Dialysis Reporting Adapting to the New Reality Virginia Guthrie Manager Health Data and Analysis

Current State ADT system is STAR (HBO) Abstracting/Encoding system is 3M, with a manual interface 350 patients treated within the Dialysis Program at St. Joseph’s Healthcare (each with potentially 3 visits per week)

Support Groups ACRTF Ambulatory Care Reporting Task Force St. Joseph’s Task Force Dialysis Focus Group Health Records Finance MIS Registration IT

Volumes Average 5250 patient episodes per month Plus approximately 400 second contact abstracts per month

Preliminary Challenges How do we accurately and efficiently register all patients? How are our MIS Functional Centre resources allocated? How are we going to code all this?

Patient Profile in STAR Based on Physician documentation (clinic summary) ICD-10-CA codes are assigned by coding staff (proactive) Codes are entered into User Defined fields in STAR These fields reside at the MPI level and therefore can be loaded for every series contact

User Defined Fields in STAR ICD-10-CA MAIN Dx (table) ICD-10-CA Dx2 ICD-10-CA Dx3 ICD-10-CA Dx4 ICD-10-CA DX5 CCI INTERVENTION (table) Inst. To Inst. From

Customization of 3M abstract User Defined fields from STAR are added to the load file (actual codes appear in abstract) All possible fields are defaulted to the most common value Mode of visit Visit Disposition Lab MIS FC

Coding by exception Coders maintain Patient Profiles in STAR Coders review abstract and compare to Dialysis Flowsheet Codes are changed or added as required (only exceptions to the normal coarse of treatment) Initiate encoder and compute

Information Flow Flowsheets are received from the Dialysis unit on a weekly basis But there is a full month lag time due to information needs for patient care within the unit Coders review and then the documentation is filed

Present Productivity Productivity goal is 400 abstracts per day Actual productivity average is presently 325 abstracts per day most productive day - 476 least productive day - 263 Anticipate passing productivity goal within the next 3 weeks

Lessons Learned Identify key stakeholders and make sure they participate Communicate with your peers Learn to adapt Streamline processes Compile clear policies and procedures BE CREATIVE!