ESM WORK PACKAGE

INFORMATION QH-RITM2906565

JUNE 2019 V1.0

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Document history The version history table is useful while the document is in draft. Once the document has been approved, delete all rows except the row with the latest version number (usually 1.00). If an approved document is later updated, update the version history table.

Version Date Status Key changes made Author/s

V1.0 21/06/2019 Complete Meghan Harvey Meghan Harvey

Contact for enquiries and proposed changes If you have any questions regarding this document or if you have a suggestion for improvements, please contact:

Contact Officer Meghan Harvey

Title ESM & HBCIS Development, Support & Training Officer

Phone 07 4433 1329

Email Meghan.Harvey@health.qld.gov.au

Commercial in Confidence This document may contain commercial-in-confidence information. The document has been produced for the sole use of Queensland Health, and should not be provided to external organisations without the written approval of the Chief Executive, Townsville Hospital and Health Services.

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Acronyms and Abbreviations Abbreviation Definition AO Administration Officer DQU Data Quality Unit ESM Enterprise Scheduling Management ieMR Integrated Electronic Medical Record

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Contents 1 INTRODUCTION ............................................................................................................... 1

2 APPOINTMENT ACCEPT FORMAT FIELDS ................................................................... 1

SERVICE DELIVERY SETTING ............................................................................................... 1 PATIENT PRESENT INDICATOR .............................................................................................. 2 CPC – CLINICAL PRIORITISATION CRITERIA – STATUS ........................................................... 2 REFERRAL SOURCE ............................................................................................................ 4 ADDITIONAL CLINICIAN FIELDS ............................................................................................. 5 SSRID – STATEWIDE REFERRAL IDENTIFIER ........................................................................ 5

3 ENCOUNTER FIELDS ...................................................................................................... 6

PAYMENT CLASS ................................................................................................................. 6

4 FUNDING SOURCE .......................................................................................................... 7

CONTRACT INDICATOR ........................................................................................................ 7 PURCHASER ESTABLISHMENT IDENTIFIED ............................................................................. 7 PROVIDER ESTABLISHMENT IDENTIFIED ................................................................................ 8 COMMONWEALTH FUNDING PROGRAM TYPE .......................................................................... 9 COMMONWEALTH EXEMPTION TYPE ...................................................................................... 9

5 REPORTING CHANGES ................................................................................................ 10

MHCP FLAG ..................................................................................................................... 10 SELF-REFERRAL INDICATOR ............................................................................................... 10

6 ENDOSCOPY SPECIFIC FIELDS .................................................................................. 11

REFERRAL CATEGORY ...................................................................................................... 11 CLINICAL URGENCY CATEGORY ......................................................................................... 11 SURVEILLANCE DUE DATE .................................................................................................. 11 SURVEILLANCE INTERVAL .................................................................................................. 11

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1 Introduction This document provides a summary of changes to ESM that will affect site scheduling support staff and end users.

2 Appointment accept format fields

Service Delivery Setting Mandatory field – default set at On Campus This field was initially deployed to serve a dual purpose, capturing service delivery setting and identifying services provided under contract. This field has been redesigned to solely capture the service delivery setting. The values in the red box are being end dated and will no longer be available for use.

This change applies to all appointment accept formats and is a mandatory field. The default is On Campus. Change the selection to Off Campus when appropriate (see below). Guide for Use of Non-admitted patient service event-service delivery setting (QLD) Information taken from Queensland Health Information Knowledgebase (QHIK) http://oascrasprod.co.health.qld.gov.au:7900/pls/crd_prd/f?p=103:7:::NO::P7_SEQ_ID:44122

For service events delivered by telehealth, the service delivery setting is recorded as 1 for the provider's location, and 2 or 3 for the patient's location.

Code 2 - OFF - the hospital campus of the healthcare provider (another hospital)

Includes the 'other hospital' setting. This code is to be used to identify 'hospital outreach-type clinics'.

Code 3 - OFF - the hospital campus of the healthcare provider (other setting)

Includes settings such as:

- Community health or day centre or other community facilities;

- General practice surgeries or clinics;

- Residential aged care facilities; or- Private residences.

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Patient Present indicator Mandatory field – Default set at Yes This additional field will assist in the capture of Multi-Disciplinary Case Conference (MDCC) service events. The field will default to ‘Yes’, indicating patient present. If the patient is not present, change to ‘No’ To capture an MDCC service event an appointment needs to:

• Involve a minimum of 3 providers from 3 specialties and be recorded as such

• Have the patient present indicator set to No. For service events where the patient is not present that do not meet the above criteria, staff are to continue using chart only appointment types. Please note: applying the patient not present flag without meeting the MHCP flag criteria will result in an EVA validation error for the service event.

