Private Hospital Data Collection Review Final Report

Executive Summary

Private Hospital Data Collection Review - Final Report

Page last updated: 14 June 2012

      The 2008 and 2010 health reforms will create a far more data reliant environment than currently exists. Further changes to those reforms, agreed to by the Council of Australian Governments (COAG) in 2011, have not altered this fact. Nationally, data will become essential for system design, financing and accountability. Thus far, implementation of data standardisation and expansion of patient level collections have focused on public hospitals, as they are the most critical to the reforms.

      However, the reforms have implications also for the private sector. In particular, those reforms centred on accountability and transparency, make reference to the private sector and are likely to drive further development of private hospital data. Private hospitals themselves have expressed interest in participating in hospital reporting and some larger providers actively contributed to the recently launched myHospitals web site. Notwithstanding this interest, the private hospital sector has observed that such reporting incurs a cost to the hospitals and pointed to issues of the diverse range of reporting required of them; duplication of requirements among mandatory collections; and unnecessary complexity of data supply chains. If reporting was rationalised, data duplications removed and data supply chains streamlined, the reporting burden on private hospitals would be reduced and more active involvement in accountability and transparency activities would follow.

      In this environment, the Australian Department of Health and Ageing (the Department) commissioned this Private Hospitals Data Collection Review (the Review) with the following objectives:

      1.   Increase the collection, management, and handling efficiency of private hospital data, so as to reduce data management burdens where possible;
      2.   To support increased comparability between the public and private sectors; and
      3.   Recommend a mechanism for creating and maintaining an authoritative list of private hospitals.

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      Term of reference 3 (an authoritative list of private hospitals) was overtaken by recent events relating to the national health reforms. In particular, the National Health Performance Authority (NHPA) will be required to report on hospitals and will have to decide what constitutes a private hospital for that purpose. This requirement effectively supersedes any mechanism that this Review might recommend.

      Accordingly, although this Review considered recommendations relating to this term of reference, the Department has advised that those recommendations are no longer required. Nonetheless, the body of this report presents the options considered by the Review in relation to this term of reference. This information is presented in the hope it may be of value to NHPA and the Department in considering the NHPA requirements for such a list under the national health reforms.

      To determine which data collections should be within scope of the Review, the following questions were asked of a set of identified data collections:
      • Does this collection comprise data generated by and used by private hospitals and which ultimately ends up in the hands of the Commonwealth?
      • Do the data from this collection end up in the hands of the Commonwealth agency, department or instrumentality? Such agencies include the Australian Institute of Health and Welfare (AIHW), Australian Bureau of Statistics (ABS) and Federal Government departments.
      • Is the collection one that the Department of Health and Ageing is likely to be able to influence?

      As a result, the following collections were identified as being within scope:
      • Hospital Casemix Protocol (HCP);
      • Private Hospital Data Bureau (PHDB);
      • National Admitted Patient Collection (APC);
      • Private Health Establishments Collection (PHEC);
      • National Hospital Cost Data Collection (NHCDC);
      • National Perinatal Statistics Collection (NPSC); and
      • Australian Cancer Database.

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      A number of additional national collections that involved private hospitals submission of data were considered but were deemed to be outside the scope of this Review. The primary reasons for excluding collections centred on whether the private hospitals' participation in the collections was imposed or otherwise mandatory and whether the Commonwealth, usually through the agency of the Department, was in a position to directly influence the operation of the collections.

      As well as the existing collections identified as within scope, two areas of potential future national collection of data from private hospitals were identified and considered for inclusion. Data collection related to safety and quality indicators under the auspices of the Australian Commission for Safety and Quality in Health Care (ACSQHC) were seen to be within scope. Health workforce data, relating to the activities of Health Workforce Australia (HWA) was determined as out of scope. The latter decision was due to the HWA expressing its view that it had no plans for ongoing data collection involving private hospitals and felt it unlikely that this would change in the foreseeable future.

