Non-Operational Reporting and Analytics (NORA) Harnessing the potential of information at Ontario s Community Health Centres Association of Ontario Health Centres Information Management Strategy Project Management Office August 2011
Table of Contents Overview...1 An Untapped Resource...1 Background...1 NORA in action...2 Technical Concept...3 How NORA works...3 How CHC data and the BIRT Solution intersect...3 The BIRT Solution service provider...4 Data Overview...5 Data ownership and access...5 Data sharing between CHCs...5 Data quality...5 Data submission to the Ministry of Health and Long-Term Care...5 Personal health information...5 Phases and Timelines...6 Phasing and NORA...6 Phase I timelines...7 Roles and Responsibilities...8 CHCs...8 AOHC...8 Performance Management Committee...9 Information Management Strategy Committee...9 BIRT/NORA Participation...10 BIRT Data Sharing and Participation Agreement...10 What the agreement covers...10 Cost and payment...10 Licensing...10 Training...11 Appendix A: Information Custodianship...12 NORA Phase I Information Custodianship Policies...12 Appendix B: CHC Information Management Strategy...13 Non-Operational Reporting and Analytics Briefing Book - August 2011
For questions or comments, please contact: Ian Brunskill Chief Information Officer (Acting), Information Management Strategy Association of Ontario Health Centres ian@aohc.org Non-Operational Reporting and Analytics Briefing Book - August 2011
Overview An Untapped Resource Every day, Ontario s Community Health Centres (CHCs) gather valuable data to support the work they do in a number of local information systems. Client information, from the number of visits, to medical conditions seen, to treatments prescribed, is collected in a variety of clinical systems. Information about local community initiatives, accounting, and human resources activities are maintained in other systems. These are just a few of the systems that facilitate the operations of each CHC, and are used to support the delivery of care and service. Although functional, this silo-system approach prevents CHCs from gaining a holistic view of their operations and the clients they serve. A work stream within the CHC Information Management Strategy, Non-Operational Reporting and Analytics (NORA) is a group of interrelated projects designed to address this gap. NORA aims to harness the potential of operational information by consolidating key data gathered from these disparate systems, and presenting it in an integrated and easy to analyze manner. Background The CHC information management environment supporting operational activities is highly complex. In addition to core systems that facilitate clinical management, accounting, human resources and community activities, over the years a number of systems have been implemented to address a range of specific operational requirements. One reason for this are the reporting requirements of funding organizations, which often specify that CHCs use systems provided by the funding organization to report on how funds were spent. CHCs receive funds from a variety of organizations, resulting in data being entered into multiple systems for reporting purposes. This means the systems function in isolation, with no way for the data to be shared with other systems within the CHC, or across the sector. At present, some CHCs operate as many as 50 unique systems capturing valuable data that, beyond a few specific uses, remains trapped within each system. Ontario s CHC sector has been discussing the need to address this gap through a robust data warehousing solution since 2007. At the CHC ED Network meeting in October 2010, CHC executive directors endorsed NORA in principle, and with the approval of the Information Management Steering Committee, confirmed support for the AOHC to act on behalf of the sector to manage NORA activities. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 1
NORA in action The following examples illustrate practical, everyday ways that NORA will, over time, offer CHCs a new view of their activities and the services they provide. Cost per client, cost per encounter At present, CHCs lack the ability to easily calculate the actual cost of service to clients on a per client or per encounter basis. Accounting data (operational costs, staff costs, etc.) is contained in one or more systems, and client information is maintained in a variety of other systems. Without a method for collecting and storing data in a single information system, CHCs are challenged to calculate the true cost of the services they provide. Through NORA, and in particular the Business Intelligence and Reporting Tools (BIRT) Solution, this information will be extracted from separate systems, consolidated, and made available for analysis, planning, reporting, evaluation and research on a centre or sector basis. NORA will also enable CHCs to undertake cost-per-encounter analysis for programs beyond those funded by the Ministry of Health and Long-Term Care. Health outcomes for clients with diabetes Almost all CHCs maintain client information in a clinical management system (CMS). Many CHCs have been funded for diabetes education programs that require reporting on data that can t be captured in