Contribution to

Business Intelligence

H Johnson

Health Atlas Ireland

Health Atlas Ireland

What do we actually do?

Support the quest for better health for

patients, their families & the public

by exploiting the

quality assurance/improvement,

health mapping & research potential

of available data.

Home page

The moving parts

Datasets

User

management

Analyses Displays

DOH – Ministers Office

HSE divisions - all

Clinical programmes

Other agencies

Researchers

How does it begin?

Scale :

National,

Regional

Local

Complexity:

Large

Medium

Small

The main streams

Mapping

AeroMedical

Service location

Service coverage

Atlas Finder

Service Directory

Resource profiler

Tracker

Analytical

Medicine (AMP)

Surgery

Radiology

Histopathology

Endoscopy

Research

In-house

Collaboration

How do we start?

3 key questions:

• What’s the problem/question?

• What data is actually available?

• What’s to be displayed (that’s actionable)?

Systematised solution = software

development (OpenApp framework)

The Atlas “clinic”

Round table - brain storm/blue sky

3 key questions:

• What’s the problem/question?

• What data is actually available?

• What’s to be displayed (that’s actionable)?

Systematised solution - OpenApp

1) Health Intelligence Team

2) The interested party

3) Software engineers

The process

Specification

Funding CMOD, HSE ….

Time frame: weeks - months

Evolutionary = mutual trust

Meet as required X 3 teams

Develop

Test

Tweak

Governance

Hand over

Access roles – levels & depth

Deploy

Implement

Monitor

Support & maintain

Enhance

Project specification

2 – 10 pages

Business case

Variables

Formulae

Visuals

Governance

Look & feel

1) Attractive & simple

2) Fast

3) Interpreted at a glance

4) Easy to “explore”

5) Signal leaps out

6) Screen & paper format

Similarities?

AeroMedical

OSI maps

Service Directory

GeoDirectory

Powerlines

Landing sites

Phone location

Tracking

NQAIS

HIPE data

National view

Hospital group view

Hospital view

Team view

Record view

Now, trend, target

Irl

Field

National

Patient

Any challenges?

Data access - export

Encryption

Definitions

Timeliness

Data quality

Governance

Unique ID, address quality (Eircode)

Culture – respect for pattern analyses, sense of control …

Implementation

What’s the real problem?

Hospital data A

Hospital data B Prescribing B

Prescribing A

Registry A

Registry B

Mortality

Survey A

Survey B

Demography

Pr care data A

Pr care data B

Service A

Service B

E-Chart A

E-Chart B

Policy A

KPI Z

HR A € B

Guideline A

Unique ID DP FOI

QA QI

Other sector

KPI A

NQAIS Acute Medicine Programme

AMP set up in 2010 by RCPI & HSE to promote:

Swifter access to senior decision makers

Swifter access to necessary investigations &

interventions for acutely ill medical patients

Reduced overnight admissions

Shorter lengths of stay

AMAU

Design concepts

Numbers

Discharges (yr) 1.6 M

Diagnostic “specialties” 20

Diagnoses 5658

CCS 261

Consultant teams 1718

Hospitals 42

Admission types 5

User levels 4

XXXXXXXXX

Complex story – needed to be told simply

NQAIS Medicine views National

Hospital group

Hospital

Team

Clinically focused Easily learnt & understood

(user friendly)

Important signals visible at a

glance

Refresh monthly

Team AMP

Health Intelligence H&W HSE

NQAIS Surgery

OpenApp

NQAIS info governance

Communication – encrypted

Devel & support OpenApp

Governance policy

Data flow

Health Atlas Ireland server

NQAIS analysis & display

HPO HIPE national dataset

Data de-identified

MRN encrypted

Hospital Data collection

Inpatient & day case

Note – equivalent OPD & ED data not

collected

Agency NQAIS M

Section H Group

User group H

Data prep

Data

analysis

Display

via

browser

Health Atlas Ireland technical

& security infrastructure

Browser

NQAIS M controller

NQAIS Access requirements

Access to the internet

IP lockdown - register IP address with Health Atlas Ireland

Browser: Complex graphics require a modern browser

Chrome

Firefox

Internet 9 or higher

(If unsuitable – options, including Atlas browser)

