1. www.chks.co.uk Epidemiology and benefit to patients from accurate coding Heather Walker CHKS Consultancy and Marketing Director 4 th May 2012

2. Epidemiology Epidemiology is the study of how often diseases occur in different groups of people and why. Epidemiological information is used to plan and evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has already developed. Epidemiological observations may also guide decisions about individuals, but they relate primarily to groups of people. This fundamental difference in the purpose of measurements implies different demands on the quality of data. Another task of epidemiology is monitoring or surveillance of time trends to show which diseases are increasing or decreasing in incidence and which are changing in their distribution. This information is needed to identify emerging problems and also to assess the effectiveness of measures to control old problems. Ref BMJ

3. The Coding Process – admitted patient care Admission to Hospital Coded informationInformation abstracted from recorded on the hospitalcase notes and translated databaseinto coded format using the ICD & OPCS classifications Discharge following treatment The Patient

4. Coding Requirements Primary Diagnosis: Main condition treated or investigated during the relevant episode of care, or Where no definitive diagnosis can be made, the main symptom, abnormal findings or problem Secondary Diagnosis: All related conditions which could affect treatment or length of stay Primary Procedure: The main procedure/intervention undertaken during that period of hospital care Secondary Procedures: Other procedures/interventions undertaken secondary to the primary procedure.

5. What do we mean by accurate coding and how can this be achieved That there is a consistent approach and the correct coding rules are applied There is appropriate audit to improve quality and highlight training needs

6. Qualifications in Coding – For consistency and accuracy The National Clinical Coding Qualification (UK) is the only nationally recognised qualification for clinical coders working in the NHS. Delivered in partnership with IHRIM The NHS Classifications Service develops the examination paper to current national clinical coding standards.. Candidates who pass both examination papers are awarded Accredited Clinical Coder (ACC) status by IHRIM Since they started 1519 coders have achieved ACC status Some of these coders go on to become clinical coding auditor and/or trainers

7. Consistent and correct – NHS Connecting for Health Classifications Service Advise - good management processes surrounding coding collection and processing.. investment in training and accreditation

8. Appropriate Audit Data validated and audited is most likely to be recognised as a true reflection of hospital activity so establishing regular clinical coding internal audits at your trust ensures a robust data quality cycle. Clinical coding audit is also an integral part of the Information Governance Requirement 505 Audit Commission Data Assurance Framework underpinning PBR audits

9. Publications on improving coding and data quality The Royal College of Physicians (HIU) Information Laboratory iLab– Project Evaluation Report – September 2006 Availability of information for appraisal, interaction with clinical coders and accuracy of information ‘Top ten tips for coding – a guide for clinical staff’ – RCP Health Informatics Unit 2007 ‘Improving clinical coding and clinical records together’ RCP with the Audit Commission – August 2009 Clinical coding from full medical record Consistent approach to medical record documentation

10. What happens to the coded data

11. Good quality information feeds decision making Health Service planning Service reconfiguration Accurate coding and procedure data

12. Using coded indicators to drive change and benefit patient care Mortality and Morbidity Reviews Reviewing all deaths and the coding associated with these cases Reviewing complications and misadventures to highlight which procedures have higher than expected rates Patient safety and quality boards

13. Improving Stroke Mortality Do hospital records match those reported for the National Sentinel Stroke Audit 30 day mortality has fallen from 24% to 17% in the 2004 – 2010 period

14. Change through Use of Good Quality Coded Data Introduction of a dedicated syncope and falls facility to reduce impact on emergency admissions. Syncope and collapse identified from coding using ICD10 is 6 th most common reason for elderly admissions to hospital. A dedicated facility reduced required inpatient beds by 18 in Newcastle compared with other teaching hospitals, also reducing cost and consultant episodes. Age and aging 2002;31:272-275 Disposable tonsillectomy kits (RCS May2005) Identified at trusts due to increase in the number of cases with a diagnosis code of haemorrhage or haematoma complicating a procedure.

15. Using coded data for revalidation and appraisal Supporting Information for appraisal and revalidation – GMC Vascular surgery complication rates following surgery

16. Information Flows

17. Benefits to patients through accurate coding Not always obvious that coding can benefit patients Benefits may not be immediate Accurate coding can lead to change in practice and services which will benefit all future patients Accurate and consistent coding allows for comparisons which can change health service delivery or provision