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

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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

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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

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Selecting Audit Type

Open AudITs display all previous codes and associated information to the Auditor.

Blind AudITs only display the summary episode information

AudIT

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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

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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

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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

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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

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Analysis and Reporting

The Suite of Error Summary Reports are generated from a similar set of filters to theSelection Sampling Engine

AudIT

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New Technologies

AudIT has been built in part using a data-point technology called Perfect Data.

Contact John Dowling (0407 099 071) 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

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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

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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

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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

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For more information contact:

Lucy Fisher

Executive Director

PHAQ

(07) 3279 7600

lucyf@phaq.org