EC TWINNING PROJECT Development of National Coding Standards within the Czech DRG System CZ2005/IB/SO/03

ICD-10 TECHNICAL ADVICE Perspective from an NHS Clinical Coding Service Manager Prague, 27 November 2007 Anita A Hudovsky ACC Clinical Coding Service Manager, Imperial Healthcare NHS Trust (Hammersmith) Development of National Coding Standards within the Czech DRG System

Managing a Coding Department in a Large London NHS Trust The Challenges The Coding Team The Tools we Use Daily Routines & Processes in NHS Trust Processes in Place for Training and Monitoring Classifications v Terminologies The Clinician’s Role Coding Flows – Data, Patient, National – SUS/HES Audit/Training & Data Standards The Underlined Message Development of National Coding Standards within the Czech DRG System

CHALLENGES PbR - Completeness and timeliness v data quality of coding Experienced staff v trainees Retention of staff Mutual misunderstandings between clinician and coder Source documentation EPR v medical record Development of National Coding Standards within the Czech DRG System

The Coding Teams: Team One October workloads 6.9 wte code 4200 fce = per coder November workloads 6.9 wte coder 4133 fce = episodes Team Two October workloads 6 wte code 5034 fce = 36.4 per coder November workloads 6 wte code 4925 fce = 37.3 per coder Development of National Coding Standards within the Czech DRG System Corporate Information Manager Clinical Coding Service Manager (8a) Data Quality Coding Manager (7) Clinical Coding Team Manager (6) Hammersmith & QCH Senior Clinical Coders x 4 (B4) Clinical Coders x 2 (B3) Trainee Clinical Coder nil (B3) Clerical Assistant (B2) Clinical Coding Team Manager (6) Charing Cross Senior Clinical Coders x 5 (B4) Clinical Coders x 2 (B3) Trainee Clinical Coder nil (B3) Clerical Assistant (B2)

The Tools We Use  Classifications  International Classification of Diseases – ICD-10  Office of Population, Census & Surveys – OPCS 4.4  Clinical Coding Instruction Manual, ICD-10 & OPCS4  Coding Clinic  Data Quality Review  Clinical Coding Query Mechanism Development of National Coding Standards within the Czech DRG System

Daily Routines & Processes in UK NHS Trust Run lists of outstanding patients uncoded from PAS system Clerical Assistants visit the wards to collect notes of daily discharged patients Coders visit the wards to collect clinical information Attend Multi Disciplinary Meetings with clinical teams Code between 18 – 50 episodes per day Development of National Coding Standards within the Czech DRG System

Classifications v Terminologies Classifications – ICD-10, OPCS4 ( ICD10-AM ) Terminologies  Read codes v.2  Clinical Terms CT3  SNOMED-CT Development of National Coding Standards within the Czech DRG System

CLASSIFICATION Collates clinical data for statistical, administrative & epidemiological purposes. Concepts usually relating to populations or groups Terminology Used to populate a computerised patient record and describe concepts related to individuals and can support the clinical decision making process Development of National Coding Standards within the Czech DRG System

THE CLINICIAN’S ROLE Providing the coder with an accurate picture of the patient’s episode of healthcare The coder translating this into an encoded format to provide data quality information fit for purpose The clinician validating this data Discussion/engagement with the coder Optimisation of HRG – ensuring correct language/terms used in order for coder to optimise funding. Development of National Coding Standards within the Czech DRG System

CODING FLOWCHARTS Clinicians term Coders input in the classifications or ensure cross-maps to ICD10 OPCS4 HRGs assigned Trust is reimbursed for patient’s treatment Development of National Coding Standards within the Czech DRG System

OUTLINE OF PATIENT FLOWS Development of National Coding Standards within the Czech DRG System

OUTLINE OF DATA FLOWS Development of National Coding Standards within the Czech DRG System

DATA FLOWS TO SUPPORT CLINICAL CODING Development of National Coding Standards within the Czech DRG System

SECONDARY USES SERVICE (SUS) What is SUS? SUS is the single repository of person and care event level data relating to the care of NHS patients Its information is used for management and clinical purposes other than direct patient care (indirect uses) SUS data is derived from commission datasets which providers of NHS care must submit and make available to commissioners SUS holds clinically coded data as it is the replacement for the former NHS Clearing Service. In time it is intended that the data managed within SUS should cover all NHS commissioned care (primary, community and acute). Development of National Coding Standards within the Czech DRG System

HES – HOSPITAL EPISODE STATISTICS HES is a data warehouse containing details of all admissions to NHS hospitals and outpatient appointments in England. Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital. This includes: –Clinical information about diagnoses and operations –Patient information such as age, gender, and ethnic category –Administrative eg waiting times and dates of admission –Geographical information on where the patient was treated and the area in which they lived. –Types of questions HES can answer: How many premature babies were born in hospital during 2004/5 ? How many emergency appendicectomies were performed on males between the ages of 14 and 25 in 2001/2002? Development of National Coding Standards within the Czech DRG System

AUDIT & TRAINING AIMS of an Internal Audit Programme To make comparison between the information contained on ICHIS assigned by Clinical Coding staff and the information contained in the case-notes, clinical information feeder systems (stand alone clinical databases) and other discharge information. To identify where possible the source of any error and provide a written report on the quality of data together with any appropriate recommendations. To support clinical directorates with subsequent analyses through the set-up of a Clinical Coding Data Quality Group To involve all clinical directorates at ward, junior & senior clinical, administrative & management levels Development of National Coding Standards within the Czech DRG System

CLINICAL CODING AUDIT METHODOLOGY V3.0 This framework identifies four key measurement criteria used for judging the quality of clinically coded data:  Accuracy  Consistency  Timeliness  Completeness Development of National Coding Standards within the Czech DRG System

TRAINING  NHS Classification Service Training  Delivers training in national clinical classifications standards and guidance for the NHS clinical coding profession.  Deliver the national clinical coding classifications Helpdesk giving official resolution to all clinical coding queries.  Manage all aspects of the suite of classifications – ICD-10 and OPCS progression  Provide training, education and accreditation programme for clinical coders Development of National Coding Standards within the Czech DRG System

NATIONAL CODING STANDARDS Accurately coded clinical data is essential in developing reliable and effective statistical analysis. Data must be accurate, consistent and comparable across time and between sources. National classifications helpdesk Clinical coding query mechanism UK coding review panel Data Quality Review newsletter with Coding Clinic National clinical coding qualification Joint UK WHO Collaborating Centre Development of National Coding Standards within the Czech DRG System

Correct and complete clinical coding relies on….. Skills of well-trained clinical coders Provision of accurate information in medical records The timely collaboration of medical personnel involved in the patient care