Population Health Needs Patterns of Service Usage

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Session 4
2

National Requirements
Learning from Others
Resources/ Costs
Population Health Needs Patterns of Service
Usage
Where want to be (Strategy)
Where are now
Commissioning Cycle
How get there (Transition Plan)
Review Impact and quality
Putting into operation
3
Identification of Key Data Sources

• Why is Data Important?
• As we have learned, the correct data will
  help you answer the key health questions you
  have. Data is key for determining
• What Problem
• Who Populations, how many people
• Where Locations, geography
• When Period of time
• Why Why is this an issue

4
Identification of Key Data Sources

• Why is Data Collection Important?
• To track changes/stability of health over time
• What is influencing changes
• To evaluate the impact of prevention/health
  promotion, and health care interventions
• To monitor resource allocation

5
Identification of Key Data SourcesApplications
Functions

• The major software application areas for
  information systems in modern health care
  organisations are
• Patient financial administrative systems
• Decision support systems
• General financial management systems
• Provider managed care systems
• Clinical systems
• Practice management systems
• Home health systems
• Enabling technologies

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Identification of Key Data SourcesPatient
Financial Administrative SystemsThese systems
are obtained from a health information system
supplier. They support the activities involved in
tracking inpatient and outpatient care.
Application Function
Data Required Data Uses

• Inpatient Admission, outpatient/clinic
  registration
• Patient Transfer
• Patient Discharge
• Census/bed control
• Preadmissions and insurance verification
  

• Patient demographic insurance data
• Current census info.
• Treating Physician Info.
• Patient clinical data
• Discharge planning
• LOS

• Population tracking, service, market analysis
• Census tracking/bed control
• Initiate, conclude services
• QI, cost control measures
• Utilization Review

Admission/Discharge/ Transfer Registration

• Multiple procedure, resource, facility support
• Conflict alert
• Surgical facility support

Scheduling

• Patient demographic/clinical data
• Test Requirements and procedures
• Resource availability/costs
• Surgical preference lists

• Cost Control
• Productivity measurement,improvement
• QA/UR
• Costing by patient group
• Conflict resource mgmt

• Patient demographic, clinical, insurance data
• Patient records number
• Deficiency types and stds.
• DRG Groupers
• Coding indices and edits
• Patient abstracting stds.

• Mgmt /physician reporting
• Provider profiling
• QA
• Patient trending

• Chart and deficiency tracking
• Coding
• Abstracting

Medical Records
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Identification of Key Data SourcesPatient
Financial Administrative Systems - cont
Application Function
Data Required Data Uses

• Estimated and actual LOS calculation

• Initial and final patient diagnosis procedures
  performed
• Patient demographic data

• Utilization control
• Patient trending
• Outcomes studies
• Management and regulatory reporting

UR
QA

• Potential quality problem alerts

• User defined quality and LOS stds.

• Quality control and risk mgmt
• Physician profiling
• Outcomes studies
• Mgmt and regulatory reporting

• Quality evaluation and maintenance
• Clinical Protocol Development
• Regulatory, state reporting

• Severity of illness classification
• Health status evaluation
• Aggregate data grouping for Quality Report Cards

• Patient financial, clinical and admin., data
• Internally or externally defined quality
  indicators

Scheduling
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Identification of Key Data SourcesDecision
Support SystemsThese systems are obtained
through a specialty group of HIS vendors.
Application Function
Data Required Data Uses
Budgeting

• Revenue/expense projections
• Volume-adjusted projections

• Historical revenue/expense data
• Case-mix data

• Budgeting

• Produce data for cost procedure, case, HRG,
  ambulatory visit grp.
• Determine per procedure, case, HRG costs

• Labor hours
• Supply costs
• Number, types of procedures performed

• Cost identification
• Budgeting
• Measure variable cost-control technique
  effectiveness

Cost Accounting

• Revenue
• Expense
• Case Mix
• Economic Modeling assumptions

• Establish appropriate funding
• Contract negotiation and mgmt

Reimbursement Modeling

• Project revenue expenses
• Compare actual/expected reimbursement
• Predict financial impact of changes

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Identification of Key Data SourcesDecision
Support Systems - cont
Application Function
Data Required Data Uses
Case-Mix Analysis

