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Northern Territory Department of Health Library Services Historical Collection
THS Case mix Clinical and Resource Management Pr
IInformation Technology Strategy and other Casemix Rel
(
(_
HORIZONS
March & April 1997 - Edition No. 11Special Information Bulletin for reporting on the THS Casemix Clinical and
Resource Management Project, Information Technology Strategy and other Casemix Related Projects
.I N S . l . . D .. E
Community ¢are lnf()rrnciflon··.
System ... ; ..•. ;,. ... Pg 3 Clinical lnltlqtlves .••• , ••... ;; .. ,., .... ,, ... Pg 4 Health Net ... , .• , ... , ... Pg 5 Education ... ; ... , ...•. , ... Pg 6 Hospital Updates ...•...•... , Pg 7 Coding Upddtes ... ·Pg 7 Hospl.tal Funding Moc:t~I Update ... Pg 8
NTA~H ... :; ... fg 8
. ..
Ambtllatory Gare Pqthways
·:Project .•. ';; ....•...•..••.•... , •...•.... Pg 9 cClserrilx News & Updates'··· Pg. 1
o
1co~ 10-AM ... Pg 11 Marketing; ...•.. ,, ... Pg 12
FRONT COVER:
The cover portrays the Barunga Community Care Centre.
From top to bottom:
+O+
BARUNGA SIGN
BARUNGA HEALTH CENTRE SHARON FROM NCOM &
MARIE-PAULETTE (DATA ENTRY)
SHANE (HEALTH WORKER) IN TRAINING
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COMMUNITY CARE INFORMATION SYSTEMS (CCIS)
Barunga goes live! The Barunga Test System (BTS) successfully went "live" ... Page 3
CLINICAL INITIATIVES Updates on Discharge Summaries, Morbidity Coding Audits, National Quality Indicators and Episodes of Care ... Page 4
HEALTHNET
This project is now complete taking just over 12 months ... a significant achievement for THS ... Page 5
EDUCATION
Casemix education is a high priority and
sessions are held regularly in a variety of areas.
Clinical Initiatives, Orientation, Policy
Workshop to name just a few ... Page 6
AMBULATORY CARE PATHWAYS PROJECT The Ambulatory Care Pathways Project is almost at it's life's end .... This article will take you through it's success ... Page 9
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COMMUNITY CAR£ INFORSMATION S1fST£MS (CCIS) USER SUPPORT AND TRAININ6 PROJECT/
BARUNGA 60£5 "LI\(£''
(and survives)Thanks to a dedicated, focused effort on behalf of the entire CCIS team and the Barunga Community Health Centre (CHC) staff, the Barunga Test System (BTS) successfully went "live" on 26 March 1997.
The "team" consisted of:
• The Barunga mob: Shane, Heather, Jim, Jo, Peter, Marie-Paulette and Andrew
• The CCIS mob: Sharon, Chris, Clayton, Bill, Margie, Debbie, Yong-ju, William, Paul and Carolyn The CCIS mob were busy insitu at Barunga, tying up all the last minute bits and pieces (and trying to stay ( ut of the way of the Health Centre staff who still had the Centre to run). Not only did the Barunga staff
have all these extra CCIS bods around, there were the usual remote area issues of hectic "doctors day", health centre closure due to Community meetings and Community Business, and medical emergencies to contend with.
The Barunga mob were absolutely fantastic. They were interested, committed and willing. Above all, they accepted us into their work environment warmly and professionally. The lunches at Jim and Heather's house were great too.
So, after a few intensive weeks which saw the technical issues being sorted out (right up until the ninth hour!); the training being conducted one-on··one and on-site; and the business issues (in-house CHC protocols and procedures relating to the use of the BTS) being identified and worked through, both the Baranga and the CCIS mob felt confident to crank up the system. It wasn't all work though, during this time there was lots of laughter, lots of communication, some frayed nerves, heaps of tolerance (from all sides!) and a mountain of good will.
(_T'"s early days yet, but the people at Baranga are still smiling.
