Data Quality HRG4 & Payment by Results Roadshow 2009
Apr 01, 2015
Data Quality
HRG4 & Payment by Results Roadshow 2009
Outline
• Introductions and welcome • Data Quality – What is it and why is it important?• Impact of Data Quality
– Impact on HRG4 and grouping process (NHS IC)– Lessons to be learnt from audits to drive improvement (AC)– Key Coding/Classification issues – preventing poor coding and
ensuring data is of good quality. (CFH)
• Summary & Key messages• Issues to consider• Q&A
The dimensions of data quality
Completeness
Relevance
Timeliness
Reliability
Validity
Accuracy
Data Quality
The importance of data quality to the NHS
• Next Stage Review (Darzi)– Quality measurement and indicators– Enabling and empowering choice– Greater accountability – Quality Accounts– Payment for Quality – CQUIN, Advancing Quality Programme (NHS NW)
• Hospital funding under PbR• World Class Commissioning• PBC• Regulation• Can contribute to poor quality of care (which may have
tragic consequences)
DQ Quotes: NHS IC DQ Programme
• Somebody, somewhere has already solved this problem – if only we knew where to look
• We don’t actually turn up every morning planning to create bad data
• Telling people off doesn’t improve data quality• It’s no good just telling us we have 5% errors – we need to
know what the errors are so we can fix them• People don’t realise that bad data is bad for patient care, bad
for income, and bad for reputation• Most of the problems occur in gaps – between systems,
organisations, programmes, standards, responsibility…
Impact of Data Quality
• HRG4 & grouping• Issues identified from PbR data assurance audits and impact on payment
• Coding accuracy
You and Your U HRG Identifying and resolving U HRGs
What are the error types and why are they generated?
Error TypesUZ01 - Invalid Diagnosis
UZ02 - Poorly Coded Primary Diagnosis
UZ03 - Age Conflicting with Diagnosis
UZ04 - Diagnosis conflicting with anatomical sites
UZ05 - Invalid Procedures
UZ06 - Poorly Coded Procedures
UZ01Z – Data invalid for grouping
How to identify the U HRGs
The FCE HRG The Spell HRG
Local Payment HRG Output File
How to identify the Error Types
Local Payment HRG Data Quality Report
Steps for resolving U HRGs
Ensure the episode contains a valid primary (ICD-10) diagnosis and/or procedure (OPCS-4) codes.
If the ICD-10/OPCS-4 codes are valid codes then examine whether the U HRG being generated is due to the lack of information available to the clinical coding teams.
Need for completeness of data
Non trauma primary diagnosis
CASE AW58.1 Primary resurfacing arthroplasty of joint
HRG: HB99Z Other procedure for non Trauma*Tariff: £493
CASE BW58.1 Primary resurfacing arthroplasty of jointZ84.6 Knee joint
HRG: HB23C Intermediate Knee Procedures for non Trauma without CC*Tariff: £3077
(*Department of Health, 2009-10 national mandatory tariffs, Elective spell tariff)
Summary
• Correct assignment of HRGs is dependent on the accuracy and completeness of the coded clinical data.
• If the grouper encounters an invalid or poorly coded primary diagnoses or an invalid or poorly coded procedure, the grouper will report a U HRG for both the Consultant Episode and the Spell.
• Details of which error(s) have been generated can be found in the quality report.
