Transcript 3m_cac_bcd_for_aug_7_ctg_-_final_v2

Care Technology Governance
(CTG) Committee
Business Case Document (BCD) for:
3M Computer Assisted Coding (CAC)
Aug 7, 2014
3M CAC
The CTG presenter(s):
SheRee Garcia, Kevin McLaren & Heidi Collins
The project:
3M Computer Assisted Coding (CAC)
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.
•
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
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3M CAC
Why 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.
3
3M CAC
3M CAC Drivers / Benefits
Optimize chart completeness
Across
UCSFHS
Improve quality and accuracy
Compliance and Reporting analytics
Department
Specific
Hospital/HIMs
Professional Billing
CDI
Gain efficiencies by reducing the amount
of time locating, reviewing, analyzing
multiple documents to find what is new in
the chart.
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
Improve clinical documentation
(consistency, completeness,
accuracy) and quality reporting,
as health care moves toward
quality-driven reimbursement.
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.
* Savings has dependency on
Physician adoption of coding.
Via
APeX
data
integration
to 3M
3M Auto
Suggested
Codes &
Queries
3M CDI
and
Coding
Content
3M Natural
Language
Processing
(NLP) Engine
3M Data
Dictionary
(as used by
the DOD and
VA)
3M Optical
Character
Recognition
3M
data
integration
to APeX
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3M CAC
Operational impact:
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.
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3M CAC
Project scope:
• 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)
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Project team roles required for success
3M CAC Steering Committee: HIMs, PB, CDI & CS
Executive Sponsors:
Barrie Strickland & Roger Cameron
*Department
* Department Sponsors (20 - 25%):
SheRee Garcia & Cliff Skinner
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
Sponsors are key to
workflow redesign,
policy and procedure
and system build
discussions.
IT/CS PM: TBD (75%)
3M Team:
Engagement Manager
PM
Implementation Analysts
Integration Analysts
CDI Consultants
Trainers (to train the trainers)
3M PM
Hospital/HIMs
Phase 1 & 2
Professional Billing
Phase 1 & 2
PM: Fei Zho (60-75%)
PM: Kevin McLaren (50%)
CDI Pilot
Phase 3 (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.
SME: Julie Marshall (20-25%)
Analyst: Hop Johnson (20-25%)
SME(s): TBD (20-25%)
Testing Lead: Fei
Testers: Hope, Judie, Fei
Testing Lead: Kevin
Testers: Rev. Mng. QA Team
CDI Pilot (3 users) is to be
scheduled (TBD 2016) .
Super User/Trainer: TBD
End Users (testing/validation): TBD
Super User/Trainer: TBD
End Users (testing/validation): TBD
Full implementation of CDI will
depend on pilot and development
of current JATA tool.
UCSF 3M CAC Implementation
3M CAC
3M Timeline proposed:
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3M CAC
Project details:
Timeline
• Caveats:
–
–
Cost estimates only; true
Project Size
costs not to be known
until contract signed and
analysis performed
Potential expansion of
3M to CHRCO not
included
• Assumptions:
–
–
Business absorbs their
labor costs, within
operating budgets:
Leaders, PMs, SMEs,
Trainers & Testing Lead
Implementation
Cost
Approved
Budget
*
~ 3,865 IT/CS Hours
 3M 360 & Code Assist
~ $1,011,498
 Epic
 IT/CS H/S
$ 800,000
 $ FY15 Capital (MedCtr)
$ 490,000
 $ FY15 Operating (MGBS)
 3M 360 & Code Assist Fees
~ $1,043,675
Annual Costs
(Operating)
(Net change to
budget = $0, due
to offsetting cuts.)
Addition to existing 3M Fees
 Epic Fees
 IT/CS Required Maintenance
Net new FTE = 0.9
Efficiency Gains
ROI
Identified
Expense Reductions
Quality Improvements
• Business PMs: Fei
60-75% / Kevin
50%
• IT/CS PM 75%
Large
To:
Mar 2016
(IT/CS To:
Sept 2016)
 IT/CS Labor
PMs
• Begin one month
prior to project kick
off.
From:
Nov 2014
(IT/CS From: Apr
2015)
Marker 1:
KPI Identified
6 months
Marker 2: 12 months
Marker 3: 24 months
* Further discussion needed on Operating verses Capital 9
3M CAC
ROI/KPIs: Hospital/HIMs
Target ROI
Coder
Productivity
Gain
Increase
10% over 2
years
22-25 Coders
(Internal / External)
Coding
Accuracy
& Compliance
Increase overall
accuracy scores
by 5%
Coding
Accuracy
Better capture of
secondary
diagnosis
Identification
of HACs &
PSIs
Reduce amount
of resource time
to correctly
identify HACs &
PSIs
Baseline
IP Cases
30,404/year
OP cases
40,154/year
85 – 95 %
Goal: 95%
88%
Change
Increase coding
capacity without
adding staff
IP Cases +
3,000/year
Markers
Measure by:
6 months
12 months
3M analytics
24 months
OP Cases +
4,000/year
6 months
Improve accuracy;
less rebilling
12 months
3M analytics
24 months
Improve to 95%;
additional diagnoses
will likely increase
severity of illness,
risk of mortality, &
CMI.
6 months
12 months
3M analytics
24 months
6 months
5 FTEs
Repurpose 2 FTE
over 2 years.
12 months
3M analytics
24 months
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3M CAC
ROI/KPIs: Professional Billing
Target ROI
* Down
Coding
Expense
20-60%
Coder
Turnaround
Improve
coding
• First
accuracy
rates
Up
60%
Baseline
FY14 Expense
= $3.2M
FY14 Avg. TAT
= 12.23 days
FY14 median
Change
Measure by:
$640K
6 months
Invoiced
$1.2M
12 months
expenses
$1.9M
24 months
& 3M analytics
10 Avg. TAT
6 months
APeX coder
productivity
4.9 Avg. TAT
12 months
Report
4.0 Avg. TAT
24 months
& 3M analytics
80%
6 months
12 months
Measured by
quality assurance
reviews
24 months
& 3M analytics
n/a
ICD-10
Up
level
bullet. accuracy
Arial atbold,85%
22pt
15%
75%
Markers
90%
– Second level bullet. Arial, 20pt
• Third level bullet. Arial, 18pt
Provide
enhanced
ICD-10 CM
translation
tool
– Fourth level bullet. Arial, 16pt
n/a
n/a bullet. Arial, 14pt
n/a
> Fifth level
* Has dependency on Physician adoption of coding via IMO - Intelligent Medical Objects (Epic’s)
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3M CAC
Recap:
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.
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3M CAC
Questions?
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3M CAC
Appendix:
• 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
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3M CAC
CAC Flow
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3M CAC
3M’s CAC Annotation Only
• Once Auto Suggested is turned on, the ICD9 code will be
sitting beside the term / phrase and ultimately ICD10 codes
will too.
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3M CAC
Example
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3M CAC
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
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3M CAC
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).
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3M CAC
Lessons learned
• 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
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3M CAC
Key Implementation stages
Pre ABASC / CTG
Approval/Prioritization
Project Initiation
Business Requirements
Installation / System Build













