Microsoft BizTalk Server 2009 for Health Plans and Providers

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					                                                                                Microsoft BizTalk Server 2009
                                                                              for Health Plans and Providers
Microsoft readies it’s Platform and Partners to take on the Health Industry’s Equivalent of the
Millennium Change: Y2K10
Executive Summary
Effectively using information technology to reduce
cost and eliminate complexity is a focus of Health Care
Reform. New mandates are an opportunity to drive
down cost while improving the quality of health care
delivery using the richer data set inherent in the
International Classification of Diseases (ICD-10)
mandated for use on October 1, 2013.
The change to ICD-10 is characterized as the health
                                         th      1
industry’s equivalent of Y2K to the 10 power . The
complete ICD-10 code set is nearly ten times larger
than the ICD-9 code set it is replacing. Further
complicating the federally mandated deadline is the
fact that before ICD-10 can be put into production, the
switch from HIPAA 4010A1 to HIPAA 5010 must be in
place. Overall, it’s easy to see that the road to reform
is littered with complex and costly challenges but by
selecting the right technology, health organizations
can smooth the path.                                                    Figure 1- The Road to Reform



ICD-10 – Complex and Potentially Costly                                 4010A1 to 5010 – Upping the “Ante”
The “Y2K problem” centered on the practice of storing a year            Adding to the risk, complexity, and costs is the fact that HIPAA
as two characters instead of four. The comparison to the ICD-           5010 capabilities are a “must have” in order to support ICD-
10 challenge is appropriate; the ICD-10 codes are larger than           10. Beginning on January 1, 2012, the HIPAA standard
the ICD-9 values, but the comparison stops there. The                   transactions, first mandated in 2000, covering the health claim
difference in length between ICD-9 and ICD-10 is trivial                process, will change version. The original version does not
compared to the sheer volume of new values:                             accommodate ICD-10.
ICD-9 Diagnosis Codes               ICD-10 Diagnosis Codes
3-5 digits, with minor exceptions   3-7 alphanumeric characters
                                                                        Not a Crisis an Opportunity
13,000 with broad descriptions      68,000 with detailed descriptions   Some call the switch to ICD-10 coupled with HIPAA 5010 a
                                                                        crisis; however it is a crisis that health plans, providers, and
ICD-9 Procedure Codes               ICD-10 Procedure Codes
                                                                        other health organizations should take advantage of to
3-4 digits                          7 characters
3,000 with broad descriptions       87,000 with detailed descriptions   redefine business process and technology to accelerate
                                                                        administrative simplification. This is an opportunity that will
Other countries have already switched to ICD-10, but the                allow health organizations to reduce dependencies on
version the U.S. has chosen to implement is more complex                antiquated systems and allow for true innovative system
and granular.                                                           consolidation.

The increased number of codes, the change in code length,               ICD-10 and Electronic Health Records
combined with considerably more code specificity means                  The key for successful migration to ICD-10 and EHRs is to
the replacement of ICD-9 requires significant planning,                 establish an environment where new and old technology,
system modifications or upgrades, along with training and               along with like and unlike data sets, coexist and exchange
other investments. Potentially all departments and their                information while reengineering existing workflow.
support systems in all U.S. health organizations, providers
and plans alike, are affected.
ICD-10 and the inherent richer data set coupled with proven                  Why Microsoft BizTalk Server 2009 for Health
Microsoft technologies, such as Microsoft Office and                         Organizations?
SharePoint, enable health organizations to:                                  Microsoft’s BizTalk Server 2009, coupled with other platform
    Predict future health issues by trending a richer data                  technologies such as Microsoft SQL Server 2008 and
      set                                                                    Microsoft Office SharePoint Server 2007, enable health
    Increase patient safety                                                 organizations to simplify their solution infrastructure and
    Administer higher quality care                                          reduce costs by leveraging the platform’s “in the box”
    Measure outcomes more effectively                                       capabilities, partner resources, and best practices. Specifically
    Reduce friction in claims and payment processing                        the Microsoft platform provides the following:
      because of significantly more granular diagnoses                       Native Support for 5010 to Meet the Mandate
    Make clinical and financial decisions faster – more                     HIPAA mandated the use of Accredited Standards
      specific information allows clinicians to evaluate                     Committee X12’s 4010 version in 2000. The new mandate,
      previous diagnoses faster, leading to more accurate                    slated to take effect on January 1, 2012, is for X12 version
      decisions – improving the quality of healthcare in the                 5010. HIPAA 5010 messaging schemas, trading partner
      process                                                                management and integration components are included
                                                                             with BizTalk 2009 at no additional cost.
Health Organization Challenges
Health Plans and Providers face numerous challenges,                         Straightforward ICD-10 Compliance to Keep Mission
including the need to:                                                       Critical Systems Going
Enable compliance while driving business process,                            Once 5010 is in production, ICD-10 is easily sent and
automation, simplification, and self service                                 received in time for the October 1, 2013 deadline.

      Business owners require an innovative technical                       Leverage your Existing IT Investment to Save Money
       foundation so innovation flourishes                                   BizTalk Server 2009 inherently integrates with the entire
      Manual workflow prevents operations and IT to plan                    suite of Microsoft tools and interoperates with legacy
       their long- and short-term strategy                                   applications and JAVA based platforms. Application
                                                                             adapters and toolkits are also included with BizTalk Server
      Information workers need to be self sufficient thus
                                                                             2009 at no additional cost.
       reducing their reliance on IT for everyday needs
Reduce dependency on legacy mainframe systems to                             Getting Started
lower IT and administrative costs                                            Downloads and Additional Information
      Costs to maintain and support legacy systems are                      The Federal mandate to transition to 5010 and ICD-10
       increasing                                                            presents a unique, time-sensitive opportunity for health
      Legacy systems do not provide the business owners                     organizations. Health Plans and Providers should act now to
       the flexible platform required to advance solutions                   define their goals, assess their current state, plan for change,
       leading to redundant systems                                          then build, test, and deploy new solutions taking advantage of
      Healthcare systems require agile, flexible                            this critical opportunity. Contact your local Microsoft Account
       environments allowing data to flow without friction                   Team to setup a solution discussion, demo and presentation:

Integrate new and old technologies regardless of data                            Contact Microsoft Health Plan Industry Group at
                                                                                    hlthplan@microsoft.com
formats
    The only constant; nothing is constant. Health                              Contact Microsoft Health Provider Industry Group at
      environments are complex and as technology                                    health@microsoft.com
      evolves organizations can’t replace multiple systems                   The resources below provide product trials, additional
      at the same time                                                       information and tools:
    Business operations must not stop - New and old                             BizTalk Server 2009 Trial License is available at
      must run side by side for a period of time. ICD-9 to                          http://www.microsoft.com/biztalk/en/us/try-it.aspx
      ICD-10, HIPAA 4010A1 to 5010, old EMR system to
                                                                                 BizTalk Server 2009 HIPAA 5010 schemas and
      new EMR system – all require tandem processing
                                                                                  components -
      and must not affect clinical, claim, or payment flow
                                                                                    https://connect.microsoft.com/site/sitehome.aspx?SiteID=218
                                                                                 Enterprise Service Bus (ESB) Toolkit at
 1
  “Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS: Challenges, Estimated
                                                                                    http://www.microsoft.com/biztalk/en/us/esb-guidance.aspx
 Costs, and Potential Benefits,” Robert E. Nolan Company, October 2003