Conference reports HIMAA National Conference. Sydney, October 2012 Janine Carter and Jenny Gilder The 2012 HIMAA National Conference was held on the beautiful Gold Coast in Queensland, Australia, and offered a clinical coding stream alongside the health information management stream. The conference was attended by Health Information Managers (HIMs) and Clinical Coders with a wide range of experience and qualifications, which generated some interesting discussions and information sharing. The conference was preceded by a series of workshops, special interest groups and user-group meetings, including a wonderful presentation from members of the Scanning Special Interest Group, who provided a wealth of information about preparing for and managing the move to digitised records. The Private Hospital Special Interest Group (PHSIG) was chaired by Cassandra Jordan, NSW Convenor of the PHSIG. Three breakaway groups discussed issues such as the future of HIMs in private hospitals, self-promotion of HIMs, salary discrepancies between public and private sectors, professional development and the lack of connection between the Department of Health (DoHA) and the private sector. The launch of the Rural Special Interest Group provided members with an opportunity to discuss how the group could provide support to others located in rural and remote areas. Dr Joanne Curry provided a crash course in using Essomenic patient journey modelling to analyse workflow and identify duplication, redundancy and cost savings (essomenic.net/). ‘Sealed with a kiss’. Dr Mervat Abdelhak with special guest at the conference dinner at Seaworld In the first session of the coding stream, Nicola Barker-Gregory used two complex case studies to educate delegates in the interpretation of ICU documentation and understanding the decision making and clinical procedures. As a nurse educator, Nicola was able to keep the session informative and interesting, albeit gory at times! The NCCC opened their session stating that the classification system was never meant to be a financial tool but it was now required to undertake that role in a pseudo fashion with casemix and activity-based funding. Jenny McNamee, NCCC Director, explored the drivers of changes to the AR-DRG classification; noted that there will be new ACHI codes for neonatal interventions and that gestational age will be a splitting variable. Ann Elsworthy, ICD Coordinator NCCC, provided an overview of the ICD/DRG submission process in 8th edition. This session concluded with Susan Claessen, NCCC ICD Education Coordinator, explaining the ICD10-AM/ACHI/ACS Chronicle. The Chronicle which can be found on the NCCC website under Quick links is a reference tool for classification changes over all editions. Activity-based funding and the fundamentals of ARDRGs were explained by Andrea Groom from Clinical Coding Services, Melbourne. The first day ended with the welcome reception, which provided delegates and vendors with an opportunity to network and socialise over drinks and canapés. On day two, the conference was opened by HIMAA President, Sallyanne Wissmann, who discussed the changing environment in which we all work and the increasing complexity and scope of health information practice. Sallyanne encouraged us all to use all opportunities to demonstrate the health information management skillset and drive change in the health sector. The keynote address was presented by Dr Mervat Abdelhak from the University of Pittsburgh.1 She reminded HIMs of the need to adapt to changes in the health sector and embrace the opportunities offered. Mervat referred to HIMs as the bridge builders, connecting systems with people, privacy and information. The fundamental shifts in health information are around the continuum of care and having enterprise-wide data in real time to support decision making. These shifts require HIMs to use creative thinking and to take a leadership role in that change. Research skills are becoming more important for HIMs to ensure best practice models are developed. Rosemary 1 http://www.shrs.pitt.edu/Abdelhak/ HIM-INTERCHANGE Vol 3 No 1 2013 ONLINE SUPPLEMENT ISSN 1838-8639 (ONLINE) 1 Conference reports Huxtable, Deputy Secretary, DoHA, provided an update on the personally-controlled electronic health record (PCEHR) project. The project is expected to achieve significant financial benefits, reduce avoidable presentations to GPs and hospitals, reduce medication errors and improve continuity of care. The PCEHR will leverage established foundation services, such as the Individual Health Identifiers and clinical terminology systems. A number of projects are underway in lead sites across the country and learning from these projects will inform the development of PCEHR policies and processes. As the NEHTA Education Strategy Lead, Sonya Hilberts was able to provide an interesting overview of their eHealth education strategy, which combines training, events and communication. Sonya noted that HIMs are in a position to take a lead role in eHealth education by advising decision makers, communicating with clinicians and consumers and driving education initiatives. Let’s take up the challenge and look at how we can contribute in our own organisations as well as a profession. Kerrie Dennison spoke about her role as project manager for the Mater Patient Portal project. The portal presents data from various sources, including the Matrix pregnancy record, the Mater shared electronic record and GP databases to provide the patient with a comprehensive record of their health care. The project has made significant achievements, partly due to their efforts in collaboration with stakeholders and the approach to training. A similar project run by Queensland Health was described by Louise Hayes, HIM Strategic Advisor. Louise outlined the challenges and opportunities associated with the development of The Viewer, a web-based application, which provides a summary of clinical and demographic data for patients in Queensland public hospitals. The difference between privacy and security was noted as well as challenges around appropriate use, legislation and data governance. Ian Langdon was the keynote speaker for the session, titled The changing structure of the health sector. Ian has only recently been appointed as Chair of the Gold Coast Hospital and Health Service and has used his ‘non-health’ background to review