Analytics in medicine

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Using patient data to reduce ED wait times and leverage alternative levels of care

By Tara Myshrall

Canadian healthcare organizations are continually pressured to provide quality patient care in the face of skyrocketing costs and rising patient loads, both of which weigh heavily on medical staff. While Ontario healthcare workers serve and save countless patients, hospitals and alternative levels of care (ALC) facilities struggle to keep up with the demands of a growing and aging population, along with ongoing fiscal restrictions. According to a recent article in the Toronto Sun, the largest and arguably wealthiest province in the country has the fewest hospital beds and nurses per capita, spends $1 billion of its home care budget on administration, and is plagued by long wait times, especially for specialist services. “Unless the federal government coughs up more cash than it’s currently offering, it’s going to get worse,” the article summed up.

But while Ontario’s health system waits for an infusion of funding from the government, some health care institutions are taking matters into their own hands by using analytics to both control costs and improve patient care. Consider Toronto-based Markham Stouffville Hospital (MSH), which has achieved a 23 per cent reduction in the Emergency Department (ED) patient length-of-stay metrics with the help of clinical analytics tools. According to Grace Auh, Manager of Decision Support and Health Information at MSH, more complete, timely, and accurate information is improving quality of care, and patient satisfaction and outcomes. Compliance reporting is also more efficient.

Hospitals in Ontario and elsewhere can achieve these performance gains by figuring out how to turn large volumes of data into useful information to improve operational efficiencies, ensure better patient experiences, and meet increasingly onerous regulatory reporting requirements. The starting point is to establish a centralized analytic and data integration platform that can automate the processing of patient data, transforming it into insights that help these institutions drive systematic improvements. For example, MSH created an integrated ED performance portal that tracks eight key metrics fundamental to ED operations. Physicians and clinical staff can easily track metrics related to clinical outcomes, ED activities, physician performance, human resources, and key operational information.

Meeting the demands of a growing population

As Ontario’s population grows and ages, the pressure on EDs will likely continue, and even intensify. While not jeopardizing good patient care, hospitals strive to be in the 90th percentile for the lowest length of patient stay. But they face major issues, such as delays in discharging patients or moving them into long-term care. Bed shortages in the main hospital can increase wait times and cause ED bottlenecks.

Analytics can play a vital role in offering hospital personnel a consolidated view of operations and ensuring integrated patient care. MSH, for example, has an automatic notification system that alerts internal staff when a long-term care home resident is admitted. The system sends notifications at each step of the patient’s experience, from arrival in the ED, admission to an inpatient bed, transfer to another unit, and discharge to ALC. Internal teams use this information as they liaise with the staff at long-term care facilities to ensure a safe and timely discharge, as well as to minimize unnecessary transfers back to the hospital’s ED. Analytic dashboards allow personnel to monitor wait times, length of stay, and readmissions for specific diagnoses or procedures, with detail down to the physician and patient levels.

Case costing is another area where hospitals can effectively use analytics to identify readmission rates and minimize potential inefficiencies, such as longer length of stays that drive up costs, or procedures where the costs exceed the funding granted by the Ontario Ministry of Health and Long-Term Care (MOHLTC).

Increasing compliance efficiency

The demand for reporting to various regulatory bodies and funding sources brings additional administrative burdens. The Canadian Institute of Health Information, for example, requires data collection for certain types of patients such as those visiting the ED or coming in for day surgery. Hospitals must provide related activity reports on a weekly, monthly, or quarterly basis. The recent merging of 54 Community Care Access Centres (CCACs) under 14 Local Health Integrated Networks (LHINs) was part of a sustained effort to better manage funds and patient care for long term care. However, legislation requires LHINs to provide the minister with annual reports, including audited financial statements, and hospitals have to meet these compliance requirements. Meanwhile, funding-based programs, such as the Ontario MOHLTC, Health Based Allocation Model (HBAM), and the Quality Based Procedures (QBP) also monitor key operating metrics and how hospitals perform in them.

Unfortunately, in many hospitals, data resides in diverse operational systems, making it difficult to comply with these regulatory reporting needs. Thus a complete analytics and reporting platform should include data management technology that can enforce data quality and unify data to accelerate the speed at which stakeholders can retrieve it. The goal is to empower hospital personnel to spend less time collecting and consolidating information and more time analyzing it.

At MSH, data resided in various operational systems such as Meditech clinical and financial systems, a Med2020 coding and abstracting system, a MedAssets case costing application, TREAT assessment databases, and other sources. It all had to be manually extracted and linked to create comprehensive reports. MSH dynamically linked these various databases using patient account numbers. Now users can instantly view high-level summary data, and drill down to more granular information when needed, which has reduced the submission timelines for key ministry compliance reports.

All hospitals wrestle with these data management and reporting challenges on some level.  They all want to improve clinical care and patient satisfaction, comply with government reporting requirements, and streamline decision making. Analytics technology can play a vital role in helping these hospitals succeed as they absorb a massive amount of data that is critical to managing stellar patient experiences.

Tara Myshrall is an account executive at Information Builders, Information Builders helps healthcare provider and payer organizations to acquire, manage, and analyze their information more effectively using business intelligence, analytics, data integration, data quality, and master data management technologies.