Dr. Bhatia
Cardiologist Dr. Sacha Bhatia and his team led the Echo Wisely trial, which examined ways to reduce the number of unnecessary echocardiograms being performed. The initiative was funded by the PMCC Innovation Committee. (Photo: The Globe and Mail)

Innovation can be life-saving, but if new and more productive ideas never make it beyond the lab or test stage, it becomes innovation inaction. Within the fast-evolving world of medicine, as new technologies, drugs and procedures are unveiled each day, having solid proof that a new innovation works as promised usually leads to greater adoption.

The Peter Munk Cardiac Centre (PMCC) is putting such innovations into action, recently finishing a nine-hospital study where an online application was used to guide physicians in the appropriate use of echocardiography.

When Dr. Barry Rubin was asked in 2013 by the Government of Ontario to examine the appropriate use of imaging tests, such as echocardiography and magnetic resonance imaging, he wanted no outside interference and the freedom to produce an honest report.

The stakes were rather high because Canada spends more than $2.2 billion annually on such diagnostic imaging. Just a 10 per cent decrease in unnecessary testing would save $220-million each year.

What Dr. Rubin, the PMCC's Medical Director, and his Expert Panel on Appropriate Utilization of Diagnostic and Imaging Studies found is that 10 per cent to 30 per cent of imaging tests are done for inappropriate reasons.

"When you focus on electrocardiography, it's a $140-million enterprise in Ontario, annually," says Dr. Rubin, a vascular surgeon and also a Professor of Surgery at the University of Toronto. "If one-quarter of those tests were not carried out, it would produce savings of $35-million each year.

"The goal is to control costs by ensuring tests are done only for the right reasons, in a safe environment, by individuals who are trained to carry out and interpret the tests."

So the problem then becomes: "What are the right reasons?"

Enter Dr. Sacha Bhatia, a cardiologist at Women's College Hospital and at University Health Network.

"One thing we know is that some people get care they probably don't need," he says.

The danger then becomes that patients will get false positive results or benign conditions will be flagged, leading to more, often unnecessary, care in a setting where health-care resources are stretched.

"The basic premise becomes: 'How do we make sure the patient gets the tests they need?'" Dr. Bhatia asks.

PMCC Magazine 

The third annual Peter Munk Cardiac Centre (PMCC) magazine published by The Globe and Mail focuses on why Canada's premier cardiac centre is known for being "the heartbeat of innovation." The magazine explores the PMCC model that supports the creation, development and evolution of innovative ideas into action – making "today's idea, tomorrow's practice." It also examines the impact that a culture of innovation has on the way cardiovascular care is delivered now and into the future.

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