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The many roles of a remote Health Information Manager // Janine Wapper
The many roles of a remote Health Information Manager
Janine Wapper
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Twenty-five years ago I moved to Alice Springs. Like many who have moved to ‘The Alice’ I thought I would be in town for one or two years at most, then move on to bigger and better things. Instead I find myself working in an environment that continues to offer a wide range of professional experiences and challenges for a Health Information Manager (HIM).
There are several remote health services around Australia that cover thousands of kilometres, with their hospitals hundreds of kilometres apart. The Central Australia Health Service (CAHS) is geographically one of Australia’s biggest health services covering 872,861 square kilometres - approximately 65% of the Northern Territory (NT), with one of the smallest populations - around 48,000 people, of which 44% are Aboriginal. There are only two hospitals in the health service region – in the centre is Alice Springs Hospital (ASH), a typical regional hospital with over 200 beds, and 500km north is Tennant Creek Hospital, which has 30 beds. Yulara (the service centre for Uluru) has a clinic, and there are 28 more primary health care clinics scattered around the region. CAHS also provides mental health and alcohol and other drug services.
Early years
My first role was as a HIM, working on clinical coding backlogs at ASH while the incumbent HIM – Jill Burgoyne – was on maternity leave. I found the clinical coding in a remote health service quite different to that on the heavily populated east coast where I had worked previously: not so much ischaemic heart disease, cancer and methamphetamine related episodes; a lot more renal disease, infectious disease (including rheumatic heart disease, ear, eye and skin infections), bronchiectasis, advanced type 2 diabetes, and alcohol related episodes. While the burden of renal disease is growing seemingly exponentially, there are good news health stories too. When I first came to ASH there were three paediatric wards – a regular ward, a child health unit that ran a nutrition program for underweight infants and their mothers, and a ward for patients with infectious gastroenteritis. Now we only have a regular paediatric ward – thanks to primary health initiatives in the remote clinics such as the ‘Strong Women-Strong Babies’ program and the introduction of the rotavirus vaccine.
The Patient Service departments at the two CAHS hospitals incorporate the medical records service, switchboard, admissions service, outpatient clerical service, and in the past, the patient travel service. Over the years the Patient Service Managers, who usually came from a nursing or operational services background, often sought advice from the HIMs regarding:
• Medical record forms management: in the early years the forms were managed through a Patient Services based committee, but now medical records forms design and approval for publication is managed by the Safety and Quality Unit through the Policy
Advisory Committee (of which the Director of Health
Information is a member)
• Privacy and release of information: when there were policy updates or patient information requests that did not seem to follow protocol, the HIM’s opinion was sought
• Department design and layout: - The medical records department moved four times and the secondary storage area twice in my first ten years at ASH. During that time the onsite HIMs provided advice regarding flow of work through various areas and the standards to be met for
medical record storage. One of our biggest wins was the compactus shelving being removed and never again used for onsite file storage at ASH. The compactus had a history of work-health safety and maintenance issues with parts requiring sourcing from interstate. The new storage areas were big enough to accommodate free standing shelving. - The clinical coding has in the past been performed in six different locations around the hospital. Less successful venues included coding on a high bench and stools in a closed off corridor during renovations, and an attempt at ‘on ward’ coding (that was actually single-coder-in-a-room-nearthe ward coding). The current Health Information
Service (HIS) office was set up four and a half years ago and has comfortable open-plan space for eight staff (including six coders) and a manager’s office.
• Relocating medical record filing areas: during the many departmental relocations it was the HIM who was tasked with coordinating the moving of thousands of terminal-digit filed records to new locations. This experience taught me that laundry trolleys are very useful for moving and maintaining bulk records in filing order. The last big move was in 2009 when I led a project to relocate over 116,000 patient files to a more spacious secondary storage area.
In those early years I also became engaged in clinical coding staff education. With the implementation of first edition of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, Australian Classification of Health Interventions and Australian Coding Standards came the opportunity to attend the ‘train-the-trainer’ sessions in Sydney, and spread the good word about the new classification to my NT coding compatriots in Darwin. It was great to meet face-to-face with other NT coders. From these sessions evolved what is now the NT Coders Forum, where all NT clinical coders meet every six to eight weeks via teleconference (those shy clinical coders aren’t keen on videoconferencing), and up until recently a yearly face-to-face coding workshop in Darwin. Jill Burgoyne became our NT-wide Coding Auditor and Educator for a few years, but with her retirement the two NT health services now have their own strategies for staff education. CAHS now has a Health Information – Coding Manager, Isabel Hayes, who is the local clinical coding guru and auditor.