As well as having a thermometer and stethoscope, the health professionals at Barunga now also use a computer system to assist them in their work.
CAROLYN WILSON - CCIS USER SUPPORT & TRAINING PROJECT MANAGER - TELEPHONE 89 99264 7 Heather - Registered Nurse in Training
central Library
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1997@HEAl.TH SERVICES 13/6/
Jim - Registered Nurse
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CLINICAL INITIATIVES
CLINICAL DATA COLLECTIONS
REVIEW OF DISCHARGE SUMMARIES, PRACTICES AND DOCUMENTATION
The policy on Written Communications for Inpatient and Outpatient Separations from Northern Territory Hospitals has been under review since March 1997.
Kerry Hamahan has been communicating with Medical Superintendents in an attempt to find out the methods adopted for auditing discharge summaries in their hospitals, whether the methods were successful or otherwise and what problems/issues had arisen through these audits.
Over the last 12 months there have been considerable efforts made by clinicians to improve the overall standard of their discharge summaries however there is a lack of regular audits in some specialty areas and this is of some concern.
The CCTRG chairperson, Dr Dale Fisher is at present communicating with all Medical Superintendents and Divisional Heads to discuss this issue.
There is a need to look directly at the quality of discharge summaries and whether they were received by appropriate outpatient caregivers. An opinion has therefore been sought from the Medical Superintendents and Divisional Heads with regard to auditing processes, intentions regarding identified deficiencies and responses to review other aspects of discharge summaries.
A review of discharge summaries will assist in gauging our progress as well as keeping this important aspect of care at the forefront of our attention.
CLINICAL SUMMARY AUDIT AND MORBIDITY CODING AUDIT
Kerry Hamahan has spoken with Divisional Heads at RDH and ASH with regard to methods of auditing discharge summaries and holding regular meetings with coders for their area. These meetings are important to solve problems with documentation for efficient coding practices and improved client management.
Presentations on Morbidity Coding and Documentation have been well received by Doctors at ASH. These will also be delivered at RDH, Tennant Creek, Katherine and Gove hospitals. Some areas are holding regular meetings with coders and auditing their own charts. Other areas rely on the coder to identify problems and contact the doctor concerned.
The Divisional Heads were also offered assistance with the development of a 'reference chart' similar to the 'front sheet' concept designed by Dr John Erlich at ASH. The final draft of John Erlich's chart should soon be ready for viewing.
Work has commenced on the development of a reference chart for the Medical Unit at RDH and the first draft will be available for viewing by the end of April.
Kerry Hamahan will liaise with Dr Paul Marks with regards to the Medical Chart. An SAS program has been developed and extractions of the ICD codes and descriptions are now accessible for each division. All Divisional Heads are interested in this concept with suggestions of pocket sized references and a list of possible comorbidities included.
NATIONAL QUALITY INDICATORS AND OUTCOME MEASURES
The working group for Quality Indicators ran a four-day workshop for Infection Control and Quality Officers from each NT hospital. The workshop aimed to provide the participants with appropriate information to assist them to accurately and consistently measure the Nationally agreed Quality Indicators pertaining to infection control in NT hospitals and the Emergency Readmission rate within 28 days among general service clients (excluding psychiatric and midwifery services).
It has been proposed and agreed that reporting on the Quality Indicators will commence by 1 July, 1997. A twelve month trial will commence on this date and be reviewed each quarter for a period of one month.
INTRODUCTION OF EPISODES OF CARE CLASSIFICATION SYSTEM
Leading up to the proposed changes required to Caresys and introduction of a 'change of clinical intent' screen, allowing a statistical discharge from one type of care and a statistical admission to a new type of care, presentations covering the definitions of an episode of care and how the implementation of this policy will further classify the work performed for
thQ
length of stay for each patient were given to doctors at ASH.
These will also be presented to all Units at RDH and Northern Rehabilitation, and the smaller hospitals when times can be arranged. All episodes of care will be linked by the automatic allocation of a code identifying the statistical discharge and the statistical admission. This will allow these patients to be identified for reporting requirements. The proposed changes will take effect from 1 July 1997.
