Transcript This Road Map is designed to…

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:
 develop a stand-alone system to
meet the requirements of the
Legislature’s mandate; or
 use a standards-based approach
that allows for integration with
other disease monitoring
systems.
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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:
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are limited in scope;
create unique ways to code commonly used variables;
have difficulty working with other systems; and
are not flexible or scaleable.
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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.
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What is the Health Care Service:
Data Reporting guide?
• An implementation guide based on the ANSI
(American National Standards Institute) ASC
(Accredited Standards Committee) X12N (Insurance
Subcommittee) Health Care Claim 837 transaction
standard – designed to:
 Facilitate standard transaction of encounter and discharge
data;
 Process HIPAA compliant health claims
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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:
 Institutional Providers
− Hospitals
− Health Systems
 Keepers of state discharge systems
− State Agencies
− Hospital Associations
 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?”
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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:
 Your information system purposes rely on institutional medical
records as data sources; and/or
 Your information system purposes rely on billing departments
as data sources.
• The guide does not address reporting professional
services
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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?
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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
 Data Content
− Diagnoses and Procedure Codes (ICD-9-CM & CPT4/HCPCS)
− Uniform Bill (UB) 92 Codes
 Data Transmission Format
− HIPAA compatible ANSI ASC X12 Format
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Data standards education should answer the
following questions:
• What other industries besides health care are
successfully using the X12 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?
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To help with these questions, the following
resources are available:
• Public Health Data Standards Web Resource Center
 www.phdatastandards.org
• National Association of Health Data Organizations
(NAHDO)
 www.nahdo.org
• National Uniform Billing Committee
 www.nubc.org
• Washington Publishing Company
 www.wpc-edi.com
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What documentation will keep the journey
heading toward implementation?
• Health Care Service: Data Reporting Guide –
Implementation Guide (004050X156) available from
Washington Publishing Company
• UB-92 Specifications available from the NUBC run by
American Hospital Association
• Other implementation experiences
 New York State Emergency Department Data Collection System
− www.health.state.ny.us/nysdoh/sparcs/pdf/soutadd.pdf
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How do you get all stakeholders to travel the
same road?
• Seek common ground
 HIPAA compatibility Issues
− Relationship building with provider stakeholders
− Common data definitions
− Common transmission format
 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
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How do you get all stakeholders to travel the
same road?
• Seek common ground, cont.
 Data use issues
− Data need to be used across state borders
− Translation of proprietary data values counterproductive
− Relationship building with research stakeholders
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What technical things do I need to know?
• Understand the “workings” of
the ANSI ASC X12 standards
 Syntax of data segments
 Transmission protocols
• Understand software needs to
translate “application
unfriendly” data streams to
be useable by information
systems
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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
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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
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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
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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
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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:
 develop a stand-alone system to
meet the requirements of the
Legislature’s mandate; or
 use a standards-based approach
that allows for integration with
other disease monitoring
systems.
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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.
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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.
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Contact Information
Bob Davis
NCHS and NAHDO Consultant
Web Sites of Note:
www.phdatastandards.info
www.nahdo.org
E-mail: [email protected]
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