Common Assessment: Enabling Coordinated Services to Improve Quality of Care

Transcription

1 Common Assessment: Enabling Coordinated Services to Improve Quality of Care HSPRN Seminar February 17, 2010 David Smith & Andrea Tait Community Care Management

2 Background The strategic vision of the Community Care Management (CCIM) program is to provide seamlessly-integrated, community-based client care where all service providers can securely share and access consistent and accurate information electronically. CCIM consists of a number of projects to support the Community Care sector within the program's two streams: Common Assessment and Business The focus of the Common Assessment stream is to facilitate the collection and use of client information to create sustainable approach to manage and measure improvement in client outcomes over time.

3 Community Care Management (CCIM) program Local Health Integration Networks (LHINs) CCAC CSS CMH&A LTCH SCCH CHC Common Assessment Common Intake Assessment Tool Long Stay Assessment Software Common Assessment Ontario Common Assessment of Need Resident Assessment Instrument MDS 2.0 Integrated Assessment Record Integrated Data Strategy Business Management Human Resources Management Human Resources Management Human Resources Management Management Human Resources Management Architecture & Integration Standards Security, Privacy & Risk Management Transition Initiation stage Pilot stage Currently rolling out Completed and transitioned CCAC = Community Care Access Centres CSS = Community Support Services CMH&A = Community Mental Health and Addiction LTCH = Long-Term Care Homes SCCH = Small & Complex Continuing Care Hospitals CHC = Community Health Centres 3

4 Why Common Assessment? More complete client-centred assessment data that identifies individual needs and helps match these to services Better engagement means services get involved earlier, reducing crisis, ER visits and admissions Facilitates inter-agency communication through common data standards Assessments can be compared over time to track client outcomes Increases organization-wide efficiencies by Reducing repetitive information gathering Creating common language Creating common processes Identifying service gaps Provides quality data that helps identify effective program offerings for continuous improvement. Aids benchmarking, decision-making and policy development Service and / or Initial Contact / Intake Common Assessment Placement Regular Re-assessments Better Quality of Life Client/ Patient and / or Service

5 Why Common Assessment for Community Mental Health? There are more than 300 Community Mental Health (CMH) agencies across Ontario The sector consists of 22 functional centres that provide consumers with varying types of service, creating a complex community care sector (e.g., Vocational Employment, Case Management, Support within Housing, etc). Currently, they use different assessment practices with little or no provincial standards to guide them. This absence of standards and common language creates a challenge for consistent and accurate data collection and collaborative service delivery.

6 OCAN (Ontario Common Assessment of Need)

7 What is OCAN? Ontario Common Assessment of Need (OCAN) is a standardized, consumer-led decision making tool that allows key information to be electronically gathered in a secure and efficient manner. Assists client-led decision-making at an individual level Identifies individual needs and helps match these to existing services and identifies service gaps Provides aggregate data to inform organizational, regional and provincial level planning and decision making that is consistent with a recovery approach Further facilitates inter-agency communication through common data standards

8 Developing OCAN 2006 Phase 1 Initiation (with stakeholder representation) Analysis of many assessments tools Selection of a core tool Camberwell Assessment of Need Province-wide consultations to introduce the tool Formation of working groups Phase 2 - Pilot Piloting of the automated OCAN in 16 CMH organizations Early learnings gatherings NE LHIN Implementation pilot Phase 3 - Implementation Provincial roll-out Integration with a changing CMH landscape Powerful reporting to drive enhanced consumer-centered service and system planning

9 How OCAN is applied Outputs:

10 10 Year Mental Health Strategy Services Available Everywhere Self Management Referral Harm Reduction Proactive Follow-up Stigma Reduction Cultural Competence Outreach Family Support Advocacy Consumer and Family Involvement Dispute Resolution System Supports Evidence and Policies Funding Models Performance Measurement Evaluation and Planning Staff Development Knowledge Exchange Leadership and Accountability and Communication Technology

11 CMH Common Assessment Project Vision

12 Moving from a service-focused to a consumer-driven and collaborative system Current Situation Consumer is attributed to each organization Track quantity of consumers receiving services Reports on Functional Centre Productivity / Efficiency Vision Organizations are attributed to a client Track quality of services accessed by consumers (met needs) Reports Consumer Outcomes / Effectiveness of Services

13 Shared Assessment Process Ax Ax Ax Ax Ax Ax Ax Ax Ax Case Manage ment

14 Shared Assessment Stream The project established the Shared Assessment stream to develop a model for sharing OCAN assessments between multiple providers serving common consumers, which will respond to the challenge: How do you streamline the common assessment processes for individuals receiving multiple services within and/or across organizations? This is being done to ensure: Streamlining of consumer supports Minimization of the number of times consumers repeat their stories Harmonization of Consumer supports Harmonization with the 10 year strategy and Minister s Advisory Group A client-centered approach to assessment The support of LHIN integration strategies

