Expanding a Regional-based Program:Resource Matching and Referral and the Inter-LHIN

Referral Model

May 28th, 2013

Faculty/Presenter Disclosure

Nothing to discloseFaculty:

– Melissa Coulson, Shared Information Management Services (SIMS)– Charlene Mathias, Shared Information Management Services (SIMS)

Relationships with commercial interests:– Grants/Research Support: None– Speakers Bureau/Honoraria: None– Consulting Fees: None– Other: Employees of University Health Network

CFPC CoI Templates: Slide 1

Presentation Overview

• RM&R Background• Inter-LHIN Perspective• Overcoming Traditional LHIN Barriers• Inter-LHIN Rehab/CCC Expansion Project• Lessons Learned• Governance• Future Opportunities

3

4

RM&R Background:What is Resource Matching and Referral?

RM&R is a shared web-based system that enables matching of patients to appropriate clinical programs/services and transmission of electronic referrals between 93 acute, rehabilitation, complex continuing care, home care, long-term care and community support health service providers (HSPs) in the Toronto Central and Central LHINs

5

RM&R Background:Challenges and Solution

6

Note: Transfer volumes are limited to Acute adult inpatient medical and surgical units sending to post-acute rehabilitation programs. The percentage represents the number of transfers sent from each LHIN with respect to the total number of referrals for that same LHIN.Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

Inter-LHIN PerspectiveReferral Patterns in the Greater Toronto Area (Rehab as an example)

Inter-LHIN Perspective Toronto Central and Central LHIN - Annual Referral Volumes

7

Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

8

Data Source: Acute to Rehab Transfer Volumes, CIHI Discharge Abstract Database (DAD), accessed via intelliHEALTH (FY 0809).

Inter-LHIN PerspectiveToronto Central and Central LHINs – Annual Referal Volumes

Inter-LHIN Perspective:Increased Complexity with Patient Transitions

9

• LHIN boundaries are fluid

• Referrals can cross LHINs for a number of reasons, including:- Acute care did not originate in patient’s “home LHIN”- Specialized/post-acute care is only available in certain

geographical areas- Patients may wish to receive care/services close to where

their family resides

• Referral processing tends to be longer when crossing LHINs- Inconsistent forms and processes exist across LHINs- Limited standardization with assessment tools- Lack of established relationships between providers

outside of LHIN

Inter-LHIN Perspective:Drivers to a Common Solution

10

• Improved quality of care and patient experience- Supports timely and seamless transitions- Repository of programs and services

• Provider process efficiencies- Standardized tools and processes- Improved communications between providers

• Enhanced system planning- Larger (cross-LHIN) data set- Better understanding of patient’s journey and history

• Greater ROI- Common infrastructure- Shared administrative and operational processes- Improved scalability

Overcoming Traditional LHIN Barriers: Sharing Common Solution

11

• TC and Central LHINs identified an opportunity to share a common RM&R solution

• In Fall 2011, the RM&R solution implemented in TC LHIN was customized and implemented across Central LHIN- Initial implementation was local within Central LHIN (intra-

LHIN referrals)

• In January 2012, expansion activities began to include sending referrals between Central and Toronto Central LHINs for Rehab and Complex Continuing Care (inter-LHIN referrals)

Overcoming Traditional LHIN Barriers:Project Approach

• Pilot Go-live

Jan 2012

• Pilot Evaluation

• Expansion Planning

May 2012 • Rehab/CCC

Inter-LHIN Expansion

Jul 2012

• Expansion Evaluation

Oct 2012

Inter-LHIN pilot launched in January 2012 between Central and Toronto Central LHINs

Pilot Outcomes:• Over 60 Rehab/CCC referrals were sent• Over 10 patients were transitioned from Central Acute Care to

Toronto Central Rehab/CCC• Process Improvements

Overcoming Traditional LHIN Barriers: Pilot Project Overview

13

Inter-LHIN Rehab/CCC Expansion Project: Benefits and Outcomes

14

15

Inter-LHIN Rehab/CCC Expansion Project: Patient Benefits and Outcomes

April 2012 – March 2013, 2003 referrals have been sent from Central Acute Care Hospitals to Toronto Central Rehab/CCC Hospitals

providing more streamlined access to over 65 Programs

Apr'12 May'12 Jun'12 Jul'12 Aug'12 Sep'12 Oct'12 Nov'13 Dec'13 Jan'13 Feb'13 Mar'130

50

100

150

200

250

300

350

Rehab/CCC Volumes (Central to TC LHIN)

