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Who is responsible for ABF Reporting? Journey so far. Cheryl McCullagh Director Clinical Integration May 2013. Why do kids cost more?. All Children require supervision All Children are vulnerable and need protection Children need more support for interventions - PowerPoint PPT Presentation
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Who is responsible for ABF Reporting?
Journey so far...
patient
service
captureclassify
report
Cheryl McCullaghDirector Clinical IntegrationMay 2013
Why do kids cost more?
1. All Children require supervision2. All Children are vulnerable and need protection3. Children need more support for interventions4. Children’s hospitals provide care to carers5. Low volume dis-advantage, in stock, pricing, dosage and
standardisation of care6. Requirement to maintain capacity to manage all sized care from
neonates to adults in the paediatric environment e.g. beds, ET tubes, monitoring
7. No mechanism to shift increases in demand, planned and unplanned8. Simple cases are kept locally, complex cases are transferred to Tertiary
centres for the same DRGs9. Provision of expert consultancy to all patients everywhere
(consultation liaison clinician to clinician)10.Additional specialty training costs11.Expectation in paediatrics of a life to be saved, all measures are taken-
always
Who is involved in ABF?
Analytics
Coders
Patient
Pharmacist
Finance
Allied
Revenue
Medico
MRDOPD
ManagersExec.
Nurse
Costers
Pathology
IT
EMR
Aims
• Use resources wisely• Document once for many purposes• Count everything we do• Improve costing of events• Report activity as a by product of good documentation
• Improve safety and quality
• Do more with less?
One Year In... What does it cost us to provide ABF data?
Admitted stream
National classification with adjustmentsWell definedCoding/costing workforce Refreshed
Patie
nt
Adm
issi
on
Dis
char
ge
Code
Cost
Repo
rtRFASelf-checkPre-admitWaitlistReferralAdmin/PASDiagnosis
RecordsHistoryDiagnosisDocumentationCC attributes
DocumentRecordsCodingAdminScanningEMRIT
AdminScanningCodingAudit
AnalysisReviewcorrectAuditMap
ReviewcorrectTransmit MOHIHPA
Is there anything left to do?
Patie
nt
Adm
issi
on
Dis
char
ge
Code
Cost
Repo
rt
• E-RFA• Self
check in• Duplicate
s• Audit• System
interfaces
Patie
nt
Adm
issi
on
Dis
char
ge
Code
Cost
Repo
rt
•EMR•Documentation•CC’s
•TAT scanning and coding•Access•workforce
•Specialty coding guidance
•SAC splits•MH splits•Private?
•New standards•Workforce•SPT
•Reports to clinicians•Benchmark•Projections•influence classification•Automation
ED stream
• EMR• Error correction• Standardise coding• Costing• Reporting
Patient
Admission
Discharge
Code
Cost
Report
ED stream
1.Mixed history of costing in ED2.Consults in ED are rarely
captured and are likely to see the events under-costed
3.No paediatric adjustment
Patient
Admission
Discharge
Code
Cost
Report
ED and Admitted stream
• Well defined• Long captured and reported• Processes to support coding• Admin and IT support• Many improvements are ‘behind the scene’• Clinician involvement in documentation and reviewP
atient
Admission
Discharge
Code
Cost
Report
We are not there yet!!
NAP stream
• EMR -scheduling• Error correction• mapping• Costing/weighting• Reporting• Gaps
Patient
Arrive
Depart
Code
Cost
Report
NAP stream
ReferralAdminCorrections
Patient
Arrive
Depart
Code
Cost
Report
AdminCorrectionsProviders
BillingAdminCorrectionsProviders
MappingNAPOOSto SE
MappingCC to events
Pt level dataMultiple systemsautomation
NAP Gaps
• Not our patient• Not a scheduled patient• Telehealth • Outreach• Costing – no paed adjustment• Reporting
Patient
Arrive
Depart
Code
Cost
Report
Improved reporting - At what cost?
What is 5 minutes of staff time ?
Admin 3 /coder 06ADMN302 $2.69
MRD manager 01HSM0300 $5.32
Staff specialist 37STSPS00 $14.71
VMO VMO $22.02
CNC 02CNC202 $5.23
Nurse 02RN08 $3.94
Pharmacist 14PHM203 $4.65
HSM 3 analyst 01HSM0300 $5.32
$63.88
16
Unscheduled activity – PowerChart CHW
1. Enter the Service (Performed) Date/Time: mandatory
2. Enter your Team/Specialty (Service Unit): mandatory
3. Enter the communication type (Modality): mandatory
4. Enter your clinical notes (as normal)5. Select option for inclusion in ABF statistics:
• No (if already captured e.g. in Scheduling) but still want a clinical note
• Yes (to open next section for additional ABF items)
This form derives ABF information from clinical capture workflow
17
Unscheduled activity – PowerChart- CHW
1. Enter your Provider Type (Role): mandatory
2. Enter the Visit Location (Setting): mandatory
3. Enter the Referral Source (Referred from): mandatory
4. Enter the Financial Class (Group): mandatory
5. Enter the Referral Date and Referral Received Date (if known): not mandatory
This section enables direct capture of the remainder of the required ABF information during clinical documentation.
18
Improving Health Service & Outcomes
Information collected for ABF can be used to:
• summarise & analyse any combination of reported patient attributes and cost detail (e.g. What patients are using my service the most?)
• support service utilisation review (e.g. what tests are being ordered and when, by patient type)
• enable benchmarking and variance analysis
• Provide evidence to change practice, and change the funding model
Quality relationshipsNational Safety and Quality Health Service Standards
Quality relationshipsEQuIP National Guidelines
Using resources wisely
• Minimise queues• Maximise process output• Reduce duplication and rework• Touch data once, use it multiple times• Correct data from anywhere• Document as we go• Report from anywhere• ? include patients in keeping information correct
• Focus on the EMR...
The Life of the eMR - like ABF
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A journey......• can support data capture• Mobile solutions are needed for accuracy and
reality• We need to meet the needs of clinicians
• The most expensive resource• The most in touch with activity
Investment in a comprehensive EMR
• Quality and safety• Reduce omission errors• Remove unclear or incomplete orders• Address administration and transcription error• Secure records• Save time- reducing duplication and Reporting
The most common reasons cited for incidents are:
» failure to read or misread (issues with legibility)» failure to have a complete picture of the patient’s
medications» failure to follow protocol (issues with compliance).
Outcomes
Improved governance for Safety and Quality in Health Service Improving efficiency and workflowLinking elements of careImproved information infrastructureAccess to recordsSharing of recordsImproved records for research and reporting purposes,Reducing clinician effort in finding patient informationReducing organisational effort in maintaining hard records
Cost benefit in investment in systems which reduce workforce hours
25
Future Development Aims
• To capture all activity• To improve documentation
•Include mobile solutions•To have a universal network approach•To reduce system and documentation duplication•To create systems that support capture with minimal effort•To enable ABF capture as a by-product of the eMR•Support more time delivering care
Good documentation
Good Patient care
Good access to information
Who is responsible for ABF – we all are...
Analytics
Coders
Patient
Pharmacist
Finance
Allied
Revenue
Medico
MRDOPD
ManagersExec.
Nurse
Costers
Pathology
IT
EMR
patient
service
capture
classify
report
27
The Journey continues
•Governance and communication•Health service administrators have a responsibility to enable clinicians to document well•Systems for documentation should reduce the burden of data collection•Development of EMRs with the output of reporting in mind•Focus on the patient and clinician•Information will better inform the accuracy of the model, pricing, classification and projections