OPCS4 9 Implementation Preparing for implementation Terminology and

OPCS-4. 9 Implementation Preparing for implementation Terminology and Classifications Delivery Service

OPCS-4. 9 checklist • Here’s a checklist to help you plan and manage OPCS-4. 9 implementation • You may not need everything included here • But, it will help you identify what needs to happen • Take what is useful for you and your organisation ……. . 2

Topics covered • Overview of OPCS-4 • What is OPCS-4 • Overview of OPCS-4. 9 • Impact and number of changes • Products delivered centrally • Implementation planning and strategies • Organisation, systems and coding readiness • Go live preparation • Post implementation • Links to central resources 3

Overview of OPCS-4 4

Overview of OPCS-4 What is OPCS-4? • An NHS Fundamental Information standard • Used to classify hospital interventions and procedures for secondary uses such as statistical purposes and reimbursement • Comprises a list of alphanumeric codes, organised into mainly anatomically based chapters, categories and subcategories 5

Overview of OPCS-4 Under the Health and Social Care Act 2012 the following bodies must have regard to this information standard: • The Secretary of State • NHS England Improvement • Public bodies exercising functions in connection with adult social care health services or • Anyone providing publicly funded health services commissioned by or on behalf of a public body 6

Overview of OPCS-4 Scope of OPCS-4 mandate: • All “in-patient” episodes and day cases that contain procedures must be recoded using the mandated version of OPCS-4 7

Overview of OPCS-4 data uses include: • National data collections including Admitted Patient Care Commissioning Data Sets (APC CDS) • Hospital operational and strategic planning to support business processes including reimbursement 8

Overview of OPCS-4 update cycle: NHS implementation on: OPCS-4 version: Up to 31 March 2006 OPCS-4. 2 1 April 2006 - 31 March 2007 OPCS-4. 3 1 April 2007 - 31 March 2009 OPCS-4. 4 1 April 2009 - 31 March 2011 OPCS-4. 5 1 April 2011 - 31 March 2014 OPCS-4. 6 1 April 2014 -31 March 2017 OPCS-4. 7 1 April 2017 - 31 March 2020 OPCS-4. 8 1 April 2020 - until further notice OPCS-4. 9 9

Overview of OPCS-4. 9 compliance • 1 April 2020 • Compliance date for NHS implementation of OPCS-4. 9 • Inpatient episodes and day cases ending on or after 1 April 2020 must be coded using OPCS-4. 9 10

Overview of OPCS-4. 9 Impact of OPCS-4. 9 change • Minor impact • Processes understood and in place • Requires upload of new data into systems • People ready, aware and trained where appropriate • OPCS-4. 9 does not require ‘conversion’ training 11

Overview of OPCS-4. 9 No change to architecture of OPCS-4. 9 • Changes made in both the Tabular List and Alphabetical Index • Addition of new codes, retirement and modifications to existing code descriptions and notes • Sex (Absolute) Metadata field not populated in order to comply with the Equality Act 2010. Where a code in OPCS-4. 8 had a Sex (absolute) flag assigned in the Metadata file this has been changed to a Sex (scrutiny) flag. 12

Overview of OPCS-4. 9 NHS and system supplier formal notification • The Data Coordination Board (DCB) oversees the development, assurance and approval of information standards, data collections, and data extractions • Notification of the intention to update OPCS-4 was communicated in the Terminology and Classifications Delivery Service Newsletter in February 2019 • Information Standards Notice (ISN) – published on 8 th October 2019, mandated the implementation of OPCS-4. 9 on 1 April 2020. See http: //content. digital. nhs. uk/isce/publications/DCB 0084 13

Overview of OPCS-4. 9 Number of changes Change Type New three-character category code New four-character subcategory code Retired (four-character subcategory) Changed three-character category code description Changed four-character subcategory description Change to three-character category code involving change to note only (new, deleted or changed includes, excludes and notes) Change to four-character subcategory involving change to note only (new, deleted or changed includes, excludes and notes) New Index entry Deleted Index entry Number Total Grand Total 28 223 5 1 33 65 83 352 43 438 395 833 14

Overview of OPCS-4. 9 Changes to OPCS-4. 9 • OPCS-4. 9 contains updates submitted via the OPCS-4 Requests Submissions Portal at: https: //isd. digital. nhs. uk/rsp/user/guest/home. jsf • Final summary of changes available at: https: //hscic. kahootz. com/connect. ti/t_c_home/view? object. Id=14270896#14 270896 15

