ICD10 compliance of a major EHR

The customer is one of the largest EHR vendors in the US healthcare

market, with revenues of over a billion dollars

The Challenge
The Department of Health and Human
Services (HHS) mandate for healthcare
organizations to transition from the old ICD-9 code
set, that has been in use for over 30 years, to the
new, more complex ICD-10 code set has placed a
tremendous burden on all healthcare organizations
who must use this new medical coding system.
After a thorough analysis, it was determined that
almost every product in their IT suite would be
impacted in some manner by the transition to
ICD-10.
The client architected a cloud based service to
provide its products with a comprehensive ICD 10
database with code maps.

Solution Requirement
As the Department of Health and Human
Services (HHS) firmed up its decision to switch
from ICD9 to ICD10, all the EHR vendors needed to
make sure that their products are compliant with
the new codes sets.
For the purpose, a detailed analysis of the
workflows impacted had to be done, estimates
had to be prepared and a carefully thought out
plan was to be put together.
Finally the changes were to be made and then the
new version was to be thoroughly tested before it
could be released.

Impact Analysis of the EHR product

The changes were made in two steps. In Step 1,

the users, who are authorized by the medical
facility, reviewed the list of ICD-9 codes in practice
by frequency of use, upcoming patient visits and
common problems. They made relevant ICD-10
assignments and got approval. This action
necessitated retrieving data from the database in
variety of ways in order to provide user-friendly
displays.

The HealthAsyst team became intricately involved

in design discussions to assess the impact of the
transition on the companys EHR Clinical
Exchange Document. It was determined that
almost every module of the product would be
impacted -- not just for current processing, but
also for historical and family problems. The
HealthAsyst team assisted the client in prioritizing
the steps needed for mapping the codes between
ICD-9 and ICD-10. HealthAsyst also helped
establish a time schedule for the conversion
process.

In Step 2, the approved mapping was applied to

the patient data. This required extensive searching
for ICD-9 codes in active situations and replacing
every occurrence with mapped ICD-10 codes. The
changes were applied in a strictly controlled
conversion environment, which involved serially
running database batch jobs all night. These
intelligently programmed batch jobs ended the
nights conversion at a logical step before users
logged-in the next morning so as to prevent them
from experiencing screen delays.

Architecture analysis for the EHR product

Inbound and Outbound Data Challenges

Using their extensive hands-on EHR product

engineering experience, the HealthAsyst team
examined the impact of the transition on the
grass-roots level, of usage and began work on
these critical modules.

Many additional configuration requirements

popped up at the point of impact analysis due to
the state of readiness of the partner systems. They
send and receive data to/from EHR, and since
ICD-10 readiness was not taking an immediate
priority on their roadmap, this forced the EHR
team to provide configurability to accept and send
ICD data in both -9 and -10 formats. This triggered
changes in message formats.

The Solution
A team of experts from HealthAsyst in
collaboration with a team of experts from the EMR
vendor organized themselves into functional teams
for the endeavor.

Changes to Database
The new architecture prescribed two sources of
medical data: for regular workflows and for search
functionality. These changes produced a ripple
effect on the existing stored procedures, requiring
significant modifications to database.

The HealthAsyst team helped determine the order

in which inbound data would be accepted,
matched and stored in the local database.

HealthAsyst has been providing services and solutions to the global

healthcare industry since 1999. It has a strong track record of successful
services engagements across the Healthcare industry spectrum. We help
our clients enhance the quality of Patient care, improve Patient safety
and increase operational efficiency

For more information, please contact: marketing@healthasyst.com or visit www.healthasyst.com

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HealthAsyst team helped determine the order in

which inbound data would be accepted, matched
and stored in the local database.
The EHR receives information from all clinical
systems, such as the RIS, LIS, billing systems and
patient portals. Keeping this data synchronized was
the next big challenge. HealthAsyst developed the
necessary checks and balances and classified data as
sanitized or raw, based on the information sent
from the other clinical systems.
HealthAsyst also ensured the integrity of data before
any information was sent back to these other
systems.
Retention of User Preferences
A superior IT product ensures that user
preferences are not lost between upgrades. In this
transition, the user preferences that were
established for ICD-9 were successfully retained on
ICD-10. The HealthAsyst team developed the
appropriate programs to match the keywords/
terminologies/disease descriptions between ICD-9
and -10. These user preferences were carried over
to ICD-10.

Benefits Delivered
HealthAsysts healthcare industry expertise played a
major role in this successful transition to ICD-10. By
requirement
changes,
carefully
examining
HealthAsyst was able to anticipate the cascading
effects these changes would produce and make the
necessary adjustments to handle these challenges.
End user testing in a renowned hospital test
environment also created unforeseen requirements
that were successfully addressed in a matter of days
with a new, stable product version that resolved the
problems in accordance with the customers
expectation. The HealthAsyst team contributed
significantly in meeting the aggressive delivery
timelines.

Software Testing Ensures User Transparency

In an ideal IT world, while the business logic layer
and the database experience major changes, these
revisions should be transparent to the end user.
This transition successfully accomplished this
mission with the exception, of course, where new
ICD-10 data replaced the old ICD-9 data on the user
interface.
Extensive testing focused on this transparency with
many test cases being written. Numerous negative
test cases were designed to ascertain the efficacy of
the user interface (UI). Grey box testing was
accomplished by feeding information from the
database and observing how the UI reflected this
data.

HealthAsyst has been providing services and solutions to the global healthcare industry since 1999. It has a strong track record of successful services engagements
across the Healthcare industry spectrum. We help our clients enhance the quality of Patient care, improve Patient safety and increase operational efficiency
For more information, please contact: marketing@healthasyst.com or visit www.healthasyst.com