Code of practice

A recent e-learning pilot increased the effectiveness of classroom training and may help to show the way forward for the NHS

We all know that the NHS has more than its fair share of unsung heroes. As well as doctors, nurses and countless auxiliary staff, there are a host of people whose roles remain largely unknown to the public, but without whose skills the NHS couldn’t function properly.

Clinical coders are the people who abstract and code information on patient diagnoses, procedures, processes and health-related problems. If you have a hip replacement, for instance, everything from your condition to how the implant is fixed by the surgeon (for example, cemented or uncemented) will affect the codes allocated. Such coding is mandatory and provides bodies the Department of Health and the World Health Organisation with valuable data when it comes to identifying health trends and carrying out planning and research exercises.

There are around 2,500 coders working in hospitals in England, and the position requires a range of skills from a grasp of health informatics (the knowledge, skills and tools which enable information to be collected, used and shared to support the delivery of healthcare) to an understanding of anatomy and physiology. Coders must also master the rules and conventions governing the classifications, which are documented in some weighty tomes, and the accompanying instruction manual, referred to as the ‘coders bible’.

Traditionally, coders learn their skills in classroom-based courses led by trainers approved by the NHS Information Authority’s National Clinical Classifications Service (NCCS). The residential course lasts 14 days (broken up into three periods) and, while effective, this does have its drawbacks. Newly recruited coders may have to wait weeks or even months before the next course is run in their part of the country and, inevitably, when they return from the course they face a backlog of work. Trainers also have to deal with coders arriving on the course with differing levels of prior knowledge and experience.

With this in mind, the Clinical Classifications Training Service (CCTS), part of the NCCS, was chosen to pilot an e-learning module that would also provide useful information and feedback for the wide implementation of e-learning across the NHS. The organisation wanted to produce an e-learning module that wouldn’t replace the traditional coder’s course but which would heighten its effectiveness.

“We also thought it might help us meet an unmet need to provide people with a refresher tool after the course and before they sit for their national qualification,” says Pam Hughes, project manager at the NHS Information Authority (NHSIA), whose remit it is to work with NHS professionals, suppliers and academics and others to provide national products, services and standards to support the sharing and use of information.

The tender for the e-learning job was won by Cambridge-based communication and training consultancy Information Transfer LLP, whose clients include Bayer Healthcare, KPMG and Shell. It decided to focus on a key area of coding: the four-step process that is used when assigning a code to a medical condition using the ‘coders bible’. The module aims to ensure that everyone has an understanding of the process before they arrive on the classroom course so that the face-to-face session can be more productive.

“There was a lot of fairly technical information to get on top of as we had three enormous volumes of reference material,” explains Roger Mann, partner at Information Transfer. “Our job was to present it clearly and coherently. The module takes you through the material in a linear way, but has a variety of user interactions built in – including questions and tips – and it gives you the option to drill down to more information.”

Response to the module, which was available online and on CD-Rom, was positive and the coding managers recognised its potential for both initial and refresher training and revision. As a by-product of the success, new recruits can also now begin their training immediately because the e-learning course can be accessed any time and anywhere.

After the initial test, the module is being rolled out to a wider audience and Kate Sweetlove, who manages the CCTS, says she will be collecting registration and feedback information from users to assess the usefulness of the project. The information will be used in decision-making matters about whether e-learning should be used for other topics.

The clinical coders project is one of several e-learning pilots, trials and full-blown programmes going on within the NHS.

In April, we reported on the North Glamorgan NHS Trust’s introduction of an online induction programme for junior doctors on clinical rotation and locums, provided by Learning Industries Ltd, a spin-off company from Cardiff University.

E-learning has also been successfully used by the NHSIA with its e-tutors programme, vital to build the necessary IT learner support infrastructure in the NHS.

At Frimley Park Hospital in Surrey, meanwhile, doctors can work through an e-learning course at their own pace, covering basic introduction to a PC. When they have completed the course, they take a test that is administered and automatically marked by the computer.

The NHS is clearly benefiting from the flexibility of any time, anywhere study in a number of areas and has an overall vision to provide staff with 24-hour access to knowledge and learning resources 365 days a year. It is currently engaged in a project to ascertain the current state of e-learning development within the organisation.

“We want to get an idea of the scale and diversity of e-learning going on and, where possible, look at escalating developments up to a national level,” explains Mike Farrell, project leader of National Scoping of e-Learning Activity within the NHS and Social Care Organisations (see box).

The project is part of a joint initiative by the Strategic Health Authority (through Workforce Development Directorates) and the NHS University (NHSU) to promote a common approach for the development and implementation of e-learning within NHS and Social Care. It also aims to establish a database of e-learning programmes planned or currently available.

Following completion of the scoping exercise, a range of participants will be invited to develop a quality process for reviewing programmes with the potential for wider adoption and application across the NHS and social care network.

After the success of the pilot for clinical coders, Information Transfer has also been commissioned to produce e-learning and reference materials to assist in anatomy and physiology training.

“They previously had a printed book which was fine, but it had all the defects of printed material of being static and not able to offer feedback,” says Mann.

“We’ve produced 10 modules based on the book, but with interactivity – you can zoom in and out of graphics and there are a variety of questions running through. You can also label relevant parts of the body.”

The modules are being created using Macromedia’s Flash software and Information Transfer is designing and building an accompanying online medical glossary of anatomy and physiology terminology. Definitions can be found by searching in one of three ways: via type of body system, alphabetical links or typing into a search engine.

Although Mann believes e-learning was right for the NHS project, he says the company still produces learning information using print, video and other media.

“In some ways, that we used e-learning is incidental. We use whatever medium is most appropriate,” he says, adding that while the e-learning market has matured, there are still some organisations taking their first tentative steps. His advice to them is to take a leaf out of the NHS’s book and get out there and have a go with a small project first rather than worry about building a complete e-learning strategy immediately.

“Get it done and get it out there,” he says. “Learn by doing and then you can start to build up a strategy.”

Reader input
Healthy outlook requires input

The Strategic Health Authority and the NHS University (NHSU) want to promote a common approach for the development and implementation of e-learning within NHS and social care and as part of this have embarked on the National Scoping of e-Learning Activity within the NHS and Social Care Organisations project. One of its aims is to establish a database of e-learning programmes planned or currently available. Mike Farrell, project leader, says he’d like to hear from any training readers within the NHS who have not yet contacted him regarding any e-learning activity they are involved in. He can be e-mailed at

In summary
Cracking the code

NHS’s aim: To create a pilot e-learning module for its clinical coders that would also serve as part of a wider e-learning pilot for the NHS.

Why? The current course is 14 days’ long and coders sometimes have to wait until one is available in their area and then return to a backlog of work. Also, coders arrive on the course at varying levels of knowledge and experience and the trainer has to spend time bringing some participants up to speed. The e-learning module was never intended to replace the classroom course but heighten its effectiveness.

Is e-learning delivering? The pilot achieved its aim of ensuring that all coders have a common understanding of one of the vital coding processes before they begin the classroom-based course. It also enables coders to begin their training immediately and acts as a revision and refresher tool before they sit for their national qualifications.

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