1. Data Quality HRG4 & Payment by Results Roadshow 2009

2. Data Quality Workshop HRG4 Roadshow 2009 Outline Introductions and welcome Data Quality – What is it and why is it important? Impact of Data Quality –Impact on HRG4 and grouping process (NHS IC) –Lessons to be learnt from audits to drive improvement (AC) –Key Coding/Classification issues – preventing poor coding and ensuring data is of good quality. (CFH) Summary & Key messages Issues to consider Q&A

3. Data Quality Workshop HRG4 Roadshow 2009 The dimensions of data quality Data Quality AccuracyValidityReliabilityTimelinessRelevanceCompleteness

4. Data Quality Workshop HRG4 Roadshow 2009 The importance of data quality to the NHS Next Stage Review (Darzi) –Quality measurement and indicators –Enabling and empowering choice –Greater accountability – Quality Accounts –Payment for Quality – CQUIN, Advancing Quality Programme (NHS NW) Hospital funding under PbR World Class Commissioning PBC Regulation Can contribute to poor quality of care (which may have tragic consequences)

5. Data Quality Workshop HRG4 Roadshow 2009 DQ Quotes: NHS IC DQ Programme Somebody, somewhere has already solved this problem – if only we knew where to look We don’t actually turn up every morning planning to create bad data Telling people off doesn’t improve data quality It’s no good just telling us we have 5% errors – we need to know what the errors are so we can fix them People don’t realise that bad data is bad for patient care, bad for income, and bad for reputation Most of the problems occur in gaps – between systems, organisations, programmes, standards, responsibility…

6. Data Quality Workshop HRG4 Roadshow 2009 Impact of Data Quality HRG4 & grouping Issues identified from PbR data assurance audits and impact on payment Coding accuracy

7. You and Your U HRG Identifying and resolving U HRGs

8. What are the error types and why are they generated? Error Types UZ01 - Invalid Diagnosis UZ02 - Poorly Coded Primary Diagnosis UZ03 - Age Conflicting with Diagnosis UZ04 - Diagnosis conflicting with anatomical sites UZ05 - Invalid Procedures UZ06 - Poorly Coded Procedures UZ01Z – Data invalid for grouping

9. How to identify the U HRGs The FCE HRGThe Spell HRG Local Payment HRG Output File

10. How to identify the Error Types Local Payment HRG Data Quality Report

11. Steps for resolving U HRGs Ensure the episode contains a valid primary (ICD-10) diagnosis and/or procedure (OPCS-4) codes. If the ICD-10/OPCS-4 codes are valid codes then examine whether the U HRG being generated is due to the lack of information available to the clinical coding teams.

12. Need for completeness of data Non trauma primary diagnosis CASE A W58.1Primary resurfacing arthroplasty of joint HRG: HB99Z Other procedure for non Trauma *Tariff: £493 CASE B W58.1Primary resurfacing arthroplasty of joint Z84.6Knee joint HRG: HB23C Intermediate Knee Procedures for non Trauma without CC *Tariff: £3077 (*Department of Health, 2009-10 national mandatory tariffs, Elective spell tariff)

13. Summary Correct assignment of HRGs is dependent on the accuracy and completeness of the coded clinical data. If the grouper encounters an invalid or poorly coded primary diagnoses or an invalid or poorly coded procedure, the grouper will report a U HRG for both the Consultant Episode and the Spell. Details of which error(s) have been generated can be found in the quality report.

14. www.ic.nhs.uk/casemix/prepare –Introduction to HRG4 –HRG4 Concepts –HRG Coding Validation –HRG4 Chapter Summaries Definitions Comparative Analysis –HRG4 Code to Group [what goes where and how] –Guide to Data Field validation –Top 10 Tips / FAQs Further information

15. PbR Data Assurance Driving improvements through audit and benchmarking

16. Data Quality Workshop HRG4 Roadshow 2009 Coding errors (Qs 1-3 2008/09)

17. Data Quality Workshop HRG4 Roadshow 2009 Individual trust comparison

18. Data Quality Workshop HRG4 Roadshow 2009 Issues affecting the quality of coding data Areas for improvement Quality of documentation Coding arrangements Clinician involvement Coding co-morbidities

19. Data Quality Workshop HRG4 Roadshow 2009 Specialty findings CodeName FCEs 0809 % HRG Error 0809 % HRG Error 0708Change Rank 0809 Rank 0708 410Rheumatology11822.0%45.9%-23.9%11 400Neurology21418.2%1.4%16.8%236 302Endocrinology20716.9%1.1%15.8%3- 180Accident & Emergency113915.6%12.9%2.8%411 430Geriatric Medicine76012.5%20.9%-8.4%55 340Respiratory Medicine58310.8%13.4%-2.6%69 420Paediatrics119610.3%11.2%-0.9%713 300General Medicine59849.7%16.7%-7.0%87 370Medical Oncology2198.7%38.4%-29.7%92 424Well Babies2317.8%37.0%-29.2%10-

20. Data Quality Workshop HRG4 Roadshow 2009 HRG Chapter findings ChapChapter Title FCEs 0809 % HRG Error 0809 % HRG Error 0708Change Rank 0809 Rank 0708 S Haematology, Infectious diseases, Poisoning and Non-Specific Groupings220213.4% 0.0%15 ANervous System13869.9%12.0%-2.2%28 DRespiratory System18679.4%20.1%-10.7%31 JSkin, Breast and Burns12169.2%15.0%-5.8%43 HMusculoskeletal System64248.3%12.3%-4.0%57 R Spinal Surgery and Primary Spinal Conditions6117.5%11.5%-3.9%610 E Cardiac Surgery and Primary Cardiac Condition28437.3%9.1%-1.8%714 FDigestive System43647.3%11.4%-4.1%811 K Endocrine and Metabolic System4627.1%11.9%-4.8%99 PDiseases of Childhood14327.1%9.2%-2.1%1013

