Download Title TBC - Cancer Care Ontario

Championing Information
Management Innovations
to Improve System
Performance and
Patient Care
Annual General Meeting
April 22nd, 2010
Presented by Terrence Sullivan, PhD
President & CEO
Better cancer services every step of the way
Overview
1
Cancer Care Ontario: 2009-2010 Year in Review
2
Championing Information Management to Improve
System Performance and Patient Care
3
Panel Discussion and Dialogue
2010 Annual General Meeting
2
2008-2011 Cancer Plan: Goals
SIX GOALS
1
Reduce the incidence of cancer
2
Reduce the impact of cancer through
effective screening & early detection
3
Ensure timely access to effective
diagnosis and high quality cancer care
4
Improve the patient experience across
continuum
5
Improve the performance of cancer system
6
Strengthen translation of research into
improvements in cancer control
2010 Annual General Meeting
3
2008-2011 Cancer Plan: Initiatives
FOUR INITIATIVES
1
Transform cancer screening
2
Streamline and speed up cancer diagnosis
3
Regional Cancer Programs to achieve high
quality cancer services in every LHIN
4
Prepare our services to respond to
molecular oncology
2010 Annual General Meeting
4
Achievements in 2009-2010
• Renewal of
Smoke-Free
Ontario
• Ontario Health
Study pilot
launched
successfully
2010 Annual General Meeting
• OBSP: OneMillionth Woman
Screened
• Launch of
InScreen
• Increased Stage
Capture for newly
diagnosed
cancers
• Launched Cancer
Imaging Program
Provincial and
Regional Leads
• ISAAC doubled
number of patients
completing ESAS
assessments
• ISAAC expanded
to 17 hospitals,
including 9
northern satellite
sites
• Imaging Leads in
every region
• Surgical wait
times down 12%
• MCC
implementation
• Increased access
to IMRT
5
2009-2010: The Cancer
Journey by the Dollars
$8M
$ 65 M
$ 7.5 M
$2M
$ 548 M
*Fiscal year ending March 31, 2010
2010 Annual General Meeting
6
2009-2010 Year in Review
Financial Picture
Access to Care Strategy
40M
Funding to Healthcare
Facilities and Universities
406M
New Drug Funding Program
200M
CCO’s Financial
Ontario Renal Network
2009/10 Total
Revenue
7M
737M
Position (000s)
Projected
March 31,
2010
Actual
March 31,
2009
150
2,209
NET POSITION
2010 Annual General Meeting
7
2009-2010 Year in Review
Actual
2008-2009
Projected
2009-2010
Growth
433,186
497,536
+ 14.86%
New Radiation Cases
40,401
42,805
+ 5.95%
New Systemic Cases
42,491
42,675
+ 0.43%
7,166
7,505
+ 4.73%
Service Volume Growth
Screens for OBSP
Additional Surgical Cases
2010 Annual General Meeting
8
2009-2010 Year in Review
MOHLTC
Revenue Growth
MOHLTC Revenue
2010 Annual General Meeting
Actual
2007-2008
Actual
2008-2009
Growth
Projected
2009-2010
Growth
587M
650M
+ 10.8%
695M
+ 7.0%
9
2009-2010: A Growing Organization
Infrastructure
Programs
Strategy
2010 Annual General Meeting

Board requested internal audit of business
processes in June 2009

Board Retreat in Fall assessed strengths/
weaknesses and future opportunities and
priorities

Launched corporate-wide business processes
improvement project

Ontario Renal Network (ORN) established in
June 2009

Access to Care (ATC) continues to expand:
Emergency Department/Alternate Levels of Care

Ontario Cancer Plan renewal: 2012-2015

ORN initial plan
10
Ontario Renal Network
Early priorities include:
The Ontario Renal Network (ORN)
is a new organization established
to lead a province-wide effort to
better organize and manage the
delivery of renal services.
2010 Annual General Meeting

Establishing/ensuring
uptake of standards
and guidelines

Developing information
systems and
performance measures

Ongoing needs
assessment

Capacity planning
11
Access to Care
Cancer Care Ontario
2010 Annual General Meeting

Provides strategic guidance
and direction

Executes Wait Time and
Emergency Room/Alternate
Level of Care strategies

Provides applications, technical
infrastructure and services in
business strategies

