ICD-10 Customer Testing Guidelines and Scenarios

Transcription

1 ICD-10 Customer Testing Guidelines and Scenarios Revision 2.0 Updated July 21, 2015 This document includes pre-release information and user interface designs that are in development for upcoming enhancements to the RelayClinical service. This document and user interface designs included herein are subject to change prior to General Release RelayHealth. All rights reserved.

2 Table of Contents Purpose... 3 Testing Scenarios Applicable to Your Organization... 3 Key Milestones... 3 Testing Feedback... 3 Frequently Asked Questions... 4 ICD-10 Test Scenario for Practice Services Setting... 6 ICD-10 Test Scenario for Add Patient Diagnosis Workflow... 7 ICD-10 Test Scenario for Patient Problems List... 9 ICD-10 Test Scenario for Patient Chart Summary (RelayClinical Record Chart Tab) ICD-10 Test Scenario for Colleague Message Workflow ICD-10 Test Scenario for RelayClinical Referral Message Workflow ICD-10 Test Scenario for RelayClinical webvisit Workflow ICD-10 Test Scenario for Download Health Data Workflow ICD-10 Test Scenario for Build Patient List Workflow ICD-10 Test Scenario for Bulk Patient Upload Workflow ICD-10 Test Scenario for Patient Merge ICD-10 Test Scenarios for Orders Manager Users ICD-10 Test Scenarios for Electronically Placed Orders - Integrated ICD-10 Test Scenarios for Electronically Placed Orders Swivel Chair ICD-10 Test Scenario for Inbound ADT ICD-10 Test Scenario for Inbound CSV ICD-10 Test Scenario for Inbound CCD / CDA ICD-10 Test Scenario for RelayHealth Aggregated CCD Outbound

3 Purpose This document provides detailed testing information for customers who prefer to evaluate RelayHealth s support for the ICD-10 code set prior to the October 1, 2015, transition deadline. Testing Scenarios Applicable to Your Organization Testing scenarios included in this document will not apply to all RelayHealth customers. To determine which testing scenarios apply to your healthcare organization, users performing ICD-10 testing should consider RelayHealth Provider Portal application workflows in use at the practice or health system, optional modules currently licensed and deployed (i.e., RelayClinical Orders, RelayClinical Notify, etc.), as well as existing interfaces inbound to RelayHealth. Key Milestones Production Environment: Limited Release August 4, 2015 Confirmed Limited Release Partners may begin testing in RelayHealth s Production environment on or after August 4, General Release September 1, 2015 ICD-10 Code Set support made available to all customers in RelayHealth s Production environment. All Practice Administrator users have the ability to enable ICD-10 display and use for all practices in which they have Practice Administration privileges. Integration Environment: Limited Release Not Applicable Limited Release in RelayHealth s Integration Environment is not applicable to customer testing or use of the ICD-10 code set. General Release August 4/5, 2015 ICD-10 Code Set support available to all customers in RelayHealth s Integration environment for testing purposes. Note: switch scheduling for August 4, 2015, has not yet been finalized; customers should anticipate testing ICD-10 code set functionality beginning on August 5, 2015.Practice Administrators who have Integration environment accounts have the ability to enable ICD-10 display and use for all test practices in which they have Practice Administration privileges. Note: The above dates are not applicable to Enhanced Orders and Orders Manager, as these features went into Production Limited Release with identified partners on June 3, Testing Feedback Please send all testing questions, issues, or comments to the following monitored inbox: ICD10testing@relayhealth.com 3

