Cancer Care Ontario The Power of Information: Transforming Cancer Services

1. Cancer Care OntarioThe Power of Information: Transforming Cancer Services Presented by: Rick Skinner, VP and CIO, Cancer Care Ontario Date: Thursday, February 25, 2010

2. Cancer Care Ontario – Business Overview • We have three lines of business: • Cancer – as mandated by the Cancer Act • CKD – Ontario Renal Network launched as of June 2009 • ATC Information – building from the Wait Times Information Strategy of 2004 2

3. S I X G O A L S Ontario Cancer Plan 2008 - 2011 2008-2011 Ontario Cancer Plan (OCP) 1 • Reduce the incidence of cancer • Reduce the impact of cancer through effective screening & early detection 2 3 • Ensure timely access to effective diagnosis and high quality cancer care • Improve the patient experience across continuum 4 5 • Improve the performance of cancer system • Strengthen translation of research into improvements in cancer control 6 3

4. 1 1 • Reduce the incidence of cancer • Transform cancer care using IM/IT and eHealth • Reduce the impact of cancer through effective screening & early detection 2 2 • Build out the cancer health system • BI Architecture 3 • Ensure timely access to effective diagnosis and high quality cancer care 3 Enable the Regional Cancer Programs • Improve the patient experience across continuum 4 4 Accelerate change through innovation 5 • Improve the performance of cancer system 5 Strengthen the organization • Strengthen translation of research into improvements in cancer control 6 Our 2008-2011 Information Strategy supports the OCP Six Goals Five IM/IT Strategic Priorities 4

5. The Cancer Journey Today Disease Pathway ManagementA framework for examining the performance of the entire system across the cancer journey – from prevention to recovery and end-of-life care – and identifying any gaps and bottlenecks along the way Focus on the Patient Experience Stronger link to Primary Care Providers :Provincial Primary Care Network Greater/Stronger Cancer System Performance and Efficiency 5

6. Our current IM/IT initiatives supporting CCO ATC Cancer CKD System Level Screening Prevention Diagnosis Treatment Palliative & End-of-Life Care Recovery WTIP SETP ERNI iPortTM Access WTIS - ALC CKD IM/IT ER-CCAC ALC RM&R InScreen DAP EPS ISAAC ICMS Stage Capture Project Cytobase Pathology Reporting STIP Ontario Cancer Registry iPortTM Databook Enterprise Data Warehouse 6

7. THE CANCER JOURNEY – there is more work to be done Path/Stage Access to MRIs and CT scans has not improved despite interventions ST CPOE ColonCancer Check ISAAC Best practice chemotherapy treatment close to home is not always available Palliative End-of-Life Care Quality and completeness of cancer stage data continues to improve Prevention efforts are fragmented Need to improve screening rates for colorectal cancer Prevention Screening Diagnosis Treatment Follow-up, survivorship and palliative care is not meeting the psychosocial needs of the patient Follow up and Long-Term Survival Integrated Screening The diagnostic journey from Cancer suspicion to possible cancer is high anxiety to the patient and high complexity to provider Access to cancer surgery has improved but needs further monitoring Cancer screening approach is not yet integrated DI- Appropriateness WTIS DAP-EPS Not all cancer patients reviewed by a multi-disciplinary cancer conference MCCs Cancer care analytics, performance metrics, dashboards and other reports are not fully integrated, making it difficult to have a full continuum of care view Cancer Registry EDW Primary care providers feel ill-equipped to manage cancer patients Hand-offs from provider to provider is not smooth with clinical information not always following the patient DAP-EPS 7

8. THE CHRONIC KIDNEY DISEASE JOURNEY – our work is just beginning Identification of renal disease and appropriate referral should occur earlier Not all patients get timely access to CKD services Palliative End-of-Life Care Prevention Screening Diagnosis Treatment Follow up and Long-Term Survival Interim data collection upload tool Navigating the renal system is confusing and complex for both patient and provider Many CKD patients are being dialyzed in the hospital instead of community Informatics, reporting, analytics, performance metrics Primary care providers feel ill-equipped to manage renal patients The Renal community is beginning to identify common standards of care 8

