Road Map for Implementing the Health Care Service

Road Map for Implementing the Health Care Service: Data Reporting guide

A typical scenario for a state Department of Health • Legislature mandates a new system to monitor “pink eye” by the Department of Health • The Department of Health approaches a fork in the road: Ø develop a stand-alone system to meet the requirements of the Legislature’s mandate; or Ø use a standards-based approach that allows for integration with other disease monitoring systems. 2

A typical road traveled In many cases, Departments of Health choose to develop new monitoring systems to meet new requirements handed down by state legislatures. These systems often: • are limited in scope; • create unique ways to code commonly used variables; • have difficulty working with other systems; and • are not flexible or scaleable. 3

This road map is designed to… …determine when and how to implement the Health Care Service: Data Reporting guide (HCSDRG) as a standardsbased vehicle for collecting health services data. 4

What is the Health Care Service: Data Reporting guide? • An implementation guide based on the ANSI (American National Standards Institute) ASC (Accredited Standards Committee) X 12 N (Insurance Subcommittee) Health Care Claim 837 transaction standard – designed to: Ø Facilitate standard transaction of encounter and discharge data; Ø Process HIPAA compliant health claims 5

Who should begin the journey down the road? • Users and collectors of discharge and encounter data are the stakeholders most likely to use the guide, including: Ø Institutional Providers − Hospitals − Health Systems Ø Keepers of state discharge systems − State Agencies − Hospital Associations Ø Those who report Medicaid encounter data • These groups collect data that addresses the issue of, “what’s wrong with you and how much does it cost? ” 6

Is the Health Care Service: Data Reporting guide relevant for my purposes? • The Health Care Service: Data Reporting guide would be an applicable data transmission standard if: Ø Your information system purposes rely on institutional medical records as data sources; and/or Ø Your information system purposes rely on billing departments as data sources. • The guide does not address reporting professional services 7

Before you begin down the road, make sure to address the following questions: • What are the prioritized questions to be answered by the proposed information system? • Has the system design team secured buy-in from executive management to the questions to be answered by the information system? 8

What data standards education is necessary to proceed? • To understand the full capabilities of the Health Care Service: Data Reporting guide it is necessary to understand data content and transmission format Ø Data Content − Diagnoses and Procedure Codes (ICD-9 -CM & CPT 4/HCPCS) − Uniform Bill (UB) 92 Codes Ø Data Transmission Format − HIPAA compatible ANSI ASC X 12 Format 9

Data standards education should answer the following questions: • What other industries besides health care successfully using the X 12 standards? • What data content is contained in the UB data specifications and integral to the 837 standard? • What other medical codes are referenced in the Health Care Service: Data Reporting guide and the HIPAA compliant 837? • What are the differences between the Health Care Service: Data Reporting guide and the HIPAA compliant 837 institutional implementation guide? • Why is a standards solution to collecting health services data worth the investment? 10

To help with these questions, the following resources are available: • Public Health Data Standards Web Resource Center Ø www. phdatastandards. org • National Association of Health Data Organizations (NAHDO) Ø www. nahdo. org • National Uniform Billing Committee Ø www. nubc. org • Washington Publishing Company Ø www. wpc-edi. com 11

What documentation will keep the journey heading toward implementation? • Health Care Service: Data Reporting Guide – Implementation Guide (004050 X 156) available from Washington Publishing Company • UB-92 Specifications available from the NUBC run by American Hospital Association • Other implementation experiences Ø New York State Emergency Department Data Collection System − www. health. state. ny. us/nysdoh/sparcs/pdf/soutadd. pdf 12

How do you get all stakeholders to travel the same road? • Seek common ground Ø HIPAA compatibility Issues − Relationship building with provider stakeholders − Common data definitions − Common transmission format Ø System costs issues − Maintaining proprietary and parallel systems is very expensive − Relationship building with vendor stakeholders for economies of scale for use of standards-based systems 13

How do you get all stakeholders to travel the same road? • Seek common ground, cont. Ø Data use issues − Data need to be used across state borders − Translation of proprietary data values counterproductive − Relationship building with research stakeholders 14

What technical things do I need to know? • Understand the “workings” of the ANSI ASC X 12 standards Ø Syntax of data segments Ø Transmission protocols • Understand software needs to translate “application unfriendly” data streams to be useable by information systems 15

What technical things do I need to know? (cont. ) • Understanding data capabilities of the standard mapped to system needs • Understanding adaptability of standard to support data “gaps” • Understanding how statespecific needs mandated by state legislation can be supported 16

The road to implementation will be smooth if… • Needs of data users balance capabilities of data suppliers • Limitations of all stakeholders are understood • Communication among all stakeholders is strong • Standards are the basis for the implementation • There is a mechanism to change the standards 17

How does the Health Care Service: Data Reporting guide help make the implementation ride smooth? • Provides guidelines for data supplier capabilities compatible with HIPAA standards • Provides robustness for data users compatible with HIPAA standards • Developed as part of a national consensus process to meet expanding data needs 18

How does the Health Care Service: Data Reporting guide help make the implementation ride smooth? (cont. ) • Provides common ground for data users and suppliers for ongoing dialog • Provides a standards-based roadmap for designing discharge and encounter systems • Provides a concrete vehicle to enhance relationships among stakeholders 19

Returning to a typical scenario for a state Department of Health • Legislature mandates a new system to monitor “pink eye” by the Department of Health • The Department of Health approaches a fork in the road: Ø develop a stand-alone system to meet the requirements of the Legislature’s mandate; or Ø use a standards-based approach that allows for integration with other disease monitoring systems. 20

The Standards-based Approach: The Road Well-traveled The Health Care Service: Data Reporting guide provides a standard solution for collecting health services data. It was designed and developed to facilitate: • outreach to providers and users of data to balance the delivery systems capabilities with data needs; • system design within the bounds of the delivery system capabilities; and • relationship building with all stakeholders and their data systems. Using the guide, the Department of Health can build a standards-based solution that meets current needs and provides an integrated system for the future. 21

Summary Taking the road less traveled made all the difference to Robert Frost, but for information system developers that road less traveled is fraught with detours, delays, and cost overruns. The Health Care Service: Data Reporting guide is meant to provide a roadmap for that well traveled road for design and development of discharge and encounter systems. 22

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Contact Information Bob Davis NCHS and NAHDO Consultant Web Sites of Note: www. phdatastandards. info www. nahdo. org E-mail: rdavis@nahdo. org 24