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Holistic transformation of clinical coding services

 

Introduction

High quality clinical information is crucial for NHS Wales' strategic and delivery programmes and the realisation of a learning health and care system. The COVID-19 pandemic severely impacted clinical coding, resulting in significant backlogs and coding completeness rates below 70%.

Recruitment of accredited coders became challenging, with limited willingness for overtime and no additional budget for contractors. Key metrics include achieving 95% coding completeness within a month, expanding coding scope, increasing productivity, reducing costs, maintaining coding quality, and improving coder retention by March and June 2024.

Methods

A coding strategy was developed to enhance coded data use, supporting CTMUHB’s COVID recovery, 2030 strategy, and Federated National Data Resource.

This multi-faceted approach addressed recruitment, professional development, technology, and standards, created collaboratively with clinical and informatics teams. The agile, iterative program focuses on workforce skills and technological advancements, using AI-driven autocoding and continuous improvement cycles, with major updates to the autocoder quarterly.

Outcomes

  • Consistently achieved 95% coding standard since June 2023, with 97.8% of 2023/24 FCEs coded by May 1, 2024.
  • Expanded coding to most outpatient procedures and supported autocoder use for referral, waiting list, and Emergency Department activities.
  • Reduced overall clinical coding expenditure by 0.8% year-on-year.
  • Increased productivity with a 20.7% rise in FCEs coded, resulting in a 17.8% gain in cost-effectiveness.
  • Maintained coding quality with no change in accuracy and completeness from the previous year.
  • Achieved full team retention of qualified and trainee coders over the past 12 months.

Learnings

  • AI has brought sustainable benefits to coding targets not achieved by previous initiatives.
  • Multi-disciplinary vision and teamwork enable different coding delivery methods.
  • Technology adoption leads to sustainable quality, financial, and productivity improvements.
  • Team skills are transferable with a commitment to learn and adapt.
  • Future efforts should focus on developing the autocoder at a specialty level for better efficiency.

What next?

  • Shared with all health boards via the clinical coders group, autocoder offered for free with the intention to scale benefits.
  • Additional resources allocated to extend AI tools for improving clinical information availability.
  • Developing a form builder to allow clinicians to create forms meeting NHS Wales standards, collaborating with UK and US institutions.
  • Training clinical coders in Snomed-CT and software development for FHIR forms deployment.