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Tackling NPI

August 1, 2005
by Rosemary Abell
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The right strategies can minimize risks.

The National Provider Identifier (NPI) regulation, mandated as a part of the Health Insurance Portability and Accountability Act (HIPAA), got under way May 23 as application for NPI numbers began. HIPAA-covered entities are required to use NPIs by May 23, 2007; small health plans have until May 23, 2008. Organizations will find that few, if any, systems or procedures are unaffected by the initiative.

The NPI is a unique health ID number assigned to healthcare entities to simplify communication between providers and health plans and eliminate the risks of fraud and abuse. The 10-digit ID will replace all other IDs. To ensure privacy, it will not include any information on the location or circumstances of a medical service.

The NPI initiative will affect both business processes and the technical systems that support them. In moving from several IDs to one, organizations must review how they have traditionally assigned IDs, plus the intelligence they have been embedding into existing IDs. They must evaluate how these numbers are used in existing IT and business processes and how the new ID requirements will affect those systems and procedures.

IT is being handed the critical task of "making it happen." However, no simple technology solution, such as creating a cross-reference table, can address all the issues. For example, how will IT ensure that its business partners within the organization are successfully complying with the requirement?

Organizations should be careful that they do not underestimate the time and effort required to shift to the new system and the impact it will have on business and services. The following tips can help ensure successful, cost-effective, on-time implementation.

Establish an enterprise PMO
Organizations need to manage cost, time, scope and quality aspects of the NPI initiative while maintaining client satisfaction. A program management office (PMO) can centralize tasks and maintain total responsibility and oversight for the project. The PMO reduces risk through effective plans and strategies and tracks program status with performance metrics. It strives to effectively deploy staff, improve awareness through communication, and maximize productivity with process management and automation. Goals of the PMO are to deliver the project on time and within budget, maintain alignment with business objectives, and meet or exceed quality objectives.

Develop an enterprise strategy
Senior management must have a clear understanding of the conversion requirements and potential business impacts and risks. The organization should develop an outline of its remediation strategy, including high-level requirements for communication, business user training and technical environment assessment. It should also frame a timeline, resource requirements and cost estimates for proceeding.

Ensure collaboration
Both business and IT personnel should identify and assess the impact of conversion, and they should develop a master plan for remediation. Evaluation by a team of business process and technical subject matter experts should cover potentially affected software components, business processes and external organizations.

The best means of requirements elicitation is focused work groups of appropriate personnel from affected business or functional areas. Another method is walk-throughs of functional areas to view business-area tasks and activities and to speak with personnel who carry out the business processes. Project personnel can develop basic information and analysis approaches from input of the work groups and findings from cross-functional interactions.

Develop a master plan
Creating a conversion program master plan for remediation greatly improves execution of the NPI project. The first step is completing a detailed assessment of impact. Work can then be partitioned into projects and prioritized to allow iterative remediation. The finished conversion program master plan should define (1) how the scope of conversion work will be partitioned into conversion projects, (2) remediation strategies, and (3) the deployment and release management approach. The plan should be managed and maintained by the PMO.

Considering the scope of systems and procedures affected, the time and effort required, and the pending deadline, some providers might look outside their organization for help in implementing the NPI initiative. These organizations should seek an IT services partner that can meet certain criteria: offer assistance with a minimum of disruption, provide a cost-effective compliance solution, and considerably improve efficiency by leveraging healthcare, development and application experience.

Rosemary Abell is a board member and past president of the North Carolina Healthcare Information and Communications Alliance, Research Triangle Park, N.C., and Director of National Healthcare Vertical Solutions, Keane Inc., Raleigh, N.C.