CPC – Clinical Prioritisation Criteria – Status Mandatory for New Appointments (consultations only) Clinical Prioritisation Criteria (CPC) are clinical decision support tools that will help ensure patients referred for public specialist outpatient services in Queensland are assessed in order of clinical urgency. CPC will be used by both referring practitioners when referring into the Queensland public hospital system and Queensland public specialist outpatient services when determining how quickly the patient should be seen (urgency category). The CPC status of a referral is determined by clinical staff. To capture a referral’s compliance with the Clinical Prioritisation Criteria, a new field is being added to all new appointment accept formats for consultation-style appointments. This means all review appointments, chart only, tests and procedures will not have this field added. This field is mandatory for appointment types that contain the CPC field.

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CPC Status Code Terms of use

Referral awaiting review This code is to be used when a referral is loaded into ESM prior to clinical review. This is an interim code that must be updated once a clinical decision has been made about the CPC status of the referral.

Meets Criteria This code is only selected once a clinical decision has been made about the CPC status of the referral.

Does not meet criteria This code is only selected once a clinical decision has been made about the CPC status of the referral.

Clinical override This code is only selected once a clinical decision has been made about the CPC status of the referral.

No criteria defined This code is only to be used for services that are out of scope for CPC such as Allied Health, Community Health and Mental Health.

Pre 1/07/2019 use only To be used for any referral with a received date prior to 1st July 2019. Refer below for additional information.

Any referrals with a Referral Received Date prior to 1st July 2019 will not require CPC status but still require an entry as this is a mandatory field. To get around this, an additional code has been added “Pre 1/07/2019 use only”. If this code is selected for a request with a Referral Received Date after 30th June 2019, an error will be generated and the appointment/request will require correction. The Pre 1/07/2019 use only code will only be available during the implementation period.

For additional information around Clinical Prioritisation Criteria (CPC) and what services are in scope, refer to the CPC webpage https://qheps.health.qld.gov.au/cpc

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Referral Source Mandatory field The codes users can select are being updated to reflect one value being end-dated and split into two values QH – Other hospital is being split into

Qld Health Other Hospital Same HHS

Qld Health Other Hospital Other HHS

All current appointments/requests that have an end dated value selected will be amended by the Data Quality Unit. This change to the code set will eliminate a large number of REQ003 EVA errors.

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Additional Clinician Fields Non-Mandatory field There are 6 new fields displayed in the appointment accept format to collect Additional Clinician details. These fields will not be used by THHS at this point in time.

At the time of implementation, these fields will simply be a data capture point. However, further work to the ESM letter suite (in the future) will allow the flexibility to pull these fields into a ‘triplicate’ letter. i.e. 1 print job will have the ability to print a letter for the patient, the referring clinician and the additional practitioner. Please Note: The decision at this time is that these fields will not be used at the THHS and are to be left blank. THHS will review the use of these fields when the additional letter functionality is implemented.

SSRID – Statewide Referral Identifier Mandatory for Smart Referral Facilities (in scope services) This field has been added to support sites that are using Smart Referrals. All requests in scope for Smart Referrals require an SSRID. Please note: This field is not to be used for any other information besides the SSRID as it can impact on downstream systems.

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3 Encounter fields

Payment Class Mandatory field at check-in This existing field has 5 new values added that relate to service events provided under the National Injury Insurance Scheme and the Torres Strait Treaty.

For more information on these payment classes:

NDIS https://qheps.health.qld.gov.au/csd/business/finance/revenue/compensable/patients

Torres Strait Treaty https://qheps.health.qld.gov.au/__data/assets/pdf_file/0041/2259689/PNG_TorresStrait-_treaty_patients.pdf

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4 Funding Source Mandatory field at check-in This field is in addition to the Chargeable Status and Payment Class fields. It is optional for pre-arrival encounters and will become mandatory upon patient check-in (outpatient encounter).

To support correct data entry, default values and rules have been applied to assist users. The rules look at the chargeable status and payment class entered and provide only valid options that comply with the Queensland Health Non-Admitted Patient Data Collection (QHNAPDC) guidelines. This will reduce the possibility of incorrect data entry. Please note: for Community and Chronic Registrations this field will be mandatory when creating the encounter.

Contract Indicator Non-Mandatory field This new field is used to capture activity:

• Contracted out (i.e. The Townsville Hospital is purchasing the activity, another facility is providing the service)

• Contracted in (i.e. another facility has purchased activity, The Townsville Hospital is providing the service.)

If a service meets the criteria for a contracted service, this field will need to be populated with ‘yes’. If ‘yes’ is selected in the contract indicator field, the purchaser establishment identifier and provider establishment identifier fields must be completed. Please note: The THHS currently only has a couple of outpatient services recorded in ESM that meet the criteria of a contracted service. All other services across the hospital are to leave as the default ‘NO’.

Purchaser Establishment Identified Non-Mandatory field This field is used to identify the establishment purchasing a non-admitted patient service event.

Purchasers include the following types of establishment:

• Hospital and Health Services

• Interstate health authorities/departments

• Hospitals

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• Hospices

• Primary Health Centres

• Community services

• Surgery Connect

• Other establishments nominated by Hospital and Health Services as purchasers of non-admitted patient service events

Please Note: • For services provided by The Townsville Hospital, this field can be left blank (this is

majority of our specialist outpatient clinics)

• Some community and mental health services will be required to complete this field. Please discuss with your admin team leader if you are unsure what code is required in this field.

