Reporting and Analytics: Evolution of
Information Needs
Enabling system change by transforming data to insight
May 2013
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
2
BACKGROUND
3
Introduction
•
There are numerous challenges in health care, that need to be solved
How can we
improve ALC
rates?
How can we
reduce
avoidable
readmissions?
How can
we
improve
the quality
of patient
care?
What % of
referrals are
denied and
for what
reason?
Are providers
meeting
target
response
timeframes?
•
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
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
5
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, 587 active registered users
• 80, 581 logins on average per month
• 109,995 unique clients referred (Feb/08 – Mar/13)
•
6
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
Determining the
common data set and
business processes
Technology
Technology that is integrated,
secure and intelligent
Reporting and Analytics
Capability to use the data to
support decision making
7
REPORTING & ANALYTICS
PROGRAM
8
Reporting and Analytics Program
Reporting and Analytics: The Evolution
2008
Reports to Demonstrate Benefits
of System Use
“Tipping
Point”
GAPS
GAPS
GAPS
Information Insight… Change Makers…
Pursuit of Action…
Reporting and Analytics: The Evolution
2010
Reports to Understand Patient
Transitions
“Tipping
Point”
GAPS
GAPS
GAPS
Information Insight… Change Makers…
Pursuit of Action…
Reporting and Analytics: The Evolution
2012
Reports to Align Data with System
Level Goals and build Accountability
“Tipping
Point”
GAPS
GAPS
GAPS
Information Insight… Change Makers…
Pursuit of Action…
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
Information Insight
Change Makers
Pursuit of Action
Reporting & Analytics: What’s the Formula?
Information Insight… Change Makers… Pursuit of Action…
14
FORMULA FOR CHANGE
15
INFORMATION INSIGHT
Goals By Audience + Interactive, Visual Reports
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
Insight Curve
“What”
Right questions for the
problem, dynamic
information
Broad, untargeted
questions, static data
“How”
17
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
18
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
Health System
Planners
• System Capacity
and Demand
• Access to Care,
Equity and
Appropriateness
• Process Efficiency
• Quality of Care /
Patient Experience
Organizations
• Referral Volumes
• Referral Outcomes
• Referral Timelines
Forums, Committees
and Special Interest
Groups
• Goals derived by
respective forums
• E.g. analytics
questions
19
Information Insight:
Goals by Audience + Interactive Visual Reports
• Static Excel reports
Resource Matching and Referral - Executive Summary - DRAFT
To Glossary of Key Performance Indicators
CARE TYPE:
Acute to Rehab/CCC Referrals
REPORTING MONTH:
November 2011
Underperforming by 25% or less compared to Baseline
DISTRIBUTED MONTH:
December 2011
Underperforming by more than 25% compared to Baseline
Overperforming compared to Baseline
Key Performance Indicators
Nov 2011
Q3 2011
Fiscal YTD
As of Nov 30
2011
Baseline
(90th Percentile
for FY10/11)
% Variance
Compared to
Baseline
Target
Status
# of Total Clients with Active Referrals in RM&R
945
1,432
4,387
11,605
N/A
N/A
N/A
N/A
# of Clients - Referrals sent through RM&R (during reporting period)
497
932
3,355
N/A
N/A
N/A
N/A
# of RM&R Clients Admitted
358
688
2,588
N/A
N/A
TBD
TBD
90th Percentile Wait times
(# of Days Waiting from Acceptance to Admission)
7.0
8.0
8.0
Highlights
Overall Volumes
[Click Here for Drill Down]
System Capacity & Demand
# of Clients Accepted but Waiting for Program / Services
9.0
-11%
TBD
-11%
698
N/A
N/A
TBD
TBD
[Admitted Clients: Click Here for Drill Down]
[Clients Waiting: Click Here for Drill Down]
Access to Care, Equity, &
Appropriateness
6.0%
N/A
N/A
TBD
TBD
90th Percentile Wait times
(# of Days Waiting from date of Acceptance to Current Month)
754.0
307.0
146%
TBD
146%
# of Clients Matched, but Denied by Receiver
70
N/A
N/A
TBD
TBD
% of Clients Matched, but Denied by Receiver
0.6%
N/A
N/A
TBD
TBD
# of Clients with all Referrals Denied
12
N/A
N/A
TBD
TBD
% of Clients Accepted but Waiting for Program / Services
[Click Here for Drill Down]
Process Efficiency
# of Referrals – Inappropriately Sent (Non-Matching Provider)
320
556
2,140
N/A
N/A
TBD
TBD
90th Percentile Referral Time for Admitted Clients (in days)
19.0
21.0
23.0
24.0
-4%
TBD
-4%
807.0
-7%
TBD
-7%
90th Percentile Referral Time
for Clients Waiting for Programs / Services (in days)
747.0
[Admitted Clients: Click Here for Drill Down]
[Clients Waiting: Click Here for Drill Down]
% of Referrals Responded to within 2 days of Referral Being Received
43.1%
48.3%
51.9%
N/A
N/A
100%
52%
Quality of Service /
Patient Experience
# of Clients Re-Admitted to Rehab within 30 days
0
3
16
N/A
N/A
TBD
TBD
[Click Here for Drill Down]
20
Information Insight:
Goals by Audience + Interactive Visual Reports
• Dynamic Web-based reports
21
CHANGE MAKERS
Leaders, Planners, Decision Support Stakeholders
22
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
23
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:
RM&R Steering
Committee
LHIN Reporting
and Analytics
Team
Reporting and
Analytics
Advisory
Committee
Organizational
Leadership
forums
Sector and
Quality Tables
Who are our
Change Makers?
