Cracking the code for surgical success
The COVID-19 pandemic has shaken the Canadian health system beyond what we could have imagined.
As Canadian operating rooms begin to catch up on the backlog caused by the pandemic, my colleagues and I need to provide the best surgical care possible in an efficient manner. We need to enhance recovery and minimize hospital time. We need to re-evaluate the physical infrastructures of operating rooms. All the while, we are preparing for the possibility of future waves of the virus.
None of this can be done without better data and tracking.
To ensure Canadians receive high-quality surgical care, we need accurate, accessible and comparable data to measure and track performance consistently across the country. This could be data on wait times to determine where there is greatest need or on post-operative infections to determine how to reduce risk.
A significant barrier to having this data at our fingertips is the coding systems used to document the procedures and services delivered to patients. Each province has its own unique set of codes. And each is speaking a different language, preventing meaningful comparisons between provinces and territories to identify gaps and opportunities.
In addition, these coding systems were developed decades ago, are often confusing and are infrequently updated. As we recently saw in Ontario with new codes for virtual care, they are not amenable to innovations and best practices. Therefore, they don’t always accurately reflect a physician’s actual work.
Our coding systems encompass everything from routine check-ups to specialist appointments to complex medical procedures. This impacts quality improvement for surgeries as well as preventative health and non-hospital physician services.
Although Canada has invested in and modernized our health system, and we take great pride in that, we do not have data in a form that we can use to understand and improve performance.
As a surgeon dedicated to improving quality and outcomes, I urge policy-makers and health system leaders to embrace this moment of rapid change. As our health system rapidly evolves in this pandemic, let’s also re-consider how we code medical services to derive better and more valuable data.
An example is the American Medical Association’s Current Procedural Terminology (CPT) language that we’ve started using at University Health Network through the National Surgical Quality Improvement Program (NSQIP). It offers a uniform language for coding medical services and procedures to streamline reporting, increase efficiency and enhance accuracy.
The development and management of CPT codes is a rigorous, transparent and open process led by a panel of clinical experts, ensuring clinically valid codes are issued, updated and maintained on a regular basis to accurately reflect innovation in medicine.
We need this level of rigour, consistency and agility in Canada. It will allow better tracking and comparability so we can improve surgical care and all other forms of physician care by providing a pan-Canadian view of health service performance.
Once we know what is working and where we are falling short, we can facilitate scaling and standardization of best practices. An NSQIP study in Alberta demonstrated that having access to valid and reliable data using CPT terminology has a positive effect on quality improvement, with significant impacts both clinically and economically.
With enhanced data, we will have an improved and more cost-effective system, and be better prepared for shocks like what we are experiencing with COVID-19. We can match surgical resources to demand and allocate resources appropriately.
During this moment of rapid change in how care is delivered in Canada, let’s use every tool in our toolbox. Now is the time for the provinces and territories to work together toward a standardized and modernized coding system.