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“Quality of coded data is clinicians’ responsibility”

A report by the NHS Information Centre – and endorsed by the Academy of Royal Medical Colleges – urges clinicians to improve the quality and value of their hospital data.

The following is a summary of the Hospital Episode Statistics: improving the quality and value of hospital data report…

The quality of hospital data is the responsibility of consultants, both in the way that notes are recorded and in relation to the accuracy with which data on patients is coded. Inaccurate data can lead to errors.

There is now an urgent need for clinicians to engage with national data because it will be used to assess the quality of clinical services and will be available in a patient anonymised format on pubic websites such as NHS Choices, for all to see.

Metrics and indicators of clinical quality will increasingly be published for individual, named consultants, in line with government policies on patient choice of consultant-led teams and “transparency” of detailed data on public services.

Furthermore appraisal and re-validation will require evidence of clinical practice (amount and quality). In most cases HES data will be the only source available but at present it is not of sufficient depth or quality for this purpose.

The report identifies seven key issues for further discussion to help find feasible solutions:

1. Providing clinicians with access to their raw data for the purposes of review and validation.

2. Recording of clinical terms (SNOMED) in addition to ICD10 and OPCS for detailed audit, analysis and validation of codes used.

3. Capture of diagnostic and procedure information in outpatients.

4. Capture clinicians, including non consultant career grade doctors, undertaking medical or surgical activities in addition to the consultant in charge so as to represent the current way in which senior clinicians work in teams.

5. A diagnosis present on admission flag to differentiate between events such as a broken leg, a pressure sore and acquisition of MRSA occurring prior to or during a hospital stay.

6. Easier and more cost effective linkage of other databases to HES.

7. Linking primary and secondary care records.

In the meantime clinicians should accept that ensuring the quality of coded data is their responsibility. To discharge this responsibility they need to make sure that all clinical notes whether paper or electronic are structured and standardised. Regular meetings with clinical coders and validation of the raw data using trust informatics departments or third party informatics providers are required.

Teaching juniors good note keeping and the importance of clinical coding is a responsibility that all consultants should accept. A review of a consultant’s workload, either as an individual or as part of a team should become an essential part of the appraisal process whenever suitable data exists.

It is accepted that the weaknesses in the current processes for collection of HES data cannot be fully rectified without radical change in this process.

These weaknesses include the limitations of the data collected from a clinical perspective, the use of statistical classifications for coding rather than a clinical terminology, and the very fact that a parallel process is used to extract data from non-standardised, largely unstructured paper records.

The AMRC called for a review of this process and a migration towards the collection of data directly from standardised, patient-focused electronic records in which the data items are recorded at the point of care.

Both the Academy and the NHS Information Centre recognise that much action can be taken to improve the existing process while this strategic vision is achieved.

The NHS Information Centre will:

• Consult front line clinical staff on the seven key issues and priorities for improvement. You can fill in the online survey here.

• Publish a feasibility report on the seven key issues.

• Design programs of work to engage all the necessary stakeholders to make change happen.

The NHS Information Centre and the AMRC will work together to:

• Ensure the outcomes of the survey and feasibility report are used to inform the future development of HES.

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