iQ PBC Data & Budget Manager

Data quality and accurate PbR tariff validation is the cornerstone of efficient commissioning.

Incorporating the iQ Clinical Data Interface.

Introduction

iQ PBC Data & Budget Manager enables Practices, Consortiums and PCTs to monitor referral and discharge information for episodes of secondary care. It compares this information to the National Tariff, automatically reconciles the data quality (correct HRG codes) against the secondary care charges and then highlights any discrepancies e.g. incorrect NHS number / excess bed days / non elective vs elective etc.

Specialist clinical knowledge is not required as it uses a sophisticated mapping mechanism which translates Read Code v2 codes combined with common descriptive medical terminology into a minimal selection of charge codes (HRG and Clinic Codes.) It significantly reduces the task of validation.

Whilst NHS budgets will increase over the next two years the DH and Government have stated that productivity and increased efficiency will be the priority target going forward. These objectives will be impossible without accurate quality and financial information which is essential to all PBC activity.

According to the Audit Commission - 'if the full benefits of PBC are to be realised, effective cost benefit analysis of business cases and ongoing monitoring of outcomes and costs is a priority for PCTs and Practices'.

Automated analysis of SUS data

The process of SUS data validation has been enhanced by the automatic extraction of information from GP clinical systems using the iQ Clinical Data Interface and feeding this directly into iQ PBC Data & Budget Manager.

It is universally accepted that the only accurate process is to cross reference SUS data back to the original referral and discharge information held in clinical systems. This automated process is therefore predicated on the correct level of information (read codes) being entered into the practice clinical system in the first instance.

Once the information is transferred the advanced search system built into iQ PBC Data & Budget Manager will make use of relevant Read Code v2 codes, search and check all 160,000+ terms and codes from Read Code V3 thesaurus (Read Code v2 does not cross reference directly to HRGs). It also automatically references OPCS and ICD10 (the hospital/trust codes) to filter the clinical description and ultimately provide the appropriate selection of HRG Clinic Code and the correct National Tariff. It also displays Split or Local / Community Tariffs.

 

Setting validation parameters

A range of analysis options covers the five characters in the HRG codes.

Therefore if the requirement is simply to ensure that a reasonably correct episode has been reported it will be sufficient to validate the first two characters.

As the requirement for greater detailed analysis develops within the commissioning framework and budgets become a more important aspect, then iQ PBC Data & Budget Manager will check all five characters of the HRG code to provide accurate validation.

Data security and patient confidentiality

The data from all Practice / PBC Cluster clinical systems is extracted daily and stored on a server located within the PCT or the lead practice within a defined cluster. Access is protected by the N3 network and prior agreed Data Sharing Agreements between all practices and the PCT.

 

Each application meets the strict standards set out by IGSoC and CfH for holding and transferring Patient Identifiable Data electronically, including ISO 27001/27002

iQ PBC Data & Budget Manager and iQ HealthMaps also meet the conditions of the 1998 Data Protection Act.

Audit Commission Report 2008/9

Small improvements have been reported but 'the introduction of HRG 4 is likely to bring higher error rates in 2009/10'. Whilst the work undertaken by the Audit Commission is invaluable, it is statistically insignificant as the 49,000 episodes reviewed represent an average of just 320 episodes per PCT; compared to an average practice referral and discharge volume of 300-500 episodes per month.

It is for these reasons the Audit Commission have recommended to all parties (NHS Connecting for Health, Trusts and PCTs) that 'Local Audit Reports' should be undertaken.

Demand management and reports

The iQ PBC Data & Budget Manager also has extensive reporting functionality which has significant management benefits when preparing commissioning plans. The data can be easily accessed and reported on in line with the requirements of Practice, Cluster and PCT.

Referrals / discharges can be analysed against charge code (Clinic Codes / HRG), provider, speciality, episode type, practitioner, patient, pathway, referral status and cost etc; and these reports can be used to identify areas of concern e.g. overcharging care providers, high incident procedures, time delay between patient being discharged and letter being received. Data can also be easily combined to PBC cluster level.

If you have any queries about the product, or if you would like to arrange a no obligation demonstration to see the product and discuss the associated issues, please do not hesitate to contact us