CAC & NLP - Vendor Selectiondocdailey.weebly.com/uploads/4/5/...final_wdailey.pdf · Computer Assisted Coding/Natural Language Processing (CAC/NLP) project. The selection committee

Northwestern University – MED INF 408 – Fall 2014

CAC & NLP - Vendor Selection Assignment 5

Russ Abercrombie, Bill Dailey, Jeremy Lutz 11/23/2014

Contents Vendor Selection ........................................................................................................................................... 2

CAC/NLP Technology Readiness ............................................................................................................ 2

Stakeholder Roles in the Decision Process ............................................................................................... 3

Vendor Size ............................................................................................................................................... 3

Political Environment ............................................................................................................................... 4

Vendor/Product Evaluation Methodology ................................................................................................ 5

RFP Response Analysis ............................................................................................................................ 7

Acceptance Testing – Role & Methodology ............................................................................................. 7

Acceptance Testing – Results ................................................................................................................... 8

Change Management ................................................................................................................................ 8

Budget Estimates .................................................................................................................................... 10

Product Selection .................................................................................................................................... 11

Summary ................................................................................................................................................. 11

Appendix A – Vendor Information – 3M ................................................................................................... 13

Appendix B – Functional & Technical Requirements – 3M ....................................................................... 14

Appendix C – Training Plan – 3M .............................................................................................................. 21

Appendix D – Vendor Information – Optum .............................................................................................. 21

Appendix E – Functional & Technical Requirements – Optum ................................................................. 22

Appendix F – Training Plan – Optum ......................................................................................................... 29

Appendix G – Vendor/Product Comparison ............................................................................................... 30

References ................................................................................................................................................... 35

Vendor Selection Vendor Selection is the point in the acquisition process in which all the required information is

gathered and analyzed and a decision is made as to which vendor/product to pursue. There are

some fundamental areas that have to be covered. These can be broken down as follows:

1. Environmental Survey – Technology readiness, constituency roles, Political

environment.

2. Product Select Process – Methodology, Analysis of RFP responses.

3. Implementation Issues – Acceptance testing, Change management.

4. Product Selection – Budgetary considerations, choice of product.

The following components address each of these issues.

CAC/NLP Technology Readiness

There are concerns that CAC and NLP technologies are not capable of the productivity increases

and costs savings that they promise. In fact, a survey sponsored by KLAS Enterprises

determined that almost 45% of the organizations surveyed, that had implemented systems from

one of the two leading CAC vendors (3M and OptumInsight), had not yet seen any positive

impacts from the installed software. (Goedert, J., 2013).

But there have also been success stories. For example, a CAC pilot program conducted by

AHIMA at the Cleveland Clinic showed that their CAC system improved coder efficiency by as

much as 22%, with coder accuracy levels remaining above the Cleveland Clinic’s certification

threshold of 95% (Dougherty, 2013). Similar results have been seen within other organizations,

including a 20% increase in coder efficiency at Geisinger Health System and a 21% increase in

coder productivity at the University of Pittsburgh Medical Center (Schwenz & Wimberley,

2012).

Because of this conflicting information, our decision to move forward on implementing a

CAC/NLP system was not taken lightly. But because of the success stories and lessons learned

from previous implementations throughout the country, and because of the potentially

devastating impact of the impending transition to ICD-10, we feel that a CAC/NLP system has

the potential to be a very worthwhile asset. Like any piece of software, a CAC system is just a

tool. It must be implemented, configured and used properly in order to get the most out of it.

That’s why selecting the right system and partnering with the right vendor is a critical decision.

Stakeholder Roles in the Decision Process

The CMIO and the Vice President of Finance were the co-sponsors and stake holders for the

Computer Assisted Coding/Natural Language Processing (CAC/NLP) project. The selection

committee was comprised of an inter-disciplinary team of professionals that would be directly

impacted by this project. The CAC/NLP team members were the CMIO, Director of IT, Director

of HIM, Manager of Coding, Director of Revenue Integrity, and an IT project manager. Each

member was responsible for:

Formulating specific criteria from which the products would be assessed against.

Participate in the review of responses to RFI’s and RFP’s.

Participate in product demonstrations

Provide input for final selection.

Every member of the selection committee had “skin in the game”, it was important that the group

came to a mutual consensus to present the final selection to the executive sponsors.

Vendor Size

The size of the vendor did play a role in the decision. The RFI and RFP have specific questions

related to size, financial stability, market penetration, and customer base. Each vendor size

category offers its own advantages and disadvantages.

The selection committee was open to considering small companies or even a startup.

Since the integration of CAC and NLP is rather new in the market place, small companies

and startups do not have competitive products to offer at this time.

The long time established “niche” vendors (3M, Optima, Dolbey-Fusion CAC.)

participated in the process. These vendors are considered the standard bearers in HIM

coding software and each have their unique approach to the business challenge, but

unfortunately none have a comprehensive solution. The committee was able to get a good

perspective of the direction the integrated solution is taking. Each vendor shared their

roadmap which gave solace to the eventual final solution.

A large comprehensive solution was not considered because GVMH is a small to medium

rural provider that has invested in many of the best-of-breed healthcare systems.

Replacing these systems is not an option at this time.

Political Environment

We are in a state of flux regarding where everything is heading in three prime spaces that drive

Health IT adoption; documentation, coding and compliance.

First, the elephant in the room is Stage 3 Meaningful Use. Everyone at the Office of the National

Coordinator has recently resigned (DeSalvo, Reider). This leaves everything in a state of flux

regarding overall direction of Health IT in this nation. The money has been spent (all penalties

from here on out), leaving the Office of the National Coordinator without any budgetary power.

