The Conference started on Sunday 17th November but the opening ceremony was not planned until Monday 18th due to time commitments of some members of the ceremony.
The first session I attended was on how to educate HIM staff for the future (Oman view). This was presented by Dr Salim al Salmi.
Dr Salmi talked about what was essential for skilled graduates beyond ‘technical’ knowledge. He talked about the necessity for having the skills to present the knowledge they have gained as non-HIM people can struggle with understanding Informatics related information as we tend to use a lot of codes and jargon!
In Oman they have set up a Skills Lab that tries to ensure that candidates have confidence, team spirt and negotiation skills as well. Qualifications are great but they really struggle with the element of explaining what they do and how they can demonstrate this easily.
Dr. Salmi’s team approached the Government and asked for support around undertaking this work. They were given approval to set up a system that supports multiple aspects and in multiple organisations. The system was sold to organisations as a Government initiative to help give them the practical skills to undertake this. Dr. Salmi’s team used De-identified information to simulate the actual attendances that enabled the candidates to present the information in different ways.
The idea is to have an interactive lab set up but the candidates still require supervision as, if no teacher is present, then the candidates are not guided through what they are doing or given tips and techniques. The candidates undertake coding as well as records management in the virtual lab and also have input that involves privacy and data management.
The initial lab was set up in 2009 and keeps developing and adapting as practices develop and change. The feeling is that the skills lab has helped improve the pass rate
Next up was Ramona Kyabaggum, Professor in HIM at Regina University (Canada).
Ramona reported that the HIM profession was seeing a very different growth rate compared to say medicine (i.e. much lower as seen as less attractive).
The HIM Professors at Regina produced a business case to build a Masters Profession in Health Information Management. The University Board initially approved this, then cancelled it and have now approved it again.
The Masters programme was originally placed as part of The Computer Sciences section but the programme directors feel this is not appropriate and would like to develop the programme differently and move to an alternative section.
The Masters programme has a very strong analytical element but it is still evolving and developing. Students on the programme are learning how to do the inputs as well as the outputs.
The programme objectives focus on high quality accessible information, deliver innovative HI education, and facilitate student engagement in applied research and evidence-based practice evaluation.
The have struggled with how to attract students both from within the profession but also to encourage wider inclusion.
The students are undertaking an element of sessions with the community so that ordinary people can understand what is happening with their data. The University is also in partnership with colleges to do some leadership and executive training programmes to encourage ongoing participation in HIM. The programme is open to international students and mapped to IFHIMA Competencies.
Next up was Dr. Susan Fenton, Associate Professor University of Texas, who asked us ‘Does the HIM profession need a Doctoral Degree? ‘. To clarify we talked about a professional doctorate not a research based one.
The feeling around the room was that the majority of HIM members are in practice and not a huge amount of research was required but we should be able to hold our head up with other professions in the Health Arena such as Doctors, Allied Health Professionals etc. HIM has been around a long time. There is not a single doctorate in HIM being undertaken anywhere in the world, but we have more than 100,000 HIM professionals actively working around the world.
Susan asked people who had a Master’s Degree in HIM in USA and 25% said they would actively want to undertake a practice based doctorate.
Looking at this it would need to be a small programme as each faculty member could only support around 3 to 4 students. They also need to develop an application process to ensure compatibility. Additionally, they really need to think about content and funding and further stakeholder feedback is required as some items still being discussed are Evidence, Scholarship, Leadership & Strategic Planning, Project Management, Negotiation, HIM Policy and Regulation. Also up for discussion was that a practical project rather than a dissertation felt more relevant.
Susan ended by saying there was a lot more work still to do but watch this space!
We then heard from Yasuo Arai, Japan talking about the role of the Health Information Manager in Japan.
Japan started to move to digitisation in 2001. Hospitals with more than 400 beds have 80% digital records. The Government drove digitisation through as it thought it would enhance patient care, optimise costs, and provide good secondary use of medical data. This has not been fully realised and the progress has been much slower than expected.
Yasuo sees this as an Ideal opportunity for HIM to step in and apply expertise in digitisation.
As everyone is moving from paper to digital there is a shift from managing paper to managing data. There has been a significant increase in staff moving to auditing posts and guiding the recording of Health information processes and really enhancing coding.
