Case Study: Using “IDS” as a Tool to Support Data Quality

Improvements and Decision Making for Funding

Overview • What is the Integrated Decision Support Business

Intelligence Tool (IDS)

• HHS Quality Based Procedure (QBP) Process and Teams

• Case Study: Using “IDS” to support QBP data quality, timely volume and metrics monitoring, and provide support for decision making

HNHB LHIN Integrated Decision Support (IDS) Business Intelligence Tool

Hosted by Hamilton Health Sciences as an Initiative of the HNHB LHIN

The IDS BI Solution and Features • Mulit LHIN solution, built with ability to link patient level data across

multiple data sources, multiple episodes, and multiple sectors to track flow of patients

• Authorized role-based access through secure web-based portal (ehealth network) providing consolidated (regional/LHIN) view down to an encounter level

• Extensive library of 250+ on-demand reports, analyses, dashboards, visualizations and export capabilities- solution based on the Microsoft Business Intelligence Reporting and Analysis and Sharepoint stack

• Data Sharing Agreement (DSA), Service level Agreement (SLA), Privacy Impact Assessment and Threat Risk Assessment (PIA/TRA) completed

Rich Set of Data Sources • IDS supports current patient level data, linked by a unique identifier per patient, for all

hospitals, CCAC, and CHC (HNHB LHIN) only

• 9 Data sources supported for HNHB, 8 sources for Toronto Central, South West , and Cambridge from Waterloo Wellington LHIN: CIHI Acute Inpatients (DAD) CIHI ER, SDS, MDC (NACRS) CCAC CHRIS Client Referral and Visits (from April 1 2005 HNHB) CCAC RAI Assessments (from April 1 2005) MIS Trial Balances from Participants and CAHO Teaching Hospitals 7 Community Health Centres (CHC) client events and provider data (EMR upload) CIHI Inpatient Rehabilitation (NRS) CIHI Acute Mental Health (OMHRS) CIHI Complex Continuing Care (CCRS)

Stats Canada 2006 Census data tables at FSA level/2010 Census Tract Level Tables HAY Level of Care Tables (Primary, Secondary, Tertiary/Quaternary)

HNHB LHIN real time ALC-IS cube level data and reports HNHB LHIN BSO Project flag with CCAC and Hospital Behavioral record level data *HNHB LHIN includes early adopter WW LHIN Cambridge Memorial

IDS Benefits & Value • Linked data at cube (aggregate level without identifying details) for all participants

• Linked data can be drilled down to record level for shared custodians of patients

(PHIPPA 39 (1)(d))

• Allows view into patient populations across regions that can be tied back to the HSP’s internal databases (Patient Journey)

• Complement to HSP’s existing information management systems. Another “Tool” in the toolkit for decision makers.

• Rich and timely data sets, depending on submission timing (currently cube uploads and data repository done weekly)

• Promotes and fosters evidence based planning & collaboration through data sharing

• Information and Metrics support to “Health Links”

HHS QBP Process and Teams • QBP Steering Committee meets monthly

• Executive Level and Program Level • Reports through to HHS Strategic Goal #4: Attract and Steward Resources

• QBP Specific Implementation Teams for each

• Reports to QBP Steering • Project Charter governs the process • Mulit Disciplinary Team led by Administrative Director and Medical Lead • Representatives from Decision Support/Case Costing, Quality, and Health

Records • Overview of Clinical Expert Panel Handbooks, Pricing and Costing • Current State assessed and compared to pathway, Value Stream Mapping

completed and GAP analysis done • Future State developed to decrease variation and increase efficiency • Working on implementing, monitoring and adjusting through PDSA cycles

Non Cardiac Vascular QBP Case Study

QBP Non Cardiac Vascular Aortic Aneurysm (AA)

Process Mapping

SETTING THE STAGE

QBP Non Cardiac Vascular Aortic Aneurysm (AA)

Carve OutCases ARIW TWgt Cases Unit Cost Carve Out

141 3.322 468.45 $5,014 $2,348,820

Funding

Cases ARIW TWgt CasesOCCI Avg Adj

Total CPWC FundingTotal Cost

per Case141 3.322 468.45 $5,334 $2,498,888 $17,723

Variance $150,0686.39%

Non Cardiac Vascular Aortic Aneurysm (AA) for Hamilton Health Sciences

At the time of Funding Announcement HHS FY11/12 OCCI was total avg $21,946When FY12/13 was available HHS OCCI costs were total average $23,297

QBP Non Cardiac Vascular Aortic Aneurysm (AA)

MIS Gro up Ca se s Avg LOS

Avg H IG ELOS Da ys

Avg HIG We ig ht

Avg La b o ur

Avg Pa t Sp e c

Sup p lie s Avg Ge n Sup p lie s

Avg Othe r D ire c t

Avg D ire c t Co st

Avg Ove rhe a d

Avg T o ta l Co st

% o f T o ta l Co sts

Allied Health 151 $378 $32 $1 $2 $412 $85 $497 2%Cardiac Catherterization Lab 3 $19 $8 $0 $1 $28 $10 $38 0%Cardiac Stepdown 143 $2,874 $0 $167 $88 $3,129 $706 $3,835 16%Day Surgery 148 $182 $0 $15 $4 $200 $62 $262 1%Diagnostic Services 150 $764 $23 $19 $251 $1,057 $429 $1,487 6%Endoscopy 3 $2 $0 $1 $1 $4 $2 $6 0%Food Services 149 $83 $0 $31 $2 $116 $28 $144 1%Laboratory 151 $260 $0 $52 $25 $338 $78 $416 2%Medical Diagnostics 47 $24 $0 $1 $3 $28 $7 $35 0%Operating Room 151 $1,325 $9,902 $371 $317 $11,915 $1,747 $13,662 59%PACU 144 $492 $0 $22 $26 $539 $124 $663 3%Pharmacy 151 $189 $120 $4 $9 $322 $66 $388 2%SCU 20 $996 $0 $86 $29 $1,111 $252 $1,362 6%Ward 43 $357 $0 $18 $11 $386 $115 $501 2%

151 4.6 5.6 3.2 $7,945 $10,085 $789 $768 $19,586 $3,710 $23,297 100%

FY13/14 decreased variation and improved costs as part of the QBP working group efforts and work with Ministry and Clinical Expert Panel as it relates to the standard, moderate, and advanced clinical grouping, which are significantly different in costs

QBP Implementation Team Questions • Immediately, when looking at the volumes there were concerns that we

were not capturing all the cases from the physicians • Re-reviewed Clinical Expert Panel Documents for Technical Specification Definitions • Re-reviewed IDS Data Definitions Reports • Concluded the query was picking up all the cases under the definition so ……..

• Obtained a list from physicians of their patient’s MRN and cross referenced to IDS MRN

• Missing a number of cases • When going into IDS patient details very clear the case was done as a Same Day Surgery and then admitted

subsequently under “non AA Codes” or as a short stay • Handbook specifies “all cases defined as planned/elective admissions, assigned to an inpatient bed”, • Estimate 8 cases done as Day Surgery with no admission and 20 cases done as day surgery with subsequent

admission to an inpatient bed

• Length of stay, average RIW, and other quality metrics captured in IDS were reasonable but there did exist some variability and room for improvement

• Questions around Standard, Moderate, Advanced case definition groupings and comparisons with other centres doing “AA”

• Significant cost differentiation between the categories

PHI information blanked out for Presentation purposes

The cost of a AA is about $22,000 and we were only getting paid out of the global budget for an SDC case. Because these cases were not in the inpatient side they were not being counted as an AA at all in the QBP funding.

PHI information blanked out for Presentation purposes

Thank You