There are many “lessons learned” but no personnel to lead the charge in a new direction. This

creates a tremendous amount of uncertainty coupled with the latest uncertainty regarding the

recent election and the potential political climate over the next 8 years once the next presidential

election is complete (Republicans have apposed nearly all initiatives).

Second, flat billing. There is a sustained effort to work toward flat billing in the outpatient

space. This has already occurred for 2014 for outpatient clinic visits and many suspected it was

going to happen this year for the physician fee schedule (it didn’t). Because of (sometimes

questionable) clinical documentation improvement initiatives, ease of up-coding in an electronic

environment and outright fraud; visit levels are soon to become a thing of the past. It is very

likely that flat billing will occur over the next year or two. This does not obviate the need for

NLP/CAC but it does seriously impair the financial assumptions used for ROI calculations.

Clearly, it will still be important to get the diagnosis coded correctly but the subtleties of note

content may become irrelevant for billing purposes. This approach would be welcomed by most

physicians who abhor the current senseless adjustment of documentation to fit coding

requirements. However, NLP will continue to be important for data initiatives.

Third, ICD-10. Finished in 1992, and slated for adoption in the United States in 2013, ICD-10

has thus far been “dead on arrival.” There continues to be opposition and sustained political

effort to block implementation this 30 year old “standard.” Tentatively slated for adoption on

October 15, 2015, there is plenty of time to delay further in favor of a more modern option (ICD-

11, SNOMED, other). The transition to ICD-10 makes sense in preparation for a potential move

to ICD-11 at some future date and very well could occur as planned. If used in a merely

transitory manner at least some of the money spent on preparation would not have gone to waste.

These changes tend to drive selection away from any and all vendors in the current political

environment.

Vendor/Product Evaluation Methodology

To evaluate potential vendors and systems, we wanted to create and use a simple, but effective,

methodology. The criteria for the evaluation was the set of questions from our RFP. We

included nearly every RFP question in our evaluation (some were deemed inappropriate and

eliminated from the evaluation, e.g. Company Name and Address) and, in an effort to evaluate

both the vendors and the systems, covered questions from the Vendor Information, Functional &

Technical Requirements, and Training Plan sections of the RFP.

In order to quantify and compare vendors and systems, we developed a spreadsheet that listed

each criterion, grouped by category. We then assigned a weight to each criterion to represent the

relative importance of each criterion. For example, having a system that supports a configurable

user password expiration period is not as important as having a system that will display ICD-9

and ICD-10 codes simultaneously. After the weights were assigned to each criterion, the RFP

responses from each vendor were reviewed and their answers were evaluated and given a score.

The scores represent how well the vendor or system supports/meets each criterion, on a scale

from 0 (does not support/meet requirement) to 6 (exceeds requirement).

Vendor/system scores for each criterion were derived from a consensus of all stakeholders. We

considered having each stakeholder or stakeholder group evaluate the vendors/systems

separately, but ultimately decided against that. Doing so could potentially have produced vastly

different evaluations, with each stakeholder preferring a different vendor/system. Instead, RFP

responses were evaluated as a team, consisting of representatives from all stakeholder groups.

We felt this would help build consensus and keep everyone on the same page, while still

considering the needs and preferences of all stakeholders.

Once scores were established for each vendor/system on all criteria, the scores were multiplied

by the weight of each criterion and used to aggregate weighted scores by category and a grand

total weighted score. The weighted scores allowed us to make an apples-to-apples comparison

of each vendor and system, which, along with price, was a major factor in our final decision.

RFP Response Analysis

It is very important to sort out differences between the vendor responses. The overall picture is

that both vendors have a very similar offering. The largest differences between the two are the

time in the analytics and coding space, company structural stability and market penetration, and

experience with interfacing with our EMR.

3M is the clear leader in all three areas. 30 years of experience in healthcare analytics coupled

with robust coding and ontology platforms mark it as a clear leader. They lead regarding market

penetration with many more sites using their product and they are a publicly held company that

has a very diverse profile. While both companies claim to be “global”, 3M is very diverse with

strong penetration in many industries aside from healthcare including manufacturing

(composites, oil/gas, films, etc.), electronics, transportation, safety/security and home/office.

They offer unparalleled stability that only this kind of diversity can offer. Finally, they are

familiar with and have interfaced with our EMR (InteGreat). This is very important because this

mean they are secure in interacting with the Medcin engine that InteGreat utilizes.

Smaller, yet other important wins for 3M is a better clarification of limitations with regard to

their numerical codes as well as build-in reporting features that Optum was lacking.

Lastly, Optum is primarily an Epic partner. That is their comfort zone and that seems to be

where they seem to excel. This is not helpful in our current environment, which incidentally we

are strategically locked to for the next 3-5 years awaiting settling or a new direction in the EMR

space technologically and politically.

Acceptance Testing – Role & Methodology

The final contract stipulates a 50-25-25 percent payment distribution. The final 25 percent will

not be paid until final acceptance testing has been concluded and all issues have been satisfied.

Acceptance testing is a multi-level activity that commences during the RFP review process, then

progresses through customer site visit demonstrations, contract negotiation, implementation, and

final user acceptance testing. Customer site visit demonstrations are a critical junction in the

acceptance process. A contract is not in place, so based on the live demonstrations and

conversations with the customers a “go no go” decision can be made with no legal repercussions.

Assuming a positive decision is made to move forward, a detailed functional test plan is created

that itemizes the pass/fail criteria for every functional aspect of the product. It is important to

keep in mind that current clinical and business processes very well may need to be altered or

replaced so as to be able to realize the full potential of the new system. During implementation a

subset of these functional tests are used for unit testing to verify the veracity of the product and

implementation assumptions. Functional test cases are executed by GVMH HIM coders. This

testing process is closely monitored by the IT project manager and the vendor which allows for

immediate communication of any failures or concerns.