A hospital was targeted to see what a focus on digital records could do. It saw a very early outcome in that it has had a significantly reduced hospital stay from 2013 to 2014 which has been mostly attributed to how information was used. The HIM team spent time and gave information to the different teams (102 meetings held in six months) and helped develop standard plans and pathways. This has been sustained at a much-reduced level but they also hold a session each year which is open to all and that gives some examples of what has worked well, what has not and they also do a session to help other areas develop. There has been a significant savings on episodic prices, a decrease in lengths of stay and improvement in care.
Next up was a session from Theresa Jones and Dr. Reem Azhari on The importance of HIM integration in interprofessional education: A perioperative scholar program initiative.
IPE - Interprofessional Education - Started in the 1970s/1980s, initially networking with lots of interested people. They commissioned an independent inquiry in 1999 which stated that medical errors are the third leading cause of death in the USA – 80% of which are due to miscommunication. This equates to approx 400K deaths each year. There is a considerable need to speak up and not have ‘passenger syndrome’ – i.e. seeing but not reporting as expecting someone else to do this.
It is globally agreed that if you put garbage in you get garbage out (aka inaccurate data gives inaccurate results).
Following the inquiry some advice was given to the Medical Community in USA on how to improve. There was a big focus on patient identification as around 10% of medical deaths were attributed to misidentification of the patient. A significant number of these are due to issues around names, e.g. middle names, misspelling of names, etc.
They have adopted GIRFT –Get It Right First Time (Spoken about at the IHRIM Coding Day in November) as it is vitally important with data to be right first time as mistakes are costly both in monetary terms but also in care, etc.
They posed a controversial question to us in the audience ‘Why not show the patient the data and ask them to check it themselves?’. This caused quite a lot of conversation with the audience that continued long after this session ended and most present thought yes, why not!
The next session was an interactive workshop led by Dr. Kerryn Butler-Henderson & Dr. Susan Fenton.
The question they posed was ‘What is the primary function of a HIM workforce?’
Australia does a consensus each year looking at who is in the Health Information Workforce and their journey to their current role. This is something that the IHRIM Board has been discussing and working on and is being shared via the IHRIM website. This was a good session and involved us splitting into multinational groups and discussing a series of questions. This was great and interesting getting through language barriers, customs as well as differences in roles and skills. I was in a group with around 10 others who were from some of the African countries, Arabian Countries, USA and Australia. We talked through roles relating to ensuring safety, continuity of care and providing basis for funding. We also talked about innovations and how HIM could help use this information.
The output of the discussions was fed back and collected in for collation and will be shared in 2020 with attendees.
Onto Session 3 of day 1 which was another Workshop but on Privacy this time. Again, we were put into different groups of nationalities and outputs collected in.
We discussed why is privacy important now? There is a lot about sharing information, it’s easy to share as a lot is held digitally, we all live in a mobile world and there is an increasing growth in Health Tourism.
We had quite a lot of discussion around things like privacy vs security, are they the same, what is different, which is most important, etc.
We also talked through the impact for keeping health information private and secure and who is responsible for what. We agreed that most people in HIM roles act as data custodians and must ensure we keep everything safe and secure. We probably do that more actively than clinical staff.
We talked about some of the different privacy standards around the world which includes FIPPS, Caldicott, HIPPA (USA) and GDPR (Europe). Most of these are specifically related to health but some are wider (e.g. GDPR).
We talked about what barriers to privacy are and we felt that a large proportion are around lack of education (i.e. what should be secure and confidential and what steps need to be taken?).
Again, a really good interactive session that continued debate long after the session had finished.
The final session of Day 1 was by Janella Wapola, Technology Lead, The College of St Scholastica, USA. Talking about the Value of the Aspiring Professional
Janella has been undertaking some research looking at when people undertake education within the HIM profession. Her research showed that HIM was a main career for people in their early to mid-20s but there is a growing take up of HIM as a second career. In addition, some current HIM professionals who want to apply learning in the current profession and are looking for advancement are actively enrolling in HIM education.
St Scholastica offers a range of teaching elements to try and encourage participation from all the above types of people. The HIM curriculum offered now includes clinical, IT and management elements.
They have recently started to focus on Professional Practice Experience (PPE). This involves undertaking project work on a variety of sites and subjects. This has been at the instigation of health organisations who feel they would benefit from fresh eyes that have HIM knowledge but no ties to the organisation. This helps the students develop and gain experience whilst still learning and being supported. It helps them gain a broad look at different organisations. Their programme also includes some international opportunities to places such as India, South Africa, Australia, Germany, Ireland and Brazil
They have also included career planning, social media education and developing transferable skills that would be beneficial outside HI careers. In order to equip students for the real world they also undertake CV writing, mock interviews and professional networking and mentoring. They have found this gives students an all-round robust education that is fit for the real world and they have had many successful students through their programme.