Interfaces/ System Testing /
User Acceptance
Training
Go Live Prep
Go-Live











Review and analyze current coding documents
Vet coding document list with CDI.
Prep Business Case Document
Confirm Operational Rollout schedule: PB (E&M and few
specialties), HIMs, CDI
Sign Contract
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
Confirm required coding documents (dependency for interface
build)
Stand up technical infrastructure: Deploy servers, complete
hardware, network, database configuration and build interfaces
Install applications
Unit test system components
Test performance, data completeness, automation and reporting.
Test interfaces
User acceptance testing of functionality and reports
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.
Transition production operations to the new system
Go-live support; Address and resolve issues as necessary
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3M CAC
Interfaces
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3M CAC
Detail Infrastructure / Interface Diagram
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3M CAC
IT/CS Costs details:
Timeline
From:
Nov 2014
(IT/CS From:
Apr 2015)
IT/CS Size
Large
Vendor Implementation
Costs
$
305,223
IT/CS Hardware /
Software Costs
$
232,500
To:
Mar 2016
(IT/CS To:
Sept 2016)
~ 3,865 IT/CS Hours
 3M Vendor ($518,223)
 Epic Vendor ($19,500)
 New Workstations ($172,500 – maybe less)
 Virtual Servers ($60,000)
 IT:
Server team (160 hrs)
DBAs (80 hrs)
Network team (80 hrs)
IT/CS Implementation
Labor Costs
$
473,775
Field Services (480 hrs - maybe less)
Interfaces (1,600 hrs)
 CS/APeX:
Access/HIMs (200 hrs)
Rev Cycle (100 hrs)
PMO (1,165 hrs)
~ $1,043,675
Annual Operating Costs
(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)
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3M CAC
Detail Cost breakdown - draft
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3M CAC
HIMs list of Docs Used by Coders - draft
APeX Enc Type
Office Visit
Anesthesia Event
Anesthesia Event
Anesthesia Event
Anesthesia Event
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Discharged)
Admission (Discharged)
ED
ED to Hosp-Admission (Discharged)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
Pre-admit (Canceled)
ED to Hosp-Admission (Discharged)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
Admission (Discharged)
ED to Hosp-Admission (Discharged)
ED to Hosp-Admission (Current)
ED to Hosp-Admission (Current)
eConsult Response
Office Visit
ED to Hosp-Admission (Current)
Admission (Discharged)
ED to Hosp-Admission (Discharged)
ED to Hosp-Admission (Discharged)
ED to Hosp-Admission (Current)
Telephone
Admission (Discharged)
Admission (Discharged)
Admission (Discharged)
ED to Hosp-Admission (Current)
Admission (Discharged)
Admission (Discharged)
Admission (Current)
Anesthesia Event
Admission (Discharged)
Admission (Discharged)
Anesthesia Event
Admission (Discharged)
Office Visit
Office Visit
ED
OP Visit
ED
APeX Note Type
Addendum Note
Anesthesia Procedure Note
Anesthesia Transfer of Care
Anesthesia Post-Op Note
Anesthesia Pre-op Evaluation
Brief Op Note
Consents
Discharge Summaries
Discharge Summaries
ED Attestation Note
ED Attestation Note
ED Provider Notes
Face to Face
H&P
H&P
H&P
H&P (View-Only)
Interdisciplinary
Interval H&P Note
Operative Report
Plan of Care
Plan of Care
Plan of Care
Procedures
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Provider Consult
Provider Consult
Significant Event
Student Note
Telephone Encounter
Progress Notes
Consents
Interdisciplinary
Interdisciplinary
Procedures
H&P
Interdisciplinary
Anesthesia Post-Op Note
Brief Op Note
Operative Report
Anesthesia Pre-op Evaluation
Interval H&P Note
Patient Instructions
H&P
ED Attestation Note
ED Notes
ED Provider Notes
Chart Tab
Outpatient Record
Operations/Procedures
Operations/Procedures
Operations/Procedures
Operations/Procedures
Progress Notes
