GIRFT Coding Survey

Closes 30 Jun 2019

Opened 6 Feb 2019

Overview

 

Coding underpins activity metrics, payment for Trusts and epidemiological data.  Despite this, coding still has a relatively low profile within provider organisations and is understood to a varying degree by clinicians. 

Each of the GIRFT reports published to date has recommended that extra work is undertaken to improve data quality, and the programme has now set up a coding cross-cutting theme, recognising coding’s crucial role in improving data quality for a variety of purposes.

This questionnaire is being sent to the coding lead or manager in every NHS Trust in England. It is the first step in the theme, gathering together a community whom it can understand and represent. We are seeking to:

  1. build relationships with coding departments
  2. identify trusts that would like support
  3. identify areas of good practice
  4. build a community of coders

Please scroll down to the links for two excel tables that will need to be downloaded, completed and then uploaded for questions 15 and 29. You will be prompted to upload these tables when completing the survey. There is also a PDF file and word version of the survey below if you  should need this to help plan your responses. Please also find a summary document to explain why we are undertaking the survey and how we plan to use the data.

We hope that you find this offer a welcome one and that you will find value and support in this much-needed and exciting theme for GIRFT. We believe there has never been a more receptive climate for change in the NHS. With the backing of the coding community, we can take this opportunity to make significant improvements to the profile of coding and data quality, and thereby provide the evidence that underpins vital clinical changes. 

 

Why We Are Consulting

The purpose of the questionnaire is to obtain a detailed national picture of variations in how coding services are provided within hospitals. The data will be used to provide each Trust coding department with their own data compared to national averages. The GIRFT coding project will be able to identify variations and start conversations with Trusts about areas of best practice, as well as areas for possible development and further collaboration. In addition, the coding questionnaire will allow analysis of possible future workforce problems in areas such as pay scale variations, training provision, workforce skills and professional skill sets.

Since the initial coding questionnaire requests were sent out in January and many responses received, it has become clear that the findings from the questionnaire could contribute usefully to GIRFT specialty deep dives being carried out by the GIRFT specialty review teams. For example, the GIRFT respiratory clinical lead is keen to include findings from the coding questionnaire to provide context where there are discussions about the quality of coded clinical data being used for the respiratory analysis.

Trusts that perform well against particular quality metrics will be invited to work with the GIRFT coding team in order to produce case studies of best practice that will be useful to other Trusts looking to improve their coded data quality

Quality metrics are very susceptible to differences in the local hospital environment for coding and should be used with caution. Influential factors include: recruitment difficulties, quality and availability of clinical records, quality of the Patient Administration System, overall data quality, culture of collaboration between clinicians and the coding team, Trust deficit, long-term professional development of coders, etc.

Quality metrics which are based on specific clinical codes and precise descriptions of good quality are more useful than general quality indicators. General quality indicators are relatively crude and don’t support specific recommendations for improvement. They include “depth of coding” and indicators based on coding service productivity/ efficiency. General quality indicators should be used only with a detailed understanding of the specific issues relevant to the Trust/ specialty/ point of delivery. Some of the possible outputs from the GIRFT coding questionnaire will be general and non-specific and should be used only where they are useful or contribute to a more nuanced description of clinical coding quality.

 

What are the topics covered by the questionnaire?

 

1. Trust activity levels

Includes: number of beds, Finished Consultant Episodes (FCEs) and Outpatient attendances

These high level figures give the context to assess the relative cost and productivity of the coding department.

2. Numbers and pay bands of the coding team

Includes: structure of the coding department, pay bands, career opportunities

The figures on coding service structure and pay will identify variations that may help to explain quality variations. There may be innovations and best practice around professional and career development that other Trusts can learn from.

3. Recruitment issues and incentives

Many Trusts have taken steps to improve recruitment and retention in their coding team. There are likely to be regional and local variations. National data may help to assess the efficacy of retention efforts, which are difficult to show at a single Trust level.

4. Processes and resource devoted to coding quality improvement

There is a wide range of techniques and processes around coding quality improvement. It is important that Trusts use the most appropriate processes that match the identified needs for quality improvement. There is no “one size fits all” and GIRFT aims to establish a varied library of best practice case studies that will provide a useful resource for Trusts.

5. Previous Information Governance clinical coding audit findings

GIRFT intends to assess the correlation between a range of specific coding quality metrics and the self-reported quality measures in the General Data Protection toolkit (previously the Information Governance toolkit). The intention is to show that the development of more specific quality metrics will improve their usefulness.

6. Self-reported areas of best practice

GIRFT is keen to identify and promote areas of best practice. It is likely that Trusts coding teams already have a very good understanding of areas of strength and weakness. GIRFT has a fundamental aim of showing and sharing “what good looks like.”

7. Areas of interest for collaboration with other coding services

The GIRFT coding project intends to facilitate collaboration and networks between Trusts that will help share best practice and develop new resources to improve coding quality. This will encompass the development of coding guidelines, learning resources and detailed coding quality metrics.

8. Scope of the coding service

Overall quality measures for coding, such as average productivity, are affected by other activities that are part of the coding service. There are many clinical data collection functions within any Trust and the clinical coding team may be involved in some of these. Examples could include Outpatients and Emergency Department coding.

Clinical coding teams are experts in assessing complex clinical information and translating this into useful data e.g. clinical codes. This is a transferable skillset and could be used in other areas of data collection that are outside the traditional remit of coding departments. GIRFT is interested in this area of innovation.

9. Current involvement in the GIRFT specialty reviews

The success of the GIRFT specialty reviews depends on a detailed understanding of the data that underpins the data packs. A lot of discussion and time can be saved by involving the local coding team early in the process so that variations in coded data can be distinguished from true clinical variation.

10. Coding training

Coding training can be provided for clinical coders, clinicians and other users of coded data. Training availability and quality has been a long-term issue for clinical coding and training provision remains patchy with widespread variation. One of the aims of the GIRFT coding project is to contribute to available training materials.