      Hospital Casemix Protocol

      The Private Health Insurance Act 2007 and its associated rules require private hospitals to provide HCP data to health insurers and insurers in turn are required to provide the HCP data, supplemented with additional data, to the Department. Private hospitals are required to submit data in accordance with data specifications published by the Department, in a fixed electronic file format.

      In effect, a private hospital is required to prepare a separate file of episode level data for each insurer whose patients were treated in the given month and transmit each file separately to the relevant insurer. Where rehabilitation patients have been treated, a further file needs to be submitted to the relevant insurer(s).

      Some streamlining is already achieved through the agency of the Australian Health Services Alliance (AHSA), which provides a bureau service for its members. This allows a private hospital to send the HCP files for those member funds to a single location – the AHSA.

      The Private Health Insurance Act 2007 requires HCP data be submitted for any and all admitted patient episodes where an insurance claim is lodged with an insurer. This requirement is imposed on all declared hospitals public and private. Under this Act both private and public hospitals may be declared. However, public hospitals provide a less complete HCP data set than private hospitals although the long-term aim is for public hospitals to move to full HCP provision.

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      Private Hospital Data Bureau

      The Private Health Insurance Act 2007 and its associated rules require private hospitals to provide PHDB data directly to the Department. Private hospitals are required to submit data in accordance with data specifications published by the Department, in a fixed, electronic file format. The Department maintains a list of PHDB eligible hospitals, which essentially is an amalgamation of the Department's list of declared hospitals and the AIHW list of hospitals that contribute to the APC.

      The Department has developed a web browser based portal for submission of PHDB data. It actively encourages hospitals to use this portal for the submission of data as it is a secure process and makes it easier for hospitals to complete the data submission process.

      National Admitted Patient Collection

      The APC is a national collection of morbidity data comprising episode level data for all hospitals in Australia – public and private. This collection is managed and maintained by the AIHW and is also referred to as the National Hospital Morbidity Database.

      The AIHW receives data annually from States and Territories. Each State or Territory supplies episode level data for the preceding financial year for all or most public and private hospitals within its jurisdiction. For the 2009-10 APC data submission process, data were not provided for 2 public hospitals, nor for private day hospital facilities in the NT or ACT, nor for 2 other private hospitals. In 2009-10, the extent of under counting of private hospital episodes in the APC was of the order of 3.3%.

      The original submission of admitted episode level data by private hospitals to the various States and Territories takes place under different arrangements within each jurisdiction (see Table E-1).

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      Table E-1 Basis on which private hospitals provide admitted patient data, by State and Territory.
      Jurisdiction
      New South Wales Required under legislation.
      Victoria Required under legislation.
      Queensland Required under legislation.
      South Australia Provided voluntarily.
      Western Australia Required under legislation.
      Tasmania Provided voluntarily.
      Northern Territory Provided voluntarily.
      Australian Capital Territory Provided voluntarily.

      Private Health Establishments Collection

      The PHEC is operated and maintained by the ABS and operates annually, under the authority of the Census and Statistics Act 1905. That Act empowers the Commonwealth Statistician to direct private hospitals to contribute their data to the PHEC.

      The scope of PHEC includes all private hospitals licensed by States and Territories and all free standing day hospitals approved by the Commonwealth. It includes data from each such facility relating to its ownership, basis for operation, accreditation, activities, staffing and finances.

      The ABS has negotiated arrangements with States and Territories to streamline collection of part of the data required for PHEC. For consenting private hospitals, the ABS receives data on admitted patient activity for that private hospital directly from the relevant State or Territory.

      This arrangement means that the hospital does not need to extract and collate the necessary data from its own systems. Feedback from industry representatives and from States and Territories suggests that around 90% to 95% of all private hospitals provide their admitted data to PHEC in this way. Nonetheless, the remaining data sought by PHEC (financial, workforce etc.) are still required to be provided by the hospital itself.

