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Care Technology Governance (CTG) Committee Business Case Document (BCD) for: 3M Computer Assisted Coding (CAC) Aug 7, 2014.

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Presentation on theme: "Care Technology Governance (CTG) Committee Business Case Document (BCD) for: 3M Computer Assisted Coding (CAC) Aug 7, 2014."— Presentation transcript:

1 Care Technology Governance (CTG) Committee Business Case Document (BCD) for: 3M Computer Assisted Coding (CAC) Aug 7, 2014

2 2 The CTG presenter(s): SheRee Garcia, Kevin McLaren & Heidi Collins The ask: At the end of this presentation, we will request this committee to approve project timeline (since the IT/CS shared resources will be paid from capital), contingent on identifying specific budget cuts to completely offset the additional operating expenses prior to signing the contract. 3M CAC Department(s): HIMs, Professional Billing and CDI Sponsor(s): –Executive: Barrie Strickland and Roger Cameron –Department: SheRee Garcia, Cliff Skinner and Brigid Ide IT/CS Leaders(s): Heidi Collins The project: 3M Computer Assisted Coding (CAC)

3 3 Why 3M CAC? 3M CAC 3M Computer Assisted Coding (CAC) is a software application that analyzes health record documents and produces appropriate medical codes for specific phrases and terms within the document using NLP (Natural language processing) technology. 3M CAC will take our healthcare operation into an automated future allowing users to communicate with specificity and accuracy in a timely fashion.

4 4 3M CAC Drivers / Benefits 3M CAC 3M Auto Suggested Codes & Queries 3M CDI and Coding Content 3M CDI and Coding Content 3M Natural Language Processing (NLP) Engine 3M Data Dictionary (as used by the DOD and VA) 3M Data Dictionary (as used by the DOD and VA) 3M Optical Character Recognition 3M data integration to APeX 3M data integration to APeX Optimize chart completeness Improve quality and accuracy Compliance and Reporting analytics Hospital/HIMs Gain efficiencies by reducing the amount of time locating, reviewing, analyzing multiple documents to find what is new in the chart. Speed turn around; get correct DRG in place the first time. Increase accuracy rates on basic and complex cases; enhance monitoring of the coding process. Hospital/HIMs Gain efficiencies by reducing the amount of time locating, reviewing, analyzing multiple documents to find what is new in the chart. Speed turn around; get correct DRG in place the first time. Increase accuracy rates on basic and complex cases; enhance monitoring of the coding process. Professional Billing Reduce expenses (*) by moving to a "coding by exception" model and by: - Replacing outsourced vendor costs - Allowing us to lower our per chart fee to vendors * Savings has dependency on Physician adoption of coding. Professional Billing Reduce expenses (*) by moving to a "coding by exception" model and by: - Replacing outsourced vendor costs - Allowing us to lower our per chart fee to vendors * Savings has dependency on Physician adoption of coding. CDI Improve clinical documentation (consistency, completeness, accuracy) and quality reporting, as health care moves toward quality-driven reimbursement. CDI Improve clinical documentation (consistency, completeness, accuracy) and quality reporting, as health care moves toward quality-driven reimbursement. Benefiting Patients Improving our bottom line Across UCSFHS Department Specific APeX data integration to 3M APeX data integration to 3M Via

5 5 Operational impact: 3M CAC Affected locations: Hospital/HIMs: All IP, all AMB same day Surgeries, some interventional radiology, special procedures for urology. Driven by patient type/class of which we have 5. Professional Billing: Initial build to encompass mostly E&M service and a few surgical procedures: –Adult and pediatric cardiology IP/OP visits –Orthopedic surgical cases –Neurosurgery surgical cases –Hospital Medicine IP services –Endoscopy unit CDI: Patient Safety and Quality Department Personnel: End Users: HIMs (20-25 internal / external), PB (55 internal / 125 external), CDI Pilot (3) and if CDI (+12) Physicians: By PB Specialty Training: Hospital/HIMs and CDI: 3M uses a train the trainer model for coders and Patient Quality team Professional Billing: Physicians, by specialty, will be provided additional training by a PFS team on IMO - Intelligent Medical Objects (Epic’s). APeX Training team is not required; 3M will train the trainers from HIMs, CDI and PB.

