Current Situation of ICD Coding in Myanmar

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Current Situation of ICD Coding in Myanmar

• Dr. Soe Myint
• Dr. Thet Thet Mu and
• Khin San Myint

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Background

• ICD was used in hospitals of Myanmar around 1960
  
  
• Health Information Division, Dept. of Health take
  responsibility of medical records and disease
  coding using ICD
  
• Medical Record Technicians (MRT) or other staff
  in the District hospitals has filled up hospital
  forms and send to the central level

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Background

• At the central level, ICD coding, data analysis
  and publications carry out
  
• Before 1979, ICD-8 was used
• In 1979, ICD-9 was used for coding
• In 1989, Dept. of Health Planning took
  responsibility of ICD coding
  
• In 1996, ICD-10 was used for coding

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Process of ICD coding

• ICD coding, tabulation and publication have
  mainly done at central level (DHP) by MRTs
  
• Regional or district hospitals has to send
  hospital forms recording diseases
  
• Only (3) big hospitals can do ICD coding now but
  it can increase to (50) medium sized hospitals in
  near future
  
• Every year hospital statistics report was
  published and the latest one is 2005

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Resources for ICD coding

• MRTs are key persons for ICD coding
• Basically MRTs are high school or university
  graduates who received two weeks ICD and medical
  record training
  
• In the big hospitals, MRTs do ICD coding
• In the small hospitals, assigned health staff
  fill up hospital forms without coding
  
• About 200 out of 832 hospitals have MRTs

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Training materials

• Medical terminology handout
• ICD 10 volume 1,2,3
• ICD 10 handout
• ICD 10 Student Workbook (National centre for
  classification in health , Brisbane)
  
• Medical record system handout
• Guideline for filling hospital inpatient report
  form 1,2 and 3
  
• Computer application handout

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Resources for ICD coding

• ICD manuals, computers and software available at
  big hospitals only
  
• Data analysis and publication can be done at
  central level and big hospitals only
  
• Human resource is not sufficient for data
  management and training
  
• Training curriculum needs to upgrade
• Altogether 481 health staff were trained in 20
  training sessions since 2000
  

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Hospital Form II used for ICD coding
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Issues and problems

• Underutilization of ICD by health staff esp.
  doctors and nurses
  
• No ICD training
• Misclassification or wrong cause of death
• Incomplete recording, poor handwriting and use of
  abbreviation by doctors
  
• Low quality of training
• Training curriculum need to imporve
• Need qualified trainers
• Need training materials more

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Issues and problems

• Inadequate infrastructure
• No sanctions for appointment of MRTs
• A lot of MRT vacancies in the hospitals
• Low interest of hospital staff to work as MRT
• No incentives such as financial or career
  development
  

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Issues and problems

• Low utilization of information due to
• No medical auditing in the hospitals
• No hospital accreditation system
• No insurance system
• Allocation of hospital budget is based on
  hospital beds alone

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Uses of information from ICD coding

• Evidence for health policy
• Planning and evaluating health programs
• Health situation and trend analyses
• Assessment on leading causes of morbidity and
  mortality
  
• Medical and public health research
• Clinical education
• Medico-legal aspects.

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Areas to be used further

• Quality of care
• Hospital accreditation
• Medical audit
• Insurance purposes.

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Critical steps to be taken

• Improve utilization of information generated by
  the medical record and ICD systems
  
• Upgrade use of ICD by health staff in diagnosis
  and death certification
  
• Promote quality of training on ICD

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Thank You