CLINICAL CARE PRACTICES
Meetings for the working party for computer-generated discharge summaries continue. Issues discussed include trials in RDH and ASH and problems arising, requirements for General Practitioners and Encryption for the use of eMail. These issues relate to the main objective of providing accurate and timely patient clinical information from HIS to support ongoing patient care across THS hospitals and the community.
KERRY HANRAHAN - ACTING PROJECT MANAGER CLINICAL INITIATIVES PROJECTS - TELEPHONE 89228258
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P l -
- - The project is now complete and signed off. The implementation phase of the project began in February 1996 and has taken just over 12 months to complete. This is a significant achievement for the Department.
The majority of staff in the Department will have come in contact with the project teams and have received either updated software on their existing PC, hardware upgrades to their PC, or new equipment. Additionally all networks were upgraded with new cabling and network connection devices and in many instances, the file servers were also upgraded or replaced.
These upgrades now provide Health with a standard environment across the whole of the Department. This means, that as a user, you should now:
+
have more reliable and better performing Local Area Networks (LANs) and better and more reliable connections to other networks;( ' access to cc:Mail;
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a PC, rather than a terminal (either for HIS, Mainframe or Pathology);+
a common standard suite of office software (Word, Excel, PowerPoint, Virus protection, cc:Mail and Organiser);and
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the ability to access to all Departmental applications from the same PC.The benefits the Department will see, include:
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increases in productivity because of more reliable systems and a common standard PC with a standard suite of software;+
a reduction in training costs because of the common environment;+
an increase in information available to users, through cc:Mail and other ~nisms;~~+
the ability to make information from many sources available from<lfie,same"PC. · * -~The Health-Net project implementation went very smoothly. This was
l
no 'small pj!.ftduet~~!
cq-9peration that the 'Yellow shirts' received from all members of the Department. The project te}pi and]!-Services\*isl/cto thank all staff for their help in driving a very large task to a successful conclusion. The efforts o.t a numjf~vof ~ff\the~pers, co-operating with the liaison team from the project, were greatly appreciated and this coJibu\atibn p;,ired to,.bJ ve 1 successful.'%. ' &'.';',,,,,,.,,,,;·-'''''
( T would
lik~
to .extend myth~s t~
all the members of the project team for the{!_Cledication, .J:lrofes~~ual(~~ ~ ~ar.d
work and determmahon to make this project a success. In all respects I beheve the prbJeCt t~anl'qay~,,achieved evetythj.ng thatwas asked of them. ""'"'
1
p»vThe Department is now well positioned to move with the changing IT requirements we are able to provide the technology to better service the Department's customers.
DOUG COOKE-TELEPHONE 8922 8713 Some interesting statistics;
• 2027 network connection outlets were installed as part of the project, this equates to 150,000 metres of cable, covering 15 different sites;
• 583 new Pentium PCs were installed to replace the terminal devices and PCs below standard, throughout the Department;
• 548 PCs received a hardware upgrade of either memory, hard disk or both. This was comprised of 367 x 550 megabyte hard disks and 1200 x 4 megabyte memory chips;
• 111 new printers, all network connected, were installed for the new CareSys application;
• 400 printers were connected to the network to provide printing capabilities to a wider group of users; and
• 1613 PCs were installed with the standard suite of software products. (Word, Excel, Powerpoint, Virus protection, cc:Mail and Organiser).
Education and facilitation of workshops have been very busy for me in the areas of Clinical Initiatives, Orientation, Policy Workshop and Casemix presentations during the months of March and April.
CLINICAL INITIATIVES
EPISODES OF CARE, AUTOMATED DISCHARGE SUMMARIES AND MORBIDITY CODING ....
Several presentations have now been delivered to senior clinicians at both RDH and ASH on Episodes of Care, Automated Discharge Summaries and Morbidity Coding. These presentations have been an overview of the three areas with follow-up education sessions by Project Managers and Project Officers, if required.
NATIONAL QUALITY INDICATORS WORKSHOP ••••
A four day workshop for Infection Control and Readmission within 28 days was held from 14 - 17 April 1997 in the training room of the Menzies Building.
