2018–2019 Changes for DAD and NACRS Update on changes to data collection requirements June 2017

Background 2018–2019 is a major change year in CIHI’s 3-year change cycle for the clinical administrative databases Changes in the Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) will be implemented in alignment with case mix and classifications (ICD-10-CA/CCI) changes Changes selected for implementation are the culmination of an inclusive, consultative and considered process

High-level timelines and milestones Milestone/task Timeline DAD and NACRS data collection and submission changes confirmed October 2016 Preliminary vendor specs released (DAD and NACRS data changes only) May 31, 2017 Vendor test system available (DAD and NACRS data element changes only) August 31, 2017 Final vendor specs released (including classifications and case mix updates) December 15, 2017 2018–2019 DAD and NACRS education products released December 2017 to April 2018 Final DAD and NACRS systems available (including classifications and case mix updates) for vendor testing February 1, 2018 2018–2019 DAD and NACRS manuals released February 2018 v2018 ICD-10-CA/CCI Folio products released 2018–2019 DAD/CMG+ and NACRS/CACS systems go live April 2018

DAD and NACRS changes

Improve care transitions data Changes standardize codes and definitions across the DAD and NACRS, where applicable Discharge Disposition Added new codes to capture more details for Died (e.g., medical assistance in dying) and Leave (e.g., AWOL separate from left against medical advice) Clarified definitions and aligned edits Institution From/To numbers and types Revised Institution and Analytic Institution Types with new categories and definitions to capture transitions to emerging post-acute care settings (e.g., hospice, community mental health, group living/supportive housing, transitional housing) Revised and deleted hard edits to align with changes in institution types and definitions

New valid Visit Disposition legend Category Description Code Database Transfer Inpatient care 01 DAD and NACRS ED and ambulatory 20 Residential care 30 Group/supportive living 40 Correctional facility 90 Home Private home 05 Leave AWOL or leave post-registration 61 LAMA or leave post–initial treatment 62 Left after triage 63 NACRS only Left after initial assessment 64 Did not return from leave 65 DAD only Died while on pass/leave 66 Suicide out of facility 67 Died Death on arrival 71 Died in facility 72 MAID 73 Suicide in facility 74 Cadaveric Donor Cadaveric donor 08 Stillbirth 09

New Institution Type legend Category Institution/Facility Type description Code Inpatient Care Acute inpatient care 1 Inpatient rehabilitation 2 Inpatient CCC 3 Inpatient mental health 5 Inpatient palliative care 9 Sub-acute S Residential Care Nursing stations 6 Long-term care (24-hour nursing care) 4 Hospice/palliative care facility P (new) Mental health and/or addiction treatment centre T (new) Group living/supportive housing G (new) Transitional housing H (new) ED and Ambulatory Care Day surgery A Ambulatory care clinic N Emergency department E Community-Based Care Community-based clinic Home care program 8 Community mental health and addiction services M Other Other health facility F (new) Correctional facility C Other non-health facility J (new) Unknown facility U (new)

Improve care transitions data (cont’d) Edit changes If disposition is 01, 20, 30, 40 or 90 (i.e., transfer related), Institution To cannot be blank If disposition is 05, Institution To must be blank or valid institution number with Institution Type From 8 (homecare), M (community mental health and addiction services), 0 (community- based clinic), F (other health facility), J (other non-health facility) or U (unknown facility) Current edits with death codes updated to include new range of death dispositions Next steps Finalize list of visit dispositions and valid institution numbers including generic and institution type listing Incorporate resources for data providers and users in manual; map between old and new codes; map local services to national institution types with generic numbers (September)

Improve mental health data New data elements (DAD and NACRS) Legal Status Upon Arrival to ED Type of Restraint Frequency of Restraint Use New data elements (DAD only) Legal Status at Admission Data elements kept (DAD) Change in Legal Status From Admission Previous Psychiatric Admissions Number of ECT Treatments Added new and deleted existing hard edits to align with reporting changes DAD: Retired Group 15 data elements Source of Referral Method of Admission AWOL Suicide Referred To ECT Treatment Education Employment Status Financial Support Mental Health flag retired from Facility Institution File

Group 15: DAD abstract layout Change from Source of Referral Method of Admission Change in Legal Status From Admission AWOL Suicide Previous Psychiatric Admission Referred To   02 03 04 05 06 07 08 ECT Treatment   Number of ECT Treatments Education Employment Status Financial Support 09 1 12 13 14 Change to Change in Legal Status From Admission Previous Psychiatric Admission Number of ECT Treatments Legal Status Upon Arrival to ED Legal Status at Admission   Type of Restraint Frequency of Restraint 04 07 1 5 6 17 8 2 3 4

Legal Status Upon Arrival to ED and at Admission Code Definition Upon Arrival to ED At Admission 10 Voluntary DAD only 20 Involuntary psychiatric assessment n/a 30 Orders for assessment/apprehension DAD and NACRS 39 Community treatment order (CTO) 40 Drug treatment court 50 Forensic admission 60 Consent to admission 70 Inmates 80 Other 99 Unknown

Type and Frequency of Restraint Use Type of Restraint M Mechanical restraint C Chair P Physical or manual restraint by staff S Seclusion room N None Frequency of Restraint Use Constant D Day or night only I Intermittent — used occasionally U Frequency of use unknown/not documented

