March 30, 2022 – Recording: Webinar: In the Spotlight — Contributing to Quality Data: A Coder's Role
In the Spotlight Webinar: Data Quality Speaker’s Notes
Slide 1: Introduction
Hello everyone. Welcome to the In the Spotlight webinar Contributing to Quality Data: A Coder’s Role. Before we get into the presentation, I will open a poll question and give you a few seconds to answer the 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.
84% of you somewhat understand but would like to learn more while 12% completely understand how the data is used.
I’ll now bring up the presentation.
Slide 4: Agenda
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 is a coder’s role, 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: Data input
We’ll start by looking at data input.
Slide 6: It all starts here…
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 classification rules, coding conventions and 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 code 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
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 or departments 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
- Health care 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 daily.
Slide 10: Data usage
Examples of data usage include indicators and reporting. For example, Shared Health Priorities or SHP indicators are indicators that CIHI started to release in 2019, when CIHI reported results for the first 3 indicators. The common set of 12 pan-Canadian indicators were developed in collaboration with federal, provincial and territorial governments, sector stakeholders, measurement experts and the public, and 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. The rollout of the 12 SHP indicators will occur over a 4-year period, from 2019 to 2022.
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; First Nations, Inuit and Métis; children and youth; and mental health and addictions services.
Slide 11: Codes in action: Dementia in Canada
Let’s look at what codes can do. Dementia is one of the top 5 conditions that account for the highest hospital costs in Canada. Let’s see how 1 dementia code can have an impact on different themes within 1 digital report.
The information that was produced for the report called Dementia in Canada, published June 2018, was generated by data collected from various data holdings, such as the Hospital Morbidity Database. Specific codes such as F00 to F03 (which are dementia codes) were used by analysts at CIHI to create this report. An example of a condition included in this report is senile dementia, as it is an inclusion term under F03.– Unspecified dementia.
An example of one of the sections of this e-report is 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.
The e-report’s section 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 care 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. Remember the previous slide that listed how many organizations and other stakeholders are using this data? If health information management professionals didn’t collect this information, reports like this 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, to which we will include a link 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 harmful events into 4 categories: health care and medications; infections; procedure-related; and patient accidents. The 4 categories are broken down 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 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 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 is diagnosed with 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 an intervention, they might assign T81.88 and assign pneumonia as a diagnosis type (3) versus a diagnosis 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 a diagnosis type (2). So, it does not fall under the selection criteria for the clinical group B16: Pneumonia. We must ensure we are telling the correct patient story, assign the correct codes and apply the correct diagnosis type so a patient’s medical data can be utilized effectively to improve patient safety in hospitals.
Slide 19: Shared Health Priorities (SHP)
As mentioned earlier, CIHI has been working on Shared Health Priorities 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 were first publicly released in May 2019.
Over a 4-year period, from 2019 to 2022, there will be 3 new indicators released each year.
Year 1 (2019) indicators include
- Hospital Stays for Harm Caused by Substance Use: This indicator 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.
Slide 20: Shared Health Priorities (SHP) (continued)
3 more indicators were released in Year 2 (2020), which include
- Self-Harm, Including Suicide
- Caregiver Distress
- New Long-Term Care Residents Who Potentially Could Have Been Cared for at Home
Slide 21: Shared Health Priorities (SHP) (continued)
The latest Year 3 (2021) indicators include
- Wait Times for Community Mental Health Counselling
- Wait Times for Home Care Services
- Home Care Services Helped the Recipient Stay at Home
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.
Slide 22: Visual — Your Health System
The next couple of slides are a summary of what we will be covering in the demo. I will now pass the presentation over to the Program Lead of Health System Performance to share a demo of the Your Health System web tool.
Slide 23: Your Health System
Your Health System, sometimes referred to as YHS, is an interactive web tool with 3 components — YHS: In Brief, YHS: In Depth and YHS: Insight. This demo will be focusing on YHS: In Brief and YHS: In Depth only.
Slide 24: Demo: Your Health System
YHS web tool can be accessed from the home page of CIHI. So once you are there, you can click on In Brief. This is the home page for YHS: In Brief. Right at the top-right corner you have the What’s New. It is a link to a table with a list of indicators and contextual measures that were updated in the most recent release. The Help link provides you a step-by-step guide how to navigate YHS: In Brief. Information in YHS: In Brief is within 5 themes: Access, Quality of Care, Spending, Health Promotion and Disease Prevention, and Health Outcomes.