IFHIMA 2019 Day 2
50 years of IFHIMA, 19th Congress. Empowering HIM specialists in a changing environment.
Around 500 attendees from 24 countries.
Hussein al Bashi – President, Sudia Health Information Management Association (SHIMA) who organised the Congress – asked us ‘Why Dubai?’ Some of the answers given were that Dubai is a known meeting point, very much a bridge between the East and West. It is a number one conference point in the Middle East. It is very cosmopolitan, it has a very low crime rate, some stunning architecture including the Tallest Building in the World, and usually has good weather.
Hussein gave us a quote from the current ruler of Dubai – In the race for Excellence there is no finish line. This seems to be prevalent in Dubai as they continue to strive to be better and better. He also quoted that the use of the word impossible is virtually unknown in Dubai.
He advised that the Governments in both Dubai and the larger United Arab Emirates (UAE) are devoted to improving health and happiness and developing technology to help people.
He feels that Health Information Management is a profession that is often hidden but vital to supporting health care.
Session 1 Day 2 - VIP Speakers
Marci McDonald, current President of IFHIMA, officially opened the Programme by striking the IFHIMA gavel made from Canadian cherry tree wood and awarded to IFHIMA in Montreal in 1976.
Marci talked about the Journey towards Value Based Health Care and how many different models of healthcare provision exist around the world but all recognize that good health information is key. An example of this is that although within Saudi Arabia Private health insurance is the predominate source of care, there is only one health record across the whole of Saudi which is shared across providers as required.
Marci went on to give an overview of how the healthcare system in Saudi works and their vision of 2030 which is a digital healthcare system that has improved the health of the population. There are over half a million people working in the healthcare sector across Saudi. They are divided into six main local areas that will work together and be integrated. There are a lot of national health registers for disease identification but also to ensure appropriate health provision.
Next up was Dr. Robert Jakob from World Health Organisation (WHO) speaking on Information meets Informatics.
He advised that ICD 11 is now officially one year old!
He went on to advise that he as part of his role in WHO is working on two separate work streams:- National Statistics and Health Provider Statistics (i.e. birth registration vs hospital birth notification) and why they don’t always match. He asked why don’t they all work together and collect the information in one place and that would give some scope to collect different things? That would then pose the question of how could they link and share information better?
He went on to ask how do we link and share safely and only allow the patient to complete one form but share safely? Would it save clinical time if we shared properly? Are we consistent in even reporting things - how much detail is included within coding? Is it consistent in a) the Unit, b) the Region c) Nationally?
We need a real time electronic record that synchronizes properly to support the patient being seen quickly, treated quickly and appropriately, and discharged sooner.
He also went on to ask why do we only have good inpatient data? It is very limited on outpatients but that is sometimes the only interaction we have, so why are we not doing more?
Also, why is digitisation within the health care industry so poor – it is second from the bottom on the industrial digitization charts but is one of the biggest industries in the world?
It is estimated that over $900 billion are spent per year on unnecessary treatment – how much of that is down to poor data?
The big issue is that the focus is on data but it should be on accurate data!
Next up was a session on Workforce Development.
It was an interactive session and discussed how there is a lot of work in Arabic countries on developing their training programmes within HIM to ensure students are career ready not just 'knowledgeable' i.e. they do practical applications as well as study.
In Oman, The Ministry of Health chair and champion the School of Health so there is a direct link both for jobs but also to help steer direction and ensure appropriate training for what the industry needs.
In Kuwait students undertake a course but there is no support from the Government and there is a big movement that is lobbying for that to change.
In Oman they are also teaching English to ensure better understanding and knowledge as part of all Health Studies - they teach communication skills too. In addition, they are working on digital skills now as these will be required to enable them in the future.
Predominately in the UAE it is recognised that they could not deliver healthcare without HIM.
We had a discussion on what needs doing in order to get HIM students recognised and in place as future leaders. What steps are being taken to advocate to support HIM? In Oman colleges and universities moved the course leader to become an advisor to the Ministry of Health to ensure HIM was embedded. They are also developing team spirit by cross working with other Health Professions Students. They acknowledge that they need to work on ensuring and highlighting importance of HIM to healthcare. They are also trying to get Clinicians on side who can assist.
