The Benefits of a Single Source of

Terminology Truth within an Enterprise

Thursday, August 14th 2014

2

1 Introductions

2 Dean Health & ETM Vision

3 Achieving the ETM Vision

4 Q & A

Tom Winchell (20 min)

Dr. Brian Levy (20 mins)

ALL (15 min)

Samantha Holvey

Today’s Agenda

Tom Winchell

3

Biography

Tom has over 18 years of project management experience and

has been at Dean since 2012. Most recently he has been

leading the ICD-10 effort with a max team size of 92 DHP

personnel and consultants. As that project moves to the back

burner, he will taking over the leadership of the Provider

Portal project. Tom also gives back to the Madison PM

community as an active member of the Project Management

Institute, and is currently serving as the President-Elect for the

PMI Madison/Southwest Chapter of PMI.

Prior to joining Dean, Tom gained his experience at Hewlett-

Packard, and Network Engineering Technologies, Inc. Tom

served as a member of the 432nd Civil Affairs Company in

Saudi Arabia, Kuwait and Iraq during the first Gulf War.

Brian Levy MD

4

Biography

Brian Levy MD has years of experience in medical informatics

with development of terminologies, clinical content, and the

use of the Internet by patients and physicians to improve care

delivery. He leads a team of physicians, nurses, PhDs, and

professional medical coders in the inclusion of terminologies,

mappings, and other content in the Language Engine.

Dr. Levy is also a practicing Board Certified Internist filling in

as a hospitalist at local hospitals, and received his medical

school training at the University of Michigan. His numerous

articles and presentations in the healthcare informatics arena

detail his experience and expertise in this field.

5

Polling Question #1

Does Your Organization Have a Single Source of Truth for

Terminologies?

A.) Yes, across and accessible within our institution

B.) Yes, but limited to a specific business function

C.) No

D.) Not sure

6

Dean Health Tom Winchell

7 About Dean Health

8

Before - High-Level Process Flow

Distribution

• Downstream Consumers Lack

Understanding and Transparency

Regarding When, How, and Even

Where to Obtain Updates

• No Accountability for Obtaining and

Applying Updates in a Timely

Manner

• Auditing Process Limited Which

Leads to Accuracy Issues.

Before - Pain Points

Without an Enterprise Strategy for managing terminology throughout our

organization, we experienced issues with intake, management, and distribution.

Acquisition & Management

• Different Departments Maintaining

Separate Lists

• Typically Managing with Spreadsheets

• No Formal Review Process For Aligning

Groups Regarding Definitions or to

Resolve Discrepancies.

• No Single Identified Group To

Coordinate Sourcing Activities

10

Internal Challenges

Competing Demands on Staff Time

Resistance to Change & Turf Wars

Responding to Specific Business Area Pain Points

Mapping Codes with Existing Staff

What a Single Source of Truth Means…

Governance & Policy

Acquisition and Promotion

Integration and Distribution

Content Authoring

Code Group Management

12

Our Focus:

Establish a Single Source of Truth

Reduce Administrative Overhead

Increase Organizational Capacity

The Quest for a Single Source of Truth

13

Establish a Single Source of Truth

Codified the Code Governance Process and achieve organizational alignment

Identified and now managing Custom Code Lists through Code Governance

Reduced Administrative Overhead

Code intake process defined and in place, including notification on new codes

Ability to automate code lists for use by Claims Processing (eliminating spreadsheets)

Pushing Data From Central Source to Other Departments or Vendors

Increase Organizational Capacity

Identified other areas of the business that can benefit (Provider Portal, Call Center, Care Management Application, etc.)

Coordination with Hospital & Clinic Systems and potential growth of DHPs network

Future SNOMED CT® Adoption & EPIC Integration

Goals – Where We Are Today

14

Conceptual Analysis – mapping DHPs current Code Set processes and identifying gaps and “pain points” throughout the organization – 2 months

Complete a review of available products & vendors; including the creation of a Request for Proposal, and review and scoring of vendor submissions – 2 months

Coordinating product demos and completing Vendor reference calls with finalist vendors – 3 months

Contract negotiations and definition – 2 months

DHPs Procurement Process

To provide some context for the amount of time and effort needed to reach an

organizational decision with a vendor partner, here is a high-level overview of the

steps the project team went through.

15

Enterprise Terminology Management Dr. Brian Levy

For healthcare delivery organizations:

“…The next challenge is to interoperate with other applications for analytics, quality measurement, and collaboration.”

“…Where they might have once relied on EHR vendors to manage terminologies, they must now assume direct responsibility for this important function.”

