Prepared by Wendy Loomes eMR Program Director, Clinical Informatics Information Management and Technology,

1. Coding Workforce – New Strategy required Prepared by Wendy LoomeseMR Program Director, Clinical InformaticsInformation Management and Technology, Northern Sydney and Central Coast Local Health Districts September, 2011

2. Acknowledgments • Nicole Stanzer – District Health Information Manager • Belinda Saad – District Coder Educator • Lizz Kopecny – former Area Quality Coding Manager • All the Coders and Managers of Health Information Services in the former NSCCAHS

3. What were our issues ? • The biggest – employing coders full stop ( and HIS staff generally) • Drawing from a limited pool of experienced or qualified managers and coders • A decreasing clinical coder workforce due to natural attrition and the low profile of clinical coding in the job market • Hoop jumping with NSW Health to have coder roles deemed “front line” and advertised externally – seek and HIMMA website • Insufficient coding FTEs to meet NSW Health coding deadlines, looming ABF requirements, maintain a data quality program and provide leave coverage • No funded trainee positions • Heavy reliance on expensive contract coders

4. Existing Strategies • Introduction of Area Coding Educators (2) and Area Coding Manager • Through additional hospital funding increased our recurrent coding workforce by 7.0 FTE across the districts • Negotiated with NSW Health for coder roles to be considered front line • As of the 1st of July coders have been instructed to use the R69 code when records are unavailable for coding and when information is missing. • Permanent add for coders on HIMAA website and automatic adds to seek.com • Establishment of a NSLHD Casual Coding pool – 3 staff that work weekends – 3 more staff being interviewed • Establishment of the Clinical Coder Traineeship Program • Contract coders still in use • Overtime always available

5. Existing Strategies continued • As sites meet NSW Health target coders moved to assist other sites • Records coded by staff and contract coders at alternate sites • Removal of any non coding related tasks from coders- • Regrade of Administration level 4 Coding staff to Administration level 5 using appropriate tool • Significant work undertaken with Workforce Metropolitan Careers Staff • Participated in a school job fair at Gosford advertising coding as a profession • Inclusion of Clinical Coding on the NSW Health HealthWise DVD which aims to promote jobs in the health industry to potential recruits

6. Coder Traineeship Program Traditional New Block Method Material delivered as modules 3 funded trainee Coders come to IM&T at Macquarie Hospital every 2 weeks for a 4 hour session with coding educator Trainee coders have an experienced coder onsite “buddy” Development of a large amount of teaching materials for the in-house trainee program Off week is a review week • 4 Coders continue to complete specialities under the mentorship of facility HIS managers • Coding educator checks records of speciality and acts as mentor • Coders have access to in house modules • These coders will be complete by end of September 2011

7. Sustainability issues • Coding workforce challenges to ensure that there is a sufficient and skilled workforce to meet the current and future external and internal reporting requirements • Coded data is routinely audited to ensure accuracy and optimal funding outcomes for the LHDs. • Reduce significantly our reliance on contract coding staff - cost • An increasing rate of separations now and into the future due to population increases, demographic changes and new models of care • Activity Based funding • Ongoing skills development and changing work practices, e.g. development of the electronic medical record, document imaging

8. Clinical Coding Workforce Model The coding workforce model aims to place the local health district in a position where it is able to retain and attract skilled clinical coders that will support a cohesive and well structured coding workforce. This will in turn enable the LHD to meet its coding reporting targets and support Activity Based Funding (ABF).

9. The Coder Workforce Project • In January 2011 a Clinical Coding Workforce Project was established by IM&T and Workforce Services to review the current clinical coder workforce. • Report was produced for both of the Local Health Districts and released to Chief Executives in May 2011. • Team: Clinical Informatics Manager- sponsor, Former Area Health Information Manager, Manager, Workforce Redesign, Former Area Coding Quality Manager, former Area Coding Educator, Beaches HIS Manager, Gosford Deputy HIS Manager, Clinical Coder, Gosford, Clinical Coder, RNS

10. What the project reviewed • Current LHD Clinical Coding Workforce • Organisational context of each LHD • Existing coder workforce education and qualifications • Current award rates • Organisational context for both Local Health District • Current coder workforce profile and FTE • Coding management and Organisational structure • Current trainee coder workforce • Contractors • Budgets – overtime/contractors

11. What the project reviewed • Challenges affecting coder productivity and Quality • NSW Health Coding deadlines • Coder education • Coder staff turnover issues • Career progression opportunities • Staff leave • Trainee or newly appointed coders- throughput • Poor documentation • Auditing requirements • Coder working environment • Flexible working hours

12. Recommendations CCLHD • Increase the number of coding FTEs by 1.81 to meet the demand for quantity and quality • Recruit 2.0 FTE Auditor roles to support an ongoing auditing program • Implement a new coding structure – Coding Manager, Coding Trainee, Senior Clinical coder • Improve the salaries for coders – Administration 6 increase after 12 months of senior coding experience • Improve working conditions –working from home, flexible hours, reduce noisy environments • Enhance continuing education opportunities for existing coders – funding two clinical coding staff per annum to undertake Intermediate or Advanced HIMAA Clinical Coding Courses

13. Recommendations CCLHD • Promote the trainee program through the establishment of an additional trainee positions – 2 dedicated trainee positions be created. Recruited from the business and enrolled in a funded certificate beginner course with HIMAA or OTEN. * Two dedicated trainee positions are advertised for candidates interested in becoming clinical coders. * Appointed as Coding Trainees at Administration Officer Grade 3 for a 12 month period and are funded by CCLHD to undertake the Introduction to Clinical Coding education at HIMAA or OTEN. * During their traineeship they will be mentored by the coding team and coding manager * On successful completion of the HIMAA or OTEN course, the candidates will be regraded as Coders at an Administration Officer Grade 4 within their current positions (ie without having to sit another interview). * Recruitment to vacant positions would remain based upon the principles of Equal Employment Opportunity.

14. Recommendations NSLHD • Increase the number of coding FTEs by 3.55 to meet the demand for quantity and quality • Increase in Assembly Staff 7.10 FTE • Recruit 2 FTE Coder Co-ordinators • Recruit 3.47 FTE Auditor roles to support an ongoing auditing program • Implement a new coding structure – Coding Manager, Coding Trainee, Senior Clinical coder • Fund coding pool – reduce reliance on contractors • Improve the salaries for coders – Administration 6 increase after 12 months of senior coding experience

15. Recommendations NSLHD • Improve working conditions –working from home, flexible hours, reduce noisy environments- document imaging coming for RNS and Ryde • Enhance continuing education opportunities for existing coders – funding two clinical coding staff per annum to undertake Intermediate or Advanced HIMAA Clinical Coding Courses • Promote the trainee program through the establishment of an additional trainee positions – 3 dedicated trainee positions be created. Recruited from the business and enrolled in a funded certificate beginner course with HIMAA or OTEN.

16. Agreement in principle by Chief Executives • Positive response from Hospital Executive • To recruit additional coding FTE’s immediately • Review and an enact other recommendations through transition process

17. Thankyou Wendy Loomes wloomes@nsccahs.health.nsw.gov.au Nicole Stanzer nstanzer@nsccahs.health.nsw.gov.au