LETTERS
Capturing health information a coding perspective
Sue Walker
National Centre for Classification in Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia (email: s.walker@qut.edu.au)
Editor In discussing the current status of global reporting of mortality data, Mathers et al.1 examine several indicators of quality and completeness of the coded data; however, they do not deal with the influence that the capacity, knowledge and skills of individual "coders" of health data can have on the quality of the resultant information.
Coders are responsible for translating the documented causes of death into the codes listed in the ICD-102 or its previous iterations. This is to enable reporting of standardized health information for use at local health service level and also at national, regional and international levels. Use of ICD facilitates the storage, retrieval and analysis of data and their comparability.
In general, cause of death information is recorded by a medical officer on the cause of death certificate recommended by WHO. However, in some countries, a different certificate may be used, or recording causes of death may rely on lay reporting or the results of verbal autopsies. In all of these situations, coders transform the documented information into standardized ICD codes.
Mortality coding is a highly specialized task that requires a thorough understanding of the coding rules in order to assign a code for an underlying cause of death. Thus the knowledge of the coder is vital to the accuracy of the resultant statistical data.
There are major differences among WHO Member States in terms of the training they provide to coders to ensure that they understand and can accurately apply the conventions and guidelines implicit in ICD. In the most developed countries, coders of mortality are generally highly qualified professionals who work in a statistical office or the Ministry of Health. Coders in such countries may learn their craft at university or community college and are employed specifically to code. They learn to abstract relevant data, use the coding rules and guidelines to determine an underlying cause of death, and produce an ICD code that accurately reflects this cause. They need a knowledge of medical terminology and medical science to ensure that the underlying cause selected for coding is in line with the requirements documented in vol. 2 of ICD-10.
In contrast, in small and developing countries, coders may not have been given any coding education at all or only have followed a short training programme. Also they may be low-paid clerical workers who not receive appropriate recognition and support for their specialized role. In some countries, even a basic level of training is not available.
WHO has a series of collaborating centre networks which function cooperatively to support work on WHO's priority health programmes. The WHO Collaborating Centres for the Family of International Classifications (WHO FIC) operates through various national and regional centres that have expertise in health classification, coding, and terminology development and application. The WHO FIC Education Committee (http://www.cdc.gov/nchs/about/otheract/icd9/nacc_ed_committee.htm) assists and provides advice to WHO in improving the quality and use of the WHO classifications in Member States by developing training and certification strategies, identifying best training practices, and providing a network for sharing expertise. The Committee's work is based on the premise that good health outcomes depend crucially on the availability and use of good health information.
The Committee has joined forces with the International Federation of Health Records Organizations (www.ifhro.org) to work on addressing the issue of coder development. The resulting Joint Committee's work is currently focused on specifying a standard curriculum for use by educators in training courses on coding. Educators who have relevant modules have been invited to submit them for possible approval in order to be considered as meeting the Joint Committee's "gold standard" for training. Further submissions of materials are welcomed. (More information is available from the Co-Chairs of the Joint Committee (Sue Walker) or Margaret Skurka (Indiana University Northwest (email: mskurk@iun.edu)). Coders who complete the full curriculum, taught by approved educators, will be eligible to apply for a certificate that acknowledges their competence, which should assist them in gaining recognition for their work. A certificated education level for coders provides a uniform base for building universal coding consistency and therefore information comparability. Ultimately, it is hoped to improve the quality, consistency and timeliness of the coded mortality data on which so many decisions are based. Finally, certified education of coders can enhance understanding of the vital role that they play in the process of creating health information and hopefully bring about improvements in their working conditions and appreciation of their needs for support and encouragement. 
Competing interests: none declared.