• www.ic.nhs.uk/casemix/prepare– Introduction to HRG4– HRG4 Concepts– HRG Coding Validation– HRG4 Chapter Summaries Definitions
Comparative Analysis– HRG4 Code to Group [what goes where and
how]– Guide to Data Field validation– Top 10 Tips / FAQs
Further information
PbR Data AssuranceDriving improvementsthrough audit and benchmarking
Coding errors (Qs 1-3 2008/09)Percentage of Primary Procedures Recorded Incorrectly
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Trust Value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008
17.0%
6.0%
Percentage of Secondary Procedures Recorded Incorrectly
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Trust value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008
27.4%
7.0%
Percentage of Primary Diagnoses Recorded Incorrectly
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Trust Value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008
21.0%
8.0%
Percentage of Secondary Diagnoses Recorded Incorrectly
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Trust Value 2008/2009 National Upper Quartile 2007/2008 National Low er Quartile 2007/2008
25.5%
8.4%
Individual trust comparison
40% 30% 20% 10% 0% 10% 20% 30% 40%
HRG errors 2007/08 HRG errors 2008/09
Issues affecting the quality of coding data
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Poor
sourc
e
docum
enta
tion
Tra
inin
g
Polic
y a
nd p
rocedure
docum
ents
Lack o
f
inte
rnal/exte
rnal audit
Codin
g o
f co-
morb
iditie
s
No o
r lim
ited c
linic
ian
involv
em
ent
Sta
ffin
g v
acancie
s a
nd
levels
Accre
dited/e
xperienced
clin
ical coders
Data
definitio
ns
Soft
ware
aff
ecting
codin
g
Not
follo
win
g c
odin
g
manual or
data
qualit
y
revie
w
Are
a n
ot
coded b
y
codin
g s
taff
or
to
national sta
ndard
s
CC
depart
ment
str
uctu
re
Issue
Pe
rce
nta
ge
of t
rust
s
Areas for improvement•Quality of documentation•Coding arrangements•Clinician involvement •Coding co-morbidities
Specialty findings
Code NameFCEs0809
% HRGError0809
% HRGError0708 Change
Rank0809
Rank0708
410 Rheumatology 118 22.0% 45.9% -23.9% 1 1
400 Neurology 214 18.2% 1.4% 16.8% 2 36
302 Endocrinology 207 16.9% 1.1% 15.8% 3 -
180 Accident & Emergency 1139 15.6% 12.9% 2.8% 4 11
430 Geriatric Medicine 760 12.5% 20.9% -8.4% 5 5
340 Respiratory Medicine 583 10.8% 13.4% -2.6% 6 9
420 Paediatrics 1196 10.3% 11.2% -0.9% 7 13
300 General Medicine 5984 9.7% 16.7% -7.0% 8 7
370 Medical Oncology 219 8.7% 38.4% -29.7% 9 2
424 Well Babies 231 7.8% 37.0% -29.2% 10 -
HRG Chapter findings
Chap Chapter TitleFCEs 0809
% HRG Error 0809
% HRGError0708 Change
Rank0809
Rank0708
S
Haematology, Infectious diseases, Poisoning and Non-Specific Groupings 2202 13.4% 13.4% 0.0% 1 5
A Nervous System 1386 9.9% 12.0% -2.2% 2 8
D Respiratory System 1867 9.4% 20.1% -10.7% 3 1
J Skin, Breast and Burns 1216 9.2% 15.0% -5.8% 4 3
H Musculoskeletal System 6424 8.3% 12.3% -4.0% 5 7
RSpinal Surgery and Primary Spinal Conditions 611 7.5% 11.5% -3.9% 6 10
ECardiac Surgery and Primary Cardiac Condition 2843 7.3% 9.1% -1.8% 7 14
F Digestive System 4364 7.3% 11.4% -4.1% 8 11
KEndocrine and Metabolic System 462 7.1% 11.9% -4.8% 9 9
P Diseases of Childhood 1432 7.1% 9.2% -2.1% 10 13
HRG findings
HRG HRG LabelFCEs 0809
% HRGError0809
% HRG Error0708 Change
Rank0809
Rank0708
A24 Cranial Nerve Disorders 39 74.4% 30.8% 43.6% 1 -
S33Examination, Follow up and Special Screening 215 46.5% 31.6% 14.9% 2 31
S31Admission for Unexplained Symptons 139 36.0% 37.0% -1.0% 3 19
H28Non-Inflammatory Bone or Joint Disorders <70 w/o cc 39 35.9% 32.1% 3.8% 4 29
F18Stomach or Duodenum Disorders <70 w/o cc 74 35.1% 19.8% 15.4% 5 95
H27Non-Inflammatory Bone or Joint Disorders >69 or w cc 75 30.7% 37.7% -7.0% 6 17
H85Intracapsular Neck of Femur Fracture with Fixation w/o cc 36 30.6% 33.3% -2.8% 7 24
H89Other Neck of Femur Fracture w/o cc 37 29.7% 42.6% -12.8% 8 9
H63 Head Injury >69 or w cc 34 29.4% 20.7% 8.7% 9 84
H08Joint Replacements or Revisions, Site Unspecified 24 29.2% 15.0% 14.2% 10 150
Error example 1
Error example 2
Err
or
exam
ple
3
Supporting Improvement: benchmarking case studies
Produced an overall assessment of our coding accuracy to provide assurance to the board
Director of Finance & Performance (trust)
Identified high level of activity in one HRG – trust had started recording outpatient test as day case
Information Development Manager (PCT)
Used regularly to investigate outlying specialties – identified area where EPR did not provide enough information for coding
Service Line Reporting Accountant (trust)
