presenting spc data collection options for user impact...
TRANSCRIPT
Presenting SPC Data Collection Options for User Impact Assessment
Webinar sessions March 30 & April 3, 2017Ontario Stroke Network, 2017
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Webinar Essentials:
1. Please ensure that you are ‘signed in’ to the webinar with your name
2. If you are attending as a group (e.g. your login is something like ‘BowmanvilleHospital’, please add the first & last names of everyone present in the ‘Question’ window so we can collect attendance.
3. During the presentation, please ‘MUTE’ your telephone to prevent interference/sound issues.
4. During the presentation, please use the ‘Questions’ function on the right of your screen to enter questions so the full audience can benefit. As we go along, we can respond to questions on screen; in addition after each system is discussed, we will open the floor for questions/discuss questions posed from the audience.
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GOAL OF THE PROJECT:A sustainable standardized data collection and reporting solution that meets stakeholder needs and enables:Monitoring, reporting and evaluation of
QBP and CSBPR implementation
Evaluation of SPC models of care
Evaluation of patient outcomes
QI initiatives
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Status of the Project:In June 2015, the Ontario Stroke Network (OSN) began exploring the new NACRS Clinic Lite system, launched earlier in 2015 by Canadian Institutes Health Information (CIHI), as a possible means to collect standardized data from Stroke Prevention Clinics (SPCs) to support Quality Based Procedures (QBP) implementation.
In December 2015, the ‘minimum data set’ (MDS) was endorsed by the OSN Best Practice Secondary Prevention and Acute Care Sub-committee and the OSN Regional and District Advisory Committee. The MDS has been informed by the 2011/2 Stroke Audit, QBP, the OSN Triage Algorithm and Canadian Stroke Best Practice Recommendations.
Following the merger of the Ontario Stroke Network with Cardiac Care Network (CCN), it became important to add an Options Analysis, to consider multiple ways SPC data could be collected and reported on. Two possible technical solutions in addition to NACRS Clinic Lite were identified.
A key step in the evaluation of the three technical solutions is to understand the impact these solutions could have on SPCs.
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User Impacts – what we are asking you:
Each solution has the potential to collect SPC data from a site and transfer it to a database which will be used to provide reports back to sites/regions, and provide copies of the data to ICES and MOH for additional reporting.
Each solution uses a different METHOD or mix of methods
We are asking you to identify HOW these different METHODS could impact your site during implementation, during routine operations, and how sustainable this is for your site and your teams going forward.
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4 Options identified:
Status quo (periodic retrospective chart audits)
NACRS Clinic Lite with Optional Abstracting
CCN Secure FTP
CCN Secure Bulk Upload and Web Portal
Today, we’ll review these last 3 technical solutions and guide you through the method to provide ‘User Impact’ assessments
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Solution Assumptions:
Each solution is expected to
1. Capture all data in the Minimum Data Set
2. Provide reports to sites and regions
3. Minimally include a User Manual (end user guide), System documentation (e.g. technical specifications, data definitions, etc.)
4. Provide access to data and ad hoc querying
5. Provide implementation support, user training, ongoing support (user and technical)
6. Protect PHI
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NACRS Clinic Lite & Optional Abstracting
EPR Abstract
Data Entry NACRS Web Tool CIHI database
Data Entry into local system/EPR Vendor abstracting module CIHI database
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NACRS Clinic Lite & Optional Abstracting, con’t
Data – housed at CIHI
SPC Reports – accessed through eNACRS
Data & Queries – accessed through eNACRS with additional capabilities for sites with CIHI Portal
Data Quality – two types of quality flags ‘hard edits’ (e.g. data format, missing data) these must be corrected and ‘Data Quality Warnings’ (e.g. potential errors) which don’t require correction although review should be done. Both sets of quality findings provided via Operational Reports available online. Web tool – ‘hard edits’ provided on screen (e.g. enforces data formats)
Help / Support – extensive user manual available for the web tool, new users can be requested online, phone/email help desk available
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NACRS Clinic Lite & Optional Abstracting, con’t
Benefits - utilizes CIHI & NACRS infrastructure and support systems (e.g. includes regular data sharing with ICES/MOH, system updates aligned with other admin datasets), supports abstracting through Meditech, Med2020 and 3M, portal can be used in real time
Constraints – sites with electronic data would need to engage directly with abstracting vendors to set up module (costs vary from $0 to $1650 for the module, and $0 - $1200 annually for supporting this module)
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CCN – Secure File Transfer Protocol
Site keys data
File format provided .csv/.xls
Secure file transfer through web (at end of period)
Data – housed at CCNSPC Reports – accessed through the CCN Custom Reporting Solution (CRS)Data & Queries – accessed through the CCN UniverseData Quality – ‘hard edit’ checks done after submission (e.g. date format, missing data), method of communication / update TBD
Help / Support – CCN Service Desk available by phone, all support managed through this service (e.g. request a new user)Benefits – files can be generated using Excel, fastest delivery timelineConstraints – sites with electronic data would need to develop their own extraction method
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CCN – Secure Bulk File Upload & Web Entry Portal
Site keys data
File format provided .csv/.xlsAND/ORweb portal
Secure file transfer through web/ portal
Sites with electronic data can develop extract methods to populate the .csv, then use the web portal to fill in missing information
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CCN 2 – Secure Bulk File Upload & Web Entry Portal
Data – housed at CCN
SPC Reports – accessed through the CCN Custom Reporting Solution (CRS)
Data & Queries – accessed through the CCN Universe
Data Quality (Web) – edit checks at point of entry for data format/missing data.
