Program Management Office (PMO)
______
OnBase
Document Scanning
Image Management Replacement
Scope Statement
Document Version 5.0: Draft
Document Date: 2014-08-14
Revision History
Revision / Date / Revised By / Changes Made – Reasons for the Change1.0 / 2014-03-28 / Steve Prevost / Initial draft
2.0 / 2014-04-09 / Steve Prevost / Incorporate updates from reviewers
3.0 / 2014-04-18 / Steve Prevost / Incorporated updates from UPG
4.0 / 2014-04-24 / Steve Prevost / Added text for batch scanning of EOBs and Patient Correspondence Containing Multiple Patients
5.0 / 2014-08-14 / Steve Prevost / Added link to final version of the Solution Design document for Professional Billing. (p. 13)
Table of Contents
Revision History 2
Project Scope Statement 4
Business Objectives 5
Project Priority 6
High Level Project Scope 6
Project 1 – Core Solution - Streamline Conversion and Replacement Solution for Siemens, GE and Epic 6
Project 1A – Registration Solution 6
Project 1B – Charity Care Workflow 7
Project 1C – Clinical Records Solution 9
Project 1D – Billing Office Solution 11
Project 1E – Disaster Recovery Consulting 12
Project 1F – Streamline Conversion 13
Project 2 – Pre-Arrival Services Solution 15
Project 3 – Revenue Cycle Management 17
Detailed Scope and Deliverables 18
Registration and Clinical Record Solution 18
Pre-Arrival Unit 22
Financial Screening 23
Out of Scope 25
Project Assumptions 25
Project Exclusions 25
Project Constraints 25
Scope Sign-off 27
Project Scope Statement
To mitigate/resolve existing deficiencies, a new document scanning and image management solution must be installed in the UVA Health System (UVAHS). The existing Streamline Health workflow and reporting solutions are not robust and must be created and maintained by the vendor. With the ever-increasing complexity of financial regulations, a workflow solution that allows the automation of business processes by system administrators is critical to the continued success of the operation from registration to collections for both UPG and the Medical Center.
While the current system has standard reports, custom and ad hoc reporting capabilities do not exist for end-user creation and maintenance.
This project will:
· Implement a robust document scanning and image management solution with significant workflow capabilities that will support/enhance business processes in both our current systems configuration as well as future state Epic.
· Address the conversion to a new solution.
· Assure the accuracy of all converted images, data, and pointers.
· Convert 15 interface and integration processes.
· Remove existing pointers in the Epic Electronic Medical Record (EMR) and GE Centricity Business repositories and add the new system pointers.
· Convert/create the Financial Screening and Correspondence workflows to the new solution.
· Select workflow solutions for Denial Management, Pre-Arrival, Treasury/Cash posting management, Registration check-in and other Revenue Cycle related work functions which are multidisciplinary across the patient continuum. Evaluate feasibility and determine prioritization of implementing these solutions in a controlled and mutually agreed upon timeline, and/or identify opportunities and apply necessary resources required to execute implementation plans, which result in improved net revenue and/or cash collections, and/or reductions in cost to collect.
· Establish work queue controls and business owners that enable departmental management of key workflow drivers under pre-defined system guidelines, change management and process controls.
· Ensure a build that allows additional phased work flows with minimal restructuring of initial phases.
· Ensure similar change management processes are followed for work flow implementation.
· Integrate the new system with Epic.
· Integrate the new system to Siemens Invision Resource Scheduling, Patient Management and Patient Accounting.
· Integrate the new system to GE Centricity Business.
· Integrate as needed workflow solutions between themselves; e.g. output from one workflow can be ingested as a work driver in another
· Integrate with other scheduling systems, such as the Operating Room’s CPM.
· Establish a new process to archive insurance card images after 180 days and/or a set configurable number of days by type of procedure and insurance with applicable prompts to the registration staff to request and scan new cards.
· Possess the capability for decentralized registration staff to quickly and easily index images, such as insurance cards at the patient level without duplication of data entry for Medical Record Number (MRN), etc., with desk top imaging and workstation signature pads
· Provide enhanced reporting capabilities.
· Establish protocols to permit utilization of document management/imaging system by areas not currently using a similar solution.
