Downloading the Adult Cardiac Database Specifications and Data Collection Forms, version 2.52.1

• Visit the STS Web site: www.sts.org.
• Select "Database" from the left ORANGE tool bar menu.
• Select "Data Managers' Section" from the right BLUE tool bar menu.
• From the list of STS Databases (Adult Cardiac, General Thoracic, Congenital) select
• Adult Cardiac Database."
• Scroll down to "Data Collection."
• Scroll down to "STS Adult Cardiac Database, version 2.52.1."

Adult Cardiac Surgery Database Vendor Software Certification

The process of certifying vendor software for the collection of version 2.52.1 of the Adult Cardiac Surgery Database is well underway! This rigorous process will help ensure that vendor software collects data correctly and is able to extract data appropriately for submission to the Duke Clinical Research Institute.

The Society of Thoracic Surgeons (STS) has entered into a contract with Digital Innovations (DI) to perform the certification testing. The certification process begins when DI receives a copy of the vendor's software. The testing process will include steps to ensure that:

• valid data can be entered into each field.
• each field rejects invalid data.
• the parent/child relationships between fields are maintained.
• all required reporting and querying capabilities exist in the software.
• records with either data version 2.41 or 2.52.1 can be appropriately created and edited.
  

All vendors should complete the certification process by July 1, 2004. Please contact your vendor directly to learn when the upgraded software will be available. Regardless of when vendor software is ready for installation at the site level, the mandatory start date for version 2.52.1 is July 1, 2004. If vendor software is not installed at the site level by this date, sites must begin or continue to collect version 2.52.1 on paper.

Sites can monitor vendor completion of the certification process by following these directions:

• Visit the STS Web site: www.sts.org.
• Select "Database" from the left ORANGE tool bar menu.
• Select "Data Managers' Section" from the right BLUE tool bar menu.
• Select "Adult Cardiac Database."
• Scroll down to "How to Become a Participant."
• Scroll down to "STS Adult Cardiac Software Vendors."

General Thoracic Surgery Database: Update

First Harvest and Report:

With the mailing of the first General Thoracic Surgery Database (GTDB) Report on March 8, 2004, it is official…the first GTDB harvest has been completed and the GTDB is now on its way to the big leagues to join the Adult Cardiac Surgery Database and the Congenital Heart Surgery Database.

Eighteen of the 37 active GTDB sites contributed to the fall 2003 GTDB Harvest. The harvest captured 19,924 patients with 20,575 operations and reflects data from 1998-2002. All harvested records were captured using version 1.3 Data Specifications. Also included with the GTDB report was a cd, pdf version of the report. An Executive Summary of the fall 2003 GTDB Harvest can be viewed on the STS Web site: http://www.ctsnet.org/file/2003GeneralThoracicExecutiveSummary.pdf.
The next GTDB harvest is tentatively scheduled for late October 2004.

Conversion to version 2.06:

In early 2004 the STS released version 2.06 of the GTDB and requirements to ensure a proper and consistent upgrade to version 2.06. In February of 2004, software designer Bill Begg began the process of converting the software of active GTDB sites from version 1.3 to version 2.06. Because version 1.3 records must be entered into 1.3 software, sites were encouraged to enter all of their version 1.3 records into version 1.3 software as quickly as possible, or before March 15, 2004. Conversion to version 2.06 could not take place at individual sites until all of the sites' 1.3 records were entered into version 1.3 software. To make a clean break from version 1.3 as of February 1, 2004, sites were instructed to collect all new cases on paper using version 2.06. Upon conversion of software to version 2.06, sites entered 2.06 cases collected on paper into their version 2.06 software. If your active GTDB site needs to be converted to 2.06 software, please contact Bill Begg at bbegg@tsda.org. Currently, new sites that participate in the GTDB will automatically receive version 2.06 software.

GTDB Volunteer Support:

As you may know, the Adult Cardiac Database (ACDB) has had a group of volunteer database participants that are referred to as the "ACDB Core Group." This group has contributed to meeting planning, clinical support, data definitions and other general ACDB issues. With the growth of the GTDB, it was decided that a similar group would be beneficial to the GTDB and its participants. The GTDB Core Group met by conference call for the first time in early April 2004. This Core Group meets monthly and will have the same input into the GTDB as the ACDB Core Group has into their Database.