      The Census and Statistics Act 1905 prevents the ABS from releasing PHEC data that might lead to the identification of individual private hospitals. Consequently, smaller jurisdictions' data are aggregated in publications derived from PHEC. This constraint limits the utility of the PHEC data somewhat.

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      National Hospital Cost Data Collection

      The NHCDC is managed by the Department. It is an annual collection of activity and cost data from public and private hospitals across Australia, which has been operating since 1996. NHCDC is essentially a voluntary collection. Public hospitals’ data are provided through the active co-ordination of each State and Territory health authority, while private hospitals’ data are provided directly by the hospitals themselves.

      For the 2008-09 round, 169 private hospitals participated, comprising 59 free standing day hospitals and 110 other private hospitals. In terms of admitted episodes in private hospitals, the 2008-09 NHCDC accounted for 41% of episodes in free standing day hospitals and 71% of episodes in other private hospitals.

      Data quality for the private hospitals’ component is variable, with significant caveats due to issues with inconsistent handling and reporting of costs, small AR-DRG volumes affecting estimates for free standing day hospitals and incomplete or inaccurate data affecting allocation of costs. In addition, private hospitals mostly lack the patient level feeder systems to capture consumption costs, thereby requiring estimation of hospitals’ costs through cost modelling, for the majority of private hospitals and free standing day hospitals.

      Data can be submitted via a web based portal and the Department provides tools to carry out quality review of the data prior to its submission. For the 2008-09 round, a national co-ordinator also was appointed to facilitate the collection and review of the private hospitals’ data. A review of the NHCDC and its processes was carried out in 2008 and the findings and recommendations from that review have guided and continue to guide the further development of the collection over time.

      National Perinatal Statistics Collection

      The NPSC is operated by the National Perinatal Statistics Unit, a collaborating unit with the AIHW based at the University of New South Wales. It collates data on pregnancy and childbirth, with State and Territory based units providing the data annually.

      The processes for collection and reporting of the perinatal data are well-established. In most jurisdictions they have been operating for more than 20 years. Some streamlining at a local level is already evident.

      Australian Cancer Database

      The Australian Cancer Database (ACD) is managed and maintained by the Cancer and Screening Unit within the AIHW. That unit operates the ACD in collaboration with the Australasian Association of Cancer Registries (AACR), as part of the functions of the National Cancer Statistics Clearing House. The processes for collection and reporting of the cancer data are well-established. In most jurisdictions they have been operating for more than 30 years.

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      Safety and Quality Indicators

      The ACSQHC was established in 2006 to develop a national framework for safety and quality in health care, together with an associated programme of work. Under the proposed national health reforms the ACSQHC has a larger responsibility to formulate and implement safety and quality standards, as well as to collect and disseminate information relating to safety and quality.

      Currently, the ACSQHC has no intentions of pursuing new collections of data from hospitals in Australia. Rather, it holds the view that existing data collections, including those from private hospitals, are under-utilised in terms of routine generation and review of indicators of health care quality. Consequently, the ACSQHC aims to populate its safety and quality measures using existing data held in collections such as the APC.

      The ACSQHC standards relating to safety and quality in health care will form the basis for future accreditation of hospitals in Australia, including private hospitals. Under this new accreditation system, private hospitals will be required to provide data on measures to accrediting bodies empowered to accredit hospitals under the standards. It is probable that the data provided by private hospitals to the accrediting organisations will also be required to be forwarded to the NHPA.

      The new accreditation system was scheduled to begin from 1 July 2011 and to be implemented fully by 2015. During the implementation phase, hospitals will have a choice of accreditation under the old system or under the new, standards’ based system.

      Private hospital licensing

      Table E-2 summarises the private hospitals’ licensing requirements within the States and Territories. It does not cover statutory reporting obligations unrelated to the licensing arrangements, such as the requirements to report to cancer registries and perinatal statistics units.

