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									CASEMIX CONFERENCE 2008 –
Casemix Evolution: extending the boundaries


    Can we plan for the future instead of
                obsolescence, please?

  Developing and implementing a (Casemix) data collection and
  reporting system that allows us to carry out our own ongoing
                 development and maintenance


                                        Ms Jill Marcus, Senior Policy Analyst
                              Casemix Policy Unit, NSW Department of Health
                                                    Adelaide November 2008
    OLD




It’s prehistoric
The bi-polar phase
GOOD
  It seemed like a good idea at the time…



                           Entrenched & moribund data collection

                           Expensive dependency on third party
                            vendors

                           It’s the 21st Century, it should be easier!




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
  It was a great idea…

          Change is good

          Update of the technology used

          Buzzwords: robust, flexible, intuitive




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
  From SNAPshot to Synaptix


                                      Sub-Acute & Non-Acute Patient
                                       casemix and activity data

                                      Road to Damascus

                                      Catharsis – change

                                      Reliability, veracity and simplicity




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 In the beginning……


                 Need for SNAP Casemix
                  classification

                 Australian National Sub-Acute &
                  Non-Acute Patient (AN-SNAP)
                  Classification

                 Temporary system, SNAPshot



CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 SNAP Casemix Classification

     DRG - Focus on Acute patient activity
     Inadequate tools for classification of sub and
      non-acute care

     Poor analysis of drivers and benchmarks

     Patient & goal of intervention
     5 case types – Palliative care, rehabilitation,
      psycho-geriatric, GEM and maintenance




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 Still using SNAPshot

  Temporary system
  Used by most sites still

  Issues
      Doesn’t meet information technology standards
      Microsoft Access 97
      No networking or interoperability
      Ongoing support and maintenance costs
      Lack of ownership or control

CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
  Why Change?

    Review of Information and Operational
     needs (SPAG)

    Main issues
                                Information technology
                                Quality and reliability
                                Duplication of effort




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 How can we make it happen?

       Options analysis completed
            Do nothing
            Modify enterprise systems
            Develop new system
                                                
       Business Requirements created and sent to
        vendors

       Proposals submitted


CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 What do we want?
 Key System Elements
  Interoperability

  Single database with application deployed via Citrix
   or the web;

  Ongoing system development and metadata
   management

  Reports




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 Expected Benefits / Goals

  Improve data quality
  Extract patient information from PAS
  Reduce manual data entry burden on staff
  Be easy to use
  Ownership of the statewide data collection tool
  Superior Security and auditing
  Maintaining and upgrading managed internally




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 Evolution and change

   Why Synaptix
   Successful Vendor -Meridian Health Informatics
   Database application for deployment with Citrix
   “Metadata modeller”
   Domain Experts apply changes when requirements
   change
   No cost for modifying the dataset or creating new
   functionality
   No vendor or developer required to institute change

CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 Metadata Modeller

    Traditional applications use program code to define what’s
     in it, how it works and what comes out

    Costly and time consuming

    Metadata - the agent of change

    Structured around groups, threads, archetypes and domain
     values

    Data items, reports and rules are saved as bits of
     information



CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 How it works

    Sorry

    Browser interface reads the subject model

    Determines the behavior of the application

    Subject matter free - clinical knowledge embedded in the
     model

    No need to enhance or modify the application.

    Reduces the cost, quick and easy to implement.




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 And so on……

    Focus of the tool / application is on SNAP casemix data

    SNAPshot to broad a tool creating conflicting priorities in
     product development

    Improve the profile of SNAP data and SNAP Funding Models

    Forces improvement in the quality of the data and its use

    We use the technology available to improve the user’s
     experience

    We can expand and transform when requirements change




CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
 And so on……

    Core business requirements

    The business need triggers change in the
     system not the other way around

    No need for big bucks or even big brains to
     change

    Peace and tranquility achieved

    Well, almost



CASEMIX CONFERENCE 2008- Casemix Evolution: extending the boundaries
Synaptix Demonstration

 Short break to swap to my laptop.

 Thank you for your patience.

								
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