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e -Health 2013 Presented by: Shiran Isaacksz , Sr. Director, Regional and Provincial Initiatives Stephanie Saull-McCa

Enabling the transition of patients to the right care: Evolution of the Toronto Central LHIN’s Resource Matching and Referral (RM&R) Program. e -Health 2013 Presented by: Shiran Isaacksz , Sr. Director, Regional and Provincial Initiatives

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e -Health 2013 Presented by: Shiran Isaacksz , Sr. Director, Regional and Provincial Initiatives Stephanie Saull-McCa

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  1. Enabling the transition of patients to the right care: Evolution of the Toronto Central LHIN’s Resource Matching and Referral (RM&R) Program e-Health 2013 Presented by: Shiran Isaacksz, Sr. Director, Regional and Provincial Initiatives Stephanie Saull-McCaig, Director, Information Management

  2. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure • Nothing to Disclose

  3. Patient – Sally This is Sally Home Care • Profile • Age: 75 • Medical • Type 2 Diabetes • History: • Mild dementia • • Recent hip replacement • • Required Rehab Services, • CCAC In-Home services and Community Support Long Term Care Community Support Rehab Acute

  4. Patient – Healthcare Landscape Sally represents the 1% of the population which account for 34% of healthcare expenditures. population healthcare expenditures

  5. Patient Challenges ??? Sally and her care team are finding the navigation through the Care Continuum difficult due to the inefficient referral processes.

  6. The Problem Patient and Provider Challenges • Inefficient paper referral processes, which require faxing referral applications between provider organizations, create unnecessary delays due to: • Incomplete information • Illegible writing • Inappropriate matching of patients to programs/services • Unnecessary delays can contribute to alternate level of care length of stay. FAX PHONE FAX PHONE PAGE PAGE FAX PAGE FAX FAX WEB PHONE PAGE PHONE FAX PHONE PAGE PAGE PHONE

  7. FAX PHONE FAX PHONE PAGE PAGE FAX PAGE FAX FAX WEB PHONE PAGE PHONE FAX PHONE PAGE PAGE PHONE

  8. The Solution Resource Matching & Referral (RM&R) A patient-centred approach to managing referrals across sectors • RM&R matches patientsto appropriate programs/services based on assessed clinical needs, reducing the number of inappropriate referrals. • RM&R enhances communication and collaboration between providers, and increases referral process efficiency by creating documentation and service referrals electronically. • RM&R improves health system reporting and planning by providing a single source of LHIN-wide referral data. WEB WEB WEB WEB WEB WEB WEB WEB WEB WEB WEB WEB WEB

  9. RM&R Achievements 28,727active registered users • 84 Health Service Providers • 6 Acute Hospitals • 8 Rehab/CCC Hospitals • Toronto Central CCAC • 34 Community Support Services Agencies • 37 Long Term Care (LTC) homes • (including 3 Convalescent) 59,239 logins on average per month 5,897 LTC beds

  10. Benefits

  11. Challenges • Further Refinement to Referral Forms and Processes • Alignment with Other Provincial Systems/Priorities • Ability to Support Growth/Expansion • Streamlined Reporting

  12. Driving Principles Enabling the timely transition of patients to the right care Vision Simplify the Referral Process Make the System Smarter Drive System Change through Information Strategic Priorities Governance Business Engagement Technology Enablers

  13. Vision for RM&R • INTELLIGENT REFERRALS • User-Driven Adoption • Real-time Auto-generated Referral • Predictive Analytics • ‘ONE’ REFERRAL • Leveraging Information from Source Systems • Smart Triage (matching upfront) • Link to Other Data Sets • FOUNDATION SETTING • Enhancing Referral Processes • Improving Matching • Business Intelligence Tool

  14. Evolution of RM&R Integrated RM&R Analogous to the evolution of Consumer Electronics Standalone RM&R Pre-RM&R

  15. Provincial Initiatives Access Provider Portal Intelligence Data Access • Clinical Data Repository • Shared central repository that stores documents and discrete data elements from health care organizations (e.g., repositories, registries).  • Health Information Access Layer • Links applications, integration engines and data repositories to form an integrated system • Provides a set of communication and integration services • Provider Portal • Browser-based tool to allow access to ConnectingGTAdata online • Single point of access for clinicians across continuum of care • Ability for clinicians to communicate and collaborate with one another Information HIAL Data CDR

  16. Convergence Towards a Common Technical Platform Access Provider Portal Information HIAL Data CDR

  17. The Road Ahead….. Better Transition of Care System Intelligence Regional Integration

  18. Thanks! Any questions, please contact us at Shiran.Isaacksz@uhn.ca or Stephanie.Saull-McCaig@uhn.ca

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