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This article is based on a policy brief titled “Enhancing Access to Diagnostic Imaging: A Proposal for a Pan-Canadian and Interoperable Teleradiology Network” written by Aftab Ahmed, Anmol Gupta, and Harshini Ramesh, recent graduates of the Master of Public Policy program at McGill’s Max Bell School. Their brief was named a finalist for the inaugural Hunter Prize in Public Policy, aiming to identify practical, cost-effective, and politically viable policy reforms for addressing health care wait times in Canada.

By Aftab Ahmed

December 6, 2023

In Canada, the protracted wait times for diagnostic imaging, such as CT scans and MRIs, have emerged as a pressing health care issue. This has far-reaching implications for individual patient care and economic productivity at the macroeconomic level. Nationally, the median wait time for a CT scan is 5.4 weeks, and for an MRI, it extends to 10.6 weeks. In some provinces, like Nova Scotia and Prince Edward Island, patients wait as long as 20 weeks. These delays are more than mere inconveniences: they represent a major bottleneck in resource-strained health care systems in many jurisdictions, leading to delayed diagnoses, prolonged suffering, and, in many cases, worsening medical conditions.

Ripple effects resulting along a patient’s care cycle due to such delays become increasingly concerning for their well-being. For example, if there is a long wait for an MRI, it delays the subsequent appointment with the doctor who suggested the MRI. The time gap between when a doctor recommends an MRI and when the patient actually undergoes the MRI, followed by the time taken for the doctor to review the results, can result in a considerable number of days lost. During this period, the patient’s health condition may worsen. Many health-compromised Canadians have experienced this, especially in the aftermath of the pandemic.

The economic toll of wait-time delays in diagnostic imaging is substantial. A report by the Conference Board of Canada highlighted that in 2018, MRI and CT scan wait times exceeding 30 days resulted in an aggregate economic cost of $3.54 billion. This figure includes the loss of productivity from 380,000 Canadians unable to work due to delayed radiology services, translating into an annual loss of $430 million in tax revenue. Addressing diagnostic wait times has become necessary through three distinct but interrelated policy lenses: timely health care delivery, fiscal prudence, and a pan-Canadian political obligation to reduce wait times.

An aging demographic is increasing the overarching demand for diagnostic imaging – a trend that is projected to continue in the coming years. At the same time, the procurement of new imaging machines is at a 20-year low, and the distribution of radiologists across Canada is uneven. For instance, Newfoundland and Labrador has the highest number of radiologists per 100,000 people at 10.5, while Prince Edward Island has the lowest at 5.8. While boosting investments in imaging infrastructure and increasing the supply of radiologists are long-term solutions, they do not directly address the high wait times currently plaguing Canada’s health care system.

A more immediate solution lies in the expansion and national coordination of teleradiology services. Teleradiology, the transmission of radiographic images from one location to another for interpretation and consultation, is already in use in various parts of Canada but not at a pan-Canadian scale. The technology central to teleradiology is the Picture Archiving and Communication System (PACS), which facilitates the efficient storage and transfer of medical images. Most of Canada’s radiology facilities are equipped with PACS, laying the groundwork for a more integrated approach towards delivering imaging services.

Consider the scenario in New Brunswick, where the radiology ecosystem is strained due to escalating demands and a limited number of radiologists. The average waiting period for a CT scan analysis in this province is eight weeks, and for MRI interpretations, it extends to 12 weeks. This delay, primarily stemming from a shortage of imaging specialists, sets off a chain reaction of effects in a patient’s health care journey, including postponed consultations, diagnoses, and treatments. In contrast, Ontario has a more robust radiology infrastructure and a greater number of radiologists. Yet today, in a context where each jurisdictional health system operates in silos, Ontario’s radiological expertise is unable to play any role in addressing the supply-side deficiencies in New Brunswick.

A proposed pan-Canadian teleradiology network, envisioned as a sort of library of radiologists at the country’s disposal, can facilitate the transmission of medical images across jurisdictions, tapping into areas with available capacity. This system would ensure that if doctors in one jurisdiction are unavailable, it can swiftly identify and engage other qualified doctors to provide assistance. Consequently, patients will receive prompt care, irrespective of their geographic location.

The interoperability of this network will be a key feature, ensuring that all Canadians, regardless of where they reside, will have access to timely, top-tier diagnostic care. The system should be adept at adapting to the varying demands for diagnostic services, capable of responding to both surges and declines in diagnostic demand across jurisdictions. This flexibility will allow for consistent care delivery, even during periods of heightened demand, while also catering to the unique diagnostic needs of different jurisdictions.

While boosting investments in imaging infrastructure and increasing the supply of radiologists are long-term solutions, they do not directly address the high wait times currently plaguing Canada’s health care system.