Overview of OPCS-4. 9 Products delivered centrally • Draft Summary of Changes (Published July 2019) • Final Summary of Changes (Published 8 October 2019) • OPCS-4. 9 data files and technical specifications (4 November 2019) • OPCS-4. 9 Volume 1 -2 available to buy from The Stationary Office (January/February 2020) • OPCS-4. 9 available in NHS Digital Classifications Browser and e. Version (January/February 2020) • National Clinical Coding Standards reference book and Key Learning Points (January/February 2020) • Updates to Clinical Coding Standards Course and Clinical Coding Standards Refresher course materials released to approved clinical coding trainers (January/February 2020) • Terminology (SNOMED CT) to OPCS-4. 9 cross-maps (March 2020) All available from https: //hscic. kahootz. com/connect. ti/t_c_home/view? object. Id=14270896#14270896 16

Overview of OPCS-4. 9 NHS National Tariff Payment System • The NHS Digital National Casemix Office (NCO) is responsible for the mapping of OPCS-4. 9 codes to Healthcare Resource Groups (HRG) for use in associated groupers. The OPCS-4. 9 updates will be incorporated into the HRGs to ensure the codes are accepted by the grouper(s) to be used from April 2020 onwards. See https: //digital. nhs. uk/services/national-casemix-office for details about the NCO and HRGs. 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 prevented/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 phases • Phase 1 – organisation readiness • Phase 2 – systems readiness • Phase 3 – coding readiness • Phase 4 – go live preparation • Phase 5 – post implementation Phases may vary, depending on the type, size and complexity of your organisation, phases may overlap 22

Implementation planning and strategies Phase 1 - Organisation readiness 23

Implementation planning and strategies – Phase 1 - Organisation readiness: • Project team established • Assess organisational readiness • Conduct survey of all business areas to determine extent of the impact • Analyse impact on all business processes • Develop communications plan • Document all risks and issues relating to implementation Delay to impact assessment will jeopardise ability to implement OPCS-4. 9 by compliance date. 24

Implementation planning and strategies Phase 2 - Systems readiness 25

Implementation planning and strategies – Phase 2 – systems’ readiness: • Perform systems’ audit • Identify new or upgraded hardware or software requirements (if necessary) • Consider impact on electronic tools (e. g. encoders) • Ensure access to legacy data • Build flexibility into IT systems under development to ensure compatibility with OPCS-4. 9 26

Implementation planning and strategies – Phase 2 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 27

Implementation planning and strategies – Phase 2 Determine your business readiness • Determine vendor readiness and timelines for software upgrades • Information Standards are included in NHS Contracts but check: • Which systems upgrades or replacements are needed, if any, to accommodate OPCS-4. 9? • Which upgrades will be covered by existing contracts, what other costs are involved? 28

Implementation planning and strategies – Phase 2 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. 8 and OPCS-4. 9? • How long will their products accommodate both code sets? 29

Implementation planning and strategies – Phase 2 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 30

Implementation planning and strategies Phase 3 - Coding readiness 31

Implementation planning and strategies – Phase 3 – Coding readiness • Review final Summary of Changes • Consider local impact of proposed changes and plan accordingly 32

Implementation planning and strategies – Phase 3 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. 9 • Implement documentation improvement strategies where needed 33

Implementation planning and strategies – Phase 3 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 • Develop closer links between clinicians and coders to effect improvement 34

Implementation planning and strategies – Phase 3 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 35

Implementation planning and strategies – Phase 3 Education and training • Minor update, changes represent improvements to reflect latest clinical knowledge, better indexing to aid coding of interventions and operations. • Code format and coding process will not change, so conversion training not required • Coders to review the Key Learning Points (KLPs) and the table of changes and full coding standard in the updated National Clinical Coding Standards OPCS-4. 9 reference book, available in January/February 2020. 36

Implementation planning and strategies – Phase 3 Education and training • Trainers, managers and coders can use the Summary of Changes, KLPs and updated reference book to learn about the changes to OPCS-4. 9 and the main changes to National Standards, available in January/February 2020 • Trusts to assess and decide level of update awareness training required to suit local needs. • To facilitate awareness sessions, the Terminology and Classifications Delivery Service provide a Power. Point slide deck with associated Exercise and Answer Booklet for Trusts to adapt to meet the local needs, available in January/February 2020 37

Implementation planning and strategies – Phase 3 Consider update awareness needs for: • Clinical coders • Information personnel • Clinicians • Senior management staff • Information technology staff • Finance • Auditors • Commissioners • Clinical department managers • Data analysts • Researchers • Epidemiologists/Public health 38

Implementation planning and strategies – Phase 3 Data uses • Performance improvements • Corporate compliance • Data quality management • Data security • Clinical documentation • Reimbursement 39

Implementation planning and strategies – Phase 3 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 • Purchase of OPCS-4. 9 books (if required), the Classifications Browser and e. Version are available for free. 40

Implementation planning and strategies – Phase 3 Additional implementation preparation steps • Refine project plan, timeline and budget as needed • Assess potential reimbursement impact • Develop strategies to minimise problems and maximise opportunities • Assess impact of –Decreased coding productivity –Decreased coding accuracy 41

