Content under review – Ordering IG in Ontario

Ordering IG In Ontario – Changes coming!

WHY:

The use of Immunoglobulin (Ig) products, specifically Intravenous Immunoglobulin (IVIg) and Subcutaneous Immunoglobulin (SCIg), continues to increase each year, at an average rate of 8-9%.

In 2020, the Office of the Auditor General of Ontario (OAGO) released the findings of their Value-for-Money Audit of Blood Management and Safety (https://www.auditor.on.ca/en/content/annualreports/arreports/en20/20VFM_02bloodmgmt.pdf).

Recommendation three specifically stated the need:

“To better manage the demand and supply of immunoglobulins so that they are available for Ontarians who need them most and to avoid costs of wasted product, we recommend that the MOH, in consultation with Ontario Health: Collect more complete data from hospitals on how immunoglobulins are being used and identify emerging conditions that may warrant inclusion in provincial utilization guidelines……”.

Currently in Ontario, Ig requests are completed by the prescriber and sent to Transfusion Medicine Laboratories on paper requisitions (MOH IG Request Forms- Neurology and Non-Neurology). These paper forms do not leave the hospital transfusion laboratory in which they are submitted. Lack of provincial Ig utilization data makes it difficult to understand how Ig is being used.

• ➢To address this situation Canadian Blood Services is developing an IT system with financial support from the Ontario Ministry of Health to understand the use of Ig in Ontario, support Ig stewardship, and make informed decisions.

Canadian Blood Services has developed Youtube videos to inform Ontario on project updates and timelines. To stay up to date on project initiatives these videos can be accessed here:

Immunoglobulin G: A Canadian perspective on its use, supply, and relevant initiatives: https://www.youtube.com/watch?v=kAv2V_9vhME

Ig IT System Project Overview: https://youtu.be/VggynYI5h5k

Ig IT System Project Update – Quarter 1 – https://youtu.be/kYvFBTg9vTU

Current State vs Future State process flow diagrams

WHO:

Key facilitators and Responsibilities

Ministry of Health – Funder of Ig IT project and all blood components and products in Ontario, including Ig.

Canadian Blood Services – Development of IT infrastructure to support central collection of Ig requests from Ontario hospital prescribers. Supplier of Ig products to Ontario hospitals.

ORBCoN – Facilitator of provincial Ig information from various stakeholders to support best practice in utilization of blood components and products

This data project would not be possible without the input from various stakeholders across the province. Core and extended working groups have been established to support this project and members include;

• ➢Ontario Ministry of Health Representatives
• ➢Ontario hospital transfusion medicine laboratory staff including; Transfusion Medicine Physicians, Laboratory Leadership, and Technologists.
• ➢Ontario Ig prescribers across various specialities including; immunology, neurology, hematology, pediatrics
• ➢ORBCoN
• ➢Canadian Blood Services Plasma Protein and Related Products formulary team

WHEN:

Anticipated timeline

• Phase 1: Develop IT system functionalities with input and testing by 4 hospital sites in ON – anticipated completion April 2027.
• Phase 2: Onboard hospitals across ON to the IT system for Ig requests – anticipated completion – April 2028.

Communications

To date the following external stakeholders have been briefed on the project