HEALTH EDUCATION &

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2014 Clinical Documentation, Coding and Analysis Conference

Enhancing the NSW Health Clinical Coding and Health Information Management Workforce Anita Jacobsen NSW Health Education and Training Institute

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Health Education and Training

Institute (HETI)

Established in April 2012 as part of the new

government’s changes to NSW Health governance

Leads, coordinates and advocates for quality education

and training for the NSW public health system

One of 4 Pillars for Health Reform

working with the Clinical Excellence Commission, Agency for

Clinical Innovation and the Bureau of Health Information, as well

as the Ministry of Health and all Local Health Districts and

Specialty Hospital Networks

Works closely with all other entities to

ensure alignment of activities.

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HETI’s Vision…

“A world class NSW Health

workforce supporting excellent

patient centred care.”

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Clinical Coding Workforce Enhancement (CCWE) Project - Background

NSW Health – research and consultation dates back to 2009, project proposal endorsed in 2011

Responding to New Government priorities

Health and Hospital Workforce Reforms

Introduction of Activity Based Funding (July 2012)

Clinical coding workforce needs

Current and projected shortfall (AIHW, 2010)

Hospital separations increasing

Challenge of achieving a balance between quality & timeliness in clinical coding

Technological developments (e-health reforms & e-MR)

New skill sets required & new opportunities (remote coding)

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Clinical Coding Workforce Census

Data collection to guide the implementation of the Clinical Coding Workforce Enhancement strategies

1 July – 30 September 2011

NSW Local Health Districts (LHDs) and 3 specialty Networks provided information on:

Clinical coding workforce profiles

Vacancies

Positions that could be created above establishment

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Health Information Services Workforce Profile

Position

NSW Health Employee Headcount FTE

F/T P/T Temp Casual Total % Filled

FTE

Vacant

FTE

Total

FTE

Health

Information

Manager

16 10 1 27 7.8 9.5 2.0 11.5

Coding

Manager 13 13 3.8 11.8 4.0 15.8

Admin/

Coders 19 2 21 6.1 5.3 5.3

Clinical

Coders 132 129 3 19 283 82.3 206.4 33.0 239.4

Grand

Total 180 141 3 20 344 100 233.0 39.0 272.0

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Coding education

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Project objective: Enhance the NSW Health Clinical Coder & HIM workforce

Strategy 1

• Recognise and develop the skills of existing clinical coding staff, to the national occupational standard

Strategy 2

• Recruit and develop new entry-level clinical coders to the national occupational standard

Strategy 3

• Increase the NSW Health HIM Workforce via professionally-recognised courses

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Clinical Coding Workforce Enhancement Project development

Scoping research and stakeholder

consultation

Development and approval of project

proposal

Formation of representative

project governance structures

Development of appropriate

implementation approaches

Implementation Evaluation

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Clinical Coding Workforce Enhancement Project Governance Structures

Project Steering Committee

Strategy 1 -

Working Party

Strategy 2 –

Working Party

Strategy 3 – Scholarships

Working Group

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Strategy 3: Increasing the Health Information Management Workforce

No degree course is currently offered in NSW

No longer any natural flow of HIM graduates into NSW Health workplaces

Identified industry needs:

Solution to chronic shortages of HIMs, particularly in regional/rural areas

Increased visibility of HIM career opportunities

Education models – supported delivery via distance education

Multiple pathways into HIM careers to capitalise on existing skills

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Strategy 3 – Supporting NSW Health employees to develop towards HIM roles

New Qualified

HIM

Existing NSW clinical

employee

Existing NSW Health non-

clinical employee

Existing NSW Health Clinical

Coder

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Strategy 3 – Qualifications to support multiple entry points

Employee without relevant Degree/experience

Bachelor of Science (Health Information Management)

- 3 years full-time

Qualified HIM

Employee with a relevant Degree/experience

Masters of Health Information Management

- 2 years full-time

Qualified HIM

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Strategy 3 - Application process

Application process opened in July 2013 for one month, requiring:

Applicants to enrol in course

Employer support for application

Support from a relevant executive

Merit-based selection process

Impartial panel, with expertise in HIM, health reform and adult education

Short essay questions

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Strategy 3 - Progress

23 applications received and considered by a panel with expertise in health information management, health reform and education

