Mandy Burns undertakes two roles for IHRIM: CEO and also IFHIMA Director. With her IFHIMA Director hat on she attended the IFHIMA General Assembly and 18th Congress recently held in Toyko Japan - Here is part two of her report.
Day 2 started with a talk from Dr Mogli a Health Informatics Consultant from India.
Dr Mogli’s focus was on Physician Treat Patient and HIM treat Hospital for Controlling Healthcare Cost. He asked us what are hospitals actually for – they are for patients. The future for our profession is Managerial HIM Administration, online monitoring of EMR/EHR and to ensure Care, Cost, Quality, and to Co-ordinate within and outside departments.
Physicians treating patients is a well-known phenomenon, HIM’s treat the Hospital in a way, as if HIM’s are not in place then no monies or information is available for the physicians to treat the patients.
Dr Mogli asked why are HIM’s capable of treating the Hospital? The answer was that they are the only department that has a close enough relationship with patients/relatives and they are there throughout the whole of a patients care in one way or another.
Therefore, the only way to ensure we have correct and qualified HIM’s is through appropriate education. This was a view that I and the rest of the audience fully supported. HIM’s are in a powerful position to be in as they can influence the future set up of Health Services in their home countries.
The role of HIM’s management is to ensure Leadership can empower and inspire people. They should be the known experts on Care, Cost and Quality Assurance.
Dr Mogli also believes that ICD 11 will influence the future by giving better information to Health services for managing services.
The next session was presented by Hidetaka Kobaysashi, Information Manager at Lizuka Hospital, Japan, on Trends and Predictors of Waiting Times for Colorectal Cancer Surgery.
Lizuka Hospital was established in 1918, with 1116 beds, 908 inpatients a day, around 1900 outpatients per day and has 2300 employees. Its covers acute care and specialises with Cancer. Cancer is the biggest cause of death in Japan. There have been very variable waiting times for patients to receive treatment and the Government felt that more information was needed.
Hidetaka and his team worked on identifying waiting times for Colorectal patients who had received surgery in 2014. The excluded neo adjuvant therapy and excluded patients treated on an emergency basis. Information was gathered from Patient Administration Systems and Medical Records. The team reviewed a variety of information from 130 patients.
The average Waiting time between initial diagnosis and treatment was 31.4 days - the maximum wait for some of those patients was 138 days. There were a variety of conditions that dramatically influenced waiting times including Housing situation and specific consultant. Patient decision also significantly impacted upon treatment times as well as family support available.
This study indicated that significant further research was required as this was only based in one hospital. The study highlighted a need to review and revise cancer treatments and one of the decisions that has been made following this study is maximum waiting time for suspected cancer treatment is being introduced.
It also showed the importance of good data and information being collected and made available.
Aya Takahashi from the Hokkaido Information University in Japan also talked through Cancer treatments and outcomes.
He looked at home and day care facilities rather than hospital care. He advised that Japan started a Cancer Registry in 2006 which now collects 49 standard items. There is also a National Cancer Centre in Japan which started with patients diagnosed in 2007. Information has shown that Cancer has a much higher prevalence in men than in women. And that the biggest age range where cancer was discovered was 70-79yrs old. Patient survival rate significantly improved with treatment other than in 90-99-year age range which was fairly equal (only 9 patients - 4 survived with no treatment vs 5 with treatment). No psychological support is available for patients and families when discussing diagnosis which clinicians feel may have impacted upon delays in deciding upon treatment causes – there is a need to review further as this may have an impact upon waiting times as well.
Japanese health care is a partial pay structure where Over 75’s has to pay 10% of health costs and under 75’s has to pay 30%. It is felt that this may also have an impact upon outcomes.
A change of direction was next with Kerryn Butler Henderson, University of Tasmania talking on Fifty Shades of HIM, Quantifying and Qualifying the Workforce in Australia.
Kerryn talked about the need for an Australian Health Information Workforce Census. She stated that HIM recognises that Health Information Workforce consists of HIM’s, Coders, Analysists, costing experts, HI Technology, Health Libraries. It is very difficult to count numbers in this workforce as only HIM and coders are readily identifiable. I think this is very realistic and is something that most of us can relate to.
On reviewing initial figures, it was felt that there was up to 50% discrepancy in what is reported as opposed to employed in HIM roles. There is very limited research on workforce.
It was agreed to establish a focus group and that was pulled together. The Focus group had nine people, 6 occupations across Australia and New Zealand. There was mix of organisation types and knowledge.
It was agreed that a need to monitor and undertake a census of HIM every 3-5 years to establish if required the need for support and engagement.
It was quickly identified that there were major problems - firstly - who is part of workforce? How do you identify, target and reach people to complete survey? They now have an independent body to undertake this. This needs to be shared by across the HIM’s community. The initial census was around competencies and function not job titles. A need to consider how graduate positions impact and should they be changed and developed further at source e.g. as part of programmes.
A steering group is being formed and looking at minimum dataset in 2017 and census due to occur in 2018. I certainly will wish to participate, and I would encourage you to participate as this becomes available.
That evening was for socialising and networking and as such a gala evening was organised featuring Japanese food, dancing, music and other traditional entertainment.
We were offered the chance to practice Origami as well as participate in some traditional dancing - Unfortunately I failed miserably at them both!
The final official day of the Congress had a variety of sessions to offer as well and it was difficult trying to choose which to participate in.