the current CMS. As a result, new systems were developed to collect information about clients receiving diabetes education. Currently, the CMS and the diabetes education systems have no way to communicate. This means CHCs can t verify whether clients receiving diabetes education have experienced positive health outcomes related to the disease, by comparing the client s clinical chart in the CMS, indicating current state of health, with the list of clients in the diabetes education system. NORA will address this challenge. Number of clients and communities served CHCs serve clients in a variety of ways, by providing medical, social and health education services, and by supporting community members through community health initiatives. Each of these client groups is captured in separate systems; many other types of CHC clients are captured in additional systems. That means CHCs are often unable to state with precision the total number of clients served at any given time. This is another significant information gap that will be addressed through NORA. NORA Value to Key Stakeholders CHCs Better analytical tools to look at data across multiple programs, use data to drive quality improvement, and make strategic planning decisions. THE SECTOR The ability to look at data across the sector and benchmark performance (i.e., by peer group, LHIN, or program). THE MINISTRY Reliable, quality-assured data for one of the primary care models to support planning in the areas of efficiency, accountability, access, and quality. LHINs Reliable, quality-assured data to support accountability, measurement and improvement. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 2
Technical Concept How NORA works At a high level, NORA will integrate data from a variety of sources, including the new Electronic Medical Record system, other clinical/client management systems, accounting, community initiative databases, and other systems, to: Ensure new information is available to analyze in revolutionary ways Allow CHC staff to focus on business analysis, instead of data collection and reconciliation Provide improved intra-sector communication through common business definitions and standardization Allow information consumers to better manage the business by accessing critical data when and how they want. How CHC data and the BIRT Solution intersect Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 3
Business Intelligence and Reporting Tools (BIRT) Solution If the NORA work stream frames the overall approach to CHC reporting and data analysis, the Business Intelligence and Reporting Tools (BIRT) Solution is the workhorse that turns concept into reality. Comprised of tools that manage and transform data into business intelligence, the BIRT Solution includes: The business, system, and quality assurance processes required to transport and transform existing extracts, and integrate new data, from operational systems to new data repositories Analytical functionality required by CHCs A bilingual web-enabled business intelligence portal the reporting layer that provides CHCs with invaluable business intelligence to guide program planning and client services on a per site and sector basis. The BIRT Solution service provider On behalf of Ontario s CHCs, the AOHC is partnering with a service provider* to deliver services required for the BIRT Solution. These include: Technical infrastructure, i.e., a secure environment to transport and store data (servers, hosting, File Transfer Protocol) Web-enabled business intelligence tools like Cognos, an industry standard, to allow end users to run queries, produce reports, etc. User training User support (help desk, etc.) * An official announcement of the selected service provider will be made following signing of a memorandum of understanding (MOU) with the service provider. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 4
Data Overview Data ownership and access Access to CHC data submitted through the BIRT Solution will remain within the purview of each CHC. CHCs will continue to own their data and be responsible for ensuring data accuracy and quality. Data sharing between CHCs Data sharing, access and management will be governed by data sharing agreements between the CHCs, and policies, procedures and standards established by the Performance Management Committee (PMC). PMC has been tasked with developing information custodianship (data availability, usability, integrity and security) guidelines on behalf of the sector. For more information on PMC and information custodianship, see pages 9 and 12. Data quality The quality of data in source systems (i.e., CMS) and the processes used to enter information into these systems will define the quality of data submitted to the BIRT Solution. While the BIRT Solution will not fix data problems related to source systems, the standards, business processes and tools that are part of the system will provide CHCs with error log reports that will identify data quality issues. This will enable CHCs to fix and maintain source system data. Data submission to the Ministry of Health and Long-Term Care The Multi-Sector Accountability Agreement (M-SAA) indicators that are currently reported monthly, quarterly and/or annually are submitted by CHCs to the provincial CHC database maintained by the Ministry of Health and Long-Term Care. In future, pending further discussion with the Ministry, CHCs and the LHINs, the BIRT Solution is expected to provide the LHINs and the Ministry with data required for these purposes. Personal health information Personal health information (PHI) will not be included in Phase I, but will be managed as part of future phases of the NORA work stream. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 5