6 6 Project scope: 3M CAC Hospital/HIMs: 3M 360 Encompass Release 2 Professional Billing: 3M Code Ryte / Code Assist QI-CDI: 3M Continuous Document Improvement System CDI product is included in 3M Package but UCSF QI-CDI use is TBD IT footprint: Servers (virtual): 5-6 test, 5-6 Prod Databases: 10 test, 10 Prod Memory: more than Epic Network configurations: Minor Interfaces: 6 – 14, depending Workstations: 120 net new (maybe)

7 CDI Pilot Phase 3 (TBD) Professional Billing Phase 1 & 2 Hospital/HIMs Phase 1 & 2 PM: Fei Zho (60-75%) IT/CS Teams: CS Leader (Heidi Collins) IT Server Team IT DBAs IT Network team IT Interface team CS Access/HIMs team + net new 3M Sys Admin CS Revenue Cycle teams IT/CS Teams: CS Leader (Heidi Collins) IT Server Team IT DBAs IT Network team IT Interface team CS Access/HIMs team + net new 3M Sys Admin CS Revenue Cycle teams Project team roles required for success UCSF 3M CAC Implementation 3M CAC Steering Committee: HIMs, PB, CDI & CS Executive Sponsors: Barrie Strickland & Roger Cameron 3M CAC Steering Committee: HIMs, PB, CDI & CS Executive Sponsors: Barrie Strickland & Roger Cameron * Department Sponsors ( %): SheRee Garcia & Cliff Skinner * Department Sponsors ( %): SheRee Garcia & Cliff Skinner SME: Julie Marshall (20-25%) Analyst: Hop Johnson (20-25%) SME: Julie Marshall (20-25%) Analyst: Hop Johnson (20-25%) Testing Lead: Fei Testers: Hope, Judie, Fei Testing Lead: Fei Testers: Hope, Judie, Fei Super User/Trainer: TBD End Users (testing/validation) : TBD Super User/Trainer: TBD End Users (testing/validation) : TBD Department Sponsor: Brigid Ide CDI will participate in policy decisions, the design of the interfaces and high level testing, to ensure technical build occurs once. CDI Pilot (3 users) is to be scheduled (TBD 2016). Full implementation of CDI will depend on pilot and development of current JATA tool. Department Sponsor: Brigid Ide CDI will participate in policy decisions, the design of the interfaces and high level testing, to ensure technical build occurs once. CDI Pilot (3 users) is to be scheduled (TBD 2016). Full implementation of CDI will depend on pilot and development of current JATA tool. PM: Kevin McLaren (50%) SME(s): TBD (20-25%) Testing Lead: Kevin Testers: Rev. Mng. QA Team Testing Lead: Kevin Testers: Rev. Mng. QA Team Super User/Trainer: TBD End Users (testing/validation) : TBD Super User/Trainer: TBD End Users (testing/validation) : TBD IT/CS PM: TBD (75%) 3M PM * Department Sponsors are key to workflow redesign, policy and procedure and system build discussions. 3M Team: Engagement Manager PM Implementation Analysts Integration Analysts CDI Consultants Trainers (to train the trainers) 3M Team: Engagement Manager PM Implementation Analysts Integration Analysts CDI Consultants Trainers (to train the trainers)

8 3M Timeline proposed: 8 3M CAC

9 9 Project details: Assumptions: –Business absorbs their labor costs, within operating budgets: Leaders, PMs, SMEs, Trainers & Testing Lead –PMs Begin one month prior to project kick off. Business PMs: Fei 60-75% / Kevin 50% IT/CS PM 75% Timeline From: Nov 2014 (IT/CS From: Apr 2015) To: Mar 2016 (IT/CS To: Sept 2016) Project Size Large~ 3,865 IT/CS Hours Implementation Cost ~ $1,011,498 3M 360 & Code Assist Epic IT/CS H/S IT/CS Labor Approved Budget * $ 800,000 $ 490,000 $ FY15 Capital (MedCtr) $ FY15 Operating (MGBS) Annual Costs (Operating) ~ $1,043,675 (Net change to budget = $0, due to offsetting cuts.) 3M 360 & Code Assist Fees Addition to existing 3M Fees Epic Fees IT/CS Required Maintenance Net new FTE = 0.9 ROI Identified Efficiency Gains Expense Reductions Quality Improvements KPI Identified Marker 1: 6 months Marker 2: 12 months Marker 3: 24 months 3M CAC Caveats: –Cost estimates only; true costs not to be known until contract signed and analysis performed –Potential expansion of 3M to CHRCO not included * Further discussion needed on Operating verses Capital

