computer assisted coding & natural language processing...

Northwestern University – MED INF 408 – Fall 2014

Computer Assisted Coding

& Natural Language

Processing RFP

Assignment 4

Team CAC/NLPL

Russ Abercrombie

Bill Dailey

Jeremy Lutz

Northwestern University – MED INF 408 – Fall 2014 Assignment 4 – RFP

Contents

Contents ........................................................................................................................................................ 2

1 Overview ............................................................................................................................................... 4

2 Opportunity ........................................................................................................................................... 5

3 Terms .................................................................................................................................................... 7

3.1 Confidentiality .............................................................................................................................. 7

3.2 Cost of Proposal ............................................................................................................................ 8

3.3 Right to Reject .............................................................................................................................. 8

3.4 Schedule ........................................................................................................................................ 8

3.5 Intent to Participate ....................................................................................................................... 8

3.6 Proposal Submittal ........................................................................................................................ 9

3.7 Payments ....................................................................................................................................... 9

4 Functionality and Scope of Services ..................................................................................................... 9

5 Costs .................................................................................................................................................... 10

5.1 Software ...................................................................................................................................... 11

5.2 Hardware/Storage/Network ........................................................................................................ 11

5.3 Implementation and Support Services ........................................................................................ 11

5.4 Training ....................................................................................................................................... 12

6 Administrative ..................................................................................................................................... 12

6.1 Technical Contact ....................................................................................................................... 12

6.2 Contractual Contact .................................................................................................................... 13

6.3 Proposal Submittal Contact ......................................................................................................... 13

6.4 Due Dates .................................................................................................................................... 13

Appendix A – Vendor Information ............................................................................................................. 14

Appendix B – Functional & Technical Requirements ................................................................................ 15

Appendix C – Training Plan ....................................................................................................................... 22

Appendix D – Abbreviations ...................................................................................................................... 23

References ................................................................................................................................................... 24


1 Overview

Golden Valley Memorial Healthcare (GVMH) is located in the rural community of Clinton, MO.

GVMH is a healthcare system comprised of one hospital and four multispecialty clinics

dispersed throughout the Clinton, MO community. The multispecialty clinic has 30 providers, 6

of which are specialists and 24 are primary care providers.

Golden Valley Memorial Healthcare inpatient volumes continue to decrease at approximately 4-

5% per year while outpatient volumes continue to grow. Over the past 5 years, the healthcare

system profit margin has been driven by this increased outpatient revenue. Optimizing

efficiency with regard to this revenue stream is critical to the continued success of GVMH.

The electronic medical record system used in the outpatient setting is McKesson IC-Chart

(formerly Med-3000/InteGreat).

Increased pressures on coding accuracy coupled with this increase in volume have created a large

opportunity for improvement in the revenue stream. There are significant “bottle-necks” in the

processes that currently exist between the point of care and the resulting reimbursement. The

methods previously in place for coding, billing and subsequent reimbursement have not “scaled

well” in response to increased outpatient volumes and the looming ICD-10 transition will only

complicate matters.

The impending requirement for all healthcare organizations to transition from the ICD-9 code set

to the ICD-10 code set in October of 2015 will create many challenges for HIM and coding

professionals. The significant expansion of the code set allows for more specific and granular

coding, but also brings with it more complexity. This complexity, along with the need for coders


to learn, essentially, a brand new code set, will require more time and effort for the coding

process.

The conversion to ICD-10 has the potential to increase data quality, analyze gaps in care,

improve clinical and billing processes, and facilitate quality reporting. But in order to fully

realize this potential, and avoid the possible negative effects of the ICD-10 conversion, GVMH

will need to take advantage of technologies that will help ensure coding accuracy and efficiency.

These issues create a great impetus to change GVMH approach to coding.

2 Opportunity

Golden Valley Memorial Healthcare wants to replace the current HIM coding solution with a

solution that is integrated with natural language processing and is capable of interfacing with the

electronic health record system that is in use today. The overarching goal of this project will be

to increase coding and billing efficiency to shorten the time between date of service and

reimbursement to recoup a portion of the cost. The calculations are straightforward -- each day

saved in the coding process results in $65,000 savings over the year. We believe this goal can be

accomplished through the implementation of Natural Language Processing (NLP) and Computer

Assisted Coding (CAC) technologies to reduce coding costs, increase coder efficiency, and

increase coding accuracy. Our goal will be met by leveraging NLP and CAC to accomplish the

following objectives:

Capture lost revenue by improving efficiencies in the coding life cycle.

Minimize or eliminate the risk of reductions in coder productivity or accuracy due to the

impending conversion to ICD-10.


Minimize or eliminate coding backlogs.

Protect the organization from potential shortages of certified coders if some level of

automation is implemented.

