opcs-4.7 implementation preparing for implementation 1 presented by clinical classifications service

OPCS-4.7 Implementation

Preparing for implementation

1

Presented byClinical Classifications Service

OPCS-4.7 checklist

• Here’s a checklist to help you in planning and managing OPCS-4.7 implementation– You may not find everything here necessary– But, it might help you identify what you need

to happen.

• Take what is useful for you and your organisation ….

Topics covered

• Overview of OPCS-4.7• Implementation planning and strategies• Go live preparation

Overview of OPCS-4

Overview of OPCS-4.7

• OPCS Classifications of Interventions and Procedures, Version 4.7

• Commonly referred to as OPCS-4.7


What is OPCS-4?• Fundamental information standard and

mandated for use by healthcare• Used to classify hospital interventions and

surgical procedures for statistical purposes / secondary uses

• Comprises list of alphanumeric codes organised into mainly anatomically based chapters


OPCS-4 applies to:• All “in-patient” episodes and day cases that

contain surgical procedures and hospital interventions and must be coded to the mandated version of OPCS-4


OPCS-4.7 use cases include:

• National data collections including Admitted Patient Care Commissioning Data Sets (CDS)

• Hospital operational and strategic planning to support business processes including reimbursement

• NHS suppliers to build/update software to support NHS business functions and interoperability


OPCS-4 updating cycle:

OPCS-4 version:• OPCS-4.2• OPCS-4.3• OPCS-4.4• OPCS-4.5• OPCS-4.6• OPCS-4.7

NHS implementation on:

-• 1 April 2006• 1 April 2007• 1 April 2009• 1 April 2011• 1 April 2014


OPCS-4.7 compliance• 1 April 2014

• compliance date for NHS implementation of OPCS-4.7

• Inpatient episodes and day cases ending on or after 1 April 2014 will be coded using OPCS-4.7


NHS and system supplier formal notification• Advanced Notification (AN) – gives warning of

update and implementation requirement published by the Information Standards Board on 10 May 2013: http://www.isb.nhs.uk/documents/isb-0084/amd-10-2013/index_html

• Information Standards Notice – mandating implementation published by the Information Standards Board in November 2013

http://www.isb.nhs.uk/documents/isb-0084/amd-10-2013/index_html



Impact of OPCS-4.7 change• Minor impact• Processes understood and in place• Requires upload of new data into systems• People ready and trained where

appropriate


No change to architecture of OPCS-4 • new entries fall within existing chapters• Addition of new codes• Retirement of some codes• Modifications to existing code descriptions

includes and excludes


New codes include:• Craniofacial procedures• Operations for disorders of sex

development• Total ankle replacements• Subcutaneous cardioverter defibrillators • Peranal resection of rectum using staples

(STARR procedure)• Leech therapy


Products delivered centrally• Draft Summary of Changes (Aug 2013)• OPCS-4.7 data files, technical specification and final

summary of changes (7 Nov 2013)• OPCS-4.7 eVersion (Feb 2014)• OPCS-4.7 Tabular List and Index via The Stationary

Office (Feb 2014)• National clinical coding standards Ref book (Feb 2014)• Coder self teach PowerPoint materials (Feb 2014)• Trainer materials (Feb 2014)


National Tariff

• Healthcare Resource Groups will group to new codes

• 2014-15 National tariff will include updates in OPCS-4.7

Implementation planning and strategies


Consequences of poor preparation• Compliance issues• Coding backlogs• Decisions based on inaccurate data• Incorrect reimbursement

Problems can be mitigated with proper advance preparation


Don’t delay getting started• Early initiation of the planning process,

thorough preparation, adequate education and proper testing will result in smoother implementation and earlier realisation of benefits


• Who is leading within your organisation to prepare a plan for implementation?


Suggested timeline• Phase 1 – organisation readiness• Phase 2 – systems readiness• Phase 3 – coding readiness• Phase 4 – go live preparation

Phases may vary, depending on the type, size and complexity of the organisation, phases may overlap


Phase 1:• Project team established• Assess organisational readiness• Conduct survey of all business areas to

determine extent of the impact• Analyse impact on all business processesDelay to impact assessment will jeopardise ability to complete all OPCS-4.7 implementation tasks by compliance date


Phase 2:• Perform systems’ audit• Identify new or upgraded hardware or software

requirements (if necessary)• Consider impact on electronic tools (eg

encoders)• Ensure access to legacy data • Build flexibility of IT systems under development

to ensure compatibility with OPCS-4.7


Systems/applications potentially impacted include:• Electronic Patient Record

systems• Clinical systems• Patient Administration

systems• Encoding software• Medical record

abstracting systems• Decision support systems

• Resource Utilisation• Quality management• Casemix systems• Case management• Financial• Compliance software


Determine your business readiness• Assess business associate readiness• Determine vendor readiness and timelines for

software upgrades• Information Standards Notices are included in

NHS Contracts but check:• Which systems upgrades or replacements are

needed if any to accommodate OPCS-4.7?• Will upgrades be covered by existing contracts,

what other costs are involved?


Determine system supplier readiness• When will upgrades be available for testing

and implementation?• What customer support and training will they

provide if required?• How will their products and services

accommodate OPCS-4.6 and OPCS-4.7?• How long will their products accommodate

both code sets?