Acceptance Testing – Results

User acceptance testing will ferret out any production level issues that hopefully are not show

stoppers. Walking away from the contract is not an option at this juncture unless there is gross

negligence or miss-representation on the vendor’s part. Aside from breach of contract, test cases

failing will have to be worked through and the final 25 percent payment withheld until the

product performs satisfactorily.

Change Management

Due to careful avoidance of real-time clinical documentation improvement this project is

primarily a coding, business office and IT change management issue. Real-time clinical

documentation improvement can appear tangentially fraudulent and will tend to further

standardize documentation to the point that audits occur with virtual certainty, for these reasons

it will continue to be avoided at GVMH. Documentation improvement will continue in the

manner it is now with in-person oral quarterly reviews with each provider to clarify any

subtleties they may be missing. This simplifies change management significantly as the

providers will be essentially unaffected unless reimbursement changes (not a goal of this

project).

Coders are excited about having a tool to ease their workload and enhance the speed at which

they can accomplish their duties. They will be eager to implement a new tool. Just as they were

when other “encoder helper” software was introduced. This project will have an iterative nature

to it to refine code sets for each specialty but they have been doing this on an ongoing basis as

we have expanded into different specialties within our multi-specialty practice.

The business office will welcome any decrease in “time in coding” realized to assist in reducing

their AR days. This is a number that is carefully tracked and has large financial implications.

AR days affect bonuses and compensation associated with staff and managers in the business

office.

IT change management is not needed. They implement new projects “at will” and as long as

coding “owns the project” they will gladly get it up and running. It will need to be inserted into

an already hectic schedule of ongoing implementations but this is all negotiated in our

administrative meetings.

No changes to the selection criteria are needed here, the scope of work clearly limited scope to

minimize organizational impact outside of these areas.

Budget Estimates

The following are the budget estimates for each vendor. Three different solution architectures

are considered in each case.

Golden Valley Memorial Healthcare

CAC/NLP Implementation Financial Summary - Optima

Contract Element

Self Hosted Implementation

Server and Storage $ 125,000.00

Licensed Software $ 415,000.00

Professional Services $ 70,000.00

Maintenance (3 year) $ 45,000.00

Total $ 655,000.00

Virtual Implementation

Server and Storage $ -




Total $ 530,000.00

SaaS Implementation

Remote Operational Support (3 years) $ 37,500.00



Maintenance (3 years) $ 45,000.00

Total $ 567,500.00

CAC/NLP Implementation Financial Summary - 3M

Contract Element

Self Hosted Implementation

Server and Storage $ 150,000.00




Total $ 620,000.00

Virtual Implementation

Server and Storage $ -




Total $ 470,000.00

SaaS Implementation

Remote Operational Support (3 years) $ 30,000.00



Maintenance (3 years) $ 35,000.00

Total $ 500,000.00

Product Selection

The product selected is the 3M virtual implementation. It was selected after careful scoring via

the scoring grid and review of the above topics. It so happens that the 3M product was the least

expensive but it was also a better fit as described above. 3M offers superior stability and

interfacing with our existing software and processes. Had it not been the least expensive product

it likely would have been selected nonetheless. Fit is very important here and the 3M product

provided the best fit. The virtual implementation was chosen due to both cost and ease of

ongoing system management and maintenance.

The Optum product was rejected due to it having lower scoring overall, higher cost, and due to it

being very closely entwined with an EMR product that is not used here (Epic). It may be more

suitable for larger organizations.

Summary

With product selection complete it is worthwhile to look at the process and information overall

and make a decision as to whether to move forward in the acquisition process. In doing this

careful evaluation of the technology is warranted. When considering the current technological

and political environment, the recommendation would be made not to pursue either vendor at

this time. The uncertainty in the technology and the political environment moving forward make

a large purchase such as this difficult to justify. There are currently too many unknowns with

regard to Stage 3 Meaningful Use that may require continued and ongoing investments to stave

the bleeding associated with penalties moving in the current healthcare environment.

Appendix A – Vendor Information – 3M

Question Response

Company Name 3M

Address of Headquarters 575 West Murray Boulevard

Salt Lake City, UT 84123

Number of years as a Medical Coding vendor 30 years assist, 2 years complete

Number of years integrating NLP into Coding

software 2

Has your product won any awards or received

any certifications? (KLAS, HIMSS, etc) NO

Please list any company mergers, acquisitions,

and sell-offs and year completed

2012, 3M acquired CodeRyte

How many employees do you have? 88,000

Is the company Public or Privately owned? Public

Have there been any bankruptcy/legal issues? No

If so, please include under which name the

bankruptcy was filed and when, or any

pertinent lawsuits, closed or pending, filed

against the company.

Number of entities actively using software 1400

How many of these entities are multi-site? 360

How many of these entities are licensed as

long term acute care?

64

Please list your top three “WOW factors”

based on client satisfaction data

Do you have a formal users group? yes

Please provide references that are available for

contact

See references page

Appendix B – Functional & Technical Requirements – 3M

Item

# Area Functionality Y/N Comments

1 HIM Are multiple groupers allowed

based on payor requirements?

List any limitations.

Y No limitations

2 HIM Does system support workflow

creation for coding?

Y

3 HIM Can the system support computer

assisted coding?

Y

4 HIM Is NLP Integrated or is it an add-

on?

NLP is an integrated software

module that can be licensed

separately.

5 HIM Does the system provide support

and updates for ICD-9 codes and

ICD10?