Kuwait has tried to get doctors to do coding instead of clinical coders. It lasted two months before the Government stepped in and brought back clinical coders because levels and accuracy of coding had dropped so much. The profession is currently lobbying the Government for recognition. The Government in Kuwait does not understand what HIM is – they think it is filing paper notes and do not fully understand the important roles that Health Informaticians undertake.
We then went on to discuss how is health care changing within UAE?
Oman - Has used regulations to clearly define whose role is whose and what is covered within the duties for that role. They are also being asked to develop HIM principles and a career pathway for all levels of staff that is helping with continued development of HIM as a set career.
Kuwait - seeing a shift to insurance/private health care. There is also a recently introduced retirement insurance cover that provides free quality healthcare.
Saudi - doing a lot of work on developing staff and using a lot of digitisation. However, this is enabling HIM to develop and move forward. They are moving into clusters for health care and now identifying support requirements from HIM professionals.
In Oman they use coding for statistics – not for any sort of payment.
Kuwait - Government hospitals must send statistics and coding daily to the central Government. Coders must have a certificate and must undertake annual update training. If central Government notice an issue then they send auditors in immediately.
Workforce Development Part 2
Saudi is recognising the need to move to qualified coders as they need good robust accurate data. They have set up a coding scientific committee and developed a curriculum based on core competencies. It was launched in Sept 2019 with 296 trainees over seven sites in three cities. They developed a three step programme covering a) Strong Foundation in Medical sciences, b) Classification guidelines, coding conventions and coding from Medical Record and c) Undertake an Internship to practice coding a medical record in a sponsored hospital under direct supervision. This gives a complete picture of what coders should be able to do on completion of the course.
Students undertake a basic medical sciences programme for three months, they then take an exam that must be passed before undertaking the six months coding element which also has an exam at the end - nine months in total.
Next one on the agenda, was Kerryn Butler-Henderson, Australia
Kerryn started discussing the Project in Health Informatics Workforce that she has been undertaking.
It started in 2015, initially as a workforce census in order to try and understand where is our evidence of who is a HIM professional? If you look at the Global professional census HIM is only recorded as a clerk. The study needs the data to say you are part of the professional workforce. The profession is going to change but we need to know what the starting block is.
She started with a Delphi Study - ask one question, get the answers from a bunch of experts and then go back a week later and ask them to add to it, then repeat, repeat, etc., etc.
There were Consultant groups which were basically peer groups in order to develop ‘what are you asking?’. The Study goes across all elements of health informatics and includes training as well as actually on the job working.
A census was launched in May 2018 in Australia. It was then repeated in Nov 2018 in New Zealand.
Census aim – initially was to review what level of qualifications/training was around for HIM. The results showed a move to Masters Degrees for a lot of staff.
Who completed the census? - anyone who identified as HIM, anyone who governs, manages, develops, delivers, analyses etc. within HIM.
Kerryn had 2051 participations across New Zealand & Australia.
This also gave a workforce profile. It showed that people were staying longer in work, but decreasing their hours as they became older. Therefore younger people were waiting longer to move into senior positions. Coding and Records have qualifications but health informatics has no specific Health Informatics qualifications. She also discovered that 25% of the HI Workforce are former clinicians who maintain clinical registration.
This showed a significant need to push to get all these work areas acknowledged as professions.
Review results on website https://www.utas.edu.au/health/projects/hiwcensus It was scheduled for repeat in May 2020 *Paused due to COVID.
We also need to consider how we raise the profile of HIM globally. There are others outside our profession who are very good at doing research and presentation/ publication and we could be consumed by them. How do we build these skills in? How do we get published? We must really focus on raising our profile globally.
Next was a session on Move to High Value Care
There will be a tremendous opportunity for HIM as organisations become very more focused on evidencing business and outcome-based medicine. How much is based on documentation etc.? Information Governance will need to ensure that we are able to support more sophisticated data analytics.
ICD11 is very driven by Artificial Intelligence as it supports algorithms. This could have a potential impact upon coders of an estimated 80% reduction in coding requirements. This will lead to significant change in the profession and would look at a more highly skilled coding establishment. It will have a very different outlook and we all will need to review what skills are being taught.
As a profession we have around 90% women but less so in management roles. Men are still being paid approx $17K more a year. There is a lot of work being undertaken to put Women into more management positions in certain countries. Whatever model is in place we must encourage women into stem occupations particularly HIM.
