Singapore Migration to a new classification system

Internationally, the area of classification and casemix has been dynamic, with many countries moving to their own adaptations of the WHO’s ICD-10; and have moved forward with regard to more recent versions of DRG systems.

The Singapore Ministry of Health and Ministry of Health (MOH) Holdings (MOHH) recognised that in order for Singapore to successfully migrate from ICD-9-CM to ICD-10-AM it would be necessary to secure the services of a migration partner with the latest classification expertise. The National Centre for Classification in Health (NCCH), the University of Sydney as the migration partner, in conjunction with MOH and MOHH successfully introduced a new classification system in Singapore from January 1 2012. Processes have been put into place that will allow Singapore to move forward and tailor the system to their needs; specifically, in relation to cost weights (as done in the past with AN-DRG Version 3.1).

The project was successful because of careful project planning of the migration strategy. The project plan included a number of phases: pre-implementation, transition and implementation and post-implementation. Education and stakeholder engagement were a key factors for success with health institution visits and stakeholder forums to launch the migration project.

  • Background and benefits of the national program of migration
  • Classification expertise of the NCCH
  • Key milestones and expected outcomes over the next year
  • Change process and education strategy to be put in place.

Stakeholders were then invited to actively participate in discussions which led to the introduction of additional elements into the migration strategy. A migration kit for all users of the classification was developed and distributed in preparation for the education strategy. Training workshops were delivered to mortality and morbidity coders, clinicians, mediclaim coders and other data users.

During January 2012 the NCCH also provided 6 weeks of mentoring to individual health institutions, followed by post-implementation training workshops in April 2012 to consolidate learning and to cover complex areas of the classification that were identified in the first 3 months of implementation.

A post-implementation coding audit was undertaken in July to August 2012 to build on the training elements and practice changes implemented across the Singapore health system. The audit was appropriately timed to acknowledge the transition period associated with the implementation of the new coding system and the need to provide an accurate picture of coding accuracy to inform the development of sound recommenda¬tions. The scope of the audit included 18 hospitals from both the public and private sector.

As well as implementation of Singapore classification governance and communication arrangements to ensure coding standardisation and accuracy, a query escalation process involving help desk support by the NCCH was introduced for a limited period of time following the coding audit.

Upon finalising the project, the NCCH recommendations to the Singapore MOH was that access, transparency, communication, continuing education and regular coding audits were vital moving forward. This would ensure the accuracy and reliability of coded data for many purposes including patient safety and quality, planning and management of health services and funding of health services.