Expanding a Regional-based Program: Resource Matching and Referral and the Inter-LHIN Referral Model May 28 th, 2013

Faculty/Presenter Disclosure Nothing to disclose Faculty: –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 Perspective Referral 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 Inter-LHIN Perspective Toronto 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 Rehab/CCC Volumes (Central to TC LHIN) # Referrals 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 Admission Wait Times Days 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) Executive Committee (EC) (Strategic / Operational) RM&R User Group (RUG) RM&R User Group (RUG) Hospital Expansion Projects* Business Transformation Initiative Reporting and Analytics Advisory Committee (RAAC) Reporting and Analytics Advisory Committee (RAAC) Reporting (Ongoing)** Steering Committee (SC) RM&R Technical Group 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 Rehab/CCC Volumes (Central to TC LHIN) # Referrals 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 Days 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 improvements Data Source: Acute to Rehab Volumes, RM&R Database, TC LHIN Reporting and Analytics Team