 2.2%, respectively, is estimated for 2015 health expenditures in the three categories from the previous year of data.

The remaining 40% of health spending goes towards purchasing other health care goods and services, administering public and private insurance plans and public-sector health programs, and funding research. Long-term care institutions will make up about 10.7% of this spending, with another 10% going to allied health professionals in the dental, vision, and other fields.

Hospitals and physicians are services covered under the Canada Health Act and are therefore financed mainly through the public sector. Drugs and other health professionals and services are primarily financed from sources in the private sector.

Health spending in Canada’s provinces and territories
Canada’s territories have the highest health expenditures per capita, in large part due to the vast geographical area that needs to be covered and low population, compared with the rest of the country. In 2015, the Yukon Territory is projected to spend $10,949 per person in health expenditures. The Northwest Territories will spend $13,880 per person. Nunavut is projected to spend the most per capita in the country at $14,059.

The provinces spend less per capita. The amounts range from the lowest, $5,665 spent in Quebec, to the highest, $7,036 spent per person in Newfoundland and Labrador. A full breakdown of health expenditures for all provinces and territories can be seen in the table below.

Amount spent per capita (projected for 2015)
% of budget for provincial/territorial government health spending (projected for 2014)
% of per capita growth/decline
British Columbia
Newfoundland and Labrador
New Brunswick
Nova Scotia
Prince Edward Island
Yukon Territory
Northwest Territories
Canadian average

Health spending by population group
The spending varies among population groups, particularly when it comes to age range. The last available data for provincial/territorial spending based on age groups is from 2013.

Age group
Average estimated amount spent per person
infants (less than 1 year old)
youths (1 year old to 14 years old)
adolescents/adults (15 years old to 64 years old)
seniors (65+ years old)

While seniors make up around 15% of the Canadian population, provinces and territories spend more than 45% of all public-sector health care funding on them. Costs increase as the population ages. By breaking down senior age groups into 5 year increments, a steady rise occurs.

Age group
Average estimated amount spent per person
65 - 69 years of age
70 - 74 years of age
75 - 79 years of age
80+ years of age

Factors that influence health spending
A number of factors influence the cost of health care, including inflation, population growth, the aging of the population, and other residual factors such as health sector inflation, the efficiency of the health care system, and changes in the technology available and the use of services.  

Health care costs have risen by approximately 14.5% over the past 15 years, 6.6% of which is estimated to be attributed to general inflation. Demographic cost drivers (population growth and aging) have only contributed to a combined estimate of 2% growth over the last decade, although these factors vary greatly by province or territory.

Since 2013, the last year that health spending data by age and sex is available, it is forecasted that health expenditures have risen by 3.1% in 2014 and another 1.5% in 2015.

For more information on health spending in Canada, please see the Canadian Institute for Health Information’s October 2015 report on national health expenditure trends [pdf].

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