Daniel Diekmann ID Information und Dokumentation im Gesundheitswesen Leiter Geschäftsbereich Medizin

Transcription

1 Daniel Diekmann ID Information und Dokumentation im Gesundheitswesen Leiter Geschäftsbereich Medizin Studium Humanmedizin Berlin Betreuung von Projekten im Bereich Dokumentation, Codierung, interaktive Wissensbasen Projektleitung Harrisons Innere Medizin in ID DIACOS Teilnahme an Projekten zur Gesundheitskarte 2006

2 Coding, Classifications, Medical Terminologies Concepts and Principles for Health Care Systems Warsaw September 2006 ID Berlin 1

3 Products, Services Coding, Controlling, Plausibility, Terminology Leistungsanalyse ID DIACOS Entgeltermittlun EBM g ID ID EFIX EBM Grouping CHECK ID Grouper ID G-DRG ID PHARMA Plausibilität KR CHECK CHECK ID MACS in ID LOGIK ID TASmed Leistungsdefinition ID DIACOS Waldeyer digital Harrison digital Pschyrembel digital ID CONSULT Klinische Systeme Wissen ID DIACOS Pharma Telemedizin Abteilungssysteme KIS DMP Wissensanalyse ID - Information and Documentation in Health Care Standard software and consulting for medical do Support of classifications and nomenclatures: ICD-9, ICD-9 BMAGS, ICD-10 WHO, ICD-10-GM, ICPM, OPS, ICD-9-CM Vol. 3 (CHOP-4), AO-Klassifikation, QUADRA, KIKA, TNM, KHG, CHIDOS, Wingert-NC Knowledge bases, coding guidelines, reimbursement systems and books, Clinical Guidelines Approximately hospital sites use solutions, insurers as well 2

4 Goals for Health IT 1. Precise clinical information 2. Management support 3. Standardized communication 4. Services to improve clinical workflow Goals for Health IT 1. Precise clinical information 1. Coding 2. Classifications 3. Medical terminologies 3

5 ID DIACOS multilingual Polish Why coding? 1. Best standardized description within patient record 2. Basis for reimbursement (DRG) 3. Problem: loss of information 4. Physicians consider coding as extra work (Bureaucracy) 4

6 ID LOGIK - Terminology Server ID MACS medical semantic network Med. dictionary > Stems >several millions of words Med/nursing präcoordinated Concepts Nomenclatures ID MACS SNOMED CT Classifications currently > 60 ICD ICPM OPS ICD-9 CM ATC CHOP References Guidelines Harrisons Innere Medizin PubMed Cochrane > Pharmaconcepts Reimbursement AP-DRG G-DRG AR-DRG LKF ID DIACOS Multilingual Coding / search Search entry HCV Classification structure Search results 5

7 Classification Systems and Languages Semantic Connections Diagnoses / Procedures 6

8 ID DIACOS multilingual German ID DIACOS multilingual English 7

9 ID DIACOS multilingual Mandarin ID DIACOS Specialised Medical Documentation 8

10 Beyond coding Architecture ID-Products Layers GUI KIS (SIEMENS, SAP, isoft, Agfa,...) ID DIACOS / ID GROUPER / ID KR CHECK / Harrison ID PHARMA CHECK, ID Doctor s letter, Informationsextraction from findings ID LOGIK (workflow-orientied Integration) Business-Logic OLE, WebService, Socket XML, HL7 V3.0, ID ID LOGIK Coding Hitlists DRG Parsen Plausibility Extraction Pharma JAVA ODMG Java, Delphi References Data Reimbursements Clinical concepts ID MACS -medical semantic network Classifications Rules References Wingert Nomenclature Semantic links 9

11 ID DIACOS Profile First introduced in 1985 for encoding of diagnosis and procedures Clinical documentation Integration of reimbursement solutions (e.g. DRG) 2006 > 1,000 hospitals in Germany, Austria, Switzerland, Slovenija Used by insurance companies More than 50 co-operation partners Integrated as a sub-module in hospital information systems, radiology information systems, lab-systems, administrative systems and others ID DIACOS Advantages Precise coding and DRG grouping Designed for needs of physicians Independent from classifications with ID MACS Client server technology Easy to integrate in existing systems International communication of emergencies International comparisons of DRG systems Multilingual EPR Plausibility checks of diagnostics and therapies Basis for telemedicine 10

