The APV Enhancements Story

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The APV Enhancements Story

• Mr. Jerry Baker, SRA
• Mr. Herb Escobar, Axiom
• 2005 MEPRS Conference

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Session Objectives
After completing this session, participants will

• 1) be familiar with APV enhancement changes
  implemented in FY05,
• 2) understand central data implications of APV
  implementation,
• 3) see which MTFs have turned the function on and
  which have not, and
• 4) know what resources are available to
  facilitate transition to enhanced APV data
  capture and reporting.

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The TMA Change Process
Described in the DoD 6010.13-M, Chapter 5
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APVs What Problem Were We Trying to Solve?

• There Were Two Problems with the APV Module in
  CHCS
• These Problems Adversely Impacted
• Ability to Collect Minutes of Service (MOS)
  Within an APU
• Ability to Collect MOS Under Different DGA MEPRS
  Codes

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What Problem Were We Trying to Solve?

1. APV Software Assumed All Pre-Procedure Occurred
   on Procedure Date
2. APV Software Assumed All Pre- and Post-Op
   Activities Occurred at Same Location

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What Supporting Data Were Provided?

• Navy Tasked SAIC to Research Data Issues in WAM
  Workload Collection
• SAIC Produced a Report Data Quality Issues by
  CHCS Module Report
• 118 Recommendations
• Recommendation 44 Called for Redesign of the APV
  Module in CHCS

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Service MEPRS Coordinator
The MMIG Approval Process
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MMIG Actions

• Prioritized the 118 Recommendations
• Approved Recommendation to Redesign the APV
  Module
• Approved New Functionality to the APV Module
• Allows Automatic Capture of Pre- and Post-
  Minutes of Service (MOS) Associated with an APV

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MMIG
The TMA Approval Process
Program Offices
Costs
No
RITPO Sustainment?
Yes
Implement
1 Program Executive Office, Joint Medical
Information Systems
2 Functional Integration Working Group
Follow Up
3 Information Management Proponency Committee
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Information Management (IM) / FIWG Actions

• IM Placed all Requirements Into One Investment
  Portfolio, Numbered RDS 433
• IM Obtained Price From Affected Program Offices
  Over 10 Million
• FIWG Placed in Unfunded Requirement Status (UFR)

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Implementation

• FY02 Funded UFR in Amount of 4.72 Million for
  Enhancements to
• APV
• WAM Core
• Order Entry / MCP
• Lab / Rad / Pharm
• APV Enhancements Work Began in FY03
• Deployed to MHS in FY04
• Service Began Processing Data in FY05

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Follow-up

• FY05 Inpatient Cost Pool Workload Data Analysis

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CHCS APV Enhancements Data Observations

• Mtfs Across The Services Are At Various Stages Of
  Implementation
• A Key Outcome Is The Change Of Inpatient Cost
  Pools Performance Factors From Occupied Bed Days
  (OBD) to Minutes of Service (MOS)
• OBD Raw work counts
• MOS Weighted work counts

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CHCS APV Enhancements Data Observations

• Data show many differences among MTFs
• Weighted counts Raw values
• Weighted counts Raw values 1,440 (minutes in
  24 hours)
• Weighted counts without Raw values
• Raw counts without Weighted values
• Missing monthly Raw and/or Weighted counts
• Mix of MOS and OBD labeled as Weighted and/or Raw
• Cost pool purification based on Raw amounts
  instead of proportion of Weighted values

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Raw Inpatient Cost Pool Workload (OBDs)
Weighted Workload (Minutes of Service)by FY05
Fiscal Month and Receiving 1st Level FCC
Most MTFs show weighted amounts (MOS) as raw
workload (OBD) multiplied by 1,440(total minutes
in 24 hours). Some show same amounts for both.
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Inpatient Cost Pool Weighted Workload (Minutes of
Service)by FY05 Fiscal Month and Receiving 1st
Level FCC
MTFs relying on the new capability to capture
minutes of service for APV recovery can purify
expensesback to ambulatory clinics based on
minutes of service (Weighted Workload)
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Mixture of Raw and Weighted Workloadby FY05
Fiscal Month and Receiving 1st Level FCC
Note how this month, Raw and Weighted are equal.
Data suggests this MTF startedcounting Minutes
of Service in April(fiscal month 7)
All cost pool expensesare purified relying on
Weightedworkload at Rota, so only FM09has
expenses purified into A FCCs
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Inpatient Cost Pool Purification Based on Raw and
Weighted Countsby FY05 Fiscal Month and
Receiving 1st Level FCC
This Navy MTF is purified inpatient cost pools
relying on Weighted (MOS) counts. Note that
most expenses go to ambulatory work centers.
This Air Force MTF is purified inpatient cost
pools relying on Raw (OBD) counts.
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Why the Differences?

