Towards a Process Reference Model for Clinical Coding.

Health Care management, since it is the basis for several activities ranging from hospital reimbursement to clinical research. Literature identifies some issues related to coding clinical data, which derives in inadequate levels of quality leading to some in acceptable situations in health care organizations, impacting even to their sustainability. To alleviate these undesirable effects, we posse that the standardization of some best practices around clinical coding can lead to a better performance of the clinical coding process. One of the most relevant concerns in the process is the quality of the data used at the various stages of the data life cycle from its generation by clinicians up to the usage and exploitation of the data once coded. The main contribution of this work is twofold: on a hand to identify which are the best practices related to clinical coding, and on the other hand to investigate how these best practices can be enriched with some other related to data quality management and data governance. As a result, we produced CODE.CLINIC, a framework that can be used to support institutions to better code their medical data. This framework consists of two main components: a Process Reference Model (PRM) and a Process Assessment Model (PAM). In this paper we are going to first introduce the CODE.CLINIC PRM, which gather 16 process grouped in 4 blocks.