Marie Glynn & Jacqui Curley, Healthcare Pricing Office, Ireland

Marie Glynn & Jacqui Curley, Healthcare Pricing Office, Ireland

Ireland: Some facts and Figures Population 4.6 million 59 Hospitals code 48 Acute hospitals 38 ABF hospitals 1.7 million admitted patients 62% Daycases 38% Inpatients 1.2 million ED attendances 3.5 million OPD attendances

HIPE Coverage Hospital In-Patient Enquiry (HIPE) coded data set 201599.8 per centof the discharges downloaded were fully coded Data complete by 4 weeks of discharge Using Australian Modification since 2005 Emergency Department and Outpatient data currently NOT collected by HIPE.

Set up on administrative basis in 2015 Located in the Health Services Executive at present Responsibility for: Costing DRG Price Setting Coding Data collection and validation Data Quality Audit Training and Education of all clinical coders Data Analysis, reporting HPO are leading the implementation of ABF

Healthcare Pricing Office (HPO) Supports Hospital In-Patient Enquiry (HIPE) HIPE: national dataset of coded hospital activity Training Classification Software data entry / reporting Audit / Data quality Supporting documentation; ICS, Coding Notes Support to hospitals & data users Data request function Coding Queries and advice

Approx 1.7mdischarges from 59hospitals ~250coders and managers including part-time and full time Coders are nominated by hospitals from administration staff A full time coder may code between 7000-8000 records per year depending on experience & specialties under review

Collection of HIPE Data Administrative & demographic Clinical data collected using: ICD-10-AM/ACHI/ACS 8 th edition Moving to AR DRG V8.0 Irish Coding Standards Diagnoses: Principal diagnosis (PDx) Up to 29 Additional diagnoses (Adx) Hospital Acquired Diagnosis (HADx) Indicator Procedures: Principal Procedure Up to 19 additional procedures

Discharge summary completed by physician Coder extracts data from chart Patient discharged from hospital Training AUDIT Data Quality Coder inputs data onto HIPE Portal: Data entry validation checks Data Quality tools Reporter Local, National and International reporting HIPE National Database HPO Monthly export to HPO The HIPE Data Collection Process

Coding Notes -Newsletter Upcoming courses Coding queries Coding features. Developments in HIPE New or amended guidelines New codes I.T. information Help and guidance

Overview of tools available to all coders and hospitals Provided by HPO Training and support available

ICD-10-AM / ACHI / ACS Irish Coding Standards (ICS) Coding queries HIPE Instruction Manual Training courses HIPE software Edits & Reporter software Coding Notes Data Dictionary HIPE Coding Audit Toolkit HCAT Checker Programme Routine data quality checks

Classification Guidelines Australian Coding Standards (ACS) Irish Coding Standards (ICS) ICS Compliment the Australian Coding Standards. ICS are not indexed in the ICD-10-AM/ACHI classification ICS Numbering corresponds with ACS where appropriate Differences between countries or additional information on existing ACS ICS are published annually

Requirement for ICS subsequently addressed in updates E.g. ICS 1204 Plastic Surgery for History of mastectomy as PDX. ICS retired as included in 8 th edition Differences in Ireland E.g. ICS 15X3-FetalViability is 22 weeks in Ireland Clinical input E.g. ICS 0104 Viral Hepatitis Carrier of Viral Hepatitis C ICS deleted as advice incorporated into 8 th edition Data Collection differences ED activity not collected by HIPE e.g. Procedures performed in ED.

ICS 0048 Hospital Acquired Diagnosis (HADx) Indicator HADxintroduced 1 st Jan 2011 Flag collected for hospital acquired conditions only Pre existing conditions are not flagged If coder is unsure do not assign flag ACS Guidelines for COF 1 apply

Data quality tools available to all hospitals Reviews of data at national level by HPO Monitoring of activity: includes Hospital DRG profiles/ working with ABF to identify/prevent High and low use of codes Unusual activity Working with ABF funders to identify/prevent issues Data quality queries issued to hospitals Chart based coding audit function Audit tool and training in audit function Recruitment of auditors

38% inpatients and 62% daycases Data quality and training issues in areas such as: New coders Z codes Histology Endoscopy guidelines Actions: Increased audit of daycase activity Increased training & refresher training Coding right first time not pre-coding ahead of histologies

Clinical Coder Training Formal Healthcare Pricing Office On-the-job Hospital

Core Coder Training for New Coders Starter Pack Intro to HIPE Webex A&P Coding Skills I Intro to abstraction & classification Endoscopies, Z codes, Intro to Obstetrics Coding Skills II basic coding & common coding areas Coding Skills III consolidation of training and experience Pre-Course reading & Exercises

Ongoing Coder Training Coding Skills IV examples of topics Diabetes Neoplasms Infectious/Sepsis Obstetrics Ventilation Procedural complications Data quality Guest speakers HIPE Reporter Training Pre-Course reading & Exercises

Certification in Clinical Coding Dublin Institute of Technology (DIT) The availability of the Dublin Institute of Technology s accredited certificate in clinical coding shows that these coders are trained in their role and skilled to abstract and code clinician s activity accurately. DIT certification is a measure of coder ability and skill and can be used: To promote the professionalization of coding In recruitment For career progression. Fully trained experienced and accredited clinical coders can achieve the twin goals of: 1. a recognised coding profession and 2. a data set acknowledged by all stakeholders reliable and high quality. There is a recommendation that this be further developed to a more advance level

Ongoing development of Training, Support, Data Quality and Audit Increased profile of HIPE coders and HIPE department Increased audit and monitoring role in ABF environment. Recommendations from National Audit of Admitted Information in Irish Acute Hospitals Planning for classification updates

Thank you for the support and assistance from HIMAA, NCCH, IHPA and all of our Australian colleagues For further information contact: Jacqui.curley@HPO.ie Marie.Glynn@HPO.ie www.hpo.ie