the impact of structural change and the opportunities and incentives for increasing efficiencies. He noted that proactive clinical engagement was critical to building a culture of performance accountability. The value of HIMs in providing quality information to support decision-making was highlighted by Kim Lewis, Clinical Service Coordinator Project Officer, Redcliffe Hospital. Kim described her role in the model of care review in the general medicine and older persons unit and offered useful data management suggestions. such as not covering too many topics and not presenting too much information at once. Hayley Koberg and Sophia Ovchinnikoff from Queensland Health described the development of the state-wide Data Quality Framework. The framework was established to create a standardised and consistent approach to data quality principles, governance and compliance and the Forms 2 Governance Framework, which coordinates the standardisation of forms to support the transition to the EMR. They noted the significant role the HIMs undertook as subject matter experts. The session concluded with Natasha Donnolley from the University of NSW, who spoke about her role in the development of the National Maternity Information Matrix (MIM). She described the MIM as an electronic inventory of maternity data collected from across the country, which is being used as a baseline for a gap analysis of national maternity data. The challenges of dealing with various data standards, sources and formats were managed by applying her newly gained HIM skills. Professor Anthony Maeder from the University of Western Sydney opened the final session with a thought-provoking discussion about the value of health informatics in improving outcomes and safety in health, for example through electronic health records, personal monitoring and mobility of data. Health informatics plays an important role in supporting new models of care, such as shared care, telehealth and home-based care. Associate Professor Joanne Callen from the University of NSW discussed research at the Concord Repatriation General Hospital into the perception of ED physicians regarding automatic notification of significantly abnormal test results to patients. While studies indicate that patients are interested in receiving test results directly, physicians are generally concerned about the potential impact on patient anxiety and confusion regarding the results. An outpatient automated arrival system was the subject of Gemma Van Fleet’s presentation. The system was implemented as part of the outpatient redevelopment project at Redcliffe Hospital and has eliminated queues, improved data quality and streamlined the workflow significantly. HIM’s skills and knowledge around business processes, problem solving and documentation were critical in redesigning the workflow and developing business rules regarding the automation processes. Margie Luke from Northern Sydney Local Health District presented the final paper of the health information management stream for day two on their transition to a digitised record. She provided a great recount of the project governance, change management, communication, decision making and training as well as the practical tasks such as the forms stocktake, cataloguing and bar coding and noted the importance of stakeholder engagement. The second day of the coding stream started with a paper presented by Lyn Williams from HIMAA, who explained how the Vocational Education and Training (VET) sector is structured and what units of competency are in place for clinical coders. She noted that there are no units of competency that adequately cover medical terminology for clinical coding, nor units for casemix funding and auditing. HIMAA is working toward accreditation of its comprehensive medical terminology course and developing Certificate III and IV and Diploma qualifications for clinical coding. Kate Horkings described the pilot Clinical Coding Training Program delivered by HIM-INTERCHANGE Vol 3 No 1 2013 ONLINE SUPPLEMENT ISSN 1838-8639 (ONLINE) Conference reports Southern Health, Victoria as part of the Department of Health Victoria health information workforce project. The goal of the project was to provide coding graduates with knowledge about Activity Based Funding (ABF), Victorian funding models, prefixes(condition onset flags) and admission policy as well as abstracting from medical records, documentation issues and auditing. Admission to the program involved various tests, including filing and logic, coding and spelling and progressive coding assessments were conducted throughout the course. Anita Jacobsen from NSW Health Education and Training discussed the Clinical Coding Workforce Enhancement (CCWE) project, currently underway in NSW which is aimed at developing the skills of existing clinical coding staff and recruiting new entry-level coders while also increasing the HIM workforce in NSW. NSW Health has partnered with HIMAA to provide recognition of current competence and to purchase a license to use clinical coding teaching resources. Once the project is completed, workforce outcomes will be evaluated and a model of sustainability will be considered to ensure the linical coding and HIM workforces are supported. Jennie Shepheard from the Victorian Department of Health drew on her extensive coding audit experience to discuss strategies and tools for managing and improving data. She spoke about some of the common misconceptions about coding quality and described the data quality roles required of HIMs and clinical coders. Jennie noted the importance of understanding the intended use of data and the associated standards and rules in order to avoid funding imperatives compromising data integrity. The coding stream for day two concluded with a workshop on PICQ and quality system data analysis, run by Joe Berry from Pavilion Health. This comprehensive workshop addressed skills such as benchmarking, performance measurement and improvement and change management. Groups of delegates participated in a number of exercises to work through the various components of clinical coding quality management, using PICQ data. The workshop provided valuable ‘hands-on’ experience in measuring coding quality and implementing change to improve the outcomes. After a full day of conference presentations, the conference dinner provided an opportunity to sit back and relax