Expanding a Regional-based Program: Resource Matching and Referral and the Inter-LHIN Referral Model

1. Expanding a Regional-based Program:Resource Matching and Referral and the Inter-LHIN Referral Model May 28th, 2013

2. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure Nothing to disclose Faculty: • Melissa Coulson, Shared Information Management Services (SIMS) • Charlene Mathias, Shared Information Management Services (SIMS) Relationships with commercial interests: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Other: Employees of University Health Network

3. Presentation Overview • RM&R Background • Inter-LHIN Perspective • Overcoming Traditional LHIN Barriers • Inter-LHIN Rehab/CCC Expansion Project • Lessons Learned • Governance • Future Opportunities

4. RM&R Background: What is Resource Matching and Referral? RM&R is a shared web-based system that enables matching of patients to appropriate clinical programs/services and transmission of electronic referrals between 93 acute, rehabilitation, complex continuing care, home care, long-term care and community support health service providers (HSPs) in the Toronto Central and Central LHINs

5. RM&R Background: Challenges and Solution

6. Inter-LHIN PerspectiveReferral Patterns in the Greater Toronto Area (Rehab as an example) Note: Transfer volumes are limited to Acute adult inpatient medical and surgical units sending to post-acute rehabilitation programs. The percentage represents the number of transfers sent from each LHIN with respect to the total number of referrals for that same LHIN. Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

7. Inter-LHIN Perspective Toronto Central and Central LHIN - Annual Referral Volumes Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

8. Inter-LHIN PerspectiveToronto Central and Central LHINs – Annual Referal Volumes Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

9. Inter-LHIN Perspective:Increased Complexity with Patient Transitions • LHIN boundaries are fluid • Referrals can cross LHINs for a number of reasons, including: • Acute care did not originate in patient’s “home LHIN” • Specialized/post-acute care is only available in certain geographical areas • Patients may wish to receive care/services close to where their family resides • Referral processing tends to be longer when crossing LHINs • Inconsistent forms and processes exist across LHINs • Limited standardization with assessment tools • Lack of established relationships between providers outside of LHIN

10. Inter-LHIN Perspective:Drivers to a Common Solution • Improved quality of care and patient experience • Supports timely and seamless transitions • Repository of programs and services • Provider process efficiencies • Standardized tools and processes • Improved communications between providers • Enhanced system planning • Larger (cross-LHIN) data set • Better understanding of patient’s journey and history • Greater ROI • Common infrastructure • Shared administrative and operational processes • Improved scalability

11. Overcoming Traditional LHIN Barriers: Sharing Common Solution • TC and Central LHINs identified an opportunity to share a common RM&R solution • In Fall 2011, the RM&R solution implemented in TC LHIN was customized and implemented across Central LHIN • Initial implementation was local within Central LHIN (intra-LHIN referrals) • In January 2012, expansion activities began to include sending referrals between Central and Toronto Central LHINs for Rehab and Complex Continuing Care (inter-LHIN referrals)

12. Overcoming Traditional LHIN Barriers:Project Approach

13. Overcoming Traditional LHIN Barriers: Pilot Project Overview Inter-LHIN pilot launched in January 2012 between Central and Toronto Central LHINs Pilot Outcomes: • Over 60 Rehab/CCC referrals were sent • Over 10 patients were transitioned from Central Acute Care to Toronto Central Rehab/CCC • Process Improvements

14. Inter-LHIN Rehab/CCC Expansion Project: Benefits and Outcomes 14

15. Inter-LHIN Rehab/CCC Expansion Project: Patient Benefits and Outcomes Rehab/CCC Volumes (Central to TC LHIN) # Referrals Month April 2012 – March 2013, 2003 referrals have been sent from Central Acute Care Hospitals to Toronto Central Rehab/CCC Hospitals providing more streamlined access to over 65 Programs Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team 15

16. Inter-LHIN Rehab/CCC Expansion Project:Provider Benefits and Outcomes • 100% of respondents agree or strongly agree that RM&R has streamlined the Rehab/CCC referral process • Satisfaction with the ability to complete a referral increased (11.1% vs. 66.7%) • More efficient and reliable management of referrals in a standard format • Increased transparency and accountability as system is able to track referral times Data Source: Inter-LHIN Rehab/CCC Expansion Project Pilot Focus Group and Survey, TC LHIN RM&R Program Team 16

17. Inter-LHIN Rehab/CCC Expansion Project: Health System Benefits and Outcomes Admission Wait Times Days Month System Planners and Health Service Providers have access to over 1,000 data elements in a centralized repository that can inform local and system-level improvements 17 Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team

18. Lessons Learned • Upfront business engagement, leadership and sign-off from all stakeholder groups critical to adoption of new business processes • Cross-jurisdictional business practices • What level of standardization is required to support inter-LHIN referrals? 18

19. Lessons Learned • Governance to support • How do local structures link to shared governance? • What structures/processes are needed for data sharing? • Operational support structure • How to best support discussion/dialogue around inter-LHIN transitions? • How to best manage standards? 19

20. TC-LHIN RM&R Governance Structure Executive Committee (EC) (Strategic / Operational) Steering Committee (SC) Operations (Ongoing)** RM&R Technical Group Hospital Expansion Business Transformation Initiative Reporting and Analytics Advisory Committee (RAAC) RM&R User Group (RUG) • * Each Project WG is temporarily formed to support a current/ongoing project, as needed • **Operational teams are in place to support ongoing Operational and Reporting activities Projects* Reporting (Ongoing)**

21. Cluster 2 RM&R Governance Structure Cluster 2 Steering Committee Cluster 2 Operational Committee Cluster 2 Delivery and Alignment Toronto Central LHIN Governance Central LHIN Governance LHIN Governance LHIN Governance Bi-monthly meetings of Cluster 2 Operational Committee to support alignment across LHINs from a project and operational perspective.

22. Future Opportunities • Coming Soon: Monitoring/leveraging the data to understand system impacts • Who should look at Inter-LHIN data? • What information is important? • Understanding unintended impacts and benefits Rehab/CCC Volumes (Central to TC LHIN) # Referrals Month 22 Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team

23. Future Opportunities • Further expansion between Central and Toronto Central • Single process for CCAC Referrals • Long-term Care • Alignment with provincial referral standards • ALC RM&R Business Transformation Initiative • Alignment and/or integration with other provincial initiatives

24. Questions?

25. Thank You

26. Appendices

27. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure • Faculty: • Melissa Coulson, Project Manager • Charlene Mathias, Senior Project Manager • Relationships with commercial interests: • Grants/Research Support: N/A • Speakers Bureau/Honoraria: N/A. • Consulting Fees: N/A. • Other: Employees of University Health Network

28. CFPC CoI Templates: Slide 2 Disclosure of Commercial Support • This program has received financial support from [organization name]in the form of [describe support here – e.g. an educational grant]. • This program has received in-kind support from [organization name]in the form of [describe support here – e.g. logistical support]. • Potential for conflict(s) of interest: • [Speaker/Faculty name] has received [payment/funding, etc.] from [organization supporting this program AND/OR organization whose product(s) are being discussed in this program]. • [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [insert generic and brand name here].

29. CFPC CoI Templates: Slide 3 Mitigating Potential Bias • [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated]. • Refer to “Quick Tips” document

30. Inter-LHIN Rehab/CCC Expansion Project: Health System Benefits and Outcomes Follow Up Times Days Month System Planners and Health Service Providers have access to over 1,000 data elements in a centralized repository that can inform local and system-level improvements 30 Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team