BORN is an example of the whole being more than the sum of its individual parts—it started with five individual registries and data information systems for maternal-child health at different stages of development. Issues in the healthcare industry can be extraordinary or life-altering but without a centralized registry and database service, Ontario could not report the most important population statistics, such as rates of outcomes and interventions. There was an obvious need to make better decisions and enhance the information used for developing policy but the paucity of data that existed was difficult to work with. No registry existed in Ontario to pull all of the data together and provide a clear picture of important trends in the system. Health care providers operate on a knowledge-based system—the more knowledge that exists, the more informed the decisions. The translation of knowledge into action is a process that, if done too slowly or incorrectly, can have a negative health impact—babies and mothers are not given the care they need or important information is left out altogether.
Every healthcare professional shares a common goal and is committed to quality improvement and better facilitation of care. This means that all want feedback but most have few mechanisms through which to get it. The feedback loop is extremely important in committing to care improvement. BORN ’s goal is not to radically change a working system, it is to use the notions of web 2.0 to allow the system to evolve and improve. BORN can exist as a node in an network—focused on making decisions in a better way, improving the facilitation of care towards families, and reporting outcomes more efficiently. Management of the business cycle involves exactly that: planning and decision-making, followed by action, with the follow-up reporting to determine how it all worked. BORN will improve the efficiency and effectiveness of each element in this cycle.
Experts in their particular fields in the health care industry are given the leeway necessary for them to succeed and perform to the best of their abilities. The defining factor amongst this professional industry is the need to improve quality of care, a concept that goes hand-in-hand with quality of information. As part of a team that provides care to a pregnant mother and her baby, the right information is necessary for providing the best health care possible. To allow this system to operate smoothly, audit and feedback is necessary from authoritative and objective sources. This contributes to continuous quality improvement in clinical practice, particularly in the area of maternal-child health; ongoing quality improvement being a key priority in the healthcare field. This involves improvement in health care for pregnant mothers, newborn children, and a better system for maintaining and following health trends amongst children as they grow older.
Management on this scale is hard to define. It is determined by the individual decisions of health care providers working within an interdisciplinary team environment across a broad spectrum with independent areas of expertise. Systems of auditing must be composed fairly and applied on the basis of differences amongst providers in the industry. To put this in context, how do you compare c-section rates between a small-volume hospital that has 80 births a year and a high-risk setting in a large-volume centre that handles a large number of complex births? How do you compare the actions of the providers who deliver these babies by caesarean section? This example outlines the necessity for high-quality information that providers can use to improve their practices.
Being a node in this network allows BORN to exist in and contribute to a system of professional organizations with a common goal. All healthcare providers have information crucial to a patient’s health at each stage of the process. BORN will collect and interpret this data in an extremely powerful dashboard system. Ultimately, this provides the most important information for providers, policy-makers, and researchers — health outcomes.
BORN is an innovative system because it creates knowledge for use by the healthcare team, without changing the framework for clinical best practice. Linking information in the system will give BORN the opportunity to identify outcomes and assess causes, and allows providers to identify gaps where care needs to be provided quickly.
This type of outcome information, using data from an entire population, is unprecedented in a maternal-child care scenario. Traditionally, this type of reporting is financially motivated - reducing the length of stay for patients or the number of tests administered for patients. However, BORN not only helps improve efficiency, but it also helps ensure that the best possible care is being provided through patients receiving the appropriate care for their specific needs. That’s maximizing return on investments and making decisions easier for policy-makers. Management and decision-making is an easy job when the right information is available.
With the value of the solution being recognized as early as 2008, it has taken until now to develop the infrastructure, community and scientific expertise to deliver the solution to the healthcare providers of the 140,000 babies born in Ontario every year. Strategic alignment of the five registries was followed by a pilot project which is almost complete, with the full system being operational by the end of this year.
There are two major challenges that exist in the adoption of a system like BORN:
- Getting high-quality information. There is no legal mandate for health care providers/sites to enter their data into the BORN system. Although BORN has government approval to collect personal health information in the interest of improving care, value must exist to the people who are entering this data if they are to be expected to fully engage. If we as an organization are not able to demonstrate how valuable BORN is, we face a major challenge. Losing information from any group defeats the authoritative aspect of this kind of system. To overcome this challenge, communication with stakeholders is extremely important. For any organization it is absolutely vital that stakeholders understand the benefits, especially when it involves change. BORN has responded to the challenge by strongly promoting our value proposition with stakeholders and communicating about the system through an array of innovative mediums.
- Buy-in. BORN faced the challenge of answering the question “How do we assess professionals in their areas of expertise?” To build community support, BORN must ensure that the benchmarks selected are relevant, appropriate and meaningful in order for them to be adopted and supported by providers. In other words, BORN needed to show these professionals that the benchmarks they are being compared against are fair and reasonable. This problem was solved through the development of a committee structure of experts for each stage of care. These committees advise BORN on what benchmarks need to be followed and how these benchmarks are used to assess performance. The committee structure is integral in gaining the support of the health care professional community.
BORN is aligned with the principles of best practice. Through the creation of a dashboard that gauges and displays performance, BORN will be able to identify how individual institutions are performing relative to benchmarks and peers. This is the most fair and practical way of instituting an authoritative—yet still respected—system.
The quality cycle comes into play, because BORN will use the information in the system and determine if improvements are being made. This is done by comparing the performance of each institution with the identified benchmarks and determining whether the gaps are narrowing. These measurements are made in the best interest of the health care providers, who concern themselves first and foremost with improving care.