The final session of the day was by Doreen Saddler, on HIM Workforce in the USA.
AHIMA (American Health Informatics Management Association) have accredited the curriculum content to ensure relevant content for students on HIM Courses in Colleges/Universities.
In 2014 AHIMA undertook a workforce study that said it needed to undertake four initiatives, one of which was to review the current curriculum.
They suggested a three year plan, to determine Core Competencies, Determine or Develop Additional Competencies, to initiate Major Change and to have Final Edits and Approval. Some changes were broader competency statements rather than very prescriptive competencies. Some hospitals look to the course for coding staff whereas a more rural hospital will probably take the students into a more management type role. They also added in Data Management & Revenue Tracks as part of the course - could do either or both (but at least one). These changes have now been adopted and are being implemented from 2021.
End of Day 2
IFHIMA Day 3
19th General Assembly - Full notes and minutes are available on the IFHIMA website.
Firstly there was an introduction to the Board and National Directors. The Spanish Directors are also the European Area Representatives that the UK falls under.
Minutes of the 18th General Assembly in Tokyo were approved.
There was a report from the President who gave an overview of IFHIMA With a reminder of the relationship with WHO that is very special and key for HIM ongoing roles.
The Mission of IFHIMA - represents and advances the global health information agenda. There are three strategic domains - see slides. See also specific Collaborations with WHO.
There had been a very supportive letter received in Feb 2019 from WHO in relation to the relationship and ongoing partnership.
Membership was looking to the workforce, developing regional focus, developing nations, working on strategies which include membership categories, new national members, new payment options and membership timeline, IFHIMA Sponsored Congress Scholarship, New IFHIMA Award - Tribute to Excellence, and member survey.
Botswana has joined as a new member nation.
There was to be a Tribute to Excellence award for contributions to IFHIMA and HIM. Anyone who has made a significant contribution in the last three years is eligible. This needs further discussion from the membership.
In the last three years IFHIMA Has produced two white papers: Information Governance and Privacy – both of these is available on the IFHIMA Website.
They have also revamped Education Modules: Health Records Paper to Electronic, MPI, Establish a Department, Filing & Tracing & Retention, Privacy, Health Classifications, Hospital & Record Computer Applications, Stats, Terms, introduction to a Health Information Programme.
A Report on Membership was received from Lorraine Nicholson.
It gave an overview of IFHIMA - 22 member nations, two corporate members.
Overall membership has increased. There has also been an increase in contributions globally from different nations and members.
A Financial report was also received. In summary:
IFHIMA received $30K following the Tokyo conference. Also $22K from Japan Hospital Scholarships for continued development of IFHIMA.
There had been a slight increase of around $11K due to investment return. Unlikely to see this year on year, however, will continue to invest funds on a very stable investment basis. Get $14K per year from membership and that is what they try and work on - most board members pay for their own travel/accommodation etc.
A Communications Report was received. In Summary: A new site had been launched in 2018. Everything was now uploaded and processed via the website.
Editor is not on the Board but is an active member.
Also have a Social Media page - Facebook has around 120 members.
There were then presentations on behalf of hosting the next congress: Jerusalem and Brisbane. After the presentations a closed ballot of member nations was taken and following counting, Brisbane was announced the winner.
There were two suggested amendments to the Constitution. Change to Article 1.1 Eligibility to hold office - as a regional director (add these words in). There was clarification that there was only one vote per country and that only the national director can vote. Article 4.4 to change to include moving IFHIMA into the modern age by considering electronic voting which should help with the movement of items for approval rather than waiting for the three-year physical meeting. This will not be used for the voting on the decision for the next Congress as this will always be done face to face at the General Assembly.
In addition they will be adding the award, i.e. significant contribution to IFHIMA and the HIM Profession.
Kerryn Butler Henderson is President Elect. Europe remains with Carolina (Spain).
Voting on 2 positions on the Board -one for the Americas and one for Indonesia.
Honorary Award - Lifetime membership to IFHIMA in recognition of support to the profession. Awarded to: Yokiko (Japan) and Lorraine Nicholson (UK)
Reports from the different regions - all available on line.
There was also a presentation in relation to the recent Membership Survey. There had been 56 responders. It became clear that the relationship with WHO was felt to be very important. It also established that most responders felt that it was essential to maintain the international set up.
There was some feedback on learning modules. The majority said these were very useful and a lot of people were intending to use them. This is supported by the app recording of visits to the website.
