Refining standard Healthcare Codes for

1
Refining standard Healthcare Codes for Military
Unique Hearing Conservation Outcomes Metrics
Dr. Thomas Helfer US Army Center for Health
Promotion Preventive Medicine
International Military Noise Conference 24-26
April 2001, Baltimore, MD
2
What is Evidence-based Practice and Why Should
We Care? Editorial by Jeri Logemann,
PH.D. President of American Speech Hearing
Assoc. March14, 2000
3
Evidence-based practice means that clinicians
use evaluation and treatment procedures based on
data published in peer-reviewed journals
4
Our professions futures depend on the
effectiveness of our treatments, not on our
impressions of their effectiveness.
5
PRINCIPLES OF PERFORMANCE MEASUREMENT
Successful implementation of performance
measurement will require substantial and
continuing efforts to overcome challenges
involved in the development and use of
performance measures and data systems
Measuring Health Performance in the Public
Sector Institute of Medicine, National Academy of
Sciences, (1999)
6
PRINCIPLES OF PERFORMANCE MEASUREMENT (contd)
Performance measurement activities will benefit
from collaborations among perspectives and
expertise of a variety of disciplines (e.g.,
public health, clinical services, statistics,
epidemiology, data processing, data management).
Measuring Health Performance in the Public
Sector Institute of Medicine, National Academy of
Sciences, (1999)
7
August 2000
Helfer et al. Amer.Jnl.Audiology
Audiology Today
Clinical Practice Guideline
Clinical statement
Clinical Algorithms
Clinical Path
Data Model of Outcomes Metrics CPT ICD-9-CM
Codes
Associated CPT Codes 92552 92557 Etc.
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Alternate Method Audiometric Database Analysis
for Hearing Conservation Program Performance
Age
Race
Gender
USUHS/ USEHA 1990-1995
MCV/ USACHPPM 1995-2000
Host
Vector
Agent
Environment
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1995 Emergent Independent Peer Review
Org. Functionality
Bio-statistics
Epidemiology
Statistical Data Management
Clinical Research
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Epidemiologist- Population basis
Clinician- Case basis
Statistician- Risk inference basis
Data/Information
The synergy of different points of view
11
Adera et al ADBA Stage 1
Clinical data conversion to
EARs
-/
n
!!!
n
dx
nT
gt
Clinical classification information
12
Adera et al ADBA Stage 2
dx
tx
mo
U
Outcomes Metric from HCDR
And then
Outcomes Analysis of Aggregated Metrics Using
Epidemiologic Inference
13
1997 the Big Aha!! re Adera et al ADBA
Stage 2
dx
tx
mo
U
Outcomes Metric from HCDR
ICD-9
CPT
mo
U
Clinical Information Elements from ADS
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SADR DATA FLOW (1 November 2000)
Release for Use
IBM (Ft. Detrick)
IBM (Ft. Detrick)
SADR
Daily (ASCII)

• Catalog Data
• Convert to SAS Dataset
• Process andQC Data

• Flat ASCII File
• Enhanced Format

Army Navy
Daily
ADS Database
Future
ARS Bridge (Falls Church)
AFMOA (San Antonio)
MDR
Air Force
Current
Scan ADS Encounter Form
Daily (ASCII)
EI/DS
ADSI

• Abridged SADR
• Enhanced Format
• Supports Enterprise
• -Wide Analyses

Daily
Future
ADS Application Server
Business Rules Edits
KG-ADS
Terminates 12/31/00
Terminates 12/31/00
Army Navy
CHCS
Daily (ASCII)
FEED NODE IBM-SP (Denver)
CEIS IDB-R (Regions)
CEIS HBOC (Regions)
SADR Raw Data
Populate COTS Products

• ADS Sites
• Appointments are scheduled in CHCS.
• CHCS transmits patient demographics and
  appointment information to ADS.
• Provider enters encounter information onto ADS
  Encounter Form or into KG-ADS.
• Encounter information is transmitted to ADS
  database by either scanning the ADS Encounter
  Form or electronic transfer of information from
  KG-ADS through ADSI.
• The ADS Database generates a SADR for each
  encounter.

Collect and Archive Raw SADR Data

• Supports Regional Users
• Quantum
• Trendpath

Regional Integrated Databases
The Air Force SADRs are collected at AFMOA and
confirmed for completeness prior to transmission
to Ft. Detrick and Denver. No edits are being
performed on these SADRs at this time.
Transformation processing that involves
enhancements and appended fields.
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Follow up (f/u) 1 out- comes
annual surveillance outcomes
Audiology referral outcomes
f/u2 out- comes
Rule out (R/O) sensory loss
WNL
within normal limits--WNL
WNL
Rule in (R/I)
STS
STS
STS
Sensory loss
F/u audio
F/u audio
Audiology referral
annual audiogram
re- establish reference
no f/u1
no f/u2
DOD procedure
no referral visit record
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(No Transcript)
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ENT
Medical Board
Audiology evaluation
Administrative Action
Hearing Loss Limiting duties
no visit
annual surveillance
Acoustic Trauma
Deploy- ment Related visits
Audiology clinic outcomes
t ?
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SADR/SIDR
Outcomes Analysis as Multi-source Information
Fusion
DMSS
DMIS
DMDC
DOD HCDR
OA
Safety
GIS
RCAS
Reports
Table of Org Equip
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Outyear Information Management At CDR/SADR
CHCS II
FP
Optom
etc
OH
e-
e-
e-
e-
ADS
SF600
SF513
Orders X-ray Lab Rx
CPT ICD
SOAP
Consult
HC
HC
HC
EAR
x
yes
x
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What have you done for the Soldier, Sailor,
Marine, or Airman Today?
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Independent Peer Review Organization
(IPRO) Functionality for Services Hearing
Conservation Programs (Mirrors TMAs National
Quality Mgt Program)
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New Era of Providers Managing Care vs Doing
Managed Care
Managing Care Case Management Managing
Information Managing Population Health
Managing Healthcare Performance Quality
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Fin