The benefits of teleradiology are evident in specific case studies. For example, the collaboration between a hospital in Iqaluit, Nunavut, and radiologists at The Ottawa Hospital demonstrates how teleradiology can reduce costs, wait times, and the emotional and logistical burdens on patients. Prior to the introduction of teleradiology services, patients in Iqaluit had to physically travel to Ottawa for scans, incurring costs of up to $25,000 and requiring stays of up to two weeks. The introduction of teleradiology services allowed for local imaging in Iqaluit, which was then swiftly interpreted by radiologists in Ottawa, leading to greater cost-efficiencies and reduced waiting periods. Overall, it was a big win for the residents of Iqaluit.

From a constitutional standpoint, the establishment of a pan-Canadian teleradiology network would align with the principles of the Canada Health Act, particularly in terms of accessibility and universality, by facilitating the sharing of medical images and expertise across provincial and territorial boundaries. An updated interpretation of the “portability” principle will not only simplify billing processes but also guarantee timely access to top-tier diagnostic care for every Canadian resident, regardless of their location.

For instance, if an Ontario patient’s MRI scan is read and interpreted by a New Brunswick specialist through a pan-Canadian teleradiology network, an evolved interpretation of the Canada Health Act’s portability clause would authorize the New Brunswick entity to directly invoice the Ontario Health Insurance Plan. Existing inter-provincial billing agreements may need adjustments to accommodate the specific nature of teleradiology. A mechanism similar to the Reciprocal Medical Billing Agreement could serve as a model, enabling a New Brunswick-based provider to directly bill the Ontario Health Insurance Plan for the provision of radiology services. This streamlined billing process can ensure that health care providers receive the agreed-upon compensation.

The success of smaller-scale collaborations, such as Prince Edward Island’s pioneering use of teleradiology to reduce CT scan wait times and Ontario’s Northern Telecommunications Health Network’s efforts to serve remote areas, underscores the viability of this approach. These examples, along with the existing technological readiness in many hospitals across all provinces and territories, suggest that the transition to a pan-Canadian teleradiology network is not just a strategic imperative but a practical next step from a health policy perspective.

The economic rationale for such a network is also compelling. The Pan-Canadian Pharmaceutical Alliance, established in 2010, serves as a prime example of the effectiveness of coordinated health care initiatives. By navigating the complexities of provincial drug negotiations, and with assessments from established review bodies, the alliance has been showcasing the fiscal benefits of pan-Canadian strategies and jurisdictional collaboration – with the alliance achieving annual savings of $3.41 billion primarily by reducing drug prices.

However, establishing such a network is not without challenges. The high cost of radiology services, interoperability issues between provincial and territorial health care systems, and the need for jurisdictional buy-in are substantial hurdles. Key among financing the development of such a network is the Canada Health Infoway Fund, a $50 million federal allocation earmarked for provinces and territories to develop pan-Canadian virtual care initiatives. Additionally, forging partnerships with the private sector is also a feasible avenue. Financial investments are likely to yield substantial returns, mirroring the tangible benefits of teleradiology, which range from economic advantages to improved patient care and increased accessibility.

Regulatory changes are also necessary to ensure the smooth operation of a teleradiology network. These changes include creating a harmonized framework for health data sharing, ensuring privacy protections, and regulating radiologists to practice across jurisdictional boundaries – all of which are challenging but important steps that should be investigated. The Federation of Medical Regulatory Authorities of Canada’s work on telemedicine and interjurisdictional licensure provides an institutional basis for undertaking such efforts.

Reforming Canada’s health care landscape requires designing policies that encourage collaboration across jurisdictions, aiming primarily at patient well-being. This effort represents a two-sided challenge. The initiative should originate from Ottawa, with the federal government leading the charge to engage and persuade provincial and territorial leaders about the benefits of a pan-Canadian teleradiology network. Critical to this is the participation of all jurisdictions, particularly those with a surplus of imaging specialists and shorter wait times for diagnostic imaging. The federal government’s advocacy role is critical. Equally vital is the willingness of all jurisdictions in Canada to listen, participate, and commit to pan-Canadian health care solutions.

Establishing a pan-Canadian, interoperable, and demand-driven teleradiology network is not only feasible but necessary given Canada’s systemic health care problems. It promises to enhance access to diagnostic imaging, reduce wait times, and improve patient outcomes across Canada. With the federal government’s leadership and collaboration between provinces and territories, Canada can leverage existing infrastructure and digital health advancements to create a sustainable teleradiology network. This network will not only address the current crisis but also pave the way for future digital innovations in the country’s health care systems.

Policy Contributing Writer Aftab Ahmed recently graduated as a Master of Public Policy from the Max Bell School of Public Policy at McGill University. He has contributed to The Line, Policy Options, and the Hill Times and is a columnist for the Bangladeshi newspapers The Daily Star and Dhaka Tribune. He is currently an Urban Fellow Researcher with the City of Toronto.

Disclaimer: The views expressed by the author of this article represent their personal opinions and do not reflect the views or opinions of any organization, or entity associated with the author.