“…must become its own system integrator for terminology.”

Gartner: Terminology Key to Future Initiatives

Source: Gartner Report, “Top Actions for Healthcare Delivery Organization CIOS…”

Terminology Management = Standardized Data

Enables interoperability Enables Interoperability

Achieve consistency

in description of

content

Consistently capture

clinical findings

Did all AMI patients receive

aspirin within 24 hours of

admission?

Normalizes data

Improves ability to

aggregate data

Improve outcomes research

Consistently identify

patient populations and

interventions

Improves ability to trend data

Providers who saw the costs of lab

tests during the ordering process

ordered fewer and less expensive

tests over 6 months.

-8.6% Number of tests

ordered fell by

8.6% versus rising

by 5.1%

The cost per

patient day fell by

9.6% versus rising

by 2.9% (JAMA, April 2013)

-9.6%

Benefits of Standardized Data

Decreases ambiguity

Does a CBC in

hospital A cost the

same as hospital B?

Normalizes data

Enables Interoperability

Improves

continuum care

Improves data

exchange

Lab results consistently

exchanged across the

enterprise

Lab Hospital Physician

=

19

No Enterprise Terminology Management

Care Mgmt

Medical

Policy

Benefits

Mandates,

Networks,

Reimbursement

Informatics

and Actuarial

PCMH

and ACO

Remark Codes

Status Codes

Remark Codes

APC

HCPCS

Medical Necessity

ICD-10-CM/PCS

ICD-9-CM

SNOMED CT

Facility Codes

Patient Relationship

Codes

Class of Contract

Codes

ICD-9-CM

ICD-9-CM

ICD-10-CM/PCS

ICD-10-CM/PCS

ICD-9-CM ICD-10-CM/PCS

Medical Necessity

HCPCS

HCPCS

APC

SNOMED CT to

CPT

SNOMED CT to

ICD-10-CM

SNOMED CT to

ICD-9-CM FDB

NDC

Medi-Span

RxNorm

ICD-10-CM/PCS

SNOMED CT ICD-9-CM

NDC

ICD-9-CM to

SNOMED

SNOMED CT to

ICD-9-CM

SNOMED CT to

ICD-10-CM

HL Smart GEMs Reimbursement

Maps

CMS GEMs

HL

Smart

GEMs

HLI

Language

Engine

Claim Processing

• Claim Adjustments Reason Codes

• Remittance Advice Remark Codes

• National Uniform Billing Committee (NUBC)

Proprietary

• Remark Codes

• Status Codes

• Facility Codes

• Class of Contract Codes

• Patient Relationship Codes

Medical

• SNOMED CT

• ICD-9-CM

• ICD-10-CM/PCS

• CPT-4

• Medical necessity

• Age/gender edits

• HCPCS

• APC

Drug

• RXNorm

• FDB

• NDC

• NDF-RT

• Medi-Span

• Multum

ICD-10 Remediation

• CMS GEMs

• Reimbursement Maps

• HL Smart GEMS

• Premiere Picks

• Custom Maps

Clinical Maps

• SNOMED CT to ICD-9-CM

• SNOMED CT to CPT

• SNOMED CT to ICD-10-CM

• ICD-9-CM to SNOMED CT

ETM

Enterprise Terminology Management

Content: including

180+ standardized

terminologies, mappings

and custom content.

1

Software: for

terminology management

and distribution, the

Language Engine (LE).

2

Tools: for the import,

modeling, mapping,

customization and

grouping of

terminologies.

3

Services: including

custom mapping and

modeling, terminology

consulting and more.

4

Ingredients for an Enterprise Terminology Platform

How an Enterprise Terminology Platform Works Ensuring the consistent use of codes, code groups and maps throughout the enterprise

HL Content

Updates

Care

Management

Medical

Policy

Benefits

API or Import Tool

Content Authoring

Tools Content Workflow,

Mapping, and Approval

Secure FTP

Data Repositories Local Content

Sets

Terminology, Maps, and Groups Governed by a Central Source

LExScape Mandates,

Networks,

Reimbursement

Informatics

and Actuarial

PCMH

and ACO

Content Database:

SNOMED, ICD-9, ICD-10

HCPCS, NDC

Language Engine

Context Aware Mapping

23

Polling Question #2

How Do You Manage Terminologies Within Your Organization Today?

A.) Spreadsheets. We do this manually.

B.) Software Tool. We have a centralized tool for this.

C.) Not sure.

