Who is responsible for ABF Reporting? Journey so far...

1. Who is responsible for ABF Reporting? Journey so far... Cheryl McCullagh Director Clinical Integration May 2013

2. Why do kids cost more? • All Children require supervision • All Children are vulnerable and need protection • Children need more support for interventions • Children’s hospitals provide care to carers • Low volume dis-advantage, in stock, pricing, dosage and standardisation of care • Requirement to maintain capacity to manage all sized care from neonates to adults in the paediatric environment e.g. beds, ET tubes, monitoring • No mechanism to shift increases in demand, planned and unplanned • Simple cases are kept locally, complex cases are transferred to Tertiary centres for the same DRGs • Provision of expert consultancy to all patients everywhere (consultation liaison clinician to clinician) • Additional specialty training costs • Expectation in paediatrics of a life to be saved, all measures are taken- always

3. Who is involved in ABF? Medico Allied • Analytics Nurse Coders Pathology Pharmacist EMR Finance Revenue Costers OPD MRD Patient Managers Exec. IT

4. 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?

5. One Year In... What does it cost us to provide ABF data?

6. Admitted stream • National classification with adjustments • Well defined • Coding/costing workforce • Refreshed RFA Self-check Pre-admit Waitlist Referral Admin/PAS Diagnosis Records History Diagnosis Documentation CC attributes Document Records Coding Admin Scanning EMR IT Admin Scanning Coding Audit Analysis Review correct Audit Map Review correct Transmit MOH IHPA

7. Is there anything left to do?

8. E-RFA • Self check in • Duplicates • Audit • System interfaces • Specialty coding guidance • SAC splits • MH splits • Private? • TAT scanning and coding • Access • workforce • New standards • Workforce • SPT • Reports to clinicians • Benchmark • Projections • influence classification • Automation • EMR • Documentation • CC’s

9. ED stream • EMR • Error correction • Standardise coding • Costing • Reporting

10. ED stream • Mixed history of costing in ED • Consults in ED are rarely captured and are likely to see the events under-costed • No paediatric adjustment

11. 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 review We are not there yet!!

12. NAP stream • EMR -scheduling • Error correction • mapping • Costing/weighting • Reporting • Gaps

13. NAP stream • Referral • Admin • Corrections Billing Admin Corrections Providers Mapping NAPOOS to SE Mapping CC to events Pt level data Multiple systems automation Admin Corrections Providers

14. NAP Gaps • Not our patient • Not a scheduled patient • Telehealth • Outreach • Costing – no paed adjustment • Reporting

15. 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 • Enter the Service (Performed) Date/Time: mandatory • Enter your Team/Specialty (Service Unit): mandatory • Enter the communication type (Modality): mandatory • Enter your clinical notes (as normal) • 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 Enter your Provider Type (Role): mandatory Enter the Visit Location (Setting): mandatory Enter the Referral Source (Referred from): mandatory Enter the Financial Class (Group): mandatory 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

19. Quality relationshipsNational Safety and Quality Health Service Standards

20. Quality relationshipsEQuIP National Guidelines

21. 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...

22. The Life of the eMR - like ABF • 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

23. 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).

24. Outcomes • Improved governance for Safety and Quality in Health Service • Improving efficiency and workflow • Linking elements of care • Improved information infrastructure • Access to records • Sharing of records • Improved records for research and reporting purposes, • Reducing clinician effort in finding patient information • Reducing 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

26. Who is responsible for ABF – we all are... Medico Allied • Analytics Nurse Coders Pathology Pharmacist EMR Finance Revenue Costers OPD MRD Patient Managers Exec. IT

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