July 19, 2019  — 

Recording: Webinar: In the Spotlight — Contributing to Quality Data: A Coder's Role

In the Spotlight Webinar: Data Quality Speaker’s Notes

Margaret Penchoff: Hello everyone. Welcome to the In the spotlight webinar: contributing to quality data: a coder’s role. I am Margaret Penchoff, one of the Classification Specialists who works with the Classifications and Terminologies team at CIHI. I will be the moderator for today’s presentation. Without further ado, it gives me great pleasure to introduce today’s speaker. Karina Lyall is a Classification Specialist with the Classifications and Terminologies team at CIHI. She is a location independent worker who works from her home in Nova Scotia. She is a certified HIM professional who comes to CIHI with previous experience as a health info technician, decision support analyst and assistant manager for coding and abstracting. Also participating in delivery of today’s webinar is Zeerak Chaudhary. Zeerak is the project lead for the Your Health System or YHS content team with CIHI’s Health System Performance branch. In this capacity, Zeerak is primarily responsible for ensuring regular and timely refresh of the YHS web tool. Prior to joining CIHI, Zeerak worked as a health services researcher at various government settings. Zeerak has a degree in medicine and also has a masters degree in medical demography. Zeerak will demonstrate the Your Health System tool and resources. Just before I pass things over to Karina, I will open a poll question and give you a few seconds to answer the poll question. The poll question is I understand how coded data submitted to CIHI is used. The options include:

  • I completely understand how the data is used.
  • I somewhat understand but I would like to learn more.
  • I do not understand but I would like to learn.

So I will leave the poll question open for a few seconds to give you an opportunity to answer. I will just leave it open for a few more seconds and it looks like a fair majority have already answered the poll question. So, I am going to end the poll and share the results. So, it looks like 84% of you somewhat understand but would like to learn more while 12% completely understand how the data is used.

I’ll now pass things over to you Karina and I’ll bring up the presentation.

Slide #4: Agenda

Thank you, Margaret and again, welcome. Our topic today is going to focus on the importance of data quality at the coder’s level and beyond.

On today’s agenda, we will look at the input and output of data- what a coder’s role is, as well as what CIHI does with that data. And we will also look at an example of codes in action. Then, we will move into data outcomes and briefly touch on health indicators and how coding affects the end result. Finally, we will talk about the impact of the data and the importance of improving high quality data for patient care.

Slide #5: It all starts here…

Data Input. So, it all starts here… The flow of the data begins with the patient. First, the patient comes into the hospital. The physician and other health professionals document in the patient’s health record regarding their diagnosis, treatment and care.

After that, the patient’s chart is sent to the health information department where the coders assign diagnosis and intervention codes, as applicable and according to the Canadian Coding Standards. Data quality checks are performed before the data is sent to CIHI, and then the data is validated again at CIHI, and any errors are sent back to the coders for correction and resubmission.  

But it doesn’t stop here…So then what? ‘Where does that data go? Who’s using it? Why is diagnosis typing and coding selection so important?’– Have no doubt, that the data that you collect day to day DOES get used and there is a reason for all the diagnosis typing!

Slide #7: Data to information

So, CIHI enhances the data! When the initial data submissions are received by CIHI, the data goes through internal edits checks and validations. On a quarterly basis, Open-Year Data Quality (OYDQ) reports are released to facilities and/or Ministries of Health flagging suspect data quality issues. The data will be further processed and CIHI adds value to the data by applying the grouping and weighting methodologies. The DAD data is also populated into other data holdings, for example, the Canadian Joint Replacement Registry (CJRR) or even databases such as the Hospital Morbidity Database (HMDB). Finally, the information produced from the data is published and extracted for various usage.

Slide #8: Data output

Now we will take a further look into those various uses of the data.

Slide #9: Who’s using the data?

First off, who is using this data? The health data that is collected across Canada is used by many different programs and organizations. It can be beneficial to:

  • Healthcare Professionals- such as clinicians, health system managers or decision support analysts
  • Media and the public may use the data to report or become knowledgeable on trending issues
  • Ministries or Departments of Health and non-profit organizations use data for making decisions to help improve the health of Canadians. Such organizations include Health Canada, Statistics Canada, or the Public Health Agency of Canada

These are just a few examples of who uses the coded data but there are many internal and external stakeholders requesting health information on a daily basis

Slide #10: Data usage

The data can be used for, but not limited to:

Indicators and reporting, Shared Health Priorities or SHP indicators are new indicators that were just released last month. These indicators focus on measuring access to mental health and addictions services and access to home and community care- (we will talk more about these indicators further into the presentation), Indicators and reporting provide information for peer comparisons and decision-making (that being at a national level or even for international comparisons), outcomes management, as well as hospital system funding and resource allocation.