Data Reporting and Business
Intelligence activities
12
Overview
1
Cancer Care Ontario: 2009-2010 Year in Review
2
Championing Information Management to Improve
System Performance and Patient Care
3
Panel Discussion and Dialogue
2010 Annual General Meeting
13
A Burning Platform
Growth of cancer incidence in Ontario
Annual number of newly diagnosed cancer cases
75000
60000
aging
45000
population growth
increasing cancer risk
30000
15000
0
1982
baseline cancer risk
1986
1990
1994
1998
2002
2006
Year
2010 Annual General Meeting
14
A Happy Problem: Increased Survivorship
Improvements in Age-standardized 5-year relative survival†
for 14 common cancers‡ Ontario, 1992-1996 vs 2002-2006
1992–1996
0%
10%
20%
30%
40%
50%
60%
2002–2006
70%
80%
90%
100%
Thyroid
Prostate
Melanoma of skin
Breast**
Corpus and uterus, NOS
Urinary bladder
Kidney and renal pelvis
Colon and rectum
Non-Hodgkin lymphoma
Leukemia
Ovary
Stomach
Lung and bronchus
Pancreas
2010 Annual General Meeting
15
A Happy Problem: Increased Survivorship
Growth in Prevalence with Improved Survival
(Jan. 1, 1997 vs. Jan. 1, 2007 10 year)
350,000
Number of cancer survivors
300,000
250,000
All other cancers** (42%)
200,000
All other cancers** (45%)
150,000
Lung and bronchus (5%)
Colon and rectum (12%)
Lung and bronchus (6%)
100,000
Colon and rectum (13%)
Female breast (20%)
Female breast (21%)
50,000
Prostate (21%)
Prostate (16%)
0
1997
2007
Source: Cancer Care Ontario (Ontario Cancer Registry, 2009)
*Prevalence (10 year) is the number of Ontarians diagnosed during the previous 10 years who are still alive on Jan. 1, 1997 or on Jan. 1, 2007.
**Excludes basal cell and squamous cell skin cancers, which are not registered in Ontario.
2010 Annual General Meeting
16
Common Elements of Performance
Improvement (5-Country Framework*)
Performance Knowledge
 Measures / Performance Indicators of Cancer Care
 Strategies for Collecting Data / Sources of Quality Data
 Performance Reporting
* Responsabilite et performance en cancerologie Sullivan, Dobrow, Schneider et al, Prat Organ Soins 2008;39(3):207-15
2010 Annual General Meeting
17
Common Elements of Performance
Improvement
Active Levers for Performance Improvement
 Institutional and Leadership Alignment on Goals
and indicators
 Commitment/Mobilization of Stakeholders

Commitment of clinician and clinician leaders

Engaging patients

Public engagement

Engagement of policy/administrative decision makers
2010 Annual General Meeting
18
Common Elements of Performance
Improvement
Active Processes
 Initiatives by Clinicians
 Payment Mechanisms
 Organizational Standards/Consolidation of Services
 Flexible Work Force Initiatives
2010 Annual General Meeting
19
How Do We Create Sustaining Value
From Data?
1
Information requirements driven by business
– clinicians, administrators, patients, funders
2
Collect once, use many times
3
Balance quality and utility
4
Integrate information collection into routine
administrative and clinical processes
2010 Annual General Meeting
20
20
Align Clear Goals, Develop Measures
and Monitor
Ontario Cancer Plan
2012-2015
?
Better cancer services every step of the way
2010 Annual General Meeting
21
Strengthen Core Competencies
2010 Annual General Meeting

Performance measurement and
management cycle

Development and adoption of
standards and guidelines
(PEBC)