Operations/Procedures
Discharge Plan/Summary
Discharge Plan/Summary
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Monitoring And Observation
Progress Notes
Operations/Procedures
Progress Notes
Progress Notes
Progress Notes
Operations/Procedures
Progress Notes
Progress Notes
Outpatient Record/Progress Note
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Progress Notes
Monitoring And Observation
Monitoring And Observation
Operations/Procedures
Progress Notes
Monitoring And Observation
Operations/Procedures
Progress Notes
Operations/Procedures
Operations/Procedures
Progress Notes
Outpatient Record/Progress Note
Outpatient Record/Progress Note
Progress Notes
Outpatient Record/Progress Note
Progress Notes
* Meds, Labs, Micro, Pathlogy, Imaing, Procedures, Cadiology, Other Orders, Scanned Documents, Outside Record
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3M CAC
CDI list of Docs Used - draft
• 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 inpatient records. HIMS is looking at discharged records.
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3M CAC
PB list of Docs Used by Coders - draft
1Progress Notes
2Consults
3Procedures
4H&P
5Discharge Summaries
6ED Notes
7Initial Assessments
10OR Nursing
11OR Surgeon
12OR PreOp
13OR PostOp
14OR Anesthesia
19ED Provider Notes
23Note to Patient via Portal
24Anesthesia Pre-op Evaluation
25Anesthesia Post-op Evaluation
26H&P (View-Only)
27Interval H&P Note
28Anesthesia Procedure Notes
29Addendum Note
33Subjective & Objective
35L&D Delivery Note
36Telephone Encounter
37Patient Instructions
38Assessment & Plan Note
39Communication Body
40ED AVS Snapshot
41Letter
42Lactation Note
43Committee Review
44IP AVS Snapshot
45MR AVS Snapshot
61Discharge Instr - Meds
62Discharge Instr - Pharmacy
63Discharge Instr - Activity
64Discharge Instr - Diet
65 Discharge Instr - Appointments
66 Discharge Instr - Lab
67 Discharge Instr - Other Orders
68 Discharge Instr - Other Info
10000 Code Documentation
10001 Sedation Documentation
61251 Inpatient Self-Administration Sheet
61252 Outpatient Self-Administration Sheet
61253 Inpatient Medication Chart
61254 Outpatient Medication Chart
100000 Psych
100001 Miscellaneous
100002 Code Status and Advance Directives
100003 Anesthesia Follow-Up
1000000 Brief Op Note
1000001 Plan of Care
1000002 Patient Care Conference
1000003 Treatment Plan
1000004 Operative Report
1000005 Downtime Event Note
1000006 Pre-Procedure Instructions
1000007 Significant Event
1000008 Anesthesia Transfer of Care
1000009 Student Note
1000010 RN Note
1000011 Interdisciplinary
1000013 Interfacility
10000010 Provider Consult
304000001 Falls
304000002 Athena Breast Cancer Risk Assessment
304000003 Athena Breast Health Consultation
1020001001 Anesthesia Post-Op Note
1120001002 Non Apex Prior Anesthetics
1600000001 ED Attestation Note
3040000010 Weekly Summary
3040000011 Face to Face
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3M CAC
BCD Facilitator's Top 10 Check list 1

Created BCD using standard template
 TEMPLATE - Project BCD as of 2014.07.22
2

Identified Executive Sponsors, Department Sponsors, Business Contacts/PMs
 TEMPLATE - Project BCD as of 2014.07.22, Project team slide
3

Confirmed project customer resource commitments by role and % of time
 TEMPLATE - Project BCD as of 2014.07.22, 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 2014.07.22, Project team slide
5

Obtained Hardware/Software cost and resource estimates from IT/CS managers and Vendor(s)
 TEMPLATE - Project cost sheet as of 2014.07.22
6

Confirmed timeframe with project customers and IT/CS project team managers
 TEMPLATE - Project timeline as of 2014.07.22
7
o
8

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.
Confirmed funding sources; supplied funding numbers on cost sheet.
 TEMPLATE - Project cost sheet as of 2014.07.22
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Thank you!