# R

efe

rra

ls

Month

Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team

16

Inter-LHIN Rehab/CCC Expansion Project:Provider Benefits and Outcomes

• 100% of respondents agree or strongly agree that RM&R has streamlined the Rehab/CCC referral process

• Satisfaction with the ability to complete a referral increased (11.1% vs. 66.7%)

• More efficient and reliable management of referrals in a standard format

• Increased transparency and accountability as system is able to track referral times

Data Source: Inter-LHIN Rehab/CCC Expansion Project Pilot Focus Group and Survey, TC LHIN RM&R Program Team

17

Inter-LHIN Rehab/CCC Expansion Project: Health System Benefits and Outcomes

AprM

ay Jun

July

Aug SepOCT

Nov Dec

13-J

an

13-F

eb

13-M

ar0

2

4

6

8

10

12

14

16

Median Admission Wait Time

90th Admission Wait Time

Admission Wait Times

Da

ys

Month

System Planners and Health Service Providers have access to over 1,000 data elements in a centralized repository that can inform local

and system-level improvements

Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team

Lessons Learned

18

• Upfront business engagement, leadership and sign-off from all stakeholder groups critical to adoption of new business processes

• Cross-jurisdictional business practices- What level of standardization is required to support inter-

LHIN referrals?

Lessons Learned

19

• Governance to support• How do local structures link to shared governance? • What structures/processes are needed for data sharing?

• Operational support structure• How to best support discussion/dialogue around inter-LHIN

transitions?• How to best manage standards?

Operations (Ongoing)**

TC-LHIN RM&R Governance Structure

• * Each Project WG is temporarily formed to support a current/ongoing project, as needed• **Operational teams are in place to support ongoing Operational and Reporting activities

Executive Committee (EC)(Strategic / Operational)

RM&R User Group (RUG)

Hospital Expansion

Projects*

Business Transformation

Initiative

Reporting and Analytics Advisory Committee (RAAC)

Reporting (Ongoing)**

Steering Committee (SC)

RM&R Technical Group

Cluster 2 RM&R Governance Structure

Central LHIN Governance

LHIN Governance

Toronto Central LHIN Governance

LHIN Governance

Cluster 2 Operational Committee

Cluster 2 Steering Committee

Cluster 2 Delivery and Alignment

Bi-monthly meetings of Cluster 2 Operational Committee to support alignment across LHINs from a project and operational perspective.

Future Opportunities

22

• Coming Soon: Monitoring/leveraging the data to understand system impacts- Who should look at Inter-LHIN data?- What information is important?- Understanding unintended impacts and benefits

Apr'12

May'12

Jun'12Jul'1

2

Aug'12

Sep'12

Oct'12

Nov'13

Dec'13

Jan'13

Feb'13

Mar'13

0

50

100

150

200

250

300

350

Rehab/CCC Volumes (Central to TC LHIN)

# R

efe

rra

ls

Month Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team

Future Opportunities

23

• Further expansion between Central and Toronto Central• Single process for CCAC Referrals• Long-term Care

• Alignment with provincial referral standards• ALC RM&R Business Transformation Initiative

• Alignment and/or integration with other provincial initiatives

Questions?

24

Thank You

25

Appendices

26

Faculty/Presenter Disclosure

• Faculty: – Melissa Coulson, Project Manager– Charlene Mathias, Senior Project Manager

• Relationships with commercial interests:– Grants/Research Support: N/A– Speakers Bureau/Honoraria: N/A.– Consulting Fees: N/A.– Other: Employees of University Health Network

CFPC CoI Templates: Slide 1

Disclosure of Commercial Support

• This program has received financial support from [organization name] in the form of [describe support here – e.g. an educational grant].

• This program has received in-kind support from [organization name] in the form of [describe support here – e.g. logistical support].

• Potential for conflict(s) of interest:– [Speaker/Faculty name] has received [payment/funding, etc.] from

[organization supporting this program AND/OR organization whose product(s) are being discussed in this program].

– [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [insert generic and brand name here].

CFPC CoI Templates: Slide 2

Mitigating Potential Bias

• [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated].

• Refer to “Quick Tips” document

CFPC CoI Templates: Slide 3

30

Inter-LHIN Rehab/CCC Expansion Project: Health System Benefits and Outcomes

Apr May Jun July Aug Sep Oct Nov Dec 13-Jan

13-Feb

13-Mar

0

1

2

3

4

5

6

7

8

9

Follow-Up Time - Waits

Follow-Up Time - Waits

Da

ys

Month

Follow Up Times

System Planners and Health Service Providers have access to over 1,000 data elements in a centralized repository that can inform local

and system-level improvementsData Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team