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V4.0 1999/2000 VEMD User Manual
POLICIES FOR COLLECTION OF DATA
HEALTH LEVEL 7
Health Level 7 (HL7) is the new messaging protocol to be implemented with the RAPID Data Warehouse (DWH). HL7 is an automatic trigger based transmission format with on-line validation and acknowledgment of receipt of data.
From 1 July 1999, hospitals will have the option of submitting data utilising the revised tab delimited VEMD format (as specified in this manual) or the alternative HL7 data transmission format. It is anticipated that hospitals will be required to submit data utilising the HL7 format by 1 July 2000. Hospitals interested in testing the HL7 format should contact Shahn Campbell on 9616-8449 or via email at shahn.campbell@dhs.vic.gov.au
Changes to collection procedures due to the HL7 protocol include
- The ability to record unlimited diagnosis and procedures, and
- The unification of Date and Time fields.
Refer to the document Victorian Health Level 7 (HL7) DWH and ODS Interface Specification for further details on the HL7 messaging protocol.
Procedure for Deletion of Record or Alteration of Campus Code and Unique Key
For tab delimited ASCII format (modified VEMD format):
- To delete a record already on the data base, enter 99999999999 in the Medicare Number field. The record will then be deleted from the VEMD.
- To change the Campus Code or Unique key, delete the record (by sending the record with 99999999999 in the Medicare Number field) and then resubmit the new record with the correct Campus Code or Unique key. Ensure the deletion record is submitted before the correction record.
- To change data in any other field (not the Campus Code or Unique key) simply correct the erroneous field and resubmit the record. This new record will overwrite the previous submission.
For further details on deletion of records / alteration of Campus Code or Unique Key for the new HL7 messaging protocol, refer to the document Victorian Health Level 7 (HL7) DWH and ODS Interface Specification.
GUIDELINE FOR CHANGES IN TRIAGE CATEGORY DURING ATTENDANCE
The following guideline should be followed when a patient changes Triage Category during an emergency attendance;
- If the triage category of a patient is altered during their attendance, the original Triage Category is to be transmitted to the VEMD (regardless of whether the re-categorisation is higher or lower)
- Changes in Triage Categories may be recorded locally but should not be submitted to the VEMD; only the original Triage Category should be reported.
Comments
- Triaging is an initial decision which is used as the basis for determining how quickly a patient should be treated.
- The same rules should apply regardless of whether the patient’s Triage Category becomes higher or lower.
It is recognised that triage categories may alter during an attendance, as specified in the following extract from the Australasian College for Emergency Medicine’s Policy Document - Triage (November 1993), ‘The triage of patients continues within the emergency department following initial assessment and treatment. Patients may be re-triaged to a different category as the diagnostic process develops and particularly in response to significant changes in physiological status’.
REPORTING OF TRIAGED PATIENTS TO THE VEMD
It is imperative that the VEMD accurately reflects the demand placed on emergency department services, therefore, if a patient is triaged, to one of the VEMD triage categories, their attendance must be recorded within the VEMD in all instances. This applies even when the patient absconds before treatment has commenced OR if registration was commenced but not completed.
All records for those patients who depart in a calendar month should be submitted in a single monthly file. That is, if a patient attends the emergency department on the 30th of April 1999 and departs on the 1st of May 1999, the record should be submitted in the May file, NOT the April file.
Data submitted to the VEMD are run through the VEMD editing program and a summary report detailing the number of records submitted, the number of records accepted and the number of records rejected is forwarded to the hospital. An excel spreadsheet is also forwarded indicating what records have rejected due to particular edit/s.
VEMD patient level data for a calendar month should be sent within 10 days of the end of that month. Hospitals are required to correct data and resubmit the entire monthly file within one week of the receipt of the DHS rejection file. The entire month’s file should be resubmitted for further editing until all records pass the editing process. A clean monthly file should be received by DHS by the end of the following month. For further details, refer to VEMD Data Quality and Timeliness.
The current VEMD editing program has been designed so that all records that are accepted and/or have a warning, are retained in one file, and all rejected data is retained in another. (This ‘reject’ file also displays any warning messages for correction when possible.)
When the file is resubmitted, the records that pass the editing process will now be included in the ‘accepted’ file. This process will continue until all records have been accepted.
Data in the ‘accepted’ file is compared with the monthly aggregate reports submitted to the Quality Unit, therefore it is important to continue to resubmit any rejections (with the whole months data) until 100% quality is achieved.
POLICY FOR PATIENTS ‘REMAINING IN’ ON 30 JUNE 1999
The Version 4.0 VEMD format is to be implemented on 1 July 1999. Therefore, all information for patients who depart the emergency department on or after this date must be submitted in the new 1999/2000 format. This includes patients who remain in the emergency department after midnight on the 30th of June 1999.
For example, Indigenous Status and Aboriginality;
| Patients remaining in the ED after midnight on 30th June 1999 | Patients departing the ED before midnight on 30th June 1999 |
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| Valid codes =
2 - Not indigenous - Not Aboriginal or Torres Strait Islander origin |
Valid codes =
1 - Aboriginal or Torres Strait Islander |
| 5 - Indigenous - Aboriginal but not Torres Strait Islander origin | 2 - Not Aboriginal or Torres Strait Islander |
| 6 - Indigenous - Torres Strait Islander but not Aboriginal origin | |
| 7 - Indigenous - Aboriginal and Torres Strait Islander origin |
During the VEMD Forum held on 6 November 1998, several suggestions were put forward as future directions for the VEMD. These proposals are outlined below and will be further defined closer to the time of implementation, (post July 1999).
ONGOING CARE COMMUNICATION
This proposal consisted of a new field indicating communication of ongoing care. The field values would be Yes/No:
Yes, indicating that active transfer of knowledge and information to the provider of ongoing care was undertaken; and
No, indicating that the transfer of knowledge and information to the provider of ongoing care was not performed.
It was suggested that this field be collected electronically by the clinician, nurse or clerk at the time of discharge. It is felt that this field is necessary as a quality marker and would be utilised to assess follow-up arrangements with primary health care workers.
Upon completion of this field, an automatic trigger may be generated creating a summary of the patient’s attendance. This summary may then be automatically e-mailed or manually faxed to the patient’s General Practitioner or other primary health care worker.
It is anticipated that, in the future, adult physiological recordings such as respiratory rate, systolic blood pressure and the Glasgow coma scale, and paediatric physiological recordings such as the size of the child, airway access, systolic blood pressure, CNS, skeletal fractures, cutaneous injury and loss of consciousness, may be collected from the emergency electronic record and transmitted to the Department for analysis against predetermined Major Trauma scores. Patients who fall into a certain category as specified by the Major Trauma Score, are required to be transferred to a facility able to provide definitive care, that is, a Major Trauma Service. Hospitals designated as a Major Trauma Service are required to provide expert care to major trauma patients (which will be determined by comparison to set criteria/specifications.)
The main principle of the Trauma Task Force model is the delivery of the best possible outcome for the majority of patients. The main advantages of this model are that it maximises the use of available skills and resources, and allows for inclusion of tertiary hospitals with substantial sub-specialisation and critical care expertise.