4 Frequently Asked Questions Testing How can I enable ICD-10 for my practice(s)? When RelayHealth has activated support for the ICD-10 code set, Practice Administrators may enable ICD-10 display and use, at the practice level, in the Settings area of the Provider Portal. Please refer to ICD-10 Test Scenario for Practice Services Setting, in this document, for detailed workflow instructions. How will I know when RelayHealth has activated support for the ICD-10 code set? Please refer to the Key Milestones schedule in this document for release dates in RelayHealth s Integration and Production environments. If I enable ICD-10 display and use for my practice(s), can I disable it? Yes. Practice Administrators have the ability to disable ICD-10 display and use in the Settings area of the Provider Portal. Refer to ICD-10 Test Scenario for Practice Services Setting, in this document. Simply uncheck the checked box(es) and Save to disable ICD-10 display and use. If I try to enter an ICD-10 coded diagnosis in the Provider Portal before enabling ICD-10 display and use for my practice, what happens? In this scenario, attempting to add an ICD-10 code manually within the Provider Portal does not return any results in the type-ahead ICD-9 search fields. Note that the field label itself specifies the type of accepted code set. For example, when an ICD search field displays an ICD-9 label, the service returns only ICD-9 results for that field. Once the practice has enabled support for ICD-10, the field label specifies ICD-10 and the service returns only ICD- 10 results for the type-ahead search. If my organization sends an ICD-10 coded diagnosis inbound to RelayHealth before RelayHealth activates support for ICD-10, what happens? The answer is dependent upon the inbound message type. For example, if the customer organization sends an inbound ADT or CSV with an ICD-10 code before RelayHealth has activated support for ICD-10, the message will process successfully, but RelayHealth ignores the ICD-10 diagnosis code. If the inbound message is a CDA, RelayHealth will add the ICD-10 diagnosis to the patient s record as free text. If the customer organization uses the Bulk Patient Upload feature and includes ICD-10 coded diagnosis data in the upload spreadsheet before RelayHealth has activated support for ICD-10, the spreadsheet will upload successfully and RelayHealth ignores the ICD-10 diagnosis code. If my organization sends an ICD-9 coded diagnosis inbound to RelayHealth after RelayHealth activates support for ICD-10, what happens (e.g., will the transaction fail)? When RelayHealth has activated support for the ICD-10 code set, the service will have the ability to accept either ICD-9 or ICD-10 codes in inbound messages, and RelayHealth will not fail the transaction. 4

5 Will RelayHealth provide mapping services from ICD-9 to ICD-10? No. RelayHealth will store the code as received in an inbound message or as entered manually in the Provider Portal; the service will not map from ICD-9 to ICD-10 or from ICD-10 to ICD-9. When the practice has enabled ICD-10, what happens to existing ICD-9 coded diagnoses data on the patient record? The patient record retains any existing ICD-9 coded diagnosis data. Updates or additions after the ICD-10 conversion will be added to the patient record, and ICD-10 codes will not overwrite a previously received ICD-9. Will RelayHealth update ICD-9 codes with the new ICD-10 code on historical patient information? For example, will the Personal Health Record update existing diagnosis codes/descriptions with new ICD-10 codes/descriptions? No. Existing ICD-9 coded diagnosis data will remain in the health record and will not be updated as a result of the ICD-10 transition. RelayHealth will not provide historical data mapping from ICD-9 to ICD-10. Will RelayHealth support dual coding (i.e., users can enter ICD-9 and ICD-10 codes) in the Provider Portal? For most workflows, no. Once the Practice Administrator has enabled ICD-10 support for the practice, ICD search fields in the Provider Portal will return results only for ICD-10 diagnosis codes. The search field label specifies ICD-9 or ICD-10 depending upon the current state of the option in the practice s Settings area (i.e., ICD-10 code display and use enabled or disabled). Exceptions are: Build Patient List Feature: When the Practice Administrator has enabled ICD-10 support for the practice, the Build Patient List feature will display separate search fields for ICD-9 and ICD-10. This design allows users to capture patient records that have only ICD-9 codes, only ICD-10 codes, or a combination of both. RelayHealth Orders Application(s): Orders Manager users RelayHealth will enable Orders Manager practices with a unique switch. Prior to enabling that switch, Orders Manager will display a field labeled ICD-9. Once the switch is enabled for the practice, the user creating the order in Orders Manager will view a field labeled ICD-10. Orders Manager will not support simultaneous use of ICD-9 and ICD-10. Enhanced Orders users Enhanced Orders will display both ICD-9 and ICD-10 fields concurrently. General Is there any cost associated with the ICD-10 transition? There is no cost passed on to customers unless it is a result of a requested Client Services engagement or request for an interface enhancement (e.g., if the customer requires an interface enhancement to ADT or CDA in order to send diagnosis data that is not currently being sent inbound to RelayHealth, standard services fees will apply). When will RelayHealth disable support for ICD-9? RelayHealth has no current plans to disable support for ICD-9. 5

