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Clinical Coding in 2020 and what’s next in 2021

By Jonathan France ACC

The “old” normal…

At the start of 2020 it was business as usual across the UK. Coding departments were working like clockwork toward deadlines in their offices. Clinical coding exams and classroom training where scheduled and booked, working from home was part time for a few and an afterthought for many, and the industry was preparing for the new decade of proposed changes with autocoding, SNOMED CT and ICD-11.

Then It happened…

Within the space of a few months it all changed…. The global pandemic hit, and the way we lived our personal and working lives was turned upside down.

This had a profound impact on the coding industry. Offices where everyone was previously crammed into the smallest of spaces, now had to work from home. Paper medical records that had previously been touched by everyone within the hospital was now a potential health risk, increasing the demand for full electronic healthcare records (EHR) systems. Not to mention the cancellation of clinical coding exams and classroom training, with examiners and trainers, being forced to adapt their approach to more online and cost effective solutions

The task of conducting the entire clinical coding industry remotely at the time seemed impossible, however looking back, the process overall has been somewhat seamless. This makes me wonder – if it was this easy why wasn’t this feasible before?

How everything changed…

Coding managers have reported increased productivity, less sickness and overall increased morale especially for those that have been in favour for flexible working (those who have young children will understand).

Many workers in the industry have also reported more financial upside in increased savings from commuting less and more time for personal use, e.g hobbies and baking.

Clinical coding training has adapted to online solutions like Microsoft teams and clinical coding examiners have managed to provide a glimmer of hope for possible online exams in 2021.

The remote service has also enabled NHS coding managers to widen the net. There are coding opportunities all over the UK with the disclaimer ‘Please note that due to the pandemic we are currently working remotely’. This not only gives coders across the UK so much more options but opens up trusts (which had previously been restricted to their own geographical area) to previously unobtainable high calibre coders.

The Drawbacks…

Mental health and well being has been a growing issue across many industries due to lockdowns and clinical coding already a somewhat solitary role, has become even more secluded for some.

With reports of less communication between colleagues and managers with less team meetings in comparison to pre lockdown, some coders have felt isolated and not feeling part of a team. Some managers and clinical coders have done well to address these issues by having weekly well-being checks, setting up WhatsApp groups and having regular team meetings, however many managers are slow to adapt to address this ever growing issue among the clinical coding community.

One major impact to the industry came from NHS Chief Executive Simon Stevens and NHS Chief operating officer Amanda Pritchard on 17th March 2020. A publication to all NHS chief executives following the initial paper stated that due to the pandemic and in an attempt to reduce expose to patients and those most at risk all NHS trust were to be placed on block contacts for the period April-July 2020. This then moved to March 2021 given the recent rise in infection rates. But what did this mean for coding?

Payment by results (PbR) is now a distant memory and it’s hard to foresee any NHS moving back from its current status. Why would they? Has this led to trusts now losing interest in the financial implications for coding? Has the importance we once had diminished? These are all questions I can’t answer – and suspect only the Clinical Commissioning Groups (CCG)s can. Has coding been demoted to a data input role for the production of data warehousing, trend analysis? It’s certainly shifted the spotlight away from our profession.

What’s Next…

With the availability of a vaccine there is now a chance in the near future, for coding to be performed in offices, training held in classrooms and exams completed in venues, similarly to what the industry looked like before. However I hope we as an industry we have learnt to embrace technology in our working life by providing optional home working and blended approaches to training clinical coders.

Auto coding and SNOMED has always been talked about since the days when I started as a trainee over a decade ago. And with trusts now having full EPR’s or ‘paper light’ systems, in 2021 it would be interesting to see how we get to that space where even very simple mapping of terminology to classification codes comes to fruition.

Overall coding is heading in the right direction to help set up robust reporting and clinical systems. It’s a very gradual process, dependant on a much larger national strategy to get systems like SNOMED out there & implemented across multiple providers. But with the unique skill set that clinical coding brings it’s fully equipped to cope with whatever the future throws at it.

 

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January 13, 2021

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