1. Preparing for implementation
OPCS-4.7 Implementation
Preparing for implementation
Presented by
Clinical Classifications Service

2. 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 ….

3. Topics covered Overview of OPCS-4.7
Implementation planning and strategies
Go live preparation

4. Overview of OPCS-4

5. Overview of OPCS-4.7
OPCS Classifications of Interventions and Procedures, Version 4.7
Commonly referred to as OPCS-4.7

6. Overview of 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

7. Overview of OPCS-4.7 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

8. Overview of OPCS-4.7
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

9. Overview of OPCS-4.7 OPCS-4 updating cycle: OPCS-4 version: OPCS-4.2
NHS implementation on: -
1 April 2006
1 April 2007
1 April 2009
1 April 2011
1 April 2014

10. Overview of OPCS-4.7 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

11. Overview of 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:
Information Standards Notice – mandating implementation published by the Information Standards Board in November 2013

12. Overview of OPCS-4.7 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

13. Overview of OPCS-4.7 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

14. Overview of OPCS-4.7 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

15. Overview of OPCS-4.7 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)

16. Overview of OPCS-4.7 National Tariff
Healthcare Resource Groups will group to new codes
National tariff will include updates in OPCS-4.7

17. Implementation planning and strategies

18. 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

19. Implementation planning and strategies
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

20. Implementation planning and strategies
Who is leading within your organisation to prepare a plan for implementation?

21. Implementation planning and strategies
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

22. Implementation planning and strategies
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 processes
Delay to impact assessment will jeopardise ability to complete all OPCS-4.7 implementation tasks by compliance date

23. Implementation planning and strategies
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

24. Implementation planning and strategies
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

25. Implementation planning and strategies
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?

26. Implementation planning and strategies
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?

27. Implementation planning and strategies
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

28. Implementation planning and strategies
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

29. Implementation planning and strategies
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

30. Implementation planning and strategies
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

31. Implementation planning and strategies
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

32. Implementation planning and strategies
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

33. Implementation planning and strategies
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

34. Implementation planning and strategies
Data uses
Performance improvements
Corporate compliance
Data quality management
Data security
Clinical documentation

35. Implementation planning and strategies
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

36. Implementation planning and strategies
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

37. Implementation planning and strategies
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.

38. Go live preparation

39. 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

40. 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)

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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.

48. Go live preparation Links to central resources
Technology Reference Update data Distribution (TRUD)
Health and Social Care Information Centre – clinical classifications service
New interactive environment that provides information about emerging and changing standards and encourages
Information standards helpdesk

49. 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