Education modules and White Paper on IG are very important to people. Informatics standards, strategic plan and Global HIM curricula Competencies. New Global News very popular.
Future Trends & Expectations. - White Papers = 95% see importance in publishing, Education within specific nations, IG, Cyber Security and future Technology trends, ICD11, Future of computer assisted coding - AI does not understand context so cannot totally replace a human, also talked about Voice Recognition pros and cons, promote value & importance of profession. Challenges with EMR implementation, moving from traditional records roles into more complex and diverse areas, some nations have limited training so IFHIMA willing to work to support governments recognising training requirements for HIM. Privacy, coping with patients, dealing with insurance agents/companies, clinical documentation improvement, developing HIM in some nations. Modernisation management - new technology, outsourcing challenges facing the profession, standardisation in the collection of data, building partnerships with IT colleagues - don't see this as a threat as IT personnel cannot replace our knowledge but they do enable us to do our jobs, ethical issues in dealing with patient records within some nations, moving to a paperless environment. In relation to this all members are the key, need feedback on to what is the direction, where are the regional concerns, did the survey reflect our views? How can IFHIMA assist in UK? Are you willing to serve on an IFHIMA Task Team?
Can we think about how we utilise 'mobile' data that is relevant to HIM and how can we utilise some of that information?
We received the gift of a book ‘IFMRO to IFHRO to IFHIMA’ which is held in the IHRIM Office for the UK
There was a discussion on the survey results and what we want IFHIMA to focus on in the future. Notes to be circulated via IFHIMA website.
Discussion on Privacy of Health Information, an IFHIMA global perspective. There is to be multinational group development which includes some case studies, different perspectives including challenges, global importance and trends, management program overview, privacy in developing nations, etc.
We also talked through the landscape, why privacy is a globally important topic, a global view of select new or pending privacy regulations e.g. EU, Brazil, California, Canada, India, more. How technology impacts privacy, privacy awareness training, the role of auditing, compliance and the Privacy Officer, privacy in developing nations.
GDPR - should stand for Global due to the far reaching scope and impact it has had.
Core purpose - protecting the processing of EU persons data, harmonise the associated processing functions across EU member states.
Everyone has a right to the protection of personal data concerning him or her
GDPR is viewed as the new baseline for privacy regulations! Other countries are using this as a base for their own privacy regulations.
Developing countries currently have limited privacy. It seems to be a policy of ‘don’t tell them what they are using their data for, how it is stored, etc.’.
We also touched on the
Expanse of digital information across the world
Expanse of mobile technologies and datafication of everything
Regulations are reaching beyond borders
Practice challenges with cultural norms
Aging existing privacy laws
Privacy advocacy roles needed in most of these countries to help develop the laws and educate on them.
We had a presentation on Healthcare Privacy Indian (On IFHIMA Website).
India has very complex healthcare - mix of modern medicine and traditional system of medicine, large scale integration of IT in healthcare, widespread adoption of electronic medical records, right to information Act 2005, complex legal and regulatory framework.
There are lots of issues in relation to termination of pregnancy (due to disabilities). Also, no revelation of sex due to a high number of abortions based on gender. But how will this fit in with privacy of health care information?
The electronic health record standard has specific elements associated with privacy. Digital information security is included within the new Healthcare Act – it talks about standardisation and regulations in relation to collect, storage and release of health data. This will change the entire spectrum of healthcare information across India. Very similar to GDPR (based on it), and includes significant penalties for breach of this act including fines and imprisonment.
We also had a presentation relating to Privacy in the OPD Setting (USA). (On IFHIMA Website)
It covered the fact that the Outpatient arena is growing, it has challenges which include HIPAA policies and procedures being written and adopted. These must be adopted as there’s no point in having them if they’re not put into practice.
We then had a Q&A Session. Notes captured and circulated via IFHIMA Website.
We talked about the Data Protection Officer role and how it fits and is adapted and why it should be a HIM professional rather than an IT person. We discussed an issue that came out recently in USA where a health system shared identifiable data for 50 million patients with google health! It was known it was happening by around 100 people in each organisation who did nothing to prevent or stop it. There will be a full investigation - likely to take months/years with significant fines and reparation.
We also discussed if we are hindering patient care by all the security and consent issues we put paper through? We do need to educate patients more on what we do with their data and consider how we utilise implied consent.
The meeting concluded with the next face to face meeting due in Brisbane in three years’ time.