6 ICD-10 Test Scenario for Practice Services Setting Scenario Verify that Administrator can enable ICD-10 from the Provider Portal. User has Practice Administrator privileges for the practice. 1. From the Provider Portal Home Page click Settings at the top of the page 2. Click on the Practices tab 3. Select Services from the left navigation menu 4. At the bottom of the View Practice Services page, click Edit 5. Check Enable. If you would like to apply to all practices, check Apply to All Practices 6. Click Save Verify that the ICD-10 code option is now present on the next series of testing work flows 6

7 ICD-10 Test Scenario for Add Patient Diagnosis Workflow Scenario Verify that the ICD-10 code option is present when adding a diagnosis code to a patient record. Verify that you can search by a full or partial diagnosis description. Must have a test patient record created 1. From the patient record, click on the Problem and Procedure Tab 2. Add a new diagnosis by clicking on New 3. Type all or part of the diagnosis that you are looking for 4. Select the appropriate code from the list 5. Check Add to patient problem list 6. Select the appropriate Status 7. (Optional) Enter Active date, Inactive date, or Resolution date 8. (Optional) Select Chronicity 9. (Optional) Select Severity 10. (Optional) Select Treating Physician 11. (Optional) Add Clinical Notes/Diagnosis in free text field 12. Click Save 7

8 Verify that ICD-10 Code field is displayed for entry when adding a New diagnosis to the patient s record Verify that you can search for an ICD-10 code Verify diagnosis and ICD-10 code displays in the patient record under Diagnoses 8

9 ICD-10 Test Scenario for Patient Problems List Scenario Verify that by clicking Add to Patient Problem List, the ICD-10 code selected adds the Problem to that section of the patient record Must have a test patient record created. Can use the same patient record created for the previous test. 1. From the patient record, click on the Problem & Proc. tab Verify that you can see both the Problems and Diagnosis in the patient record Verify that the descriptions on both lists match Note: You will not see the SNOMED codes on the Problem List 9

10 ICD-10 Test Scenario for Patient Chart Summary (RelayClinical Record Chart Tab) Scenario Verify that the Problems section is populated on the patient s Chart Summary tab. Problems and Diagnosis previously added to the patient record 1. Find the patient record that you added Diagnosis and Problems Verify that the Problems are listed on the patient Chart Summary 10

11 ICD-10 Test Scenario for Colleague Message Workflow Scenario Verify that you are able to enter an ICD-10 code when completing a Colleague to Colleague Message Must have a test patient record created. Can use the same patient record created for the previous tests. 1. From the patients record, select New Colleague Message from the Actions drop down menu 2. Add Recipient and Date of Visit 3. Add the diagnosis code by typing all or a partial description of the issue 4. Complete all remaining fields (noted by an *) 5. Complete message by selecting desired option a. Send b. Forward Draft c. Save Draft d. Delete e. Cancel Verify that the Colleague message populated with the selected ICD-10 code. 11

12 ICD-10 Test Scenario for RelayClinical Referral Message Workflow Scenario Verify that you are able to add an ICD-10 code to the Referral Message. Must have a test patient record created. Can use the same patient record created for the previous tests. 1. From the patient record, select New Referral from the Actions drop down menu 2. Add Provider Information 3. Under Referral Information, search and add the ICD-10 code 4. Complete all remaining fields (noted by a red asterisk *) 5. Complete by clicking Send Verify that the ICD-10 code populates in the Referral Message 12