Y

6 HIM Can ICD9 & ICD10 be used

concurrently?

Y Coaching mode or final coding

mode.

7 HIM Does your system suggest both

ICD-9 and ICD-10-CM/PCS

codes simultaneously in one

view for the coders?

Y

8 HIM Does your system handle

outpatient codes for ICD-9 and

ICD-10? If so, for which

departments?

Y

9 HIM Does your system generate early

warning indicators when there

might be insufficient

documentation for ICD-10

coding?

Y





Y


and regulatory updates for CPT,

DRG, APC, HCPCS?

Y

12 HIM Does the system include a DRG

grouper?

Y

13 HIM If a DRG grouper is included, are

updates provided?

Y

14 HIM Does the system include an

OP/APC grouper?

Y

15 HIM If the system does not include an

OP/APC grouper can the system

interface with an external system

and what are the costs for the

interface?

Y Optimum is interfaced with the

3M encoder out of the box. No

additional cost.

16 HIM

Can we load historical MPI from

previous system?

Y 3M can convert MPI patient data

from a file extraction provided in

our format.

17 HIM Does the system allow for users

to establish special studies to

support clinical data collection

where applicable?

Y Future Development

18 HIM Can each facility define which

types of ROI requests need to be

written to a disclosure log?

N Future Development

19 HIM Can alerts be established when

multiple ROI requests are

received from same auditing

entity (ie QIO/RAC)?

N

20 HIM Does your system provide any

tools that would assist with RAC

audits and tracking?

Y Customized reporting

21 Interfaces Does your software support

standard HL7 formatting for

importing and exporting data

to/from other systems or outside

providers? If any limitations

describe.

Y We support standard HL7

formatting, inbound and

outbound.

22 Interfaces Have you interfaced with another

Clinical Information System? If

yes, please provide the names of

the other systems.

Y Capable of interfacing with any

downstream system through an

HL7 interface engine


Patient Financial System? If yes,

please provide the names of the

other systems.

Y 3M has interfaced with many

different vendors. If the system

is HL7 compliant and will work

with 3M, we can interface with

them.

24 Interfaces

Do you have experience with the

InteGreat ICChart EMR?

Y We have experience with many

EMR systems including the ones

mentioned.

25 Interfaces Regarding ADT interfaces – do

you specifically allow an

inbound ADT interface to create

a patient encounter?

Y

26

27 Audit Do audit logs track actual

activity that has been changed?

Y

28 Audit Are audit logs available to track

what users have viewed and or

edited in the system?

Y


any user who has printed and or

exported patient data from the

system?

Y

30 Audit Does the system provide reports

on encoder and CAC utilization

and productivity?

Y

31 Audit Does the system provide coder

productivity statistics?

Y

32 Audit Does the system support the

ability to build quality audit

alerts for management review?

Y

33 Reporting Does system provide standard

revenue and usage reports with

YTD information flexed by

hospital/provider FTE.

Y Yes if multiple databases are

used. A single database would

require an enhancement to

produce the report by hospital.

34 Reporting Does the system allow for ad-hoc

reporting?

Y eCQ Report Writer

35 Reporting Are all data elements captured

within the system available from

a reporting perspective? Please

list any limitations.

Y

36 Reporting Does the system provide roll-up

reporting from single facilities,

grouping of facilities and

corporate wide?

Y eCQ Report Writer

37 Reporting Are clients able to directly access

backend production database for

creating own custom queries and

reports?

Y eCQ Report Writer

38 Reporting Does the system provide the

ability to export data to MS

Office applications?

Y Excel


ability to restrict access to reports

by employee role?

Y

40 System Is your system available in a

SaaS model?

Y Hosted or fully managed


hosted model?

Y

42 System Can your system be located in

our data center?

Y We can remotely manage

43 System If hosted at our data center, what

technical and hardware

requirements are needed for your

product?

Y See attached requirements

document.

44 System Is there a limit to the number of

financial classes allowed?

Y A maximum of 1,332 financial

classes can be created.

45 System

Is there a limit to the number of

payor codes allowed?

Y A maximum of 1,679,616 payor

codes can be created (excluding

the use of spaces).

46 System

Is there a limit to the number of

patient types allowed?

Y A maximum of 36 patient types

and 46,656 medical service

codes can be created (excluding

use of spaces).


adjustment and payment codes

allowed?

Y A maximum of 36,000

transaction codes can be created.

48 System Does the system allow users to

access enterprise and facility-

specific reports from remote

locations?

Y

49 System Please provide a description of

how the system would support a

centralized management model

for multiple facilities?

Y Centralized management is

maintained by a single SQL

database is utilized for facility-

shared menu displays, menu

security, functions, pages, home

facility assignment, and

reporting dictionaries. When

changes to the SQL database are

made by the customer, it does

not have to be copied or

exported anywhere as facilities

share a single set of definitions.

50 System Does the system run multiple

locations on a single relational

database? If so, please describe

how security functions for

corporate users?

Y

51 System Does system support the

technical requirements set forth

in HIPAA and the HITECH act?

Y

52 System Does vendor adhere to standards

of ICD9/ICD10, LOINC, CPT,

SNOMED?

Y

53 System Has your CAC/NLP product

been certified by an authorized

certification body? If so, please

list all certifications achieved.

N/A NO

54 System Do you provide 24/7 customer

support?

Y US based service desk

55 System Where is your support center

located?

Y Two support centers – central

and west

56 System Does the system support online

help function/feature within the

application?

Y Help is context based

57 System How often are software releases

scheduled?

Y Major releases are once a year

and maintenance releases are

released as necessary

58 System How often is your product

updated? How are they

deployed?

