1. Burden of Disease Research Unit (BOD) Towards a National Procedure Coding Standard for South Africa Lyn Hanmer Health Informatics R&D Co-ordination (HIRD) WHO Collaborating Centre for the Family of International Classifications (WHO-FIC SA) 3 July 2013 SAHIA HISA 2013, NMMU, Port Elizabeth

2. Outline: Towards a national procedure coding standard Why are national clinical coding standards required? Proposals for defining requirements for a national procedure coding standard for South Africa New developments at WHO: – Progress towards ICHI (International Classification of Health Interventions) – New resolution on ‘eHealth standardization and interoperability’ (WHA 66.24, 27 May 2013) Proposed next steps towards a national procedure coding standard for South Africa. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

3. Perspective Extensive involvement of MRC in clinical coding issues – MRC convened the meeting at which the private sector took the decision to adopt ICD-10 as a diagnosis coding standard – hence the adoption of ICD-10 as the national diagnosis coding standard. WHO Collaborating Centre in South Africa for the Family of International Classifications (WHO-FIC SA) – Participation in ICHI development. MRC project to support the identification of a national standard for casemix grouping/DRGs; will require a national procedure coding standard – MRC role is to support decision making – THIS IS WORK IN PROGRESS. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

4. Why national clinical coding standards? Good clinical practice requires accurate health records Coding facilitates consistency and comparability SA health legislation requires recording and reporting National Health Insurance implementation is dependent on the availability of coded clinical data National eHealth strategy includes specific reference to clinical coding standards. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

5. eHealth WHO definition: The cost-effective and secure use of information and communication technologies (ICTs) in support of health and health-related fields, including health-care services, health surveillance, health literature and health education, knowledge and research. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

6. National eHealth strategy – Ten strategic priorities 1.Strategy and leadership 2.Stakeholder engagement 3.Standards and interoperability 4.Governance and regulation 5.Investment, Affordability and Sustainability 6.Benefits Realisation 7.Capacity and Workforce 8.eHealth Foundations 9.Applications and Tools to support Healthcare Delivery 10.Monitoring and Evaluation of the eHealth Strategy. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

7. National eHealth strategy – eHealth Foundations Infrastructure Connectivity Registration of patients, facilities and providers A basic national electronic health record. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

8. Health Information Standards - National eHealth strategy Require national standards for: – Interoperability, to ensure the accurate exchange of data – Procurement (hardware and software) – Software accreditation – Data structure – Terminology – Clinical coding – Security – Messaging – Electronic health record. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

9. National clinical coding standards (cont.) Current status: – National diagnosis coding standard: ICD-10 – Multiple procedure codes in use: CCSA™ ICD-9-CM procedures ?? – Multiple standards for other components of clinical records, e.g. pharmaceutical coding NAPPI National Stock Number ATC (WHO standard) ?? 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

10. Proposals for defining requirements Much has already been done; there have been studies. Identify users and uses: – Who are the potential users/stakeholders? – What are their needs? Define criteria for selection of standards – What are our national needs? Understand the landscape – What is the current situation in South Africa? – What are the available options? – Consider national and international developments and experiences. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

11. Proposed criteria Single standard(s) for public and private sectors Open source/open access/internal IP/ access to source Internal capacity to support ongoing development, maintenance and updating – Take account of experiences to date (e.g. ICD-10) – Identify existing capacity; capacity building requirements. Availability of resources to support ongoing maintenance and updating. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

12. Proposed criteria (cont) Reflect SA national health practice and organisation – include comprehensive primary health care component – include public health interventions. Appropriate level(s) of granularity to meet requirements, including – support for reimbursement – support for casemix grouping/DRGs. Support manual and electronic coding. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

13. Progress towards ICHI Being developed as a component of the WHO Family of International Classifications (WHO-FIC) ICHI Alpha was published in October 2012 at the annual meeting of WHO-FIC collaborating centres – Further development is required – Further expert consultation is required ICHI Alpha 2 is planned for release at WHO-FIC 2013 – Field testing will be required. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

14. ICHI (cont.) A very comprehensive approach to ‘interventions’: – Medical and surgical interventions – Functioning interventions – Public health interventions – Primary health care interventions – Planned: traditional medicine interventions. The ICHI content model is based on international standards for procedure coding systems. – Three axes: target, action, means – Target: three letters – Action: two letters – Means: two letters. Granularity similar to ICD-9-CM procedures. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

15. ICHI (cont.) ICHI will in future have a defined management structure within WHO – To date, ICHI development has been carried out as part of the work programme of the Family Development Committee of the WHO-FIC network – An ICHI development project plan is being compiled – A WHO ICHI Management Committee is planned Initial consultation held June 2013. The aim is to publish ICHI in 2017, depending on resource availability. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

16. WHO resolution 2013 Previous resolution on eHealth in 2005 (WHA 58.28) New resolution on ‘eHealth standardization and interoperability’ (WHA 66.24, 27 May 2013) – ‘… should address standardization and interoperability issues related to hardware, systems, infrastructure, data and services’ – … scientific evaluation of the impact on health care outcomes of HIS … is necessary to justify strong investment …’ – member states to ‘draw up a road map for implementation of ehealth and health data standards …’ ‘Consider developing … (a) national eHealth strategy’ 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

17. Proposed next steps Consult nationally on a national procedure coding standard – National Department of Health – Other stakeholder groups Provincial departments of Health ICD-10 Task Team PHISC (Private Health Information Standards Committee) etc. Review national experience and status of procedure coding implementation Review international best practice. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

18. Next steps (cont.) Review proposed criteria for the evaluation of national procedure coding standards for South Africa Review ICHI as a potential procedure coding standard for implementation from 2018 – Identify resources to support SA participation in ICHI development and testing Review existing de facto procedure coding standards as candidates for the SA national standard for 2013 to 2017 – Identify de facto procedure coding standards in use in SA – Review de facto standards against defined criteria for evaluation, including resource availability. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

19. Next steps (cont.) Identify a decision making process and structures for national procedure coding standards. Consider implications for the development of national DRGs Consider implications for other institutions and organisations, and related existing processes Define requirements for ongoing development/updating, implementation and maintenance of national procedure coding standards – Including capacity development – Could be combined with structures/processes for other clinical coding standards. 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

20. Lyn Hanmer Burden of Disease Research Unit, Health Informatics WHO-FIC Collaborating Centre for the Family of International Classifications (WHO-FIC SA) Medical Research Council PO Box 19070 Tygerberg 7505 South Africa Tel: +27 21 9380343 Fax: +27 21 9380315 Email: lyn.hanmer@mrc.ac.za http://www.mrc.ac.za/hird/whofic.htm 2016/07/03 12:38 PM Towards a national procedure coding standard for SA

21. eHealth framework 2016/07/03 12:38 PM Towards a national procedure coding standard for SA