NSW intern blog

My first year as a HMIP Intern

Author: Lea Sugay

Date: 11 February, 2018

My first placement for the internship was in the Health Informatics Unit within District Finance Directorate of Western Sydney Local Health District. At this placement, I had the opportunity to work with the various members of the Health Informatics Unit across the district, such as the clinical coding managers, clinical coding educator/auditors, clinical coders, and the medical health records manager. 

The clinical coding team is responsible for coding every patient episode that is discharged from the hospitals in the district. One of the key performance indicators (KPI) of a clinical coder is to code thirty five episodes a day, however this is quite difficult as each episode have different levels of complexity. There are various clinical coding advice and rules that clinical coders must follow to code accurately. The resources used by the clinical coders were stored in various places, therefore searching for the right coding advice could be time consuming, thus preventing the coders from meeting their KPIs. My first project was to put together a Clinical Coding Resource database. The objective of this project was to have one place for the coders to access that would include all the information they need, thereby allowing them to code more efficiently. 

I liaised with the clinical coding team and determined which resources they accessed the most - clinical coding advice/rules, links to websites with coding advice and local coding advice/reminders. I attended a website publishing training session to learn how to use the district's publishing system. I worked with Corporate Communications to design a database that is easy to navigate and user friendly. Privacy was also a factor and we had to ensure that files uploaded onto the database could not be accessed by other staff members in the district. A unique login for the clinical coding team was created to address this issue. Changes to the database can only be made by myself or the District Clinical Coding Operations Manager.

After fixing the privacy issue, it took approximately three weeks to upload all the information onto the database. I then conducted training sessions in different hospitals across the district to teach the clinical coding team how to navigate and use the database. After the database going live, only simple maintenance is needed to keep it going, for example, uploading new coding advice or updating website links. Overall, the project took two months to complete which was much quicker than anticipated in our six month project plan.

I received positive feedback from the clinical coding team and my manager. Some coders have stated that the search functionality of the database has saved them time and helped them work quicker.

Audits are conducted by the clinical coding educator/auditor to keep track of the coder's work and to determine which areas need improvement. Most audits are completed quarterly or monthly depending on the need, for example, ensuring that episodes with sepsis are coded accurately to ensure that the right reimbursement through Activity Based Funding (ABF) will be received. My second task was to audit the Clinical Documentation Queries. A clinical coder can raise a query to the clinician if there are ambiguous information in the patient record. Raising a query can sometimes change the Diagnosis-related Group (DRG) coded to the episode which could increase the National Weighted Activity Unit (NWAU), which means more money.

Auditing the documentation query was used to determine how efficient the process is, how many days it takes to receive feedback from the different specialities and the difference of NWAU if there is a DRG change. This also allows the Clinical Documentation Specialists (CDS) to educate clinicians on how to document in a way that's easy for clinical coders to code. 

During my placement, I managed to audit all the four quarters of the 2016/17 financial year. Firstly, I collected all the data from the five hospitals in the District and stored it in one database. After each audit, there was a positive cost differential from the DRG changes. The clinical coders were encouraged to raise queries as much as they can, as there is a higher chance of getting more money reimbursed from a changed DRG. The audits also found which specialities took the longest to provide feedback; this allowed the CDS team to target these specialities to improve the efficiency of the documentation query process.

My second placement for the internship was in Human Resources (HR). I was fortunate enough to be working closely with the Director of Human Resources of WSLHD. My supervisor allowed me to attend various meetings with her in order to observe the way she managed her team. I was also able to network with Directors across the district through these meetings. HR revolves around ensuring that policies put in place are upheld by all employees. HR's job is also to ensure that the right processes are put in place to ensure that all employees are given a fair chance in the instance of a breach of policy. HR is also responsible for providing support to managers on how to deal with performance issues in the workplace.

During this placement, there were no set projects for me to be involved in. What I have learnt in HR is the work which comes up when there is a complaint lodged or if there has been a breach of one of the policies. Each issue is addressed in a case-by-case basis and is processed depending on which policy was breached. A breach to a policy would be considered as a misconduct and is managed through the NSW Health PD2014_042 Managing Misconduct. The policy outlines the procedures to be conducted to determine the right and fair disciplinary actions to a misconduct behaviour.

A risk assessment would be completed to determine the seriousness of the incident. An incident is given a rating against the Severity Assessment Code (SAC) matrix from the NSW Health PD2014_004 Incident Management Policy. A SAC rating of 1 is considered an extreme risk, for example, a clinical incident that has resulted in a patient's death. The SAC matrix also has guidelines on what actions to take once the risk rating has been determined. 

An investigation would usually then occur to obtain all the information from the employee/s involved in the incident and to gain an understanding of the nature of the environment which might have caused the employee/s to breach policies. Parties involved in the incident could be issued an allegations letter where they are expected to write a response. Interviews can be conducted to obtain information from all parties involved in the incident. Once all the information has been received, an investigation report is written for an independent decision maker (usually a level 2-3 manager) to review and produce an outcome for the parties. An outcome can vary from a first and final warning, suspension or termination of employment in more serious cases. 

Depending on the workload of the HR managers, I was able to assist in drafting risk assessments, briefs to suspend, allegation letters, and other documents to help with the processes. I was also involved in a change project within the Integrated Care & Community Health space and assisted with finding redeployment options for staff affected by restructures.

I have just started my next placement with the Information and Technology Services department. I am hoping to gain experience in project and change management with the Digital Health Program rolling out in WSLHD.