IFHIMA Congress Day 4
Cassi Brinbaum – University of California, San Diego
Cassi talked through the set-up of the health organisation she works at in regards to Health Informatics training. It has brought things together under one structure and linked systems and processes. A learning center with around 40K students covering all types of health-related training as well as actually delivering care.
This Framework has helped to improve care and has quadrupled delivery of care. She felt it was key to look at how your actual information compares to the predictive information obtained. There is a need to have clinical buy in to deliver on a quality care good value health service, especially within a Health Informatics environment.
She found that the three top barriers to value based care are: 70% integration for information sharing with other systems etc., 55% lack of adoption by use of physicians and 45% prioritising areas for improvement that will best impact the organisation.
In order to deliver their improvements they used as much technology as the clinicians wanted rather than insisting that they all adopt the same models. By the end most had adopted similar standards and use.
Isaac Eyram Tegbey, Africa.
Isaac highlighted that health care in most parts of Africa was very difficult – there were lots of issues associated with people seeking traditional help rather than structured government health care. There is a significant programme of work underway to reduce this and move to a more hospital based care system.
Poor Quality. There were improvement initiatives to look at what the cause for this is and the need to understand why there was an issue first. Delay in care was impacting upon treatment outcome as many people did not have localised hospitals and had significant distances to travel to receive this, thus delaying any diagnosis and care.
Records are critical as records were reviewed in order to establish where people were coming from, what was happening and what treatment was actually being given. It also helped identify areas where medical aid needed to be concentrated.
They looked at changing: Outpatient settings, utilising focused outreach clinics, education sessions in the community, broadcasting, educating children, working to establish community based maternal health service to try and reduce still births etc.
There has been a significant improvement from implementing these, for example a reduction from seven days to three days before seeking care, still births have reduced by 50% alone. Steady increase now in attendance at Outpatient Clinics and 81% of mothers say there has been improved care and a positive impact.
Clinical staff were not aware of the scale of the problem until they saw the information and feel that if they did not have this information then they would not have changed the practices.
There had been no increase in costs, they had just moved resources to the most appropriate area. Radio gave free airtime to support this initiative.
They have utilized the three A's, adopt, adapt or abandon for any project/initiative moving forward.
Geoffrey Semur, Tanzania. Quality data on medical certificate as causes of death in Tanzania.
Geoffrey advised that in a given year approximately 367,346 Deaths had occurred - but only 60,209 were actually registered, of which 41,126 occurred in a medical setting. Of those in medical setting those with a usable cause of death was 33,062 - only 9% of overall death rate.
Geoffrey undertook a study working with clinical staff on who, how, why, when, what etc. the Death Certificate was completed. He asked about Standard Operating Procedures (SOPs) and what training has been given and how they felt when filling in the Death Certificates. There were some unique issues i.e. culture was an issue where some causes of death could lead to stigmatism for families etc., and there were also some concern over level of staffing and whether that could be attributed to the cause of death.
Using the data collected an improvement programme was put in place including training and education for clinical staff and administration staff alike. There has been a significant improvement in reporting but exact figures were yet to be released.
Session 2 -Clinical Coding in South Korea
An overview of what could impact upon time taken to code.
Coding time increases were dependent upon length of stay due to complexity and reading requirements etc. and were also dependent upon the complexity of condition. This also means that coding varies significantly depending upon complexity, length of stay, number of beds in hospital, specialties within hospitals. Longest samples are for patients with tracheostomies etc. If working at a Trauma Center then they are likely to have a much longer coding turnaround time.
They undertook several case studies to review coding productivity model - Oncology had significant coding time requirements. Is there a correlation between coding times and quality? Accuracy takes more time so this is worth investigation.
In South Korea they are undertaking some coding at Point of Admission to identify any hospital acquired infections or conditions. This is important in Korea as it is an incentive indicator and also gives full accuracy on final diagnosis. It is also a safety indicator. This may also be required to prevent harm whilst in hospital i.e. prevent falls, prevent flare up of condition, etc. Further guidance is required from clinicians. They may need to adapt current coding systems/practice as most are for discharge only. If recorded and coded electronically rather than just in medical records it will give richer information and help reporting but also can be used to ensure patient care is noted and monitored appropriately.
They can also separate fully hospital acquired infections to show compliance with relevant monitoring/ regulations.
Then on to Dr Azza Badir, WHO, based in Cairo.
Dr Azza gave an overview on a recent study covering 22 countries (mostly Arabia) on the Importance of mortality and cause of death statistics.
