AudIT a project sponsored by A Presentation of the Coding Software Tool and Project Outcomes

AudIT a project sponsored by Project Background PHAQ represents 64% of Queensland private hospitals The PHAQ Health Information Manager Network was re-established in 2004 with 21 active members The high priority for members was to conduct their own internal clinical coding audits A clinical coding audit tool had been developed by PHAQ in 1997 Outcome: Re-develop the initial audit tool to meet today’s clinical coding audit requirements

AudIT a project sponsored by A Needs Survey showed... A survey of Queensland private hospital HIMs and Health Executives revealed: o No standard audit methodologies, manual sampling, no linked casemix funding rules to auditing processes o Access to coding audit expertises varies greatly o Few suitable tools for audit sampling, audit data entry, classification of coding errors, analysis and reporting o A strong desire for benchmarking of coding audit results between private hospitals o Health Executives want to demonstrate to health funds that regular coding audits are occurring

AudIT a project sponsored by Creating a Workflow AudIT operates from a a series of simple workflow steps. Each workflow is assigned a name. Each step is shown in red, once completed.

AudIT a project sponsored by Import Data Extracts An HCP file format is the initial data extract for AudIT HCP Plus allows users to quickly import and use additional hospital- specific information: Future extensions are planned to extend the importing options for State Morbidity Extract Formats · Unit Record Number · Doctor · Specialty · Ward · Coder AudIT begins by importing standard pre- defined and user-defined data sets

AudIT a project sponsored by Selecting Audit Type Open AudITs display all previous codes and associated information to the Auditor. Blind AudITs only display the summary episode information

AudIT a project sponsored by Selecting AudIT Criteria At the heart of AudIT is a random selection engine for discharge sampling Many different filters can be applied to alter the profile of records selected. The Future: AudIT will include the wide-scale expansion of these filters. Common casemix funding rules and references will be included.

AudIT a project sponsored by Performing the AudIT Diagnostic and procedural codes can managed separately or displayed together. Each record selected can be re-examined using (by the Undo Complete Button) A single data entry screen is maintained for ease of use.

AudIT a project sponsored by Performing the AudIT Additional features: Pre and post AudIT DRGs are displayed An enhancement will soon extend the automatic grouping feature to this screen Open AudITs: Each and every change has an associated reason and cause Errors are tracked code by code

AudIT Continuing Australian Coding Standards Discrepancy Causes Coder Error System Error Local Coding Policy Late Information Unclear Documentation A data standard for external morbidity coding errors in the AudIT User Network. Error Statistics derived from agreed definitions. Discrepancy Reasons Incorrect PDx Sequencing Incorrect PDx Coding Incorrect PDx Selection Incorrect Additional Dx Missing Dx Code Unjustified Additional Dx Code (non-optional) Incorrect Additional Dx (4th or 5th character) Incorrect Px Code Missing Px Code

AudIT a project sponsored by Grouping the Results AudIT has an interface with the 3M Grouper The user can determine which version of the 3M Grouper to use for each audit Viewing of the pre and post audit DRGs is flexible as shown on the previous slide Grouping within AudIT enables reports to be based on DRG changes

AudIT Entering Reports Accessing the Reporting Suite Once all data entry is completed the workflow menu is used to generate the reporting suite

AudIT a project sponsored by Analysis and Reporting The Suite of Error Summary Reports are generated from a similar set of filters to the Selection Sampling Engine

AudIT a project sponsored by New Technologies AudIT has been built in part using a data-point technology called Perfect Data. Contact John Dowling ( ) for further details.

What our Beta Sites said... “AudIT is an easy to use, flexible product that enables coding audits to be conducted and managed according to industry best practice with excellent reporting capabilities. AudIT will make our coding audit process more efficient and effective" Sallyanne Wissmann, Manager Clinical Coding Services, Mater Health Services Brisbane. May 2005

AudIT a project sponsored by Affordable Pricing $790 per hospital < 150 beds (annual subscription) Annual $990 per hospital > 150 beds (annual subscription) Discounts for State or Group purchases by negotiation Project-specific (sample size) subscription pricing models

AudIT a project sponsored by For Hospital Executives The Reporting Suite clearly shows the revenue impacts of coding quality changes Reasonably priced, cost-effective Advantages For Coders Able to have multiple unfinished audits at one time Easy sampling, data entry and suited to multi-campus auditing Workflows designed by HIMs and Clinical Coders

AudIT a project sponsored by The Future Rollout throughout PHAQ member hospitals As an intranet or secure internet product (2006) Expanding the user base (in addition to PHAQ hospitals) National marketing User forums and input into internet/intranet design Including state-based import formats Refinement and customisation of Report Suites As a workflow – fully customisable “author” controls On-line benchmarking

AudIT a project sponsored by For more information contact: Lucy Fisher Executive Director PHAQ (07)