13 ICD-10 Test Scenario for RelayClinical webvisit Workflow Scenario Verify that you are able to enter an ICD-10 code when conducting a webvisit Test patient record created. Can use the same patient created for all of the previous tests The test patient must be Online 1. From the patient record, select New Patient Message from the Actions drop down menu 2. From the left hand navigation click on the webvisit button 3. From the drop down menu select the category of your webvisit, or click on go to select all categories 4. From the list Select Quick Pick, select the Symptom associated with your webvisit a. You can either Preview or Attach 5. After attaching the desired webvisit, complete the remaining components of the Message 6. Click Send to Patient 7. To continue testing this work flow, you will need to log out as the provider, and log back in as the patient that you just sent the webvisit to. 8. Logged in as the patient, open the webvisit message that you just sent. 9. Complete the webvisit questions 10. When you reach the screen that asks you to enter a Credit Card Number, use the following number: All other information can be test information 11. Complete and click Send 12. Log out as the patient, and log back in as your provider 13. From your Inbox find the patient webvisit and open message 14. Click on Reply to Patient 15. Add a free-text test message. 16. At the bottom of the message, click on Working Dx Add 13

14 17. Search for your desired ICD-10 Diagnosis Code 18. Complete webvisit and Send to Patient 19. Click on Confirm and Send to Patient Verify that when adding a working diagnosis, you see the option to search for or select an ICD-10 Code in these sections: Search for a Diagnosis Search for ICD-10 Diagnosis Verify that ICD-10 code was added to the webvisit message reply back to the patient under the Working Dx Add 14

15 ICD-10 Test Scenario for Download Health Data Workflow Scenario Verify that a patient s ICD-10 coded diagnosis data is included in the downloaded/exported file Test patient record created with ICD-10 coded diagnoses data. Can use the same patient created for all of the previous tests The test patient must be Online (Test 3 requires logging in to the Patient Portal) Tests: Test 1: Provider Portal 1. From the patient s RelayClinical Record, click the Administrative tab 2. On the secondary navigation, click Import/Export data 3. In the Download Health Data section, leave the dropdown set to PDF 4. Click the download button 5. Depending upon your browser s functionality, either Open the PDF immediately or Save the PDF to a local drive and then open the file Verify that the PDF document s Problems section includes ICD-10 description, code, and code type. If the test patient account had previously entered ICD-9 coded diagnoses data, verify that the ICD-9 entry is included in the Problems section as well. NOTE: If the Add to patient problem list checkbox was checked when the diagnosis was added to the patient record manually, or if the customer account is configured to add Diagnoses to Problems automatically, this data will be combined in the CCD Problems section and the section will display duplicate Problem, Date, and Status information. This is expected behavior. 15

16 Test 2: Provider Portal 1. From the patient s RelayClinical Record, click the Administrative tab 2. On the secondary navigation, click Import/Export data 3. In the Download Health Data section, use the dropdown to select XML 4. Click the download button 5. Open the XML file 6. Use Ctrl + F combination to launch your browser s Find functionality. 7. Search for Problems Verify that the XML document s Problems section includes ICD-10 description, code, and code type. If the test patient account had previously entered ICD-9 coded diagnoses data, verify that the ICD-9 entry is included in the Problems section as well. 16

17 Test 3: Patient Portal 1. Log in to the Patient Portal using the account that contains ICD-10 diagnosis data (i.e., use the same patient created for all of the previous tests) 2. On the Home page, click the Download My Data section 3. On the More Options page, click the blue button at the center of the page 4. The CCD Format Health Data page displays. In the Download Health Data section, leave the dropdown set to PDF 5. Click the download button 6. Depending upon your browser s functionality, either Open the PDF immediately or Save the PDF to a local drive and then open the file Verify that the PDF document s Problems section includes ICD-10 description. The ICD-10 code will not be included in the patient generated document. This is expected behavior. If the test patient account had previously entered ICD-9 coded diagnoses data, verify that the description from the ICD-9 entry is included in the Problems section as well. Again, the ICD-9 code will not be included in the patient generated document. This is expected behavior. 17

