Echocardiography Quality
Improvement Program

Frequently Asked Questions

The CorHealth Ontario’s Echocardiography Quality Improvement (EQI) Program is a quality improvement initiative for all facilities providing echocardiography services in Ontario. The EQI Program reviews all registered echocardiography facilities according to the 2015 Standards for Provision of Echocardiography in Ontario
Please note that the EQI Program only evaluates the practice of complete echocardiographic examinations on adult patients and currently does not review any of the following echocardiography services:

• Pediatric echocardiography, inclusive of fetal echocardiography
• Intraoperative transesophageal echocardiography
• ICU transesophageal echocardiography

If you have questions pertaining to the billing of any of the above echocardiography services, please direct your questions to the Ministry of Health and Long-Term Care:

Service Support Contact Centre
1-800-262-6524
IncidentSupport@ontario.ca
If you are a provider who performs fetal echocardiography on pregnant mothers and your facility is not registered to the EQI Program (i.e. it is a pediatric institution), please contact the EQI Team for further instructions on how to continue normal billing practices for fetal echocardiographic examinations.

EQI Team
416-512-7472
eqi@corhealthontario.ca
As described in the MOHLTC bulletin #4664 published on January 26, 2016 , facilities must be actively engaged in the EQI Program after April 1, 2016 to continue regular billing practices for echocardiography services.

The EQI Program and the MOHLTC require a valid OHIP group number or numbers, as a unique identifier for your facility. If you have not already done so, please submit all valid OHIP group billing numbers associated with your facility to the EQI Program.

If your facility does not have a group billing number, one can be obtained here.
After April 1, 2016, all facilities should exclusively use the valid OHIP group billing number(s) they submitted to the EQI Program to bill for echocardiography services. If you have received a new group number, you may also use this number to bill for other services. Group billing numbers submitted to the EQI Program for your facility have been approved and activated by the MOHLTC.

The use of any additional billing numbers (e.g. solo billing numbers, “0000”) or group billing numbers not submitted to the EQI Program will result in the receipt of an error message (EG1) on your error report.

If your facility receives an error message or experiences difficulties with claim submissions after April 1, 2016 that you are unable to resolve, please contact:

Service Support Contact Centre
1-800-262-6524
IncidentSupport@ontario.ca
Please ensure your facility is only submitting billing claims for echocardiography services using a valid OHIP group number that was provided to the EQI Program. You may resubmit claims with a group number that has been submitted to the EQI program and activated by the MOHLTC.

To resolve any issues with OHIP billings, please contact:

Service Support Contact Centre
1-800-262-6524
IncidentSupport@ontario.ca
No. As described in the MOHLTC bulletin #4664 published on January 26, 2016 , facilities must be actively engaged in the EQI Program after April 1, 2016 to continue regular billing practices for echocardiography services.

For more information about OHIP billing practices please visit the MOHLTC's OHIP Billing Number Registration webpage
Valid OHIP group billing numbers allow CorHealth Ontario to update the MOHLTC with a list of active EQI Program participants. If your facility has a group billing number(s) you can submit them to the EQI program to have them activated for billing claims for echocardiography.

If you have not already done so, please make sure to submit all valid OHIP group billing numbers associated with your facility and practicing physicians to the EQI Program.

If your facility does not have a valid OHIP group billing number, one can be obtained here.

Please note that only physicians can bill and be paid for echocardiography technical and professional fees. Physicians are reminded that the Schedule of Benefits for Physician Services has requirements for billing technical fees and those requirements must be met for the technical fee to be eligible for payment.
No. Please note that only physicians can bill and be paid for echocardiography technical and professional fees. If echocardiography services are provided in the same location as an Independent Health Facility (IHF), the IHF group number is not valid for payment. A physician group will require a new OHIP group billing number for the purposes of billing for echocardiography if services are provided in the same location as an IHF.

If your facility does not have a valid OHIP group billing number, one can be obtained here.

Physicians are reminded that the Schedule of Benefits for Physician Services has requirements for billing technical fees and those requirements must be met for the technical fee to be eligible for payment.
Yes. Sole physician clinics require a valid OHIP group billing number.

