Activity based costing of medication to the individual in the public hospital setting. Date: May2015 Prepared by: Dr Peter Cronin Prepared for: Activity Based Funding Conference 2015 Agenda ̶ Collaborators ̶ 1 Understand – Context, Question ̶ 2 Analyse – Analytics engine development ̶ 3 Communicate – Web based reporting ̶ Challenges ̶ Demo and Interim Results ̶ Opportunities St Vincent’s Hospital, Sydney • E health innovator • First hospital in Aust to roll-out EMMS across inpatient wards incl ICU • First hospital in Aust to connect to PCEHR and upload discharge summaries, specialist letters, event notifications • First hospital in NSW to implement wireless infusion pumps with dose error reduction software • First hospital in Aust to implement active RFID tracking of medical devices • Developed, implemented and commercialised its in-house PAS and clinical information systems • 80:20 Rule …. The game is “communications and behaviour change” • System integration … more than sum of parts … • IT Department - nimble, flexible solutions. In-house, open source, vendor Prospection • Health analytics company – cloud based web platforms • Medication utilisation– 200m script claims, geo-mapping Medication vs Pharmacy costs Direct Pharmacy costs = medication + salaries and wages + goods and services + other Source: Australia’s hospitals 2012-13 at a glance AIHW Source: NHCDC COST WEIGHTS FOR ARDRG VERSION 6.0x, Round 17 (2012-13) Defining Scope In scope – Medication costs per DRG • Medication costs only related to each inpatient episode of care including dispensed, distributed and discharge medication using the average weighted inventory cost Out of scope • Outpatient Presentations • Emergency Presentations and Admissions • Inpatient medication documented on paper charts e.g. complex infusions (dobutamine, levosimendan, heparin), insulins • Maintenance fluids – e.g. sodium chloride 0.9% (distributed and costed by stores) • Theatres – most intra-op medicines are recorded manually on “blue” paper chart • Non-Medication Pharmacy costs The Problem • Activity Based Funding (ABF) - how can we allocate medication costs to an individual patient? Pharmacy • Have the data but…… Inventory (stock on hand) Purchases (info sent to Oracle / General Ledger) Distributed stock (at SVHS inpatients approx. 60% of drug costs) Dispensed stock Clinical Scenario – Blood and Marrow Transplant Snapshot of MedChart® admins Yellow = items kept on this wards imprest Green = individually dispensed to the patient Blue = chemotherapy externally manufactured and costed to the patient The challenges - data gathering iPharmacy • Medications dispensed (inpatient, leave, discharge) • Medications distributed (imprest, other) • SKU level costing • NSW HPPL therapeutic classifications MedChart • Administered Medications • Dose level administration • Phase 2: medication on admission histories, medication orders (prescriptions), discharge medications PAS / HIE • Patient info • Admission info (Episodes, AMO, Specialty, Ward) • DRG (+ ICD 10 diagnoses) Baxter • Externally compounded medications (Chemotherapy, antibiotic infusors, eyedrops) • Costs independently charged The Solution – interactive, visual The Solution – drill down Costing → Utilisation The Opportunities • Medication Costing → Other Costing • Pathology • Imaging etc • Medication Costing → Medication Utilisation • • • • Quality Use of Medicines Reporting Treatment monitoring / outcomes Specialties - Antimicrobial stewardship etc Prediction models Acknowledgements ̶ Prospection – Eric Chung, Ricky Chen, Meng Xie, Amelia Papamanos ̶ St Vincent’s Hospital – David Roffe, Kate Richardson, Skip Hodgson, Vinh Dinh Bui, Melita Howes, Prof Ric Day. ̶ Centre for Health Informatics - Professor Enrico Coiera ̶ NSW Trade and Investment NSW Innovate Collaborative Solutions ̶ Ethics Approval: HREC : LNR/14/SVH/334 Prospection Pty Ltd National Innovation Centre Australian Technology Park Suite 145, 4 Cornwallis Street Eveleigh NSW 2015 Dr Peter Cronin E [email protected] P +61 (2) 9209 4035 M +61 413 803 072