Health information management : journal of the Health Information Management Association of Australia最新文献

Background: While the smart aged care service platform in China significantly enhances aged care services in China by integrating resources, it struggles with "data silo" issues due to the absence of data standards, leading to poor data integration, limited data-sharing and fragmented system functions. Objective: The study aimed to develop a minimum dataset (MDS) for smart aged care service platforms that constitutes core data to support real-time demand analysis and cross-regional cooperation, as well as to provide a foundation for the construction of a smart aged care data resource framework. Method: The study was developed in three phases: (1) bidding documents, policies, standards and literature were collected; (2) by analysing the content of the documents, the study constructed the structure of the MDS and extracted data elements afterward; and (3) a two-round Delphi process with 26 specialists was subsequently performed to revise the draft, and 24 institution staff invited to review and determine the MDS prototype. Results: Smart aged care service platforms included three types of users: older adults and their families; aged care organisations and regulatory authorities. The final MDS contained 122 items (26 optional items) with 6 first-level categories and 17 second-level categories. The most recognised sub-categories were nursing diagnosis, demographics and medical history. The data of government regulatory agencies was also important. Conclusion: The developed MDS provides a standardised framework for data integration and sharing in smart aged-care service platforms. Implications for health information management: The MDS can enhance data quality, facilitate personalised care, support evidence-based decision-making and promote research and innovation in aged care.

Background: Research underpins and informs a profession's growth. Research and practice have a fundamental relationship involving knowledge production and its applications to a profession's work.

Objectives: To investigate health information management professionals': interest in investigator involvement in research; exposure to, or opportunity for, research investigator involvement; areas of research interest; barriers to research investigator involvement.

Method: A cross-sectional study design was utilised. An online survey elicited data on respondents': demographics, employment, roles; access to research information; interest and experience in research engagement; experience of barriers to research investigator involvement.

Results: Of 112 respondents: 64.3% reported no research involvement; 35.7% had research team experience; 83.9% retrieved research information from the web; 73.9% had no role-based research component; 51.3% had been approached by other (workplace-based) researchers to access and analyse data. Barriers to investigator involvement were personal, organisational and logistical, with lack of time the greatest impediment (62.5%) followed by cost (33.9%), lack of confidence (33%) and not knowing who to approach, or how (31.3%). Research skill development was important for 14.1%. Clinical Coding and Classification Systems (13.3%) and eHealth (12.6%) were considered likely to benefit most from health information management-related research.

Conclusion: Health information management practitioners generally have interest in research engagement; barriers include time, money and confidence.

Implications for practice: Provision of research skills and the anomaly of requests for facilitation of data access and analyses alongside absence of a research component in their formal roles require attention. The professional association should actively encourage collaborative academic-practitioner research and showcase new evidence for practice.

Background: Accurate coded diagnostic data are important for epidemiological research of stroke.

Objective: To develop, implement and evaluate an online education program for improving clinical coding of stroke.

Method: The Australia and New Zealand Stroke Coding Working Group co-developed an education program comprising eight modules: rationale for coding of stroke; understanding stroke; management of stroke; national coding standards; coding trees; good clinical documentation; coding practices; and scenarios. Clinical coders and health information managers participated in the 90-minute education program. Pre- and post-education surveys were administered to assess knowledge of stroke and coding, and to obtain feedback. Descriptive analyses were used for quantitative data, inductive thematic analysis for open-text responses, with all results triangulated.

Results: Of 615 participants, 404 (66%) completed both pre- and post-education assessments. Respondents had improved knowledge for 9/12 questions (p < 0.05), including knowledge of applicable coding standards, coding of intracerebral haemorrhage and the actions to take when coding stroke (all p < 0.001). Majority of respondents agreed that information was pitched at an appropriate level; education materials were well organised; presenters had adequate knowledge; and that they would recommend the session to colleagues. In qualitative evaluations, the education program was beneficial for newly trained clinical coders, or as a knowledge refresher, and respondents valued clinical information from a stroke neurologist.

Conclusion: Our education program was associated with increased knowledge for clinical coding of stroke. To continue to address the quality of coded stroke data through improved stroke documentation, the next stage will be to adapt the educational program for clinicians.

Background: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse.

Objectives: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data.

Method: Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used.

Results: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001).

Conclusion: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs.

Objective: To map clinical registries within the Central Adelaide Local Health Network (CALHN); and to identify how these registries were currently used for addressing unwarranted clinical variation in care.

Method: An online survey was sent to all Heads of Units (HoUs) within CALHN. The survey addressed participation, type of data, reporting processes and use of the clinical registries for research, quality assurance (QA), quality improvement (QI) and clinical variation in health care.

Results: Twenty-six HoUs responded (26%); 25 contributed to a clinical registry (96%); all provided data to more than one registry, but only 34.6% had an existing financial and governance arrangement with the network. Health outcomes were the most common datapoints; 77% of all data were collected manually; and 38.5% of data analysis was risk adjusted. Access to aggregated data varied across the registries; and 65.4% of reports included benchmarks and outliers. Clinical registries were used for research in 65.4%, and QA and QI in 73.1 and 69.2%, respectively. Most used external comparators and measured clinical variation, but there was marked inconsistency in the exploring clinical variation, improving care and reporting activities.

Conclusion: Based on this sample, clinical registries within CALHN did not currently appear to be a reliable resource to consistently address unwarranted clinical variation but were shown to be valuable resources for research and quality initiatives at a high level. Further research is required to facilitate effective integration of clinical registries with administrative and quality systems.

Background: Electronic medical records (EMRs) have the potential to improve and streamline the quality and safety of patient care. Harnessing the full benefits of EMR implementation depends on the utilisation of advanced features, defined as "mature usage." At present, little is known about the maturity of EMR usage by allied health professionals (AHPs).