      It is clear that the concepts of private hospital and day hospital, while broadly similar across borders, differ substantially in terms of how they are specifically defined. The most extreme example of this is South Australia where the notion of a day hospital is not defined at all within the licensing arrangements.

      There is also substantial variation in the range and nature of facility level details captured through licensing application and renewal processes. In particular, the information captured on service profiles varies significantly among jurisdictions.

      The level of reporting and data submission expected of private hospitals also varies significantly among States and Territories. At one extreme, Queensland imposes significant reporting burdens across a range of operational areas. While at the other extreme South Australia imposes very little in the way of legislated reporting requirements.

      No jurisdiction has a formal arrangement in place with the Department to provide the latter with updates to licence details for private hospitals and day facilities that they license. Informal arrangements operate for two jurisdictions.

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      Table E-2 Summary of legislative requirements by State and Territory.

      Jurisdiction Facililties licensed Service classes Reporting requirements Data provided to DoHA
      New South Wales • Private Hospitals
      • Day facilities
      16 classes of service • Adverse Events
      • Root Cause Analysis
      • Regular audit
      • Admitted Parent Collection
        No
      Victoria • Private Hospitals
      • Day facilities
      15 classes of service • Self-audit tool
      • Episode level data
      • Admitted Parent Collection
        Informally
      Queensland • Private Hospitals
      • Day facilities
      42 classes of service • Sentinel events
      • Root Cause Analysis
      • Adverse outcome data on six monthly basis
      • Self-audit tool
      • Admitted Patient Collection
        No
      South Australia • Private Hospitals excluding day facilities 6 classes of service • Provision of documents for inspections   No
      Western Australia • Private Hospitals
      • Day facilities (4 types)
      34 classes of service   Informally
      Tasmania • Private Hospitals
      • Day facilities
      Three types of service, based on admitted status and overnight stay status • Nil   No
      Northern Territory • Private Hospitals incuding day hospitals Unknown • Unknown78   No
      Australian Capital Territory • Healthcare facilities, including public, private and day hospitals 10 types of service • Notifiable incidients
      • Annual report
        No

      Issues and potential opportunities

      There was a general acceptance that the processes for collecting cancer and perinatal data were largely independent of other processes and there were no opportunities for substantial streamlining in relation to those national collections.

      The main concerns with respect to the NHCDC related to the issue of data quality, rather than to the burden associated with data preparation and submission. This partly reflects the voluntary nature of NHCDC participation for private hospitals.

      A link to reporting burden arose in this context when considering how data quality might be improved for the private hospital component of the NHCDC. The main mechanism for improving data quality was seen as being the capture of patient level cost or resource use data, through the implementation of “feeder systems”. However, stakeholders saw no intrinsic business case for a private hospital to invest the cost and effort to adopt such systems and modify their business processes to apply them.

      There may be an opportunity to overcome some comparability issues through preparation of a series of experimental estimates’ reports, in addition to the usual NHCDC reports with their standard caveats. For example, one report may be on the pharmacy cost for private hospitals versus the pharmacy cost for public hospitals. The experimental estimate reports would build on the findings from the Productivity Commission Research Report into Public and Private Hospitals.

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      There is significant support for the PHEC and its modus operandi, principally from users of the data at sector level as well as from policy makers and planners. The ABS recently undertook a major review whose outcomes were implemented with the 2009-10 PHEC. Further changes will be implemented with a rolling out of the 2011-12 PHEC in August 2011.

      The Department recently commissioned the AIHW to undertake a dataset specification development for a private hospital establishments' collection that would correspond to the existing National Public Hospitals Establishment Dataset (NPHED) operated by the AIHW. In addition, the ABS and AIHW have commenced the work of aligning the NPHED and PHEC. The ABS has made changes to the PHEC collection form to better align the two collections.