10 10 ROI/KPIs: Hospital/HIMs Target ROIBaselineChangeMarkersMeasure by: Coder Productivity Gain Coders (Internal / External) Increase 10% over 2 years IP Cases 30,404/year OP cases 40,154/year Increase coding capacity without adding staff IP Cases + 3,000/year OP Cases + 4,000/year 6 months 12 months 24 months 3M analytics Coding Accuracy & Compliance Increase overall accuracy scores by 5% 85 – 95 % Goal: 95% Improve accuracy; less rebilling 6 months 12 months 24 months 3M analytics Coding Accuracy Better capture of secondary diagnosis 88% Improve to 95%; additional diagnoses will likely increase severity of illness, risk of mortality, & CMI. 6 months 12 months 24 months 3M analytics Identification of HACs & PSIs Reduce amount of resource time to correctly identify HACs & PSIs 5 FTEs Repurpose 2 FTE over 2 years. 6 months 12 months 24 months 3M analytics 3M CAC

11 11 ROI/KPIs: Professional Billing First level bullet. Arial bold, 22pt –Second level bullet. Arial, 20pt Third level bullet. Arial, 18pt –Fourth level bullet. Arial, 16pt > Fifth level bullet. Arial, 14pt Target ROIBaselineChangeMarkersMeasure by: Coding Expense * Down 20-60% FY14 Expense = $3.2M $640K $1.2M $1.9M 6 months 12 months 24 months Invoiced expenses & 3M analytics Coder Turnaround Up 60% FY14 Avg. TAT = days 10 Avg. TAT 4.9 Avg. TAT 4.0 Avg. TAT 6 months 12 months 24 months APeX coder productivity Report & 3M analytics Improve coding accuracy rates Up 15% FY14 median accuracy at 75% 80% 85% 90% 6 months 12 months 24 months Measured by quality assurance reviews & 3M analytics Provide enhanced ICD-10 CM translation tool n/a ICD-10 3M CAC * Has dependency on Physician adoption of coding via IMO - Intelligent Medical Objects (Epic’s)

12 Recap: 12 We are requesting this committee to approve this project timeline (since the IT/CS shared resources will be paid from capital), contingent on identifying specific budget cuts to completely offset the additional operating expenses prior to signing the contract. 3M CAC

13 Questions? 13 3M CAC

14 Appendix: 14 CAC Flow, 3M’s CAC Annotation view, …, Lessons learned: Multicare, River Valley Health, Henry Ford Health Systems Key Implementation stages Diagrams: UCSF Interface Diagram 3M Infrastructure / Interface Diagram Costs: IT/CS High Level Cost Breakdown IT/CS Detail Cost Breakdown Detail list of document types from HIMs, CDI, PB – draft Housekeeping: BCD Facilitator's Check List 3M CAC

15 CAC Flow 15 3M CAC

16 3M’s CAC Annotation Only 16 Once Auto Suggested is turned on, the ICD9 code will be sitting beside the term / phrase and ultimately ICD10 codes will too. 3M CAC

17 Example 17 3M CAC

18 Lessons learned Multicare (5 Hospitals, 1016 Beds, on Epic 2012, Cloverleaf engine, …,) –Live on 3M: Hospital and CDI only; Multicare did NOT implement 3M Code Assist for PB –Would do it again even though coders are still working from two applications: Epic: Vitals, Medications (pre-Mar for CDI), Mechanical bed times 3M: Notes, Results, Medications (Mar for HIMs) –Cutover: In Patient admits stayed on old system (JA Thomas) New IP admits were coded via 3M –Quarterly updates requiring ongoing maintenance to install and test and up to 2 service packs/year, … –Not seeing impact of Epic SUBs on 3M work –Didn’t use train the trainer but hear from other Epic sights its very good –Document interface is special and requires additional hours It's different from the typical doc/transcription interface. This one is an RTF (?). And requires an RTF server. Each message opens the TCP-IP socket. So the server helps balance that across 8 threads. –Resources: Recommend adding a Lead Tester of workflows to relieve managers 1 PM: 100% until Go-Live then reduced to 75% Interface Engineers: 2 at 50% Application Analyst: 1 at 50% IS LAN: 1 FTE 18 3M CAC

