Vera Alonso

Coded data are the basis of information systems in all countries that rely on Diagnosis Related Groups in order to reimburse/finance hospitals, including both administrative and clinical data. To identify the problems and barriers that affect the quality of the coded data is paramount to improve data quality as well as to enhance its usability and outcomes. This study aims to explore problems and possible solutions associated with the clinical coding process. Problems were identified according to the perspective of ten medical coders, as the result of four focus groups sessions. This convenience sample was sourced from four public hospitals in Portugal. Questions relating to problems with the coding process were developed from the literature and authors’ expertise. Focus groups sessions were taped, transcribed and analyzed to elicit themes. Variability in the documents used for coding, illegibility of hand writing when coding on paper, increase of errors due to an extra actor in the coding process when transcribed from paper, difficulties in the diagnoses’ coding, coding delay and unavailability of resources and tools designed to help coders, were some of the problems identified. Some problems were identified and solutions such as the standardization of the documents used for coding an episode, the adoption of the electronic coding, the development of tools to help coding and audits, and the recognition of the importance of coding by the management were described as relevant factors for the improvement of the quality of data.

Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially calculated from the DRGs. Moreover, the administrative database generated with these data is widely used in research and epidemiology, among other purposes. Objective: To explore the perceptions of medical coders (medical doctors) regarding possible problems with health records that may affect the quality of coded data. Method: A qualitative design using four focus groups sessions with 10 medical coders was undertaken between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed from the literature and authors’ expertise. The focus groups sessions were taped, transcribed and analysed to elicit themes. Results: There are several problems, identified by the focus groups, in health records that influence the coded data: the lack of or unclear documented information; the variability in diagnosis description; “copy & paste”; and the lack of solutions to solve these problems. Conclusion and implications: The use of standards in health records, audits and physician awareness could increase the quality of health records, contributing to improvements in the quality of coded data, and in the fulfilment of its purposes (e.g. more accurate payments and more reliable research).

This paper describes the role of human-computer interaction (HCI) design in the development and deployment of mission systems. We make the argument that more broad application of HCI methods and practice will be necessary to complete the ambitious objectives of future missions. In particular, the introduction of increased autonomy, reduction of ops personnel, increasingly tactical nature of surface operations, and more distributed mission ground operations present unique challenges that must be met with sound HCI-driven solutions. We describe a case study from where solid underlying technology was hindered by lack of attention to HCI issues, and describe how this is being remedied moving forward. Future missions will require planning processes to be much more efficient (orders of magnitude) than what was achieved for the Mars Exploration Rovers mission (2003). The case study focuses on the critical shift from the MAPGEN software used for tactical activity planning on MER to SPIFe, now base-lined for the Phoenix 2007 and MSL 2009 missions. MAPGEN added automated planning functionality (Europa) to the APGEN manual planning tool. SPIFe provides a next generation interface designed specifically to take advantage of an automated planner. The design of SPIFe is based on hundreds of hours of observation and operations experience on MER. This paper examines how key HCI lessons learned are being fed forward into this new set of planning tools, SPIFe and Europa 2