18 ICD-10 Test Scenario for Build Patient List Workflow Scenario Verify that you can build a patient list by using the ICD-10 criterion Test patient record created. Can use the same patient created for all of the previous tests 1. From the Provider Portal, click on the Patients tab on the top navigation bar 2. From the left hand navigation click on Build Patient List 3. Click on New Patient List 4. Begin building your list by adding a free text List Name 5. Select your desired ICD-9 and/or ICD-10 Diagnosis code NOTE: You will see both the ICD-9 Diagnosis and ICD-10 Diagnosis options. The service displays both so that you can capture existing patients with only ICD-9 codes in your selection if you are building your list based on a different criterion. 18

19 6. Complete by clicking Build List 7. Allow required time for the service to build the list. Click F5 on your keyboard to refresh. 8. When the list has finished building, click the Include Patient Health Data in Export checkbox. 9. Open the export file. Verify that exported list includes both ICD 9 and ICD 10 diagnoses 19

20 ICD-10 Test Scenario for Bulk Patient Upload Workflow Scenario - Verify RelayHealth accepts, processes, and stores ICD-10 diagnosis code from an uploaded CSV spreadsheet using the Bulk Patient Upload tool. User has Data Administration privileges. The bulk upload process requires that your practice have an established Partner ID. If your practice does not have an established Partner ID (if, for example, your organization does not currently use ADT integration with the RelayClinical service), please contact your RelayHealth Project Manager or Deployment Specialist to request configuration of the ID. When RelayHealth has enabled ICD-10 support, users with Data Administration privileges can test the Bulk Patient Upload workflow in the provider portal as follows: 1. When logged in to the Provider portal, click the Patients tab. 2. On the left navigation, select Bulk Patient Upload. 3. Download the blank spreadsheet titled "Upload Patients - Bulk doc" and save it to a local drive. 4. In the spreadsheet file, complete all fields marked as required. 5. In the PatientDiagnosis field, enter a valid ICD-10 code and save the file. 6. Upload the file. Patient record uploads successfully. To validate, search for and select the patient record. On the Chart tab, select Problems & Proc. from the secondary navigation bar. Review the patient's Diagnosis list to confirm the Diagnosis, Code, and Code set (ICD-10) display as expected. If invalid ICD-10 code used in the spreadsheet, patient upload spreadsheet will process successfully (i.e., patient record created as expected), but RelayHealth ignores the invalid code and does not add the ICD-10 diagnosis to the new patient record. 20

21 ICD-10 Test Scenario for Patient Merge Scenario - Verify ICD-10 diagnosis data is retained on the surviving patient record when two patient records are merged. User has Merge Patient Record privileges enabled for his/her account. 1. In the Provider portal, using the Add a New Patient workflow, create Patient A. 2. When the patient's RelayClinical Records displays, on the Chart tab, select Problems & Proc. from the secondary navigation bar. 3. In the Diagnosis section, click New. 4. Add an ICD-10 coded diagnosis to this patient's record, and Save. 5. In the Provider portal, using the Add a New Patient workflow, create Patient B with the same demographics as Patient A, but do not merge the records when application offers. 6. When Patient B's RelayClinical Records displays, on the Chart tab, select Problems & Proc. from the secondary navigation bar. 7. In the Diagnosis section, click New. 8. Add a different ICD-10 coded diagnosis to Patient B's record, and Save. 9. On the Chart summary tab of either Patient A or Patient B, click Find Duplicates. 10. Merge the records. The Diagnosis list for the merged record (on the Problems & Proc. tab) includes both diagnoses from the merged records. RelayHealth will not map an ICD-9 code to an ICD-10 code or map an ICD-10 code to an ICD-9 code. ICD-10 codes will not be "rolled up" to previously received ICD-9 diagnoses. 21