21. Data Quality Workshop HRG4 Roadshow 2009 HRG findings HRGHRG Label FCEs 0809 % HRG Error 0809 % HRG Error 0708Change Rank 0809 Rank 0708 A24Cranial Nerve Disorders3974.4%30.8%43.6%1- S33 Examination, Follow up and Special Screening21546.5%31.6%14.9%231 S31 Admission for Unexplained Symptons13936.0%37.0%-1.0%319 H28 Non-Inflammatory Bone or Joint Disorders <70 w/o cc3935.9%32.1%3.8%429 F18 Stomach or Duodenum Disorders <70 w/o cc7435.1%19.8%15.4%595 H27 Non-Inflammatory Bone or Joint Disorders >69 or w cc7530.7%37.7%-7.0%617 H85 Intracapsular Neck of Femur Fracture with Fixation w/o cc3630.6%33.3%-2.8%724 H89 Other Neck of Femur Fracture w/o cc3729.7%42.6%-12.8%89 H63Head Injury >69 or w cc3429.4%20.7%8.7%984 H08 Joint Replacements or Revisions, Site Unspecified2429.2%15.0%14.2%10150

22. Data Quality Workshop HRG4 Roadshow 2009 Error example 1

23. Data Quality Workshop HRG4 Roadshow 2009 Error example 2

24. Data Quality Workshop HRG4 Roadshow 2009 Error example 3

25. Data Quality Workshop HRG4 Roadshow 2009 Supporting Improvement: benchmarking case studies Produced an overall assessment of our coding accuracy to provide assurance to the board Director of Finance & Performance (trust) Identified high level of activity in one HRG – trust had started recording outpatient test as day case Information Development Manager (PCT) Used regularly to investigate outlying specialties – identified area where EPR did not provide enough information for coding Service Line Reporting Accountant (trust) Identified sudden increase in activity in outpatients as trust changed their way of counting Deputy Director of Commissioning (PCT)

26. Data Quality Workshop HRG4 Roadshow 2009 Summary Coding accuracy still undermining data quality Consistent issues affecting quality of coding Variability on Specialty and Chapter Direction of travel for HRG errors is positive Coding accuracy impacts HRGs price charged by a trust

27. Supporting Data Quality Hazel Brear Principal Cross-mapping Specialist NHS Classifications Service NHS Connecting For Health March 2009

28. Priorities Maintenance & Development of the NHS Information Standards – ICD-10 & OPCS-4 Quality source documentation Adherence to National Standards Dimensions of coding accuracy Training and accreditation. The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

29. Documentation and Clinician Involvement Improve the quality of source documentation Utilise best practice Engage clinicians – in partnership with coding professionals. The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

30. Essential Roles in the Provision of Coded Information The Clinician provides the information from which to code the patient’s diagnosis and treatment The Clinical Coder translates that information into the appropriate coded format to reflect the patient’s hospital stay. The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

31. The Three Dimensions of Accuracy Individual codes Sequencing Totality

32. Training and Accreditation Training and development of coders has a positive impact on limiting coding errors Invest in and develop your coding departments Support coder education and training. The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

33. Training and Accreditation The NHS Classifications Service is the definitive source of clinical coding guidance and standards. NHS Classification Service – Clinical Coding: Training and accreditation Training Service Delivery (training & materials) Train-the-trainer programme Cascade national standard Training materials Development (training & materials E-learning) Accreditation National Clinical Coding Qualification (UK) Delivery National Clinical Coding Qualification (UK) Development

34. Collaborative Working PbR Data Assurance Framework Clinical Coding Working Group Data Definitions Working Group Stakeholder Groups The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

35. Summary We all have a responsibility for data quality National Clinical Coding Standards are crucial to ensure accurate, consistent and comparable information Encourage partnerships between clinical and coding professionals Support the training and accreditation of coders. The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

36. Data Quality Workshop HRG4 Roadshow 2009 Figures you can trust: Improving wider data quality to meet future need Leadership Clinician engagement Board assurance processes External monitoring and review Support

37. Data Quality Workshop HRG4 Roadshow 2009 The NHS IC Data Quality Programme: Vision Improve the quality of data throughout the NHS and Social Care by: Raising awareness about the impact of data quality Helping data suppliers to improve data quality Providing data suppliers and data users with a data quality grading scheme.

38. Data Quality Workshop HRG4 Roadshow 2009 Summary & Key messages Coding errors impact on HRG assignment and therefore payment under PbR Inaccurate and incomplete data leads to assignment of u codes in HRG4 Improving clinician engagement, source documentation and training will improve coding accuracy Data quality needs to be improved in the wider context in trusts

39. Data Quality Workshop HRG4 Roadshow 2009 Key issues In tables, identify what your key issues are around improving the accuracy of coding and wider data quality Feedback your main issues

40. www.ic.nhs/casemix/prepare –Introduction to HRG4 –HRG4 Concepts –HRG Coding Validation –HRG4 Chapter Summaries Definitions Comparative Analysis –HRG4 Code to Group [what goes where and how] –Guide to Data Field validation –Top 10 Tips / FAQs Further information

41. Useful Contacts For clinical coding queries, classification training products, course bookings and enquiries contact: www.cfh.nhs.uk/clinicalcoding datastandards@nhs.net For OPCS requests for change www.cfh.nhs.uk/opcsrequestsportal The NHS Classifications Service is the definitive source of clinical coding guidance and standards.

42. For more information… www.audit-commission.gov.uk/pbr