Identified sudden increase in activity in outpatients as trust changed their way of counting
Deputy Director of Commissioning (PCT)
Summary
• Coding accuracy still undermining data quality• Consistent issues affecting quality of coding• Variability on Specialty and Chapter • Direction of travel for HRG errors is positive• Coding accuracy impacts HRGs price charged by a trust
Supporting Data Quality
Hazel BrearPrincipal Cross-mapping SpecialistNHS Classifications ServiceNHS Connecting For Health
March 2009
Priorities
Maintenance & Development of the NHS Information Standards – ICD-10 & OPCS-4
Quality source documentation
Adherence to National Standards
Dimensions of coding accuracy
Training and accreditation.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Documentation and Clinician Involvement
Improve the quality of source documentation
Utilise best practice
Engage clinicians – in partnership with coding professionals.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Essential Roles in the Provision of Coded Information
The Clinician provides the information from which to code the patient’s diagnosis and treatment
The Clinical Coder translates that information into the appropriate coded format to reflect the patient’s hospital stay.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
The Three Dimensions of Accuracy
Individual codes
Sequencing Totality
Training and Accreditation
Training and development of coders has a positive impact on limiting coding errors
Invest in and develop your coding departments
Support coder education and training.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Training and Accreditation
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
NHS Classification Service – Clinical Coding: Training and accreditation
NHS Classification Service – Clinical Coding: Training and accreditation
Training ServiceTraining Service AccreditationAccreditation
Delivery (training & materials)
Delivery (training & materials)
Development(training & materials
E-learning)
Development(training & materials
E-learning)
National Clinical Coding Qualification (UK) DeliveryNational Clinical Coding
Qualification (UK) Delivery
National Clinical Coding Qualification (UK)
Development
National Clinical Coding Qualification (UK)
DevelopmentTrain-the-trainer programmeCascade national standard
Training materials
Train-the-trainer programmeCascade national standard
Training materials
Collaborative Working
PbR Data Assurance Framework
Clinical Coding Working Group
Data Definitions Working Group
Stakeholder Groups
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Summary
We all have a responsibility for data quality
National Clinical Coding Standards are crucial to ensure accurate, consistent and comparable information
Encourage partnerships between clinical and coding professionals
Support the training and accreditation of coders.
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
Figures you can trust: Improving wider data quality to meet future need
• Leadership• Clinician engagement• Board assurance processes• External monitoring and review• Support
The NHS IC Data Quality Programme: Vision
Improve the quality of data throughout the NHS and Social Care by:
• Raising awareness about the impact of data quality
• Helping data suppliers to improve data quality• Providing data suppliers and data users with a
data quality grading scheme.
Summary & Key messages
• Coding errors impact on HRG assignment and therefore payment under PbR
• Inaccurate and incomplete data leads to assignment of u codes in HRG4
• Improving clinician engagement, source documentation and training will improve coding accuracy
• Data quality needs to be improved in the wider context in trusts
Key issues
• In tables, identify what your key issues are around improving the accuracy of coding and wider data quality
• Feedback your main issues
• www.ic.nhs/casemix/prepare– Introduction to HRG4– HRG4 Concepts– HRG Coding Validation– HRG4 Chapter Summaries Definitions
Comparative Analysis– HRG4 Code to Group [what goes where and
how]– Guide to Data Field validation– Top 10 Tips / FAQs
Further information
Useful Contacts
For clinical coding queries, classification training products, course bookings and enquiries contact:
www.cfh.nhs.uk/clinicalcoding
For OPCS requests for change
www.cfh.nhs.uk/opcsrequestsportal
The NHS Classifications Service is the definitive source of clinical coding guidance and standards.
For more information…
www.audit-commission.gov.uk/pbr