A personal experience of Patient Administration Systems, Coding and Information in the UK NHS.Charles Carson April 2008Development of National Coding Standards within the Czech DRG System
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What this discussion will cover:-Section 1Introduction and overview of PASModules of PAS Patient Master Index etc.
Section 2System Set upSystem SecuritySystem Management
Section 3Information CultureTurning Data into Information
Section 4How information is produced from PAS for building HRGsDevelopment of National Coding Standards within the Czech DRG System
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What is a Patient Administration System (PAS)?A computerised administrative system used to manage and record patient demographic details and any treatments that the patient has, as an inpatient or outpatient.
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
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Importance of PASPAS 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
It provides management with information on service delivery as a by product of its operational use.
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PAS ModulesPAS 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
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Patient Master IndexThis is the core of the system and is a list of all patients known to the organisation
Each patient will have a unique number on the system, linking all locally used numbers
Patients can be identified using various search criteria
Data includes demographics, General Practitioner details and next of kin detailsDevelopment of National Coding Standards within the Czech DRG System
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Patient Master Index (PMI)Development of National Coding Standards within the Czech DRG System
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Admitting, transferring & discharging (ADT)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
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Outpatients Management ModuleThis 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 consultationDevelopment of National Coding Standards within the Czech DRG System
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Waiting List ModuleThis 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 !
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Clinical Coding 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
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Example from PAS - DiagnosisDevelopment of National Coding Standards within the Czech DRG System
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Example from PAS - OperationDevelopment of National Coding Standards within the Czech DRG System
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Other ModulesBed management used to track bed availability Casenote trackingStatistical 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
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System structurePAS is structured in such a way that core masterfiles work across the whole range of modules.
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
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Specialty MasterfileDevelopment of National Coding Standards within the Czech DRG System
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Other Masterfiles to name a few!Diagnostic Codes (ICD10)Operation Codes (OPCS4)Consultant CodeSpecialty CodesWaiting List CodesWard CodesSource of referral codesMethod of admission codes
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Importance of regionally defined codes?So comparisons can be made, comparing like with likeIf 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
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System securitySecurity 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.
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Who has access to our systems?Nurses, Doctors, Administrative staffDevelopment of National Coding Standards within the Czech DRG System
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System Managers roleMonitoring management and performance of the system- including backup procedures- to ensure it meets user requirements
Controlling and ensuring accurate recording of data on system in keeping with MOH definitions and guidance
Planning for, and implementing new hardware, software releases (scheduling down time etc.)
Responsible for monitoring data security and confidentiality
Submitting relevant statistical returns to the MOH for the organisation
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System ManagementUser 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 performanceEnsure system supports/complements work flow processes Oversee implementation of new software i.e. testing and sign off Ensure backup and recover procedures are in placeSet up security policies for users
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The Information CultureHealthcare 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 settingsDevelopment of National Coding Standards within the Czech DRG System
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The Managers Role in Information SystemsPlanning : setting goalsOrganisingDirectingMonitoring: evaluating performanceControlling resourcesContinuous improvement
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Types of information used by Health Managers: at different levels.
Strategic: conceptual and knowledge-basedTactical : human relations and information basedOperational : Technical and data-based.Development of National Coding Standards within the Czech DRG System
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Many systems in UK NHS.Acute healthcareClinical information Corporate information Primary care informationDevelopment of National Coding Standards within the Czech DRG System
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Information RequirementsCommissioning bodies, providers and MoH are all involved in planning health services in the UKGood planning needs information
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SMART Acronym used in UKStrategicMeaningfulAccurateRelevantTimelyDevelopment of National Coding Standards within the Czech DRG System
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The Challenge for the ManagerManagers relying on Health Information need to:Assess and analyse the information requirements of their organisationPlan innovative and integrated solutions to meet those requirementsEmpower and gain the interest of clinicians, and patients through the carefully managed implementation of health information systems
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The Challenge for the Manager (2)Continually and thoroughly evaluate the performance of the systemsMake information effectiveImplant information as an integral part of delivering Healthcare throughout the Healthcare systemTo constantly develop further improvements to the systems.
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Main cultural change for us at the outstartCreating and sustaining a sharing environment, Realising that there are many stakeholdersLearning to trust these other stakeholdersProblem solving togetherSharing solutionsGetting away from data/ statistics to useable management informationDevelopment of National Coding Standards within the Czech DRG System
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Major operational problems for usIn 1989/ 90 when our process started, our PAS database was poorCoding was in its infancy, with little status.Data were therefore unreliable so there was resistance / no ownership from doctors and nursesOur analytical skills were undevelopedOverabundance of hardware solutionsSoftware didnt exist or was only being developed.Coders, Medical Records and Information staff were demotivated.