If you currently do not have a group billing number, one can be obtained here.
Yes. All sites affiliated with your facility must be documented and reviewed by the EQI Program. Please ensure that ALL sites, where echocardiography services are performed have been registered to the EQI Program.
Once registered, a facility will need to ensure the documents listed below are submitted to the EQI Program in order to arrange a Site Visit date. Please visit the EQI website, specifically Step 2 of the EQI Process, for information on how to submit required documents electronically via the website’s file manager.

a) A signed Facility Agreement is required from the signing authority at each site location listed under your facility. This form is currently being revised in coordination with the Ontario Association of Cardiologists and will be updated to the EQI website under the EQI Document Updates section (above your account login), as soon as possible.

Please send original hard copies by mail or courier to:

CorHealth Ontario
4100 Yonge Street, Suite 502
Toronto, ON M2P 2B5

b) Signed Attestation Forms are required from all practicing physicians within a facility and can be found on the EQI website under the EQI Document Updates section (above your account login).

Please submit them electronically via the website’s file manager.

c) A full policy and procedure manual is required for all facilities. The EQI website provides samples and templates for a complete policy and procedure manual. These can be found under Resources -> Sample Templates.

Please submit them electronically via the website’s file manager.

After CorHealth Ontario receives all required documentation from a facility, a Site Visit will be booked based on the size and location of a facility. Please note that due to high registration volumes all facility Site Visits may not be scheduled within 3 months of registration, as originally planned.
  1. The Medical Director should be available on-site (in person) for a minimum of 1 hour during the site visit to meet with CorHealth Ontario Site Reviewer to answer questions.

  2. The Technical Director must be available to coordinate the site review, provide a tour of the facility and to answer questions.

  3. It is expected that other members of the facility staff are available to answer questions pertaining to their role and the facility operations.

  4. The policy and procedure manual must be available on site for review.

  5. The CorHealth Ontario Site Reviewer must be able to observe each type of examination on the day of the visit (patient consent required). Site Visits will be collaboratively scheduled, so that each modality performed at the site, has scheduled patients on the day of the Site Visit.

  6. Case Studies (images and accompanying reports) must be available on location for each modality performed at your facility for the CorHealth Ontario Site Reviewer.

CorHealth Ontario does not provide a pre-evaluation assessment.
A CorHealth Ontario echocardiography sonographer will conduct the Site Visit. Larger facilities may have more than one reviewer for the Site Visit.
The length of a Site Visit will depend on the size of the facility and the number of modalities to be reviewed. Smaller facilities may take 1 day, whereas a large academic facility may take several days.
Yes. All echocardiography facilities/sites, whether mobile or fixed, will need to be reviewed as part of the EQI Program.

Please note that Site Reviewers will need to review all physical locations where your facility provides echocardiographic examinations, inclusive of mobile facilities/sites.
All echocardiographic examinations must occur in a physical space dedicated to the practice of echocardiography. This may be present in some Long-Term Care Homes, Nursing Homes or Retirement Residences.

Echocardiographic examinations that occur in private patient rooms or residences where the physical environment is changing, do not align to the Standards and will not be reviewed by the EQI Program.

Please note that EQI Facility Agreements will need to be submitted by the signing authority at Long-Term Care Homes, Nursing Homes or Retirement Residences before CorHealth Ontario will be able to conduct a Site Visit.
Yes. Mobile sites will need to register to the EQI Program to continue normal billing practices for echocardiographic examinations, as indicated in MOHLTC bulletin #4664, published on January 26, 2016 .
The site reviewer will assess if the room is adequate to perform echocardiography procedures and determine if the environment is safe for patients and the echocardiography facility staff.

No single element of the EQI Program will result in the need for an EQI Quality Improvement Plan to be actioned. Specific elements of your facility Site Review may be highlighted in the final report as areas that require improvements and room size could be one of those elements.
No. The CorHealth Ontario EQI program is provided in English only.
Yes. A Medical Director is a required position for all echocardiography facilities in Ontario. Several facilities have partnered with Medical Directors from external facilities to meet this requirement of the Standards. If your facility would like help in partnering with an external Medical Director, please contact the EQI Team at eqi@corhealthontario.ca.
No. Minimum volume requirements are in place for the Medical Director and Medical Staff performing echocardiographic examinations. There are no required volumes for the facility.