9. THE ACCESS TO CARE JOURNEY There is more work to be done ER data required for decision making, planning and public reporting is not as timely as it could be ERNI Demand for diagnostic imaging continues to increase resulting in access issues and requiring a review of ordering practices Unnecessary inpatient admissions through the ER continue DI Appropriateness Palliative End-of-Life Care Referrals from acute to post-acute facilities is a cumbersome and complex process Prevention Screening Diagnosis Treatment Follow up and Long-Term Survival Efficient ORs working at optimal capacity are critical to maintaining appropriate surgical wait times SETP Wait times for alternate levels of care are largely unknown RM&R WTIS-ALC PIP Access to Care analytics, performance metrics, dashboards and other reports are not fully integrated, making it difficult to have a full continuum of care view EDW 9

10. We’re Focused on Driving Performance Improvement 10

11. 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%. Cancer System Provincial Scorecard December 2009 • Note: • Overall Provincial Ranking is the sum of all rankings relative to all other Regions normalized to number of measures available. Collaborative Staging and Pathology indicators are excluded from this calculation as implementation is scheduled at different times for hospitals. • Cancer surgery ranking is based on provincial performance, not LHIN targets. • The previous scorecard (October 2009) include the following measures: Radiation Apr-Jul 09, Systemic Ref-Con Apr-Jul 09, Systemic Con-Tr Jul 09, Surgery WT Apr-Jul 09, Surgery Vol Apr-Jun 09, Colonoscopy Apr-Jul 09, FOBT Participation 2006-07, Stage Rate Apr-Nov 08, Symptom Management Apr-Jun 09, Thoracic Apr-Jan 09, MCC Q4. Note that the MCC indicator is different in this scorecard. • An asterisk (*) in the header means the data in the current scorecard is the same as the previous one. • There is no trend symbol for data being measured for the first time in the scorecard. Performance against the previous scorecard Improved Decreased No change 11

12. Ensuring Accountability through Public Reporting Cancer System Quality Index 12

13. Lead by Clinical Priorities • Clinical leadership that spans the continuum of Cancer Care • Evidence based guidelines • Knowledge Transfer and Exchange • Workshops • Publications • Information Management • Information Technology 13

14. Our Work Cannot Be Done Without Data Information Management and Information Technology are critical to the collection of timely and relevant data 14

15. From Data to Information to Action Set Goals DEFINE MEASURES 1 1 ESTABLISH TARGETS Define Measures 2 Take Action to Improve Performance 5 3 IMPLEMENT INTERVENTIONS 2 Provider Engagement 4 • MEASURE & MONITOR PERFORMANCE Measure & Monitor Performance Establish Targets 5 TAKE ACTION TO IMPROVE PERFORMANCE 4 Implement Interventions 3 15

16. Active clinician engagement and administrative alignment Performance measurement and management cycle Development and adoption of standards and guidelines Public reporting and transparency in performance Successful deployment of IM/IT solutions to support the transformation of cancer care and access to care Key Core Competencies 16

17. A Proven IM/IT Track Record • Information technology development • Informatics capabilities • Provincial deployment ability • Change management tools • Enabling clinical best practice 17

18. Achieving Value through Performance Measurement 18

19. Increasing screening rates for colorectal cancer 19

20. ColonCancerCheck (CCC) – Supporting the Need to Screen Patients • Canada’s first population-based screening program to reduce colorectal cancer deaths • Supported by InScreen, CCO’s innovative IM/IT solution • Integrates and links disparate data sets to create screening records for all Ontarians • Identifies, invites, notifies, and recalls approximately three million Ontarians eligible for screening • Tracks screening activity, create reports and other information products • Can be leveraged for other screening programs 20

21. ColonCancerCheck: Information Driving System Change Data & Technology • Operate Program • Identification • Invitation • Recall • Reminder • Result notification • Get / Use Information • Planning • Funding • Evaluation • Contract management • Performance management • Quality management • Access management • Public reporting • Research Information to Drive Change More Screening Better Screening Increased support for Primary Care 21

