In Ontario, Canada, the region’s Community Health Centres (CHCs) have been around for more than 40 years, with the core mission to deliver primary care services in combination with health promotion and illness prevention services, all with a strong community development focus. But in more recent years, with the rate of complex care clients in the area continuing to increase, there has been an increased emphasis on analytics for evidence-based planning, officials say.
In 2011, the sector, with a total of 74 government-funded CHCs that serve approximately 500,000 people with 250, 000 of these accessing primary care services, had a vision to unify its data asset into a single enterprise data warehouse and associated business intelligence reporting tool (BIRT). Supporting 85 independent organizations, the vision was to unify accountability reporting to funders and create a robust self-service analytic environment. “This was delivered within a security infrastructure that permits containment of sensitive clinical information but a shared business intelligence [BI] environment where all organization users can share and collaborate the ad hoc reports among peers,” officials note. Indeed, the BIRT solution looks to give member centers a holistic view of operations by consolidating key data and presenting it in an integrated and easy-to-analyze manner. As such, the project was awarded semifinalist status in this year’s Healthcare Informatics Innovator Awards Program.
Taking a few steps back, Rodney Burns, CIO, Association of Ontario Health Centres, which represents Ontario’s CHCs, notes that the centers are the only part of primary care in the region that has accountability contracts with the government funders; the rest of primary care in Ontario bills health insurers directly, or uses some blend of the two. “But we have a lot of provincial oversight for services delivered for our members. So the funders play a significant role in supporting an information management strategy,” says Burns.
As such, about five years ago when Burns was still serving his previous role as CIO and eHealth lead at the North Simcoe Muskoka Local Health Integration Network (LHIN)—whose focus is to plan, fund and coordinate services delivered by CHCs and other healthcare organizations in the region—there was a newfound concentration to develop an information management strategy, which started out with the BIRT project. “For primary care in Ontario, the focus on evidence and data is relatively new. Other than sending in billing codes, doctors here haven’t cared much about the data. And that’s what led [us] to ask, how do we begin to use that data that we spend a lot of money gathering in our EHRs [electronic health records], to improve clinical decision making, administrative decision making, and informing best practices,” he says.
From that, the association’s membership base came together on a non-operational reporting and analytics strategy in which they all agreed to throw $5,000 a year into a pool to fund the development to what has become BIRT, Burns notes, who joined the Association of Ontario Health Centres after that first round of funding. “The intention in phase one of BIRT was to focus on data quality, comparability to other centers, and helping the centers use that data to improve services,” he says. It began to grow from there, adding additional data elements. The vision was, from the vantage point of our local LHINs, to produce a high-quality electronic dashboard that you could use to monitor in near real-time what any Community Health Center was doing across the province.”
As a result, much more funding since that point has helped support the development, Burns continues, and the BIRT project was implemented in phases with each phase adding additional data sources and capabilities to integrate and query data against multiple data sources. Although the development of the tool itself was done by a skilled group of BI experts, all decisions pertaining to the development of this solution—i.e. the content of the tool, the reporting needs of the sector, and the need for dashboards and further reporting capabilities—were made through consultations with members of the sector, officials note. In addition, prior to any changes or developments being implemented on a broad scale, the members once again are involved in the testing and validation of the proposed changes and enhancements; members always have the final word of approval, officials say.
Drilling down, Burns says that BIRT can look at key performance indicators such as cancer screening rates, and how the centers compare to each other, and to the rest of the province. “It was a great way of seeing how the data brought back to clinicians impacted performance. Clinicians were looking at the data, too, and because we have a strong data quality framework around our program, we were able to do investigations, and we found out that clinicians were putting activity statistics in the wrong part of the EHR. So when they corrected for that, we saw a 20 percent increase, in some instances, in screening rates, which is heads and tails above the provincial average in other primary care performance models,” he says.
Indeed, Burns says that this level of analytics means that the centers are improving data quality, getting better services, and measuring outcomes for their clients “in ways others cannot do.” What’s more, he adds, this is all voluntary; the whole sector has committed to working out-of-network to enable it. “So we have had great leadership support. And we are at point where we can show clinician performance at an individual level, and they are now starting to use BIRT as a quality improvement tool,” he says.
Further, from a cultural point of view, the CHCs are returning clinical decision support data to those clinicians, who are seeing their performance, and once they validate that the data is accurate, they are then seeing if there is an opportunity for improvement, notes Burns. So for example, “Why are Dr. John’s [cancer screening] rates so much higher than mine? This has facilitated dialogue amongst our team. And our clinicians are all salaried, so there is no fee-for-service imperative,” he adds.
Taking the BIRT data that a clinician can drill down to even further, Burns says that one can see if a center’s diabetes management activity is at the average or above average in the province, and then drill down to the clinicians individually for the clients they support. “So I look up my own panel population, and see if my patients have been screened against clinical best practices in terms of routineness. BIRT will return a list with those patients who have not met the preventative screening activity within the recommended period of time. That then goes directly to the doctor to set up appointments for screening. This improves chronic disease management and population health,” Burns says.
The tool also uses demographic data, which is captured in many different ways. For example, a client’s income or country of origin can be captured to see if there are barriers for people getting the right service they need. The center is then using that data to set up programs, Burns says. “Those people with low incomes are getting connected to the right people such as social workers, so they would be more likely to engage with the organization going forward. This can get them back to work, and provide them with housing and education,” he notes.
Burns also points out that the centers are helping Syrian refugees, many who have come to Ontario and are highly educated, but their health status deteriorates over time since don’t have the proper social support systems in place. “We have found them, and helped them get their kids into school, get them connected with the Syrian community here, and get employment for their family. This has had a big impact in maintaining their health status,” he says.
Moving forward, Burns says he would like to see a broader use of BIRT beyond the centers to include research communities, the funders, the Ministry of Health and Long-Term Care, and other partner organizations. “In Ontario, we are under a strong push to integrate the systems around high-cost clients,” Burns says. “Data sharing is very difficult in Ontario, but we can use platforms like this to inform and improve the effectiveness of dealing with those complex clients that require a multi-provider approach. We think this will continue to be a clinically-grounded, operationally-supportive framework that can visualize data in as close to real time as possible,” he says.