Participants were chosen based on their exceptional clinical understanding of general thoracic procedures, their technical understanding of databases, and prior volunteerism with the GTDB.

GTDB FAQ Document:

The GTDB Core Group decided to create and support a GTDB FAQ Document. Based on the amount of submitted clinical questions, this FAQ document will be updated three times a year: in April, August and December. Please follow the directions below to view the GTDB FAQ Document:

• Visit the STS web site: www.sts.org.
• Select "Database" from the left ORANGE tool bar menu.
• Select "Data Managers' Section" from the right BLUE tool bar menu.
• From the list of STS Databases (Adult Cardiac, General Thoracic, Congenital) select "General Thoracic Database."
• Scroll down to "Clinical Support."
• Select "2. FAQ Document."
  

GTDB to Open to Commercial Vendors:

In early 2004, the STS approved the concept of transitioning the GTDB from the current STS Access-based shareware to a database that allows for commercial vendor involvement. Many of the GTDB sites are familiar and accustomed to the advanced, sophisticated software that commercial vendors offer to the Adult Cardiac and Congenital Heart Surgery Databases. The STS supports offering this same level of software to the GTDB through commercial vendors.

The plan to involve commercial vendors in the GTDB includes:

• The development of a GTDB Software Vendor Contract similar to the contract used by vendors that supply services for the Adult Cardiac and Congenital Heart Surgery Databases. All current STS certified vendors will be given the opportunity to offer services to our GTDB sites.
• Notifying GTDB sites that version 2.06 will be the final software upgrade received from the STS.
• The STS decision to stop support of the Access-based shareware by January 1, 2005. This decision will be reflected in an amended software license and participation agreement.
• Allowing sites to have the option of continuing to participate in the GTDB using the STS Access based shareware or to use software created by a commercial vendor. Those sites that choose to stay with the STS Access based shareware do so with the understanding that all future upgrades and software changes must be completed by and are the sole responsibility of the site. The STS will no longer offer customer support of the STS Access-based shareware.
• Understanding that if a site chooses to stay with the STS Access-based shareware, it must continue to fulfill its obligations of participating in the GTDB by harvesting data to the Duke Clinical Research Institute (DCRI) once a year. Harvested data that is not compliant with the current version of software specifications will not be accepted by DCRI.
• New sites interested in joining the GTDB will be offered the option of collecting their data on paper using version 2.06 until commercial vendor software is available or they can use the STS Access-based shareware with the understanding that as of January 1, 2005 the product will no longer be supported by the STS.
• Commercial vendor focus is to remain on the Adult Cardiac Database Certification process. All potential sites will be notified upon the availability of commercial vendor software for the GTDB.

STS members and staff are excited about the progress of the GTDB, and are eager to facilitate its future growth.

Call for Abstracts!

The Society of Thoracic Surgeons
Call for Data Managers' Abstracts

Adult Cardiac Surgery Database
Congenital Heart Surgery Database
General Thoracic Surgery Database

(Electronic Deadline: June 14, 2004, Midnight CDT)

Abstracts may be submitted for consideration for the October 21-23, 2004 Society of Thoracic Surgeons (STS) Data Managers Meeting, which includes a formal poster presentation session. Selected abstracts will also be presented orally at the October 2004 STS Data Managers Meeting. Following is a list of the 2004 themes for abstract presentation:

Using the STS National Database Core Fields and Participating Sites' Custom Fields to achieve:

• Data Collection/Data Management
• Use of Evidence-based Practice to Improve Outcomes
  

Cost Example: Effect of Intraoperative Extubation on Clinical Practice
Clinical Example: Decrease Incidence of Postoperative Atrial Fibrillation/Flutter
Functional Status Example: Impact of Cardiac/Congenital/General Thoracic Surgery on Quality of Life

• Cost as Related to Quality
  

  Example: Resource Utilization

• Use of Advanced Surgical Technologies to Improve Cardiac Outcomes
  

Example: Robotics/Anastomotic Connectors/SVR Procedures

• Patient Safety and Risk Management Initiatives

Due to the huge success of the abstract and poster presentations at the November 2003 Data Managers Meeting, along with the break-out session titled, "Turn your Research Question into an Abstract or Poster," STS representatives hope to receive a record-breaking number of abstracts submitted for consideration at the October 2004 Data Managers Meeting. Last year's abstracts and the Power Point presentation "Turn your Research Question into an Abstract or Poster" are available on the STS Web site (www.sts.org).