22. Fecal occult blood test (FOBT) cancer screening on the rise 22

23. Increasing safety for Ontario’schemotherapy patients 23

24. Systemic Treatment Computerized Physician Order Entry (ST CPOE) system: Improving patient safety • Reduces prescription errors, offers clinical decision support to medical oncologists through the Oncology Patient Information System (OPIS) 2005 – CCO’s ST CPOE system • Our current successes • Used by more than 1,000 physicians, 750 nurses and 250 pharmacists serving 50,000 Ontario patients • 100% physician adoption rate (where deployed) • 250,000 orders placed annually through OPIS 2005 system Helps prevent approximately 8,500 drug errors, 750 hospitalizations, 500 physician office visits annually 24

25. Reducing Wait Times for Surgery and MRI/CT Scans in Ontario 25

26. Multi-dimensional Challenge to Reduce Wait Times & Transform Healthcare • Limited, dated information to manage care, allocate resources • Resources allocated based on anecdotes, politics (small p) Health System • Resources (eg. Staff and OR time) not optimally managed • Unable to determine who is waiting, how long and at which surgeons’ office Hospitals • Ad hoc, best-effort approach to prioritizing patients • Manual patient lists to manage waits • Lack of objective data made it difficult to justify more operating room time Clinicians • Information unavailable to manage own care • Difficult to hold government , hospitals accountable for wait times • Anecdotal data driving the public debate Public & Patients 26

27. Solving the Problem: The Wait Time Information Strategy • April 2005, Wait Time Information Strategy sets goal of: • Building an information architecture that would contribute towards reducing wait times (and sustaining that reduction) for five key clinical services • Supporting better wait list management and wait times reporting through standardized, accurate, objective wait time information • Building Ontario’s capacity to advance e-Health deployment and adoption Focus of the Wait • Visit to Specialist • Decision to Proceed with Surgery • OR • MRI/CT Scan Order Received • Scans or Surgery • MRI/CT Scan • Cancer Surgery • Cardiac Surgery • Cataract Surgery • Hip & Knee Total Joint Replacement • Visit to • Primary Provider • Decision to Refer to Specialist • After Care • Rehab • Etc. • Long-Term Care Wait Wait Wait 1 2 3 WAIT TIME STRATEGY 27

28. 20 15 10 2 (6) (1) 10 2 9 1 12 19 1 (5) 12 9 The Wait Time Information System Was Built Surgeons can now see how many patients are waiting & take action to ensure they are being treated in a timely manner 28

29. The Wait Times Information System (WTIS) – lets public, clinicians & administration use information to make decisions Information at the patient’s fingertips Simple steps for public to manage own care • www.ontario.ca/waittimes • Consumer view of information • Increased accountability Transparency in wait times reporting 29

30. Cancer Wait Times are Trending Down 30

31. Seeing the Results in Lower Wait Times • Wait times for cancer surgeries down nearly 12% • Wait times for angiographies down about 38% • Wait times for cataract surgeries down over 63% • Wait times for knee replacements down over 59% • Wait times for CTs down about 46% 31

32. Improving the quality and completeness of cancer stage data collection and cancer pathology reporting 32

33. CCO’s Stage-Path Project is providing Ontario with a new dataset of cancer information • Improve the quality and completeness of cancer stage data collection and cancer pathology reporting through implementation of common data and reporting standards and innovative new e-Tools Stage-Path Project Goals • Enable semi-automated capture of cancer stage at diagnosis for 90% of all eligible new cases using the Collaborative Staging (CS) minimum data set • Ensure electronic cancer pathology reports are received in a standardized (synoptic) format with discrete data fields and 90% complete based on the College of American Pathologists (CAP) cancer checklists 33

34. Cancer stage capture rates increasing 34

35. What’s next… • Focus for the next year • Performance Management • Client Services • Business Development • Informatics

36. How do we evolve our services? Information products and services Data Collection Interpretation and strategic advice Analysis Drive questions and investigation Reporting Respond to requests Focus on quality and performance improvement Historical trend analysis Predictive analysis Information access through defined channels Flexible and mobile user access 36

37. Questions 37

38. Thank You! For more information, visit our website at: www.cancercare.on.ca 38