Holistic transformation of clinical coding services
Andrew Nelson, Chief Information Officer, Cwm Taf Morgannwg University Health Board
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.