Other forums
(Transition,
Patient Access
and Flow)
PURSUIT OF ACTION
Active Dialogue
25
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
26
Pursuit of Action: Active Dialogue
Outcomes
Action Cycle:
This is the “do something” part.
Dialogue stimulates a plan of action
Identify the
Problem/
Question
Monitor
outcomes
Action begets action.
Analyze and
Generate
Insight
 Actively approaching Existing
Networks and forums outside of
RM&R to initiate dialog
 Support organizations to
establish mechanisms to review
and action information
Intervention
Active
Dialogue
 Process established within
RM&R governance to review and
action information
STIMULATING SYSTEM CHANGE
28
Stimulating System Change
2013
4th Gen. Reports to Improve
Understanding
“Tipping
Point”
Information Insight
Change Makers
Pursuit of Action
29
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
30
30
Demonstrating insights from a LHIN perspective
SYSTEM CHANGE – TC LHIN
31
31
RM&R System Level reports
• 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 smalldot indicators
Big-Dot
Big-Dot
Indicators
Big-Dot
Indicators
Big-Dot
Indicators
Big-Dot
Indicators
Big-Dot
Indicators
Indicators
Hospital
Hospital
Hospital
Hospital
Hospital
MH&A
Hospital
MH&A
MH&A
MH&A
MH&A
MH&A
LTC
LTC
LTC
LTC
LTC
LTC
CSS
CSS
CSS
CSS
CSS
CSS
CCAC
CCAC
CCAC
CCAC
CCAC
CHC
CCAC
CHC
CHC
CHC
CHC
CHC
32
Sample Report – Referral Decision Rendered within 2 days
4ai) Percent of Complete Referrals with Decision Rendered
within 2 Days by Receiving Facility - 2012 Q3
100
90
80
Percent
70
60
50
40
30
20
10
0
Hospitals
Receiving Facility
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%.
33
Sample Report – Denial Reasons for Rehab/CCC
Percent of Denials by Reason - Acute to Rehab/CCC Q3 2012/13
Source: Resource Matching & Referral
Use of restraints/observer cannot be accommodated
Psychiatric needs cannot be accommodated
Patient functional status too high for inpatient rehab
Not appropriate for CCC : Functional level -low
Not appropriate for CCC : Functional level -high
Not Rehab Ready: Insufficient participation/tolerance
Not Rehab Ready: Inconsistent…
Not Rehab Ready: Due to physical impairments
Not Rehab Ready: Due to cognitive impairments
Medically unstable
Medical needs cannot be accommodated: TPN
Medical needs cannot be accommodated:…
Medical needs cannot be accommodated: Other…
Medical needs cannot be accommodated: Bariatric
Equipment cannot be accommodated: Other (specify)
Equipment cannot be accommodated: Bariatric
Total Denials = 158 or 26%
0
5
10
15
20
25
30
35
40
45
50
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.
34
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
35
THANK YOU
RM&R Program
Alvin Cheng - Alvin.cheng@uhn.on.ca
TC LHIN
Shez Daya - Shez.daya@lhins.on.ca