      Stakeholders generally were comfortable with the notion of AIHW operating as the collection agency for PHEC or an equivalent collection. The private hospital sector felt that the AIHW's governing legislation offers the same level of protection of the data as does that of the ABS. They and other stakeholders felt that the AIHW has in place well established and effective protocols for providing different levels of access to the data, while protecting privacy and confidentiality.

      This support for the AIHW operating the PHEC or replacing it with a similar collection was qualified in the following ways:

      • the range of data collected and definitions used would need to be maintained, so that the integrity of time series data is preserved;
      • the coverage of private hospitals contributing to PHEC would need to be maintained or improved over the current high level achieved by the ABS;
      • the ABS would need to have access to at least those aspects of the PHEC data required for national accounts and other reports relying on the PHEC data other than private hospitals Australia reports; and
      • private hospitals would need to have control over the level of access provided to their individual data in a similar way to the protection that is currently afforded to States and Territories in relation to the APC. It may be possible to develop a standard agreement – analogous to the National Health Information Agreement – that could be used to effect such control.

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      Safety and quality reporting burden varies enormously across the private hospital sector in Australia. Some States and Territories impose significant reporting requirements specific to safety and quality while others impose very few.

      In addition, health insurers impose their own requirements for reporting related to quality of care. This requirement is imposed through conditions inserted into contracts between private hospitals and health insurers. These requirements vary enormously in the specific data and supporting information sought and the frequency with which data are required.

      The new accreditation arrangements are likely to be implemented across all hospitals and day facilities by January 2013. The ACSQHC is hopeful that this will lead to a greater sharing of common safety and quality data which will allow health insurers to reduce their demands for safety and quality reporting from private hospitals.

      The details of national performance monitoring and reporting of safety and quality accreditation are, as yet, not determined. If there is to be a national collection, that may well fall to the NHPA.

      This Review found that there is significant uncertainty about future data collection from private hospitals related to safety and quality. The ACSQHC and AIHW have recently undertaken a project to populate safety and quality indicators developed by the ACSQHC. Experience from this project highlights the following issues:

      • ownership and custodianship of private hospital admitted patient data, which is provided to the APC by the jurisdictions, but "owned" and generated at source by private hospitals within differing jurisdictional arrangements;
      • technical difficulties in identifying individual private hospitals within the APC, in order to generate nationally risk adjusted indicators through efficient central mechanisms; and
      • the lag in achieving centrally collated, national data (somewhere between 5 and 17 months) for efficient and consistent central generation of a series of measures.

      There is variety in the effort involved among hospitals in the process of extracting and providing data for the HCP, PHDB and APC. The variation largely related to issues of information systems’ capability, economies of scale and access to suitable information management skills.

      A consistent view from stakeholders was that there is a subset of day hospitals that simply lack the scale and information systems to collect and provide the data sought by collections such as HCP, PHDB and APC. These day hospitals are often, but not always, small scale providers, whose data collection is limited to what is required to provide good clinical care and to manage the business aspect of the hospital. In some cases, these are day procedure centres providing services for which no insurance claims are made. As such, they may not be declared hospitals under the Commonwealth Private Health Insurance Act 2007, thereby not being subject to HCP and PHDB requirements.

      The general view was that these admitted patient data collections themselves are warranted and that the range of data items collected should not be reduced. However, all stakeholders expressed concern over the fact that the HCP, PHDB, and the APC collect a significant set of common data items with common definitions and code sets. They also expressed concern over the substantial effort required to generate monthly extracts for these collections.

      On a monthly basis a private hospital within any jurisdiction in Australia will submit a large amount of health data to insurers, State and Territory health authorities and the Department. Figure E-1 illustrates the processes for the submission of data to the APC – via jurisdictional admitted patient collections – and the HCP and PHDB collections.