Phases and Timelines Phasing and NORA Phasing is an important concept that underlies the NORA work stream. It s important for CHCs to understand each new phase of NORA will provide greater value over time. For example, Phase I, which is due to be completed by December 2011, focuses primarily on establishing the technical infrastructure and processes that are the foundation of NORA. The principal deliverable of this phase is data currently extracted from Purkinje into the provincial CHC database will now be extracted into the BIRT Solution. The scope for future phases of NORA is yet to be approved, but activities planned for phases II and III include expanding the current extract from Purkinje to include other data, adding data from the new Electronic Medical Record system, and integrating costing data. Perhaps most crucial, however, is an understanding in the CHC sector that the NORA strategy encompasses a continuous cycle of improvement through future phases, with each new phase providing greater information value. Phase I (Current Phase) Deliverables (approved by the NORA Business Application Committee) Phase I Infrastructure and Processes Select a not-for-profit organization to partner with the AOHC to deliver the BIRT Solution Sign a memorandum of understanding with the BIRT Solution service provider Establish the technical infrastructure to securely collect and house CHC data Provide a secure web portal to enable end users to query and access CHC data Register authorized users Provide training Implement operational processes such as end-user support (help desk) One-time upload of current data, and ongoing transfer of new data, from the provincial CHC database to the BIRT Solution NOTE: Personal health information (PHI) is not included in Phase I, but will be part of future phases. Future phases of NORA will include expanding the data sources to systems such as the new Electronic Medical Record system, financial information and other sources that will enhance reporting. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 6
Phase I timelines Milestones Completion Dates Invitation to not-for-profit organizations to partner with the January 2011 (complete) AOHC (Request for Expression of Interest for Phase I released) BIRT Solution service provider selected March 2011 (complete) BIRT Data Sharing and Participation Agreement signed by CHCs Summer 2011 Memorandum of Understanding with selected BIRT Solution August 2011 service provider executed; announcement of selected service provider BIRT Solution operational (tested and implemented in October 2011 production) BIRT Solution in use at first CHC October/November 2011 BIRT Solution in use at all participating CHCs December 2011 Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 7
Roles and Responsibilities CHCs The following are some of the responsibilities of CHCs who choose to participate in NORA: Submit data to the BIRT Solution according to defined schedules and processes Continue to act as owners of data submitted Ensure data is accurate and accept responsibility for the correction, cleansing, quality and validity of data submitted to the BIRT Solution Assign a CHC staff member or members as site contact(s) to coordinate activities related to the implementation and ongoing operation of the BIRT Solution within the CHC Identify authorized CHC personnel who require access to the BIRT Solution according to established policies and processes Work with the AOHC and other CHCs through the Information Management Strategy Committee (IMSC) and the Performance Management Committee (PMC) to prioritize and implement enhancements to the BIRT Solution (i.e., new data sources and functionality). AOHC The AOHC has been approved by the sector to implement the CHC Information Management Strategy (IMS). Below are some of AOHC s responsibilities related to NORA in this capacity: Manage the contract with the BIRT Solution service provider on behalf of CHCs and ensure services are developed, implemented and delivered in a timely manner according to CHC specifications Monitor BIRT Solution service provider compliance to the agreement and service levels Establish a bilingual help desk (Tier 2 support services) and escalate technical issues (Tier 3 support services) to the service provider; Tier 2 will also support CHCs with business issue resolution (i.e., developing a query, understanding data, business support) Oversee the development and execution of a BIRT Solution training program by the service provider Coordinate future phases of the BIRT Solution with input from the CHCs through IMSC and PMC Solicit input from CHCs on the BIRT Solution business and technical requirements Coordinate testing and implementation with CHCs, other third-party vendors and the service provider for new BIRT Solution releases Define requirements for reports (including standard and ad hoc queries sets in consultation with CHCs requirements) Manage the relationship with stakeholders like MOHLTC, the LHINs and ehealth Ontario on behalf of CHCs Develop processes, policies, and procedures to support NORA operations in compliance with direction from the Performance Management Committee Manage the development and execution of agreements. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 8
