Welcome to the second issue of 2017, and my first as Editor of HIM-Interchange. The issue has some interesting personalperspectives and the reports are very much “on trend”, covering a number of topics that are currently in the media and which are relevant to Health Information Managers (HIMs) everywhere.
There is strong evidence that the provision of timely and relevant data to clinicians is a key driver for the delivery of safe and high quality healthcare. The rich clinical data provided by admitted patient data collections has played an important role in measuring and monitoring safety and quality indicators to date in Australia, but has arguably not been used to its fullest potential. The April 2016 Heads of Agreement signed by all Australian governments to incorporate a safety and quality component to the national activity-based funding (ABF) model looks set to unlock some of this potential. It means an even greater spotlight on the clinical coded data and the health information management workforce involved in its collection. The health information workforce, which has already had to adapt as a profession to accommodate the changing healthcare landscape due to ABF, are well placed to deal with these developments.
The concept of the My Health Record is a wonderful thing – a national, centralised, standardised, secure, summary medical record accessible by any treating clinician and the patients themselves. The original version, the Personally Controlled Electronic Health Record, was born in 2012, set up by the Commonwealth Government and overseen by the then National Electronic Health Transition Authority. As at 7 May 2017, 4,803,022 or around 20% of Australians had a My Health Record (Australian Digital Health Agency [ADHA], 2017). However, there remains a low public awareness of the My Health Record. How do we turn the concept into reality?
In the writing of clinical documentation queries, Clinical Coders (CCs) must be careful what they ask for. They must be aware of the purpose of a documentation query, their professional responsibility and the pitfalls to avoid in writing documentation queries, as well as the positive and negative impacts on data products which arise from the process of writing documentation queries. This article is a further discussion of a paper entitled “Coding Queries – be careful what you ask for!” which was presented at the 2016 Health Information Management Association of Australia/National Centre for Classification in Health Conference by Patricia Catterson of Ballarat Health Services, and Jennie Shepheard of Department of Health and Human Services Victoria.
Scarcity in a coding workforce is not a new issue to health information service departments. This issue has been identified in the Coding workforce shortfall report (Australian Institute of Health and Welfare, 2010) and also in the Health information workforce report (Health Workforce Australia, 2013). Common challenges in clinical coding recruitment have been identified as there being an ageing workforce, and commonly Clinical Coders (CCs) would like to work part-time (Health Workforce Australia, 2013). In addition to these issues, there is an increased need for clinical coding quality and efficiency to meet requirements for activity-based funding (ABF) as CCs spend significant time on quality projects such as clinician engagement meetings and query discussion forums. The introduction of electronic medical records has added an extra burden on CCs to review multiple systems to gather clinical information for the purposes of clinical coding.
In April 2016, while undertaking a Masters of International and Community Development (MICD dual specialisation), I had the opportunity to undertake a work internship at the World Health Organization (WHO) Western Pacific Regional Office and Country Office in the Philippines. According to the United Nations (UN) Foundations, the WHO is the directing and coordinating authority for health within the UN system. It is the member of the United Nations Development Group that is responsible for providing leadership on global health matters, including shaping the health research agenda, providing support to countries and monitoring and assessing health trends (United Nations Foundation, 2016).
The changing healthcare environment brings exciting and interesting times for healthcare professionals. With the move towards activity-based funding (ABF) and complex data modelling, HIMs are equipped with skills that make them valuable assets to healthcare providers and managers in a sector striving for efficiency in service provision. HIMs are well recognised for their broad wealth of knowledge based in the hospital sector, but as demands for knowledge are changing, so is the expertise of the HIMs.
The 18th International Federation of Health Information Management Associations (IFHIMA) Congress was held in Tokyo, Japan, from Wednesday 12 October to Friday 14 October 2016. The Congress was attended by approximately 240 registrants, including 30 Australians, representing 47 countries. Speakers presented on topics of contemporary significance within the international scope of health information management.
One of the biggest challenges facing the health information management workforce in the healthcare system in Australia is the tyranny of distance. The National Rural Health Alliance (2016) lists workforce shortages as one of the key issues in rural and regional health. Shepheard (2015) identified the issues facing regional and rural Health Information Managers (HIMs), including isolation, communication, workforce retention, and technological opportunities and challenges. Over the last few years Australian regional and rural HIMs have been working with their state branches and the Health Information Management Association of Australia (HIMAA)on ways to support the rural and regional health information management workforce, including the dissemination of information, implementing ways to provide professional development, and support of each other in overcoming the obstacle of distance.
Belief is such an interesting thing – central to who we are, what we do, and how others see us. What does this have to do with quality of care? Well, quite a lot as it turns out. In the various health, community, and aged care organisations I visit, I see a lot of “belief-based quality”. What does that mean? Boards and executives are generally very optimistic about the quality of care their organisation provides. They all think their care is above average (hmmmmm) and that in general their staff are out there every day doing a great job. Sometimes they have valid and reliable information to support this view, sometimes they do not. Many of you will have heard my theory on this: we have a deep belief, embedded in our healthcare DNA, that high quality care is created by smart, well trained, well intentioned people coming to work and doing their best. Even in the face of copious evidence to the contrary, in the shape of adverse event studies and public inquiries into poor care, many boards and executives cling steadfastly to the view that all is well – until it’s not. Their mantra is: “We’re accredited and we have great staff. What else is there?”