• Similar data presentation made before the MMIG in
  early April 2005
• Potential explanations included
• Improper Data Set ID (SDI) setup in CHCS
• Enhancements Not Available Until December 2004,
  Not Beginning Of FY05
• Training Delays
• APV Enhancements Must Be Turned Off At CHCS-II
  Sites

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Available Resources for APV Data Improvements
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Course Title Course Description
WAM APV Clinical Enhancements Session 1 (WAM APV 1) The objectives for this session provide the specified Clinical staff with an overview of the enhancements APV Order Entry, APR Order Entry, APPs, MAPV option, how MOS are entered for pre-admission and observation patients, enhanced APV reporting, and F/T Build requirements.
Course Title Course Description
WAM APV File and Table Session 2 (WAM APV 2) The objectives for this session familiarize students with WAM/APV functions to capture workload, create new hospital location types (T and V) for APV encounters, designate pre-op teaching locations, recovery locations, APU locations, and the addition of new locations for pharmacy ward groups.
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MEPRS Manager
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WAM Ambulatory Procedure Visit (APV)
Enhancements Training
Updated 03 Sep 2004 Clinical, PAS/MCP, and AD
Staff
VTC Session I

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Course Agenda

• This course has the following components
• Overview
• APV Order Entry Enhancements
• Entering APR Orders
• Ambulatory Procedure Profiles (APPs)
• MAPV Option Enhancements and Entering MOS for
  APV Patients
• Entering MOS for Pre Admission and Observation
  Patients
• Updated APV Reporting
• File and Table Requirements.

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WAM Ambulatory Procedure Visit (APV)
Enhancements Training
MEPRS Coordinators, Data Quality Managers, and
Database Administrators
VTC Session II Updated 16 Sep 2004

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Course Agenda

• This course has the following components
• Overview
• File and Table Build
• MAPV Option Overview
• APV Workload Reporting.

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File and Table Build Activities for the WAM APV
Software
Updated 14 Sep 2004
Appendix E
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Hospital Location File Modifications

• Two new location types for APV encounters (T
  and V)
• These new locations allow you to use different
  Performing MEPRS code for MOS capture
• Pre-op teaching (T)
• Location where a patient receives pre-surgical
  guidance and testing.
• Used to document MOS for teaching related to an
  upcoming APU or inpatient surgery.
• Can also be used to document the Nursing time
  spent on Observation patients.
• PAS/MCP appointing/scheduling is available to
  manage the flow of patients, but optional, for
  T-type (Pre-Op Teaching) locations.
• Recovery (V)
• Location for patient care during recovery on the
  day of the APV procedure.
• Location where patient goes after PACU.
• Used to document MOS performed during patient
  recovery from an APV. This location type is
  optional for APVs, but allows you to document
  that a separate place of care provided nursing
  care to an APU patient in recovery. It is not
  required if the APV patient recovers in the APV
  Clinic.

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Quick Reference Guide for the WAM APV Software
SAIC D/SIDDOMS Doc. D2-NWDQ-5001A 30 Mar 2004
Appendix D
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Using this Quick Reference Guide

• This is a Quick Reference Guide for the commonly
  used features of the WAM APV Software.
• There are many different ways in which sites
  manage APVs, and multiple ways to use the WAM APV
  software. This guide is intended to provide
  suggestions as how to use the software. However,
  each site should review and customize this guide
  based on their own procedures and preferences.
• The APV Desktop Document Guide has detailed
  instructions on how to use the software and
  should be reviewed in conjunction with this Quick
  Reference Guide.

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The APV Enhancements Story

• Questions?
• Comments?