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I n the late 1990s, Ontario joined a number of other provinces in referring cancer patients out of the country for radiation treatment. The province and its cancer agency had failed to build sufficient capacity in anticipation of a highly predictable increase in the demand for radiation in Ontario. Public discontent with cancer services and Ontario's cancer agency in 2001 led to some dramatic strategic and operational changes in 2002/03, resulting in a revised business model for Cancer Care Ontario (CCO) (Sullivan et al. 2004). In the fall of 2003, the newly minted Cancer Quality Council of Ontario released a book based on what was known and available through information systems to drive the improvement in quality of cancer services. This volume sketched out a preliminary agenda for quality that is still being pursued today (Sullivan et al. 2003). In spring 2004, the Quality Council introduced a four-point strategy for wait time reductions, which included a focus on reducing demand for cancer services, increasing the supply of cancer resources, coordinating access to cancer services and increasing the efficiency of existing resources. When the province selected former CCO chief Alan Hudson to lead the effort to reduce wait times, it was logical that, with its expertise and experience, CCO would be a strong and committed partner in addressing the backlog for a range of cancer services, including radiation and surgery. As an extension of its own imperative to reduce wait times for cancer patients, CCO became the technical and logistical home for the overall Wait Time Strategy. In addition, CCO had the systems capacity, the organizational commitment and a province-wide mandate that had already been demonstrated in other areas, including electronic pathology reporting. CCO had also just hired a talented new Chief Information Officer (CIO) in the person of Sarah Kramer, who had the necessary ambition and competence to provide part-time support for the Wait Times program. The larger effort, under Alan Hudson's leadership, included Sarah and a team of specialty practice leaders in each of the " big five " wait time reduction candidates specified by the first ministers in 2004. Additionally, as a consequence of the newly introduced Personal Health Information Protection Act (PHIPA) in Ontario, CCO was moving from what was already a secure environment for health information to an extremely high security environment for personal health data collection, use and disclosure. In many respects, the introduction of …

Commentary: Waiting for the Referee or Refereeing the Wait? - CCO's Role in Hosting and Deploying the Wait Time Information System in Ontario