The PbR Data Assurance Framework for 2008-09 sets the error rate at 12.8% for the year, an improvement from the 16.5% of 2007-08 but still a cause for concern given the wider use of clinical coding data in the health service.
The commission conducted an audit of approximately 49,000 episodes as part of its assessment of progress of the Payment by Results Data Assurance Framework. It also established an error rate of 8.1% for codes affecting health resource group assignment, which determines the accuracy of payments. Although this was down from 9.4% the previous year and in most cases there was little financial impact, it still led to a gross financial error of £2.6m.
According to the report, the factors affecting coding accuracy relate largely to the need for clinicians to get more involved in improving the standards of records and other source documentation. There is also a need for greater local emphasis on engaging with clinicians and national guidance on co-morbidities (conditions that exist in conjunction with another disease).
It calls for improvements in training and development programmes for for clinical coders and the development of local audit and assurance programmes.
Among the specific recommendations are that trusts should: ensure that findings from their own audits of clinical coding are reviewed through internal governance arrangements; introduce local audit and assurance programmes; use the PbR National Benchmarker to improve coding and address wider data quality issues. It also urges NHS Connecting for Health to review the current coding audit methodology, provide training for trusts and work with the Department of Health on guidance for coding co-morbidities.
For its own part, the Audit Commission says it will continue to develop tools and case studies to support the improvement of clinical coding, and work with CfH on training issues and the development of networks for organisations to share knowledge and promote consistency.
Andy McKeon, the Audit Commission's managing director, health, commented: "Accurate information is essential for a quality focused and efficient NHS. There is a clear picture of improvement in the way trusts are coding data for payment under PbR, but problems remain and there is very significant variation in trust performance, with errors ranging from 1% to 40%.
"Crucially, the payments system is now more sophisticated and more sensitive to data quality accuracy, which means we are likely to see an increase in error rates in 2009-10.
"Improving the quality of the data, and in some cases the quality of medical records too, is important if the NHS is to improve the quality of its care and its efficiency as well as accurately report its performance. Our report shows how improvements can be made."
A supplementary report produced by the Royal College of Physicians makes a number of recommendations based on a study held at an acute hospital trust that had recently introduced a new electronic discharge summary. These include: ensuring that clinical coding is done using full medical notes rather than just a discharge summary; taking a consistent approach to medical record documentation; avoiding the duplication of administrative or clinical data; establish regular meetings between the clinical coding and audit teams and clinicians; and ensuring that all staff recognise the need to keep notes in good order.