Y

59 System Is downtime required for

software releases? If yes, please

provide average down time.

Y Major releases require 2-4 hours.

Maintenance releases need 1-2

hours.

60 System Describe your disaster recovery

plans including the protection of

source code as well as patient

data.

Y Hosted and SaaS model

deployments are fully redundant

61 System How are customer requests for

enhancements handled?

Y Enhancements can be submitted

two ways, through your sales

person and user group.

62 System Describe your flexibility in

customizing base product for

hospital specific rules and alerts.

Y We do not force our clients to

change the way they do business

- the Optimum suite is table

driven, fully customizable

software package that will allow

the client to build the system

around their business model.

63 System Does vendor allow for a separate

test system at no cost?

Y

64 System

Does the system provide

configurable error checking on

data entered?

Y Where a field is supported by a

table, data entry is restricted to

those values. There is no

restriction on free form fields.

65 System Is the system accessible through

mobility devices?

Y Mobile access is available.

66 System-

Implementation

& Training

Does the system provide for a

separate training system? If yes,

is there a cost associated?

Y The test environment is what is

used for training

67 System-

Implementation

& Training

For implementation and training

do you utilize a third party

partner? If so please provide the

partner name.

N All trainers are 3M employees

68 System-

Implementation

& Training

What is the typical time frame

for installation of a site?

Y Varies – 1-2 months

69 System-

Performance

What are the performance and

accuracy benchmarks we can

expect from the NLP engine?

Y Performance is dependent upon

network connection(s) and

adhering to hardware

requirements.

70 System-

Performance



expect from the CAC system?

Y Unknown

71 System-

Performance

Have these performance

benchmarks been met in

organizations similar to ours?

Y See attached benchmark

document

72 System-

Performance



organizations that are larger than

ours?


document

73 Users/Security Does the system support the

configuration of password rules

(e.g. length of password, strength

of password, special characters,

keyword exceptions, etc.)?

Y Security is Microsoft AD aware,

so all present AD architecture

can be utilized.

74 Users/Security Can passwords be configured to

expire in a configurable amount

of time?



can be utilized

75 Users/Security Does the system provide self-

service password reset

functionality?

N

76 Users/Security Does system allow for users to

be set up once and then granted

access to all facilities required?

Y

77 Users/Security Does system allow for creation

of master roles to be assigned

when creating new user?

Y

78 Users/Security Is there a limit to the number of

concurrent users allowed to

access system?

N Unlimited

Appendix C – Training Plan – 3M

Question Response

Do you offer instructor-led classroom

training?

Yes we do at our Corporate office in Salt Lake City, UT.

Do you have classroom training

facilities?

Yes we do at our Corporate office in Salt Lake City, UT.

Do you offer online/CBT training?

Yes, computer based training is available.

Do you offer interactive/hands-on

training in a simulated live

environment?

All of our training is interactive and simulation based.

Do you customize your training to

match any system customizations that

are required?

Unfortunately we are not able to provide this at our corporate

office. Customized training can be purchased and led at the

customer site.

Do you offer an LMS or other system

to track training progress?

No

Is all of your training available to us

throughout the term of our software

license agreement?

Yes

Do you offer training specific to

major system updates?

Yes, as necessary

When can we begin training our end-

users?

Our training methodology is flexible.

Appendix D – Vendor Information – Optum

Question Response

Company Name Optum

Address of Headquarters 13625 Technology Drive

Eden Prairie, MN, USA

Number of years as a Medical Coding vendor 8 years assist, 2 years complete

Number of years integrating NLP into Coding

software 2

Has your product won any awards or received

any certifications? (KLAS, HIMSS, etc) Konfidence 3 (Nov 21, 2014)

Please list any company mergers, acquisitions,

and sell-offs and year completed

None

How many employees do you have? 80,000 worldwide

Is the company Public or Privately owned? Private

Have there been any bankruptcy/legal issues? No

If so, please include under which name the

bankruptcy was filed and when, or any

pertinent lawsuits, closed or pending, filed

against the company.

Number of entities actively using software 234

How many of these entities are multi-site? 5

How many of these entities are licensed as

long term acute care?

0

Please list your top three “WOW factors”

based on client satisfaction data

Do you have a formal users group? yes

Please provide references that are available for

contact

See references page

Appendix E – Functional & Technical Requirements – Optum

Item

# Area Functionality Y/N Comments

1 HIM Are multiple groupers allowed

based on payor requirements?

List any limitations.

Y

2 HIM Does system support workflow

creation for coding?

Y

3 HIM Can the system support computer

assisted coding?

Y

4 HIM Is NLP Integrated or is it an add-

on?

NLP is an integrated software

module that can be licensed

separately.


and updates for ICD-9 codes and

ICD10?

Y

6 HIM Can ICD9 & ICD10 be used

concurrently?

Y Coaching mode or final coding

mode.





Y

8 HIM Does your system handle

outpatient codes for ICD-9 and

ICD-10? If so, for which

departments?

Y

9 HIM Does your system generate early

warning indicators when there

might be insufficient

documentation for ICD-10

coding?

Y





Y


and regulatory updates for CPT,

DRG, APC, HCPCS?

Y

12 HIM Does the system include a DRG

grouper?

Y

13 HIM If a DRG grouper is included, are

updates provided?

Y

14 HIM Does the system include an

OP/APC grouper?

Y

15 HIM If the system does not include an

OP/APC grouper can the system

interface with an external system

and what are the costs for the

interface?

N

16 HIM Can we load historical MPI from

previous system?

N

17 HIM Does the system allow for users

to establish special studies to

support clinical data collection

where applicable?