• If the service is performed under a contract arrangement, then this field becomes mandatory.

Provider Establishment Identified Non-Mandatory field This field is used to identify the establishment of the provider for each service event. Each separately administered health care establishment has a unique identifier.

Purchasers include the following types of establishment:

• Hospital and Health Services

• Interstate health authorities/departments

• Hospitals

• Hospices

• Primary Health Centres

• Community services

• Surgery Connect

• Other establishments nominated by Hospital and Health Services as purchasers of non-admitted patient service events

Please Note: • For services provided by The Townsville Hospital, this field can be left blank (this is

majority of our specialist outpatient clinics)

• Some community and mental health services will be required to complete this field. Please discuss with your admin team leader if you are unsure what code is required in this field.

• If the service is performed under a contract arrangement, then this field becomes mandatory.

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Commonwealth funding program type Non-Mandatory field This field is being added to identify service events provided under a commonwealth funded program. The field is optional and will only require user input where service events are being provided under these program types.

Programs are:

National Partnership Agreement The service event is funded under a National Partnership Agreement.

Other Commonwealth program The service event is funded under a Commonwealth program other than a service associated with a National Partnership Agreement.

Commonwealth exemption type Non-Mandatory field This field is being added to identify service events provided under a commonwealth exemption. As with the commonwealth funded program field above, the field will be optional and will only require user input where service events are being provided under the provisions of a commonwealth exemption.

At the time of implementation, no services recorded on ESM fall under the Commonwealth Exemption funding therefore this field is to be left blank. Code 1 COAG S19(2) Exemptions Initiative This code should be used to identify primary healthcare service events provided to public non-admitted and non-referred patients eligible to be claimed against the Medicare Benefits Schedule (MBS) under the COAG 19(2) Exemptions Initiative.

Code 2 Rural & Remote Medical Benefits Scheme (RRMBS) exemption This code should be used to identify primary healthcare service events provided to public non-admitted and non-referred patients eligible to be claimed against the Medicare Benefits Schedule (MBS) at RRMBS exempt sites under RRMBS exemption.

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5 Reporting changes

MHCP Flag The Multiple Health Provider (MHCP) flag (also commonly known as Multidisciplinary team or MDT flag) is a derived value for the appointment. The change package will see modifications to the logic to improve the accuracy of this flag. To capture a service event as an MHCP/MDT flagged event, three resources from differing specialties need to be scheduled for the one appointment. In the case of nursing resources, where the resource role codes are not speciality specific, the logic will count each nurse towards the requirements of the MDT flag. e.g. 1 x Medical Oncologist, 1 x General Surgeon and 1 x Physiotherapist Or

1 x Gastroenterologist, 2 x Clinical Nurse Consultants

For more information on around MHCP and MDCC, please contact the Data Quality Unit.

Self-referral indicator This is a change to reporting logic and will not impact functionality for front-end users. If the Health Care Client – Self is selected in the referral source field, the service event will have a self-referral indicator of yes in the back end of the system.

Please note: The addition of this data element will not impose workload on administration staff as this is being derived from an existing mandatory field. For information about which services can accept self-referrals, refer to the QHNAPDC Business Rules https://qheps.health.qld.gov.au/hsu/datacollections#QHNAPDC , Rule 10. To reference this table, you will need the corporate clinic code that is mapped to an appointment type. You can find this in ESM:

• Click on

• Request List

• ESM – Request – Person

• Search for you patient

• Click on FIND

• In your display Look for the Column Corp Clinic Code

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6 Endoscopy Specific Fields To meet Gastrointestinal Endoscopy Data Collections (GIEDC) statutory reporting, a number of new data elements have been deployed. Due to the build of ESM, we were already able to deploy these fields specifically to endoscopy appointments therefore the below fields will not have an impact on general outpatient appointments.

Referral Category This existing new case referral category applied to the endoscopy accept format is being retained in a read only format. Users will see the existing value in a greyed-out field; this is to assist users with guiding the input of the Clinical Urgency Category field below.

Clinical Urgency Category This new data element is based on the HBCIS Elective Admissions Code set, including categories 4, 5, 6 and Surveillance for endoscopy activity. For existing waitlist entries, sites can use the existing Referral Category in read only capacity to identity the correct value for clinical urgency category as follows

Referral Category Clinical Urgency Category

Cat 1 Referral category Cat 4 Clinical Urgency Category

Cat 2 Referral category Cat 5 Clinical Urgency Category

Cat 3 Referral category Cat 6 Clinical Urgency Category

Please note - In endoscopy activity, categories 1, 2 and 3 are not applicable

Surveillance due date This optional field is being deployed to assist sites managing endoscopy surveillance programs following current business rules.

Surveillance interval This optional field will assist sites managing endoscopy surveillance programs. As a business rule if the clinical urgency category is marked as surveillance, the surveillance interval must be entered.

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