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Indicators & Change Ideas

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Explore the quality indicators being tracked by health care organizations in Ontario through Quality Improvement Plans (QIPs) and change ideas to help improve them. Connect with others to share your experiences and ideas of your own.

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Number of faxes sent per 1,000 rostered patients

As part of Your Health: A Plan for Connected and Convenient Care announced in 2023, the Ministry of Health laid out a plan to replace “antiquated fax machines with digital communication alternatives among all Ontario health care providers within the next 5 years.” Eliminating faxing in health care settings will:

  • Promote safer patient care, decreasing risks posed by delays in receiving timely and appropriate care due to faxing errors and illegible information
  • Reduce the risk of delays in diagnosis and treatment caused by unnecessary waits from slower processing time, fax backlog, and unnecessary follow-ups associated with fax errors and misdirects
  • Better protect personal health information (e.g., misdirected faxes accounted for 50% of the complaints about health care privacy breaches made to the Information and Privacy Commissioner of Ontario in 2021)
  • Make it easier and faster for health data to follow the patient wherever they access care

Key resources

Change Ideas

Implement digital health tools

Ontario Health’s new initiative, Patients Before Paperwork (Pb4P), is supporting innovative and creative digital solutions to make it easier for providers to deliver and connect people to care. Phase one of Pb4P is focused on improving utilization of digital health tools such as:
  • eConsult is a secure digital health tool that provides family physicians, nurse practitioners, and midwives timely access to specialist advice that they may need to deliver care to their patients, often eliminating the need for an in-person specialist visit. eConsult eliminates the need for a traditional referral to the specialist, which is typically sent by fax.
  • e-Prescribing enables prescribers and pharmacists to transmit prescriptions electronically and enables prescribers to electronically transmit a prescription directly from an electronic medical record (EMR) to the pharmacy management system (PMS) of a patient’s pharmacy of choice. e-Prescribing also enables clinical communications, making it easier for prescribers and pharmacists to clarify questions about a patient’s prescription. Historically, prescriptions have made up a substantial portion of a primary care office’s fax volume. Sending prescriptions electronically would eliminate this.
  • eReferral (electronic referral) enables quick and secure referrals between primary care clinicians, specialists, and organizations across the province, reducing administrative burden and allowing clinicians to spend more time delivering patient care. eReferral removes the need for referrals to be sent via fax.
  • Health Report Manager (HRM) facilitates secure electronic transfer of patient records between hospitals, independent health facilities, specialty clinics, and community-based primary care clinicians. It reduces the reliance on paper- and fax-based workflows by adding patient reports, such as narrative, text-based medical records, and diagnostic imaging, directly into a patient’s record within their clinician’s EMR. This allows for timely access to clinical reports and faster patient follow-up.
  • Online appointment booking solutions enable patients to book in-person, video, or telephone appointments electronically, by choosing a date and time and receiving an automated appointment confirmation, all in a self-serve environment available 24/7. Additionally, online appointment booking solutions allow clinicians and administrative staff to set parameters on the types and number of appointments available, and offer other beneficial features such as automated email, text message, and voice reminders.
  • Ontario Laboratories Information System (OLIS) is a secure digital health tool that provides authorized health care providers with access to patients’ laboratory test orders and results, both past and present, from hospitals and public health and community labs through 1 platform. The centralization of information enables a patient’s results to follow them as they move between different care settings, and enables health care providers to make more informed, timely, and safe care decisions. OLIS also reduces laboratory errors caused by illegibility or misinterpretation of requested lab orders, improves the turnaround time for lab results, and enables patient orders and results to be added directly into an EMR. 

Implementation of 1 or a combination of these tools has the potential to reduce the volume of faxes sent and received in a primary care practice.

As part of the Pb4P initiative, each Ontario Health region is equipped with a Regional Digital Health Team that can:

  • Answer your questions or requests for information about digital health tools
  • Provide guidance around digital health tools
  • Facilitate connections to enable digital health tool sign-up and onboarding

To get started, contact your Regional Digital Health Team:

If you don’t know your Ontario Health region, email the Pb4P Change Management and Adoption Team for assistance.

Note: The tools mentioned above have been included as optional indicators for primary care on the 2025/26 Quality Improvement Plan (QIP). If your organization chooses to use 1 or a combination of these digital tools as your change idea(s) for reducing faxes, also select the corresponding optional QIP indicator to help create an implementable and measurable plan.

