Blog Posts

Improving clinical coding to deliver better patient care

by Rodianne Degabriele Ferriggi, Marketing Executive, 6PM Group

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Clinical coding is essential for the NHS Trusts’ financial stability as it forms the core of the reimbursement process. Furthermore, recent years have seen an increase and diversification in the use of the clinical codes which include the effectiveness of care and enhancing the quality of care pathways. Incorrect coding results in incorrect funding, various complications and resources being wasted as well as providing incomplete data to the Trust’s leadership upon which decisions are being based. 

With an aging population, the importance of recording all the conditions that a patient is afflicted with, is essential to determine the necessary focus points for a trust as well as forecasting care pathways. Recent results have shown that following an audit, “the best performing 25% of trusts had error rates between 1.1 and 5.2% of spells changing price… 25% of trusts had between 10.5 and 45.8% of spells changing price.” The results also show that up to 45.5% of the spells had a change in HRG due to comorbidities and complications.

Accurate recording of the care given to a patient using clinical terms entered into the electronic record, leads to better quality information within the healthcare information system and enables sharing of data across multiple systems more effectively. It enables more effective searching of clinical records to support patient care, patient monitoring and risk management as well as the ability to use such information for clinical trials and research.

How clinical coding is utilised and what are the consequences of error?

Clinical codes or terms provide a detailed description of the care and treatment of patients and contain terms for things like diseases, symptoms, operations, treatments, drugs and healthcare administration. If clinical information is to be transferred safely and exchanged electronically, a standard clinical terminology is a necessary component of all clinical systems. This enables the clinician to record patient information in a consistent manner which is then able to be communicated efficiently and unambiguously between the different systems used by health and social care workers to support, for example, prescribing, referrals, hospital discharges and other business processes.

The importance of clinical coded data can be split into various areas, all contributing to deliver safer patient care. One of these areas includes the Mortality Indicators such as the SHMI. Having accurate mortality indicators is key, so that all comorbidities are coded to ensure that the appropriate level of risk is applied to each patient. Consequences of error will falsely indicate poor patient care and reports an incorrect position on mortality indicators to national bodies and regulators, resulting in financial and other penalties. Other areas include the Standards Monitoring which ensures that a number of standards are routinely monitored. Failure to monitor these standards can result in financial losses, misreported Trusts’ standards, and resources being wasted trying to resolve issues that do not exist.

Coding errors can also lead to poor planning and monitoring of healthcare as the data does not provide a clear understanding of the needs of the community, making the delivery of care more difficult. Other consequences include; savings and investment plans based on inconsistent data,inconsistencies in national data affects analysis which can give an inaccurate picture of public health, poor decision making for public funding, gives a misleading picture of what has actually happened to patients with certain conditions. This is why 6PM thrived to develop Javali, a best-in-class healthcare solution to improve the quality of clinical coding.

About Javali:

Javali automatically scans all available patient documents for each individual inpatient encounter and looks for particular keywords. If keywords are found, it checks whether the coding is correct, either via HRG Code or via ICD10/OPCS codes. If none are correct, an ‘inference’ is raised and assigned to the Coder. This all takes place automatically overnight. Over the past 6 months Javali has been refined, making the solution able to significantly increase medical record quality and improve the mortality index (SHMI) through improved complication and comorbidity coding.

For more information visit: http://6pmsolutions.com/products/hospital-management/javali

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