Public reporting and
transparency in performance

Clinical and Administrative
Alignment of Leadership

Successful deployment of IM/IT
solutions to support the
transformation of cancer care,
access to care and Ontario
Renal Network
22
Accelerate Patient-based Funding
to Drive Access and Quality
 Surgical wait times and quality improvement
 Colonoscopy quality and data capture
 Renal registry expansion with incremental
volumes funding
 System therapy volume expansion tied to
regional standards
2010 Annual General Meeting
23
IM Tools ‘Instrumenting’
the Disease Journey
• Symptom
Management
• Robust Date
Systems
-
• Risk Factor
Surveillance
• In Screen
• Integrated
Cancer
Screening
• Diagnostic
Assessment
Programs
• Recovery /
Survivorship
• Structured Care
Plans
• Wait Times
• Computerized
Physician Order
Entry
• Multi-disciplinary
Case
Conferences
• Stage Capture
• Quality Indicators
Supported by IM/IT
Cancer System Quality Index
Disease Pathway Management
Regional/Corporate Scorecard
2010 Annual General Meeting
24
screening
Increasing Screening Rates
for Colorectal Cancer
CCO programmatic target: 40% by 2011
2010 Annual General Meeting
25
screening
ColonCancerCheck:
Information Driving System Change
Information
Driving Change
OPERATE PROGRAM
 Identification
 Invitation
 Recall
 Reminder
 Result notification
2010 Annual General Meeting
GET/USE INFORMATION
 Planning
 Funding
 Evaluation
 Contract management
 Performance management
 Quality management
 Access management
 Public reporting
 Research
 More
Screening
 Better
Screening
 Increased
support for
Primary Care
26
diagnosis
treatment
Wait Time Information System
2010 Annual General Meeting
27
diagnosis
treatment
CSA Funding Compared to Total Cost
of Cancer Surgery
CSA Funding Compared to Total Cost of Cancer Surgery
Source: CIHI DAD/NACRS
$400
Non-CSA Funding ('000,000s)
CSA Funding ('000,000s)
Cancer Surgery Funding ($'000,000)
$350
$300
$250
$200
$150
$100
$50
$0
04/05
05/06
06/07
07/08
08/09
Fiscal Year
09/10
10/11
11/12
12/13
Total Cancer Surgery funding is estimated by applying index surgery funding rates to all the hospitals in Ontario
2010 Annual General Meeting
28
treatment
Ontario’s Wait Times: Worst to the Best
Priority Areas
PROV.
CT
MRI
Hip
Knee
Can
SR
NL
B
B
A
B
PE
A
B
A
F
NS
F
F
NB
C
F
QC
A
ON
Car*
A
NA
B
na
A
C
A
A
A
na
na
A
A
A
A
A
MB
B
D
A
B
A
SK
C
F
D
C
A
AB
A
B
D
A
A
BC
A
B
A
A
A
NA
Source: Wait Time Alliance Report Card
2010 Annual General Meeting
29
diagnosis
One Stop Shopping:
Diagnostic Assessment Programs (DAPs)
Percentage With Abnormal Breast Screen and Resolution Within 7 Weeks (Target)
All Women, Aged 50-69 Requiring a Tissue Biopsy, 2005-2008
Data Source: Provincial Breast Cancer Screening Data Base
2010 Annual General Meeting
30
diagnosis
DAP Update
Erie St. Clair:
Lung Clinic
South West:
Lung Clinic
Waterloo Wellington:
Lung /Prostate/GI DAU
Hamilton Niagara:
Lung Clinic
CW/MH:
Lung Clinic*
Toronto Central:
Lung (TEGH) / Colorectal (Sunnybrook)*
Toronto Central:
Lung Clinic 2010 (PMH)
Central:
Colorectal*
Central East:
Lung Clinic* /Colorectal*
South East:
Colorectal* & Lung Clinic*
Champlain:
Lung Clinic /Colorectal /Prostate
North Simcoe Muskoka:
Lung Clinic / Colorectal*
North East:
Lung Clinic*/Colorectal*
North West:
Colorectal* / Lung Clinic*