19 Lessons learned Baptist Health / River Valley Health –CAC project with 3M took little over a year from discovery to Auto Suggested implementation –Keep end user in mind at all times! CAC is for coders so it is important to involve them during the document configuration process and application set up and always advise business decision makers of any risks of decisions made, but final decisions rest with the content owners. –Comprehensive code assignment doesn’t kick in until the NLP engine learns your documents –Documentation collection is a complex process – quality and format issues –Strong project team is key to success –Expect the unexpected –Be assertive with your vendor and hold them to your Scope of Work which you tailor for your own site. –If scanned document is all typed (text), it can be sent to the OCR (optical character recognition) and converted to text so it, too, can be sent to the NLP for auto suggested coding. –Technological issues (route based on account number except there is a document that is global – what then? –Potential increase in coding errors (they are just suggestions! The process still requires the brain of the coder to apply more complex rules/guidelines). 19 3M CAC

20 Lessons learned 20 3M CAC Henry Ford Health System (4 acute hospitals, on Epic,..) –Live on 3M: Hospital and CDI only; Did not implement 3M Code Assist for PB –Engage Project Management dedicated resources IT and Revenue Cycle –Understand the change management process – there is always resistance, therefore, involve your staff early in the process. –Understand this is a process that involves technology, people and time from both your facility, 3M and Epic (AM, AC & TS) –Account for development of Epic WQs Assign accurate WQs: Workflow specific, Business unit specific Define WQ ownership and assign users – Important –Figure out if need split provider types for Auto-Suggested Coding (Epic and 3M) and avoid an additional cycle of interface design, development and testing The solution uses the provider type from Epic to map the associated documents to the correct folder in 3M. The mapping occurs inside the interface engine. –Verify Hardware: Epic needed dedicated resources to create documents from interfaces and EPS (Printing, server hardware) –Considerations Assignment of appropriate security level for staff and leadership in 3M Validate log-ins prior to go-live –Training 3M Encoder Training, 3M Code Assist Training, CAC annotation training, Report training, Superuser training, CV Config training, System Admin Training, Auto Suggest training –Secure 3M and Epic HIM onsite resource for each implementation –Benefits: Reduce pre-AR Days (DNB), decrease contracted coding usage, reduce denials, Improve accuracy of patient severity, increase coder effiecency

21 21 Key Implementation stages 3M CAC Pre ABASC / CTG Approval/Prioritization  Review and analyze current coding documents  Vet coding document list with CDI.  Prep Business Case Document Project Initiation  Confirm Operational Rollout schedule: PB (E&M and few specialties), HIMs, CDI  Sign Contract Business Requirements  Confirm hardware and supporting software requirements  Review operational and departmental procedures and workflows.  Review coding guidelines, coding practices and preferences.  Review and analyze current coding documents  Vet coding document list with CDI.  Finalize plans for functions and interfaces Installation / System Build  Confirm required coding documents (dependency for interface build)  Stand up technical infrastructure: Deploy servers, complete hardware, network, database configuration and build interfaces  Install applications Interfaces/ System Testing / User Acceptance  Unit test system components  Test performance, data completeness, automation and reporting.  Test interfaces  User acceptance testing of functionality and reports Training Go Live Prep  Management and System Administrator Training  Confirm user access and workstation readiness  Provide Training materials  On-site training: o Coders on use of the coding application. o Management staff on reporting, auditing, user management and reconciliation capabilities. Go-Live  Transition production operations to the new system  Go-live support; Address and resolve issues as necessary