Number of faxes sent per 1,000 rostered patients

As part of Your Health: A Plan for Connected and Convenient Care announced in 2023, the Ministry of Health laid out a plan to replace “antiquated fax machines with digital communication alternatives among all Ontario health care providers within the next 5 years.” Eliminating faxing in health care settings will:

  • Promote safer patient care, decreasing risks posed by delays in receiving timely and appropriate care due to faxing errors and illegible information
  • Reduce the risk of delays in diagnosis and treatment caused by unnecessary waits from slower processing time, fax backlog, and unnecessary follow-ups associated with fax errors and misdirects
  • Better protect personal health information (e.g., misdirected faxes accounted for 50% of the complaints about health care privacy breaches made to the Information and Privacy Commissioner of Ontario in 2021)
  • Make it easier and faster for health data to follow the patient wherever they access care

Key resources

Change Ideas

Implement digital health tools

Ontario Health’s new initiative, Patients Before Paperwork (Pb4P), is supporting innovative and creative digital solutions to make it easier for providers to deliver and connect people to care. Phase one of Pb4P is focused on improving utilization of digital health tools such as:
  • eConsult is a secure digital health tool that provides family physicians, nurse practitioners, and midwives timely access to specialist advice that they may need to deliver care to their patients, often eliminating the need for an in-person specialist visit. eConsult eliminates the need for a traditional referral to the specialist, which is typically sent by fax.
  • e-Prescribing enables prescribers and pharmacists to transmit prescriptions electronically and enables prescribers to electronically transmit a prescription directly from an electronic medical record (EMR) to the pharmacy management system (PMS) of a patient’s pharmacy of choice. e-Prescribing also enables clinical communications, making it easier for prescribers and pharmacists to clarify questions about a patient’s prescription. Historically, prescriptions have made up a substantial portion of a primary care office’s fax volume. Sending prescriptions electronically would eliminate this.
  • eReferral (electronic referral) enables quick and secure referrals between primary care clinicians, specialists, and organizations across the province, reducing administrative burden and allowing clinicians to spend more time delivering patient care. eReferral removes the need for referrals to be sent via fax.
  • Health Report Manager (HRM) facilitates secure electronic transfer of patient records between hospitals, independent health facilities, specialty clinics, and community-based primary care clinicians. It reduces the reliance on paper- and fax-based workflows by adding patient reports, such as narrative, text-based medical records, and diagnostic imaging, directly into a patient’s record within their clinician’s EMR. This allows for timely access to clinical reports and faster patient follow-up.
  • Online appointment booking solutions enable patients to book in-person, video, or telephone appointments electronically, by choosing a date and time and receiving an automated appointment confirmation, all in a self-serve environment available 24/7. Additionally, online appointment booking solutions allow clinicians and administrative staff to set parameters on the types and number of appointments available, and offer other beneficial features such as automated email, text message, and voice reminders.
  • Ontario Laboratories Information System (OLIS) is a secure digital health tool that provides authorized health care providers with access to patients’ laboratory test orders and results, both past and present, from hospitals and public health and community labs through 1 platform. The centralization of information enables a patient’s results to follow them as they move between different care settings, and enables health care providers to make more informed, timely, and safe care decisions. OLIS also reduces laboratory errors caused by illegibility or misinterpretation of requested lab orders, improves the turnaround time for lab results, and enables patient orders and results to be added directly into an EMR. 

Implementation of 1 or a combination of these tools has the potential to reduce the volume of faxes sent and received in a primary care practice.

As part of the Pb4P initiative, each Ontario Health region is equipped with a Regional Digital Health Team that can:

  • Answer your questions or requests for information about digital health tools
  • Provide guidance around digital health tools
  • Facilitate connections to enable digital health tool sign-up and onboarding

To get started, contact your Regional Digital Health Team:

If you don’t know your Ontario Health region, email the Pb4P Change Management and Adoption Team for assistance.

Note: The tools mentioned above have been included as optional indicators for primary care on the 2025/26 Quality Improvement Plan (QIP). If your organization chooses to use 1 or a combination of these digital tools as your change idea(s) for reducing faxes, also select the corresponding optional QIP indicator to help create an implementable and measurable plan.