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
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.
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.
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…”