Performance Management Committee A committee of the CHC Executive Director Network, the Performance Management Committee (PMC) has been identified by the sector as the committee responsible for information custodianship of pan-sector data holdings like the BIRT Solution. For more information on information custodianship, see Appendix A. Information Management Strategy Committee The Information Management Strategy Committee (IMSC) is a committee of the CHC Executive Director Network, the principal forum for making decisions that impact the sector. IMSC is responsible for the development and implementation of an information management strategy for Ontario CHCs. The strategy includes four work streams, one being NORA. IMSC has established the NORA Business Application Committee (BAC) to oversee activities associated with the work stream at a more detailed level. The NORA BAC can direct the project team subject to limitations set by IMSC. Supported by the NORA project team, members include data management coordinators and regional decision support specialists, health planners, an executive director appointed by IMSC, representation from the Ministry of Health and Long-Term Care, and AOHC staff. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 9
BIRT/NORA Participation BIRT Data Sharing and Participation Agreement To participate in NORA, CHCs are required to sign the Business Intelligence and Reporting Tools (BIRT) Data Sharing and Participation Agreement. A contract between the AOHC and participating organizations, the agreement establishes the framework for CHC data submission, and authorized access to and use of the BIRT Solution. It covers Phase I deliverables of the NORA work stream. All organizations that wish to submit and share CHC data through the BIRT Solution must sign this agreement. Initially, participation in NORA will be limited to CHCs, but future phases will provide the Ministry of Health and Long-Term Care (MOHLTC), the LHINs, and other organizations with access to the BIRT Solution. What the agreement covers The BIRT Data Sharing and Participation Agreement covers Phase I of the NORA work stream, including the rules participating organizations must follow to ensure data submitted to and accessed through the BIRT Solution is managed appropriately, in compliance with privacy and security requirements. Cost and payment The cost to participating CHCs is $5,000 a year, due upon signing of the BIRT Data Sharing and Participation Agreement. The AOHC will use the annual fees to support the development, implementation, and operation of the BIRT Solution, and will provide an annual accounting on the use of the fees to the Information Management Strategy Committee. Participating CHCs will also be required to pay for one or more Cognos license(s). Cognos is the business intelligence software required for the BIRT Solution. Licensing Participating CHCs will need to purchase one or more Cognos license(s) directly from IBM Canada. The AOHC and the BIRT Solution service provider are working with IBM to streamline the procurement process for CHCs. The AOHC will provide information on the type and cost of Cognos licenses CHCs may wish to acquire. Based on experience in other sectors CHCs are advised to start with a single, Enhanced Consumer Business Intelligence License and become familiar with available functionality before procuring additional licenses or upgrading to other options. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 10
CHC access to the BIRT Solution will be established through a phased approach this fall. CHCs should submit a purchase order for the Cognos license(s) at least four to six weeks before BIRT Solution access setup activities are scheduled to occur at their site. Training The BIRT Solution service provider will provide training in both English and French to CHC users on the business intelligence software (Cognos) that will be used for reporting and analytics. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 11
