Session 2 Technology Updates
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Transcript Session 2 Technology Updates
ICD-10 Executive
Overview
Idaho
ICD-10 Site Visit
Training segments to assist the State of
Idaho with ICD-10 Implementation
Segment Two: Business
Requirements Drive the
Technical Updates
January 26-27, 2012
A Brief Synopsis of
ICD-10
Business Requirements
Drive the Technical
Updates
Policy & Claims
Management
Policy Remediation & Best
Practices
Provider Communication
Managed Care
Analytics, Reporting, &
Program Integrity
Agenda
Introduction – What’s Really Involved
Business Requirements
Technology Updates to Support Business Requirements
Vendor Support
Non Functional Requirements
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More Than an Update to a Code Set
Source: Cognizant Health Care 2009
2
Determining the Requirements
Errors made during
the requirements
stage account for 40
to 60 percent of all
defects found in the
software program
Business Purpose
Business Process
Models
Business
Requirements/
Business Rules
User
Requirements
Functional
Requirements
Historically known as System
Requirements
Non- Functional
Requirements
3
SMA High Level ICD-10 Implementation
Timeline
Awareness
•Awareness, Communication, and Education/Training
Sep 2010 – Mar 2014
Assessment
Remediation
• Plan for ICD-10 Activities
• Develop Change Requests and Requirements
• Perform an Impact
• Develop Policy Updates, Process Updates, and
Assessment
• Develop a Remediation
Strategy
• Finalize APDs
System Updates
• Execute Systems Testing
Sep 2010 – Jun 2011
Jun 2011 – Jun 2012
End-to-End Testing
• Conduct Internal End-to-End Testing (Level I)
Transition
• Implement Policy,
Process, and System
Changes
• Conduct External End-to-End Testing (Level II)
May 2012 – Jul 2013
Impact
Start
Assessment
Program Completed
Sep 2010
Core ICD-10
Strategies
Developed
Remediation
ICD-10 Changes
Completed
Jun 2011
Jun 2012
Window for developing policy, process, and
system updates
Jul 2013 – Oct 2013
ICD-10 End-toEnd Testing
Completed
Jul 2013
ICD-10
Implemented
and Live
Oct 1, 2013
4
Technology updates must be coordinated…
System
Interfaces
Business
Rules
Preparation
& Planning
System
Engineering
Data
Warehouses
/ Data Marts
User
Interfaces
NonFunctional
Requirements
Architectural
Changes
Auditing and
Logging Code
Translation
Data Definition
& Validation
Vendor
Dependency
5
Business Rules
Update the business rules to reflect revised internal business policies:
–
–
–
–
Re-point all rules that use tabled codes to appropriate reference tables
Re-code rules that are hard-coded to reflect the intent of the rules in ICD-10
Update algorithms
Update claim edits
6
Data Definition and Validation
Data Dictionaries
Validation processes
based on date of
service and code
type
Inbound and
outbound
transactions
File format
specifications
Perform updates across systems
7
Architectural Changes: Structural
Changes Influence Systems
Database Size
(increased codes
per claim)
Dual Code Sets
Code type
support
Alphanumeric
Characters
(place holders)
Field Length
(qualifier)
Systems
Retaining/linking
translated code
to original code
8
User Interfaces
Updates will be needed to the following:
Captions
Data Type Support
Field Length
Data Sources
Code Descriptions Displays
Number of Supported Codes Per Claim
9
System Interfaces
Internal Interface
Exchange of information within an organization
External Interface
Exchange of information within an internal
organization and from an external organization
10
Data Warehouses / Data Marts
Impact to Reporting:
Data Warehouse/
Data Mart
Ability to store data
Retrieve and extract data
Transform and load data
Manage the data dictionary
Update defined
aggregation schemes
Evaluate Grouper Logic –
DRG, DXCG, ETG
Report
11
System Engineering
Evaluation of the hardware or systems engineering environment is critical.
Hardware and processing capacity
Dual processing supported in operations and testing
Test Servers to support varying vendor go-live dates
Inventory equipment and evaluate the transmission capability and physical storage
of hardware
Data Server’s ability to support increased claims, records, and other data
Adequate processing and storage capacity for live operations and testing
Transmission capacity
Ability to handle increased call volume and system interaction
12
Auditing and Logging Code Translation
The SMA will need a log to identify each ICD translation
created for each system transaction:
Data translated;
Translation direction;
Purpose of translation;
Date of data translation; and
What was the original code and can you retrieve it?
Who or what performed the translation?
13
Vendor Support
Application Support
Interoperability
Programming and Testing
Appropriate mapping and crosswalk programming
Maintenance and Support
14
Non Functional Requirements
Requirements Governance
Non-Functional Requirements Types
Design Constraints
and Qualification
Legal
System Quality Characteristics
Internal Data
Performance
SMAs should maintain
strong Requirements
Governance to assure
there are proper
controls related to:
• The standard
CRUD
(Create, Read, Update
and Delete)
• Change Control Process
Internal Data
Human Factor
Engineering
(Ergonomics)
Section 508
Privacy
Security
States and Modes
Usability
• Approval processes
Operational
Maintainability
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Closing Points
Communicate to your teams the importance of evaluating
business processes for ICD-10 impacts to further define
supporting requirements for applications, databases and
enterprise infrastructure.
Identify gaps in business requirements to meet ICD-10
compliance. Inventory of Business Requirements
Work with SMEs from business and IT to identify remediation
strategy advantages and disadvantages. Access hardware.
Communicate timelines with vendors and define common
ground to evaluate ICD-10 vendor readiness.
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