Reporting and Analytics: Evolution of Information Needs Enabling system change by transforming data to insight

1. Reporting and Analytics: Evolution of Information Needs Enabling system change by transforming data to insight May 2013

2. Faculty/Presenter Disclosure • Presenters: Shez Daya and Alvin Cheng • Relationships with commercial interests: • Grants/Research Support: nothing to disclose • Speakers Bureau/Honoraria: nothing to disclose • Consulting Fees: nothing to disclose • Other: nothing to disclose

3. background

4. Introduction • How can we improve ALC rates? • How can we improve the quality of patient care? • There are numerous challenges in health care, that need to be solved • Technology can support health care providers to begin to tackle these problems but this is only the one step • We propose that the next step is through the utilization of information: “Currently, healthcare providers are underutilizing 90 percent of [health care] information” McKinsey Global Institute • How can we reduce avoidable readmissions? • What % of referrals are denied and for what reason? • Are providers meeting target response timeframes?

5. What is RM&R? A shared electronic tool that enables matching of patients to appropriate clinical programs/services and transmission of electronic referrals between 86 acute, rehabilitation, complex continuing care, home care, long-term care and community support health service providers (HSPs) in the Toronto Central LHIN

6. RM&R Project Highlights RM&R is one of the fastest-moving and most coordinated regional implementations in Ontario • Who currently uses RM&R? • 86 Health Service Providers • 7 Acute Hospitals (Med/Surg units and 7 EDs) • 1 Mental Health Facility • 8 Rehab/CCC Hospitals • Toronto Central CCAC • 34 Community Support Services Agencies • 37 Long Term Care (LTC) homes • (including 3 Convalescent) • RM&R by the numbers • Clients can be matched to: • 25 Community Support Services • 60 Rehab/CCC programs & services • 5,897 LTC beds • 27, 587active registered users • 80, 581 logins on average per month • 109,995 unique clients referred (Feb/08 – Mar/13)

7. RM&R Program Objectives and Components Resource Matching and Referral - Program Objectives Provide equitable access to care Enhance the quality of care and improve patient safety Streamline the referral process Allow for real-time access to timely, legible, complete and a comprehensive inventory of programs/services Have a single source of system-wide referral data for planning purposes Provide information on health system utilization and potential service gaps Information Standards Technology • Determining the common data set and business processes Reporting and Analytics • Technology that is integrated, secure and intelligent • Capability to use the data to support decision making

8. Reporting & Analytics Program

9. Reporting and Analytics Program

10. Reporting and Analytics: The Evolution 2008 Reports to Demonstrate Benefits of System Use “Tipping Point” GAPS GAPS GAPS

11. Reporting and Analytics: The Evolution 2010 Reports to Understand Patient Transitions “Tipping Point” GAPS GAPS GAPS

12. Reporting and Analytics: The Evolution 2012 Reports to Align Data with System Level Goals and build Accountability “Tipping Point” GAPS GAPS GAPS

13. Reporting and Analytics: The Gaps • “One-size” doesn’t‘ fit all • Limited understanding of what the information means • Not all the right players were at the table • Low awareness, low engagement “Tipping Point” GAPS GAPS GAPS

14. Reporting & Analytics: What’s the Formula? Information Insight… Change Makers… Pursuit of Action…

15. Formula for change

16. Goals By Audience + Interactive, Visual Reports Information insight

17. Information Insight: Translating Data into Information to Create Understanding • Information Insight: • What: the questions needing to be answered • How: how information is presented and interpreted Right questions for the problem, dynamic information Broad, untargeted questions, static data

18. Information Insight: Gaps and Approach Gaps • One-size” doesn’t‘ fit all - Reports were not meeting all stakeholder groups needs • Limited understanding of what the information means - Quality over quantity Approach • 17 Site Visits • Clinical and Data Experts • Elicit feedback about reports • Elicit information needs of varying stakeholder groups

