HIMAA National Conference. Sydney, October 2012 Conference reports Janine Carter and Jenny Gilder

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/
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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
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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
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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,
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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]
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