Thank you to the Australian Health Information Management (HIM) community for their participation and contributions to this study. We’ve identified valuable insights about Health Information Systems (HIS) departments and hospital data quality.
The quality of coding has a direct impact on data quality. We therefore know the important work carried out by Health Information Managers (HIMs) has a direct impact on hospital strategy and business outcomes.
This study shows that there are three major factors affecting the quality of coding, and therefore hospital data quality:
- The need for continuing education and training programs for HIMs.
- Investing in Health Information Technology (HIT).
- Clear communication to HIS staff from leadership.
There’s a disconnect between directors and HIS department managers on how much work goes into high quality coding. The medical record has evolved, and so too has the role of the HIM. HIMs are no longer clerical support to hospitals, instead they work with software, policies, and processes to ensure high quality coding which leads to better business outcomes:
- Education and training of HIMs affects coding quality.
- Coding quality affects Activity Based Funding (ABF).
- ABF affects business outcomes.
This is an important connection for all levels of hospital staff and leadership to agree on.
As you will see from this report, there are standout factors for HIS staff satisfaction and dissatisfaction, and interesting insights into the dissemination of data strategy from hospital executives to managers. There is also a notable correlation between the size of the hospital and the probability of the data quality decreasing.
The report uncovers solvable problems, and we believe it also reveals the necessary steps to solve them. The report is broken down into the following sections:
Stats – Factors affecting coding quality that impact data quality
Stat 1 – Top causes of poor coding quality in HIS departments
These are the top causes for poor coding quality in HIS departments identified uniformly by hospitals of all sizes, and personnel across all roles:
- Incomplete clinical documentation.
- Variations in coding standards interpretations.
- Pressure caused by quota to HIMs and clinical coders.
Investment in Health Information Technology (HIT), combined with efficient workflows and processes, will aid in solving causes 1 and 3. Investment in further training will aid in solving the cause 2.
It’s important to note that HIMs use software to provide insights into areas for improvement on workflows and processes.
Stat 2 – 86% of Directors vs 55% of Managers agree or strongly agree with “The HIS department is getting the support it needs to take proactive steps to ensure the quality and maintain the integrity of our health data.”
The gap between directors and managers agreeing with this statement is considerable. This could indicate a lack of dissemination of strategy from top leadership down the chain of command.
Having a clearly communicated data strategy is paramount for hospitals as the investment in technology increases.
Stat 3 – 45% of Managers don’t believe they are receiving the support they need to maintain the integrity of their health data.
The need for further support from hospital leadership of HIS departments is evident. Hospital management could examine if there is a disconnect by asking:
- Are there open communication channels between directors and managers to discuss the need for support?
- And the types of support required?
- Does this issue relate to the importance placed on health data integrity by leadership?
Stat 4 – What is the main reason for staff satisfaction / dissatisfaction within an HIS?
There were multiple reasons provided to the survey respondents but the correlation is clear. The two main reasons for satisfaction and dissatisfaction are linked; investment in HIT, and training.
The pressure for meeting quotas was a significant cause of dissatisfaction for large hospitals. Interestingly, it is not a reason for dissatisfaction for small or medium sized hospitals at all.
Another interesting insight is the desire for an ‘efficient workflow’, which correlates with respondents’ dissatisfaction with the ‘pressure of meeting quota’. Refer to the next section for more insights into education and training.
Refer to stat 8 below to see a breakdown of the types of software in demand.
As there’s further investment in HIT, new software added to the existing software architecture needs to be fully integrated.
Stats – Education
Stat 5 – 88% of Directors vs 53% of Managers agree or strongly agree with “I’m satisfied with the continuous training and education provided for HIMs in our hospital.”
There is a misalignment between leadership and staff on the training and education being provided. 86% of leadership believe the HIMs are getting enough training, compared to 55% of managers.
Stat 6 – 47% of Managers are not satisfied with the training and education provided to HIMs.
This highlights a strong desire for further education from managers but isn’t reciprocated by directors, with only 12% not being satisfied with the level of training and education. Clear communication is missing between hospital seniority. If the communication was improved, would we still see this gap in satisfaction for education?
Stat 7 – How often do HIMs receive training or attend educational webinars?
This is a very interesting insight in combination with the data from the previous statistic. A large proportion of directors believe that their HIMs are receiving enough training but 0% believe they are receiving 6 or more webinars per year. Compared to the opposite sentiment surveyed of officers and managers.
This could indicate the senior level management is not aware of the amount of training and education required for continued professional development. With new coding rules, are the HIMs given work time to allow for training? Or are they expected to train themselves in personal time?
Stats – Technology
Stat 8 – Which HIT do you think your hospital should invest more on?
Interestingly around a third of all staff felt there was a strong need for analytics and/or auditing software. This is part of the professional evolution of HIMs into analysis, and the desirability for high coding quality. Senior management will experience better business outcomes by providing the tools to HIMs to be able to analyse coding quality and data.
Stat 9 – What will be the biggest change to HIS departments by the end of 2023?
There’s a disparity between leadership and managers/officers on the challenges they believe HIS departments will face.
Use of cloud computing is a challenge for directors, compared to increasing volume of data for managers/officers.
Interestingly, one problem solves the other. Clear and open communication between leadership and staff could easily resolve apprehension of future challenges.
Stats – The HIS Department
Stat 10 – In your opinion, will there be significant changes in the roles of HIMs by the end of 2023?
Overwhelmingly, respondents surveyed “yes”. There was no difference between role seniority. HIM professionals in large hospitals expect the least amount of change occurring over the next 18 months. This is an interesting result, and could be the result of many factors. It would benefit hospital leadership from large hospitals to investigate this.
Stat 11 – Only 45% of Managers believe the department is adequately staffed
Compared to 71% of directors who believe the department is adequately staffed, this is a large difference. There are many factors that go into staff recruitment decisions, of which we are not going to solve here.
However, this report does highlight 3 key solvable factors that contribute to better business outcomes and a more satisfied HIS workforce.
- The need for continuing education and training programs for HIMs.
- Investing in HIT.
- Clear communication across an organisation.