22 ICD-10 Test Scenarios for Orders Manager Users Scenario 1 - Verify ICD-10 codes can be entered as part of an order created via Orders Manager and transmitted via integrated outbound workflow. Ordering Practice is configured for order creation The Ordering Practice ICD-10 settings have been enabled. Health System is configured for integrated outbound workflow. 1. User logs in and enters credentials as a staff member/provider that can create an order. 2. Click Orders and Results Tab 3. Click Create New Order link 4. Add a new or search for and select an existing patient 5. Select an Ordering Provider 6. Select an orderable(s) from Favorites or search for and select an orderable. 7. Select an ICD-9 code(s) in the ICD-9 field (required) 8. Select an ICD-10 code(s) in the ICD-10 field (required) 9. Enter any additional orderable information as needed. 10. Select a destination facility. 11. Select any Billing Type and enter information. 12. Click Send, then OK, then Sign Out. 13. User logs in and enters credentials as a staff member/provider that can process inbound orders. 14. Select the order created above from the queue. 15. View each orderable panel to confirm both ICD-9 and ICD-10 codes and descriptions are present. 16. Click Transmit Selected Orderable(s) button and confirm the pop-in. Via Message Management, view the resulting outbound A14 HL7 message: DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code Via Message Management, view the resulting outbound ORM HL7 message: OBR segments present for each orderable with an OBR-31 segment in the format below. OBR-31 is repeating per ICD-9 and ICD-10 code entered per orderable. [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 22

23 Scenario 2 - Verify ICD-10 codes can be entered as part of an order created via Orders Manager and transmitted via swivel chair outbound workflow. Ordering Practice is configured for order creation The Ordering Practice ICD-10 settings have been enabled. Health System is configured for integrated outbound workflow. 1. User logs in and enters credentials as a staff member/provider that can create an order. 2. Click Orders and Results Tab 3. Click Create New Order link 4. Add a new or search for and select an existing patient 5. Select an Ordering Provider 6. Select an orderable(s) from Favorites or search for and select an orderable. 7. Select an ICD-9 code(s) in the ICD-9 field (required) 8. Select an ICD-10 code(s) in the ICD-10 field (required) 9. Enter any additional orderable information as needed. 10. Select a destination facility. 11. Select any Billing Type and enter information. 12. Click Send, then OK, then Sign Out. 13. User logs in and enters credentials as a staff member/provider that can process inbound orders. 14. Select the order created above from the queue. 15. View each orderable panel to confirm both ICD-9 and ICD-10 codes and descriptions are present. 16. Click Transmit Selected Orderable(s) button and confirm the pop-in. Via Message Management, view the resulting outbound ORM HL7 message: OBR segments present for each orderable with an OBR-31 segment in the format below. OBR-31 is repeating per ICD-9 and ICD-10 code entered per orderable. [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 23

24 ICD-10 Test Scenarios for Electronically Placed Orders - Integrated Scenario 3 - Verify ICD-10 codes can be entered as part of an order created via any EHR and transmitted via integrated outbound workflow. Ordering Practice is configured for order creation The Ordering Practice ICD-10 settings are enabled. Health System is configured for integrated outbound workflow. 1. Create an inbound ORM HL7 message from the Ordering Practice s EMR system. o Orderables need to be updated with one or more OBR.31 segments containing ICD-9/ICD-10 codes and descriptions in the following format: [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 2. Submit the inbound ORM for processing. 3. User logs in and enters credentials as a staff member/provider that can process inbound orders. 4. Click Registration Tab 5. Select the order created above from the queue. 6. View each orderable panel to confirm both ICD-9 and ICD-10 codes and descriptions are present. 7. Click Transmit Selected Orderable(s) button and confirm pop-in. Via Message Management, view the resulting outbound A14 HL7 message: DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code Via Message Management, view the resulting outbound ORM HL7 message: OBR segments present for each orderable with an OBR-31 segment in the format below. OBR-31 is repeating per ICD-9 and ICD-10 code entered per orderable. [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 24

