One in ten hospital episodes miscoded

Almost one in ten hospital episodes is incorrectly coded, according to an analysis carried out by the Audit Commission.

The spending watchdog’s analysis of more than 50,000 episodes of care, equating to approximately £73m of expenditure under Payment by Results, found an average error rate of 9.4% - with error rates across trusts ranging from 1% to 52%.

The Commission warned that the errors would not only affect Payment by Results but other issues, including activity planning and commissioning.

It recommended that the Department of Health and NHS Connecting for Health should introduce a wider data quality programme to drive improvements in the standard of NHS data and increase confidence in its use.

The Commission said the coding mistakes identified contributed to a gross financial error of about £3.5m, but that in most cases the net financial impact was close to zero.

It found no national evidence of under or over-charging or gaming. However its report added: “There is a number of cases where the net financial impact of errors was locally significant.”

The report says the most common issue affecting the accuracy of clinical coding is the quality of the source documentation. Other problems include the adequacy of trust coding arrangements and the level of clinician involvement.

Audits showed that the training and development of coders had more of an impact on limiting the number of errors than the number of coding staff. Foundation trusts had marginally lower Healthcare Resource Group (RG) errors than non-foundation trusts, but higher error rates were encountered at specialist trusts.

The Audit Commission has also recommended that trusts should review and, where necessary, improve their source documentation to promote accurate coding and ensure that clinicians are engaged and involved in validating coding.

It further said that trusts should develop their coding departments through professional training and development.

The data analysis was undertaken at all trusts in England throughout 2007/8 and the Commission said the results provide the first comprehensive national picture of the quality of data underpinning not only financial but clinical and commissioning information.

The Audit Commission has developed its benchmarking methodology into an online tool called the National Benchmarker. It has recommended that trusts and primary care trusts use the Benchmarker regularly to review potential coding anomalies and areas for improvement.

Link

Audit Commission report on PbR clinical coding

 

privacy issues with NHS database

 

Privacy campaigners will be screaming "I told you so" at anybody who will listen, following the news that the police are to be given access to the national children's database to look for evidence of crime outside its original remit of protecting children.

Function creep seems to be an inevitable feature of such databases. No matter how much trust and goodwill they destroy in the process, ministers just cannot help themselves when the police - and then other authorities - suggest they should be able to have a look around for evidence of serious wrongdoing - which then becomes less and less serious.

Did Patricia Greenhalgh understand this when, following an ethnographic study of the first NHS summary care records pilots, she suggested that NHS Connecting for Health should review its consent model and its "do not create" option?

That patients do care who has access to their records has become very clear in the Wirral, where the primary care trust has got into hot water for trying to pass patient data onto a private company to run a telephone advice campaign. Another interesting aspect of the case: a privately-run coaching service is bang in line with national policy on long-term conditions; but local people don't seem to have recognised it as NHS business.