1	Episode Matching & Bundling Who, when, where Note See also 2003/2004 Changes
2	Episode Matching The Fundamental of a costing system is to determine the cost of a patient episode. How we define the concept of that episode is a key to understanding episode matching. Some utilisation has no “episode”
3	Episode matching order Episode matching occurs in an order of precedence The first match found by the defined rules in the following order is used. Inpatient Emergency Outpatient
4	Inpatient Episodes For the purposes of the exercise let us suppose that an “inpatient event” or “episode” starts from the date and time of admission, to the date and time of discharge. All services of all types provided between those times are part of the “Episode”. The Date and time of Admission. Is that when they arrive in their bed, at triage in the ED, when the Dr decides they have to be admitted? What time is entered on your system. Is the X-ray, taken before admission, on which the decision to admit was based, in or out. The Drugs from pharmacy they pick up on their way out AFTER discharge, or the next day, are they in our out. Who sets the rules, “the Medicare Agreement”? QH. What are the Rules. Why is the ED different.
5	Episode Matching Rules
6	Episode Matching Rules (2) There are three modes for IP linking, 0 Ignore admit and discharge times, use Admit, Discharge and Service dates only 1 Use Discharge date and time, Admit date and time, and service date and time 2 Ignore Discharge time, use Admit date and time, and service date and time, and Discharge Date and Service Date only
7	Emergency Episode Matching Emergency Events are defined from Arrival Date to Departure Date Depending on the Feeder System, Dates of Service between Arrival Date and (Departure Date Plus one Day) are linked to an Emergency Episode. This span is chosen as there can be problems with events crossing midnights.
8	Outpatient Appointment Bundling HBCIS system does not have an OP Episode ID, the key to OP Appointment records is very long, and complex. How do we define an OP Episode, a Visit, a series of OP Clinic visits, what about visits to other clinics within the series. TALONS creates a pseudo episode built from the clinic code, Auto mapped from there to a clinic 4 digit number, add the Date of the clinic and the URNO, and we have the episode Identifier. The Appointments are processed for the current month, next and previous months before XVI extracts commence. An index is created (combined with the EMERG index) Clinics can be excluded from generating Episodes for other utilisation to link to. (2003-2004 changes) see also APP Clinic Excludes Where an IP or AE episode exists on same day, APP utilisation will link to that Episode rather than to clinic. (2003-2004 changes)
9	Outpatient Appointment Bundling (2) This is a sample index entry showing both an Emerg Episode and OP Episode for 999999 UR.
10	Outpatient Appointment Bundling (3) Depending on the Module, a service within 14 days either side of an OP event is linked to that event. Until such times as Feeder Systems can provide the requesting clinic code, the closest OP appointment will always be chosen, and where multiple clinic visits occur on the same day, there can be no predictability as to which will win the utilisation link