25 ICD-10 Test Scenarios for Electronically Placed Orders Swivel Chair Scenario 4 - Verify ICD-10 codes can be entered as part of an order created via any EHR and transmitted via swivel chair outbound workflow. Ordering Practice is configured for order creation The Ordering Practice ICD-10 settings are enabled. Health System is configured for integrated outbound workflow. 1. Create an inbound ORM HL7 message from the Ordering Practice s EMR system. o Orderables need to be updated with one or more OBR.31 segments containing ICD-9/ICD-10 codes and descriptions in the following format: [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 2. Submit the inbound ORM for processing. 3. User logs in and enters credentials as a staff member/provider that can process inbound orders. 4. Click Registration Tab 5. Select the order created above from the queue. 6. View each orderable panel to confirm both ICD-9 and ICD-10 codes and descriptions are present. 7. Click Transmit Selected Orderable(s) button and confirm pop-in. Via Message Management, view the resulting outbound ORM HL7 message: OBR segments present for each orderable with an OBR-31 segment in the format below. OBR-31 is repeating per ICD-9 and ICD-10 code entered per orderable. [ID]^[TEXT]^[CODESYS]~ [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code DG1 segments present for each ICD-9 and ICD-10 code entered in the format of DG1 [SETID [CODEMETHOD] [ID]^[TEXT]^[CODESYS] [SETID] = set identifier starting with a value of 1 incrementing by 1 per DG1 segment. [CODEMETHOD] = a value of I9 or I10 per code [ID] = ICD-9/ICD-10 code [TEXT] = corresponding ICD-9/ICD-10 description [CODESYS] = a value of ICD9 or ICD-10 per code 25

26 ICD-10 Test Scenario for Inbound ADT NOTE: Most RelayHealth customers do not send Diagnosis data inbound to RelayHealth via ADT and do not need to complete ADT ICD-10 testing. Customers who do not currently send Diagnosis data to RelayHealth in an existing ADT interface, but prefer to do so in the future, should contact their RelayHealth Project Management team to prioritize an interface enhancement. Scenario - Verify RelayHealth accepts, processes, and stores ICD-10 diagnosis code from an inbound ADT A08/A31 or verify the RelayClinical Notify message transmitted to the provider includes the ICD-10 diagnosis description. Customer has existing inbound ADT interface with RelayHealth. Sending system configured to transmit: o ADT A03 and/or A04 messages for licensed RelayClinical Notify customer testing o A08 or A31 messages for all other customer testing Sending system configured to send DG1.3 containing ICD-10 diagnosis code. When RelayHealth has activated ICD-10 support, customers that have interfaces configured to send DG1 segments can test ICD-10 support as follows: Send an ADT inbound to RelayHealth with EVN1 of A03 and/or A04 (RelayClinical Notify) or A08 or A31 (all other customers) and the DG1.3 field valued with a valid ICD-10 code. RelayHealth accepts, processes, and stores ICD-10 diagnosis code from an inbound ADT A08/A31 or verify the RelayClinical Notify message transmitted to the provider includes the ICD-10 diagnosis description. RelayHealth will not map an ICD-9 code to an ICD-10 code or map an ICD-10 code to an ICD-9 code. ICD-10 codes will not be "rolled up" to previously received ICD-9 diagnoses. 26

27 ICD-10 Test Scenario for Inbound CSV NOTE: Most RelayHealth customers do not send patient clinical data inbound to RelayHealth via CSV (comma separated value) spreadsheet and do not need to complete CSV ICD-10 testing. Customers who would like to test CSV inbound can do so using the Bulk Patient Upload tool available in the Provider Portal. Scenario - Verify RelayHealth accepts, processes, and stores ICD-10 diagnosis code from an uploaded CSV spreadsheet using the Bulk Patient Upload tool. User has Data Administration privileges. The bulk upload process requires that your practice have an established Partner ID. If your practice does not have an established Partner ID (if, for example, your organization does not currently use ADT integration with the RelayClinical service), please contact your RelayHealth Project Manager or Deployment Specialist to request configuration of the ID. When RelayHealth has enabled ICD-10 support, users with Data Administration privileges can test CSV ICD-10 using the Bulk Patient Upload tool in the provider portal as follows: 1. When logged in to the Provider portal, click the Patients tab. 2. On the left navigation, select Bulk Patient Upload. 3. Download the blank spreadsheet titled "Upload Patients - Bulk doc" and save it to a local drive. 4. In the spreadsheet file, complete all fields marked as required. 5. In the PatientDiagnosis field, enter a valid ICD-10 code and save the file. 6. Upload the file. Patient record uploads successfully. To validate, search for and select the patient record. On the Chart tab, select Problems & Proc. from the secondary navigation bar. Review the patient's Diagnosis list to confirm the Diagnosis, Code, and Code set (ICD-10) display as expected. If invalid ICD-10 code used in the spreadsheet, patient upload spreadsheet will process successfully (i.e., patient record created as expected), but RelayHealth ignores the invalid code and does not add the ICD-10 diagnosis to the new patient record. 27