EG Construction workers are 3 times more likely to die from falls than any other profession. Why is this important to know? So we can do something about it and adapt both health and safety and health care to ensure they have correct things in place.
How do you compare and contrast this? You can do something on measuring inequalities i.e. by mapping mortality rates and factoring in age, gender etc. That is why WHO feels it is vital to have appropriate reporting on Death Certificates.
The example given on effective public health was smoking – there had been a rapid decrease following pressure from WHO on countries who took action for example banning smoking in public places, taxes on tobacco, mass education (by Government), etc.
Also the example of Road Traffic Accident – significant reduction in deaths following speed limits and introduction of seat belt laws.
Porto Rico Hurricane - actually thousands died related to this incident but only 64 deaths recorded at time, many deaths later due to infection, lack of water/food, heating, etc. but they were not accurately recorded so could not be attributed correctly.
Five steps are required for accurate recording – need for a dead body, access to it by a physician before burial, an available (and qualified) physician, good coding and they need a system to collect it all.
There has been a massive improvement in the Arabic region - now over 90% in all 22 countries covered.
Death needs to be coded properly using ICD 10 or ICD 11. Also, ICD 11 working on automated software that will allow more automated processing. Need to ensure collated and sent around company wise and region wise and then world wise!
Dr. Makoto Anan - Improvement of classification accuracy in Japan
DPC - Diagnosis Procedure Center - Japanese case mix system. Health insurance system based on statistics from 1961. In 1988 the Government introduced a case mix system and then followed up in 2003 with a more complex system for recording coding. Japan had 66,900 hospital beds in 2003.
In Jan 2019 there were now over 7300 hospitals and over 809K beds with a view to increase by further 1730 beds in the next two years.
They use ICD 10 and then add in a Japanese K Code in which there are 19 majority diagnostic categories. It was introduced to support the payment system. Japanese medical expenses are more than $400million p.a. Private companies (e.g. Toyota) have made big profits but workers are poor and gaps are widening and that impacts on health care as less to spend on supplementing health care.
Japan revise their copy of ICD 10 every 2 years to fit in with changing requirements of insurance & Government.
There are over 37,000 HIM certified staff in Japan but they lack experience and skills currently. Their process for coding is a doctor does the basic coding and then HIM person checks and audits. It is the HIM that manage the database to organise payment. In order to ensure payment, the complexity level of coding has risen by 40% and accuracy has improved significantly and is regularly audited.
They are also carrying out significant work with clinicians on what they record and how they record it in order to code more effectively.
The final session of the day was on ’How to Predict Workforce Trends in HIM’.
The method used was discussed. A review of the website Indeed.com was undertaken to identify HIM posts.
It reviewed jobs globally related to health care sales, leadership, marketing and management. Most jobs were in USA, UK, Australia and India in Health Information and IT. For UAE, jobs were more in the areas of information governance/compliance. There were lots of links between technology and clinical information areas. Job listings were categorised into four key listings. UK has a greater prevalence of data analysis jobs compared with US. US was very focused on clinical documentation improvement and IG. This was for postings only and not necessarily what the government is interested in. It was suggested this be repeated in five years’ time as would show if there is a shift and also consider how this can influence education and development.
The conference concluded with a brief closing ceremony and a look forward to 2022 in Brisbane.
I arrived late at night on Friday and the Conference started on the Sunday so I had a free day to try and cram in as much sightseeing as possible – limited considerably by my being on crutches at the time.
I booked myself onto the Hop On Hop Off bus, although not much hopping was done and I sat on the bus and viewed Dubai in sunshine. It has changed and grown considerably in the 10 years since I was last there with many new very tall buildings spanning the horizon. It still maintains its old world charm around the canal and harbour and indeed the gold district looks like it has not changed for at least 50 years. I had pre-booked an evening trip up the Burj Khalifa, the tallest building in the world that was just being completed when I visited last, and the views of Dubai were stunning. Looking across all the lights of the city into the stunning blackness of the desert is something I will never forget.
I was moved considerably by the friendliness and helpfulness of all the people I came across in Dubai, as I said I was on crutches and was nervous about how I would manage – I should not have worried! Nothing was too much trouble and everyone wanted to help and assist. From the bus driver running up and down with water for me, for people putting me in the front of the taxi queue, to the chef personally filling my plate at the buffet and carrying it to the table for me! A great congress, an amazing city and enchanting people!