N Future Development

18 HIM Can each facility define which

types of ROI requests need to be

written to a disclosure log?

N

19 HIM Can alerts be established when

multiple ROI requests are

received from same auditing

entity (ie QIO/RAC)?

N

20 HIM Does your system provide any

tools that would assist with RAC

audits and tracking?

N

21 Interfaces Does your software support

standard HL7 formatting for

importing and exporting data

to/from other systems or outside

providers? If any limitations

describe.

Y We support standard HL7

formatting, inbound and

outbound.


Clinical Information System? If

yes, please provide the names of

the other systems.

Y Capable of interfacing with any

downstream system through an

HL7 interface engine


Patient Financial System? If yes,

please provide the names of the

other systems.

N Integrated product offering

cohesiveness

24 Interfaces Do you have experience with the

InteGreat ICChart EMR?

N Epic

25 Interfaces Regarding ADT interfaces – do

you specifically allow an

Y

inbound ADT interface to create

a patient encounter?

26

27 Audit Do audit logs track actual

activity that has been changed?

Y


what users have viewed and or

edited in the system?

Y


any user who has printed and or

exported patient data from the

system?

Y

30 Audit Does the system provide reports

on encoder and CAC utilization

and productivity?

Y

31 Audit Does the system provide coder

productivity statistics?

Y

32 Audit Does the system support the

ability to build quality audit

alerts for management review?

Y

33 Reporting Does system provide standard

revenue and usage reports with

YTD information flexed by

hospital/provider FTE.

Y

34 Reporting Does the system allow for ad-hoc

reporting?

N

35 Reporting Are all data elements captured

within the system available from

a reporting perspective? Please

list any limitations.

Y

36 Reporting Does the system provide roll-up

reporting from single facilities,

grouping of facilities and

corporate wide?

Y Custom

37 Reporting Are clients able to directly access

backend production database for

creating own custom queries and

reports?

Y Custom


ability to export data to MS

Office applications?

Y Excel


ability to restrict access to reports

by employee role?

Y


SaaS model?

Y Hosted or fully managed


hosted model?

Y

42 System Can your system be located in

our data center?

Y We can remotely manage

43 System If hosted at our data center, what

technical and hardware

requirements are needed for your

product?

Y See attached requirements

document.


financial classes allowed?

N


payor codes allowed?

N


patient types allowed?

N


adjustment and payment codes

allowed?

N

48 System Does the system allow users to

access enterprise and facility-

specific reports from remote

locations?

Y

49 System Please provide a description of

how the system would support a

centralized management model

for multiple facilities?

Y Fully

50 System Does the system run multiple

locations on a single relational

database? If so, please describe

how security functions for

corporate users?

Y

51 System Does system support the

technical requirements set forth

in HIPAA and the HITECH act?

Y

52 System Does vendor adhere to standards

of ICD9/ICD10, LOINC, CPT,

SNOMED?

Y

53 System Has your CAC/NLP product

been certified by an authorized

certification body? If so, please

list all certifications achieved.

N/A NO

54 System Do you provide 24/7 customer

support?

Y US based service desk, long wait

times

55 System Where is your support center

located?

Y Two support centers – central

and west

56 System Does the system support online

help function/feature within the

application?

Y Help is context based

57 System How often are software releases

scheduled?

Y Major releases are once a year

and maintenance releases are

released as necessary

58 System How often is your product

updated? How are they

deployed?

Y cloud

59 System Is downtime required for

software releases? If yes, please

provide average down time.

Y Hours

60 System Describe your disaster recovery

plans including the protection of

source code as well as patient

data.

Y Hosted and SaaS model

deployments are fully redundant

61 System How are customer requests for

enhancements handled?

Y Enhancements can be submitted

two ways, through your sales

person and user group.

62 System Describe your flexibility in

customizing base product for

hospital specific rules and alerts.

Y All available

63 System Does vendor allow for a separate

test system at no cost?

Y

64 System Does the system provide

configurable error checking on

data entered?

Y Strict filtering

65 System Is the system accessible through

mobility devices?

Y Mobile access is available.

66 System-

Implementation

& Training

Does the system provide for a

separate training system? If yes,

is there a cost associated?

Y The test environment is what is

used for training

67 System-

Implementation

& Training

For implementation and training

do you utilize a third party

partner? If so please provide the

partner name.

N Train the trainer

68 System-

Implementation

& Training

What is the typical time frame

for installation of a site?

Y Varies – 1-2 months

69 System-

Performance



expect from the NLP engine?

Y Did well in Jamaica

70 System-

Performance



expect from the CAC system?

Y None

71 System-

Performance



organizations similar to ours?


document

72 System-

Performance



organizations that are larger than

ours?


document

73 Users/Security Does the system support the

configuration of password rules

(e.g. length of password, strength

of password, special characters,

keyword exceptions, etc.)?



can be utilized.

74 Users/Security Can passwords be configured to

expire in a configurable amount

of time?



can be utilized

75 Users/Security Does the system provide self-

service password reset

functionality?

N

76 Users/Security Does system allow for users to

be set up once and then granted

access to all facilities required?

Y

77 Users/Security Does system allow for creation

of master roles to be assigned

when creating new user?

Y

78 Users/Security Is there a limit to the number of

concurrent users allowed to

access system?

N Unlimited

Appendix F – Training Plan – Optum

Question Response

Do you offer instructor-led classroom

training?

Yes we do at our Corporate office in Eden Prairie, MN.

Do you have classroom training

facilities?

Yes we do at our Corporate office in Eden Prairie, MN.

Do you offer online/CBT training?

Yes, computer based training is available.