• Analyse patient service mix by point of
  service., department, physician, payer/contract,
  diagnosis

• Diagnosis procedure data from all depts and
  point of service
• Patient accounting and administrative data

• Population analysis
• UR
• Contract negotiation and mgmt
• Physician staffing recruiting
• Budget requirements by service line

Productivity Management

• Management of labor hours

• Labor hours and costs
• Patient acuity data

• Staffing requirements and projections
• Labor cost management

Clinical Process Improvement

• Rules base processing alerts to patient events
• Diagnostic and treatment prompts

• Patient clinical data
• External databases
• Critical paths and protocols

• QA
• Risk Management
• Cost Control
• Clinician education/ awareness

Critical Paths Protocols

• Std trmt procedures for cases
• Variance tracking and research

• Diagnosis procedure data
• Drug cost patient outcome data

• Physician profiling evaluation
• Clinical cost id, control, RM

Physician/Provider Profiling

• Treatment patterns case-mix
• Outcomes

• Diagnosis Procedure data
• Severity methods protocols

• Variance reports
• Clinical cost id and control

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Identification of Key Data SourcesClinical
SystemsClinical systems support the
documentation management for direct patient
care.
Application Function
Data Required Data Uses
Nursing Care Planning

• Clinical documentation
• Care planning
• Dosage calculation
• Acuity classification

• Patient clinical data
• Facility-defined care paths
• Dosage stds

• UR/QA
• Regulatory reporting and compliance
• Provider profiling.case management

Critical Paths Protocols

• Std trmt and procedures for similar cases
• Variance tracking and alerts
• Research support for clinical protocols

• Diagnosis and procedure data
• Procedure drug cost data
• Patient outcome data

• Physician profiling/ evaluation
• Clinical cost Identification and control
• RM

• Automated order verification
• Online inquires for orders
• Prompts for best practice
• Order set Maintenance
• Order explosion
• Automated results reporting

• Patient demographic and clinical information
• Ordering physician information
• Testing procedures, results
• Clinical protocols

• Management reporting
• Cost control
• RM
• QA/UR
• Medical records

Order Entry and Results Reporting
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Identification of Key Data SourcesClinical
Systems - cont
Application Function
Data Required Data Uses
Clinical Process Improvement

• Rules based processing alerts
• Diagnostic and treatment prompts

• Patient clinical data
• External databases
• Critical paths and protocols

• QA
• RM
• Cost Control
• Clinician education and awareness

Physician/Provider Profiling

• Treatment patterns
• Case-mix
• Outcomes

• Clinical diagnosis and procedure data
• Severity, risk adjustment methods
• Standard protocols

• Variance reports
• Clinical cost identification and control

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Identification of Key Data SourcesAncillary
Department Clinical SystemsAncillary systems
support the internal activities of a health care
organisations individual departments.
Application Function
Data Required Data Uses
Pharmacy

• Inventory tracking
• Regulatory compliance
• Medication risk management
• Order fulfillment

• Type of controlled substances
• Stock transfer data
• Rx transfer data
• Patient administrative and clinical data
• Location/expiration dates
• Rx service costs

• Regulatory reporting
• Inventory cost and space planning
• Patient/payer billing

Radiology

• Order fulfillment
• Film tracking
• Regulatory compliance

• Patient, clinical administrative data
• Location of films
• Radiology service costs

• Management reporting
• Patient/payer billing

Laboratory

• Type of controlled substances
• Lab ranges and values
• Pending orders
• Coding data, costs of orders

• Regulatory compliance
• Parameter definitions
• Worklists management
• Order fulfillment

• Patient /payer billing
• Order fulfillment
• Productivity management

Operating Room

• Scheduling, OR prep
• Inventory control

• Staffing costs
• Surgical supply preference

• Productivity
• Cost identification and control

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Identification of Key Data SourcesPractice
Management SystemsThese systems support the
clinical and administrative activities relating
to physician practice.
Application Function
Data Required Data Uses
Scheduling

• Multiple procedure resource
• Conflict alert
• Recalls/reminders
• Variable time slots

• Patient demographic/clinical data
• Test requirements/procedures
• Resource availability and costs

• Cost control
• Productivity measurement,improvement
• QA/UR
• Resource/supply costing by patient group

