The Use of Analytics for Real-Time Patient Care

Chief Analytics Officers Forum, Canada

June 2016

Michael Spinks

Chief Knowledge Officer

South East LHIN, Ontario

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Presentation Overview

• Overview of LHINs, Health Links and Technology Assessment

• Introduction to SHIIP and associated methods for evaluating

and acting on risk indicators

• Examples of SHIIP for monitoring and examining performance

• Key lessons learnt as SHIIP transitioned from pilot to a mature

model

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Overview of LHINs

• Created in 2005

– Ontario is the last province to devolve health care

• Local Health Services Integration Act passed April 2006

• 14 LHINs – averaging 900,000 people per

• SE LHIN 500,000 – most rural of southern LHINs

• Just under 120 Health Service Providers (including 7 hospital

corporations) accountable to the SE LHIN

• Governed by nine member Board – OIC appointed

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South East Local Health Integration Network

Mandates

• Local Health System Planning

• Service Integration

• Accountability Agreements

• Performance Targets, Monitoring and Reporting

• Community Engagement

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Ontario has recognized the need to better coordinate care for the most complex

patients to improve health outcomes and drive health system efficiencies.

Proportion of Ontario Patients*

Proportion of Costs*

• 5% of Ontario’s patients account for 65% of health care spending

• 75% of complex patients see six or more physicians, with 25% of those seeing more than 16.

*Data from HSPRN/ICES

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Health Expenditures for Ontario Patients*

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• A Health Link is a team of

providers in a geographic area

• Providers work together to provide

coordinated health care to patients

with multiple complex conditions –

with the patient at the center.

• Providers design a care plan for

each patient and work together

with patients and their families to

ensure they receive the care they

need.

Impetus for Health Links Health Link providers are from

primary care, hospital, home,

community care, long-term care,

community support agencies and

other community partners.

How will we know if Health Links are working?

Health Links are accountable to the LHINs

System-level metrics will be used to monitor progress of Health Links

Patient care will be positively impacted

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Assessment of SE LHIN’s Ability to Respond to Technology Needs - 2012

1. Need for a system that can support the IM objectives of Health

Links:

• Identify patients with complex health care needs

• Track patient activity across health care providers

• Facilitate care coordination of patients

• Generate metrics for decision making

2. Need for a system that can link patient activity across multiple

sectors in real time or near real time.

3. Need for a system that can evaluate and report on key provincial

and regional integration indicators.

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Distribution of Expenses across Health Care Types for Top 10% High Cost Users, South East LHIN, 2010/11

Data Source: Health Analysis Branch, Ontario MOHLTC

Acute inpatient care represents the majority of top high cost

user expenses; Average acute inpatient cost for top 10% high

cost users was $13.8K

All expenses in post acute inpatient care and long term care are for the top 10% high cost

users who also have the highest average patient cost among these services ($22K-39K)

88% of home care cost originated from the 10% high cost users;

Average home care cost for top 10% high cost users was $4.5K

Given the magnitude and proportion of expenses, the South East LHIN approach is to start complex/high needs patient identification with Acute Inpatients.

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SHIIP is a secure, web application that is capable of

sharing patient data in real time (or near real time) among

providers within the circle of care by leveraging available

technology solutions and working collaboratively with

stakeholders. It allows for the identification and reporting

of complex high needs/patients and supports care

coordination by integrating the care coordination form

recommended by the MOHLTC.

What is SHIIP?

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SHIIP Startup View for Primary Health Care Physicians – Demo Site

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Defining the population with Complex Health Care Needs*

* Results based on 2011/12 data; Generated by Health Analysis Branch, MOHLTC

Indicator Description

LACE (Length of Stay,

Acuity of Admission,

Comorbidities, ED Visits)

Quantifies risk of death/ unplanned readmission within 30 days after discharge from

hospital; Other factors may also be necessary to discriminate index; Limits noted on

applying in older populations

Hospital Admission Risk

Prediction (HARP)

Identifies a patient’s short/long-term risk of future hospitalization; short and long forms;

limited application in PHC environments; has strong sensitivity but low specificity.

AUA (Assessment

Urgency Algorithm)

A screening tool to support the identification of high risk adults (loss of independence,

has restorative potential, and requires facility-based care). It enables risk stratification

in support of the development of referral pathways based on the risk level and local

resources.

MAPLe (Method for

Assigning Priority

Levels)

A decision support tool that may be used to inform choices related to the allocation of

home care resources and prioritization of clients needing community or facility-based

services. It is also a valid predictor of nursing home placements, and caregiver distress

and ratings.

CSI (Caregiver Strain

Index)

A tool that can be used to quickly identify families with potential caregiving concerns. It

consists of 13-questions that measures strain related to care provision. Question

domains include: Employment, Financial, Physical, Social and Time.

Examples of SHIIP Analytics South East Health Links Supplementary Risk Indicators

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Example of SHIIP Risk Indicators

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Risk Assessment: Part 1

• Is this patient currently a complex/high needs patient?

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Risk Assessment: Part 2

• Is this patient at risk of becoming a complex/high needs patient?

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Clinical Assessment: Part 1

• Does this patient have a modifiable condition?

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Acute Care Dashboard

Provider Group: All Providers Patient Group: All Patients Date/Time Scale: Weeks Start Date: 01/08/2015 End: 31/10/2015

Distribution by Patient Res idence

General Patient Information

Ambulatory Services

Acute Inpatient Encounters

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Main Dashboard

Care Coordination Dashboard

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SHIIP – Lessons Learned

• A compelling business case is key

• Take a roadmap approach and be agile

• Sometimes simple is best

• Collaboration over Negotiation

• Change takes time

• Welcome change requirements, even late in project development

• Work daily with your stakeholders

• Continuous communication is critical

• Support and trust your team

• Evaluate constantly

• Data variation across Health sectors will be exposed

• Important to incentivize use of data and analytics

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Questions

Please contact michael.spinks@lhins.on.ca for further information.