1. ICD10 Implementation: Lessons from SA’s experience Rajesh Patel September 2014 Windhoek, Namibia

2. Objectives What is health governance? Need for language standardisation SA background to implementation NAMAF or ?: Coding in Namibia Implementation needs International developments Q&A

3. Stakeholders Government/funders Health governance Service providers Health governance Medical audit Coding relevant for all stakeholders!

4. Health governance 1.Health needs 2.Health services or benefits 3.Actions, interventions, programs 4.M&E Medical Scheme: Vehicle for the collection of funds to provide for the health needs of “private” members

5. Dx Prevalence SA (%): Use of coding Disease20102011 Asthma2.83.1 Diabetes2.83.1 Hypertension9.910.6 HIV (CMS)1

6. Need for language standardization! ICD or ICPC ICD10 or ICD11 or other Which one? Choose and make the move!

7. Why Is Diagnostic Coding Important? used in the health care industry to classify and organize groups of diseases, disorders and symptoms. intended to improve both the response time and the accuracy of medical organizations. it improves the services that are available to the average person, and also makes them more manageable from an organizational perspective. is an information conduit, facilitating communication between different agencies and health care professionals.

8. Background Managed care introduction in SA 1995 Need for clinical information to be captured Establishment of PHISC from RAMS/BHF offices ICD10 ICPC ICD9CM 1997: DG announced adoption of ICD10 No documented record

9. Background MSA & Regulations 1999 PMB Minimum data on claims, incl. diagnostic code PMBs from 2000 NHA of 2003 chapter 9 Need for coding to access PMB benefit ICD10 implementation for private sector billing from June 2005. Implementation TT co-ordinated by CMS 2011: Role of coding in NHI 2012 Ministerial implementation task team

10. Implementation in Namibia Do you have regulatory support/enabling legislation? Yes! No! Voluntary implementation Start with funder coding for managed care activities Lots of documentation from SA »www.health.gov.zawww.health.gov.za

11. NAMAF or ? co-ordination Emphasis on coding training Accredited coders Coding trainers Train the trainer programs Staff coding training Provider coding training

12. NAMAF or ? co-ordination Technical team: ICD10 Implementation Task Team Coding expertise Business process expertise IT system expertise Clinicians with HIS expertise Governm. officials

13. NAMAF or ? co-ordination Standardisation of rules, use and systems to capture and communicate data Quality of coding Confidentiality concerns Legitimate Purpose of coding Excuse for not co-operating Call centre

14. Grouper ACG: Johns Hopkins DRG: various

15. International developments WHO: Family of coding classification Diagnostic Procedure Disability MRC in SA: collaborating center ICD10 rollout in US current Development of ICD11

16. Thank You