Security cert

Diamond plot

National My

hospital

25th centile AvLOS 75th centile

On

target

Off

target

Short

LOS

Long

LOS

White

On-target

Yellow

Close to

target Red

Off-

target

Grid

Diamond creation, AvLOS,

trim point

25th

centile

75th

centile

Trim

point

AvLOS

Trim

75%ile + 3 X (25%ile –

75%ile)

LOS

Inter quartile

range

Target setting – for each CCS

Target setting AMAU only & same

day emergency On target = 6 hr

Off-target = 9 hr

Target yellow line

= top

25th Off-target

On-target

Calculate each team’s AvLOS (BDU/# cases)

Sort rows by AvLOS – shortest AvLOS at top

Calculate cumulative # & % cases - ranks teams by vol

On-target = AvLOS of team closest to top 25th centile

(top quartile or median of top 50%). Yellow line.

Off-target” value = AvLOS of team at 50th percentile

Red line.

Cases & bed days “lost”

Cases lost & bed days lost indicate the “theoretical”

potential for increased patient throughput if the target

AvLOS was to be consistently achieved

Bed days lost = Bed days used - (# cases X target AvLOS)

Cases lost = Bed days lost

Target AvLOS

Cases/bed days lost value can help identify & prioritise

processes within the hospital most likely to reveal the

potential for AvLOS reduction

NQAIS design

Gold buttons

1) Hospital

2) Period (month/year)

3) Diagnosis (+proc)

4) Specialty

5) Age

6) Display

Silver buttons

1) Summary 1

2) Summary 2

3) Grid

4) Plots

5) Trends

Other

1) Report

2) PDF

3) Excel

Selection

box

Summary views Summary 1

Summary 2

Grid view

Key

values

Diagnoses

National

Group

Hospital

Admission type

Plot view

Expand ribbon

Key values

Enlarge

Values

Axes

Diamond plot

Histogram LOS

Cumulative LOS

Readmission

trend

Explorer Flexible interaction of

parameters of interest

Charlson Dx 2-30 risk Score

Acute myocardial infarction 5

Cancer 8

Cancer metastatic 14

Cerebral vascular accident 11

Congestive heart failure 13

Connective tissue disorder 4

Dementia 14

Diabetes 3

Diabetes complications -1

HIV 2

Liver disease 8

Liver disease - severe 18

Paraplegia 1

Peptic ulcer 9

Peripheral vascular disease 6

Pulmonary disease 4

Renal disease 10

Trends No. cases

trend AvLOS

trend

Record review

On-screen review

List options

Excel export

(beware DP)

E-MRN

Record review – MRN decryption

Nominated user - click lock icon on

Record display screen to begin

MRN decryption if:

1) Special password

2) “See identifier” role

3) Viewing a single hospital view

4) Physically present in hospital -

IP lockdown

5) State reason

All MRN decryption requests

logged for audit purposes

Comment – user feedback

Enter your comment

•What you find works well

or not so well

•Make a suggestion

•Upload a screen shot if

required

Comment is forwarded to

OpenApp for moderation &

feedback as appropriate

NQAIS – implementation

1. Identify “patterns of interest” - PLOs

2. Identify options - root cause analysis

3. Implementation plan

4. Outcome

5. Document & share learning (simply)

6. Celebrate success & apply elsewhere

7. Monitor AvLOS trends

Display tiers

Clinical team view

Hospital view

Hospital group view

National view

E-Chart

KQIs

Unusual

patterns

On tgt

Close to tgt

Off-tgt

PLOs

QA/QI

The future?

“Data unification”

Record linkage/association

A) Patient care – patient centric data

B) Research – de-identified data

Infrastructures to enable both safely & properly