Objective: To examine current maturity of EMR use by AHPs and explore perceived barriers to mature EMR utilisation and optimisation.

Method: AHPs were recruited from three health services. Participants completed a 27-question electronic questionnaire based on the EMR Adoption Framework, which measures clinician EMR utilisation (0 = paper chart, 5 = theoretical maximum) across 10 EMR feature categories. Interviews were conducted with both clinicians and managers to explore the nature of current EMR utilisation and perceived facilitators and barriers to mature usage.

Results: Questionnaire responses were obtained from 193 participants AHPs. The majority of questions (74%) showed a mean score of <3, indicating a lack of mature EMR use. Pockets of mature usage were identified in the categories of health information, referrals and administration processes. Interviews with 21 clinicians and managers revealed barriers to optimisation across three themes: (1) limited understanding of EMR opportunities; (2) complexity of the EMR change process and (3) end-user and environmental factors.

Conclusion: Mature usage across EMR feature categories of the EMR Adoption Framework was low. However, questionnaire and qualitative interview data suggested pockets of mature utilisation.

Implications: Achieving mature allied health EMR use will require strategies implemented at the clinician, EMR support, and service levels.

Background: One of the challenges when transitioning from International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to International Classification of Diseases, 11th Revision (ICD-11) is to ensure clinical coding accuracy.

Objective: To determine the accuracy of clinical coding with ICD-11 in comparison with ICD-10 and identify causes of coding errors in real clinical coding environments.

Method: The study was conducted prospectively in two general hospitals. Medical records of discharged inpatients were coded by hospital clinical coders with both ICD-11 and ICD-10 on different days. These medical records were recoded by five mentors. Codes assigned by mentors were used as the gold standard for the evaluation of accuracy.

Results: The accuracy of ICD-10 and ICD-11 coding for 1578 and 2168 codes was evaluated. Coding accuracy was 89.1% and 74.2% for ICD-10 and ICD-11. In ICD-11, the lowest accuracy was observed in chapters 22 (injuries), 10 (ear) and 11 (circulatory) (51.1%, 53.8% and 62.7%, respectively). In both ICD-10 and ICD-11, the most important cause of the coding errors was clinical coders' mistakes (79.5% and 81.8% for ICD-10 and ICD-11, respectively).

Conclusion: Accuracy of clinical coding with ICD-11 was lower relative to ICD-10. Hence, it is essential to carry out initial preparations, particularly the training of clinical coders based on their needs, as well as the necessary interventions to enhance the documentation of medical records according to ICD-11 before or simultaneous with the country-wide implementation.

Implications: Clinical coders need complete training, especially in using extension codes and post-coordination coding. Local ICD-11 guidelines based on the needs of local users and reporting policies should be developed. Furthermore, documentation guidelines based on ICD-11 requirements should be developed.

Background: Employment outcomes of La Trobe University's 2012-2016 health information manager (HIM) graduate cohort were reported previously. Objectives: To identify the 2017-2021 Australia-based, graduate HIMs' early career employment experiences; identify employment roles and destinations; investigate knowledge and skill sets utilised in professional performance; and compare outcomes with the previous study. Method: A cross-sectional design was utilised. An online survey elicited: demographic data, position-related details and knowledge-skills applied in the workplace. Inter- and intra-cohort comparisons were calculated. Results: Of contactable graduates, 75% (n = 150) completed the survey; 90% (n = 132) had held at least one profession-related position postgraduation; 51% gained employment before final examinations and 92% within 6 months. In their first role, 87% joined the public healthcare sector, 47% had worked in two or more positions and 12.3% in three or more positions. Categorisation of position titles showed that 40% had undertaken "health information management" roles, 14.9% "health classification," 16.6% "data management and analytics," 17.4% "health ICT" and 11.1% "other," roles. Almost two-thirds (64.1%) had utilised three or four of the four professional knowledge-skill domains. There was an increase, from the 2012 to 2016 cohort, in those undertaking "data management and analytics" and "health ICT" roles, and a decrease in "health classification" role uptake. Conclusion: Early-career HIMs have very high employability. They engage throughout health care, predominately in the public health sector. Their mobility reflects national workforce trends. The majority utilise all or most of the professional knowledge-skill domains studied at university.

Background: Access to accurate and relevant patient health information is crucial for community pharmacists to deliver high-quality care. The use of electronic patient medication records (e-PMR) in the United Arab Emirates (UAE) is currently limited to hospital settings, and community pharmacists do not have access to patient records.

Objective: To evaluate the perceptions of community pharmacists regarding the potential benefits, barriers, and concerns associated with the implementation of the e-PMR system in community pharmacies in the UAE.

Method: A validated questionnaire was administered to a sample of licensed community pharmacists using proportionate random sampling. The survey was structured and consisted of 40 questions in four sections: characteristics of community pharmacists and pharmacies; perceived usefulness of e-PMR; perceived barriers; and concerns about the use of e-PMR.

Results: In total, 552 pharmacists filled out the questionnaire (82.1% response rate). The majority of participants somewhat or strongly agreed that e-PMR would reduce drug abuse (71.6%), dispensing errors (64.4%) and prescribing errors (69.0%), and believed that e-PMR would enhance pharmacists' ability to perform medication reviews (76.0%). Pharmacists in charge (adjusted odds ratio (AOR) = 2.5; 95% confidence interval (CI): 1.6-3.6), facing difficulty tracking the medical history of patients (AOR = 3.2; 95% CI: 2.8-3.9) and working in pharmacies providing telepharmacy services (AOR = 3.4; 95% CI: 2.7-3.8) were more likely to consider e-PMR useful.

Implications: The implementation of the e-PMR system in community pharmacies has potential benefits for patient safety and medication therapy management in the UAE.