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Coding and classification in the Pacific: Why Clinical Coding and Continuing Education is Important

Credit: Sue Walter/ Brisbane Accord Group

Coding and Classification in the Pacific:
Why Clinical Coding and Continuing
Education is Important

Health care workers have a professional responsibility to stay current with their education. This includes access to continuing education with the latest clinical coding updates. With the need to have better information to make better decisions for better healthcare, the growing number of diagnosis codes and the need to apply these codes accurately is now more important than ever.

The International Statistical Classification of Diseases 10th Edition (ICD-10) is a globally adopted coding tool used to standardise the collection of health information for epidemiology, health management and clinical purposes. The classification is maintained by the World Health Organization (WHO). ICD-10 has been designed to promote international comparability in the collection, processing and presentation of morbidity and mortality statistics. As a result, this is the quintessential reference used worldwide for mortality coding to accurately establish the underlying cause of death, and for morbidity coding to record the patient’s main condition during an episode of care. Some countries (such as Australia among many others) have developed ICD-10 modifications and accompanying procedure classifications to better capture specific diseases, medical and surgical interventions. These additions provide better insights on healthcare episodes to facilitate better program planning and decision making.

Sue Walter/ Brisbane Accord Group

The integrity of a country’s health information requires standardized and accurate clinical coding based on complete and accurate hospital medical records and death certificates. The positive outcomes are unquestionable. This includes producing quality information in a standardized way with high coverage that can be used by governments, researchers and NGOs to formulate public health policies, interventions and programs aimed at improving the health of a nation. Therefore, for Pacific countries that have adopted clinical coding to support the provision of data to manage healthcare, well-trained morbidity and mortality coders has proved to yield the greatest value.

The next edition of the international disease classification is ICD-11. It is scheduled for international implementation commencing in January 2022. It will be accompanied by a procedure classification termed ICHI. ICD-11 has almost 5 times more codes than ICD-10. Therefore, establishing a solid education foundation in the Pacific is now much more important to support the transition to the updated classifications in the future. Furthermore, as medical knowledge advances, new diseases emerge and health information systems become more sophisticated such as adopting artificial intelligence, there will be a need to continually update the ICD. By moving to ICD-11, countries will be in a much better position to take advantage of these new capabilities and features in the future.

PHIN is working collaboratively with the Brisbane Accord Group (BAG), the Queensland University of Technology (QUT), the Pacific Community (SPC) and WHO in improving the clinical coding capabilities in the Pacific region. Furthermore, PHIN is exploring academic partnership opportunities with the Fiji National University (FNU) to provide continuing education for clinical coders for Pacific countries.

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Pandemic Highlights Need For Unique Patient Identifier

Credit: UNICEF Pacific/Stephen

Pacific Countries Adopt Digital Tool for COVID-19 Surveillance and Outbreak Data Management

As countries patiently wait and think on how to rollout the much awaited COVID-19 vaccines, health sectors around the world are also preparing for large scale immunization of its population. With the high likelihood of misidentification posing a threat on patient safety and public health, the need for patient identification strategies has reached a crescendo. In addition, secure and trusted COVID-19 vaccination certificates may play a critical role to reopen economies and resume international travel.

The pandemic accelerated the need for countries to adopt unique health identifiers for its population. Unique health identifiers (UHI) are structured numeric or alphanumeric sequence that stay with an individual for life. Countries that have recently adopted UHI also introduced smart cards and biometrics either using fingerprints, retina or facial recognition or a combination. There are also added benefits with UHI beyond the pandemic. Once every individual have been properly identified, it also shortens the path in achieving universal health coverage (UHC).

In many Pacific countries, health information systems are fragmented and incomplete. This include the lack a national health identification registry and/ or a master patient index (MPI). Most often the same individual have multiple patient numbers issued from various health services. This has lead to disruptions along the continuum of care, including hindering strategies for the identification and immunization of this individual during mass immunization campaigns. Due to the large-scale efforts required to introduce the COVID-19 vaccine, an electronic immunization system or a robust vaccine data management model will be required in the Pacific to identify the vaccine recipient and the vaccine event itself such as date administered, place of administration, schedule, doses applied, etc.

Globally there are various initiatives to develop a digitally enhanced International Certificate of Vaccination, or a “smart yellow card” to provide proof of vaccination. WHO has established a consortium to establish common architecture standards for a smart yellow card to support the mass rollout of anticipated vaccine(s) against COVID-19 and other immunizations in the future.

During the COVID-19 pandemic, some countries have started introducing biometric solutions to solve inherent challenges such as the lack or missing health identifiers for the purpose of contact tracing, testing and managing cases. From testing to discharge, suspected cases require multiple touch points within the health system. Scarce resources also need to be carefully prioritized amongst confirmed cases. Without a unique identifier, valuable time is wasted searching for patient records, patients may fail to receive their test results, and lives may be lost from compromised quality of care. Biometric identification enables accurate enrolment and identification of patients. Biometric technology can facilitate high quality data collection flowrate for new and suspected cases. What is more, the technology can be rapidly deployed and scaled on inexpensive devices. Biometric fingerprint technology has also been used to create digital identities as part of the public health surveillance response and boost immunization coverage in developing countries (mostly focusing on children 1-5 years of age).

WHO/Yoshi Shimizu

UHI, Biometric Use and Electronic Immunization Records in the Northern Pacific

The Republic of the Marshall Islands (RMI) has implemented unique hospital numbers associated with patient records and biometrics in its two most populous islands, Majuro
and Ebeye. In 2016, RMI recently introduced the use of biometrics (fingerprints) for its mass tuberculosis screening, which has proven valuable for follow-up, consequently reducing time spent tracking down previous patient records. On Majuro, the hospital has set up its health information system to use fingerprint registration which can be used to access patient information.