In all, the data is used to improve health system performance and quality patient care.

The coded data allows CIHI to use evidence-based reporting to focus on current health priorities such as patient experience, quality and safety, outcomes, and value for money and priority Populations also include Seniors, Indigenous peoples, Children and Youth, and Mental Health and Addictions

Slide #11: Codes in action: Dementia in Canada

Let’s take a look at what codes can do. Dementia is one of the top 5 conditions that acquire the highest hospital costs in Canada. So, let’s see how one dementia code can create an impact on different themes within one digital report.

The information that was produced for the report called, ‘Dementia in Canada’ was generated by data collected from various data holdings, such as the Hospital Morbidity Database. Specific codes such as F00-F03 (which are dementia codes) were used by analysts at CIHI to create this report. An example of a condition included in this report would be ‘Senile Dementia’ as it is an inclusion term under F03- Unspecified Dementia.

An example of one of the sections of this eReport is called, ‘Dementia in Hospitals’. Hospitals use dementia reporting to see where they can improve wait times for patients with dementia- In the emergency department, seniors age 65 to 79 with dementia spent twice as long in the waiting room compared to seniors without dementia

Dementia data has been used to develop infographics to show the population of ‘Young-onset dementia’.

‘Dementia and Falls’ focuses on patient safety as seniors with dementia are twice as likely to be admitted with a fall related injury compared to seniors without dementia.

Lastly, dementia coding can also impact palliative and end-of-life care. This section of the report shows that seniors with dementia are facing a gap in palliative care treatment as few seniors living with dementia are receiving palliative care. It helps raise questions about the reasons for lack of palliative care such as difficulty assessing needs or assessing prognosis, or even if there is a limitation of access in a specific community.

New reports are always being published on the CIHI website. This is only a small example of what quality coding can provide and remember the previous slide of how many organizations and other stakeholders are using this data. If health information management professionals didn’t collect this information, reports like this one would not be possible, so know that each chart you code can produce meaningful health information.

If you go to CIHI’s website under the ‘Access Data and Reports’ page, you can find recently released reports on different priority themes of interest which we will include a link to at the end of the presentation.

Slide #12: Data outcomes

Data Outcomes- We are now going to briefly touch on examples of how the data is used to report on outcomes and how they can be measured

Slide #13: What is a health indicator?

What is a health indicator? It is a single summary measure that is reported on regularly and provides relevant, actionable and comparable information

It summarizes information on a given priority topic and helps clinicians, facility leads, decision support teams ask the right questions to analyze outcomes:

  • Are we providing the right care?
  • How well are we doing?
  • Can we improve and where can we improve?
  • How do we compare?

The purpose of indicators is to be able to take action on results to improve health system performance where it is applicable.

Slide #14: Hospital Harm Indicator

An example of a health indicator is Hospital Harm. This indicator classifies harm into 31 separate actionable clinical groups that were developed in collaboration with the Canadian Patient Safety Institute and CIHI. The indicator records the occurrence of unintended harm in acute care hospitalizations that could have potentially been prevented by implementing known evidence-informed practices.

The indicator enables facilities to identify patient safety improvement priorities and to also track the outcome of improvement efforts undertaken to reduce this potentially preventable unintended harm. The Hospital Harm indicator is one of the few indicators that is not meant for peer comparison but is used to help facilities see potential issues and make better informed decisions to improve patient safety at their own facility.

Slide #15: Hospital Harm

Here are the 31 clinical groups that the Hospital Harm Indicator tracks and in orange, are examples of some of the codes that are needed in order to track these harmful events. And if you notice some of the code examples, many post-intervention conditions or PIC codes are tracked. As coders, it’s important that we know where and how to use the standards for coding PIC conditions.

Slide #16: Job Aid

Job aids are available on the Codes and Classifications page on the CIHI website. These are created to help ensure data quality. This job aid in particular was created to help guide the assignment of those post-intervention conditions. Let’s look at an example of using this standard and how it impacts the Hospital Harm results.

Slide #17: How does coding affect indicators (e.g., Hospital Harm)?

For example, a patient acquires post-operative pneumonia following a hysterectomy

If you follow the PIC job aid, it will lead you to assign a regular code for pneumonia, J18.9. If a coder assumed you always need a T code for complications of procedures, they might assign, T81.88 and use pneumonia as a type 3 versus a type 2. Here is where the diagnosis typing comes into action.

Slide #18: How does coding affect indicators? (continued)

If the incorrect codes were collected, this case would not fall within the hospital harm indicator because the pneumonia was not captured as the type 2 and does not fall under the selection criteria for the clinical group of B16: Pneumonia.  We need to ensure we are telling the correct patient story with assigning the correct codes and diagnosis typing so a patient’s medical data can be utilized effectively to improve patient safety in hospitals.