      Another issue with participating in these data collections is the validation of the monthly data submission. For example, in Victoria there are 403 different edits or “business rules”, violation of which may lead to rejection of submitted data. A rejection requires the hospital to check, correct and re-transmit that particular episode, which is not a simple task for the hospital. In addition insurers may have similar or different business rules to each other and to State health authorities. This means an episode of care may be accepted by an insurer but rejected by the State health authority.

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      Figure E-1 Overview of HCP, PHDB and APC data submission processes.
       Figure E-1  illustrates the processes for the submission of data to the APC – via jurisdictional admitted patient collections – and the HCP and PHDB collections.

      The other main area of inefficiency in relation to these three data collections is the area of data overlap. Table E-3 summarises the key differences between the HCP and PHDB data specifications. Aside from these key differences, the two datasets capture essentially the same data items, with some minor differences in code sets.

      Both the PHDB and the HCP require data to be submitted in a fixed field, ASCII file format. The specified format for the PHDB is different to that for the HCP, in spite of the fact that they have so many items in common.

      Table E-3 Differences between the HCP and PHDB.

      Field No or issue HCP PHDB
      1
      Insurer Membership Identifier - valid value added Insurer Membership Identifier - blank filled
      2
      Insurer identifier - the health fund registered three character code. Example: AHB - Defence Health AUF - Australian Unity Etc. Payer Identifier - indicator of the type of funder of the episode: IH - Insured with Agreement with Hospital IN - Insured with no Agreement with Hospital SI - Self Insured WC - Workerís Compensation TP - Third Party CP - Contracted to Public Sector CV - Department of Veteransí Affairs patient DE - Department of Defence patient SE - Seaman OT - Other
      Family Name Family Name - Blank filled, as not required for reporting to DoHA Given Name Given Name - Blank filled, as not required for reporting to DoHA

      There is a significant amount of overlap between the PHDB and APC (see Table E-4). Very few items included in the APC are not also included in the PHDB specification or able to be derived from PHDB items. There are a large number of items within the PHDB that are not available in the APC. By far the majority of these items relate to private hospitals’ charges and supporting information for different types of specialist care.

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      Table E-4 Relationship between PHDB and APC data items.

      Items common to APC and PHDB 18
      Items mappable from PHDB to APC 15
      Items in PHDB and not in APC 43
      Items in APC and not in PHDB 4

      The other key difference between PHDB and APC data items is the fact that some States and Territories do not provide private hospital identifiers when submitting data for private hospitals within their jurisdiction. These jurisdictions maintain that the basis on which they collect and hold the private hospitals’ data is as custodians and that the data remain the property of the private hospitals. As such, they are not willing to provide the information that would allow individual private hospitals to be identified within the admitted episode data submitted to the APC.

      These jurisdictions also are not willing to provide a data linkage field that would allow episodes from the same hospital to be identified as such, without explicitly identifying the hospital itself. This reflects the view that it would be possible, by comparing episode profiles for each hospital in the jurisdiction, to then identify individual hospitals.

      Comparing the most recent complete year of data for PHDB and APC with the corresponding year’s data for PHEC shows that both PHDB and APC under enumerate numbers of private hospitals and of total admitted private hospital activity in Australia (see Table 8).

      Some stakeholders pointed out that an opportunity exists to submit data via the ECLIPSE claiming system. ECLIPSE stands for Electronic Claim Lodgment and Information Processing Service Environment and is an online claiming system developed by Medicare Australia (now part of the Australian Department of Human Services). It is used by private hospitals to lodge claims electronically with a health insurer and facilitates the checking of eligibility and payment of the claim by the insurer.

      ECLIPSE contains within its file specification the HCP data specification, but this part of the record specification remains unused. In addition, the HCP specification within the ECLIPSE record has become outdated and no longer matches the current HCP specification.

      According to Medicare Australia all health insurers are using ECLIPSE for online claiming and eligibility checking. One major health insurer informed this Review that around 50% of its private hospital claims are handled using ECLIPSE. The DVA also indicated that around 50% of claims from contracted hospitals and day procedure centres are handled using ECLIPSE.