Registration

• Inpatient admission or outpatient clinic
  registration
• Patient transfer or discharge
• Referral tracking

• Patient demographic insurance data
• Census information
• Treating physician information
• Patient clinical data
• Discharge instructions

• Population, census tracking
• Initiate and conclude services
• QI
• Cost control

Medical Records

• Chart deficiency tracking
• Coding
• Retention/evaluation

• Management reporting
• Patient/payer billing
• Provider deficiency profiling
• QA

• Patient demographic clinical, insurance data
• Patient medical records
• Deficiency types, HRGs
• Coding indices and edits

UR and Case Management

• Actual vs expected/contracted utilization

• Case mix by provider/contract
• Contract terms
• Patient diagnosis /procedures
• Patient demographic/Hx data

• Compliance with contract terms
• Provider profiling
• Utilisation control
• Contract profitability analysis

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Identification of Key Data SourcesSocial
Services/Mental HealthThese services support the
integrated health care spectrum surrounding
mental health and associated needs.
Application Function
Data Required Data Uses
Scheduling

• By patient, physician, resource
• Conflict alert
• Recalls/reminders
• Variable time slots

• Patient demographic/clinical data
• Visit requirements and procedures
• Resources
• Patient eligibility

• Cost control
• Productivity measurement
• QA/UR
• Resources
• Case Management

Clinical Documentation, Care Pathways/Plans/
Protocols

• Automated visit notes
• Assessments - ADL, SF-36
• Treatment and procedures for similar cases
• Severity adjust care plans
• Variance tracking
• Research support

• Clinical diagnosis (ICD-10, NANDA)- procedure
  visits
• Actual visits completed
• Drug cost data
• Outcome data,care paths
• Severity of illness measurement

• Clinician profiling and evaluation
• Clinical cost identification/control
• RM
• UR/QA
• Regulatory compliance reporting

Patient Management

• Patient demographics
• Registration/discharge
• Third party billing (UB-92)

• Patient demographics, medical Hx
• Required billing form data

• Case-mix
• Population studies
• Health status outcomes
• Patient tracking

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Identification of Key Data SourcesKey System
Focuses and Applications

System Focus Critical System
Applications

• Enterprise scheduling
• Enterprise patient index
• Enterprise capabilities for eligibility, benefit,
  utilization and protocols

Patient Administration Applications
Enterprise wide view uniform data accessible
across the System possibly uniform systems
support central business operations as required

• Clinical data repository
• Evolve toward electronic health record

Medical Records
Shift to single enterprise record
encounter-based longitudinal focus on patient

• Commissioning analysis
• Clinical case management/analysis
• Actuarial/risk-adjusted outcome analysis
• Patient satisfaction analysis
• Budgeting and productivity mgmt

Decision Support
Support multiple organisations and entities used
in pursuit of cost reduction, managed care
contracting, clinical continuum

• Common procedures, order protocols
• Computerized protocols
• Case management solutions
• Integrated ambulatory acute care
• Physician office result reporting

Clinical systems
Managing efficacy of care within contract
support continuum of care
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Identification of Key Data SourcesEnabling
TechnologiesTechnologies have enabled providers
to utilize new and more efficient methods of data
communication.
Category What They Enable
Technologies

• Data warehouse clinical data repository
• Enterprise area networks
• Community health networks
• EDI

Networking and Telecommunications Technologies
More efficient, complete data storage and
communication. New ways to capture and store raw
data ability to communicate required data across
geography, facilities.

• Clinical workstation
• Data mining
• Graphical user interfaces

Networking and Telecommunications Technologies
Technologies that broaden the potential IT user
base, through more visual, intuitive presentation
and interpretation of data.

• Scheduling
• Case Management
• Protocol management
• Member health record
• Uniform eligibility database

Networking and Telecommunications Technologies
Work to integrate information - with associated
improvement in care quality and efficiency, cost
maintenance and control.

• Relational databases
• Interface tools,Query languages
• Graphical interfaces
• Open systems
• Client/server

Networking and Telecommunications Technologies
Technology available to develop and support new
applications. These technologies ease financial
and risk barriers to new development and shorten
application development timetables.
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Groupwork

• You are building a transition plan for COPD.
  What would you need to know to
• identify success criteria, barriers and
  obstacles
• understand the different pressures across the
  system