Business Objectives
The University of Virginia Medical Center has been operating the Streamline Health AccessAnyWare, Folder View, RegScan, Data Manager, and Ultimus Workflow applications since August 2003. AccessAnyWare is deployed for document management within Health Information Services to keep patient data and documents online and secure to facilitate transactions and processes automatically from one user to the next. It is integrated with the Epic electronic health record. However, there are system deficiencies:
· The system cannot provide offline access to documentation, forms scanning/completion, and subsequent database synchronization.
· The system also cannot import from within Microsoft Word or Excel.
· The system cannot parse print streams and index documents in a single process.
Folder View allows the University Physicians Group (UPG) to manage documents from various departments across the enterprise. It also allows Patient Financial Services (PFS) to manage documents not associated with a specific patient record such as Explanation of Benefits (EOB) and cash posting batches. Drawbacks associated with Folder View:
· Not integrated with the GE Centricity Business application maintained by UPG.
· Does not provide integration with Microsoft Outlook to allow users to import emails and attach documents into the repository directly.
The Ultimus workflow engine is installed and supports workflows within PFS for documents associated with both charity care application processing, as well as patient correspondence. Data Manager is utilized to scan and route documents to both workflows listed above.
Drawbacks associated with the Ultimus and Data Manager workflow solutions:
· Technical Support for workflow related issues
· System stability and downtime
· Printing capabilities are limited within the workflow
· User changes to system settings (e.g. changing/adding queues, altering times) are cumbersome
· Challenges automating document indexing
· Batch printing is not supported
· Reporting capabilities are weak
· Workflow steps associated with patient/insurance correspondence require multiple user touches to drive workflow including assignment of work
RegScan is utilized by Patient Access for insurance card, photo IDs, long-term signature card, and other document scanning at the point of patient registration in over 200 locations.
Project Priority
1: / A discretionary project that provides significant business value or one that is highly aligned with the strategic direction for the organization.2: / A discretionary project that provides moderate business value or one that is moderately aligned with the strategic direction for the organization.
3: / A discretionary project that provides limited business value or one that is not aligned with the strategic direction for the organization.
Non-Discretionary: / The project fulfills a regulatory requirement, operational requirement or other reason for being mandatory.
Project Budget
The approved capital budget for the project is $1,900.000.
Hyland’s approved cost estimate as found in the Services Proposal document is as follows:
Estimate Type / AmountCore Solution
1A / Registration Solution / Time and Materials / $ 252,306.00
1B / Charity Care Workflow Solution / Time and Materials
1C / Clinical Records Solution / Time and Materials
1D / Billing Office Solution / Time and Materials
1E / DR Consulting / Time and Materials
1F / Streamline Conversion / Fixed Fee / $ 306,000.00
Add-on Solutions
2 / Pre-Arrival Services Solution / Time and Materials / $119,880.00
3 / Revenue Cycle / Time and Materials / $125,160.00
Total / $803,346.00
High Level Project Scope
After significant review by key stakeholders within UVAHS, Hyland Software’s OnBase Software was selected to provide the following solutions as outlined in the Services Proposal:
Project 1 – Core Solution - Streamline Conversion and Replacement Solution for Siemens, GE and Epic
Project 1A – Registration Solution
Scope
The project will consist of initiation, discovery, build, testing, training, and project management services in association with linking captured registration documents to the registration system.
Content Capture
a. Day-forward capture of registration documents such as insurance card, photo identification, and consent form;
b. Capture during registration will utilize the Front Office Scanning (“FOS”) module of the Software;
i. Indexing of registration documents using Application Enabler within Siemens Invision.
c. Batch Scanning – capture may also consist of Software batch scanning for high page-count document volumes (e.g. over forty–five (45) pages per batch); and
d. Electronic completion and signing using a device such as a tablet PC (e.g. Panasonic H1 Health Toughbook or equivalent), interactive pen display (e.g. Wacom pen display) or signature pad (e.g. Topaz SignatureGem) capable of capturing “digital ink”. The estimate includes the creation of up to seven (7) Image Documents and up to two (2) E-Forms.
Interfaces
a. Incoming ADT interface from Siemens Invision (“SMS”) capture patient and account data for fast and accurate indexing of documents scanned in batch; and
b. (Optional) Outgoing MDM interface to Epic.