I started the day with a session from Naomi Goshen of Israel on Coding forum for quality improvement.
Health care in Israel is like the NHS in that it is Government run, with 14 hospitals, 1400 Community Clinics, 420 Pharmacies and 39 Paediatric Units.
Israel have been using ICD9. They are just starting to implement ICD 10. There is a focus on the provision of National Medical Quality Indicators. The Government are aiming to increase coders knowledge to improve accuracy and uniformity across Health Care. They are looking to create a stockpile of information for all coders and reduce inaccurate coding. Their Government initiated a coders forum with reps from each of the 14 hospitals which gives a Q&A space to help one another. It is currently operating within 21 medical areas e.g., ENT, Neuro etc.
Questions are answered locally but these answers are published onto the forum and if it cannot be answered locally then it is published, and a national answer is sought, if no response is received it will be escalated to Ministry of Health and then decision cascaded.
Within 6 months of forum being established 57 discussions had been initiated. Audits of coding showed incorrect use was growing during 2005 to 2015 (173 to 547). This was a significant Increase. Within 2015 a decrease has been shown which is associated with the forum and government support for coding.
Hosizah Markam of Indonesia talked on Electronic Integrated Antenatal Care.
Hosizah talked about how having an Electronic Integrated Antenatal Care record has led to a significant improvement in safe delivery of children and has decreased the mortality in pregnant women. The midwife is responsible for completing basic medical record cards. Before this electronic care record was established only 15% of women had records throughout their whole pregnancy and delivery. For those that had records significant Data Quality issues were in place.
With electronic document there is a significant improvement in quality and accuracy and record keeping. Studies and audits by the midwives feel that accurate record keeping is supporting lower mortality rates in mother and child.
The next session was delivered by Margaret Skurka, re Student Learning outcomes within Health Informatics.
Margaret advised that there had been a change in focus of HIM education within USA. There were now courses covering both 2 years and 4 years. HIM courses have a full separate committee (like OFQUAL) for accreditation. There is a mix of self-assessment and full assessment. This is to ensure full accreditation of the course and then the students. It includes things like coding, privacy etc. It was curriculum driven but is now using Blooms Taxonomy for student learning outcomes. It is outcome based rather than curriculum based. The government felt that it needed to be able to demonstrate things like Critical thinking, and personal branding. It was agreed that students needed to demonstrate how to think outside the box – not just memorising and repetitive learning. It was felt that students needed to be able to go out and work in the field fully and be able to demonstrate this. Skill assessment is very much about the outcome. The 4-year programme is looking at more managing team/department whereas 2 years is a more doer focussed programme e.g. Coder.
6 overall domains –
Data Content, structure and standards includes IG.
Information Protection: Access, disclosure, archival, privacy and security
Informatics, Analytics and Data Use
Revenue Management (inc Coding)
Compliance – playing by all the rules, be top accredited are things like Health Records and Data Management
Leadership - Taught at different levels e.g., leader, supervisor, manager etc.
AHIMA the American version of IHRIM is significantly bigger with thousands of members. They have developed, with support from IFHIMA health information curricula which can be found here:- https://ifhima.org/global-health-information-curricula-competencies/
The final session of the day was the Closing Ceremony. Marci McDonald was formally inaugurated as the President of IFHIMA and Angelika Handel thanked for her contribution as the outgoing president. The next Congress location was confirmed as Dubai for 2019 and attendees thanked for their participation and contributions.
An optional Hospital Tour was offered for those staying on in Tokyo and I took this opportunity up.
Our visit was to the National Center for Global Health and Medicine. This is a large General hospital based in the Shinjuku region of Tokyo. It is a hospital and research institute and one of the oldest in Japan.
They also have an obstetrics section which is quite unusual as this is not covered as part of Health Insurance. They have ward based pharmacist on every ward and a new pharmacy dispensing system. There is a also a Disease Control unit based in the hospital but managed separately.
The hospital serves around 300,000 people that live in the area but this number doubles during the normal working week due to the large number of offices based in the area. However, people can choose to use this hospital (as it has an excellent reputation) for an additional 5000 Yen (Approx. £40) per visit although the total cost depends on the Speciality, type of visit and actual treatment received. Under 75-year olds have to pay 30% of total cost of treatment.
The Hospital has a innovative self-check in system that applies for outpatients 2nd visit onwards. Patients are given an access card that they use via dedicated check in machines that are situated on the 4 lower floors that support Outpatients (Inpatients are on floors 5 to 16.
Patients must report to the 4th Floor when departing the hospital to get their bill and pay. No follow-on appointment is made until the bill is paid. There is also a large Emergency Department on the Ground Floor of the hospital. Emergency care is not free, and the 30% cost applies.
As mentioned above there is a pharmacist on every ward supported by a new dispensing system which is run from the basement via a POD system. Tablets are picked per patient following a prescription entry in the electronic system and placed into a tray that is then sent via the POD system to the ward for the pharmacist to collect. The system is also able to automatically produce and deliver IV Drugs.
The hospital is also paperless, inpatients have been paperless for 10 years and outpatients for 5 years. The archive library storage for records was the tidiest I had ever seen!
The records are filled purely numerically based on the unit number issued by the hospital.
Records are retained for 10 years post discharge or death, so a significant destruction system will be required for those inpatients who went electronically in the first wave.
The final part of the tour was to the roof where the helipad is situated which has a direct access lift to the Emergency Department and Emergency Theatres. It has amazing views of the city.