Department of Health
Fredericton, NB
The Department of Health is responsible for delivery of acute care in-patient and out-patient services through 51 facilities, serving over 750,000 residents. The facilities are located in 8 Zones, managed by 2 Regional Health Authorities. Patient volumes in 2009 included 95,835 inpatient separations, 632,203 emergency room visits, 726,674 outpatient clinic visits, 78,082 dialysis visits and 73,287 oncology visits.
Situational Analysis
Hospitals in the province had been collecting workload / acuity data and reporting it to the Department for a number of years. Seven of the eight Zones had independently automated the data collection and reporting processes, utilizing software from the same vendor. Within these 8 systems, there was no consistency of the activities being collected, either with respect to the naming conventions or the definitions. Likewise there were limited provincial guidelines regarding how workload should be collected and monitored. These circumstances made turning data into information, and comparing data across Zones and Regions, a painful process. The result was that workload data had limited utility and leadership at all levels was frustrated. One senior manager commented that despite having workload data they continued to be involved in “decision-based evidence making” when what they wanted to achieve was “evidence-based decision making”. They had a vision and knew that a workload / acuity system could provide them with much more than they were getting. Their vision was one system tracking workload no matter where the patient was seen and linked workload to the diagnosis and other attributes of the health record of individual patients. They wanted to use workload to drive data-driven decisions and positively impact patient outcomes.
Solution
Emerald Health Information Systems Ltd. was selected through a competitive tendering process to implement Dynamine™ workload analytics software for data capture and reporting and Dynaboard™ Business Intelligence Software for business analytics to link workload with the Health Records databases. Dynamine is centrally located and interfaces with 8 ADT systems through a Provincial Integration Engine, 3 scheduling/payroll systems and one e-documentation system. Data is being entered daily by over 11000 service providers. The system operates in High Availability Mode so that performance and resiliency remain high. Dynaboard is implemented centrally and receives data from Dynamine and Health Records systems from 8 zones. To make this happen seamlessly, the Emerald and provincial team worked in partnership to normalize thousands of activities previously used by the Zones to a core dictionary utilized throughout all Zones. The team also defined provincial guidelines for data collection and reporting.
Outcome
Normalization of workload activities allowed the development of consistent definitions and coding across the province, reflecting requirements for internal decision making as well as external reporting to the Department. The Dynamine structure allows central control of key elements of activity definition, leaving control of time values and other configurable items at the individual facility level.
Within Dynaboard, 3 dashboards of daily and monthly Key Performance Indicators were created, to support the needs of all managers. Everyone now accesses the same data in the same format. With a key stroke, front line managers are able to obtain up-to-date information on utilization of services, and types of services by patients in their units. Senior executive are able to see the data across units, rolled up or detailed to serve their specific needs for information at a given time. Managers at all levels, from front line to the Department of Health are now able to benchmark data by Unit Type or Case Mix grouping of their patient populations.