2010 Annual General Meeting
DAPS under
development(*)
and/or in place:
Regions currently
focused on
coordinating
activities around
central intake of
referrals for
colorectal & lung
diagnosis
31
Disease Pathway Management:
Site and region-specific data for
each phase of the journey- CRC
• Crude / age
standardized
incidence
2010 Annual General Meeting
• FOBT participation
rates
• % rectal cancer
patients having
MRI
• Wait time from
diagnosis to 1st
treatment
• Symptom
assessment
rates
• Age
standardized
5-year survival
rates
• Chemotherapy
guideline
concordance
• % rectal cancer
patients with rad
onc consult
32
diagnosis
Diagnostic Assessment Programs
Diagnostic
Processes
Electronic
Pathway
Solution
• Reduce diagnostic
wait times
• Reduce anxiety and
confusion
• Increase diagnostic
volumes
• Increase access to
service
• Coordinate
diagnostic
processes
• Increase system
efficiency
• Reducing system
waste
• Increase capacity to
properly manage
patients with
suspicion of cancer
Diagnostic
Wait Times
• Validate the
diagnostic wait
times parameter
• Develop cancer
system indicators to
monitor access &
quality of care in
diagnostic phase
• Develop priority
levels for testing
Improves the patient experience, improves patient
outcomes and quality of cancer diagnostic services
2010 Annual General Meeting
33
diagnosis
treatment
Improving Cancer Stage Data Collection
and Cancer Pathology Reporting
90%
target
Since Implementation:
Completeness of Pathology Reports
2010 Annual General Meeting
34
diagnosis
treatment
Synoptic Pathology Reporting:
Implemented in 76% of Ontario Hospitals
# of hospitals implemented
# of hospitals that implement synoptic pathology reporting in discrete data fields
(level 5 reporting for 5 common cancer resections) by date of GO-LIVE implementation
90
80
70
60
50
40
30
20
10
0
Projected
Actual
Apr - Jun
2008
Jul - Sep
2008
Oct - Dec
2008
Jan - Mar
2009
Apr - Jun
2009
Jul - Sep
2009
Oct - Dec
2009
Jan - Mar
2010
Apr - Jun
2010
Quarter of Implementation
% of hospitals implemented as of April 2010
LIHN
1
2
3
4
5
6
7a
7b
8
9
10
11
12
13
14
ALL
# hospitals implemented
discrete synoptic reporting
5
14
6
9
2
3
2
4
5
7
5
4
0
14
1
81
Total # of hospitals
5
16
6
9
2
3
2
5
6
7
6
13
5
19
6
110
100%
88%
100%
100%
100%
100%
100%
80%
83%
100%
83%
31%
0%
74%
17%
74%
%
2010 Annual General Meeting
35
treatment
Improving Safety for Patients:
Computer Physician Order Entry (CPOE) System
Helps prevent approximately 8,500 drug
errors, 750 hospitalizations, 500 physician
office visits annually
2010 Annual General Meeting
36
treatment
Engaged Clinicians:
Prostate Margin Rate Audit
Positive Surgical Margin Rate for Radical Prostatectomies for pT2 Patient Overall
Since Synoptic Pathology “Go Live Date” to Sept. 2009
2010 Annual General Meeting
37
37
palliative
and endof-life care
Empowering Patients:
Interactive Symptom Assessment
and Collection (ISAAC) Tool
2010 Annual General Meeting
38
palliative
and endof-life care
Patient Based Tools
2010 Annual General Meeting
39
palliative
and endof-life care
How Are We Using Information to Add
Value?
 Patient based payment tied to information management
(IM) deployment
 Quality performance tied to evidence-based Clinical
and Organizational Standards
 Targeted improvements in performance/quality

