1. BC SCR CALL DECEMBER 2011

2. Outline Updates - What is you biggest challenge at this time? Providence Health – Data Automation Online Community at BCPSQC Website CPT Codes BC NSQIP Timeline and Important Dates

3. Updates: (1-2 minutes per site) When did you start your ramp-up? What is your biggest challenge at this time?

4. Providence Health Authority’s Data Automation and Data Quality Control Strategies - Paul Smith, Clinical Care Analyst

5. PHC Automated NSQIP Data Our Team Lisa Toback Paul Smith Julie Pichur Meghan Macleod Also Starring….. Karl Newholm & Bruce Nicholson Decision Support Team

6. Overview  Background & Context  Where we where & where we are now  Our Current Strategies (What we can do)  Use of the database – OR Log & Crosswalk  Worksheets & Call Sheets  Uploading & Data Cleaning  Our Strategies for the Future  Q & A Session

7. Background & Context: Where we were: – Spending on average 1.5 days each SCR to – Collate OR Log – Choose Cases – Writing up Worksheets & Telephone Scripts – Entering basic Information into NSQIP Workstation – Only at the beginning of data cleaning – We were behind about 6 to 7 cycles – All charts available electronically (We are 2 sites collecting 80 cases per cycle with 2.5 SCRs)

8. Where we wanted to be  Spend far less time on paperwork & more time collecting the data and analysis  Catch up with our cycles  Enable a long-term robust system for data collecting and processing  Begin a journey for paperless environment  Spend far less time on paperwork & more time collecting the data and analysis  Catch up with our cycles  Enable a long-term robust system for data collecting and processing  Begin a journey for paperless environment

9. How did we get there?  Facilitation from Leader of Decision Support Team– Karl Newholm  Karl’s insight for data automation  Karl brought Bruce Nicholson to us to collaborate for data automation  Bruce developed our database with automation features based on OUR needs  Built-in capacity for future needs

10. Main Page

11. Operating Log

12. Uploading Data to NSQIP Workstation

13. Filtering the Data

14. Worksheet Cover

15. Procedure Matching

16. Data Cleaning

18. The Future Pre – Populated Surgeon Information Letter Draft Written – waiting final approval G.P. Letter similar to Surgeon Letter also Pre - Populated Wait for Provincial letter first Strategies for monitoring errors in Wound Classifications ASA Scores Patient Contact Management

19. Questions

20. Online Community - Rebecca Brooke

21. CPT Code OpenLap Description 44140 44204 Partial ColectomyPartial colectomy Sigmoid Resection Left Hemicolectomy 44160 44205 Right Hemicolectomy Partial colectomy with removal of terminal ileum with ileocolostomy (anastomosis of ileum to colon) Extended Right Hemicolectomy Ileocecectomy Ileocolic Resection 45111--- Anterior Resection Partial resection of rectum transabdominal approach 4414544207 Low Anterior Resection Partial colectomy with low pelvic anastomosis 4413944213 Splenic Flexure take downMobilization of splenic flexure 4414344206 Hartmann’s ResectionPartial colectomy + colostomy + closure of distal segment Common Colorectal CPT Codes:

22. CPT Code Tissue Expander 19357 - Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion RVU: ~18 Includes Pectoralis Flap If done concurrent with Simple Mastectomy: Add 19303: RVU~15 If done concurrent with Radical Mastectomy Add 19307 : RVU ~19 If done with Pectoralis Flap + Simple Mastectomy Most US coders use 19357+19307 (just because RVU for radical mastectomy is greater than simple mastectomy) BC: use 19303, 19357 and 19499: Unlisted Procedure, Breast

23. Books: Pocket Guide to the Operating Room Maxine Goldman ISBN-13: 978-0803600331 $25.00 Netter’s Atlas of Human Anatomy for CPT Coding Second Edition, AMA ISBN#: 978-1-60359-109-6 $71.95

24. BC NSQIP Timeline and Important Dates Jan 2012 “Doug’s Challenge” J. Berkowitz on BC SCR Call Online community Feb 2012 Workshop with Kathy Rowell (Feb 8, 2012) Mar 2012 NSQIP’s SAR Release (Jul 2010-Jun 2011 Data) Apr 2012 Submit 2011 Excel Spreadsheet for Data Analysis (April 30, 2012) May 2012 First BC NSQIP Report (Jan-Dec 2011 Data)

25. Vacation Cycles

26. Q&A

27. Happy Holidays!