Improve mental health data (cont’d) Edit changes To ensure new data reported for acute and psych submitting institutions for records with Main Patient Service or Transfer Service of 64/65 Legal Status on Arrival to ED (for all provinces/territories except Ontario, Alberta and Yukon) Legal Status Upon Admission Type and Frequency of Restraint Use New data elements will be validated against corresponding valid values Multiple occurrences of Type and Frequency applied for consistency across restraint use fields (e.g., if “N — None” reported for Type, frequency is also “N — None”) Next steps Update manuals with definitions and province-/territory-specific mapping to local terms Confirm mental health and addiction patient definition to be used for monitoring coverage of new fields in the DAD and NACRS

Updated Blood Transfusion Products list New blood products Cryoprecipitate plasma Cryosupernatant plasma Intravenous/subcutaneous immune globulin (IVIG/SCIG) Fibrinogen Prothrombin complex concentrate (PCC) Anti-inhibitor coagulant (FEIBA) Antithrombin III C1 inhibitor Protein C/other factors Plasma renamed Plasma — other and unspecified Standardized edit across provinces/territories to allow mandatory collection of Blood Transfusion Indicator for acute care records (excluding stillborn and cadavers) Rationale Blood Transfusion Indicator data is integral to the calculation of the Hospital Harm indicator Comprehensive and current product listing

Implement open-year quality checks in edits DAD Incorporated current open-year quality tests into new hard edits and data quality warning messages to promote high-quality data collection in the following areas Diagnosis typing Interventions and attributes Diagnosis codes that require other codes to describe complications or external causes Project 340 Canadian Stroke Strategy Performance Improvement dates/times NACRS Implemented new core hard edit and data quality warning messages to enforce correct date/time recording in Project 340 Canadian Stroke Strategy

Streamlined DAD and NACRS data collection Retire poorly used data elements to reduce burden of data collection No changes to submission layout to minimize system change impacts DAD: Retired data elements Group 01 Field 11 Second Chart or Register Number Group 07 Field 04 Abstract Overflow Group 10 Fields 05–11 Cancer Staging Group 11 Field 08 Tissue Code NACRS: Retired data elements 15 Ambulance Call Number 16 Living Arrangement 17 Residence Type 19 Ambulatory Visit Status 64–68 Units Transfused 104 Referral Date (from ED) 118, 119 Ambulance Arrival Date and Time (from day surgery and clinic care types) 120, 121 Ambulance Transfer of Care Process Date and Time (from day surgery and clinic care types) Special Project 280 (Cancer staging)

DAD-only changes

Capture Canadian Joint Replacement Registry (CJRR) data Change summary: Created new data elements to enable capture of CJRR data Added new Group 20 Hip and Knee Prosthesis Information (CJRR) New CJRR data elements to capture joint identifier, side, cement and component information, including manufacturer, product number and lot number (11 elements in total, multiple occurrences) Capture up to 2 joint replacement interventions per abstract within defined CCI codes Use of a barcode scanner strongly recommended to capture prosthesis information Added 2 new data elements in Group 11 Intervention Information Field 22 Intervention Joint Identifier and Field 23 Revision Reason added to link CJRR-specific interventions to the corresponding Group 20 prosthesis information For all DAD abstracts: Added 2 new data elements in Group 03 Patient Demographics Field 28 Height (optional) to collect height in centimetres Field 29 Weight to collect data in kilograms for all patients; optional for adults; mandatory for newborns and neonates, replacing former Group 07 Field 03 Weight (in grams) Rationale Enable jurisdictions to submit CJRR information as part of hospitalization record, as an alternative to continuing to submit to the separate CJRR database (Note: CJRR web tool to be decommissioned)

Gestational age on all stillbirth records Change summary Implemented mandatory collection of gestational age on stillborn abstracts by adding new edit and revising existing edits Rationale Improves accuracy and completeness of valuable obstetrics information

Improve obstetrics information Maternal morbidity: Capture appropriate I-code(s) in addition to the code O99.4 for all obstetric admissions for specific complication conditions New edits enforcing recording of ICD-10-CA complication code when 099.– series is recorded on the DAD abstract Rationale Ensure proper coding of pregnancy-related complication(s) and provide additional valuable obstetrics information

Improve SCU Admit Date/Time New edits to ensure SCU Admit Date/Time is the same or after Date/Time Patient Left ED Hard error: If SCU Admit Date/Time (first occurrence) are both coded and valid and Date/Time Patient Left ED are both coded and valid, and SCU Admit Time and Time Patient Left ED are both not 9999, then SCU Admit Date/Time (first occurrence) must be greater than or equal to Date/Time Patient Left ED Date/Time Patient Left ED will be changed to Z in cases of hard error

Remove Nova Scotia Special Project 308 Change summary Retired Special Project 308 (Psychiatric Information, Adult Protection Act) and all related edits Rationale The Nova Scotia ministry has confirmed that this project has been discontinued

NACRS-only changes

Emergency Department Intervention Pick-List Change summary Created 3 new data elements in NACRS for ED Level 2 submissions 173a–c ED Intervention Pick-List 174a–c ED Investigative Technology 175a–c Number of ED Investigative Technologies Performed Added new hard edits to validate new ED intervention data elements Rationale Enables assignment of Case Mix Groups and Resource Intensity Weights for ED Level 2 submissions

Vendor engagement Vendor specifications

Vendor engagement CIHI has a broad, organizational vendor engagement strategy Vendors want to be more responsive, provide good service and be efficient Vendors want to collaborate and have a role to play in DAD and NACRS data submission and use Starting with 2018–2019 data collection changes, CIHI will augment vendor data submission/edit specifications with recommended use cases and functionality (e.g., capture of weight fields, implementation of pick-list data, special project fields) CIHI will meet with vendors to explore other common features designed to enhance user experience in data submission and to increase data quality

cad@cihi.ca