Project plan is in place• Project lead to ensure all the activities and

tasks required for local Trust implementation are included in the project schedule tracking tool and estimates for these tasks are regularly reviewed for accuracy


Phase 3• Review “draft summary of changes”

available on NHS Classifications Service website from August 2013

• Feedback where appropriate• Consider local impact of proposed changes

and plan accordingly


Gap analysis• Conduct gap analysis of coding

professionals’ knowledge and skills• Assess coding professionals’ knowledge• Refresh coding staff’s knowledge as

needed on basis of assessment results


Assess quality of medical record documentation• Evaluate samples of various types of

medical records to determine whether documentation supports level of detail found in OPCS-4.7

• Implement documentation improvement strategies where needed


Coding and documentation - always work toward better documentation• Avoids misinterpretation• Provides a more accurate clinical picture of

the quality of care provided• Supports current and future initiatives aimed at

improving quality and improved patient care• Issues related to poor documentation must be

resolved by the provider


Determine education and training plan• Who will need education?• What type and level of education will they

need?• How will the education be delivered?• Clinical coder training should not be provided

until ? Months before implementation• Hospital inpatient coders require ? hours of

training


Consider education needs for data users

• Clinical coders• Information personnel• Clinicians• Senior management• Information technology• Finance• Auditors• Commissioners

• Clinical department managers

• Data analysts• Researchers• Epidemiologists


Data uses• Performance improvements• Corporate compliance• Data quality management• Data security• Clinical documentation


Identify all implementation expenses and estimate associated costs including:

• Education / training• Hardware/software upgrades if applicable• Staff time / Temporary or contract staff• Systems’ testing related costs• Data conversion• Maintenance of dual code set


Additional implementation preparation steps• Refine project plan, timeline and budget as

needed• Assess potential reimbursement impact• Develop strategies to minimize problems and

maximise opportunities• Assess impact of

• Decreased coding productivity• Decreased coding accuracy


Register now ….• Agree the authorised person within the

organisation to accept licence agreements on TRUD

• Pre-register on TRUD for the OPCS-4 sub-packs in readiness to download the data files when released. Requestor to be notified when files become available.

Go live preparation

Go live preparation

Phase 4• Follow-up on readiness status of business

associates• Develop contingency plan for continuing

operations if critical systems or other problems occur when the OPCS-4.7 implementation goes live

• Develop communication plan• Provide senior executives and stakeholders with

updates

Go live preparation

Information Standards Notice (ISN)• Review ISN and Standard Specification

and ensure business associates have read and are taking appropriate actions to meet planned deliverables (ISN published November 2013)

• http://www.isb.nhs.uk/documents/isb-0084/amd-10-2013/index_html



Go live preparation

OPCS-4.7 data files• Download data files released via

Technology Reference Update data Distribution (TRUD) in November 2013:• OPCS-4.7 codes and title• OPCS-4.7 metadata• OPCS-4.7 table of equivalences• Technical specification documents

Go live preparation

For terminology users• Download released data via Technology

Reference Update data Distribution (TRUD) in March 2013:• SNOMED CT to OPCS-4.7 Cross-maps• Technical Specification document

• Legacy data• Read Version 2 to OPCS-4.7 Cross-maps• Clinical Terms Version 3 to OPCS-4.7 Cross-maps

Go live preparation

Complete tasks identified in Phase 1 - during impact assessment• Implement system changes• Provide education to users• Implement and monitor documentation improvement

strategies• Re-engineer processes and workflows identified in

Phase 1 if necessary• Complete internal testing• Begin external testing once business associates are

ready

Go live preparation

Training and education• Deliver local awareness sessions and training

requirements previously identified• Ensure protected time for clinical coders• Download key learning points for coding

departments• Register for:

• Clinical Coding Standards – OPCS-4

• Purchase from The Stationary Office:• OPCS-4.7 Volumes I-II for clinical coders

Go live preparation

Data analysis• Determine impact on longitudinal data

analysis• Will legacy data be converted? If so, how will

it be converted?• Determine which data will be linked by using

mapping applications and which data will be maintained separately according to the source code set

Go live preparation

Equivalences• Equivalences are mappings to assist users

in navigating the complexity of translating meaning from the content of one code set to another code set

• They should not be used for coding medical records

• The OPCS-4 Table of Coding Equivalences is available in Excel from TRUD

Go live preparation

Continue to assess and improve coding documentation• Continue to assess quality of medical record

documentation, implementation documentation and strategies as needed, and monitor impact of documentation improvement strategies

• Coders should continue to gain familiarity with OPCS-4.7 codes and coding guidelines and improve skills in areas identified in gap analysis.

Go live preparation

Links to central resourcesTechnology Reference Update data Distribution (TRUD)• http://www.uktcregistration.nss.cfh.nhs.uk/trud3

Health and Social Care Information Centre – clinical classifications service• http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/opcs4

New interactive environment that provides information about emerging and changing standards and encourages

• http://www.infostandards.org

Information standards helpdesk• [email protected]

http://www.uktcregistration.nss.cfh.nhs.uk/trud3



http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/opcs4

http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/opcs4

http://www.infostandards.org/

mailto:[email protected]

Go live preparation

Lessons Learned• Implementation follow-up

– What can you learn for next time?– What can we learn for next time?

• Awareness Pack - let us know if it helped, and how we can improve

opcs-4.7 implementation preparing for implementation 1 presented by clinical classifications service

Documents

overview of opcs

impact of opcs

architecture of opcs

nhs implementation of

mandated version of

appropriate slide

interoperability slide

live preparation slide