      Data suggest that around 19% of insured private hospital episodes are claimed using ECLIPSE. As health insurers are actively pursuing further roll-out of ECLIPSE for managing claims lodged by private hospitals, this level of coverage will rise in the future.

      The marketing of ECLIPSE as an online claiming solution has been the subject of a previous court case, brought by the distributor of a competing online claiming solution against Medicare Australia, alleging contravention of the Trade Practices Act. That case was settled out of court in October 2009 and at present there is no competing solution in the marketplace. However, there remains a possibility that competing solutions for online claiming may enter the marketplace in the future.

      Stakeholders identified the need to obtain information on privately insured patient stays in public hospitals as a high priority. An option was suggested, for the Department to work closely with a jurisdictional health department and an insurer to undertake a data linkage exercise, to test this as a means to fill this gap.

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      There have been issues with disconnection between data development and implementation of APC NMDS items, and operating constraints for the private hospital sector. This Review found the issues most likely have arisen because the data development and implementation processes largely have focused on the public sector and not adequately dealt with factors unique to the private sector.

      There are 2 key factors that differentiate the private sector from the public, in terms of implementing changes to data standards and systems. The first is that costs of implementation for private hospitals and insurers need to be recovered through fees and charges and the second is that contractual arrangements dictate the data that private hospitals need to collect and report to insurers.

      A recent issue with disconnection between implementation of changes in the code set for ICD-10 AM under the APC NMDS and the private hospital sector operating environment led to significant work for private hospitals and jurisdictional staff to develop a “work around” that allowed the hospitals to submit different data to different recipients. Risks of similar situations arising in the future would be reduced if there was greater involvement of private hospitals and insurers in national data development work and implementation planning.

      Recommendations

      This Review made a number of recommendations for future change, based on the findings contained in this report. Along with these recommendations, this Review has proposed an implementation timetable, whose key milestones are summarised in Table E-5.

      From that consolidated timetable, it is clear that there is a significant workload involved in order to implement the full range of recommendations. Much of this workload falls to a few key actors. Principally, these are the Department, the Private Hospital Working Group (PHWG) and the HCP Working Group (HCPWG).

      The ability to deliver on the recommended timetable is likely to be constrained by availability of adequate resources among these key actors. As such, this timetable may require revision as time progresses. Progress against the timetable should be reviewed regularly and milestones revised as necessary.

      It must also be noted that the arena of hospital data collection and reporting is dynamic and more so at present, with the changes demanded by the recently agreed national health reforms. This fact is underlined by the supersession, by the establishment of the NHPA, of this Review’s term of reference relating to an authoritative list of private hospitals.

      In light of this fluidity of environment, the recommendations of this Review and associated implementation plans should be routinely monitored and modified as circumstances change.

      Recommendation
      Undertake increased analysis of NHCDC information and develop a series of "experimental estimate" reports.

      Recommendation
      That the responsibility for the Private Health Establishments Collection be transferred to the Australian Institute of Health and Welfare.

      Recommendation
      That CSV file format with field names in the first record be adopted as the standard file format for PHDB and HCP files. This recommendation covers all HCP files, including HCP1, HCP2 and AN-SNAP.

      Recommendation
      That jurisdictions and private hospitals be approached to undertake a pilot test of a process for effecting a common file format for those data fields common to PHDB, HCP and the APC NMDS.

      Recommendation
      That, subject to the above pilot succeeding, the successful model for common specification of common fields be rolled out to all private hospitals and all jurisdictions.

      Recommendation
      That the health insurance industry formally seek membership of NHISSC as an observer. This could be either as a permanent (observer) member or on an occasional basis, when issues specific to health insurers are to be considered.

      Recommendation
      That PHWG and HCPWG meet together at least once per year to discuss data related issues. This meeting should take place in the December quarter, to allow sufficient time for issues requiring implementation in the following financial year to be identified and considered.

