The Royal Marsden was one of the first hospitals in the UK to become fully electronic with an in-house built hospital information system (HIS) installed over 20 years ago. To encompass the growing digital demands of a world-renowned cancer centre, The Royal Marsden underwent a full electronic patient record (EPR) procurement and chose EPIC in 2017. But as a specialist centre with very advanced auto-coding requirements, rather than simply choose the encoder offered with the EPR, The Royal Marsden decided to do a separate procurement for the encoding solution — post EPR implementation. The project was awarded to Woodward Associates and SimpleCode Web went live in March 2023.
Historically, diagnostic (ICD-10) and procedural (OPCS) activities were coded by different coders, against different deadlines - resulting in two submissions into the data warehouse. This caused significatn reporting, team training and coding analysis issues for the Trust. With SimpleCode all OPCS and ICD-10 coding in done in the one system, at the same time, and submitted against the same deadlines.
Enis Cifdaloz, Clinical Coding Manager at The Royal Marsden, mentions, “Data accuracy is my main priority, and with coding coming from different sources, people were far more likely to miss things.”
Also, as clinical auditor for the Trust he remembers, “Auditing the old system was very, very difficult because assessing people against diagnostic OR procedural activities we were not comparing like with like. So, getting accurate stats and giving training feedback was next to impossible.” Now the coders have their own specialties, and they code the whole inpatient or daycase stays and auditing is far easier.
The Royal Marsden deals with inpatients, daycases and Regular Day Attenders (RDAs). As a leading cancer centre the Trust has developed a lot of algorithm-generated automated coding and this is key to keeping the coding team small. So, for example, if a patient comes in for a radiology of nuclear medican scan, the OPCS code will be auto generated, and the procedure automatically captured with no involvement from the team. And if the admission is an RDA the coders wouldn't touch it at all. So, the diagnosis comes from the problem list in EPIC and the procedure from the relevant area and then merged with no coder involvement.
“As the world's first hospital dedicated to cancer diagnosis, treatment, research and education, the flexibility of SimpleCode Web to meet Royal Marsden's unique coding needs has been invaluable. The ability to combine our auto-coding with coder-created diagnostic and procedural codes and manage this workload in one easy to use, agile system has resulted in more accurate coding data and financial submissions.”
Enis Cifdaloz, Clinical Coding Manager, The Royal Marsden NHS Foundation Trust
Having evaluated the market and chosen SimpleCode Web as the only solution that couldsupport their complex coding mix, The Royal Marsden were faced with a challenge. SimpleCode Web at that time didn't integrate with EPIC. But they were undeterred. Having worked with Woodward for years, Mr. Cifdaloz knew how responsive the company was to user needs. Woodward delivered and the Trust now has full EPIC integration which has generated a lot of interest from other EPIC users nationwide and two major Trusts have recently signed.
Also, because of the sophistication of SimpleCode Web, obvious clinician coding errors can now be corrected by the coders. The team can remove irrelevant codes without the time-consuming involvement of IT. And data that can skew HRG coding is no longer included in submissions which has had a major impact financially.
With SimpleCode the Trust has only had very minor issues, all of which were deal with in a few hours. The implementation had detailed preparation, auto-coding was set up ahead of time, the team had both preliminary and formal training. And the whole team were given access to a demo site for familiarising themselves. So, on day one the coders were comfortable with the system.
“I can't emphasise enough how supportive Woodward has been and not only in sorting issues but optimising the solution,” confirms Enis Cifdaloz.
A true development partnership
Whilst SimpleCode Web is technically advanced and versatile in meeting site-specific needs, Mr. Cifdaloz is setting up an EPIC users' consortium from local London Trusts to help develop the product even further. Being UK coding specialists and suppliers to the NHS for over 30 years, Woodward are keen to understand the emergent needs of the industry and to help develop solutions to meet those needs.
“Whilst accurate coded data is vital for clinincal reporting, mortality rates, consultant appraisals and financial submissions, it has much wider implications across the NHS. Coded data is not only used in research, but also in determining population health trends and the resources needed to support them. With Woodward we know we have clean coded data and a company that is easy to work with and is responsive to our needs.”
Steven Francis, previously Direct of Performance & Information, now Chief Information Officer (CIO), The Royal Marsden NHS Foundation Trust