Through IM and active engagement processes

By Disease Site Targets

By Regional Program Targets

By Provincial Targets
2010 Annual General Meeting
40
Regional Performance Driving Improvement
April 2010
SYSTEMIC
Ref-Con = Apr-Dec 2009
Con-Tr = Oct-Dec 2009
RADIATION
Apr-Dec 2009
Region
WT
WT
Ref-Con RTT-Tr
(% w/in (% w/in
14 days) target)
Vol
(C1R)
% of
WT
WT
Budgeted Ref-Con Con-Tr
Vol in the (% w/in (% w/in
Province 14 days) 14 days)
Vol
(C1S)
SURGERY
WT = Apr-Dec 2009
Vol = Apr-Dec 2009
% of
WT
Budgeted
(% w/in
Vol in the
target)
Province
WT
(90th)
COLONOSCOPY
WT & Vol = Apr-Dec 2009
Participation = 2006-2007
% of
WT
Vol
Budgeted
WT
(Family
(cases) Vol in the (FOBT+)
History)
Province
Vol
STAGE
PATHOLOGY
Rate = Apr 2009
# hosp = Mar 10, 2010
% Hosp = Mar 10, 2010 % Complete = Oct-Dec 09
SYMPTOM
MGMT
Oct-Dec 2009
FOBT
% of
% Hosp.
% Hospitals
Budgeted Participat Combined Collaborat
% CompleteDiscrete
Lung
ion
Vol in the
Rate
ive
ness
Path Report
Province
Staging
*
THORACIC
Apr-Mar
08
All
Other
*
RSTP
Safe
Change
MCC Handling Overall
from
Q3
as of Provincial Previous
09/10
Rank
Nov 09*
Rank
PROVINCE
▲
▬
▼
100%
▲
▲
▼
100%
▲
▬
▲
100%
▲
▬
▼
100%
▼
▲
▲
▼
▼
▲
▲
▲
Waterloo
Wellington
▲
▲
▼
4%
▲
▼
▼
6%
▲
▬
▲
4%
▼
▼
▼
6%
▼
▬
▲
▼
▼
▲
▲
▲
1
0
North Simcoe
Muskoka
▲
▲
▼
1%
▲
▲
▼
6%
▼
▲
▼
1%
▼
▼
▲
1%
▲
▲
▬
n/a
▼
▼
▬
▬
2
1
North West
▲
▲
▼
2%
▲
▲
▼
4%
▲
▬
▼
2%
▼
▲
▼
3%
▼
▬
▬
▲
▼
▼
▬
▲
3
-1
Central
▼
n/a
▼
0.2%
▲
▼
▲
2%
▬
▲
▲
10%
▲
▬
▼
12%
▼
▬
▲
▼
▲
▲
▲
▲
4
1
Erie St. Clair
▼
▼
▼
3%
▲
▼
▼
4%
▼
▬
▼
4%
▲
▲
▼
9%
▼
▬
▬
▲
▼
▼
▬
▼
5
-1
Toronto Central
PMH
▲
▲
▼
24%
▼
▲
▲
16%
▲
▲
▲
20%
▼
▼
▼
4%
▼
▲
▬
▲
n/a
▼
▲
▬
6
0
South East
▲
▼
▼
4%
▲
▲
▼
5%
▲
▲
▼
4%
▼
▼
▲
6%
▲
▬
▲
n/a
▼
▲
▬
▲
7
3
Central East
▲
▲
▲
4%
▲
▼
▼
7%
▲
▲
▲
3%
▲
▲
▼
13%
▲
▲
▬
▼
▲
▲
▼
▼
8
3
Champlain
▼
▬
▼
10%
▲
▲
▼
11%
▲
▲
▲
10%
▲
▲
▼
10%
▲
▲
▬
n/a
▼
▲
▲
▲
8
1
Hamilton NHB
▼
▼
▲
12%
▲
▲
▼
9%
▼
▼
▲
9%
▲
▲
▼
15%
▲
▲
▲
n/a
▼
▼
▬
▲
10
-3
North East
▲
▼
▼
5%
▼
▲
▼
4%
▲
▼
▼
4%
▲
▲
▼
5%
▼
▬
▲
▲
▲
▲
▼
▲
11
-3
n/a
▼
6%
▼
▬
▬
▲
n/a
▲
▲
▲
▼
▲
12
2
Central West &
Miss. Halton
▲
▲
▼
5%
▲
▲
▲
5%
▲
▼
▲
12%
n/a
▲
n/a
▲
Toronto Central
Odette
▼
▲
▼
15%
▼
▼
▼
11%
▲
▬
▼
8%
▲
▲
▼
3%
▼
▲
▬
▼
▼
▼
▼
▲
12
-1
South West
▲
▲
▼
9%
▲
▲
▲
10%
▲
▬
▲
10%
▼
▲
▼
6%
▼
▲
▲
n/a
▼
▼
▲
▼
14
-3
Performance against the regional target
Not meeting target
Not meeting target, but improving or meeting provincial target
Meeting or within 2% of target. If the region has a stretch target, it is within 5%.
2010 Annual General Meeting
Performance against the previous scorecard
Improved
Decreased
No change
41
Society’s Data and IM Challenge
“Information has gone from scarce to
superabundant. That brings huge new
benefits . . . but also big headaches.”
“Managed well, the data can be used to
unlock new sources of economic value,
provide fresh insights into science and
hold governments to account.”
The Data Deluge, The Economist, March 2010
2010 Annual General Meeting
42
Overview
1
Cancer Care Ontario: 2009-2010 Year in Review
2
Championing Information Management to Improve
System Performance and Patient Care
3
Panel Discussion and Dialogue
2010 Annual General Meeting
43
Future Opportunities, Challenges, Solutions
How can information management
address gaps in the patient journey?
2010 Annual General Meeting
44
Championing Information
Management Innovations
to Improve System
Performance and
Patient Care
Annual General Meeting
April 22nd, 2010
Presented by Terrence Sullivan, PhD
President & CEO
Better cancer services every step of the way