Scrolling down, you can see all the indicators that are listed within each theme. You can access the indicators either using the theme’s link or, if you want to see the results of an individual indicator, you can click on the link of that particular indicator. So, for the purpose of demo, I'm going to click on the theme Quality of Care.
This takes me to the theme page with much more information about all the indicators which are listed in Quality of Care theme. If I want to know more details about the indicator — so, if I’m interested in All Patients Readmitted to Hospital — I will click on this link. This will take me to the indicator page, which has much more detail. The More button here can be expanded to see detail on the calculations, source, etc., about the indicator.
Scrolling down, you will see some infographics related to that indicator, as well as provincial comparison to the Canada link.
Trends are also available. You can access any province by clicking on that province link. All the data behind those graphs can be exported using the Data Export button. Results are also available as maps. As well, we also provide top results. So, the top results identify hospitals and health regions in the top 10% for the last 3 consecutive years.
Let’s go into In Depth.
On the main In Depth main page, similar to In Brief, we have the Help. This is, again, it’s a go-to and how-to guide that clearly explains how to navigate the website and provides interpretation information for the visuals on the site.
From the In Depth main page, you can search for provinces, territories, regions, cities, hospitals or long-term care organizations in the search bar. The results can be seen as indicator results, which displays all indicator results, in comparison for the search criteria organized by the health system performance theme.
Results can also be viewed as overall results page, which is a snapshot in form of the 3-by-3 matrix of a hospital or health region’s indicator’s result, relative to the peer group or national average, as well as their trend over time.
Let’s type in Vancouver. I am going to select Vancouver Coastal Health, and let’s see the results first as indicator results. The contextual measures for Vancouver Coastal Health are provided here. The list can be expanded to see much more contextual measures. The technical notes are provided as links here. Indicators are under each theme, which can be expanded. So, if I click on the plus sign, it shows me all the indicators under Access. Again, I can get into more detail of the indicator by clicking on the result.
So, it shows results for Vancouver Coastal Health. Next to it is the provincial results and whole Canada results.
Again, you have results in the form of trends, bar graphs and maps. As I mentioned, results can also be seen as overall results page and that can also be accessed by clicking on the cube-like structure here.
The 3-by-3 matrix provides a snapshot of how results for hospitals, long-term care organizations and health regions compare with those of others and change over time. Each number in these boxes represents the number of indicators in that box.
So, 5, by clicking on this box, it will show a list of 5 indicators, which has results above-average performance and the trend over time is improving. So, blue colour indicates the results are the same as average and where you see pink it means those indicators in these boxes are generally considered below-average performance.
The results can be downloaded as a PowerPoint presentation or as PDF. Results can also be downloaded as an Excel file, by clicking on this Excel button here. It provides all the data which is in In Depth in a nice Excel format.
Thank you.
Slide 25: Data impact
So, we already looked at how the data is used and how it can be measured. Finally, we will look at data impact. 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 26: Data quality is a shared responsibility
Data quality is a shared responsibility, especially because many stakeholders encounter 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 admission and ambulatory care visit.
CIHI’s responsibility is to set the national standard for the consistency of morbidity data and ensure that the coders have what they need to be successful.
Slide 27: 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 28: 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 investigate more details about the quality dimensions on this slide, they are available in CIHI’s Information Quality Framework. Again, all these links will be available at the end of the presentation.
It is important for coders to be subject matter experts! Coding teams 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, they will know they can consult with a coder because they have access to the source documentation, and they are experts using the classifications and applying the coding standards. It may also provide some valuable insight for coders about how the coded data are seen from an analyst’s perspective.
And lastly, CIHI provides the data governance by having the standards and resources to make sure the coders are successful. Keep up the great work and continue to use those available resources.
Slide 29: Tools to enhance data quality
Here is a list of available resources that CIHI has available for us to enhance the quality:
• Canadian Coding Standards for Version 2022 ICD-10-CA and CCI
• ICD-10-CA/CCI classifications
• Bulletins and job aids, which are located on the Codes and Classifications page on CIHI’s website
• Continuing 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 30: 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 31: Conclusion
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.
If we can keep improving the coded data, we can continue to be a vital part of our health care system and continue to help provide better-quality care.
Slide 32: Questions
Thank you for joining us for today’s presentation. If you have any questions about this webinar, please contact us by email: classifications@cihi.ca.