22 22 Interfaces 3M CAC

23 23 Detail Infrastructure / Interface Diagram 3M CAC

24 24 IT/CS Costs details: Timeline From: Nov 2014 (IT/CS From: Apr 2015) To: Mar 2016 (IT/CS To: Sept 2016) IT/CS Size Large~ 3,865 IT/CS Hours Vendor Implementation Costs $ 305,223 3M Vendor ($518,223) Epic Vendor ($19,500) IT/CS Hardware / Software Costs $ 232,500 New Workstations ($172,500 – maybe less) Virtual Servers ($60,000) IT/CS Implementation Labor Costs $ 473,775 IT: Server team (160 hrs) DBAs (80 hrs) Network team (80 hrs) Field Services (480 hrs - maybe less) Interfaces (1,600 hrs) CS/APeX: Access/HIMs (200 hrs) Rev Cycle (100 hrs) PMO (1,165 hrs) Annual Operating Costs ~ $1,043,675 (Net change to budget = $0, due to offsetting cuts.) 3M 360 & Code Ryte Fees ($841,027) Epic Fees ($2,500) IT/CS Required Maintenance Interfaces (.4 FTE = ~ $74,600) Access/HIMs (.5 FTE = ~ $125,798) 3M CAC

25 25 Detail Cost breakdown - draft 3M CAC

26 26 HIMs list of Docs Used by Coders - draft 3M CAC APeX Enc TypeAPeX Note TypeChart Tab Office VisitAddendum Note Outpatient Record Anesthesia EventAnesthesia Procedure Note Operations/Procedures Anesthesia EventAnesthesia Transfer of Care Operations/Procedures Anesthesia EventAnesthesia Post-Op Note Operations/Procedures Anesthesia EventAnesthesia Pre-op Evaluation Operations/Procedures ED to Hosp-Admission (Current)Brief Op Note Progress Notes ED to Hosp-Admission (Current)Consents Operations/Procedures ED to Hosp-Admission (Discharged)Discharge Summaries Discharge Plan/Summary Admission (Discharged)Discharge Summaries Discharge Plan/Summary EDED Attestation Note Progress Notes ED to Hosp-Admission (Discharged)ED Attestation Note Progress Notes ED to Hosp-Admission (Current)ED Provider Notes Progress Notes ED to Hosp-Admission (Current)Face to Face Progress Notes ED to Hosp-Admission (Current)H&P Progress Notes Pre-admit (Canceled)H&P Progress Notes ED to Hosp-Admission (Discharged)H&P Progress Notes ED to Hosp-Admission (Current)H&P (View-Only) Progress Notes ED to Hosp-Admission (Current)Interdisciplinary Monitoring And Observation ED to Hosp-Admission (Current)Interval H&P Note Progress Notes ED to Hosp-Admission (Current)Operative Report Operations/Procedures ED to Hosp-Admission (Current)Plan of Care Progress Notes Admission (Discharged)Plan of Care Progress Notes ED to Hosp-Admission (Discharged)Plan of Care Progress Notes ED to Hosp-Admission (Current)Procedures Operations/Procedures ED to Hosp-Admission (Current)Progress Notes eConsult ResponseProgress Notes Office VisitProgress Notes Outpatient Record/Progress Note ED to Hosp-Admission (Current)Progress Notes Admission (Discharged)Provider Consult Progress Notes ED to Hosp-Admission (Discharged)Provider Consult Progress Notes ED to Hosp-Admission (Discharged)Significant Event Progress Notes ED to Hosp-Admission (Current)Student Note Progress Notes TelephoneTelephone Encounter Progress Notes Admission (Discharged)Progress Notes Admission (Discharged)Consents Progress Notes Admission (Discharged)Interdisciplinary Monitoring And Observation ED to Hosp-Admission (Current)Interdisciplinary Monitoring And Observation Admission (Discharged)Procedures Operations/Procedures Admission (Discharged)H&P Progress Notes Admission (Current)Interdisciplinary Monitoring And Observation Anesthesia EventAnesthesia Post-Op Note Operations/Procedures Admission (Discharged)Brief Op Note Progress Notes Admission (Discharged)Operative Report Operations/Procedures Anesthesia EventAnesthesia Pre-op Evaluation Operations/Procedures Admission (Discharged)Interval H&P Note Progress Notes Office VisitPatient Instructions Outpatient Record/Progress Note Office VisitH&P Outpatient Record/Progress Note EDED Attestation Note Progress Notes OP VisitED Notes Outpatient Record/Progress Note EDED Provider Notes Progress Notes * Meds, Labs, Micro, Pathlogy, Imaing, Procedures, Cadiology, Other Orders, Scanned Documents, Outside Record

