Slides are only valid in combination with the oral presentation.

2012-01-12

Routine data in German hospitals

Jrgen Stausberg, MD, PhD
Full Professor for Medical Informatics
Institut fr Medizinische Informationsverarbeitung, Biometrie
und Epidemiologie (IBE)
Ludwig-Maximilians-Universitt Mnchen, Germany

Definition
Electronic medical record
Basic documentation
Legislations for data interchange

Situation in Germany
(Sample 2009, 126 hospitals)

Hbner U, Sellemann B, Egbert N, Liebe J-D, Flemming D, Frey A. IT-Report

Gesundheitswesen. Schwerpunkt Vernetzte Versorgung. Hannover: nordmedia, 2010.

Situation in the USA

(Sample 2008, 2952 hospitals)

Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of Electronic Health Records in U.S.
Hospitals. N Engl J Med 2009; 360: 1-11.

Definition
Electronic medical record
Basic documentation
Legislations for data interchange

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

 301 Hospitals Social Code Book V

Hospital

Admission message
Assumption of cost messg.
Prolongation message
Assumption of cost messg.
Discharge message
Invoice message
Payment message

Sickness fund

 21 Hospital Remuneration Act

Institute for the Hospital Remuneration System
All hospitals covered by the act
DRG-Definition for the year after next, e. g.
data from 2007
data transfer until 2008-03-31
DRG-system 2009

Ten files
file billing
file inpatients
file ICD
...

 137a Implementation of quality assurance and

quality reporting Social Code Book V

AQUA Institute
Selected clinical situations covered
Feedback and public reporting, e. g.
data from 2008
data transfer promptly 2009
confidential report June 2009
public quality reports with selected results autumn 2009

Outpatient/inpatient/pharmacies
Home care
Rehabilitation
Cancer registry
cause of death statistics
....

Inpatient
KHStatV

. Statistical
Federal
Office

DALE UV
quant
3M

21 KHEntgG
InEK

301 SGB V

137a SGB V
LQS/AQUA

ASHIP

SHI

ZI

DGUV

295 SGB V
295 SGB V
DMP ( 140a
SGB V)

DALE UV

T-Systems

300 SGB V
Outpatient

Pharmacies

Data processing
centers for pharmacies

Clearing house for

private medicine

Extract

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

Parameters
Master data

Parameters
Master data
Diseases
principal/secondary diagnoses
ADT-Diagnoses
special diagnoses in external quality assurance modules

Parameters
Master data
Diseases
Procedures
operative procedures
some therapeutical non-operative procedures
some diagnostic procedures
ventilation time
...

Parameters
Master data
Diseases
Procedures
Medication

Parameters
Master data
Diseases
Procedures
Medication
Fees, costs

Parameters
Master data
Diseases
Procedures
Medication
Fees, costs
(Anamneses)
(Outcome)
(....)

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

Discharge message from hospitals

Datenbermittlung nach 301 Abs. 3 SGB V, Stand: 7.

Fortschreibung vom 8.12.2006

Yearly adaptation of the DRGsystem: procedures

Anlage zur Vereinbarung ber die bermittlung von DRG-Daten nach 21 Abs. 4 und Abs. 5 KHEntgG, Stand 28.11.2006

IK;Entlassender-Standort;KH-internes-Kennzeichen;OPS-Version; OPS-Kode;
Lokalisation;OPS-Datum;Belegoperateur; Belegansthesist;Beleghebamme
260100012;;2;2006;5-470.0;;200601070910;;N;N
260100012;;3;2006;5-194.2;;200601081415;;J;J
260100012;;3;2006;5-193.x;;200601081415;;J;J
http://g-drg.de/, access 2007-11-11

External quality assurance

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

Samples
21 Hospital Remuneration Act
18,348,426 inpatients (2006)
80.8 % of all hospitals (1,701 from 2,104)

Data of DRG cost calculation

3,900,098 inpatients (2006)
21.3 % of all inpatients (2006)

External quality assurance

3,591,604 records (2007)
96.6 % in comparison to counts from reimbursement

Reliability and validity

21 Hospital Remuneration Act
risk adjustment scheme +, operative procedures
complete, secondary diagnoses unknown

Data of DRG cost calculation

5 % records with formal errors
72.1 % inpatients included in cost calculation
65.5 % inpatients with standard length of stay

External quality assurance

high plausibility: 3,000 rules for 1,500 items

Identification of a patient
301 Hospitals Social Code Book V
master data, health insurance policy number, hospitals
episode ID

21 Hospital Remuneration Act

hospitals episode ID, hospitals patient ID

Data of DRG cost calculation

hospitals episode ID, hospitals patient ID

External quality assurance

hospitals episode ID

(Health insurance number)

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

Access
Each hospital its own data
301 Hospitals Social Code Book V
sickness funds of their clients
research projects in cooperation with sickness funds

21 Hospital Remuneration Act

aggregated data publicly available
raw data completely available for the organs of self-government
raw data partially available in benchmarking projects
teleprocessing provided by the Federal Statistical Office

137a Implementation of quality assurance and quality reporting Social

Code Book V
secondary use possible in the AQUA-institutes office

...

Agenda
Legislations for data interchange
Parameters
Data interchange formats
Data quality
Access
Conclusions

Conclusions
A lot of routine data available
Data quality
full number available
completeness moderate
validity unknown

Problems
redundant data recording
different vocabularies
record linkage only partly possible

To be solved
Unambiguous identification of an individual
Standardization
terms
concepts
data models
use cases

Data quality
! Careful analyses recommended
! http://www.ekmed.de/routinedaten/ [in German]

End