The Victorian Admitted Episodes Dataset (VAED) – what’s it for?

1. The Victorian Admitted Episodes Dataset (VAED) – what’s it for? Andrew Brown Manager Health Data Standards & Systems DHS Victoria Information Management Community of Practice Open Forum 2008-06-19

2. The Data Black Hole Black Hole at centre of Virgo Cluster (Hubble)

3. Overview “Using the VAED to demonstrate that DHS is not really a data black hole.” • What is the VAED? • History, context, background. • Uses of the VAED. • The future of the VAED. Housekeeping: It’s OK to ask questions as we go.

4. What is the VAED? The Victorian Admitted Episodes Dataset (VAED) is an administrative data collection used to record and report on all admitted patient activity in Victoria.

5. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date on Separation (b) Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG

6. Terminology VAED The Victorian Admitted Episodes Dataset is the name of the data collection. PRS/2 The Patient Reporting System (version 2) is the software processing system and interface through which the VAED is collected by DHS.

7. Exciting VAED trivia! Scope: All public and private acute hospitals, including acute facilities in rehabilitation and extended care institutions and day procedure centres, are required to report the relevant minimum data set of admitted patient activity. Public: 147Private: 152

8. More exciting VAED trivia!! Enabling Legislation: Data is collected under the authority of Section 9 of the Victorian Health Act 1958. 9 Data collection The Secretary must— (a) establish a comprehensive information system which includes information on— (i) the causes, effects and nature of illness among Victorians and groups of Victorians; and (ii) the determinants of good health and ill health; and (iii) the utilisation of health services in Victoria; and (b) analyse and disseminate this information widely to members of the public.

9. More exciting VAED trivia!! Enabling Legislation: Data is collected under the authority of Section 9 of the Victorian Health Act 1958. 9 Data collection The Secretary must— (a) establish a comprehensive information system which includes information on— (i) the causes, effects and nature of illness among Victorians and groups of Victorians; and (ii) the determinants of good health and ill health; and (iii) the utilisation of health services in Victoria; and (b) analyse and disseminate this information widely to members of the public. (b) analyse and disseminate this information widely to members of the public.

10. More exciting VAED trivia!!! Enabling Legislation (Privates): ...and under the authority of Section 47 of the Victorian Health Services (Private Hospitals and Day Procedure Centres) Regulations 2002.

11. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG The green highlights show the data elements specified in the Health Services (Private Hospitals and Day Procedure Centres) Regulations 2002.

12. Even more exciting VAED trivia!!!! How old is the VAED? • 1979-80: Started as Victorian Inpatient Minimum Database (VIMD) – 50 hospitals • 1987-88: Electronic data available • 1992-03: Episodes of care • 1995-96: Newborn reporting (publics) • 1999-00: Name change to VAED

13. Exciting VAED trivia with big numbers!!!!! How big is the VAED? • 79 data elements x • 299 reporting units x • Approx. 2,000,000 separations pa = • 47 billion pieces of data each year

14. Not quite so exciting HDSS trivia but related to the VAED none the less Who looks after the VAED? • Operated by the Health Data Standards and Systems (HDSS) Unit • PRS/2 is hosted by a FM company (The Pay Office) at an off-site location • 2 staff for collection management and operations • 1 IT support contractor • 1 P/T staff member + 1 P/T contractor dedicated to the Victorian ICD Coding Committee (VICC) • 1 P/T staff member for VAED audit • 1 P/T staff member for VAED education

15. The 409kg Gorilla of data collections

16. What’s it for? Casemix Funding • Casemix funding was introduced in Victoria in 1993-94. • The VAED supports Casemix funding through its diagnosis and procedure codes, and other administrative items.

17. Casemix funding in 2 minutes...

18. Casemix funding ICD-10-AM codes Length of Stay Grouper module DRG WIES module PRS/2 WIES value ($)

19. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG The orange data elements are used to support funding.

20. What’s it for? Casemix Funding (II) • $3.0 bn is paid to acute hospitals in the form of WIES payments.

21. What’s it for? Other Acute Funding $400m is paid for acute services in other grants – most of which are apportioned in some way by use of data wholly or partly from the VAED: • Training and Development and Research grants • Complexity, Early graduates, Workforce priorities, Research • Access, performance and incentive grants • elective surgery access bonus funding, Trauma, transplants, NETS, PETS, Maternity services, Integrated Cancer Services, Maintenance dialysis, Long stay older patients, vulnerable children, medical displan, neonatal hearing screening, quality and safety and workforce and service planning • Specified grants • Includes complexity, contracts and formula, awards, adjustments, incl critical and neonatal care, and other hospital-specific grants

22. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG The orange data elements are used to support funding.