12 Goals for Health IT 2. Management support 1. On time Data crucial for decisions 2. Medical controlling has the same importance as Financial controlling for hospitals 3. Case management is not possible without Medical Controlling tools Consequences of DRG introduction in Germany Reduction of average length of stay (11 days in 2000, 8 days in 2005) Standardised Clinical data sets Active quality discussions (ISO, Joint Commission) Increased financial pressure on hospitals Reduction of number of hospitals Rise of private hospitals After optimizing revenue cost controlling is major issue Introduction of pathways 11

13 DRG lessons learnt 1. Coding quality is crucial, of course 2. Good coding quality alone won t make you successful 3. You need a proactive medical controlling, constant monitoring of coding errors, length of stay, Quality management (patient with complications, which are readmitted cost you money) 5. Integrated Care concepts become important 6. It doesn t work without a IT structure 7. Reform your IT-solutions stepwise and reasonable, big shots (i.e. the all integrated system) may cause more damage than help ID EFIX DRG Analysis 12

14 Configuration DRG - figures Configuration Quality indicators 13

15 report ID EFIX Planning Module 14

16 ID EFIX plus Medical Pathways Goals for Health IT 3. Standardized communication 1. Solutions for Health Card projects 2. Intersectoral interoperability 3. Web Service Technology / Service oriented architecture 15

17 Goals of Electronic Health Card Interoperability Physician A Physician B Medical actions Medical content Health Card Pragmatic Interop. Semantic Interop. Medical actions Medical content XML-Structure Signatures HL7, Connector Syntactic Interop. Reliability Communication XML-Structure Signatures HL7, Connector ID MACS Standardised Communication D0015B1 V0005E1 V0005F2 GA000D2 GA00DD5 GA00F54 T GA000DF <value xsi:type= CD code= E05.8 codesystem codesystemname= icd10gm2006 >... <translation code= D0015B1 codesystem= codesystemname= IDMACS /> </value> Intersectoral Communication Coding 16

18 Communication Standards Technical Standards Edifact, HL7, DICOM, XML Content Classifications Nomenclatures Reference Terminologies ICD-9 / ICD-10, ICPM, OPS-301, DRG, FP/SE, Score Systeme CIOMS, Wingert NC SNOMED CT GALEN, ID MACS Semantic Interoperability Stenosis LCA 80 % Stenosis R. cirumflexus 90 % 17

19 Semantic Network - Structure Medical Part Rules-Editor {main_idx} isa {D000377} {class_idx} == {48} chapter := O24 Ontology based on Wingert Nomenclature Semantic Network Rules-Engine (Arden-Syntax) Support of clinical processes Integration in HIS/MIS/EHR HIS functional Process-oriented ID DIACOS bidirectional ID LOGIK + ID MACS - msn Coding/ Capture DRG- Grouper Plausibility References Direct access to ID LOGIK -Services 18

20 Goals for Health IT 4. Services to improve clinical workflow 1. Decision support 2. Length of stay management 3. Clinical pathways On the agenda: Medication Safety Estimates for Germany regarding Medication risks: patients in hospitals every year 6 % of admissions through adverse drug reactions Deaths are discussed (exceeds traffic accidents) First Projects Indication Check shows 6-9 % of medications questionable Decision support systems not used 19

21 PharmaCheck in ID DIACOS : Morbus Crohn Abszess - Infliximab Medical Knowledge in Context to DRG 20

22 Medical Documentation DRG / Plausibility / Knowledge Outlook / Discussion 1. New health care reforms are not possible without efficient IT-infrastructure 2. Health care is very complex, implementation processes should be realistic 3. Quality of data is essential for planning 4. Terminologies, Classifications can increase data quality and may even improve quality of care 21

23 Thank you 22