The CASSANDRE Project: automated alerts for optimal coding of diagnosis and interventions

As of 1 January 2012,all Swiss hospitals have had to charge acute somatic care hospitalization according to the Swiss disease related group (DRG) System. In this system, hospital bills are based on the discharge summaries. Coders analyze these in order to identify diagnostic and interventional codes. These codes are used by the system grouper to determine a specific DRG code and cost-weight. The amount to be charged per episode is based on this cost-weight. Since acute care billing relies on discharge summaries and knowing that these are incomplete, our aim was to inprove the completeness of these documents by automatically detecting pathologies that should have been coded and charged. We also aimed to help improve the selection of the main diagnosis. We have implemented algorithms for the automatic detection of pathologies that directly inform the coders whilst by-passing the physician. Final validation of the new pathologies remains with the physician. Our results are very encouraging from a financial point of view.