24

Case Studies

Customer Case Study #1: Statewide Health Information Exchange Utilizing LE® to Achieve Interoperability and Enable Statewide HIE Deployment

Innovative State HIE

Customer description: One of the first and most comprehensive statewide Health Information Exchanges

(HIEs) in the country. The HIE covers approximately 70% of all inpatient, outpatient, and ER visits in the

state.

Customer problem

identified:

Description of Health

Language solution:

• Consolidate a vast amount of disparate patient information and test results captured within the

state’s hospitals, primary care practices, and commercial laboratories

• Challenge in mapping local laboratory codes to the required MU lab standards

• System requires single portal access for providers and patients

Results:

• Deployed LE® to address all of the HIE’s transformation and data normalization requirements

• Enables the data integration and aggregation needed for meaningful data exchange, analytics,

and reporting

• LE® eliminated the existing data silos

• Streamlined processes, enhanced system flexibility, and improved and simplified mapping,

integration, and sharing of data

Customer Case Study #2: Healthcare IT Vendor Utilizing LE® and PFT to Achieve Systems Interoperability and Meaningful Use

Large, Diversified

Healthcare IT Vendor

Customer description: One of the largest developers of Information Technology systems for hospitals,

ambulatory service providers, and payers.

Customer problem

identified:

Description of Health

Language solution:

• Size of organization and significant acquisition-driven growth has resulted in many disparate

systems and duplicate processes

• End users demanded timely code set and standards updates as well as the ability to map local

lab codes and problem lists to standards for Meaningful Use purposes

Results:

• LE®

• Provider Friendly Terminology (PFT®)

• Redundant processes and expensive licenses were eliminated

• PFT® greatly improved the end user’s ability to search and select relevant problems and

procedures within the EMR in order to comply with MU reporting requirements

• Today more than 160 hospitals and thousands of clinicians utilize HL’s capabilities through

the customer’s healthcare IT solutions

Customer Case Study #3: Payer Customer Utilizing LE® to Create a Single “Book of Record” for Top 5 Health Plan

Customer description: Top 5 health plan offering integrated health services to over 18 million members

Customer problem

identified:

Description of Health

Language solution:

Top 5 Health Plan

• Unable to reliably and consistently update the myriad of code sets and standards across the

organization

• Significant duplication of personnel effort, inconsistent claim adjudication, problems with EOBs,

and delayed updating of mandatory code sets

Results:

• LE® was selected as the central repository and primary distribution channel for all code sets and

standards across the organization

• Higher auto-adjudication levels and reduced pending and overpayment claims for an estimated

savings of approximately $10 million per year

• Consistent and accurate explanation of benefits (EOBs) and elimination of redundant processes

and licenses

• The customer expects to save hundreds of millions of dollars over the project’s life

Customer description: Large, multi-state Blue Cross Blue Shield plan

Customer problem

identified:

Description of Health

Language solution:

Leading Blues Plan

• Convert thousands of medical policies and benefit plans across multiple claim system

applications from ICD-9 to ICD-10

• Create custom ICD-9 to ICD-10 mappings

Results:

• LEAP I-10

• Range of Professional and Content Services to create custom mappings to coincide with the

plan’s existing business rules and policies linked to the ICD-9 code set

Customer Case Study #4: Payer Customer Utilizing LEAP I-10 to Achieve Compliance and Payment Integrity: Blue Cross Blue Shields

• Automated workflow for mapping between ICD-9 and ICD-10

• Established controls during system configuration and policy renovation

• Identified accurate and appropriate usage of ICD-10 codes to support quality initiatives and

claims adjudication

• Targeted analytics renovation to improve insight into population and individual patient health;

precursor to more targeted disease and care management programs

Delivering a Single Source of Truth within your Enterprise

Governance & Policy – Govern how terminologies are utilized through the alignment of definitions, intended use, versioning, and implementation across business domains.

Acquisition and Promotion – Validate and prioritize the promotion of standard and custom content by understanding the business use of terminologies across enterprise systems.

Integration & Distribution – Ensure the implementation of terminologies within defined SLAs, supported by change notifications and auditing processes.

Content Authoring - Establish the consistent creation of local content and define the content structure and import requirements for modeling, mapping, and loading local terminologies.

Code Group Management - Aligns code driven business rules such as quality measures, medical benefit policies, and cohort identification rules, quality measures used within analytic methodologies.

Start an ETM deployment centered on a

key initiative – SNOMED or ICD-10*

Don’t try to boil the ocean

*Source: Gartner Report, “Top Actions for Healthcare Delivery Organization CIOs…”

31

Q & A