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Systems & StructuresManagers 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
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Information Systems Basics (very!)Even a simple form such as a service quality questionnaire at McDonalds constitutes an information systemThe written data in the form are the InputThe layout of the form restructures the dataThen the restructured data are the Output when read by another personDevelopment of National Coding Standards within the Czech DRG System
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Data into InformationDevelopment of National Coding Standards within the Czech DRG System
ANALYSIS
Information Collection
Information Sharing
Health Insurance House Financial data
National PHI information
Activity data
Usable Management Information
Hospitals
Strategic HealthManagement /PPUs
Clinicians
Charles Carson 2005
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How do you turn data into information?You start by restructuring the Input (data) into Output (information)
What main types of data are collected by Commissioners, the Ministry, hospitals etc?
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I suggest 3 main categories, although there are others:
Activity data: comes from PASwhat facilities were used? how many patients used them? (Coding)what sorts of patients were seen? ( Coding)
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Category 2
Manpower data: Not held in PASHow many and what kinds of staff were involved in caring for different kinds of patient?
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Category 3
Financial data : Not held in PASHow much money was spentHow it was spent:hospital departments, drugs, medications, facilities etc..
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Information for HRGs
Development of HRGs needs all three categories of information, butOnly one category is held on PASDevelopment of National Coding Standards within the Czech DRG System
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Other kinds of Data SetsSimilar data from other districts, for comparisonPopulation data, census statisticsData about catchment areas, bed complements and normsData about family doctor services : maternity services, child health, family planning, etc.Development of National Coding Standards within the Czech DRG System
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The basic data set which management needs, in a manner that it can use:
So there are different versions of Minimum Data SetsThe Contract Minimum Data Set (CMDS) is one of the key building blocks of management information in the hospital
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Data into InformationWhen you have decided what should be the contents of your MDS: you can identify the componentsspecify the way in which you would like them presentedAnd use/train reliable information staff to pilot the first MDS.
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Information Culture againSo you are on the threshold of your own information cultureEncouraging the education and training the data collectors, the clinical coders and the information usersEncouraging the involvement of everyone with an interest in data or informationDeveloping good administrative procedures to ensure that data about patients and staff are kept confidentialContinually testing and improving data qualityDevelopment of National Coding Standards within the Czech DRG System
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Information CultureDeveloping standards against which to check the accuracy and timeliness of the data productionIdentifying the manpower and skills needed to provide an effective information service.Willingness to share problems and solutions with othersDevelopment of National Coding Standards within the Czech DRG System
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What HRGs have meant for us as a Provider Hospital in Ireland.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 ProvidersStatutory requirement to provide information which will feed into HRG developmentWe had to get used to the philosophy of sharing information, and collaborating with other stakeholdersDevelopment of National Coding Standards within the Czech DRG System
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Information TechnologyInformation technology can only be exploited to the full when developments are information-ledInformation 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
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Information from PASHow it is extracted
Who has access to the data
Uses of information
Data for HRG grouping
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How data is extracted from PAS
Standard statistical reports (Korner)
KEPS Extracts
Decision Support ExtractsDevelopment of National Coding Standards within the Czech DRG System
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Who has access to the data (1)Internal
Information department
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
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.
This allows contract managers to take timely action in areas of over or under performance
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Who has access to the data (2)External
DOH Hospital Information Branch
KEPS Extracts
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 UKe.g. day case rates for particular procedures
Purchasers
Decision Support extracts directly from the Hospital but they also have access to the Regional database (data warehouse) at the DOHDevelopment of National Coding Standards within the Czech DRG System
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Uses of informationPerformance monitoring i.e. how we are performing against government targets such as numbers of patients in waiting lists by time waitingCapacity planning and analysisCasemix analysis
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Information extracted for HRGs
Regionally defined process which all Hospitals use
Data extracted from PAS and transferred to SQL Decision Support database
Business Object Report generated to provide the minimum data set for the HRG Grouper Software to analyse and assign the correct HRG
Once HRG assigned by the Grouper, activity reports produced and provided to Hospitals Finance Department to begin the process of costing each HRG Development of National Coding Standards within the Czech DRG System
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And finally, the Minimum Data Set for HRG GroupingAgeSpecialty code (regional code e.g. 101 Urology)SexLength of stay (episodic)Method of discharge codePrimary DiagnosisSecondary diagnosis code 1Secondary diagnosis code 2Secondary diagnosis code 3Secondary diagnosis code 4Secondary diagnosis code 5Primary operation codeSecondary operation code 1Secondary operation code 2Secondary operation code 3Secondary operation code 4Patient classificationMethod of admission code (elective or non elective)Hospital (code)Ward (code)Consultant (code)Patients local IDDate primary operation Date Secondary operation 1Date Secondary operation 2Date Secondary operation 3Date Secondary operation 4Just look at the importance of Coding !
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