Data Quality (Bulk File) – ‘hard edit’ checks done after submission (e.g. date format, missing data), method of communication / update TBD
Help / Support – CCN Service Desk available by phone, all support managed through this service (e.g. request a new user)
Benefits –files can be generated using Excel and/or using the portal, portal can be used in real time
Constraints – sites with electronic data would need to develop their own extraction method
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User Impact - assessment
1. How acceptable are the solution's support features for sites (Managing Users & Access, Managing Reports, Initial training and ongoing support)?
2. How users will access/receive reports? (site users, districts)
3. How sites will access & query their data?
Survey assesses the impact using a grading system and 8 questions for each system:
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4. How well does the solution leverage existing data at your site?
5. How well does the solution leverage the existing knowledge of your team (e.g. clinical team, coders)
6. What is the expected impact of this solution on site operations (e.g. to implement the system)
7. What level of burden the solution place on site operations (e.g. to submit data)
8. How sustainable is the solution over the next 3 years? (e.g. with anticipated growth in patients, staff changes, changes in environment such as a new EPR)
User Impact – assessment, con’t
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Each question provides 3 possible responses, as well as some guidance on selecting responses:
User Impact – assessment, con’t
One final question asking:
Of the 3 solutions which one is most preferable?
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Survey Link:
SPC Data Collection Solutions - Impact Assessment
ONE assessment per Stroke Prevention Clinic OR
ONE assessment per Stroke Region
The survey is open now, we are asking for assessments to be completed by April 10, 2017.
User Impact – assessment, con’t
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www.ontariostrokenetwork.cawww.ccn.on.ca
Get in Touch!4100 Yonge St., Suite 502P.O. Box 2414Toronto, ON M2P 2B5
905-242-1559
For more information, please contact:Kathy Godfrey
Stroke Prevention CoordinatorStroke Services
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Minimum Data Set (MDS)For your reference, the following slides lay out the data to be collected in this project, and may be helpful during your assessment.
Please Note:
The MDS was developed using the NACRS Clinic Lite data model, as such the following slides reference NACRS terminology for the ‘Elements’ (e.g. the colour coding is reflective of type of NACRS fields).
If another solution is used to collect SPC data, there will be some adjustment to the fields to reflect that solution (e.g. would not need the Visit MIS Functional Centre Account Code), however this would not impact the types of information collected (e.g. would still be collecting where the patient came from, what happened, etc.).
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MDS: 4 Types of Information
Mandatory Elements (17)
– required by the NACRS
Clinic Lite platform for
submission to CIHI
Optional Elements (8) –
fields that exist in the
NACRS Clinic Lite system,
that we have elected to
utilize in this project
Project Specific
Elements (19) –
fields/options designed by
our task group for use in
this specific project
• Who is the Patient?• Where did they come from?
• What facility provided services, where/when?
• What brought the Patient to the clinic?
• What has been done & when?
• At the end of the visit, what was the outcome?
• What is happening next?
Data is a mix of three types of Elements:
The Minimum Data Set identifies elements to provide evaluation data based on:
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Patient Identification
Health Care Number
Province/Territory Issuing Health Care
Number
Postal Code
Gender
Birth Date
Birth Date Is Estimated (if age isn’t known)
Abstract Identification Number
Chart Number
What brought the Patient in?
Referral Received from
Referral Date
Who is the Patient? Where did they come from?Additional Patient Information
*Ethnicity
*ETOH use (Ethyl Alcohol use)
*Smoking status/cessation
*items that have a pre-defined list of entry options
Additional Patient Information?
Other Problem (up to 9 instances**)
**This field will be used to collect Known Medical History using CCI codes. By using current NACRS
Lite fields, we create a flexible and robust data capture system.
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Site & Record Identifiers
Submission Fiscal Year
Submission Period
Submission Level Code
Reporting Facility’s Province/Territory
Reporting Facility's Ambulatory Care Number
Visit Information
Mode of Visit/Contact
Date of Registration/Visit
Visit Disposition
Visit MIS Functional Centre Account Code
What facility provided services, where/when?
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What brought the Patient to the clinic?What has been done & when?
What brought the Patient in?
Referral received at SPC (date)
*Initial SPC Appointment Delayed?
Date & Time of stroke symptom onset
*Presenting Symptoms
*Reason for Referral
What was done/when?
Main Intervention (x1)**
Other Interventions (up to 9 more)**
Main Intervention start date
Other Intervention start date
What was done/when?
Medication reconciliation done?
Cognitive screen completed ?
Depression screen is completed?
Documentation of completion of swallowing screen?
Was screening for Sleep Apnea completed?
Behaviour modification counselling provided/referred?
Documentation of stroke prevention education?
Patient screened for fitness to drive?
**These fields will record imagingand other interventions using CCI codes. By using current NACRS
Lite fields, we create a flexible and robust data capture system.
*items that have a pre-defined list of entry options
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At the end of the visit, what was the outcome?What is happening next?
What was the outcome?
*Medications prescribed on discharge
*Referral to allied health
Final Assessment
Main Problem (x1)**
Other Problems (up to 9 more)**
**These fields will record finaldiagnosis’ using ICD-10-CA codes. By using current NACRS Lite fields,
we create a flexible and robust data capture system.
*items that have a pre-defined list of entry options