23. What’s it for? Subacute Admitted Funding Approximately $400m is paid for subacute admitted services – either VAED funded or VAED data assisted in calculation of grants. • VicRehab: sub-acute rehabilitation patients in designated units • CRAFT casemix system for rehabilitation • Geriatric Evaluation and Management (GEM) • Palliative care • Transition care • Interim care • NHT days • Post acute care

24. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG The orange data elements are used to support funding.

25. What’s it for? Reconciliation for Third-Party payers • Department of Veterans’ Affairs (DVA) • Transport Accident Commission (TAC) • WorkSafe Victoria (VWA) • Cross-border agreements with other states • Reciprocal health care arrangements with other countries

26. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG The orange data elements are used to support funding.

27. What’s it for? DHS also has reporting obligations • Requirement to report to Commonwealth Government under the Australian Health Care Agreements (AHCA)

28. Australian Hospital Statistics

29. What’s it for? DHS also has reporting obligations • Requirement to report to Victorian Treasury under ERC requirements • Performance targets • Health Care for diverse populations and Indicators of Cultural and Language Diversity • Your Hospitals Report

30. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG Pink data elements that support DHS’ reporting obligations.

31. What’s it for? The VAED is a collection of hospital morbidity and health service activity.

32. What’s it for? • The data collection is used extensively within DHS to support programs, it: • Monitors effectiveness • Helps advise on policy decisions • Helps set funding priorities and develop funding models

33. Who’s it for? Examples of program users: • Mental Health Branch • Integrated Cancer Services • Palliative Care • Aged Care • Quality and Safety • Maternity Services

34. What’s it for? • VAED is used to monitor health sector performance: • Hospital finance performance • Metro Health finance branch • Rural & Regional Health & Aged Care • KPI measurement • Private hospitals • Capital planning

35. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG Purple data elements that have been included to assist program monitoring. (Note – only one black one left!)

36. What’s it for? “...information on... (i) the causes, effects and nature of illness among Victorians and groups of Victorians; and (ii) the determinants of good health and ill health” Hundreds of ad hoc requests for VAED information are processed each year from other government departments, for ministerial briefings, the private sector, researchers and the media.

37. Data Linkage Increased interest in data linkage of VAED – linking it with itself and with other collections: • VAED for continuity of care • VEMD for NAESG • ACAS data set allowed removal of Hospital Bed Census collection and reduced data collection burden • ESIS for Elective Surgery blitz initiative

38. The future of the VAED

39. The future of the VAED • PRS/2 – effectively 1980s technology (PRS) with a 1990’s upgrade (PRS/2). • Problems with the structure of the data collection, such as limits on numbers of reportable instances of various items, limited numbers of changes per day. Plans for revision: 1. Internal work to identify problems, solutions and changes. 2. Internal DHS consultation to explore impacts and feedback from data users. 3. Develop ‘straw man’ proposal for change. 4. Consult with Data Providers and their Software Vendors. 5. Examine impacts on output reporting. 6. Synthesise into proposal specification for change. 7. Consultation. 8. Release final spec for implementation mid 2009. 9. Implementation... NB: This slide was not part of the original presentation but was added for web publication.

40. The VAED Data Elements Indigenous Status Intended Duration of Stay Intention to Re‑Admit Interpreter Required Leave With Permission Days Leave Without Permission Days Level of Insurance Locality Marital Status Medicare Number Medicare Suffix Mental Health Legal Status Mental Health Statewide Patient Identifier Onset Date Palliative Care Patient Days Patient Days Patient Identifier Postcode Preferred Language Procedure Codes Qualification Status RUG ADL Separation Date Separation Mode Separation Referral Separation Time Sex Source of Referral to Palliative Care Surname TAC Claim Number Transfer Destination Transfer Source Unique Key ACAS Status Accommodation Type Account Class Admission Date Admission/Re‑Admission to Rehabilitation Admission Source Admission Time Admission Type Admission Weight Barthel Index Score Campus Code Carer Availability Care Type Clinical Sub-Program Contract Leave Days Contract Role Contract/Spoke Identifier Contract Type Country of Birth Criterion For Admission Date of Accident Date of Birth Diagnosis Codes Duration of Mechanical Ventilation in ICU Duration of Non-invasive Ventilation (NIV) Duration of Stay in Cardiac/Coronary Care Unit Duration of Stay in Intensive Care Unit DVA ID Functional Assessment Date Funding Arrangement Given Name(s) Health Insurance Fund Hospital Generated DRG This makes it go! What’s Unique Key for? It makes the VAED go!