15 Shared Assessment Criteria The following criteria were considered in the development of the solution model: Consumer centered Flexible Effective Privacy and security Alignment Efficiency Collaboration Accountability

16 Shared Assessment Process The Consumer Perspective

17 Shared Assessment Vision Current Situation Multiple assessments for same consumer Vision One assessment and one submission of CDS per consumer OCAN The Organization Perspective

18 Shared Assessment Reporting Vision Current Situation Multiple assessments for same consumer Vision One assessment and one submission of CDS per consumer

19 Reporting Process

20 Shared Assessment: Expected Benefits Consumer centered Promotes and supports a culture where the consumer participates at the centre of coordinated and streamlined assessment processes. Collaboration Supports integration and coordination of services to meet consumer identified needs and supports systems planning. Common practices Improves information sharing across services through the development of common processes. Accountability Establishes a model of collective accountability across the system that focuses on consumer outcomes. Effectiveness Supports effectiveness by reducing duplicate assessments and collectively identifying consumer needs.

21 Shared Assessment: Next Steps The CMH CAP Steering Committee agreed to a joint pilot of the Shared Assessment model Planning for a pilot is currently underway with. Some organizations in North East LHIN and Central West LHIN have agreed to participate Pilot learnings to be presented to the steering committee in Spring 2010 Piloting with Integrated Assessment Record (IAR) as the enabling technology solution

22 Integrated Assessment Record (IAR) Andrea Tait, Lead, Strategic Products and Relationships

23 Community Care Management (CCIM) program Local Health Integration Networks (LHINs) CCAC CSS CMH&A LTCH SCCH CHC Common Assessment Common Intake Assessment Tool Long Stay Assessment Software Common Assessment Ontario Common Assessment of Need Resident Assessment Instrument MDS 2.0 Integrated Assessment Record Integrated Data Strategy Business Management Human Resources Management Human Resources Management Human Resources Management Management Human Resources Management Architecture & Integration Standards Security, Privacy & Risk Management Transition Initiation stage Pilot stage Currently rolling out Completed and transitioned CCAC = Community Care Access Centres CSS = Community Support Services CMH&A = Community Mental Health and Addiction LTCH = Long-Term Care Homes SCCH = Small & Complex Continuing Care Hospitals CHC = Community Health Centres 23

24 What is the Integrated Assessment Record (IAR)? IAR is a solution designed to enable health service providers across the continuum of care to view client/ patient assessment information IAR enables health service providers within the circle of care to view assessments from other providers via a central repository of assessment data (e.g., OCAN and RAI-MH (CMH), RAI-MDS 2.0 (LTC), LSAS and CIAT (CCAC)). The IAR application is centrally housed at a Health Network Provider and implemented to support client/patient flow patterns.

25 How IAR works IAR allows clinicians to electronically view existing client assessment information from other health service providers INTEGRATED ASSESSMENT RECORD ACCESSED BY CIRCLE OF CARE HOSPITAL CMH CLIENT ASSESSMENT INFORMATION CHCs RAI-CHA CIAT RAI-MDS OCAN RAI-MH OTHER Ax OCAN LEAD Other Primary Care HOUSING CRISIS INTER. PEER SUPPORT

26 Benefits Consumer: Supports Client Centric Approach to Care Assessment information will be shared among client s circle of care Improving the quality and reliability of information sharing Ensuring a secure exchange of personal health information Providing the basis for coordinated communitybased care planning Assisting organization in identifying service overlaps and gaps to provider better, more comprehensive services Organization: Supports Business Process Reduces redundant workload and assessment, more time to focus on delivery of service Provides the basis for co-ordinated communitybased care planning to help eliminate service gaps and overlaps Supports Risk Mitigation Increases ability to evaluate clients effectively by providing more information Improves quality and reliability of information shared Ensures secure exchange of personal health information Ontario Health Care System: Will map assessment data to common definitions and fields across the community sector Facilitate co-ordinated community based care planning and service delivery Simplify the integration of assessment data into the electronic health record

27 Where we are Pilot in Erie St. Clair LHIN was launched in community mental health organizations and hospitals, CHCs and ambulatory mental health programs. More than 3000 assessments are in the system Historical OCAN and RAI-MH assessments have been uploaded addictions assessments currently targeted. Recently, IAR was successfully launched in Central West LHIN Implementation has begun in the Champlain, North East, North West, North Simcoe Muskoka LHINS. This project, jointly funded by ehealth Ontario, will demonstrate the integration of assessment information into the Electronic Health Record.

28 Questions?

29 Thank you! CMH CAP Project Support Centre Telephone: (416) or (8:30-4:30 weekdays) Online portal: IAR Support Centre Telephone: (416) or (8:30-4:30 weekdays)