Do you offer interactive/hands-on

training in a simulated live

environment?

All of our training is interactive and simulation based.

Do you customize your training to

match any system customizations that

are required?

Unfortunately we are not able to provide this at our corporate

office. Customized training can be purchased and led at the

customer site.

Do you offer an LMS or other system

to track training progress?

No

Is all of your training available to us

throughout the term of our software

license agreement?

Yes

Do you offer training specific to

major system updates?

Yes, as necessary

When can we begin training our end-

users?

Our training methodology is flexible.

Appendix G – Vendor/Product Comparison

CAC/NLP Vendor Comparison

Product Scores: 0 - product/vendor does not meet/support the criterion 2 - product/vendor partially meets/supports the criterion 4 - product/vendor fully meets/supports the criterion 6 - product/vendor exceeds expectations for the criterion

Vendor Information:

Rqmt Weight Value

(1, 3 or 5)

3M Weighted

Score Optum

Weighted Score

Number of years as a Medical Coding vendor

3 6 18 4 12

Number of years integrating NLP into Coding software

3 4 12 2 6

Has your product won any awards or received any certifications? (KLAS, HIMSS, etc)

5 4 20 0 0

Number of entities actively using software

5 6 30 4 20

How many of these entities are multi-site?

3 6 18 2 6

How many of these entities are licensed as long term acute care?

3 6 18 0 0

Please list your top three “WOW factors” based on client satisfaction data

5 4 20 2 10

Do you have a formal users group? 1 4 4 0 0

40 140 14 54

Minimum functional requirements:

Rqmt Weight Value

(1, 3 or 5)

3M Weighted

Score Optum

Weighted Score

Are multiple groupers allowed based on payor requirements? List any limitations.

3 4 12 4 12

Does system support workflow creation for coding?

5 4 20 4 20

Can the system support computer assisted coding?

5 6 30 4 20

Is NLP Integrated or is it an add-on? 5 4 20 4 20

Does the system provide support and updates for ICD-9 codes and ICD10?

5 4 20 4 20

Can ICD9 & ICD10 be used concurrently?

5 6 30 4 20

Does your system suggest both ICD-9 and ICD-10-CM/PCS codes simultaneously in one view for the coders?

5 4 20 4 20

Does your system handle outpatient codes for ICD-9 and ICD-10? If so, for which departments?

5 4 20 4 20

Does your system generate early warning indicators when there might be insufficient documentation for ICD-10 coding?

5 4 20 4 20

Does your system suggest both ICD-9 and ICD-10-CM/PCS codes simultaneously in one view for the coders?

5 6 30 4 20

Does the system provide support and regulatory updates for CPT, DRG, APC, HCPCS?

5 4 20 4 20

Does the system include a DRG grouper?

3 4 12 4 12

If a DRG grouper is included, are updates provided?

3 4 12 4 12

Does the system include an OP/APC grouper?

1 4 4 4 4

If the system does not include an OP/APC grouper can the system interface with an external system and what are the costs for the interface?

1 6 6 0 0

Can we load historical MPI from previous system?

1 6 6 0 0

Does the system allow for users to establish special studies to support clinical data collection where applicable?

3 0 0 0 0

Can each facility define which types of ROI requests need to be written to a disclosure log?

3 0 0 0 0

Can alerts be established when multiple ROI requests are received from same auditing entity (ie QIO/RAC)?

3 4 12 0 0

Does your system provide any tools that would assist with RAC audits and tracking?

3 4 12 0 0

Does your software support standard HL7 formatting for importing and exporting data to/from other systems or outside providers? If any limitations describe.

5 4 20 4 20

Have you interfaced with another Clinical Information System? If yes, please provide the names of the other systems.

5 4 20 4 20

Have you interfaced with another Patient Financial System? If yes, please provide the names of the other systems.

5 4 20 0 0

Do you have experience with the InteGreat ICChart EMR?

3 4 12 0 0

Regarding ADT interfaces – do you specifically allow an inbound ADT interface to create a patient encounter?

1 4 4 4 4

Do audit logs track actual activity that has been changed?

1 4 4 4 4

Are audit logs available to track what users have viewed and or edited in the system?

3 4 12 4 12

Are audit logs available to track any user who has printed and or exported patient data from the system?

3 4 12 4 12

Does the system provide reports on encoder and CAC utilization and productivity?

5 4 20 4 20

Does the system provide coder productivity statistics?

5 4 20 4 20

Does the system support the ability to build quality audit alerts for management review?

3 4 12 4 12

Does system provide standard revenue and usage reports with YTD information flexed by hospital/provider FTE.

3 4 12 4 12

Does the system allow for ad-hoc reporting?

1 4 4 0 0

Are all data elements captured within the system available from a reporting perspective? Please list any limitations.

3 4 12 4 12

Does the system provide roll-up reporting from single facilities, grouping of facilities and corporate wide?

3 4 12 2 6

Are clients able to directly access backend production database for creating own custom queries and reports?

3 4 12 2 6

Does the system provide the ability to export data to MS Office applications?

1 4 4 2 2

Does the system provide the ability to restrict access to reports by employee role?

1 4 4 4 4

Is your system available in a SaaS model?

5 4 20 4 20

Is your system available in a hosted model?

5 4 20 4 20

Can your system be located in our data center?

3 4 12 2 6

If hosted at our data center, what technical and hardware requirements are needed for your product?

1 4 4 4 4

Is there a limit to the number of financial classes allowed?

3 4 12 4 12

Is there a limit to the number of payor codes allowed?

3 4 12 4 12

Is there a limit to the number of patient types allowed?

3 4 12 4 12

Is there a limit to the number of adjustment and payment codes allowed?

