Alternative Level of Care Resource Matching and Referral

Ontario’s eHealth strategy supports wait times reduction as one of its clinical priorities. The initial focus of the strategy is on those areas where the greatest results can be achieved: Emergency Room (ER) length of stay for admitted patients and the wait time from hospital care to an alternate level of care (ALC).     

A patient is given ALC status when they are occupying a bed in a hospital, but no longer require the intensity of services provided in that care setting. These ALC patients can often experience long waits for a more appropriate care setting (e.g. home, rehabilitation facility, long-term care etc.).  These delays prevent other patients coming from the ER setting from accessing hospital beds and increase emergency room wait times as patients wait longer to be admitted.   

Moving patients from one care setting to another is a complex process that involves a multitude of health service organizations, each requiring varying levels of information in order to help identify the most appropriate level of care for the patient.  Currently there is very little standardization for referrals across organizations and most referrals are done via telephone or fax.

One of the priority projects that will help to improve referral efficiency, improve access to care and reduce wait times is the Alternate Level of Care Resource Matching and Referral Project (ALC RM & R). The project is focused on patient referrals that offer the greatest potential opportunities for improving ALC wait times:

• Hospital to rehabilitation facility
• Hospital to complex continuing care facility
• Hospital to in-home services
• Hospital to long-term care

The project has developed provincial guidelines for implementing RM & R solutions and enable Local Health Integration Networks (LHINs) to implement RM & R solutions that are aligned to these guidelines.

eHealth Ontario is undertaking this project with an external delivery partner - Cancer Care Ontario. Cancer Care Ontario, is leading a number of provincial Wait Times initiatives through their Access to Care Program.

Benefits

The ALC RM & R project will help to reduce ER wait times, improve access to alternate levels of care, improve referral efficiency, improve patient care and increase patient satisfaction.

Patient benefits:

• Improved access to alternate levels of care and placement in the most appropriate care setting
• Reduced time spent waiting in hospitals for access to ALC resources
• Patient information being shared with all relevant care providers, thereby reducing the need for the patients to re-tell their story at each care transfer point; and
• Improved patient experiences and outcomes resulting from more streamlined referral processes and the ability to move seamlessly between health care settings

Health service provider benefits:

• Health care providers making referral decisions with up-to-date and comprehensive  information, resulting in improved delivery of care;
• Fewer manual transactions and personal interactions currently associated with the referral process, resulting in fewer errors;
• Time saved by replacing cumbersome manual processes, such as phone and fax, with electronic processes, resulting in increased time that can be directed to patient care; and
• Improved work flow will help service providers provide better patient care and have greater job satisfaction.

Health system benefits:

• Better, standardized and complete information in electronic format allows health system managers to make better planning decisions and assess performance at local and provincial levels;  
• Improved efficiency and timeliness of referral and resource matching processes enable cost savings, cost avoidance and better use of limited health care resources;
• Reduced wait times in  Emergency Rooms and for ALC patients ; and
• Improved patient access to care.

Progress to date

• With input from an extensive provincial consultation process launched in the summer of 2009, a Provincial Reference Model (PRM) for ALC RM & R has been developed.
• The PRM is a set of guidelines that will assist LHINs and health service providers with implementing RM & R solutions and will help to promote more standardized processes and practices for referral across the health care system. The PRM also forms the basis for funding future LHIN-based ALC RM & R initiatives.
• The guidelines provide information on  the following key areas:

1. Business process and data elements
   
2. Technology solution framework
3. Privacy framework
4. Security framework
5. Performance management framework

• In October 2009, all fourteen LHINs expressed strong support for ALC RM & R and initiated planning activities for LHIN-based ALC RM & R initiatives. LHINs received funding to set up project teams, conduct current state assessments and develop project charters. These activities are all underway and are pre-requisites for implementing RM & R solutions.

Next steps

• LHINs will complete their planning activities for ALC RM & R by March 31, 2010.
• At the conclusion of the planning activities, the information provided by the LHINs will be reviewed and used to inform next steps for the implementation phase.
• The implementation approach will require input and approvals from the Ministry of Health before proceeding.
• Updates will be provided by June 2010 on next steps in the project.

Reference Documents:

Provincial Reference Model Overview Document

Business Process and Data Elements

Technology solution framework

Privacy framework

Security framework

Performance management framework