Transcript Patient Administration Systems

Development of National Coding Standards within the Czech DRG System
A personal experience of Patient
Administration Systems, Coding
and Information in the UK NHS.
Charles Carson
April 2008
Development of National Coding Standards within the Czech DRG System
What this discussion will cover:Section 1
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Introduction and overview of PAS
Modules of PAS – Patient Master Index etc.
Section 2
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System Set up
System Security
System Management
Section 3
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Information Culture
Turning “Data” into “Information”
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How information is produced from PAS for building HRG’s
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Section 4
Development of National Coding Standards within the Czech DRG System
What is a Patient Administration
System (PAS)?
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A computerised administrative system used to
manage and record patient demographic details and
any treatments that the patient has, as an inpatient
or outpatient.
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It is vital to effective operation and management of
the hospital, generating such documents as labels
and letters and providing information to monitor
throughputs against contracts and report
performance against key targets.
Development of National Coding Standards within the Czech DRG System
Importance of PAS
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PAS is at the ‘heart’ of all other hospital patient
management systems and is integrated with them to
provide the ‘core’ demographic and local patient
identifier details e.g. Radiology Systems,
Laboratories, A&E Systems
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It provides management with information on service
delivery as a ‘by product’ of its operational use.
Development of National Coding Standards within the Czech DRG System
PAS Modules
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PAS is normally made up of various software modules each
having a particular application with specific functions e.g.
- Patient Master Index (PMI)
- Recording clinical coding (KES)
- Admitting, transferring and discharging patients (ADT)
- Recording outpatient referrals and booking appointments (OPI)
- Waiting list management (WL)
- Bed management (IPL)
- Casenote tracking (CNT)
- Statistical analysis (STA)
- System Management (AMS)
- Order Communications (OCS)
Development of National Coding Standards within the Czech DRG System
Patient Master Index
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This is the ‘core’ of the system and is a list of all
patients known to the organisation
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Each patient will have a unique number on the
system, linking all locally used numbers
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Patients can be identified using various search
criteria
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Data includes demographics, General Practitioner
details and next of kin details
Development of National Coding Standards within the Czech DRG System
Patient Master Index (PMI)
Development of National Coding Standards within the Czech DRG System
Admitting, transferring &
discharging (ADT)
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Patients are admitted, transferred or
discharged on the system and such details
as dates of events, consultant and specialty,
ward on admission/discharge,method of
admission,method of discharge are recorded
as part of this process.
The system is updated in ‘real time’
Development of National Coding Standards within the Czech DRG System
Outpatients Management Module
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This module records everything from initial
referral, to the patient being seen at the
outpatient department: again capturing
details such as dates of events, consultant
and specialty,source of referral, clinical
urgency and outcome of outpatient
consultation
Development of National Coding Standards within the Czech DRG System
Waiting List Module
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This module of PAS records details relating
to patients waiting for inpatient or day case
treatment.
Details include date added to waiting list,
consultant, specialty, clinical urgency and
procedure to be carried out.
Has been very political in the UK !
Development of National Coding Standards within the Czech DRG System
Clinical Coding
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This module of PAS records clinical coding
using prescribed coding conventions i.e.
ICD International Classification of Diseases and related
health problems (Version 10)
OPCS Surgical Operations and procedures (Fourth
Revision)
Development of National Coding Standards within the Czech DRG System
Example from PAS - Diagnosis
Development of National Coding Standards within the Czech DRG System
Example from PAS - Operation
Development of National Coding Standards within the Czech DRG System
Other Modules
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Bed management – used to track bed availability
Casenote tracking
Statistical Analysis – monthly/quarterly reports
submitted to the MOH and purchasers
System Management – setting up and maintaining
users access and masterfiles,setting up patient
letters,managing printing queues,fault reporting to
software supplier
Order Communications
Development of National Coding Standards within the Czech DRG System
System structure
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PAS is structured in such a way that core masterfiles
work across the whole range of modules.
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These masterfiles are compiled using local codes
but structured to include such data items as
regionally designated codes e.g. Specialty Codes
For example, our local code for the Specialty of Urology is
UROL but the MOH code is ‘101’ and so we must reflect this
on our masterfile.
Development of National Coding Standards within the Czech DRG System
Specialty Masterfile
Development of National Coding Standards within the Czech DRG System
Other Masterfiles – to name a few!
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Diagnostic Codes (ICD10)
Operation Codes (OPCS4)
Consultant Code
Specialty Codes
Waiting List Codes
Ward Codes
Source of referral codes
Method of admission codes
Development of National Coding Standards within the Czech DRG System
Importance of regionally defined
codes?
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So comparisons can be made, comparing
like with like
If medical or surgical services are transferred
from one provider to another, eg. the whole
service, or the workload / activity of an
individual consultant can be tracked
Development of National Coding Standards within the Czech DRG System
System security
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Security of PAS is of vital importance and
significance due to the sensitive nature of the
data being held, and the number of users
who will require access: it is common to have
several hundred accredited users at one
hospital.