Content Delivery
a. Document retrieval and viewing from within any Siemens Invision and GE Centricity Business screen using Application Enabler; and
b. Document retrieval using native client(s) of the Software.
Third-party Application Integration
a. Software will integrate with the following applications using Application Enabler:
i. Siemens Invision Patient Management; and
ii. GE Centricity Business.
Facilities
a. The solution will be deployed at approximately three hundred (300) registration points for one (1) hospital which includes the following:
i. University Hospital
b. The solution will be deployed at the registration points throughout the Health System. Registration points to be identified by UVAHS.
Project 1B – Charity Care Workflow
Scope
The project will consist of initiation, discovery, build, testing, training, and project management services in association with the capture and management of financial assistance documentation.
Content Capture
a. Day-forward capture of financial assistance application and supporting documentation; and
b. Batch Scanning for high page-count document volumes (e.g. over forty–five (45) pages per batch). ADT interface will be leveraged for patient demographic information in order to facilitate indexing.
Content Management
The Financial Screening workflow is needed to facilitate the identification, application and follow up processes that relate to patients who might need financial assistance for their care but are not eligible for Medicaid.
The concept of a charity care workflow is focused on identifying patients who require financial assistance for medical care, collect pertinent documentation, make decisions for a level of assistance and, finally, to collect those funds.
The process is initiated by an application form filled out by the patient. This form will then be routed and evaluated by a clerk to determine qualification into the process. The initial decisions that can be made are:
1. Accepting the applicant
2. Unqualified Applicant
3. Intake (Indigent Care)
If the clerk decides to accept the applicant (#1), work queues will be provided as necessary to support the processing of the application, as well as gathering other supporting documentation.
If the application evaluation determines this applicant to be unqualified (#2), work queues will be provided as necessary to support the processing of the application potentially for other charity funds.
If the applicant is an Intake for Indigent Care (#3), the application will need to route so that processing of the application for Intake to Indigent Care can take place.
The workflow will also provide exception handling for any application which might be denied, including the ability to capture comments and reasons for rejections, as well as alternate routing based on a denied status.
The document types used in support of this workflow may potentially need additional security as these may be considered sensitive financial documents.
Content Delivery
a. Application Enabler retrieval within Siemens Invision; and
b. Document retrieval using native client(s) of the Software.
Third-party Application Integration
a. Software will integrate with the following applications using Application Enabler:
i. Siemens Invision Patient Management
Interfaces
Intentionally left blank
Facilities
a. The solution will be deployed at Patient Financial Services which include the following:
i. University Hospital
Assumptions
a. Workflow distribution of applications is completed either by a FIFO method or by a manual assignment of items;
b. Unity Forms will be utilized for the development of the electronic application document;
c. Applications will be identified as unique based on a Patient ID;
d. A method to withdraw applications will be provided;
e. Time-sensitive items will be monitored by the system; and
f. Any pre-populated information on applications will be supplied by UVAHS’s LOB system.
Project 1C – Clinical Records Solution
Scope
The project will consist of initiation, discovery, build, testing, training and project management services in association with linking captured clinical documents to the Epic EMR.
Content Capture
a. Day-forward capture of clinical documents such as history and physical, discharge note, and referral;
b. Batch Scanning – centralized, high volume, scanning of patient records post-discharge/visit; and
c. Integrated Scanning – distributed capture for designated document types using the Software integrated scan control from the Epic scan acquisition launch points and Epic MediaManager as required.
d. Import capability from other scanning vendors as necessary, e.g., ImageX.
Content Management
a. Deficiency Analysis – analysis of scanned documents for missing signature deficiency from Epic Health Information Management (“HIM”) Chart Deficiency. Notification of signature deficiencies to assigned physician in-basket;
b. Physician Completion – resolving deficiencies of scanned chart documents from Epic HIM Chart Deficiency and the electronic signing of a deficiency from the physician in-basket. Initial physician metadata load for Epic HIM Signature Deficiency integration with Software will be executed in a one-time bulk import with subsequent updates provided in the same format. UVAHS will provide the physician metadata from an Epic Clarity report which will be scheduled to automatically import into the Software;