27 27 CDI list of Docs Used - draft 3M CAC Both HIMs and PB lists appear close to what CDI needs. CDI is dependent on MD documentation, however they also use the information. Listed are the other areas CDI uses in addition to HIMS lists: Patient summary (Nursing info, MAR, I/O record) Results tab (Radiology reports: includes many specialized studies such as IR procedures, EGD, CT scans, MRI, lab findings) Cardiology reports, EPS studies, Cardiac Cath lab Prepare Notes (preop Anesthesia) Note: APeX records change a bit from in-patient to the discharged patient and CDI needs the interface of the in- patient records. HIMS is looking at discharged records.

28 28 PB list of Docs Used by Coders - draft 3M CAC 1Progress Notes65Discharge Instr - Appointments 2Consults66Discharge Instr - Lab 3Procedures67Discharge Instr - Other Orders 4H&P68Discharge Instr - Other Info 5Discharge Summaries10000Code Documentation 6ED Notes10001Sedation Documentation 7Initial Assessments61251Inpatient Self-Administration Sheet 10OR Nursing61252Outpatient Self-Administration Sheet 11OR Surgeon61253Inpatient Medication Chart 12OR PreOp61254Outpatient Medication Chart 13OR PostOp100000Psych 14OR Anesthesia100001Miscellaneous 19ED Provider Notes100002Code Status and Advance Directives 23Note to Patient via Portal100003Anesthesia Follow-Up 24Anesthesia Pre-op Evaluation Brief Op Note 25Anesthesia Post-op Evaluation Plan of Care 26H&P (View-Only) Patient Care Conference 27Interval H&P Note Treatment Plan 28Anesthesia Procedure Notes Operative Report 29Addendum Note Downtime Event Note 33Subjective & Objective Pre-Procedure Instructions 35L&D Delivery Note Significant Event 36Telephone Encounter Anesthesia Transfer of Care 37Patient Instructions Student Note 38Assessment & Plan Note RN Note 39Communication Body Interdisciplinary 40ED AVS Snapshot Interfacility 41Letter Provider Consult 42Lactation Note Falls 43Committee Review Athena Breast Cancer Risk Assessment 44IP AVS Snapshot Athena Breast Health Consultation 45MR AVS Snapshot Anesthesia Post-Op Note 61Discharge Instr - Meds Non Apex Prior Anesthetics 62Discharge Instr - Pharmacy ED Attestation Note 63Discharge Instr - Activity Weekly Summary 64Discharge Instr - Diet Face to Face

29 29 BCD Facilitator's Top 10 Check list - 3M CAC 1 Created BCD using standard template  TEMPLATE - Project BCD as of Identified Executive Sponsors, Department Sponsors, Business Contacts/PMs  TEMPLATE - Project BCD as of , Project team slide 3 Confirmed project customer resource commitments by role and % of time  TEMPLATE - Project BCD as of , Project team slide 4 Identified IT/CS Leader, IT/CS skill sets and Vendor skill sets project is dependent on to be successful.  TEMPLATE - Project BCD as of , Project team slide 5 Obtained Hardware/Software cost and resource estimates from IT/CS managers and Vendor(s)  TEMPLATE - Project cost sheet as of Confirmed timeframe with project customers and IT/CS project team managers  TEMPLATE - Project timeline as of o Confirmed funding sources; supplied funding numbers on cost sheet.  TEMPLATE - Project cost sheet as of Allowed for project start lead time, on timeline, if need negotiate Vendor contract / POs – post creation of BCD 9 Secured a CS PM to begin working with Business Partner PMs 1 month prior to targeted project kick off. Purpose is high level project planning, charter, …, etc. prior to involving the IT/CS skill sets 10 Scheduled 3 check point meeting(s) with the CS Project Portfolio Manager (PPM), to review together as the BCD is being created, completed and finalized.

30 Thank you!


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