Epworth HealthCare

Implementing information technology to increase revenue collections, reporting accuracy and optimise theatre utilisation.

 

The BriefEpworth HealthCare Logo

Epworth spends valuable time and resources ensuring the integrity of the data it uses to manage its surgical services and report to both insurers and government. A solution was required to validate the data as it is entered up front to minimise costly downstream corrections.

MKM Health was engaged to implement MKM ValidationEngine - business rules software for Patient Administration Systems (PAS) that can trigger custom messages to the user and ensure data integrity at the point of entry.

Our Client

Epworth HealthCare is Victoria’s largest not for profit private healthcare group, renowned for excellence in diagnosis, treatment, care and rehabilitation. Epworth is an innovator in Australia’s health system, embracing the latest in evidence-based medicine to pioneer treatments and services for our patients. 

Epworth comprises seven hospitals across the Melbourne metropolitan area, and three specialist centres. In 2016, Epworth will also open a new teaching hospital in partnership with Deakin University.

 The Situation

Epworth uses CSC’s iPatient Manager product for patient administration and billing. Epworth wanted to be able to define edit checks to validate data at the point of data entry to its PAS. It also wanted the ability to build additional ‘Epworth specific’ business rules (via MKM ValidationEngine) that were not natively supported by its underlying PAS application. This would provide Epworth with the ability to monitor, intercept and/or create events and to ensure that data errors would be ‘trapped’ at the source - preventing the user from making mistakes or omitting essential information in the first place.

Epworth also needed to be flexible and responsive to reporting requirements of statutory bodies and health funds. It was suggested by MKM Health that Epworth could be the first site to leverage its own technical in-house capabilities and write its own business rules, giving it control over priorities, timeframes and edit checks.

The Solution

MKM ValidationEngine is a non-obtrusive overlay that monitors the users’ interaction with the PAS. It allows an additional ‘layer’ of defined business rules to be applied to the entered data, integrating seamlessly with hospital systems and work practices.  It is designed to help align IT systems more completely with business processes and data validation rules.

Essentially MKM ValidationEngine can trigger an ‘event’, which is typically a warning screen or additional validation (i.e. an OK button), at the point that the user is entering the data into the system (PAS). This means that the incorrect data is fixed before it occurs.

The initial project was completed over a three month duration over three phases:

  1. Based on the agreed rule specifications, initial rules were selected for MKM Health to build and to use as examples for the Epworth team
  2. MKM Health then worked with Epworth developers in order to handover these rules and to train them in rule creation - this also included installation of the framework which would then make it relatively simple for Epworth to build and implement additional business rules
  3. Epworth then created in-house rules with support from the MKM Health team

The Result

Epworth now has the ability to write its own business rules, to its own specifications to be applied at any point in the PAS data entry process, within existing software applications.

Significant benefits have been delivered from the implementation of MKM ValidationEngine including:

  • Valid and complete data capture (including capturing the correct funding arrangements)
  • Removing the need for significant manual intervention to correct data issues
  • Reducing the time lag on request for edit checks to be applied in the software by the vendor
  • Avoiding the need to develop or maintain validation reports and separate software packages to check and manage the quality of data
  • More accurate data, captured at source, for all levels of reporting
  • More timely delivery of statutory and other extracts
  • Reducing ‘process’ orientated training required for end users

One rule that Epworth developed forces estimated Commonwealth Medicare Benefit Schedule (eCMBS) codes to be entered into PAS when creating a theatre booking. Since this rule went live in September 2014 compliance has increased nearly 25% between August and December 2014, with the goal of 100% compliance now in sight:

 

Epworth eCMBS hospital Statistics

 

The main benefits of capturing the eCMBS at the time of booking means that Epworth can now more accurately (or proactively):

  • Calculate duration of procedure to predict expected utilisation
  • Allow bookings to know when optimal utilisation has been reached or identifying sessions that are under used and to book additional sessions
  • Manage AM sessions to reduce the impact on PM sessions by running overtime
  • Reduce unplanned staff overtime by predicting late sessions
  • Check patients’ level of cover under their health fund
  • Predict discharge dates and improve bed management capabilities
  • Predict required instrumentation for each specific type of procedure
  • Allow wards to understand incoming acuity of patients based on accurate admission reason

The Future

MKM Health continues in a support role to Epworth on an as-need basis. We continue to provide advice and software upgrades as required.

 

Related Stories:

Data Errors Can Cause Harm
Empowering the Victorian State Department of Health and Human Services
MKM Health ValidationEngine