Barriers to high quality coding of hospital chart information to administrative data: A qualitative study

ABSTRACTObjectives Administrative data are widely used in research, health policy, and the evaluation of health service delivery. We undertook a qualitative study to explore the barriers to high quality coding of chart information to administrative data, at the level of coders in Canada. ApproachOur study design is qualitative. We recruited professional medical chart coders and data users working across Alberta, Canada, using a multimodal recruitment strategy. We conducted an in-depth, semi-structured interview with each participant. All interviews were audio-recorded and transcribed. We conducted thematic analysis (e.g., line-by-line open coding) of interview transcripts. Codes were then collated into themes and compared across our dataset to ensure accurate interpretations of the data. The study team met to discuss, modify, and interpret emergent themes in the context of the barriers to coding administrative data. ResultsWe recruited 28 coding specialists. In general, coders had high job satisfaction and sense of collegiality, as well as sufficient resources to address their coding questions. They believed themselves to be adequately trained and consistently put in the extra effort when searching charts to find additional information that accurately reflected the patient journey. Barriers to high quality coding from the coder perspective included: 1) Incomplete and inaccurate information in physician progress notes and discharge summaries; 2) Difficulty navigating a complex hybrid of paper and electronic medical records; 3) Focus on productivity rather than quality by the employer, which at times resulted in inconsistent instructions for coding secondary diagnoses and discordant expectations between the employer and the coders’ professional standards. ConclusionFuture interventions to improve the quality of administrative data should focus on physician education of necessary components in charting, evaluation of electronic medical records from the perspectives of those who play a key role in abstracting data, and evaluation of productivity guidelines for coders and their effects on data quality.

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Implementing electronic medical records in a psychiatric hospital: A qualitative study

International Journal of Psychiatry in Clinical Practice ◽

10.3109/13651501003717243 ◽

2010 ◽

Vol 14 (3) ◽

pp. 223-227 ◽

Cited By ~ 11

Author(s):

Laurent Boyer ◽

Jean-Claude Samuelian ◽

Marius Fieschi ◽

Christophe Lancon

Keyword(s):

Qualitative Study ◽

Electronic Medical Records ◽

Psychiatric Hospital ◽

Medical Records

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Cancer patients’ attitudes and experiences of online access to their electronic medical records: A qualitative study

Health Informatics Journal ◽

10.1177/1460458216658778 ◽

2016 ◽

Vol 24 (2) ◽

pp. 115-124 ◽

Cited By ~ 31

Author(s):

Hanife Rexhepi ◽

Rose-Mharie Åhlfeldt ◽

Åsa Cajander ◽

Isto Huvila

Keyword(s):

Qualitative Study ◽

Cancer Patients ◽

Electronic Medical Records ◽

Patient Engagement ◽

Medical Records ◽

Healthcare Outcomes ◽

Doctor Visits ◽

Phone Calls ◽

Medical Issues ◽

Online Access

Patients’ access to their online medical records serves as one of the cornerstones in the efforts to increase patient engagement and improve healthcare outcomes. The aim of this article is to provide in-depth understanding of cancer patients’ attitudes and experiences of online medical records, as well as an increased understanding of the complexities of developing and launching e-Health services. The study result confirms that online access can help patients prepare for doctor visits and to understand their medical issues. In contrast to the fears of many physicians, the study shows that online access to medical records did not generate substantial anxiety, concerns or increased phone calls to the hospital.

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Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review (Preprint)

10.2196/preprints.12779 ◽

2018 ◽

Author(s):

Ronald Dendere ◽

Christine Slade ◽

Andrew Burton-Jones ◽

Clair Sullivan ◽

Andrew Staib ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Outcomes ◽

Electronic Medical Records ◽

Patient Engagement ◽

Medical Records ◽

Provider Communication ◽

Patient Portals ◽

High Quality ◽

Patient Provider Communication

BACKGROUND Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. OBJECTIVE The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. METHODS A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). RESULTS The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. CONCLUSIONS While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

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Auditing service delivery in glaucoma clinics using visual field records: a feasibility study

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2019-000352 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000352

Author(s):

Stephen R Kelly ◽

Susan R Bryan ◽

John M Sparrow ◽

David P Crabb

Keyword(s):

Visual Field ◽

Service Delivery ◽

Electronic Medical Records ◽

Medical Records ◽

Large Scale ◽

Health Service Delivery ◽

Mean Deviation ◽

Normal Limits ◽

Field Analyser

ObjectiveThis study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care.Method and analysisHumphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated.ResultsOne-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and −6 (–10, –4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was −0.2 (−0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001).ConclusionThis study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres.

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131 - Identifying Type 1 Diabetes in Electronic Medical Records and Administrative Data in Ontario

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2019.07.140 ◽

2019 ◽

Vol 43 (7) ◽

pp. S45

Author(s):

Alanna Weisman ◽

Karen Tu ◽

Jacqueline Young ◽

Matthew Kumar ◽

Peter C. Austin ◽

...

Keyword(s):

Type 1 Diabetes ◽

Electronic Medical Records ◽

Administrative Data ◽

Medical Records

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Preliminary Development and Evaluation of an Algorithm to Identify Breast Cancer Chemotherapy Toxicities Using Electronic Medical Records and Administrative Data

Journal of Oncology Practice ◽

10.1200/jop.2013.001288 ◽

2015 ◽

Vol 11 (1) ◽

pp. e1-e8 ◽

Cited By ~ 7

Author(s):

Jeanne S. Mandelblatt ◽

Karl Huang ◽

Solomon B. Makgoeng ◽

Gheorghe Luta ◽

Jun X. Song ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cost Effectiveness ◽

Electronic Medical Records ◽

Administrative Data ◽

Cancer Chemotherapy ◽

Medical Records ◽

Community Practice ◽

Health Care Settings ◽

Breast Cancer Chemotherapy

If validated in other samples and health care settings, algorithms to capture toxicity could be useful in comparative and cost effectiveness evaluations of community practice–delivered treatment.

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Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia

Current Opinion in Psychiatry ◽

10.1097/yco.0000000000000579 ◽

2020 ◽

Vol 33 (2) ◽

pp. 163-169 ◽

Cited By ~ 1

Author(s):

Jenni Ilomäki ◽

Edward Chia-Cheng Lai ◽

J. Simon Bell

Keyword(s):

Electronic Medical Records ◽

Administrative Data ◽

Medical Records ◽

Medication Safety ◽

Clinical Registries

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How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-028329 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028329 ◽

Cited By ~ 5

Author(s):

Ruby Biezen ◽

Cassandra Roberts ◽

Kirsty Buising ◽

Karin Thursky ◽

Douglas Boyle ◽

...

Keyword(s):

Decision Support ◽

Qualitative Study ◽

Electronic Medical Records ◽

General Practitioners ◽

Clinical Decision Support ◽

Medical Records ◽

Clinical Decision ◽

Antibiotic Prescribing ◽

Evidence Based ◽

Practice Culture

ObjectiveThis study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia.DesignThis is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework.SettingThis study was conducted in general practice in Victoria, Australia.ParticipantsTwenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018.ResultsGPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients’ expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use.ConclusionsCurrent barriers to the use of antibiotic guidelines include GPs’ experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.

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