eHealth and DRG in the Austrian Health Care System

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eHealth and DRG in the Austrian Health Care System

• Karl P. Pfeiffer)
• Dept. f. Medical Statistics, Informatics and
  Health Economics
• Innsbruck Medical University, Austria
• ) Chairman of the Austrian eHealth Initiative
• ) Statistical Project Manager for the Austrian
  DRG-System

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The Austrian DRG-System Strategic Goals

• Introduced in 1997 for all inpatients
• Increase efficiency, effectiveness, quality
• Reduce the length of stay
• Reduce inpatient care - more outpatient care
• Continuous quality improvement
• More specific reimbursement for the services
• And not for the length of stay
• Use of case groups
• Structured and standardized documentation of
  diagnoses and procedures
• More transparency in the hospital sector

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The Austrian DRG-System10 Years Experience

• The system works since 1997
• For all Austrian hospitals
• 2.4 Mio admissions for 8 Mio inhabitants
• About 6 Billion / year
• Reduction in the length of stay
• No loss in quality has been found
• More admissions
• Mainly coming from the ambulatory sector
• Because of no interface between in- and
  outpatient financing
• High transparency of the hospital sector
• Planning and control is based on these data
• Plan for the structure of the Austrian health
  care system
• The system is owned by the Ministry of Health
• But the increase in efficiency was not
  sufficient!!!
• E.g. missing interface to the outpatient sector,
  discharge management

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The Austrian eHealth Strategy

• Developed by a group of gt100 independent experts
• Including all stakeholders
• IT-companies, social insurance companies, doctors
  and pharmacists association, patient
  representatives, science,
• AIM Support the modernization of the Austrian
  social- and health care sector by IT
• Seamless patient centered communication of all
  health care providers
• The Electronic Patient Record / a personal health
  record
• DRG-data are an important part of eHealth
• Active integration of the citizen / patient in
  his own health care process

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eHealth Topics
Health System Research
Medical Informatics Research
Strategy
Evaluation
Feasibility
Business Processes
Applications
Technology
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e-Health Model
ELGA EHCR/PHR
Portal
Know- ledge base
Processing
e-card
Archiv
e-Health Applications
Indices
Laws
Network
Aczeptance
Terminology
Pseudonymisation
Standards
e-Health Infrastructure
Roles
Transformation Management
Usability
e-Health Framework
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eHealth Areas
AccompaningMeasures
Benefit
e-Health Applications
Technical Interoperability
Semantic Interoperability
Legal Framework
Privacy Safety
e-Health Strategy
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The Austrian eHealth StrategyChallenges

• Set up of the IT-infrastructure
• Who is responsible for the IT-infrastructure?
• Who should pay?
• Who has the benefit?
• Using existing equipment
• eCard is available for 98 of the citizen since
  2005
• Management of the 2 without an eCard
• Many advanced hospital and GP information systems
• Harmonization and standardization
• Unique identifier for the citizens with regard to
  PRIVACY
• Unique and up-to-date registry of all health care
  providers
• Professional card
• Definition of their role for the access
• Decentralized storage of the data
• Master Patient Index (MPI)
• Acceptance Management

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The Austrian eHealth StrategyApplications

• ELGA Electronic patient record
• Electronic discharge letter
• All relevant documents
• ePrescription / eMedication
• Safety, avoiding drug interaction
• eLab
• LOINC based communication of laboratory data
• eRadiology
• DICOM based picture and result communication
• eHealth portal
• Consumer information
• Information for the professionals
• Decision support
• eOrdering
• eImmunization record

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The Austrian eHealth StrategyFundamental Problems

• Who should pay for the infrastructure?
• What are the standards of tomorrow?
• Technical interoperability
• Who has which benefit?
• Patient / doctor / financiers
• Who can demonstrate the benefit?
• Acceptance Management
• Resistance from health care providers
• Change management / transformation management
• Content of the electronic patient record
• What is a relevant information?
• Semantic interoperability

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Key Elements of eHealth

• Identification Management
• Documentation
• Supported by IT
• Communication
• Based on technical and semantic standards
• Archiving
• And fast retrieval
• Data processing
• For science, planning and control
• Knowledge Management
• For professionals and citizen

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eHealth Vision

• An ubiquitous management of health by supporting
  the processes of all health care professionals by
  using information technology with special
  attention to privacy and data safety
• In some years (2015 ?) all necessary data are
  available electronically for the person who has
  the right to access to this data
• Independent of time and location

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Developement of Healthcare Information Systems
Continous knowledge based care Selflearning
systems
Knowledge based care
Paperless electronic record
Clinical Database
2000
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Summary / Discussion

• Integrated health care needs an integrated
  financing system
• Modernization of the health care system needs IT
• Not vice versa
• Agreement or contradiction model for
  participation
• Acceptance by the citizen
• Acceptance by the health care providers
• Time to implementation
• Start with small and realistic projects
• Demonstrate feasibility and

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Thank you for your attention!
karl-peter.pfeiffer_at_i-med.ac.at
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Example of a classification tree

• Most important classification criteria
• Main diagnosis (SPEZHDG)
• Surgical / therapeutic procedures (LGRxx, HGRxx)
• Indicated by a specific diagnosis
• Age
• Less important
• Additional diagnoses
• At the moment no comorbidity and complexity level

Example DRG Acute heart diseases
Easy to understand!
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The Austrian DRG-System Implementation

• Development of our own DRG-system
• To reflect the medical culture
• Transparent classification process
• Using regression trees
• Ownership and responsibility of the MOH
• Easy maintenance
• Year by year to
• Include new procedures, eliminate old procedures
• Adjust the length of stay
• Recalculate cost weights

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e-Health Applications and Portal
e-Health strategy
e-Health- care- system
Know- ledge data base
?
e-vaccination record
Decision- Support
e-mother- child- record
e-Surveillance
Home- Monitoring
e-Docu- mentation
e-Learning
e-discharge letter
e- Prescritption
e-sheduling
e-Wellness
e- reimbursement
Analysis- Systems
e-Lab
e-Transfer
e-Ordering
e-patient diary
e-Consulting
?
?
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Content

• The Austrian DRG-System and its importance for
  eHealth
• Goals
• Implementation
• Experience since 10 years
• The importance of structured documentation
• The concept for an Austrian eHealth strategy
• Strategic goals
• Implementation
• The Austrian Electronic Health Care Record

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The Austrian eHealth StrategyFramework

• Technical
• Commitment to international communication
  standards
• HL 7 CDA / IHE / DICOM / LOINC /
• Organizational
• Coordinated development - national strategy
• Role of the Ministry of Health
• Legal
• Privacy
• Data security
• Definition of roles
• Nomenclature / Terminology
• Standardized nomenclature