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