The program was developed to provide Infection Control and Quality Practitioners with a broad overall knowledge and understanding of Quality Indicators pertaining to Infection Control in hospitals and the Emergency Re-admission's rate within 28 days among general service clients.
High profile Health Professionals were invited to give presentations to the workshop part1c1pants in conjunction with other Healthcare professionals who wished to attend a particular session. Some of the guest speakers were Dr Vicki Krause, Disease Control; Dr Gary Lum - Director Microbiology; Dr Bart Currie - Head of Clinical Research Unit at Menzies; Lorraine Porter - Accreditation Officer; RDH, Dr Jan Savage Coordinator for NT Program AIDS/STD; Dr Fay Johnston, A/Head, Immunisation and Surveillance, Disease Control Centre; and Nan Miller, Senior Project Officer, Disease Control Centre.
The participants highlighted the fact the workshop was well overdue and all felt that they benefited greatly from the exchange of information, networking and being able to discuss issues and concerns that arise not only in the smaller hospitals but the larger hospitals also. An action plan
was developed with
recommendations being submitted to the THS Casemix Clinical and Technical Reference Group.
ORIENTATION
Orientation programs seem to come around very quickly. I have been presenting Casemix overviews for new Health Care staff at RDH.
These orientation programs have had around forty participants for the last
KAY COOK - EDUCATION AND MARKETING COORDINATOR TELEPHONE 89 992749
months. Orientation in ASH was well received with over sixteen healthcare professionals attending and Tennant Creek Hospital had a few new staff for the Casemix education session.
POLICY WORKSHOP
The Policy Workshop held on Monday 24 and Tuesday 25 March 1997 was for key stakeholders to evaluate the policies to assist in the determination of the Hospital Funding Model (HFM) Generation 2 and 3.
The workshop was successful in gathering information to assist in the development of the policy documentation for submission to the Casemix Steering Committee. For further information of the development of the Policies, contao Jan Marlborough on telephone 8 992895.
CASEMIX EDUCATION March particularly, has been very busy with education programs to a variety of areas. These have included ASH, Tennant Creek Hospital, Renal Unit at Nightcliff, Health House and Darwin Community Care Centre.
All sessions have been well received and well attended.
I also gave a Casemix presentation to the NT Coding Association for new coders providing them with overviews on Casemix and its related projects.
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: At the time of printing, Royal Darwin Hospital, Gove :
thtATHERINE ~OSPITAL
MICHELLE PHILLIPS-TELEPHONE 89 739233
: District Hospital and Tennant Creek Hospital :
: articles were not available. :
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Well, after accepting the temporary position and huge challenge of Hospital Business Manager, it appears as though Katherine Hospital is once again about to get back on track in relation to Casemix and Clinical Costing.
This is only due to the fantastic support that has been offered by everyone and I am now starting to feel a lot more confident about what I am doing than I did eight weeks ago - even though I have a lot yet to learn!
Visitors to Katherine since early March have included Jan Marlborough and Patrick Jackson for a brief
introduction to ascertain what I did and didn't know; Stewart McDermid for three days to explain the mechanics of how and why Trendstar works and an overview of the system; Margaret Foley to briefly explain the intricacies of the Hospital Funding Model and Art Huston to talk to the Katherine Hospital Executive about his model for smaller hospitals. Helen Morton then popped in for a day and I had 101 questions fired at her in relation to how and why the figures for the next Performance Agreement were ascertained. Between us, and with consultation with members of staff, we managed to come to some agreements!
I would like to thank everybody for their support to date and hope to have plenty to report in the next issue.
j\.LICE ~PRINGS ~OSPITAL
CHRIS BURROWS - BUSINESS MANAGER - ASH - TELEPHONE 89517598 Alice Springs Hospital has again become embroiled in the annual battle to secure an optimum share of the budget to meet its weighty obligations. Thank you to Bruce Dunn for informing us on progress this year and Helen Morton in helping us with the settings for next year; both travelled down to ASH do this.
