Personal Perspectives - Health Information Management ...

Personal Perspectives
Introducing
‘Personal Perspectives’
Welcome to the new Personal Perspectives section of
our HIM-Interchange (HIM-I). We hope it will become a
forum for some robust discussion and exchange of ideas
for Health Information Managers (HIMs) and others
grappling with new systems and ways of doing things.
Michelle Martella and Evelyn Robinson have provided
our fi rst piece in this new section, with their overview
of the introduction of a Digitalised Medical Record and
a remote coding service at Barwon Health. Michelle and
Evelyn provide a list of requirements for implementation
of successful remote coding and highlight some of the
issues that need to be addressed. Many health services
have already or are in the process of implementing
scanned medical records, which would enable them to
also embark on a process of remote coding. We would
like to hear from HIMs who are involved with these
developments. Have you tried remote coding? If so, does
it work for you? Do you have any thoughts or ideas that
you would like to contribute to this discussion? Author
your own Personal Perspective piece or write a Letter
to the Editor of this journal to respond to this or any
other article you read in HIM-I. We look forward to
hearing everyone’s views!
Jennie Shepheard, Editor
INVITATION
Are you planning to attend the HIMAA
Conference in Melbourne in September 2011?
If so, or even if not, but you live in Melbourne you might
like to attend a planning meeting for HIM-Interchange on
Wednesday 21 September (afternoon). HIM-Interchange
is HIMAA’s professional practice journal and attendance
at this meeting will give you an opportunity to
contribute to the future direction of this journal and
obtain some insight into how such a journal gets to
production. More details will be available closer to the
date. Meantime, if you would like to discuss anything
about this meeting please contact me (Kay.Bonello@
healthecare.com.au).
Kay Bonello, Chair, Editorial Board
Clinical coding –
near or far?
Michelle Martella and Evelyn Robinson
In an ideal workplace environment, there would be
an endless supply of skilled human resources on tap,
all of whom work happily onsite in a dynamic and
cohesive team. Of course, there would also be plenty
of office space, complete with window view! However,
reality can be quite different. At Barwon Health,
remote coding has proved extremely beneficial to the
organisation, and has helped fill a vital need for scarce
clinical coding resources. Although there have been
challenges along the way, if implemented efficiently,
with good quality checks and key performance indicators
in place plus strong management, remote coding
can be a handy resource in assisting organisations to
meet their needs for clinical coding services, as well as
providing benefits to Clinical Coders themselves.
Barwon Health overview
Barwon Health, which covers the Barwon region of
south-western Victoria, offers an excellent work environment.
It is the largest employer in the region, with
53,000 Emergency Department presentations annually.
Barwon Health uses a unique patient identifier across
its 23 sites. It is comprised of a number of facilities on
these sites, including:
•
•
•
•
The Geelong Hospital (390 acute beds)
McKellar Centre, a rehabilitation and aged care
facility (511 sub-acute and aged-care beds)
Swanston Centre for mental health, drugs and
alcohol services (40 mental health beds)
Regional receiving hospital, servicing 400,000
people across Barwon South West Region
The digital medical record (DMR)
Barwon Health uses the digital medical record (DMR),
which is a combination of :
• the electronic health record (EHR), where
information is entered electronically or imported
via external electronic systems
• the scanned medical record, where information is
created using paper, then scanned and archived in
an electronically viewable format
The easiest way to think of the DMR is as ‘digital
storage and viewing’ of a patient’s medical history.
16 HIM-INTERCHANGE Vol 1 No 2 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE)

Personal Perspectives
Barwon Health’s chosen system is BOSSnet by Core
Medical Solutions.
Remote coding
Remote coding initially commenced at Barwon Health
because of a pressing need to meet external coding
deadlines, coupled with the statewide shortage of
Clinical Coders. Traditional advertising for both Health
Information Managers (HIMs) and Clinical Coders
was, as many other regional Victorian hospitals have
also found, generally unsuccessful. With the introduction
of the DMR to Barwon Health in October 2007,
the opportunity to use those Clinical Coders who
would not otherwise have been available to work in
a regional area, become a reality. Barwon Health has
been able to secure skilled resources well beyond the
region, not only in clinical coding, but also in other
areas of health information management.
One of the flow-on benefits of remote coding has
been the opportunity to offer permanent onsite staff
the flexibility to work from home, as needed. To be
in a position to offer staff family-friendly workplace
flexibility has been beneficial; as a consequence of
this situation staff retention rates have improved in a
profession which has a recognised industry shortfall. In
an environment that is bound by deadlines, flexibility
to increase or decrease remote coding services as the
need arises has been invaluable.
To implement successful remote coding, there are
important requirements and other issues which should
not be overlooked:
• the need for detailed planning for implementation
from an IT perspective
• strong orientation of facility-specific systems and
processes
• collaborative recruitment to ensure qualifications
and experience meets own casemix environment
• ongoing quality audits and involvement in
education programs
• clear expectation of quality and throughput key
performance indicators (KPIs)
• employment arrangements (e.g. contractors vs.
permanent remote staff)
• building relationship between internal and external
staff to maintain strong team ethic
• a strong communication plan to address challenges
of non face-to-face communication
• daily challenges of managing a team that is widely
spread out
• knowledge of state-specific coding standards,
editions, advice, admission policy and casemix
• occupational health and safety considerations.
Advances in IT enhance the opportunity for remote
coding, but can also contribute to its demise if not
carefully managed. A robust and secure network
platform is essential, as is a team of IT support staff
who understand the complex needs of a coding
team. The following measures are important for the
successful use of IT sytems in this environment:
• There should be a well-mapped path to setting up
new remote users, who can face greater challenges
than onsite staff; if possible, assign a dedicated IT
support staff member to assist with initial set up.
• Slowness or downtime of systems for various
reasons (individual Internet speed, site-specific
performance) should be covered in contractual
agreements.
• Where possible, plan ahead for system downtime
and upgrades.
• Given remote coders often work out-of-hours,
ensure there is appropriate afterhours IT support.
With the proposed National Health Reform and an
already identified national Clinical Coder workforce
shortage, there is a growing need for a remote
workforce, so start the planning early and lead the way
for a smooth and successful remote coding program.
Your organisation and the coding profession as a whole
will benefit.
Michelle Martella
Manager Casemix and Coding Processes
Barwon Health
1-75 Bellerine Street
Geelong VIC 3220
email: michellem@barwonhealth.org.au
Evelyn Robinson, BBus(HIM)
Health Information Management Consultant
Queensland University of Technology
E&C Consulting Pty Ltd
PO Box 816
Woodend VIC 3144
email: evelynrobinson@yahoo.com.au
•
HIM-INTERCHANGE Vol 1 No 2 2011 ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE) 17