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

2. 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 3

4. Introduction 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 improve the quality of patient care? How can we improve ALC rates? How can we reduce avoidable readmissions? What % of referrals are denied and for what reason? Are providers meeting target response timeframes?

5. 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 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) RM&R is one of the fastest-moving and most coordinated regional implementations in Ontario 6

7. 7 RM&R Program Objectives and Components Determining the common data set and business processes Technology that is integrated, secure and intelligent Capability to use the data to support decision making Information Standards Technology Reporting and Analytics 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 Resource Matching and Referral - Program Objectives

8. REPORTING & ANALYTICS PROGRAM 8

9. Reporting and Analytics Program

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

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

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

13. Reporting and Analytics: The Gaps GAPS “Tipping Point” “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

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

15. FORMULA FOR CHANGE 15

16. INFORMATION INSIGHT Goals By Audience + Interactive, Visual Reports

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

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

19. 19 Information Insight: Goals by Audience + Interactive Visual Reports 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 Outcomes

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

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

22. 22 CHANGE MAKERS Leaders, Planners, Decision Support Stakeholders

23. 23 Change Makers: Gaps and 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 Reports were often only going to decision support experts; many clinical leaders were not reviewing reports Gaps Approach

24. Change Makers: Leaders, Planners, Decision Support Stakeholders Who are our Change Makers? Sector and Quality Tables Organizational Leadership forums RM&R Steering Committee LHIN Reporting and Analytics Team Reporting and Analytics Advisory Committee Other forums (Transition, Patient Access and Flow) Outcomes Individual health system planners, organizational leaders and decision support stakeholders are comprised in the following segments that utilize RM&R data:

25. 25 PURSUIT OF ACTION Active Dialogue

26. 26 Pursuit of Action: Gaps and 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 Low awareness, low engagement - engagement to date had been passive with little call for action Gaps Approach

27. Identify the Problem/ Question Analyze and Generate Insight Active Dialogue Intervention Monitor outcomes Pursuit of Action: Active Dialogue 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 Action Cycle: This is the “do something” part. Dialogue stimulates a plan of action Action begets action. Outcomes

28. 28 STIMULATING SYSTEM CHANGE

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

30. 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 30

31. 31 SYSTEM CHANGE – TC LHIN Demonstrating insights from a LHIN perspective 31

32. 32 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 small- dot indicators Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC Big-Dot Indicators Hospital MH&A LTC CSS CCAC CHC

33. 33 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%. Sample Report – Referral Decision Rendered within 2 days Hospitals

34. 34 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. Sample Report – Denial Reasons for Rehab/CCC

35. 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. THANK YOU RM&R Program Alvin Cheng - Alvin.cheng@uhn.on.caAlvin.cheng@uhn.on.ca TC LHIN Shez Daya - Shez.daya@lhins.on.caShez.daya@lhins.on.ca