3 4 12 4 12

Does the system allow users to access enterprise and facility-specific reports from remote locations?

1 4 4 4 4

Please provide a description of how the system would support a centralized management model for multiple facilities?

1 6 6 4 4

Does the system run multiple locations on a single relational database? If so, please describe how security functions for corporate users?

3 4 12 4 12

Does system support the technical requirements set forth in HIPAA and the HITECH act?

5 4 20 4 20

Does vendor adhere to standards of ICD9/ICD10, LOINC, CPT, SNOMED?

5 4 20 4 20

Has your CAC/NLP product been certified by an authorized certification body? If so, please list all certifications achieved.

5 4 20 4 20

Do you provide 24/7 customer support? 5 4 20 2 10

Where is your support center located? 3 4 12 2 6

Does the system support online help function/feature within the application?

5 6 30 6 30

How often are software releases scheduled?

3 4 12 4 12

How often is your product updated? How are they deployed?

3 4 12 4 12

Is downtime required for software releases? If yes, please provide average down time.

1 2 2 2 2

Describe your disaster recovery plans including the protection of source code as well as patient data.

3 4 12 4 12

How are customer requests for enhancements handled?

5 4 20 4 20

Describe your flexibility in customizing base product for hospital specific rules and alerts.

3 4 12 4 12

Does vendor allow for a separate test system at no cost?

5 4 20 4 20

Does the system provide configurable error checking on data entered?

3 4 12 4 12

Is the system accessible through mobility devices?

3 4 12 4 12

Does the system provide for a separate training system? If yes, is there a cost associated?

1 4 4 4 4

For implementation and training do you utilize a third party partner? If so please provide the partner name.

1 4 4 4 4

What is the typical time frame for installation of a site?

3 4 12 4 12

What are the performance and accuracy benchmarks we can expect from the NLP engine?

5 4 20 4 20

What are the performance and accuracy benchmarks we can expect from the CAC system?

5 4 20 4 20

Have these performance benchmarks been met in organizations similar to ours?

5 4 20 4 20

Have these performance benchmarks been met in organizations that are larger than ours?

5 4 20 4 20

Does the system support the configuration of password rules (e.g. length of password, strength of password, special characters, keyword exceptions, etc.)?

1 4 4 4 4

Can passwords be configured to expire in a configurable amount of time?

1 4 4 4 4

Does the system provide self-service password reset functionality?

3 0 0 0 0

Does system allow for users to be set up once and then granted access to all facilities required?

3 4 12 4 12

Does system allow for creation of master roles to be assigned when creating new user?

5 4 20 4 20

Is there a limit to the number of concurrent users allowed to access system?

5 4 20 4 20

308 1044 256 904

Training Plan:

Rqmt Weight Value

(1, 3 or 5)

3M Weighted

Score Optum

Weighted Score

Do you offer instructor-led classroom training?

5 2 10 2 10

Do you have classroom training facilities?

5 2 10 2 10

Do you offer online/CBT training? 5 4 20 4 20

Do you offer interactive/hands-on training in a simulated live environment?

5 4 20 4 20

Do you customize your training to match any system customizations that are required?

3 4 12 4 12

Do you offer an LMS or other system to track training progress?

3 0 0 0 0

Is all of your training available to us throughout the term of our software license agreement?

5 4 20 4 20

Do you offer training specific to major system updates?

3 4 12 4 12

When can we begin training our end-users?

1 4 4 4 4

28 108 28 108

Costs: 3M Weighted

Score Optum

Weighted Score

Product 5 4 20 2 10

Training 5 4 20 4 20

Maintenance/Support 5 4 20 2 10

12 60 8 40

3M Weighted

Score Optum

Weighted Score

388 1352 306 1106

References Goedert, J. (2013). KLAS Details Rough Start for Computer-Assisted Coding Vendors. Health

Data Management. Retrieved from: http://www.healthdatamanagement.com/news/klas-rough-

start-for-computer-assisted-coding-vendors-46995-1.html

Dougherty, M., Seabold, S., and White, S. E. (2013). Study reveals hard facts on CAC. Journal

of AHIMA / American Health Information Management Association, 84(7):54-56.

Getz, L. (2009). CAC: It Still Needs the Human Touch. For the Record. Retrieved from:

http://www.fortherecordmag.com/archives/101209p14.shtml

Schwenz, C. & Wimberley, M. (2012). Computer-Assisted Coding: Is It Time for Your

Organization to Make the Transition?. Santa Rosa Consulting – Team Blog. Retrieved from:

http://www.santarosaconsulting.com/SantaRosaTeamBlog/post/2012/09/05/Computer-Assisted-

Coding-Is-it-Time-for-Your-Organization-to-Make-the-Transition.aspx

http://www.healthdatamanagement.com/news/klas-rough-start-for-computer-assisted-coding-vendors-46995-1.html

http://www.healthdatamanagement.com/news/klas-rough-start-for-computer-assisted-coding-vendors-46995-1.html

http://www.fortherecordmag.com/archives/101209p14.shtml

http://www.santarosaconsulting.com/SantaRosaTeamBlog/post/2012/09/05/Computer-Assisted-Coding-Is-it-Time-for-Your-Organization-to-Make-the-Transition.aspx

http://www.santarosaconsulting.com/SantaRosaTeamBlog/post/2012/09/05/Computer-Assisted-Coding-Is-it-Time-for-Your-Organization-to-Make-the-Transition.aspx

Documents

CAC & NLP - Vendor Selectiondocdailey.weebly.com/uploads/4/5/...final_wdailey.pdf · Computer Assisted Coding/Natural Language Processing (CAC/NLP) project. The selection committee