1. The APV Enhancements Story
Mr. Jerry Baker, SRA
Mr. Herb Escobar, Axiom
2005 MEPRS Conference

2. 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.

3. Described in the DoD 6010.13-M, Chapter 5
The TMA Change Process
Described in the DoD M, Chapter 5

6. What Problem
are You Trying
to Solve??

8. 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:

9. What Problem Were We Trying to Solve?
APV Software Assumed All Pre-Procedure Occurred on Procedure Date
APV Software Assumed All Pre- and Post-Op Activities Occurred at Same Location

10. 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

11. The MMIG Approval Process
Service MEPRS
Coordinator
The MMIG Approval Process
TMA MEPRS Program Office
Service MEPRS Coordinator
TMA MEPRS Program Office
MMIG

12. 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

13. The TMA Approval Process
MMIG
Information
Management
PEO
JMIS1
FIWG2
The TMA Approval Process
Program Offices
Costs No
RITPO Sustainment?
IMPC3
Yes
Approval
Implement
1 Program Executive Office, Joint Medical Information Systems
2 Functional Integration Working Group
Follow Up
3 Information Management Proponency Committee

14. 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)

15. 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

16. FY05 Inpatient Cost Pool Workload Data Analysis
Follow-up
FY05 Inpatient Cost Pool Workload Data Analysis

17. 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

18. 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

19. 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….
Data Source: EAS IV Repository 22 August 2005

20. 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 expenses back to ambulatory clinics based on minutes of service (Weighted Workload)
Data Source: EAS IV Repository 22 August 2005

21. Mixture of Raw and Weighted Workload by FY05 Fiscal Month and Receiving 1st Level FCC
Note how this month, Raw and Weighted are equal.
All cost pool expenses are purified relying on Weighted workload at Rota, so only FM09 has expenses purified into A FCCs
Data suggests this MTF started counting Minutes of Service in April (fiscal month 7)
Data Source: EAS IV Repository 22 August 2005

22. Inpatient Cost Pool Purification Based on Raw and Weighted Counts by 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.
Data Source: EAS IV Repository 22 August 2005

23. 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

24. Available Resources for APV Data Improvements

28. 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.
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.

29. MEPRS
Manager

36. WAM: Ambulatory Procedure Visit (APV) Enhancements Training
Updated 03 Sep 2004
Clinical, PAS/MCP, and A&D Staff
VTC Session I

37. 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.
Background:
The APV Enhancements software modifications have resulted from analysis performed by the Navy SDS working group.
The APV module has been re-designed to accurately capture the nursing time (Minutes of Service – MOS) spent supporting APV patients for upward reporting.
In addition, the APV functionality has been modified to be more flexible and user friendly.

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

39. Course Agenda This course has the following components: Overview
File and Table Build
MAPV Option Overview
APV Workload Reporting.
Background:
The APV Enhancements software modifications have resulted from analysis performed by the Navy SDS working group.
The APV module has been re-designed to accurately capture the nursing time (Minutes of Service – MOS) spent supporting APV patients for upward reporting.
In addition, the APV functionality has been modified to be more flexible and user friendly.

40. File and Table Build Activities for the WAM APV Software
Updated 14 Sep 2004
Appendix E
File and Table Build Activities for the WAM APV Software

41. 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.
14 Sep 2004
APV Software Modifications

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

43. 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.
30 Mar 2004
APV Software Modifications

44. The APV Enhancements Story
Questions?
Comments?