SDOH | REN Learning Design

(Due to confidentiality reasons, these images are mockups of the project and do not contain PHI, proprietary information, or copyright branding.)

Tools:

Adobe Captivate
Adobe Illustrator
Camtasia

Skills:

eLearning Development
Video Editing
Graphic Design

Project Overview:

This case study focuses on an adapted version of a real eLearning project developed to educate coders on the 2023 updates to the Social Determinants of Health (SDOH) coding guidelines. The course was specially designed to address the updated guidelines with an emphasis on coding for homelessness.

Approach:

Analyze: In this phase, the diverse learner demographics, including their language capabilities and varying levels of coding expertise, were carefully analyzed. I determined that the learner group was comprised of approximately 2500 learners, including 30% native English speakers and 70% non-native English speakers. This analysis informed the development of content that was accessible and relevant to all learners, irrespective of their native language and coding proficiency.

I discovered that coders need to understand and apply the updated guidelines into their workflow when coding medical records with the goal of increasing their coding quality score. Focusing the analysis discussion on what the learners needed to be doing rather than what they needed to know allowed me to recommend the use of scenario-based learning to the stakeholders.

I also uncovered the complex issues surrounding productivity being overemphasized, potentially resulting in lower quality. Keeping this in mind, I recognized the importance of applying Malcolm Knowles' adult learning theory, which emphasizes that learners need to understand the 'why' behind their learning before they are fully willing to commit to it - also known as 'WIIFM'.

Design: During the design phase, I collaborated with Senior Coding Managers and Regulatory Compliance to create a learning experience that included pre-training of content followed by scenarios that authentically simulated the real-life coding tasks coders face, with a focus on the updated SDOH guidelines. Richard Mayer's Pre-Training Principle allowed me to find a balance between the content that coders needed to be successful ('need-to-know') versus the content stakeholders felt the module needed to include ('nice-to-know') and it also served as a level set for less experienced coders.

As a strong advocate for practice and authentic real-world tasks with feedback, I collaborated with coding SMEs to develop 9 SDOH coding related scenarios. Each of these scenarios presented a segment of a patient's medical record, then guided the learner through the key indicators and relevant sections pertaining to Social Determinants of Health (SDOH), and concluded just before the final SDOH code was determined. Pulling again from Richard Mayer's Principles of Multimedia, particularly the Personalization principle, I made sure to write the scenarios using a conversational tone to make the experience more engaging and personal.

Develop: As the development phase began, I knew I wanted to utilize Robert Gagne's 'Gain Attention' principle. Often coding education is dry and wordy. I decided to begin the module with an animated graphic of a medical coder sitting at a computer desk utilizing the same medical software. I designed custom graphics that matched the company's branding and mimicked the real coding software to appear on the screen as the narration introduced the module. This brought a moment of delight or novelty into the experience right away.

After developing the pre-training content, I utilized Camtasia to turn the 9 coding scenarios into 9 interactive scenario videos. Each video lasted 1-3 minutes and utilized Mayer's 'Signaling' principle to highlight relevant information and included closed captions to increase accessibility.

Once the videos were created, they were embedded into Adobe Captivate using the web-object method which allowed them to be hosted externally and essentially 'streamed' into the learning experience resulting in a smaller project file size. This integration was critical to creating an interactive and immersive learning experience.

Captivate's advanced actions were employed to design custom quiz questions for each scenario. After presenting all of the relevant parts of the medical record, the scenario video ends with the question, 'What step should you take next?', encouraging the learner to make a decision based on the medical record (possible decisions included - assign a specific SDOH code based on the medical record details, query the provider, or assign no SDOH related codes).

Alongside the scenarios, the module was designed to include easily accessible job aids. These resources were strategically embedded within the module to assist learners in completing the scenarios. They included up-to-date coding definitions related to SDOH and homelessness, as well as the newly updated SDOH guidelines.

Examples of job aids embedded into the module:

Implement: The implementation phase involved piloting the module with the Regulatory Compliance team. Once approved, I published the module on the LMS and ensured that it was seamlessly accessible to the 2500 learners spread across various geographical locations. After launching the module, I made sure to closely watch the End-of-Course survey data to look for trends or technical issues.

Evaluation: Formative evaluation was conducted with the use of the coding scenarios and quiz questions giving learners the change to self-evaluate. The module was followed with an end-of-course survey using Dr. Will Thalheimer's 'Performance-Focused Learner Survey' method.

Data visualization from the primary question in the EOC survey:

Lessons Learned:

When focusing on the primary question from the EOC survey (training effectiveness), the acceptability index is sitting at almost 85%. In this particular project, because it was the first time the coders were exposed to the SDOH updates, 'Needing More Experience' was deemed as an acceptable standard. Following evidence-based best practices, learning is not an event and it is expected that coders would receive continuing education surrounding this topic. In that event, we would hope that the level of needing more experience would drop and potentially that standard would become 'Unacceptable'. Although with frequent turnover, the standard for that percentage may be fluid.

Another thing to note is that there is a high percentage of learners indicating that this education does not apply to their job role (9.34%). This brings to light several concerns - the need for a job function audit to take place and the potential to influence stakeholders in their decision making for who should receive the education.

First, our LMS is driven by job function, meaning that some employees may have a job function associated with their account that is no longer needed due to position changes or restructuring of job duties. A job function audit is crucial to aligning education to need; doing so could greatly help that percentage lower.

Secondly, part of Dr. Thalheimer's survey method includes using EOC data to send subtle messages to our stakeholders. I think using this data in the future to introduce the idea of potentially narrowing down learner list applicability or allowing the ability to test out of pieces of education could be useful. When it comes to medical coding though, it is a delicate balance due to regulatory requirements.

Comments from Senior Regulatory Compliance stakeholders included positive remarks towards the interactive video scenario method (as it was a new modality for Regs - traditionally their education has been very cut and dry) and has been requested to be utilized in an up-and-coming 2024 coding education project.

One final consideration for assessment and evaluation - because improving coding quality scores is always the main, underlying goal for coding education, it is imperative that reviewing the coding quality scores surrounding SDOH prior to and after the planned 2024 coding education project takes place.