Development of National Coding Standards within the Czech DRG System
Who has access to our systems?
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Nurses, Doctors, Administrative staff
Development of National Coding Standards within the Czech DRG System
System Manager’s role
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Monitoring management and performance of the system- including
backup procedures- to ensure it meets user requirements
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Controlling and ensuring accurate recording of data on system in
keeping with MOH definitions and guidance
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Planning for, and implementing new hardware, software releases
(scheduling down time etc.)
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Responsible for monitoring data security and confidentiality
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Submitting relevant statistical returns to the MOH for the organisation
Development of National Coding Standards within the Czech DRG System
System Management
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User administration (set up and maintaining accounts)
Maintaining system
Verify that peripherals are working properly
Quickly arrange repair for hardware in event of hardware
failure
Monitor system performance
Ensure system supports/complements work flow processes
Oversee implementation of new software i.e. testing and sign
off
Ensure backup and recover procedures are in place
Set up security policies for users
Development of National Coding Standards within the Czech DRG System
The Information Culture
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Healthcare is an information-intensive
business.
So health managers in the UK have a
responsibility to be able to access, analyse
and report on a wide range on information
produced by PAS and other databases.
To provide the basis for well-informed
decision making in both the clinical and
managerial settings
Development of National Coding Standards within the Czech DRG System
The Manager’s Role in Information
Systems
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Planning : setting goals
Organising
Directing
Monitoring: evaluating performance
Controlling resources
Continuous improvement
Development of National Coding Standards within the Czech DRG System
Types of information used by Health
Managers: at different levels.
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Strategic: conceptual and knowledge-based
Tactical : human relations and information –
based
Operational : Technical and data-based.
Development of National Coding Standards within the Czech DRG System
Many systems in UK NHS.
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Acute healthcare
Clinical information
Corporate information
Primary care information
Development of National Coding Standards within the Czech DRG System
Information Requirements
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Commissioning bodies, providers and MoH
are all involved in planning health services in
the UK
Good planning needs information
Development of National Coding Standards within the Czech DRG System
SMART Acronym used in UK
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Strategic
Meaningful
Accurate
Relevant
Timely
Development of National Coding Standards within the Czech DRG System
The Challenge for the Manager
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Managers relying on Health Information need
to:
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Assess and analyse the information requirements
of their organisation
Plan innovative and integrated solutions to meet
those requirements
Empower and gain the interest of clinicians, and
patients through the carefully managed
implementation of health information systems
Development of National Coding Standards within the Czech DRG System
The Challenge for the Manager (2)
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Continually and thoroughly evaluate the
performance of the systems
Make information effective
Implant information as an integral part of
delivering Healthcare throughout the
Healthcare system
To constantly develop further improvements
to the systems.
Development of National Coding Standards within the Czech DRG System
Main cultural change for us at the
outstart
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Creating and sustaining a sharing
environment,
Realising that there are many “stakeholders”
Learning to trust these other stakeholders
Problem solving together
Sharing solutions
Getting away from data/ statistics to useable
management information
Development of National Coding Standards within the Czech DRG System
Major operational problems for us
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In 1989/ 90 when our process started, our PAS
database was poor
Coding was in its infancy, with little status.
Data were therefore unreliable – so there was
resistance / no “ownership” from doctors and nurses
Our analytical skills were undeveloped
Overabundance of hardware ‘solutions’
Software didn’t exist or was only being developed.
Coders, Medical Records and Information staff were
demotivated.
Development of National Coding Standards within the Czech DRG System
Systems & Structures
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Managers should support and foster the
coordinated and well-integrated developed
“end-user” capacity.
But maintain control of centralised and
corporate systems.
Maintain close involvement of medical and
nursing staff: they need to have “ownership”
of the systems too.
Development of National Coding Standards within the Czech DRG System
Information Systems Basics (very!)
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Even a simple form such as a service quality
questionnaire at McDonalds constitutes an
information system
The written data in the form are the “Input”
The layout of the form restructures the data
Then the restructured data are the “Output”
when read by another person
Development of National Coding Standards within the Czech DRG System
Data into Information
Information Collection
Information Sharing
National PHI information
Health Insurance
House
Financial data
ANALYSIS
Activity data
Usable
Management
Information
Hospitals
Clinicians
Strategic Health
Management /
PPUs
Charles Carson 2005
Development of National Coding Standards within the Czech DRG System
How do you turn “data” into
“information”?
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You start by restructuring the “Input” (data)
into “Output” (information)
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What main types of “data” are collected by
Commissioners, the Ministry, hospitals etc?
Development of National Coding Standards within the Czech DRG System
I suggest 3 main categories, although
there are others:
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Activity data: comes from PAS
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what facilities were used?
how many patients used them? (Coding)
what sorts of patients were seen? ( Coding)
Development of National Coding Standards within the Czech DRG System
Category 2
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Manpower data: Not held in PAS
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How many and what kinds of staff were involved
in caring for different kinds of patient?
