Volume 39 Number 3: >>  The health information management workforce: changes and opportunities


Matched comparison of GP and consultant rating of electronic discharge summaries 
Lesley Stainkey, Tilley Pain, Margaret McNichol, John Hack and Lynden Roberts p7 [

Queensland Health is implementing a state-wide system to electronically generate and distribute discharge summaries. Previously, general practitioners (GPs) have indicated that the quality of the discharge summary does not support clinical handover. While the electronic system will address some issues (e.g. legibility and timeliness), the quality of the discharge summary content is predominantly independent of method of generation. As discharge summaries are usually generated by interns, we proposed that improvement in the quality of the summary may be achieved through education. This project aimed to compare the perceptions of hospital-based consultant educators and recipient GPs regarding discharge summary content and quality. The discharge summary and audit tool were sent to the recipient GP (n=134) and a hospital consultant (n=14) for satisfaction rating, using a 5- point Likert scale for questions relating to diagnosis, the listing of clinical management, medication, pathology, investigations, and recommendations to GP. Sampling was performed by selecting up to 10 discharge summaries completed by each first-year intern (n=36) in 2009, during the second, third and fourth rotations at the Townsville Hospital until a total of 403 was reached. Matched responses were compared using the Kappa statistic. The response rate was 93% (n=375) and 63% (n=254) for consultants and GPs respectively. Results from this study demonstrated that GPs were more satisfied with discharge summaries than were consultants. An anomaly occurred in three questions where, despite the majority of GPs rating satisfied or very satisfied, a small but proportionally greater number of GPs were very dissatisfied when compared with consultants. Poor or fair agreement between GPs and consultants was demonstrated in medications, pathology results, investigations and recommendations to GP, with GPs rating higher satisfaction in all questions. Lower consultant satisfaction ratings compared with GP ratings suggest that consultants can evaluate discharge summary content to the level required by GPs for clinical handover. Therefore, consultants can appropriately educate interns on discharge summary content for GP needs.

Reliability of ICD-10 external cause of death codes in the National Coroners Information System 
Lyndal Bugeja, Angela J Clapperton, Jessica J Killian, Keran L Stephan and Joan Ozanne-Smith p17 

Availability of ICD-10 cause of death codes in the National Coroners Information System (NCIS) strengthens its value as a public health surveillance tool. This study quantified the completeness of external cause ICD-10 codes in the NCIS for Victorian deaths (as assigned by the Australian Bureau of Statistics (ABS) in the yearly Cause of Death data). It also examined the concordance between external cause ICD-10 codes contained in the NCIS and a re-code of the same deaths conducted by an independent coder. Of 7,400 NCIS external cause deaths included in this study, 961 (13.0%) did not contain an ABS assigned ICD-10 code and 225 (3.0%) contained only a natural cause code. Where an ABS assigned external cause ICD-10 code was present (n=6,214), 4,397 (70.8%) matched exactly with the independently assigned ICD-10 code. Coding disparity primarily related to differences in assignment of intent and specificity. However, in a small number of deaths (n=49, 0.8%) there was coding disparity for both intent and external cause category. NCIS users should be aware of the limitations of relying only on ICD-10 codes contained within the NCIS for deaths prior to 2007 and consider using these in combination with the other NCIS data fields and code sets to ensure optimum case identification.

A response to Bugeja, Clapperton, Killian, Stephan and Ozanne-Smith 
Jessica Pearse and Leanne Daking p27 [

The National Coronial Information System (NCIS) Unit welcomes all studies that aim to assess the reliability of the NCIS and to increase understanding of any limitations when using these data. In accordance with the limitations outlined in the study by Bugeja et al. (2010), we endorse the authors’ recommendations against sole reliance on ICD-10 codes to identify cases of interest on the NCIS, and encourage supplementing searches by using additional NCIS data fields such as Intent, Mechanism of Injury, Object or Substance Producing Injury. These extra data fields may allow for identification of cases that do not have an ICD-10 code (due to an inability to match NCIS and Australian Bureau of Statistics [ABS] data), or more recent cases that have not yet been assigned an ICD-10 code. We also acknowledge that the NCIS has limitations when it comes to the completeness of ICD-10 codes across the NCIS dataset and we are working with the ABS to improve the data-matching process between our two data collections.

© 2010 Health Information Management Journal of the Health Information Management Association of Australia Ltd