Integrating Care between Hospitals and Public Health Paula D. - - PowerPoint PPT Presentation

The Electronic HBHC Project – Integrating Care between Hospitals and Public Health

Paula D. Morrison, RN, BScN, MSPsy November 7, 2019

Outline

Introduction Objectives Processes Results Next Steps

Ontario families

69 Hospitals

33 Public Health Units

Midwives supporting hospital partners

BORN Ontario

MCCSS

CYSS I&IT Cluster

eHBHC partnerships

Dapasoft

Introduction

The project was intended to result in the following benefits:

• Increased efficiency and ease of HBHC screen

completion

• Reduced duplication of data entry
• Protection of personal health information (PHI)
• Reduced number of missed HBHC screens
• Faster follow-up with families identified as “with risk”

Objectives

1. Improve outcomes for children and families in Ontario by applying innovative strategies with accurate, complete screening 2. Enhance knowledge of the initiative 3. Understand the use of innovation to provide a standardized mechanisms for universal post partum screening 4. Utilize pre-population and data validation rules to reduce data quality issues 5. Reduce the risk of privacy breaches by eliminating non-secure transfer methods of PHI

Improve outcomes for children and families in Ontario

Healthy Babies Healthy Children Screening (HBHC)

Postpartum: Universally paper screening to be offered on all parents before discharge from hospital Transferred through fax or manually - higher chance of breach

eHBHC is the electronic version of the HBHC

Pilot (2016) and Provincial Roll-out (2018/19) Designed to enhance the way in which HBHC screening information moves between hospitals to community public health providers

How postnatal HBHC screening works

BIS ISCIS

Acronyms BIS= BORN Information System ISCIS=Integrated Services for Children Information System HBHC=Healthy Babies Healthy Children

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Electronic HBHC screening

• Submission of the HBHC

screen to the integrated path between the BIS and ISCIS is contingent on consent verification in the BIS

HBHC Screen in the Born Information System

• Based on standardized MCCSS

HBHC Screen

• Screens are ONLY sent to the

PHU based on consent

• Sharing of the information is

based on the authority as a prescribed registry

BIS-ISCIS Interface

• Decision to accept/ forward

the HBHC Screen

• Verify that the data entered

populates the correct data points in ISCIS for HBHC Program response

ISCIS

Provincial Rollout 2018/19

33/35 PHUs (94%) 69/96 birthing hospitals (72%)

9 18 52 69 9 13 27 33 2016 PILOT JAN-18 DEC-18 JUN-19

eHBHC participation

Birthing Hospitals Public Health Units

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Flexibility in eHBHC

HBHC procedural factors

• HBHC model

– Public Health Nurse (PHN) – Hybrid (Hospital staff & PHN) – Hospital staff

• Type of BIS data entry

– Manual sites – Upload sites

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eHBHC Mobilized

• All sites in cycle
• BORN eHBHC

project team

• MCCSS
• eHBHC champions
• BORN Clinical Lead

triaging issues and questions

• Logging of all issues

identified – solutions

• Individual sites
• Generalized to all

sites – biweekly during cycles

• Process Mapping
• BIS training site
• eHBHC Encounter

Training Manual

• BIS training (BORN)
• BIS training videos
• ISCIS training

(MCCSS) Training

Communication

Biweekly teleconference

Support to sites

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How eHBHC screening has improved facilitation of care

Improved data quality

Screens more complete More room for comments

Increased efficiencies

Removed major bottlenecks in screening and follow-up process Easier data entry and transmission

Better privacy protection

Patient data securely transmitted electronically Consent confirmation before screens are transmitted

Improved relationships

Closer working relationships between hospitals and associated PHU – teamwork with new process

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Missed HBHC Screening

• About 20% missed HBHC screens prior to eHBHC (based
• n study by PHO 2014) – estimate now around 10%
• verall with 52 participating hospitals in 2018
• Understanding the factors that influence why screens are

missed and we can target interventions

Results

Percentage of eHBHC screens not

• ffered & eHBHC screens offered

(2018 data - 52 hospitals)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Screens offered Screens not offered

Results

• Our analysis shows that factors being

associated with missed screens were the following clinical variables

• NICU/SCN admissions
• maternal postpartum length of stay
• neonatal health complications
• type of birth
• parity

HBHC procedural factors showed no statistical significance

• HBHC model
• type of BIS data entry
• weekend/weekday discharge date
• no variables were statistically significant

What is the impact of this project?

• BORN has helped improve facilitation of care
• We are now able to actually match missed screens

to the BIS data we can now:

• target interventions
• Understanding the factors that influence why

screens are missed and we can target interventions

• Development of eHBHC Screening Rate Report for

health units to quantify and understand the magnitude of missed eHBHC screens within their health unit catchment area

eHBHC Completion Rates by PHU Residence

(pseudo data)

Organization Total # births by PHU residence # Live Births # Stillbirths # of screens not yet matched to a birth

N n n n Hospital Y 716 716 25 Parity Parity 1 354 354 Parity 2 or more 362 362 Language English 617 617 French 10 10 Other language 24 24 Unknown language 62 62 Discharge Home with mother Yes 542 542 No 64 63 Unknown 110 110

Next Steps

Sustainability

• Technical
• technical fixes and

improvements

• Site support & education
• CQI activities – missed screens
• Continued support to eHBHC

users

• Look towards the future
• pportunities
• Expansion of eHBHC
• Engage hospitals and health

units not participating yet

• Explore opportunities with

Midwives Teams

Research opportunities

• Missed HBHC screening

QUESTIO IONS

• Contact information:

pmorrison@BORNOntario.ca