The deadline for receipt of abstracts is June 14, 2004. Abstracts received after this date will not be accepted for inclusion in this year's program unless prior authorization is obtained. Abstracts are to be submitted electronically using the Abstract Submission Form located on the STS Web site.

• Visit the STS Web site: www.sts.org.
• Select "Database" from the left ORANGE tool bar menu.
• Select "What's New" from the right BLUE tool bar menu.
• Scroll down to "Data Managers' Abstract Submission 2004."

Please contact Barbara A. Garren at bgarren@sts.org, or 312-202-5818, if you have questions pertaining to the 2004 abstract process.

New to the Adult Cardiac Database? This meeting is for you!

Time Devoted to New Data Managers at the October 2004 Meeting!

Based on written comments received from the November 2003 Meeting evaluations, The Society of Thoracic Surgeons (STS) will devote time at the October 2004 Meeting for Data Managers who are "new" to the Adult Cardiac (AC) Database.

Many comments from both seasoned and new AC Data Mangers suggested that time at the Annual Meeting be dedicated to the needs of the new AC Data Manager. Seasoned Data Managers said they did not want to sit through information that was directed toward new Data Managers, while new Data Managers said their needs were not being met.

The dedicated time for new AC Data Mangers will be allotted at the beginning of the AC Data Managers Meeting to give those new to the process a "jump start" before the rest of the AC meeting begins. Because defining "new Data Manger" could be as difficult as defining "Perioperative MI," all are welcome to attend, including Data Managers from both the Congenital Heart Surgery and General Thoracic Surgery Databases.

Following is a tentative list of discussion topics:

Cardiothoracic Reimbursement: Can You Make a Difference?

If your practice is like most cardiothoracic surgery practices, then you and your colleagues may have reached an all-time high frustration level with the current payment system. Significant reimbursement cuts from the past few years, coupled with the availability of new technologies and surgical techniques, have created an even more complicated coding and reimbursement system. The introduction of the resource-based relative value system (RBRVS) and the conversion of RBRVS to a fully resource-based system have taken a toll on the specialty with regard to the amount of work, practice expense, and professional liability insurance values over the past several years. The added cost and pressure of compliance and HIPAA issues have also affected the specialty.

The American Medical Association currently houses the Relative Value System Update Committee (RUC), which plays a vital role in developing the work and practice expense values for the CPT codes. The work and practice expense relative value units (RVU) are two of three payment components included in the RBRVS (professional liability insurance is the third) that determine the payment basis for Medicare and many private payers. The RUC consists of 29 members; the medical specialties represent the majority of the RUC membership.

Other than new codes, the only opportunity to change a work or practice expense value associated with a code is during a five-year review. Congress is mandated to review the work, practice expense and malpractice RVUs every five years. The last five-year work review was in 2000, and the next one will take place in 2005. The STS is in the process of identifying codes that are valued improperly and should be addressed in the 2005 five-year review. The STS will mine the STS National Database during the next several months for data supporting increases in payment to the cardiothoracic codes. In addition, the STS will seek names of physicians willing to participate in the survey process in April-June of 2005 and cardiothoracic surgery practices that are willing to provide additional data from extended local databases.

The work-relative value unit takes into account the physician's time, technical skills and physical effort, mental effort and judgment, and psychological stress when adverse outcomes develop. The STS will provide physician survey data, as well as any additional data, to support changes in physician work since the last five-year review. This will include data mined from the STS National Database that support an older, sicker patient population. In addition, the surveys and additional database data will be used to identify changes in ICU care, length of stay, intra-operative time, and post-operative care. The STS National Database provides a distinct advantage in this process for cardiothoracic surgery compared with other surgical specialties because of its comprehensive data.

