Non-Admitted Patient Level data Collection in NSW Susan Dunn, Manager, ABF Workstreams Michael McDaid, Non Admitted Project Manager NSW ABF Taskforce May 2013 Current Environment in NSW Mismatch between activity and costing (can’t cost if you can’t count them) OOS to SE – relationship unclear (not transparent – LHD unable to unbundle) Outdated policy directives and business rules Obstacles to collection of patient level data: o Patient level data not required before – underinvestment o missing data due to lack of resources or reluctance to impact clinician time o lack of system extracts o many small clinical ‘off the shelf’ systems Coverage - NAPOOS 37% 6% Risks Payment from Administrator is at Risk Current Data Collection Coverage $2 Billion Known Unknown Unknown Unknown Patient Level Data 37% Known Systems not in WebNAP (eg ISOH) State Data Respositiory (WebNAP) Motivation to improve Non Admitted data IHPA Non admitted Commandments (or is that Compendium!) – NWAUs at Service Event levels – Tier 2 clinic based on service unit As System manager NSW is working blind – Minimal patient level data – Inability to run Non admitted costing Interpretation of Guidelines – Struggle between classification guidance and policy decisions – Use of PHE – OOS to SE algorithm Key Challenge Service Event Concept Alien to clinicians Issue with immaturity of Tier 2 Clinic classification Complex/non Complex Key Challenge OOS to SE bundling Service Event Service Event 20.47 Rehabilitation 20.47 Rehabilitation Both receive NWAU = 0.0688 Service Type 90 – Rehabilitation Provider type 13 – Medical Surgical Specialist PROJECT APPROACH Project Approach - Communication Aim: coverage and consistency Senior Executive support – Demonstrated extent of issue at LHD level Engage with key working groups – ABF Non Admitted Working Group (NAWG) members – NAPP PCG Workshops aimed at NAP Coordinators, IT & ABF staff LHD Roadshows to Executive, Clinical Managers, Data Managers, Clinicians Project ApproachRoadshow & Workshop Content General Non admitted & ABF Education Review of updated Policy, Business rules etc Explanation of Tier 2 classification and linkage Engage clinicians, technical and admin staff via a redesign process to identify and prioritise NA issues at the LHD o to identify LHD specific issues o to design solutions solutions and quick wins o building of a local implementation plan, risk register and business case Summary - Roadshow and Workshop Follow Up Ministry’s role to be visible and available throughout the change process Coordination of state-wide initiatives Ongoing communication and guidance o follow up video conferences and visits o NAP project emails • all issues logged • solutions sheets with recommendations Enabling of implementation plans Populate a state plan CHALLENGES ARISING FROM ROADSHOWS AND WORKSHOPS Challenges 5 Themes 150 issues logged during consultation A. Data Collection B. Data Extraction C. Data Reporting D. Resources E. Change Management SOLUTIONS Possible Solutions Exploring innovative methods of data collection – Bar code solutions, eMR Extract Development – Review Core, constant, divergent systems – State co-ordination and negotiation – Train Local builders State wide ABF Management tools to make reported data transparent and meaningful (eg SE unbundling) Focused communication and ongoing education Business Process Redesign Home Delivered Services Patient level for each patient administrated service Unwilling to put this burden of data collection onto clinical staff Met with Renal Network, Renal Dialysis Network and individual stakeholders to out line issue and to discuss proposed solution Gained support and commitment to work with the solution Design phase has now commenced on a reporting solution based on prescription, census and leave option EVALUATION PHASE 1 “Good day, topics flowed well. Very interactive” “I now understand what I need to do, but I don’t know how to cost it” “We need more sessions like this one” “Face to face opportunity to discuss NAP issues is much appreciated” “It would be preferable to have a Statewide extract approach ” “Susan spoke to Fast” “more information on Community Health” Questions?