Using SNOMED CT in Casemix for Determining Costs for Pathology Services

Transcription

1 Using SNOMED CT in Casemix for Determining Costs for Pathology Services Georg A Brox, Janis L. Huston Independent Healthcare Consultants; Scarborough, United Kingdom jangeorg@yahoo.com

2 Casemix Design for Costs in Pathology Background Requirements for Casemix Tool Design (Healthcare Resource Groups HRG) Why HRG and not DRG? Why SNOMED CT and not an intervention classification? Requirements and work done to create Pathology HRG

3 quietly funded

4 Cost collections available at the Department of Health (DH) for 2006 Specialty No. of National Interquartile Range of Unit Costs 2 No. of Data Code Specialty Label Tests Average Unit Cost Lower Quartile Upper Quartile Submissions DAP823 Haematology [Excluding Anti-Coagulant Services] 41,593, DAP824 Histology / Histopathology 1,894, DAP830 Immunology 1,436, DAP831 Microbiology / Virology 17,899, DAP832 Neuropathology DAP838 Cytology [not including Cervical Screening Programmes] 979, DAP839 Phlebotomy 1,164, DAP841 Biochemistry 151,791, DAP842 Other 3,299,

5 Casemix Tool Design Review existing coding and terminology systems Creation of Pathology HRG Dataset Development of Complexity Matrix Pathology information dataflow

6 What are Health Resource Groups (HRG)? Similar to Diagnostic Related Groups (DRGs), a way to allocate resources for treatment and diagnostic costs but unlike DRG, HRG have the possibility to identify Dominant Grouping Variant Procedures (DGVPs) along with Major Diagnostic Categories (MDC) either together or alone in each clinical specialty (HRG chapter) Pathology depends on procedures, but is also dependent on diagnoses of previous procedures for the same patient in order to make procedures of higher complexity clinically meaningful the HRG grouper is available in 2 formats: downloadable tool for either stand alone or system use (i.e., in the National Secondary User Service [SUS]) services/classification and standards/casemix/prepare for hrg4 click HRG4 reference cost grouper

7 WELCAN UK 93 (Welsh Canadian) System Workload Measurement System for Pathology Nationally recognized schedule of Unit Values Includes pathology procedures across all specialities First reviewed in the Province of Alberta for the Welsh Office

8

9 OPCS 4.3 a problem for Pathology Services SNOMED CT Procedure (label) SCT Concept ID SCT Description ID WELCAN' 93 (Labels) WELCAN' 93 (Code) SNOMED v 3.5 (Description) SNOMED v 3.5 ID READ CTV3 ID READ CTV3 (Description) OPCS4.3; OPCS4.4 Antidiuretic hormone measurement Adrenal hormone - serum measurement Antidiuretic hormone 2355 Arginine vasopressin measurement P XaERn Plasma arginine vasopressin level XM1VA Adrenal hormone - serum U29.6: Arginine Vasopression response to hypotonic saline test U29.5: Adrenal suppression test Glucagon stimulation test Glucagon tolerance panel, for insulinoma, including glucose and insulin measurements P X77YA Glucagon stimulation test U29.2: Insulin secretion glucagon test OPCS 4.3 codes are ambiguous and partly contain clinical preparation procedures to carry out a pathology test

10 Content Sources for the HRG Pathology Database National Pathology Alliance Benchmarking Review University of Keele Representatives Members of the Specialty Panel Biochemistry Cytology Haematology Histopathology Microbiology Radiology Virology

11 Is machine readable: SCTID Concept ID SCTID Description ID SCT Compositional grammar Representation of SNOMED CT System: Pre coordinated terms (Enumeration) Post coordinated terms used for electronic messaging and EPR Not used for messaging or EPR used for basis of messaging and post coordination Compositional Grammar: Compositional Grammar: Rules, Rules, sanctioned sanctioned attributes, attributes, relationship, range range of terms, of terms, and and tests tests of composite of composite terms terms Compositional Grammar format: suspected condition : associated finding = ( fracture of tibia : associated morphology = chip fracture, laterality = left, finding site = malleolar structure of tibia ) Domain Attribute Range Clinical Finding Pathological Process autoimmune Interpunctuation (Bachus Naur Form (BNF): ws means Whitespace ) : concept::= ws conceptid ws [" " ws term ws " " ws] attribute::= attributename ws "=" attributevalue attributeset::= attribute ws ("," ws attribute ws) more than one attribute attributevalue::= concept (ws "(" expression ")" ws)