We have again become involved in the quest to expand the usefulness of CareSys, with deadlines on 1 July!
Rose Murphy has been seconded to act as Project Officer at ASH in the Revenue Optimisation project. This will link developing business opportunities with re-structure of the Emergency Department and Outpatient modules and development of a new Billing module. Rose will work locally with Ruth Coles who has stepped into Julianne Clift's position as Patient Services Manager. Julianne is enjoying long service leave.
Bronwyn Taylor (ASH Quality Management), Jenny Rossiter and Irene McKenzie (ASH Infection Control) participated in a week long workshop in Darwin facilitated by Kay Cook and Kerry Hanrahan. The NT-wide team met with representatives from THS Clinical and Resource Management Project members and finalised arrangements to report on three quality indicators required by the Commonwealth, ie rates of nosocomial
infection, wound infection, and related re-admissions within 28 days. A trial should commence from 1 July 1997 .
MORBIDITY CODING - RDH
The Morbidity Coding section of Royal Darwin Hospital offered to be a test site for the Australian Standard Benchmark Audit. It is the National Centre for Classification in Health's (formerly the National Coding Centre) first attempt to create national consistency between
\
... .
ICD coding auditing methods. The audit is based on the philosophy of Continuous Quality Improvement (CQI). It aims to distinguish between "coder" and "system" errors. The NCCH will calculate a national benchmark which will aim to be a national standard to which all health care facilities can aspire. This has been an extremely busy time for the Morbidity Coding section at RDH whilst attempting to maintain the current workload.
The section continues to have a dedicated commitment to quality projects in order to maintain high standards in health information.
ANDREA MORRISON -HEALTH INFORMATION MANAGER - RDH - TELEPHONE 89228699
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HOSPITAL FUNDING MODEL (HFM) 1997/1998
UPDATE
Stakeholders from across the NT met for a two day workshop in March to discuss the future policy direction for Hospital Funding Model - Generation 2. The workshop was a very successful one, enabling some clear policy recommendations to be tabled at the Casemix Steering Committee meeting in April. These policies will now be presented to the Departmental Executive for endorsement on 15 May 1997.
One of the major outcomes for the
Steering Committee was the re-naming of the Hospital Funding Model the Hospital Budgeting Model. The Steering Committee believed that the new name more accurately reflects the reality of what the model is actually meant to do - and that is to inform the budgeting process.The next step will be the development of Technical papers which will reflect the policy direction.
Helen Morton has undertaken a major task this year in 'pulling together' the affiliated support
component of the Hospital Budgeting Model, toenable completion of the Performance
Agreements. She is commended on her ability to ask a lot of the 'right' questions to ensure a positive and fair outcome for all hospitals.
(Itappears she is leaving 'no stone unturned').
Itis
envisaged that the task will be well on its way to being completed by the end of May.We would like to take this opportunity to thank all of those people who have assisted in the
development of the Hospital Budgeting Model - Generation 2.
JAN MARLBOROUGH
SENIOR POLICY OFFICER - CASEMIX TELEPHONE
89 992895
NORTHERN TERRITORY ASSOCIATION FOR QUALITY IN HEALTH CARE {NTAQH)
The NTAQH is an Association which is associated with the Australasian Association for Quality in Health Care Inc. and the primary role is to inform members and the wider health workforce of the latest information in relation to Quality.
Quality Week at RDH was integrated with the NT Quality Association and our guest speakers were Stewart La Brooy from Correctional Services speaking on 'Quality Contracting in Prisons' and Murray Alexandra from Best Practice Initiatives Australia speaking on 'Quality Committed Enterprise'.
The Northern Territory Branch meets monthly and provides stimulating guest speakers and furnishes members with a network of contacts for both professional and personal gain. The Australasian Association's newsletter which keeps members abreast of current Health and Quality information both interstate and Territory-wide is issued quarterly.
Ms Geraldine Wood from Royal Adelaide Hospital presented her views on 'The Concept of Payment for Health Outcomes rather than Throughput' on 30 April, 1997. The session was very informative and well attended.
