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November 20, 2009

HIPAA 5010 transition – building a case for automation

Bad news first… HIPAA 5010 has nearly 1,000 unique changes. Some of these changes (like expansion of patient last name alone) could have thousands of impact points across your applications and databases. Overall, the number of impact points could easily run into a couple hundred thousand for an organization of average size. The direct and indirect impact of these 1,000 changes on the IT systems needs to be analyzed as the first step in the 5010 transition journey.

Now, imagine your engineers having to manually review each source file and record the impact. How would you ensure that the analysis is accurate – by engaging another developer to review the analysis reports, or by spending four times as much money on comprehensive testing? How would you ensure consistency between analysis reports from different developers so that you are able to see rolled up data for program level planning and tracking? What will be the basis of your status reports to senior management – just gut feel?

These and many more similar questions that are faced by the 5010 program manager converge into one important question – can this transition be automated, at least a significant portion of it? The answer is… yes and very much yes! That’s the good news.

Call it luck, or the generosity of CMS/X12, majority of the 5010 changes follow a pattern – and simple patterns are good candidates for automation. We are talking about patterns that are easy to recognize and automate (no fuzzy logic or artificial intelligence required here).  Take for example, the patient last name, or even better the ICD-9 code. If a tool can recognize the format of ICD-9 code (VVV.VV) in source programs and databases, it is easy to figure out the impact points. Of course the tool can confuse amount fields for ICD-9 codes, and building the ability to differentiate between the two is not that difficult. Not everything is going to be as straightforward, but as I said, majority of the impact is.

Based on my analysis, 80% of the changes or can be identified and remediated via automation. Testing is another area, where automation can allow you to generate 5010 test files (from existing 4010 files) that will cover majority of your business scenarios. I estimate that by leveraging automation in these areas, the overall savings could be anywhere between 40 – 70%. That is a staggering amount considering the cost of this transition could run into millions for an average sized organization.