28 ICD-10 Test Scenario for Inbound CCD / CDA NOTE: To support the requirements of Meaningful Use, many EMR vendors send diagnoses to RelayHealth using SNOMED codes, rather than ICD codes. Please confirm your vendor sends ICD codes before following the test recommendations for CCD/CDA; if the vendor sends SNOMED, it is not necessary to complete ICD-10 testing. Scenario - Verify RelayHealth accepts, processes, and stores ICD-10 diagnosis code from inbound CCD / CDA. Customer has existing CCD / CDA interface inbound to RelayHealth Sending system (vendor) is configured to send ICD coded diagnosis information to RelayHealth When RelayHealth has enabled ICD-10 support, customers that have existing CCD/C-CDA inbound interfaces can test ICD-10 support as follows: Send a valid CCD/C-CDA transaction inbound to RelayHealth. Within a Problems entry, RelayHealth looks for the ICD code in the <value> element within the Problem Observation (templateid root=" ). For ICD-10 codes, RelayHealth expects to receive a codesystem of in this <value> element. The ICD-10 coded diagnosis will parse to the patient s RelayClinical Record Diagnosis section and will be visible to clinicians in the Provider/Staff Member portal. This aligns with current functionality; diagnosis data is not visible to patients unless the customer account is configured to add diagnosis data to the Problems list. If this configuration is currently enabled for your organization: Validate that the ICD-10 coded diagnosis displays in the PHR Problems list when logged into a patient test account. Note that with above configuration enabled, there may be duplications in the Diagnoses (from a SNOMED description) and Problems (from an ICD description) sections. This is expected behavior Note: when RelayHealth has enabled ICD-10 support, RelayHealth will accept, process and store ICD-9 and ICD-10 diagnosis codes; however, RelayHealth will not map an ICD-9 code to an ICD-10 code or map an ICD-10 code to an ICD-9 code. Additionally, ICD-10 codes will not be "rolled up" to previously received ICD-9 diagnoses. 28

29 ICD-10 Test Scenario for RelayHealth Aggregated CCD Outbound NOTE: RelayHealth has the ability to generate an aggregated CCD upon request by an EMR. If the customer's EMR does not currently pull CCDs from RelayHealth, there is no need to validate the CCD Outbound workflow for the ICD-10 transition. Customers who want to have their EMR pull CCDs from RelayHealth should contact their RelayHealth Project Management team to prioritize an interface enhancement. Scenario - Verify the outbound RelayHealth Aggregated CCD includes ICD-10 coded diagnosis data. Customer EMR is configured to pull CCDs from RelayHealth Access a patient record that has existing ICD-9 coded diagnosis data. Save an ICD-10 coded diagnosis to the patient record. From the EMR system, send a CCD request to RelayHealth for the patient's aggregated CCD. If the requested patient record includes ICD-10 codes from any source, RelayHealth will include them in the RelayHealth-generated CCD document with code system: ICD10 codesystem: Diagnoses originally sent to RelayHealth in ICD-9 format will be included in the RelayHealth-generated CCD document with code system: ICD9 codesystem: If the customer account is configured to allow the diagnosis description from subsequent inbound CCD/C-CDAs to be added to the patient's Problems list as well as Diagnoses list, outbound CCDs will include the diagnosis description in the Problems section. Note that there may be duplications in the Diagnoses (from a SNOMED description) and Problems (from an ICD description) sections. This is expected behavior. RelayHealth will not map an ICD-9 code to an ICD-10 code or map an ICD-10 code to an ICD-9 code. Additionally, ICD-10 codes will not be "rolled up" to previously received ICD-9 diagnoses. 29