Further guest speakers will be Greg Moo from NCOM speaking on 'Quality Standards in Information Systems'.
The venue is the Blue Room, Health House at 2.30pm on 17 June 1997.
For further information on the Association and future meetings, please contact Lorraine Porter, President -NTAQH on telephone 8922 8215.
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AMBULATORY CARE PATHWAYS PROJEC1-1
The Ambulatory Care Pathways Project is almost at it's life's end. The project has been going for two and a half years and after much blood, sweat and sometimes tears, the data has been collected and entered into a specifically formulated data base for analysis.
For those of you who can't remember what the Ambulatory Care project was all about I will refresh your memory:
The Ambulatory Care Pathways project was commenced because there is considerable evidence to support the hypothesis that the Northern Territory is considerably disadvantaged in relation to funding, when compared to other States and Territory's with respect to the provision of ambulatory care services. This is primarily due to Territory Health Services inability to provide substantiated information regarding client needs, service provision and the related costs for provision of services for ambulatory type clients.
For a select group of twelve (12) ANDRG's the Ambulatory Care Pathways project primarily aims to identify and describe:
=> what constitutes an ambulatory care episode in the NT
(
=> what is the weighted cost of a specified ambulatory episode of care
=> the range and frequency of activities undertaken in urban and rural clinics in the NT for a select
group of conditions.
the range and frequency of activities undertaken in urban clinics.
=> the degree of substitutional care between hospital related ambulatory care
services and services provided in rural/remote health clinics.
=> an average cost for providing post discharge care to those clients in both
an urban and rural/remote environment in the NT
The project has been a great success and the information that has been collected has the potential to assist many other Territory Health Services projects in the future. The success of this project can only be attributed to the great support and assistance the project received from the participating hospitals and clinics.
I would like to take this opportunity to personally thank all of those people, if I miss anyone I apologise.
OPERA TIO NS NORTH
• Administrative, Medical, Nursing, Patient Services and Clerical staff at RDH, ASH, GDH, and KH.
• Darwin, Palmerston and Casuarina Community Health Centres; Barunga and Beswick Health Centres; Jabiru, Ngukarr, and Binjari Health Centres; Bathurst Island, Oenpelli, Galiwinki, Maningreda and Port Keats Pine Creek; Mataranka and Adelaide River, Yirrkala and Alyangula Community Centres. Danila Dilba and Wurli Wurlinjang Aboriginal Health Services.
( \JPERA TIO NS CENTRAL
• Alice Springs Community Health Centre, Central Australian Aboriginal Congress (CAAC), Hermannsburg, Santa Teresa, Papunya, Yuendumu, Harts Range, Ti Tree, Aplatwatja Community and Mt Liebig Community Health Centres.
BEV FISHER - TELEPHONE 89227220
, .. ,.,,., .. , .. ,.'!
orizons Bulletin welcomes letters to the Editor regarding information that would be of interest to our readers or any
queries or concerns that you may have about previous articles.
Kay Cook - Editor
cc:Mail address - Cook, Kay - Health email address - [email protected]
CASEMIX NEWS AND UPDATES
QUALITY REVIEW OF CLINICAL CODING
Joanne Chicco, Quality Manager, NCCH has outlined a review on the use of codes in the following specialities and is offering the following suggestions to improve coding quality :
EAR, NOSE AND THROAT (ENT)
• CHRONIC SINUSITIS -
• SIALOADENECTOMY -
• CLEFT PALATE-
• RHINOPLASTY-
RESPIRATORY MEDICINE
• USE OF TOBACCO-
Clinical coders should seek more information from clinicians about which sinuses are
chronically inflamed. Ethmoidectomy is the most frequently coded procedure to treat chronic
~inusitis, and therefore it may be that the ethmoidal sinus is the one chronically inflamed.
Check with the clinician to determine if this assumption is correct.
The most frequently used procedure code for sialoadenectomy is 26.30 sialoadenectomy, not otherwise specified. This non-specific code, a commonly occurring problem in editing software, is a constant source of query to private hospitals from health funds.
