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

Development of National Coding Standards within the Czech DRG System ICD training support for information paradox countries Prague, 27 November 2007 Christine Sweeting ACC (Hon) Clinical Coding Consultant UK NI-CO

Development of National Coding Standards within the Czech DRG System Need for: Planning for implementation Planning for implementation Negotiating with data providers Negotiating with data providers Engaging with users of Engaging with users of coded data Participation by stakeholders Participation by stakeholders Standardised education and Standardised education andtraining Challenges

Development of National Coding Standards within the Czech DRG System Need for educators to engage with senior officials and (potential) coders Gain understanding of context in which coding will be done Ensure necessary building blocks are in place prior to implementation Creating a shared vision

Development of National Coding Standards within the Czech DRG System Planning for the vision Who collects the information –mortality –morbidity At what level to report and to whom? What does the current system do to support this? What would we like it to do? What do we need to do to proceed?

Development of National Coding Standards within the Czech DRG System Review of health information systems Coding is only as good as the source documentation

Development of National Coding Standards within the Czech DRG System Medical record coding Do unit records exist and are they accessible? Do records have a specific structure so particular data items can be easily located? Are records complete? Is there a record completion process? Who is responsible for documentation and are there documentation standards? Are there processes to facilitate interaction between coders and clinicians? Linkage between coding & DRG/HRG’s Is a disease index maintained for research purposes?

Development of National Coding Standards within the Czech DRG System Health information system review for morbidity planning Will the medical record support morbidity coding? Morbidity only or mortality also? Who will perform the coding? Training requirements? Training resources? Ongoing training?

Development of National Coding Standards within the Czech DRG System Health information system review for mortality planning Who are the current stakeholders in death certification? Who needs to be notified of deaths? Who will perform the coding? Training requirements? Training resources? Ongoing training?

Development of National Coding Standards within the Czech DRG System Planning for implementation Stakeholders Medical record officers or statistical officers clinicians and certifiers hospital managers, health department officers Epidemiologists, planners and data users Implementation committee to act as liaison between coders and documenters Implementation kit

Development of National Coding Standards within the Czech DRG System Documentation and coding standards Vital for complete and comparable coded data For example: –code to 3 rd or 4 th characters? –use of external cause and morphology codes? –what is to be coded? –definitions for main & additional diagnoses/care types/neonates –recording of coding decisions

Development of National Coding Standards within the Czech DRG System Clinicians and Data Quality (UK) The Clinician should: Have a good working relationship with the coding department to ensure the timeliness and accuracy in clinical coding A working knowledge of standardised statistic collection which occurs in hospital

Development of National Coding Standards within the Czech DRG System Coding workforce issues What makes a good coder? –Aptitude –Enquiring mind –Attention to detail –Interest in medicine –Ability to locate specific information in source documents –Education and training Coders need management support, conducive working environment and sufficient time to code

Development of National Coding Standards within the Czech DRG System Coding workforce issues Training programs are only first step in education process Coders need ongoing support –Local clinical & management support –Maintenance of coding currency –Responsibility for ICD updates –Continuing education –Networking with other coders and with WHO-FIC Network

Development of National Coding Standards within the Czech DRG System Using coded data locally Using coded data for management, resource allocation and research highlights work of coders Quality issues identified and addressed Best coding practice encouraged

Development of National Coding Standards within the Czech DRG System Uses of Clinical Coding (UK) Local community: Clinical governance Commissioning PFI projects Epidemiology Planning commissioning Services – now includes independent sector as awarded NHS contracts Disease registers

Development of National Coding Standards within the Czech DRG System Uses of Clinical Coding (UK) Hospital: Resource allocation Planning Service development Litigation Risk management Clinical audit Care planning Clinical governance

Development of National Coding Standards within the Czech DRG System Uses of Clinical Coding (UK) Nationally: Resource allocation Performance indicators Clinical indicators League tables Media National research

Development of National Coding Standards within the Czech DRG System WHO-FIC IFHRO joint collaboration Greater recognition of coders’ skills and knowledge Standardisation of coding knowledge internationally Improved coding quality

Development of National Coding Standards within the Czech DRG System SEAMLESS HEALTH CARE (UK Model) PATIENT Accident & Emergency Dept. Hospital Outpatient Appointment Community Professional GP Surgery Discharge Admission to Hospital

Development of National Coding Standards within the Czech DRG System Accurate Consistent Timely Complete MEANINGFUL COMPARABLE DATA £ £ £ £ £ £