6 high scoring applicants – awarded scholarships

7 met selection requirements, unsuccessful

3 – did not meet selection requirements

4 did not meet employment requirements

3 could not show proof of enrolment

Strong applications showed:

Commitment to a career as an HIM

Ability to balance education and employment

understanding of the current and future needs of the system, strongly linking the role of HIMs

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Strategy 3 – Future

Improving the process for future intakes

Timeframes

Target group

Funding amount / number of scholarships

Education providers

Application process

Obtaining funding for future scholarship processes

Potential co-funding with LHDNs

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Strategy 1: Recognise and develop the skills of existing clinical coding staff

In June 2012, 120+ health information service staff enrolled in the HLT43212 Certificate IV in Health Administration

Generic qualification – aligned to the mid/senior clinical coder role through selection of electives

Cohorts commenced in groups of 20-25, according to the capacity of the RTO

Program structure:

Recognition of current level of competence

Development to next level of clinical coding skills

Gap training for any areas remaining in qualification

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Strategy 1 - Progress

Approximately 120 learners across NSW

Completions to start in June

Unique opportunity for professional recognition and development – ‘free’ training

High level of enthusiasm among participants – particularly in relation to the recognition process

Low withdrawal rate increasing interest

Growing ‘learning culture’

Observed increase in staff’s knowledge and motivation, broadened outlook on functions surrounding coding

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Strategy 2: Recruitment and development of new entry-level trainee clinical coders

Agreement to act

11 of 17 District and Network Chief Executives agreed to create 33 new 24-month trainee positions across NSW

Many districts created positions above establishment

Some recruited to existing vacancies

Some unable to participate due to various pressures, hoping to be in a position to do so in future.

Consistent state-wide recruitment process followed

Common position description, interview questions & Aptitude test

Common recruitment timelines

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Strategy 2 – the model

2 years temporary employment

Supported traineeship – 80:20 rule

Blended Education program

Online learning

Face-to-face or teleconference sessions

Supervised workplace experience

First 12 months in medical records department

Second 12 months coding in the workplace

Dedicated supervisor when commencing coding in the workplace

Ongoing assessment

Enhanced and staggered focus on medical terminology and medical science

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Strategy 2: Funding support

HETI and the NSW Ministry of Health

Funded the education component through the RTO

Small contribution towards new trainee salary for all newly created positions

Locally-based Clinical Coding workplace supervision positions

To support trainees in the workplace

Commonwealth traineeship financial assistance

Employer incentives for LHDs/Networks

In some cases, funding to the NSW Health RTO

Allowances to trainees

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Strategies 1 & 2 – Impacts to date?

Participation remains consistent

Growing a learning culture in coding departments

Re-energising departments or supporting change

Improvement in quality of new entry-level staff

Improvements to recruitment approaches for clinical coding generally

Collaboration

Higher expectations for education

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Strategies 1 & 2 - Challenges

Using Vocational Education & Training (VET) sector

Adult learners – flexibility

‘State-wide’ program and variation between districts

Change, change and more change

Keeping our trainees/learners – and our trainers!

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What next for the project?

Sustainability – long term approach to coding workforce development is needed – there is no ‘quick fix’

Project --> Program: planning for sustainability

Evaluation of training & workforce outcomes

Overall impact

Outcomes (once training is complete)

Training to full qualifications to remain on the NSW Health RTO’s scope of delivery

Aim: To source ongoing funding to continue to deliver outcomes for the workforce.

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What next for clinical coding education?

Employers must become informed purchasers of education

Demand quality outcomes – job-ready workers

Support for adult learners

Appropriate, effective learning and assessment modalities

Encourage more competition

Contribute to review of the national qualifications - the second Draft is due for release in coming days.

Imperfect qualifications

Only informed feedback will improve them

Question – how closely do these qualifications reflect the work roles/functions of my clinical coding staff?

www.cshisc.com.au – from 1 March until mid-April

New directions?

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Recommendations for addressing clinical coding workforce needs

Improve recruitment practices – test, test, test!

Restructure and redesign – think broadly about potential scope of destination roles for clinical coders – or risk losing them all

New directions?

Advocate:

Investment is critical

Sustainability – advocate for a long term approach to coding workforce development – there is no ‘quick fix’

Speak up - Keep articulating the need and advocating for this ‘critical link’ in Activity Based Management.

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Thank you Anita Jacobsen, Senior Program Officer

Education Strategy & Implementation ajacobsen@heti.nsw.gov.au