Appendix A: Information Custodianship A key areas of focus for the NORA strategy is information custodianship, and the development of policies and procedures for pan-sector data holdings. A policy subcommittee reporting to the Performance Management Committee will lead these activities. An Information Custodianship briefing book was distributed to CHC executive directors in May. For a copy, email ims@aohc.org. Many of these policies may also be applicable to other Information Management Strategy work streams, as well as other pan-sector holdings. NORA Phase I Information Custodianship Policies Access permitted uses of NORA data and a definition of access levels. Examples of access levels (permissions) may include the ability to view reports, access data to conduct aggregate CHC data analysis, and/or access to data to conduct aggregate CHC sector data analysis. The policy will address push (i.e., scheduled distribution of reports) and pull (user-initiated reports) modes of access. Authorized User the registration process for authorized users to access data within a pan-sector holding. This policy will define who can sponsor or approve an authorized user, what the user or sponsor has to confirm about the identity of the user, and sponsor responsibilities. Authorized User Agreement terms and conditions for the use of the NORA data. Covering acceptable use of data and other conditions related to the protection of the information, it will require the signature of each authorized user. Data Quality the responsibilities of each CHC around the quality, accuracy, and timeliness of source data that will be shared across the sector, and restrictions on the use of data should quality not meet policy requirements. Monitoring and Auditing the approach and responsibilities of the various parties with respect to auditing and monitoring compliance to the policies, and potential repercussions of non-compliance. Data Retention, Archiving and Disposal data retention, archiving and disposal policies with respect to pan-sector data. Safeguarding Information the administrative, physical and technical safeguards that must be put in place to protect information. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 12
Appendix B: CHC Information Management Strategy The Ontario healthcare system is highly dependent on the strategic use of information and information management systems. For Community Health Centres (CHCs), this reality has over the last several years moved the sector from a silo-driven approach of operating in isolation, to a vision of resource consolidation and sector-wide management of information systems. This includes alignment with provincial healthcare strategies and national plans such as those advanced by Canada Health Infoway. The CHC Information Management Strategy is designed to support optimal client service and care at Ontario's Community Health Centres through the strategic management of information and information systems. The strategy is guided by two key principles: IMS supports the strategic direction of Ontario CHCs, which is guided by the CHC Model of Care CHCs act as a unified sector to own their information and information management systems. Over the next two years, IMS will focus on four interrelated work streams: ehealth Alignment Designed to align CHCs with the provincial ehealth strategy, ehealth Alignment includes three initiatives: Sector-wide deployment of a next generation Electronic Medical Record (EMR) system Implementation of the Drug Profile Viewer System, providing authorized health care providers at a limited number of CHC locations with the prescription drug claim information of Ontario Drug Benefit and Trillium Drug Program recipients CHC healthcare provider access to health information and clinical decision support tools on OntarioMD, the Ontario Medical Association web portal. Ontario Healthcare Reporting Standards/Management Information Systems (OHRS/MIS) The OHRS/MIS project involves the development of standards and implementation of a software solution to support consistent financial and program/service activity reporting by CHCs across Ontario to the Ministry of Health and Long-Term Care and Local Health Integration Networks. The project is managed by Community Care Information Management (CCIM). It is envisaged that data from the OHRS/MIS system will be integrated with the BIRT Solution in future phases of NORA. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 13
Community Initiatives (CI) The CI work stream focuses on developing a system to gather and analyze data on community initiatives at CHCs to demonstrate CI effectiveness at improving community health. The system will also support knowledge sharing across CHCs related to community development and community initiatives programs. Non-Operational Reporting and Analytics (NORA) NORA is a group of interrelated projects to integrate data from multiple systems and provide CHCs with a holistic view of their operations and the clients they serve. Information made available through NORA will help CHCs enhance client care by improving reporting and data analysis at each CHC and across the sector. Management and Governance The Association of Ontario Health Centres (AOHC) has been approved by the CHC Executive Director Network and the AOHC Board of Directors as the management structure to implement the CHC Information Management Strategy. The AOHC acts under the guidance of the Information Management Strategy Committee (IMSC) and its subcommittees in managing IMS activities on behalf of the sector. A committee of the CHC Executive Director Network, the principal forum for making decisions that impact the sector, IMSC is responsible for establishing a long-term direction for the Strategy that supports best practices, addresses the needs of CHCs, and aligns with the direction of the provincial healthcare system. Non-Operational Reporting and Analytics Briefing Book - August 2011 Page 14