The outbreak of COVID-19 has challenged all health services across the world. The importance of good record processes and clinical data management continues to be pivotal in supporting pressured clinical teams as they battle a demanding and rapidly changing world-wide pandemic. The experiences of the Royal Brisbane and Women’s Hospital (RBWH) health information management team has demonstrated that Health Information Managers (HIMs) have an important role to play in hospital disaster management.
Under the Health Emergency Mission, the Department of Health and Human Services (the Department) is coordinating Victoria’s COVID -19 response through a single Departmental Incident Management Team (DIMT). Its purpose is to manage and slow the spread of coronavirus within Victoria. While the Victorian government reorganised itself around eight missions to drive the government’s public health response, this article discusses the development of a digital solution to support rostering, payroll and timesheet management for the expanding COVID-19 Surge Workforce.
Recent literature has found that appropriate coping mechanisms during the pandemic and lockdown are essential. Labrague and Ballad (2020) found establishing a support system, as well as individual problem-solving skills, were protective factors in resilience during the pandemic. As you may expect, different individuals have different coping strategies. Savitsky, Findling, Ereli and Hendel (2020) identified five coping behaviours demonstrated by nursing students: individual resilience (i.e. one’s ability to ‘bounce back’ after stress); gathering information (i.e. to increase COVID-19 knowledge and become more informed about current events); mental disengagement (i.e. engaging in excessive consumption of food and alcohol; or the use of drugs to distract themselves from current situations); seeking spiritual support (i.e. using spirituality and religious beliefs to deal with difficulties) and humour (i.e. finding the ‘funny’ in things and keeping themselves amused).
With advancements in digital health across Victoria and Australia – including the implementation of an electronic medical record in many major tertiary health services – an appropriate governance of the collection, use and access of patient and consumer health information is more pertinent than ever. As the custodians of health information, Health Information Managers (HIMs) are entrusted with managing, interpreting and protecting the use and collection of a health service’s health information, while operating in partnership with clinicians to support the provision of effective, integrated and comprehensive clinical care. This collaborative relationship fosters a shared responsibility for health information governance and is essential for harnessing the delivery of responsive care across the ‘creation to destruction’ life cycle of health information. A well-defined health information governance framework provides a basis upon which this partnership can be built and sustained and is of particular relevance for HIMs who are working in a space that is transitioning into a digital environment.
The COVID-19 pandemic has driven increased demands for timely, high quality statistics that can help governments to respond to the social, health and economic impacts of the disease. Data has also been critically important for informing the public during this time of high uncertainty. During the early stages of the pandemic, Australia relied on health surveillance systems to provide critical information on numbers of COVID-19 infections and deaths, with these systems continuing to play an important role in managing subsequent outbreaks. As the pandemic progressed, the need to understand the broader impacts on mortality, both direct and indirect, also became apparent. These impacts could not be measured through disease surveillance systems but could be captured through civil registration based mortality data. The Australian Bureau of Statistics (ABS) recognised both the challenge and opportunity in seeking to deliver rapid registration based mortality data, and after consultation with the Australian Health Protection Principal Committee, agreed to find a way to deliver the required data.
Clinical documentation in medical records can be broadly defined as any notation made by medical practitioners and other health professionals relating to a patient’s symptoms, past history, test results or treatments provided during a clinical encounter.Clinical documentation is critically linked to accurate clinical coding and accurate generation of the diagnosis related group (DRG) resulting in appropriate remuneration to the hospital in a case-mix based funding model (Cheng et al. 2009). With the exception of DRGs ending in ‘A’ or ‘Z’, a proportionately higher level of funding may be generated for complications and comorbidities that have been treated, investigated or have required increased clinical care but have not been coded within an admitted patient episode. These complications/comorbidities have the potential to change the Episode Clinical Complexity Score (ECCS) (previously known as Patient Clinical Complexity Level (PCCL)) which influences the acuity of the DRG and resulting reimbursement. The ECCS is a measure of the cumulative effect of a patient’s complications and comorbidities and is calculated for each episode of care using the Diagnosis Complexity Level (DCL) value assigned to each diagnosis code (including principal diagnosis) as a complexity weight.Simple checklists or proformas have been shown to improve the accuracy of the principal diagnosis and procedure code resulting in a higher remuneration for the organisation (Clement et al. 2013; Naran et al. 2014; Murphy et al. 2017). Such checklists are completed by the medical team responsible for the patient in hospital. This task is usually delegated to the most junior member of the team. The clinical coding department at the Mater Health Services have developed such checklists for various specialties. The uptake of the use of these checklists during the inpatient stay is variable.This study aims to confirm the increased remuneration achieved by using checklists and to compare the remuneration generated by a junior medical person as compared to a senior doctor using these lists to help with chart reviews.
The World Health Organization Family of International Classifications (WHO-FIC) has a suite of classifications that can be used in an integrated way to collect, compare and report health information at a local, national and international level (Madden et al. 2007). WHO-FIC contains three reference classifications: the International Classification of Diseases (ICD) (World Health Organization 2016), the International Classification of Functioning, Disability and Health (ICF) (World Health Organization 2001)
Residential aged care has recently been in the spotlight in Australia for all the wrong reasons. The Royal Commission into Aged Care Quality and Safety has highlighted many deficiencies in the provision of care (Commonwealth of Australia 2019), and the tragic impact of the COVID-19 pandemic has further laid bare the extent of the failings within the sector. Principal among the contributing factors identified has been insufficient and ineffective funding allocation along with inadequate staffing arrangements.
Health Information Management Awareness Week turned into the Health Information Management Awareness Month in 2019 as the Health Information Management Association of Australia (HIMAA) celebrated the 70 year anniversary of the profession. For the whole month of May our members were busy organising branch events and celebrations, lobby displays, Health Information Services (HIS) department tours and social functions, and making headlines in their health organisations’ newsletters.
When clinical documentation improvement (CDI) was first introduced in the United States (US), it emerged within the policy climate of the Bush administration, with a major focus on increasing the effectiveness of hospital care and reducing the cost of the healthcare system. The Deficit Reduction Act 2005 was a combination of withholding reimbursement (for hospital acquired conditions), assigning mandatory indicators (‘Present on Admission’ flags), and incentivising best practice (through ‘value-based purchasing) (Wilson, 2009). In order to achieve the requirements of the legislation, CDI programs in the US focused on improving the clinical documentation in the medical records so that resultant coded data submitted to internal and external agencies were as complete and accurate as possible, so as to manage the direct impact on reimbursement (Wilson, 2009).