Recent years
Five years ago, I was appointed to a newly created position – Director of Health Information of CAHS, reporting to the Chief Finance Officer. The Director manages the HIS, which consists of the Coding Manager, two ‘advanced’ clinical coders (with over 10 years experience), two clinical coders and our trainee ‘associate’ clinical coder position (an attempt to grow our own clinical coders locally). The service also has a data integrity officer who is responsible for making episode data corrections in our ancient Patient Administration System (PAS) – an often laborious process as some episode data must be removed then re-entered, after the correction is made. There is also the newly created position of activity-based funding (ABF) non-admitted data project manager who will review our non-admitted data in the current PAS system and make changes and improvements in preparation for a new PAS system to be rolled out in the next two to three years.
The roles of the Director of Health Information include:
• Human Resources Manager: essentially this is complying with NT Public Service requirements to recruit and retain suitable clinical coding and data staff to supply timely, accurate ABF data for CAHS.
With executive approval I can create new roles that will enhance CAHS ABF data. This requires writing job descriptions and completing job assessment questionnaires to determine salary levels for the new positions. Currently clinical coders are part of the administrative salary stream, but with executive support I am working towards moving clinical coders into a professional or technical salary stream.
• Staff advocate: identifying issues for staff and finding and implementing resolutions for those issues. For example, it was identified that some workstation desks within the office were old and unsound and required replacement. An independent workplace assessment was commissioned with the outcome that sit-stand workstations were recommended for all staff within the Health Information office. Sit-stand workstations were sourced and installed in the workplace within two months of the recommendation.
• Educator of clinical staff – by providing targeted group education about: - Clinical Documentation Improvement (CDI). - ABF and how this relates to CDI
Clinical staff education sessions can vary in size from a presentation in a lecture theatre to 30 new clinical staff to a tea-room chat with three to four midwives. I was averaging two education sessions every month, but this has dropped away with COVID-19 meeting conditions. Online self-education is now the favoured mode of delivery so there will now be a focus on developing online education about ABF and CDI.
• Data Analyst: interrogating health data sets for audits, management reporting and research. While I can produce simple data reports for local audits, our local data analysts are experts at extracting data. I liaise regularly with our analysts about report setups – particularly those that require data sourced from coded diagnoses and procedures. Our analysts regularly send me reports to review to check their validity from an ABF or clinical coding perspective.
• Data Governance: I am a member of several departmental committees concerned with the data governance process. Some of the committees are concerned with data policy and procedure issues, and others are designed to keep abreast of ongoing data governance issues and projects.
Over the last three years I have also been involved in the NT’s Core Clinical System Renewal Project (CCSRP). From the project’s information website: ‘CCSRP is developing a single, secure, Territory–wide, electronic patient record that integrates multiple systems currently used by NT Health, and replaces current aging clinical systems.’ This includes in the initial stages, replacing the three separate PAS used in acute, community and primary health care centres. The NT does have a bit of a headstart regarding the PAS, as for the last 30 years every NT health client has been allocated a unique identifier (known as the Health Record Number or HRN) that is used across the remote clinics, the urban health centres and the Territory’s five hospitals.
As one of the patient administration leads for the CCSRP, I provide ‘expert knowledge’ on our old acute care (hospital) PAS, concerning how the patient registration data is captured and reported. My advice includes:
• Which current PAS processes are useful and should be part of the new system
• Where PAS data capture processes can be improved using the new system’s existing program or requiring program development
• Where reporting processes can be improved using the new system’s existing program or requiring program development.
The next two years will be very interesting for patient service departments and health information work units as the PAS program is developed and implemented across the NT.
I consider myself fortunate to be employed in a remote health service where the knowledge of a HIM is respected and regularly sought by other health service managers and clinicians. My roles have evolved over the years and will continue to transform with the everchanging health environment.
Janine Wapper Ba App. Sci. Health Information Management Director, Health Information Central Australia Health Service Alice Springs, Northern Territory Email: Janine.Wapper@nt.gov.au