Clinical coders should be encouraged to ask the surgeon whether or not the procedure performed is a complete or partial sialoadenectomy, and use those codes when appropriate.
Again, the most frequently used code is 749.00 Cleft palate, unspecified. Clinical coders should attempt to obtain more specificity from the surgeon.
Australian Coding Standard 0806 (Volume 4, page 84) states that "Procedures on turbinates are often performed in conjunction with a rhinoplasty or septoplasty as part of the operative approach, therefore, codes from category 21.6 Turbinectomy need not be assigned in this circumstance".
Clinical coders are encouraged to discuss the issue of coding (or not coding) turbinectomies with their ENT and Plastic Surgeons.
Australian Coding Standard 0503 (Volume 4, page 63) states that the codes for use of tobacco
"should be assigned as additional diagnoses for all cases where documentation is provided regarding tobacco consumption". Use of tobacco may fall into one of the following codes:
=> Vl5.82 History of tobacco use
=> V15.83 Current use of tobacco
=> 305.l Tobacco use disorder
Please consult this Standard for definitions of each term. These codes were introduced for use in 1995 as clinicians have realised that smoking may be linked to a number of diseases, and will undoubtedly use these codes for medical research in years to come.
• MECHANICAL VENTILATION- Don't forget to code mechanical ventilation when the patient is treated by this ventilatory mechanism for more then 24 consecutive hours. Ensure that ICU and CCU notes are consulted. Mechanical ventilation consumes high levels of hospital resources, and omission of the code may result in a hospital being under-reimbursed in a situation ofCasemix-based funding. Consult Australian Coding Standard 1006 (Volume 4, page 94) for more
information.
• PNEUMONIA - The most frequently used pneumonia code across Australia is 486 Pneumonia, organism unspecified. Once again, clinical coders should seek more specificity from clinicians.
• ACUTE PULMONARY OEDEMA - Clinical coders are reminded that if a patient with acute pulmonary oedema has coexisting heart failure or heart disease (as specified by the clinician), the diagnosis code to use will be from the 428 Heart Failure rubric. Please ensure that the lookup procedure for acute pulmonary oedema is followed carefully.
Many of the problems listed above are due to inadequate documentation in the medical record. Hospital managers should be informed of the documentation requirements for clinical coding. Policies should be implemented to ensure that all medical staff are trained to provide a level of documentation to enable the clinical coder to perform their tasks adequately.
(Source Coding Matters, Volume 3 Number 4, April 1997)
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Introducing ICD-10-AM
....•. a new disease and procedure classification for Australian hospitals and day surgeries ...•
ICD-10-AM stands for the International Statistical Classification of Diseases and Related Health Problems - tenth revision -Australian Modification.
The clinical classification consists of a list of diseases and accompanying index, a list and index of
procedures, and the Australian Coding Standards.
ICD-10-AM is based on the World Health Organisation's (WHO) publication ICD-10. The disease classification is being modified in Australia by the National Centre for Classification in Health (NCCH), with assistance from clinicians and clinical coders, to ensure that the classification is current and (appropriate for Australian clinical practice. Close links
ill be maintained with WHO to ensure international compatibility is upheld.
The new Australian classification of procedures is a multiaxial classification based on the Medicare Benefits Schedule (MBS) and is referred to as MBS- Extended or MBS-E.
The Australian Coding Standards, set by the NCCH, are national standards for the coding of clinical data, and will form another integral part ofICD-10-AM.
BENEFITS OF THE NEW CLASSIFICATION :
The planned introduction ofICD-10-AM will have significant benefits for Australian health services in terms of the completeness, accuracy and integrity of coded health data. The new classification will give a greater specificity in code assignment, a more logical ( esentation, a dual system for coding the
manifestation and aetiology of certain conditions, more consistent method of coding post-procedural
conditions, and an improved format. In addition, through an annual updating process, ICD-10-AM will remain current and relevant to Australian clinical practice.