or groove on the dance floor. Dr Abdelhak was additionally lucky enough to be kissed by the performing seal! Mark Cormack opened the final day of the conference by discussing the work Health Workforce Australia (HWA) is undertaking to address workforce shortages and build a sustainable workforce to meet future demands. Challenges such as an ageing workforce, maldistribution of the workforce and limitations on training capacity are being addressed including specific work associated with the health information workforce. Promoting health information management courses, raising the profile of the profession and establishing strategic relationships with key stakeholders is required to ensure the long-term viability of the health information workforce. Kerryn Butler-Henderson from Curtin University described a collaborative project to identify the eHealth competencies included in the curriculum of Australian health professional courses. The national health informatics competencies were released in 2011 by the Australian Health Informatics Education Council to identify eHealth competencies for all healthcare workers. The results of the study demonstrated significant deficiencies in teaching eHealth competencies across the sector. The results will be used to provide education about eHealth and the associated competencies to clinical educators and to assess educator assumptions against industry views. The issues of recruiting and retaining a clinical coder workforce were discussed by Patricia Catterson from Ballarat Health Services. She provided details about the formal training program offered to clinical coding/HIM graduates to provide structured coding experience and enable mentoring, monitoring and assessment against expected outcomes. Vera Dimitropoulos from NCCH and Dr Joanne Curry from UWS, provided some good news when they described the proposed new course at UWS, which offers a health information management major within their existing Bachelor of Information & Communications Technology. The proposed unit has been mapped to the health information management competencies and they’ll be seeking HIMAA accreditation with a plan to start the unit in 2014. Day 3 of the coding stream started with Anne Elsworthy, NCCC ICD Coordinator, discussing the ICD, ACHI and ACS changes for 8th edition in 2013. Work is underway on the hard copy of 8th edition as well as the electronic version (CodeXpert) and the Chronicle. Education will be delivered in May and June 2013. Professor Richard Madden from NCCH followed on with an update on the development of ICD-11. He discussed a variety of qualifiers, including severity and aetiology of diagnosis. The final coding stream session included case studies in coding process improvement. Karinne Daley and Kelly Williams from Epworth Hospital described their ‘Coding for Complexity’ program, which involved engaging and educating clinical coders and clinicians to achieve better documentation, a better understanding of DRG allocation and ultimately more accurate coding. Nicky Williams followed with a presentation about the use of coded data in the Smokefree Health Target project in New Zealand which aims to eliminate smoking by 2025 by offering hospitalised smokers advice and help to quit smoking. Smoking related ICD-10-AM codes are being used to measure compliance by clinicians against the targets. The final session of the conference focused on activity-based funding and was opened by Professor Ric Marshall, Executive Director of Independent Hospital Pricing Authority (IHPA). Ric noted that the three crucial aspects of ABF readiness are data integrity around the classification model and associated definitions, the accuracy and timeliness of activity measurements and responsiveness to ABF signals. Tony Sherbon, IHPA CEO, HIM-INTERCHANGE Vol 3 No 1 2013 ONLINE SUPPLEMENT ISSN 1838-8639 (ONLINE) 3 Conference reports described the role of IHPA in setting the efficient price specifying the associated standards and definitions. He provided details regarding the scope of ABF funding and the classifications being applied to admitted and nonadmitted patients and ED services and the calculation of the National Weighted Activity Unit. Nicole Predl, Senior HIM at AHSA, discussed the need to streamline the data submission process between hospitals, health funds, State health departments, DoHA and AIHW to reduce duplication and inefficiency. The Private Hospital Collection Review was undertaken to investigate options for streamlining and further work is underway to implement some of the recommended strategies with a goal of reducing reporting burdens for all stakeholders. Patient costing was the focus of the final conference presentation by Garth Barnett of Power Health Solutions. He noted that the projected increase in the health budget necessitates collection of quality costing data from various sources, including coding and DRG data. Engaging clinicians to improve documentation and educating clinical coding staff were listed as key factors in ensuring quality coded data to facilitate accurate costing data. The conference ended with a panel discussion about the future of health information management. The panel members, Katerina Andronis (HISA), Maryann Wood (QUT), Julie Price (HIM Hons Student), Natasha Dunnolley (2011 Curtin Graduate) and Sallyanne Wissman (HIMAA President), represented various professional backgrounds and experience. They responded to questions about what initiatives would drive change in health information management, how health information management skills would need to be adjusted to retain relevance, how we can increase the visibility of the profession and promote it positively, how new graduates can have an impact in their workplaces and how HIMAA can work with the membership to take a lead role in health reform. The panel session and the conference in general generated much discussion and hopefully triggered some thoughts about how we can all promote the profession and ensure we continue to have a key role in the health sector. The next HIMAA conference will be held in Adelaide 21-23 October 2013. Janine Carter BAppSc(HIM) Director, HIMAA Board Manager, Patient & Client Systems Grampians Rural Health Alliance email: [email protected] Jenny Gilder MRL Director, HIMAA Board email:[email protected] 4 HIM-INTERCHANGE Vol 3 No 1 2013 ONLINE SUPPLEMENT ISSN 1838-8639 (ONLINE)