Because the system is a relative value based system, the procedure that is being surveyed is compared with an existing procedure to help establish a "relative value." The physician work surveys use the mean pre, intra, and post service work times provided by the survey respondents. If surgeons estimate times that are too low or too high, this will have a negative effect on the resulting relative value units assigned to that procedure. Therefore, it is critical that surgeons consider and indicate in the survey the amount of time they spent on each of the pre, intra, and post operative activities identified when they receive a RUC physician work survey from the STS. It is often beneficial to look at the operative log for a given procedure and use the average time for the procedures performed within the past several months. It is also important to accurately reflect the type, number, and level of post-operative visits associated with a procedure, such as critical care, hospital visits, and office visits provided within the 90-day global period.

The Data Manager will play a critical role because the surgeons will depend on their Data Manager to assist them in obtaining and providing the most accurate data available. They also rely on Data Managers to help them complete the surveys on time. The accuracy, thoroughness, timeliness, and volume of surveys are critical to making arguments for increases in reimbursement during the five-year review process. If your practice is willing to participate in this process, please send your contact information to Julie Painter at JULIEPAINTER@GRANDSUITES.COM, fax it to 720-946-4816, or call 720-946-4815.

STS Wisconsin Regional Group Round Up
Jean C. Sesing, R.N. BSN, CCRN

On March 16, 2004 The Society of Thoracic Surgeons (STS) National Database Regional Groups had their first scheduled conference call. The purpose of the Regional Group conference call is to provide a forum for all Regional Group primary contacts to discuss their experiences and activities. During the first of what we hope will be many calls, a participant expressed her frustration with the difficulty in forming and maintaining interest in a regional group. I would like to highlight our regional efforts in Wisconsin and emphasize the value of regional meetings.

The Wisconsin Cardiovascular Data Manager Group (WCDMG) was established November 9, 1994. The first meeting was held at Waukesha Memorial Hospital and, since then, has rotated throughout the state. Our group meets biannually in the spring and fall. In October 2004, we proudly mark our tenth anniversary.

The Wisconsin group was formed initially to facilitate networking. We discuss strategies for collecting data, obtaining physician input and submitting data successfully. Members will often demonstrate ways to use the data for quality improvement. Most important, we have a professional bond that allows us to vent frustration as well as celebrate triumph, which helps us attain an understanding of our roles, and, ultimately, a higher standard of excellence in what we do.

After several years we have developed a statement that describes our regional group's intent: "The mission of the WCDMG is to pursue the greatest integrity of data possible for the improvement and development of cardiac services." This mission is achieved by:

• promoting the quality and efficiency of cardiovascular care in the state of Wisconsin.
• documenting and analyzing health care outcomes on cardiac patients in conjunction with national recognized criteria.
• providing data to those parties designated in the Wisconsin Bylaws, to improve and/or change clinical practice.
  

We use case studies to ensure a higher level of data integrity. In this process, a volunteer from the group will create a narrative case study from a complex situation that he/she has encountered. Each member then completes a basic collection tool and sends it back to the author, who tabulates and presents the results on a Power Point display, along with pertinent definitions and FAQ's. The case study presentation often generates much discussion and learning. Any remaining questions regarding definitions are then e-mailed to the STS FAQ mailbox for clarification. The STS response to the questions is subsequently shared with all regional group members.

The WCDMG is currently developing a Web site that will be available in fall of 2004. The Web site will hold valuable information, such as key contacts, the case studies, and more.

Our next meeting will be held on Wed., Nov. 10, 2004 at Oconomowoc Memorial Hospital. All Data Managers are welcome to attend to learn about the value of these meetings! Please feel free to contact me at 262-928-2621, or jean.sesing@phci.org, for further information and directions.

As WCDMG prepares to celebrate its 10th anniversary, we remember the words of Abraham Lincoln, "Always bear in mind that your own resolution to succeed is more important than any other."