Development of National Coding Standards within the Czech DRG System
Category 3
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Financial data : Not held in PAS
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How much money was spent
How it was spent:
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hospital departments,
drugs,
medications,
facilities etc..
Development of National Coding Standards within the Czech DRG System
Information for HRGs
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Development of HRGs needs all three
categories of information, but
Only one category is held on PAS
Development of National Coding Standards within the Czech DRG System
Other kinds of Data Sets
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Similar data from other districts, for
comparison
Population data, census statistics
Data about catchment areas, bed
complements and norms
Data about family doctor services : maternity
services, child health, family planning, etc.
Development of National Coding Standards within the Czech DRG System
The basic data set which management
needs, in a manner that it can use:
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So there are different versions of “Minimum
Data Sets”
The Contract Minimum Data Set (CMDS) is
one of the key building blocks of
management information in the hospital
Development of National Coding Standards within the Czech DRG System
Data into Information
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When you have decided what should be the
contents of your MDS:
you can identify the components
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specify the way in which you would like them
presented
And use/train reliable information staff to pilot the
first MDS.
Development of National Coding Standards within the Czech DRG System
Information Culture again
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So you are on the threshold of your own
“information culture”
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Encouraging the education and training the data collectors,
the clinical coders and the information users
Encouraging the involvement of everyone with an interest in
data or information
Developing good administrative procedures to ensure that
data about patients and staff are kept confidential
Continually testing and improving data quality
Development of National Coding Standards within the Czech DRG System
Information Culture
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Developing standards against which to check the
accuracy and timeliness of the data production
Identifying the manpower and skills needed to
provide an effective information service.
Willingness to share problems and solutions with
others
Development of National Coding Standards within the Czech DRG System
What HRGs have meant for us as a
Provider Hospital in Ireland.
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Not currently used for invoicing, but will be vital when Payment
by Results introduced in full in very near future.
English service is further down the line than Ireland, or
Scotland.
At present used for comparative analysis by Purchasers and
MOH to compare costs against other Providers
Statutory requirement to provide information which will feed into
HRG development
We had to get used to the philosophy of sharing information,
and collaborating with other stakeholders
Development of National Coding Standards within the Czech DRG System
Information Technology
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Information technology can only be exploited
to the full when developments are
information-led
Information requirements must be identified
first and only then should a choice be made
from the hardware and software available.
Development of National Coding Standards within the Czech DRG System
Information from PAS
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How it is extracted
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Who has access to the data
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Uses of information
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Data for HRG grouping
Development of National Coding Standards within the Czech DRG System
How data is extracted from PAS
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Standard statistical reports (Korner)
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KEPS Extracts
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Decision Support Extracts
Development of National Coding Standards within the Czech DRG System
Who has access to the data (1)
Internal
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Information department
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Requests for information come from many sources within the hospital but it is best managed
centrally as the Information Manager will have a sound knowledge and understanding of how the
data is captured and its relevance to meeting their needs.
Contracts department
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Standard reports showing activity by specialty for each purchaser are
created and updated as necessary by the information department but can be run as required to
provide updates on activity performance for each purchaser against agreed contract targets.
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This allows contract managers to take timely action in areas of over or under performance
Development of National Coding Standards within the Czech DRG System
Who has access to the data (2)
External
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DOH Hospital Information Branch
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KEPS Extracts
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Decision Support extracts as and when required relating to a particular aspect of service which they
want to analyse on a regional basis and perhaps compare to regions in the rest of the UK
e.g. day case rates for particular procedures
Purchasers
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Decision Support extracts directly from the Hospital but they also have access to the Regional
database (data warehouse) at the DOH
Development of National Coding Standards within the Czech DRG System
Uses of information
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Performance monitoring i.e. how we are
performing against government targets such
as numbers of patients in waiting lists by time
waiting
Capacity planning and analysis
Casemix analysis
Development of National Coding Standards within the Czech DRG System
Information extracted for HRG’s
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Regionally defined process which all Hospitals use
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Data extracted from PAS and transferred to SQL Decision
Support database
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Business Object Report generated to provide the minimum data
set for the HRG Grouper Software to analyse and assign the
correct HRG
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Once HRG assigned by the Grouper, activity reports produced
and provided to Hospital’s Finance Department to begin the
process of costing each HRG
Development of National Coding Standards within the Czech DRG System
And finally, the Minimum Data Set for
HRG Grouping
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Age
Sex
Length of stay (episodic)
Method of discharge code
Primary Diagnosis
Secondary diagnosis code 1
Secondary diagnosis code 2
Secondary diagnosis code 3
Secondary diagnosis code 4
Secondary diagnosis code 5
Primary operation code
Secondary operation code 1
Secondary operation code 2
Secondary operation code 3
Secondary operation code 4
Patient classification
Method of admission code (elective or non elective)
Hospital (code)
Ward (code)
Consultant (code)
Patients local ID
Date primary operation
Date Secondary operation 1
Date Secondary operation 2
Date Secondary operation 3
Date Secondary operation 4
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Just look at the importance of Coding !
Specialty code (regional code e.g. 101 Urology)