Data is at the heart of VAHI’s work. We transform data into trusted, accurate and useful information that can be used to drive improvements. VAHI ensures the data we collect and use is complete and accurate, protected from unauthorised access, and available when needed. We want data on safety and surveillance to be easy to collect and share across the healthcare system.
Establishing information management and standards
VAHI has many functions related to the use of data. Our information management practices ensure that we handle and govern the data we use in compliance with all relevant legislation and policies. We seek to share data and information as much as possible to support system improvements, while protecting the privacy of patients and organisations.
VAHI has developed an Information Management Framework and other information and data management policies to describe the way that we collect, store, use, analyse, share and govern information. VAHI follows best practice principles for all data management.
During the year, VAHI began a project to document the specifications and calculations for all measures we report, for example those in the Monitor and Inspire reports. Documenting how the measures are produced will provide transparency and aid analysis.
Supporting classification and coding
The aim of clinical coding is to classify clinical concepts into code. Clinical codes are assigned for each admitted patient, once the patient is discharged from hospital. Coders use the diagnoses and clinical interventions (surgeries and investigative procedures) that clinicians have documented in the patient’s medical record.
The clinical codes form part of the Victorian Admitted Episodes Dataset (VAED), which is one of the key health datasets in Victoria. It holds both public and private hospital data. Coded data are used extensively to support quality and safety monitoring in health services, clinical research, health service planning and funding.
In July 2017, VAHI created a new Victorian addition (known as Vic 0002) to an Australian standard code, after recognising that health information managers and clinical coders needed direction to interpret clinical significance when applying additional diagnosis codes.
In December 2017 and January 2018, VAHI held 11 face-to-face education workshops to assist health information managers and clinical coders in application of the new coding standard. In total, 435 clinical coders attended the workshops from metropolitan and rural public health services as well as private hospitals. VAHI also produced educational resources to support the information provided at the workshops. Feedback on the workshops and resources has been overwhelmingly positive, with coders feeling much more confident in using the code.
As a result of the introduction of Vic 0002, VAHI will now contribute to the revision of the Australian classification to promote national consistency in reporting of additional diagnosis codes.
VAHI will also continue to engage with health information managers and clinical coders to better understand variations in reporting of coded data.
Ensuring integrity of data
VAHI is responsible for ensuring the integrity of performance and activity data reported to the Department by health services. This means ensuring that health datasets accurately reflect the care provided to patients. Accurate data are essential for all uses, including funding purposes, performance monitoring, policy development and planning, and clinical research. When stakeholders trust that data is accurate, they can trust the information derived from that data.
VAHI has developed a Health Data Integrity Program to monitor and support improvement in health data integrity. The program has benefits for health services and those responsible for oversight, transparency and accountability of health services, and for stimulating improvements in patient quality and safety and outcomes.
The Health Data Integrity Program monitors and strengthens the internal data integrity controls in health services. It also detects and reports on inaccurate health data, and recommends opportunities to improve both controls and data.
During 2017–18, VAHI conducted 47 data integrity audits of admitted patient data reported by Victorian public health services to the Victorian Admitted Episodes Dataset (VAED).
Following a review, VAHI has moved its data integrity approach from an emphasis on random reviews and statewide estimates of overall accuracy of data, to a more targeted approach based on data analytics and risk assessment.
In June 2018 VAHI revised and distributed the Data integrity guidelines for health services. These guidelines will assist health services in understanding and meeting health data integrity requirements.
Responding to arising issues
In December 2016, the Department became aware of more than 900 patients who had not been placed on the publicly reported elective surgery waiting list due to an administrative error. Between January and May 2017, VAHI commissioned an independent review of all health services reporting elective surgery waiting list data to the Department.
In July 2017, VAHI released the results of the review in the report Elective surgery waiting lists: a rapid review to ensure full transparency. The review found that 11 health services had assigned 949 patients to an obsolete procedure code. The review made a series of recommendations for the Department, VAHI and health services to fix the issue. The Department continued to monitor health service activity to ensure that the appropriate actions had been taken.
Informing health policy and service design
VAHI, in collaboration with the New South Wales Government, is undertaking the Delivering Better Cardiac Outcomes: Primary, Specialist and Hospital Care project. This project is an initiative under the National Data Linkage Demonstration Project (NDLDP).
The NDLDP was established in response to a request by the Australian Health Ministers Advisory Council (AHMAC) for advice on the feasibility and benefits of arrangements that could be adopted to bring together data from across jurisdictions, including access to and use of this data.
Linked data increases the useability of existing data to answer more complex questions about how to drive improvement in patient care. It allows clinical networks to gain a more robust understanding about the impact of different models of care on the patient journey and outcomes.
The Victorian-led Delivering Better Cardiac Outcomes project aims to demonstrate to AHMAC the value of authorising ongoing use of linked data. VAHI has partnered with clinicians, academics, government and experts in using big data to create tangible information to inform policy and service design related to quality cardiac care. Initial analysis of the data was completed in early 2018.
This initiative is one of many collaborative projects that VAHI intends to contribute to over the coming years to add value and inform policy in different areas.
Managing incident data
All Victorian public health services are responsible for investigating incidents, near misses and hazards that occur in their service. Each incident is assigned a severity rating guiding the level of investigation needed. Investigations are important as they can identify ways to reduce or eliminate the risk of the incident happening again.
The Victorian Health Incident Management System (VHIMS) is the repository for data on incidents and near misses and provides a statewide picture. It also includes data on clinical and occupational health and safety incidents, as well as patient feedback (such as complaints, compliments and suggestions).
Oversight of VHIMS was transferred from the Department to VAHI when it was established in 2017.
Through feedback from stakeholders and others it quickly became apparent that the system needed to be reformed. VAHI set up an advisory group to inform this work. The group includes health service chief executives, directors of medical services and nursing, quality directors, interstate experts and representatives from SCV and the Department.
The group identified short- and long-term strategies to improve Victoria’s approach to collection and reporting of incident and feedback information. In the short term, VAHI implemented a simpler approach to data collection across Victoria. These short-term collection arrangements will enable statewide reporting on incidents for the very first time since VHIMS was first introduced in 2010.
For the longer term, VAHI is developing a new incident and feedback reporting and management system for small services including bush nursing, community health and small hospitals. VAHI has sought input from a wide range of VHIMS users to ensure the new system will support improvements to staff and patient safety. The VHIMS ‘Critical Friends’ group tested a pre-release version of the new system and provided vital feedback. The system will be implemented later in 2018.
VAHI is also conducting a tender in partnership with Health Purchasing Victoria to identify a panel of appropriate suppliers for other Victorian public health services to use.
In April 2018 VAHI began working with representatives from across the sector to co-design a new statewide minimum dataset for incident reporting. This will make incident reporting easier for Victorian public health services as they will only be required to collect the incident data that is essential to support statewide oversight of quality and safety.
Page last updated: 20 Sep 2018