19. Information Insight: Goals by Audience + Interactive Visual Reports Outcomes • Identified 3 broad groups of stakeholders with different information needs • Revised report structure to match stakeholder needs • Modified delivery and presentation of reports

20. Information Insight: Goals by Audience + Interactive Visual Reports • Static Excel reports

21. Information Insight: Goals by Audience + Interactive Visual Reports • Dynamic Web-based reports

22. Leaders, Planners, Decision Support Stakeholders Change Makers

23. Change Makers: Gaps and Approach Gaps • Reports were often only going to decision support experts; many clinical leaders were not reviewing reports Approach • Review of stakeholders: • distribution lists for regular reporting • committee memberships • Identification of forums and existing networks • Ensured site visits included engagement of both clinical and decision support experts from each organization

24. Change Makers: Leaders, Planners, Decision Support Stakeholders Outcomes • Individual health system planners, organizational leaders and decision support stakeholders are comprised in the following segments that utilize RM&R data:

25. Active Dialogue Pursuit of Action

26. Pursuit of Action: Gaps and Approach Gaps • Low awareness, low engagement - engagement to date had been passive with little call for action Approach • Leverage momentum from site visits to engage in dialogue around information • We sought invitations to different groups and forums to discuss meaning of RM&R data • Leverage existing governance and forums • Use technology (i.e. webinars) to reach a broader audience

27. Pursuit of Action: Active Dialogue This is the “do something” part. Dialogue stimulates a plan of action Action begets action. Outcomes Action Cycle: • Actively approaching Existing Networks and forums outside of RM&R to initiate dialog •  Support organizations to establish mechanisms to review and action information •  Process established within RM&R governance to review and action information

28. Stimulating system change

29. Stimulating System Change 2013 4th Gen. Reports to Improve Understanding “Tipping Point”

30. Stimulating System Change: The Signs • Web traffic is significantly greater than anecdotal use of previous reports • Many organizations have extended invitations to the program to present and discuss data • Analytics proposals have generated interest from stakeholders • RM&R information currently being used within organizational and system planning processes

31. Demonstrating insights from a LHIN perspective System change – TC LHIN

32. RM&R System Level reports • Hospital • Hospital • Hospital • Hospital • Hospital • Hospital • MH&A • The RM&R Program supports many of the LHINs strategic priorities • Initiated to support the ER/ALC imperative but now supports the work of the LHIN Quality Table as well • RM&R is a key data-source for some of the big and small-dot indicators • MH&A • MH&A • MH&A • MH&A • MH&A • LTC Big-Dot Indicators • LTC • LTC • LTC • LTC • LTC Big-Dot Indicators Big-Dot Indicators Big-Dot Indicators Big-Dot Indicators Big-Dot Indicators • CSS • CSS • CSS • CSS • CSS • CSS • CCAC • CCAC • CCAC • CCAC • CCAC • CCAC • CHC • CHC • CHC • CHC • CHC • CHC

33. Sample Report – Referral Decision Rendered within 2 days Hospitals Finding:82% of TC LHIN referrals have a decision rendered within 2 days. Considerable variation in decision time among receiving facilities – ranging from 64% to 96%.

34. Sample Report – Denial Reasons for Rehab/CCC Finding:26% of referrals from acute to rehab/ccc hospitals were denied in Q3 2012/13. “Medical needs cannot be accommodated: Other” and “Not rehab ready: inconsistent participation/tolerance” were the most common reasons for a denied referral.

35. Moving Forward • LHIN perspective is one example of how RM&R data has begun to stimulate change • Each organization has their own goals – the work completed to date has aligned RM&R to help drive progress against those goals • The “tipping point” is a place to start – infinite potential to continually improve and tailor the information to needs of organizations • Will pursue further enhancements • Business Intelligence solutions • Ability to link data from across organizations to understand the patient journey

36. RM&R Program Alvin Cheng - Alvin.cheng@uhn.on.ca TC LHIN Shez Daya - Shez.daya@lhins.on.ca Thank you