WHEN IS ICD-10-AM TO BE IMPLEMENTED:
The Australian Health Ministers' Advisory Council (AHMAC) has unanimously endorsed the
implementation of ICD-10 and a new Australian procedure classification for use in all Australian hospitals and day surgeries from 1July1998. ICD-10- AM is due to supersede the currently used ICD-9-CM (International Classification of Disease - ninth revision - Clinical Modification). The introduction of the new classification system is being overseen by the National Committee for the Implementation of ICD-10 in Australian Hospitals, whose membership reflects the
wide range of users of the clinical classification.
Organisations and stakeholders represented included health authorities, private hospitals, health insurers, educational facilities, the Health Information Management Association of Australia and National Centre for Classification in Health (NCCH).
DIFFERENCES BETWEEN ICD-9-CM AND ICD- 10-AM:
Diseases -ICD-10-AM uses an alphanumeric coding scheme for diseases. It is structured by body system and aetiology, and comprises three, four and five character categories.
Procedures -MES-Extended (MBS-E) is an Australian classification of surgical procedures and interventions based on MBS. It has been developed by the staff of NCCH with assistance from specialist clinicians and clinical coders. MBS-E codes have seven digits, the first five being the MBS item number plus a two digit extension to represent the specific procedures included in that item. The classification is structured by body system, site and procedure type. Procedures not currently listed in MBS have also been included ( eg Allied Health interventions, cosmetic surgery).
EDUCATION FOR ICD-lOAM:
To assist with the transition to ICD-10-AM, a range of educational programs are planned for clinical coders, and for users of coded data, such as staff in health authorities, insurers, researchers, hospital managers, epidemiologists and Casemix co-ordinators.
An implementation kit to support the introduction of ICD-10-AM is now available from NCCH (Sydney).
Education will be offered in a variety of training formats ( eg face to face workshops, distance education courses etc) with a number of organisations and associations being involved in development and presentation.
FOR FURTHER INFORMATION :
Contact Kay Cook on telephone 89 992749 or if you wish to speak to someone from the Centre, contact Faculty of Health Services, University of Sydney, PO Box 170, Lidcome NSW 2141 or telephone
61293519461 or fax 61 2 93519603.
MARKETING
The Department of Health
&
Family Services have a large educational series of Casemix books. They have now issued a new book into their series ... for Mental Health Workers, their clients and their carers.Mental Health in Context: An Introduction
Applied information technology is central to effective health care. Diagnostic an re ent decisions require detailed information from and about patients. Managing the health system requires equally detailed information.
Mental Health in Context : An Introduction is about the application of Casemix Classifications to mental health care.
FEATURES INCLUDE:
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An introduction to general issues in health economics and the funding of health services+
An introduction to Casemix+
An extensive annotated bibliographyI now have this book which is available for lending. Please give me a ring if you would like to borrow the book. ...
AUSTRALIAN CASEMIX BULLETIN
The Australian Casemix Bulletin is issued on a quarterly basis; these bulletins are very comprehensive and well worth having a read of. I hold 1996's editions so if you would like to peruse, let me know.
KAY COOK - EDUCATION AND MARKETING COORDINATOR - TELEPHONE 89 9927 49
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HORIZONS BULLETIN PRODUCED BY:
BUSINESS INFORMATION MANAGEMENT BRANCH HEALTH HOUSE, MITCHELL STREET DARWIN DIRECTOR
EDITOR/PUBLISHER FORMAT
ENQUIRIES
PRINTED NEXT EDITION
STEPHEN MOO KAY COOK MICHELLE FIDOCK STEPHEN Moo 89992847 OR KAY COOK 89993749 GOVERNMENT PRINTER OF THE NT MAY/JUNE 1997 - EDITION NO. 12
THE NINTH CASEMIX CONFERENCE IN
AUSTRALIA
BRISBANE CONVENTION &
EXHIBITION CENTRE
7 • 1 0 SEPTEMBER 199 7
THE 1997 CASEMIX CONFERENCE IN AUSTRALIA WILL BE THE NINTH IN THIS
SERIES OF CONFERENCES HELD NATIONALLY IN THIS COUNTRY.
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Government Printer of the Northern Territory