In addition, the minimum volume requirements for the Medical Director and Medical Staff are cumulative across all locations where individuals practice and count towards a practitioner’s total annual volume.
For referrals without a standard indication (see Appendix B of the Standards), facilities must have mechanisms in place whereby the referring physician is contacted and provides the indication prior to the study being performed.
Please refer to Standard F2, which outlines the criteria required of echocardiography imaging systems. If not in place at the time of the Site Visit, this will likely be a suggested area for improvement.
The goal of the EQI Program is quality improvement of echocardiography services in Ontario. Quality improvement is on-going and it should not begin, nor end, with an EQI Review.

There are three potential outcomes, all of which highlight areas for quality improvement as follows:
  1. Compliant with the Standards
  2. Not Compliant with the Standards, requiring Minor Improvements
  3. Not Compliant with the Standards, requiring Significant Improvements
Facilities found to be compliant with the Standards will receive a detailed report and Certificate that is valid for a three year term. Notice of this status will also be shared with the Ministry of Health and Long-term Care (MOHTLC).
The goal of the EQI Program is quality improvement of echocardiography services in Ontario. Quality improvement is on-going and it should not begin, nor end, with an EQI Site Visit. Any site that does not meet the Standards upon initial review will be given a detailed report indicating key areas of required improvements.

Facilities may be asked to submit an EQI Quality Improvement Plan to CorHealth Ontario within a defined time frame to address these key areas. CorHealth Ontario will also work with facilities to determine if any further assessments are required.
Yes. Facilities are required to notify CorHealth Ontario prior to any of the following:
  1. Change of ownership and/or facility name
  2. Change of Medical Director
  3. Any addition or deletion of services and/or modality offered (e.g., stress echocardiography)
  4. Any addition or change of site locations to the facility/practice
  5. Any addition or removal of Medical Staff to the echocardiography facility group
  6. Any addition or removal of Technical Staff to the echocardiography facility group
Yes. The EQI Program will be adapting some of its processes to accommodate the review of all new site locations. One such change will be to review Case Studies on location during the Site Visit whenever possible. Therefore, unless specifically requested by the EQI Team, Case Study submission to CorHealth Ontario will no longer be required.
If your facility is requested to submit Case Studies, this is done electronically on the EQI website or for very large cases through an FTP server. The EQI Team will contact your facility directly with FTP instructions if this method is required. Please see below for guidelines regarding the submission of Case Studies.

  1. CorHealth Ontario requires that all case study images are in Digital Imaging and Communications in Medicine (DICOM) format.

  2. All patient identifiers must be removed prior to submission. CorHealth Ontario will not accept Case Studies with patient identifiers. The following must be removed from all images:
    1. Patient Health Information (PHI), such as Patient Name, MRN, Health Card Number, Date of Birth, etc.
    2. Interpreting and Referring Physician identifying information, such as name.
    3. Facility Name and Address.

  3. Apply a unique identifier to ensure the original Case Studies can be referred to if necessary:
    1. Patient Health Information is replaced by the site with alphanumeric identifiers (e.g. 1, 2, 3 or A, B, C).
    2. Patient Date of Birth must be replaced with the patient’s age. Age is an important factor for the case review process.
    3. Interpreting Physician is replaced with alphanumeric identifiers (e.g. 1, 2, 3 or A, B, C).
    4. Facility name and address are replaced by a unique identifier provided to the site by CorHealth Ontario (e.g. Site Z).
    5. *Do not remove anything other than the items listed above. It may include information that is required as part of the case review (e.g. heart rate, indications, blood pressure etc.).
    6. NOTE: Ensure that records are kept to match identifiers to the original case study for future reference if necessary (e.g. Mr. Smith = Patient 1, Exam date, Interpreting Physician A = Dr. Jones).
As of April 1, 2016, Case Study submission to CorHealth Ontario will no longer be required from all facilities, as Case Study review will occur on location whenever possible. If the EQI team requests Case Study submission, the number of studies required will depend on the number of modalities in use at your facility.