Sub Acute & Non Acute Clinical Data Collection & Activity Based Costing

Situation

The NSW Health branch responsible for Casemix required a new system to replace a legacy MS Access database. The requirement was for a system to record the episodic data for palliative care, rehabilitation, psycho-geriatric care, clinical assessment and eventually ambulatory care. This represents around 5,000 to 6,000 inpatient admissions each year. The main purpose of the data collection is for case classification and costing.

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Unlike the original system, Synaptix was to be deployed as an enterprise wide database to be accessed by clinicians at all public hospital facilities throughout the NSW. The solution also required integration via HL7 messaging with the core patient administrative system (PAS).

The Synaptix system supports the following high level requirements including:

  • enabling the Casemix Policy Unit to both manage and maintain the system
  • new items, or changes to existing data items for minimum datasets to be defined
  • new reports and extracts to be set up
  • comply with statutory and mandatory reporting to NSW Treasury and the Commonwealth
  • reporting of benchmarks and other performance data
  • analysis and planning of step down care services
  • analysis and better understanding of the diversity and effectiveness of SNAP services

The key purpose of the initial system was to support assessment and classify and calculate cost weights.

Solution

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Meridian proposed that its intelligent clinical data management technology, named Clinixian, was ideally suited for creating a solution. Clinixian is an award winning application that supports the rapid development of electronic clinical applications. The technology had already been successfully used for maternity care solutions in NSW, TAS and QLD and for a Drug and Alcohol and Visit Management system for Justice Health in NSW.

The approach underlying Clinixian is to separate the clinical knowledge from the application code by providing two major components, a modeller and an application browser.

The modeller allows expert users, such as clinicians, to define the data terminology, associated rules and reporting. The modeller records all this knowledge in a database called the subject model. This subject model is easily maintained by one or more domain or subject matter experts.

Approach

Almost all of the clinical knowledge was already available in the legacy MS Access database schema. Meridian prepared scripts to extract meta data from the schema and import and transform them into the modeller. This saved a significant amount of effort and avoided potential migration errors.

Meridian conducted modeler training for key users of the system who are familiar with the SNAP subject matter. Using the modeller cut and paste capability the Synaptix model was created from the imported elements.

While Meridian has played a significant role in the initial development of the Synaptix model and business rules, this was done in close consultation with the expert users. It is been demonstrated that these expert users can assume complete responsibility for the model contents and its ongoing management.

The system has completed extensive user acceptance testing (UAT) in November 2008. It was be deployed throughout NSW starting in January 2009.

Key Advantages to NSW Health

  • The ability to develop and refine the SNAP data collection model in close consultation with all stake holders
  • The opportunity for Department of Health staff to assume a primary role in the SNAP model development
  • An exceptionally consistent and easy to learn user interface
  • Automatic integration with core administrative system, PAS (Patient Admission System) using HL7 messaging
  • Flexible reporting and analysis capability that requires a minimum of IT skills
  • Scalable architecture that can be used on a single workstation or on an enterprise wide basis.