Implementation planning and strategies – Phase 3 Register now …. • Agree the authorised person within the organisation to accept licence agreements on TRUD • Register on TRUD in readiness for the OPCS-4. 9 data files to download when released. Requestor will be notified when files become available. 42

Implementation planning and strategies Phase 4 – Go live preparation 43

Implementation planning and strategies – Phase 4 – Go live preparation • Follow-up on readiness of systems suppliers • Develop business continuity plan in case critical systems are adversely affected when the OPCS-4. 9 implementation goes live • Completion of communication plan • Provide senior executives and stakeholders with updates 44

Implementation planning and strategies – Phase 4 Information Standards Notice (ISN) • Review ISN and associated documentation and ensure those with responsibility for IT contracts have read and are taking appropriate actions to meet planned deliverables 45

Implementation planning and strategies – Phase 4 OPCS-4. 8 data files • Download data files released via Technology Reference Update data Distribution (TRUD) in November 2019: • OPCS-4. 9 Codes and Titles • OPCS-4. 9 Metadata • OPCS-4. 9 Table of Coding Equivalences • Technical specification documents 46

Implementation planning and strategies – Phase 4 Complete tasks identified in Phase 1 - during impact assessment • Implement system changes • Provide education to users where needed • Implement and monitor documentation improvement strategies • Re-engineer processes and workflows identified in Phase 1 if necessary • Complete internal testing • Begin external testing once system suppliers are ready 47

Implementation planning and strategies – Phase 4 OPCS-4. 9 volume sets • Purchase OPCS-4. 9 Volumes sets from The Stationary Office from January/February 2017 if required, purchase and discount information will be available on our collaborative site – Delen • Ensure staff can download the e. Version from TRUD and access the NHS Digital e. Version Classifications Browser, when available • Clinical coders should not attempt to manually add the OPCS-4. 9 changes into their OPCS-4. 8 books because of the number of changes and of the risk of introducing errors which will impact data collection and statistical outputs. 48

Implementation planning and strategies – Phase 4 Training and education • Deliver training requirements where needed • Download key learning points and National Clinical Coding Standards OPCS 4. 9 reference book from Delen in January/February 2017 • Ensure protected time for clinical coders to review: • Changes to the classification • Key Learning Points and the table of changes and full coding standards in the updated National Clinical Coding Standards OPCS-4. 9 reference book. 49

Implementation planning and strategies – Phase 4 NHS Digital Classifications Browser • Accessible from any computer with an internet connection • Free to all so an alternative to purchase of books. Trusts may wish to purchase 1 or 2 copies as a backup. • OPCS-4. 9 available in the browser January/February 2020 • Clinical Coders • Advise Trust IT department to allow access to the NHS Digital Classifications Browser • IT Manager/ IT department • Whitelist, if necessary, the NHS Digital Classifications Browser to ensure access OPCS-4. 9 e. Version • Available for download from TRUD to load into e. Version January/February 2020 More information on the e. Version and Classifications Browser available on Delen. 50

Implementation planning and strategies – Phase 4 SNOMED CT users: • Download data via Technology Reference Update data Distribution (TRUD) website in March 2020: • SNOMED CT to OPCS-4. 9 Cross-maps • Cross-maps Change Report • Cross-maps Tables Technical Specification 51

Implementation planning and strategies – Phase 4 Legacy terminologies • V 2 terminology was retired following the April 2016 terminology release and CTV 3 was retired following the April 2018 terminology release • Consequently the V 2 and CTV 3 cross-maps to ICD-10 and OPCS-4 are no longer updated – the last release was April 2016 • Static legacy cross-maps files will continue to be available from NHS Digital, on request. 52

Implementation planning and strategies – Phase 4 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 53

Implementation planning and strategies – Phase 4 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. 9 Tables of Coding Equivalences are part of the data files available for download from TRUD from 4 November 2019. 54

Implementation planning and strategies – Phase 4 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. 9 codes and coding standards and improve skills in areas identified in gap analysis 55

Implementation planning and strategies Phase 5 – Post implementation 56

Implementation planning and strategies – Phase 5 – Post implementation • Lessons learned and post implementation review • What can you learn for next time? • What went well? • What didn’t go well? • Did you implement OPCS-4. 9 on time? • Did you implement the required changes that were identified in each phase of your implementation plan? • Informs future updates 57

Did this help you? • Let us know if this implementation support helped, and how we can improve for future releases ………. . 58

Links to central resources Technology Reference Update data Distribution (TRUD) https: //isd. hscic. gov. uk/trud 3/user/guest/group/0/home NHS Digital – Terminology and Classifications Delivery Service Collaboration site https: //hscic. kahootz. com/connect. ti/t_c_home/grouphome 59

Connect with us @nhsdigital company/nhs-digital www. digital. nhs. uk 60