The Federated States of Micronesia (FSM) Department of Health and Social Affairs has been working to set up an EMR system with a unique hospital number for each patient. In 2017, Pohnpei State and Chuuk State health departments in collaboration with WHO, developed an electronic data collection form with fingerprint registration to facilitate integrated outreach service programmes. These programmes included noncommunicable diseases, tuberculosis, leprosy, maternal and child health immunization, HIV, sexually transmitted infections, oral health, and other services at designated village outreach posts.

The health team enters the individual’s unique hospital number into the system after returning from the outreach service. This new registration scheme has already accelerated outreach programme operations, facilitating continuity of care for registered villagers and aiding in monitoring programme achievements. The programme currently covers Madolenihmw and Kitti Municipalitiesy in Pohnpei State and Toleisom Island, PPO Island and Weno Island in Chuuk State. WHO continues to support the Department of Health and Social Affairs to implement the same registration scheme in hospitals and remove duplicate records from an old legacy database.

All U.S. affiliated Pacific Islands (USAPI), including FSM and RMI, use a system called WebIZ as their immunization information system (IIS). Individual-level data in the IIS has also made possible more varied analyses of indicators of immunization program performance such as timeliness of vaccination, proportion of invalid administered doses, and frequency of missed vaccination opportunities. Overall, WebIZ has contributed to the overall strengthening of the territories’ immunization programs.

The combination of a robust health identification systems, electronic patient records and an ISS provides a strong foundation to roll-out COVID-19 vaccines in the countries.

Compared to many other parts of the world, the Pacific have a head start by firstly recognizing there is a regional problem with the lack of universal health identification. The Pacific Community (SPC) Heads of Health in 2018 had the foresight and started a national identification mapping initiative with emphasis on civil registration and UHI. In 2019, the World Health Organization (WHO) also commissioned a landscape analysis and confirmed the limited use of UHI. With the assistance of the WHO and SPC, the collective plan is to build on this foundational piece of work for future initiatives such as the COVID-19 vaccine rollout.

WHO/Yoshi Shimizu

The Pacific COVID-19 Joint Incident Management Team (JIMT) and its COVID-19 vaccination taskforce is supporting the overall COVID-19 vaccination roll-out across the Pacific. The JIMT is ready to provide the necessary support to advance country-level planning in introducing the new COVID-19 vaccine and to identify key components (including health information systems and patient identification) to strengthen its state readiness as global preparations are well underway to vaccinate the population against this pandemic.

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MATERIAL  DECEMBER 2018

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Pacific Countries Adopt Digital Tool For Covid-19 Surveillance

Credit: WHO / Joy Rivaca

Pacific Countries Adopt Digital Tool for COVID-19 Surveillance and Outbreak Data Management

Pacific countries are among the most successful in the world at keeping out or delaying importing COVID-19 into the region. Working in close partnership with the Pacific Joint Incident Management Team for COVID-19 the region’s leaders have come together to commit to protect their population by taking decisive actions early in the pandemic.

As early as February 2020, Pacific countries and territories implemented border control interventions at key ports of entry to delay the importation of COVID-19. This allowed countries to stall for time and to put into place national containment and mitigation measures, including strengthening their COVID-19 surveillance and outbreak management response. The collection and use of data is presented as a key strategy in response to the COVID-19 and the pandemic has triggered a rapid rollout of digital public health technologies.

Traditionally in the Pacific, surveillance and outbreak response tools used to detect, assess and respond to acute public health events such as COVID-19 have been manual paper-based systems. Transmission models suggest that contact tracing must be highly effective (i.e. more than 70% of contacts traced) and leverage technology to facilitate instant contact notification to contain the epidemic.

The Commonwealth Healthcare Corporation (CHCC), Commonwealth of the Northern Mariana Islands

Several countries have been introducing, piloting and planning the use of digital tools to enhance and speed-up case investigation and contract tracing processes.

Since March 2020, Fiji has employed an active surveillance and contact tracing system called SORMAS. Fiji was one of the last countries in the world to report its first case, yet was one of the first to implement an integrated multi-communicable disease event-based and contact tracing solution to detect early public health events requiring rapid investigation and response. Fiji also implemented a proximity tracking tool called CareFiji in June 2020 to digitally augment the country’s contact tracing efforts to continuously to detect and record close proximity of individuals through the use of personal mobile devices. Also the Cook Islands and Guam have launched similar proximity tracing tools to support traditional contact tracing.

Papua New Guinea (PNG), French Polynesia, the Cook Islands, New Caledonia, Palau and the FSM have been using or piloting Go.data, a case and contact data management tool, to digitally optimize processes to support contact tracing demands and to ensure that data flows appropriately to inform public health measures.

Guam, the Marshall Islands, Palau and the CNMI implemented and expanded the use of a symptom self-reporting tool called Sara Alert to allow public health officials to monitor the health status of quarantined individuals.

Today, because of the pandemic, several Pacific countries and territories have not only added more tools to their digital surveillance toolbox, but also made improvements to well established national syndromic surveillance systems such as the Early Warning Alert and Response System (EWARS)
from WHO.

Ministry of Health & Medical Services, Fiji

However, no single technological solution covers all functions required for case investigation and contact tracing. Taking full advantage of technological options may require layering and linking multiple technologies across the case investigation and contact tracing workflows. Integrating these tools into the public health infrastructure will require careful thinking about operational issues, privacy and consent, and stakeholder engagement. At the country level, it is crucial to ensure the interoperability of such digital systems and enable efficient, harmonized, secure and sustainable cross-national data sharing to optimize the COVID-19 response.

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MATERIAL  JUNE 2020

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