      Recommendation
      That NHISSC be asked to develop a formal protocol for assessing business and related impacts of proposed changes to APC NMDS data items and associated metadata on the private hospital and health insurance sector.

      Recommendation
      That the ECLIPSE record specification be updated to permit transmission of HCP data according to the current HCP specification.

      Recommendation
      That the ECLIPSE record specification thereafter be maintained to ensure its capability to transmit HCP data remains current.

      Recommendation
      Investigate the feasibility of conducting a data linking exercise between a jurisdictional health department and insurers for improved HCP information.

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      Table E-5 Implementation plan milestones and their timing.

      Recommendation Milestone Timing
      CSV format for PHDB and HCP Agreed timetable for implementing CSV format for HCP and PHDB October 2011
      HCP capable ECLIPSE Agreed cost and process for effecting ECLIPSE changes December 2011
      Health insurers and NHISSC Write to Chair of NHISSC December 2011
      Joint HCPWG/PHWG meetings Agreed format, business rules and timing for annual PHWG/HCPWG joint meeting December 2011
      Pilot of new data transfer process In-principle agreement with at least one jurisdiction December 2011
      HCP data linkage for public hospitals Develop a detailed project plan. This will include developing a data set specification for use in a data linkage process December 2011
      HCP data linkage for public hospitals Arrange meeting with private health insurer to outline project and obtain participation consent. Provide the data set specification with the identifiers that will be required. Insurer to provide a sample dataset to use in linkage process February 2012
      HCP data linkage for public hospitals Arrange meeting with state health department. Organise to have data custodians and data linkage representatives from state health department. Specify the identifiers that will be supplied to the state health department February 2012
      Joint HCPWG/PHWG meetings First PHWG/HCPWG joint meeting (items for discussion to include NHISSC private sector impact assessment protocol and protocol for regular communication between HCP and PHWG) February/March 2012
      PHEC transfer Agreed project plan for transfer of PHEC, including timetable for final transfer February/March 2012
      HCP capable ECLIPSE Agreed terms of ongoing arrangement March 2012 Private hospital impact assessment protocol Draft terms of reference for a protocol March 2012
      Pilot of new data transfer process Agreed scope and objectives and operating parameters for the pilot with a jurisdiction(s) April 2012
      NHCDC experimental estimates Develop draft reports for each of the selected areas May 2012
      HCP capable ECLIPSE Agreed timetable for update and release of HCP capable ECLIPSE May 2012
      HCP data linkage for public hospitals Commence data exchange, linkage and analysis May 2012
      CSV format for PHDB and HCP Implement new CSV file formats for HCP and for PHDB June 2012
      HCP capable ECLIPSE Release of HCP capable ECLIPSE June 2012
      Private hospital impact assessment protocol NHISSC agrees to final protocol June 2012
      Pilot of new data transfer process In-principle agreement for involvement from private hospitals July 2012
      HCP data linkage for public hospitals Finalise data linkage exercise and prepare report. Identify issues and how process might work on larger scale July 2012
      NHCDC experimental estimates Release report(s) for feedback and comment August 2012
      Pilot of new data transfer process Agreed operating parameters and governance arrangements with partner hospitals December 2012
      HCP data linkage for public hospitals Report and consider expanded pilot results March 2013
      Pilot of new data transfer process Report outcome of pilot test to NHISSC, HCPWG and PHWG June 2013
      Roll out new data transfer process to all jurisdictions Agreed plan to roll out the new process to all jurisdictions and private hospitals June 2013
      HCP data linkage for public hospitals Commence work of rolling out pilot to other jurisdictions July 2013
      HCP capable ECLIPSE Determination of need for annual update of ECLIPSE or not September of the relevant year (2013 onwards)
      PHEC transfer PHEC transfer to AIHW completed June 2014
      Roll out new data transfer process to all jurisdictions Rollout completed June 2015

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