NEW JERSEY DISCHARGE DATA COLLECTION SYSTEM VERSION 2

NEW JERSEY DISCHARGE DATA COLLECTION SYSTEM VERSION 2 LESSONS LEARNED JULY 21, 2009

Agenda • • • Introductions Background/Project Overview Expectations of Pilots/Vendors Implementation Process Implementation Results Ongoing System Monitoring Lessons Learned Summary and Close Q&A Vince Yarmlak, NJDHSS Sherry Badran, Quadra. Med Chiarina Fanara, Quadra. Med Vince Yarmlak, NJDHSS All

The NJDDCS Version 2 Project Team • NJDHSS staff • Quadra. Med staff • NJ Acute Care Hospitals and their data vendors

Background /Project Overview Original Contract: • Data Intermediary Services Initial Contract May, 1999 – December, 2007 • NJ general acute care hospitals reported UB information for 4 million annual inpatients, same day outpatients and emergency dept. visits in modified ANSI 4010 HIPAA or flat file format

Background /Project Overview New Contract for Version 2 system: • NJDHSS issued RFP November, 2005. Required use of ASC X 12 N/005010 X 225 Health Care Service: Data Reporting Guide • Bids Due December, 2005 • 3 Bids Submitted • Contract Award to Quadra. Med April, 2006

Background /Project Overview Goals of NJDDCS Version 2: • Quadra. Med is the agent of NJDHSS in an electronic commerce transaction • Provide hospitals with an internet-based, user friendly system with a graphical user interface that functions quickly and reliably

Background /Project Overview Goals of NJDDCS Version 2: • Utilize existing electronic claims processing and telecommunication technologies via national standards such as the Uniform Bill (UB) and HIPAA compatible claim transactions and succeeding updates • Reduce the per-record cost

Major Project Activities • • • System Definition System Development Test System for Pilot Train Pilot Staff Conduct Pilot Test, train, rollout to all hospitals Project started on May 15, 2006 and went live effective with January 1, 2008 discharges

About the Pilot Hospitals • Started with 11 volunteers to be pilot hospitals representing 6 different HIS vendors (i. e. : Siemens, HBOC Mc. Kesson, Meditech) • Ended with 3 pilot hospitals – 2 major HIS vendors and 1 internal hospital system • Pilots dropped out due to other priorities (UB-04 implementation) and ANSI 5010 programming complexities • Took 6 months for 1 st pilot to have file certified – many iterations of test files created and reviewed • Pilot data submission lasted about 5 months

Expectations of Pilot Hospitals and Vendors • Review documents from pilot kickoff meeting • Meet with hospital HIS vendor(s) to plan V 2 file creation • Return completed forms from Implementation Guide to Quadra. Med • Work with Quadra. Med to resolve technical issues with test files for certification • Create daily claim file for transmission to Quadra. Med

Implementation Process

Tasks & Responsible Parties • Obtain / create ability to produce data files in required format - Facility / HIS or EDI Vendor • Submit 3 daily data files – Facility • Certify data files - Quadra. Med & Facility • Training - Facility End Users & Quadra. Med • Install/Setup - Quadra. Med, Facility Techs & End Users

Implementation Process • Create Implementation Guide • Distribute Implementation Guide to all Hospitals • Receive Installation Forms and test files from hospitals • 3 daily data test files (inpatient and outpatient data) • Load and review test file format and data • Pass or fail test files • System training at Quadra. Med • System setup of administrative user login and password

Implementation Guide • • ANSI 837 X 5010 Addendum Guide Data Dictionary • • • Field list Definitions Inpatient and/or outpatient required Allowable values Field comparison – old to new system Edits Implementation forms Contact Information (Quadra. Med and NJDHSS) Installation Forms [Contact (system administrator) information/system certification for facility]

Hospital Responsibilities • Complete installation forms • Contact HIS vendor and provide them with the data file requirements and project timeframes • If necessary set up conference call with vendor and Quadra. Med • Designate staff for project roles • Set schedule with Quadra. Med Implementation Coordinator • Ready hardware and software • Attend training

Quadra. Med Responsibilities • Review test files format and data integrity • Work with hospitals and hospital vendors on data format questions and issues • Certify test files • Conduct training for all certified hospitals • Conduct bi-weekly status meetings with NJDHSS • Ongoing monitoring of data integrity and completeness

Implementation Results • Implementation waves created to streamline process • Waves did not work out – only 1 hospital met timeline • Hospital test files were accepted on first come first serve basis – maximum wait time = 1 – 2 weeks • Average 3. 5 test file iterations per hospital (range 1 -13 iterations) • Implementation of non-pilot hospitals lasted 13 months • Implementation ongoing for some hospitals after system live

Ongoing System Monitoring • Data Completeness: volume comparisons to prior year • Data Integrity: numerous audit reports to identify data errors/issues before full year is complete • Routine Email notifications of volume and data integrity issues • New system start date with 1/1/08 discharges allowed for clean break of data by year

Ongoing System Monitoring • Data integrity issues identified • • • Race and Ethnicity Missing ICD-9 procedure codes Present on Admission Indicators Do Not Resuscitate (DNR) as a condition code Marital Status – change in definition for value of ‘S’ • Data volume issues identified • Missing data for early months of 2008 • Missing types of patients (inpatient, same day, ER)

Benefits of Web-based system • Immediate feedback that file is in wrong format or unloadable • Immediate feedback of data errors and missing data elements • Fast figures of cases in error • No software installation at hospital – just a web browser

Lessons Learned • Survey your hospitals ASAP to learn who their vendors are, obtain contact information for key people and solicit their suggestions and comments. Collect information on their operational procedures and technical configuration • Keep hospitals informed. Our proposed regulation to change from the modified HIPAA 4010 to the Reporting Guide 5010 had NO public comments • Recruit pilot hospitals that represent all vendors and an inhouse developer for an easier rollout. The NJ hospital that created their own test files did so before any hospital using a vendor

Lessons Learned • Pilot effort provides a mechanism to review your documentation and procedures before full rollout • Schedule facilities for full implementation in waves, if possible, to balance your technical resources and provide additional time for stragglers • Monitor volume and quality of data, especially early on • Cutover date of January 1 made for a consistent and uniform annual file

Summary and Close NJDDCS V 2 System was about an 18 Month Project: • Reflected UB-04 changes and uses Health Care Services Reporting guide version 5010 • Pilot began in late 2006 and ended in about one year, December, 2007 • Rollout to all hospitals followed the pilot • Fully implemented V 2 system as of Jan. 1, 2008

QUESTIONS

NJDHSS and QUADRAMED THANK YOU FOR YOUR PARTICIPATION