NEW JERSEY DISCHARGE DATA COLLECTION SYSTEM VERSION 2 LESSONS LEARNED JULY 21, 2009

1. NEW JERSEY DISCHARGE DATA COLLECTION SYSTEM VERSION 2 LESSONS LEARNED JULY 21, 2009

2. Agenda • Introductions Vince Yarmlak, NJDHSS • Background/Project OverviewVince Yarmlak,NJDHSS • Expectations of Pilots/VendorsVince Yarmlak, NJDHSS • Implementation Process Sherry Badran, QuadraMed • Implementation Results Sherry Badran, QuadraMed • Ongoing System MonitoringChiarina Fanara, QuadraMed • Lessons Learned Vince Yarmlak, NJDHSS • Summary and CloseVince Yarmlak, NJDHSS • Q & AAll

3. The NJDDCS Version 2 Project Team • NJDHSS staff • QuadraMed staff • NJ Acute Care Hospitals and their data vendors

4. Background /Project Overview Original Contract: • Data Intermediary Services Initial Contract May, 1999 – December, 2007 • NJ general acute care hospitals reported UB information for 4 million annual inpatients, same day outpatients and emergency dept. visits in modified ANSI 4010 HIPAA or flat file format

5. Background /Project Overview New Contract for Version 2 system: • NJDHSS issued RFP November, 2005. Required use of ASC X12N/005010X225 Health Care Service: Data Reporting Guide • Bids Due December, 2005 • 3 Bids Submitted • Contract Award to QuadraMed April, 2006

6. Background /Project Overview Goals of NJDDCS Version 2: • QuadraMed is the agent of NJDHSS in an electronic commerce transaction • Provide hospitals with an internet-based, user friendly system with a graphical user interface that functions quickly and reliably

7. Background /Project Overview Goals of NJDDCS Version 2: • Utilize existing electronic claims processing and telecommunication technologies via national standards such as the Uniform Bill (UB) and HIPAA compatible claim transactions and succeeding updates • Reduce the per-record cost

8. Major Project Activities Project Activities • System Definition • System Development • Test System for Pilot • Train Pilot Staff • Conduct Pilot • Test, train, rollout to all hospitals Project started on May 15, 2006 and went live effective with January 1, 2008 discharges

9. About the Pilot Hospitals • Started with 11 volunteers to be pilot hospitals representing 6 different HIS vendors (i.e.: Siemens, HBOC McKesson, Meditech) • Ended with 3 pilot hospitals – 2 major HIS vendors and 1 internal hospital system • Pilots dropped out due to other priorities (UB-04 implementation) and ANSI 5010 programming complexities • Took 6 months for 1st pilot to have file certified – many iterations of test files created and reviewed • Pilot data submission lasted about 5 months

10. Expectations of Pilot Hospitals and Vendors • Review documents from pilot kickoff meeting • Meet with hospital HIS vendor(s) to plan V2 file creation • Return completed forms from Implementation Guide to QuadraMed • Work with QuadraMed to resolve technical issues with test files for certification • Create daily claim file for transmission to QuadraMed

11. Implementation Process

12. Tasks & Responsible Parties • Obtain / create ability to produce data files in required format - Facility / HIS or EDI Vendor • Submit 3 daily data files – Facility • Certify data files - QuadraMed & Facility • Training - Facility End Users & QuadraMed • Install/Setup - QuadraMed, Facility Techs & End Users

13. Implementation Process • Create Implementation Guide • Distribute Implementation Guide to all Hospitals • Receive Installation Forms and test files from hospitals • 3 daily data test files (inpatient and outpatient data) • Load and review test file format and data • Pass or fail test files • System training at QuadraMed • System setup of administrative user login and password

14. Implementation Guide • ANSI 837 X5010 Addendum Guide • Data Dictionary • Field list • Definitions • Inpatient and/or outpatient required • Allowable values • Field comparison – old to new system • Edits • Implementation forms • Contact Information (QuadraMed and NJDHSS) • Installation Forms [Contact (system administrator) information/system certification for facility]

15. Hospital Responsibilities • Complete installation forms • Contact HIS vendor and provide them with the data file requirements and project timeframes • If necessary set up conference call with vendor and QuadraMed • Designate staff for project roles • Set schedule with QuadraMed Implementation Coordinator • Ready hardware and software • Attend training

16. QuadraMed Responsibilities • Review test files for format and data integrity • Work with hospitals and hospital vendors on data format questions and issues • Certify test files • Conduct training for all certified hospitals • Conduct bi-weekly status meetings with NJDHSS • Ongoing monitoring of data integrity and completeness

17. Implementation Results • Implementation waves created to streamline process • Waves did not work out – only 1 hospital met timeline • Hospital test files were accepted on first come first serve basis – maximum wait time = 1 – 2 weeks • Average 3.5 test file iterations per hospital (range 1-13 iterations) • Implementation of non-pilot hospitals lasted 13 months • Implementation ongoing for some hospitals after system live

18. Ongoing System Monitoring • Data Completeness: volume comparisons to prior year • Data Integrity: numerous audit reports to identify data errors/issues before full year is complete • Routine Email notifications of volume and data integrity issues • New system start date with 1/1/08 discharges allowed for clean break of data by year

19. Ongoing System Monitoring • Data integrity issues identified • Race and Ethnicity • Missing ICD-9 procedure codes • Present on Admission Indicators • Do Not Resuscitate (DNR) as a condition code • Marital Status – change in definition for value of ‘S’ • Data volume issues identified • Missing data for early months of 2008 • Missing types of patients (inpatient, same day, ER)

20. Benefits of Web-based system • Immediate feedback that file is in wrong format or unloadable • Immediate feedback of data errors and missing data elements • Fast figures of cases in error • No software installation at hospital – just a web browser

21. Lessons Learned • Survey your hospitals ASAP to learn who their vendors are, obtain contact information for key people and solicit their suggestions and comments. Collect information on their operational procedures and technical configuration • Keep hospitals informed. Our proposed regulation to change from the modified HIPAA 4010 to the Reporting Guide 5010 had NO public comments • Recruit pilot hospitals that represent all vendors and an in-house developer for an easier rollout. The NJ hospital that created their own test files did so before any hospital using a vendor

22. Lessons Learned Pilot effort provides a mechanism to review your documentation and procedures before full rollout Schedule facilities for full implementation in waves, if possible, to balance your technical resources and provide additional time for stragglers Monitor volume and quality of data, especially early on Cutover date of January 1 made for a consistent and uniform annual file

23. Summary and Close NJDDCS V2 System was about an 18 Month Project: • Reflected UB-04 changes and uses Health Care Services Reporting guide version 5010 • Pilot began in late 2006 and ended in about one year, December, 2007 • Rollout to all hospitals followed the pilot • Fully implemented V2 system as of Jan. 1, 2008

24. QUESTIONS

25. NJDHSS and QUADRAMED THANK YOU FOR YOUR PARTICIPATION