12 Sample of Pathology Procedures which drive Healthcare Resource Groups (HRG)

13 Minor Pathology Test Intermediate Low cost level 1A One ordered test could mean: series of laboratory procedures Minor Pathology Screening/Test Low cost level 3 Procedures in Pathology require a 2 tier system: complexity level of methodology procedure cost level The levels of both tiers are not necessarily correlated to each other Major Pathology Test High cost level 22 Manual procedures in histopathology to enable the analysis of a diagnostic image Intermediate Pathology Test Neuropathology: Major Pathology Test Intermediate cost level 16 High cost level: 30

14 Complexity Matrix of Pathology Procedures Procedure Codes Diagnostic codes Category 1 laboratory test procedure w/o clinical diagnosis (any specialty) Category 2 laboratory procedure with clinical/pathology diagnosis; clinical/pathology diagnosis required (any specialty) Category 3 extended laboratory procedure based on clinical/pathology diagnosis Excludes: requests for Immunocytochemistry, diagnostic Cytogenetics, or Electron microscopy Category 4 extended laboratory procedure based on clinical/pathology diagnosis Includes: requests for Immunocytochemistry Excludes: diagnostic Cytogenetics, or Electron microscopy Category 5 extended laboratory procedure based on clinical/pathology diagnosis Includes: animal inoculation/virus morphology Excludes: requests for Electron microscopy Category 6 all extended laboratory procedures based on clinical and pathology diagnosis

15 HRG4 Flag Logic Description a e f g h j k Direct mapping to HRG from diagnosis or procedure Dominant procedure and primary diagnosis combination. Dominant procedure and primary diagnosis combination, or secondary procedure. Dominant procedure and primary diagnosis combination with secondary diagnosis, or dominant procedure and primary diagnosis combination. Dominant procedure and primary diagnosis combination with secondary procedure. One subsequent procedure. Two subsequent procedures. HRG4 logic for Pathology Used where a specific primary diagnosis is defined in combination with the procedure. Used where the primary diagnosis or a secondary dominant procedure in any combination. The procedure defines the correct group Used where the combination of dominant procedure and a specific diagnosis is required (which can be a secondary diagnosis) Used where a primary diagnosis and 2 procedures are required in combination (one of the procedures is required to be dominant). Used where a combination of 2 codes in successive order is required, the second providing additional information about the first (i.e. qualifier of intended procedure or substance of submitted material) Used where a combination of 3 codes in successive order is required, the second and third providing additional information about the first such as qualifier of intended procedure or substance of submitted material and/or indicating urgency Pathology Chapter WG Y Y Y Y Y Y Y l u v z Secondary diagnosis. Used when a specific secondary diagnosis confirms the presence of a condition pertinent to grouping Newly created HRG4 logic for Pathology 1 HRG of previous test was already assigned More than 1 HRG of previous test was already assigned; Clinical Diagnosis and or Pathology Diagnosis with previous HRG(s) SNOMED CT code combinations added Qualifier and Substance Codes: - Used when SNOMED CT codes is associated with up to 3 Qualifier codes and up to 1 substance code Y

16

17 Sample of Diagnoses (clinical findings) relevant as additional Information to allocate appropriate Levels of HRG Minimal changes disease of Glomerulonephritis DNA Instablity Syndrome Acute myeloid leukaemia without maturation FAB M1 Centromeric instability syndrome of chromosomes 1,9 and 16 and immunodeficiency

18 Report HL7 XML Required codes and terminology for HRGs <Specimen classcode="islt"><id root=" " extension="i, a"/> <specimennatural classcode="ent" determinercode="instance"> <code code=" " displayname="e.coli"/> </specimennatural> </Specimen> <component typecode="comp"> <ObservationBattery classcode="battery" moodcode="evn"> <id root="3ca988cb 28BB FCC 7E5BE7C55138"/> Mobile POC test? <code codesystem=" " code=" " displayname="culture sensitivity"/> <component typecode="comp"> <sequencenumber value="1"/> <ObservationEvent classcode="obs" moodcode="evn"> <id root="3ca988cb 28BB FCC 7E5BE7C55039"/> <code codesystem=" " code=" " displayname="antibiotic sensitivity, disk method"> <qualifier> <name codesystem=" " code=" " displayname="amoxycillin"/> <value nullflavor="na"/> </qualifier> </code> <statuscode code="completed"/> <interpretationcode codesystem=" " code=" " displayname="sensitive"/> Modified from original slide authored by: Ian Green, Connecting for Health Laboratory Communications January 2007

19 Thank you!..any questions, please??! Dr Georg A Brox and Dr Janis L Huston jangeorg@yahoo.com ICD10 K29.5