Slide #19: Shared Health Priorities

As mentioned earlier, CIHI has been working on Shared Health Priority or SHP Indicators identified by federal, provincial and territorial (FPT) health ministers as priorities.

Canadians now have more information about access to home care and mental health and addictions services in their province or territory

Shared Health Priorities and its companion report was just publicly released on May 30th

Over the next 4 years, there will be 3 new indicators each year.

Year 1 indicators include:

  • ‘Hospital Stays for Harm Caused by Substance Use- this measures how many hospital stays are a direct result of substance use
  • ‘Frequent Emergency Room Visits for help with Mental health and/or Addictions’- this indicator measures how many Canadians visited the ER 4 or more times in 1 year and;
  • ‘Hospital Stay Extended Until Home Care Services or Supports Ready’- which measures the number of days a patient remains in hospital waiting for support services. You will know this as alternate level of care or ALC patients.

The main purpose of developing these indicators is to help policy makers identify and earmark investments where they are most needed

Shared Health Priorities and its companion products can be found on CIHI’s website which provides context and assists with interpretation.

The next couple of slides are a summary of what Zeerak will be covering in the demo. Zeerak will now share her screen and do a demo of Your Health System.

Slide #24: Data impact

Thank you, Zeerak! So we already took a look at how the data is used and how it can be measured. Finally, we will take a look at data impact. In order for data to have a positive and factual impact on the health of Canadians, we need to ensure high data quality is in place throughout the entire data transformation process.

Slide #25: Data quality is a shared responsibility

Data quality is a SHARED responsibility especially because many stakeholders come in contact with the data along its journey.

The responsibility of the facility is to ensure that the data submitted accurately reflects the clinical aspect of each inpatient and ambulatory visit

CIHI’s responsibility is to set the national standard for the consistency of morbidity data and ensure that the coder’s have what they need in order to be successful.

Slide #26: CIHI’s information quality framework

CIHI’s Information Quality Framework really brings together the importance of shared responsibility in data quality. Data quality is what enables information quality. Health information management professionals capture and submit quality data by having access to the necessary tools and standards, and quality data can be transformed into quality information that can be actionable and comparable.

Slide #27: Improving high-quality coding: Be the data steward

To improve high quality coding, the coder should be taking on the role as the data steward. We need to make sure data stewardship is in place because high quality data is required for evidence-based decisions. Then, when data has to be extracted, we know the data is complete and accurate as possible.

The 5 dimensions of quality should always be applied. If you want to look into more details about the quality dimensions on this slide, they are available in CIHI’s information Quality Framework, and again, all of these links will be available at the end of the presentation.

It is important for coders to be subject matter experts! Coding departments should promote collaboration between clinicians and other teams such as clinical documentation improvement teams. Coders can leverage their knowledge and expertise to help physicians understand the level of specificity to which data can be captured. There is also a course for data analysts (which is called, ‘Using ICD-10-CA/CCI: What Every Analyst Needs to Know’). It provides researchers and analysts with an understanding of coding and the classifications and the flow of data. This course can be found in CIHI’s Learning Centre and we will also provide a link to this course at the end of the presentation. It is a great tool for analysts because when a data analyst has a question or requires further clarification about the data, he or she will know they can consult with a coder because they are the ones that have access to the source documentation and they are the experts with using the classifications and applying the coding standards. It may also provide some valuable insight for coders about how the coded data is seen from an analyst’s perspective.

And lastly, CIHI provides the data governance of having the standards and resources to make sure the coders are successful. So keep up the great work and continue to use those available resources.

Slide #28: Tools to enhance data quality

Here is a list of available resources that CIHI has available in order for us to enhance the quality:

  • Canadian Coding Standards, currently at v2018
  • ICD-10-CA/CCI Classifications
  • Bulletins and Job Aids which are located on the Codes and Classifications page on CIHI’s website
  • Continued Education- eLearning and Tips for Coders
  • eQuery Service as well as operational reports and Open Year Data Quality (OYDQ) reports which are sent out to facilities

Slide #29: Helpful links

Here is a list of links that we chatted about during the presentation. There are direct hyperlinks for your convenience, except for the eLearning as your need a login to access that course

Slide #30:

We will wrap up with the webinar with a quote for everyone to think about- “Quality is everyone’s responsibility and we never have to stop getting better”. We hope this webinar provided you with more clarity of where the data goes and how it’s used and how important everyone’s role is within the data life cycle.

As long as we can keep improving the coded data, we can continue to be a vital part of our healthcare system and continue to help provide better quality care.