Provide valuable data and insights for any current or future efforts to improve evidence-

based care and standardization of care.

Golden Valley Memorial Healthcare desires a solution that will provide benefits in the following

areas:

Financial

o Improved financial reporting allowing for more categorization and analysis of

results

o Support for all data collection required for Medicare cost reporting

o Capable of handling additional lines of business in the future, e.g. orthopedic

surgery

o Reasonable acquisition and recurring expense

o Reduced dictation/transcription cost

o Reduce risk cross-section with respect to RAC audits

Technical

o Interface with McKesson InteGreat and Meditech C/S

o Easy to deploy and support

o Capability for customization with vendor assistance and continued vendor support

o Capability to be deployed internally via private cloud


o Scalable architecture

o Open architecture to allow the use of third party reporting tools.

o Ability to retain data for at least ten years

3 Terms

This Request for Proposal (RFP) is being sent to candidates who have been identified through

the RFI process as potentially having the capability to satisfy GVMH preliminary requirements

for an integrated NLP/CAC solution. The solution selected will be chosen on the basis of

GVMH’s evaluation and determination of which solution provides the greatest benefit to the

GVMH community.

The following terms will apply to this RFP process. Submission of a proposal in response to this

RFP indicates your acceptance of all the following terms. If you do not agree or intend to

comply with any term in this RFP, you must clearly indicate this in your Proposal.

3.1 Confidentiality

Any data that you consider confidential (Vendor Confidential Data) shall be

conspicuously marked as such in your Proposal. GVMH will not disclose any Vendor

Confidential Data to any party other than its agents supporting this RFP process, and

agrees that such data will not be used for any purpose other than evaluation of the

Proposal. You may not make any public announcement regarding this RFP or its

contents. Breach of confidentiality may lead to GVMH’s enforcement of any other

remedies available.


3.2 Cost of Proposal

GVMH shall not bear any responsibility or liability for any costs incurred by you in the

preparation, submission, or delivery of a proposal, or any subsequent demonstrations or

presentations.

3.3 Right to Reject

GVMH reserves the right to reject any proposals submitted which it finds non-

responsive, late in submission, or unsatisfactory in any way. GVMH reserves the right to

request additional information from you in response to any proposal you submit and shall

have no obligation to award a contract for products, work, goods, or services as a result

of this RFP.

3.4 Schedule

Below are the key dates in our RFP process:

3.5 Intent to Participate

If you are interested in responding to this RFP, please send your written intent to

participate via email to Dr. William Daily ([email protected]). Notice of Intent to

Participate must be submitted by 1700 CST on February 13, 2015. Once we have

received your Notice of Intent to Participate, we will email a copy of our Confidentiality

Agreement to the email address from which the Notice of Intent was sent. This

Date Event

Jan. 19–23, 2015 Request for Proposal distributed electronically by GVMH

Feb. 9-13, 2015 GVMH receives Intent to Participate from Candidate vendors

Feb. 16-20, 2015 Selected candidate vendors execute Confidentiality Agreement

March 19-20, 2015 GVMH hosts RFP Question and Answer conference call for

participating vendors

April 13, 2015 GVMH receives Proposals from candidate vendors

May 4, 2015 GVMH notifies candidates regarding status of their Proposal and

next steps

mailto:[email protected]


Confidentiality Agreement must be executed and returned to GVMH by 1700 CST on

February 20, 2015. Return instructions will be sent in the email with the Confidentiality

Agreement.

3.6 Proposal Submittal

Send one electronic copy of your Proposal via email to [email protected] by 1700 CST

on April 13, 2015.

3.7 Payments

Payments will be made in the following manner:

1. 50% payment made upon signing of contract

2. 25% payment at a mutually agreed upon project milestone

3. 25% remaining payment will be made when GVMH is satisfied with the

installation, training, and overall implementation.

4 Functionality and Scope of Services

Please provide responses to all items in both Appendix A – Vendor Information and Appendix

B – Technical & Functional Requirements. Please provide complete and accurate answers to all

questions. While responding, please note the following:

You must provide responses that are in accordance with existing software and services

which can be immediately procured and implemented if GVMH desires.

Any features or functionality planned for future releases of projects or services must be

clearly identified as such.

You must clearly state if your product does not fulfill the stated requirement.

Any deviation from the stated requirements must be specifically identified and explained.


Please respond to all items in Appendix C – Training Plan to outline the training capabilities

offered.

In addition to the software and support requirements, we are also seeking vendors who will

supply thorough and ongoing training to our staff on proper use of the product. We prefer a

blended learning model that includes the following elements:

Training in a variety of formats, including instructor-led classroom training, CBT/online

training, and hands-on training in a test environment (TrainingToday, 2014).

Training for all current and future end-users, including role-based and processed-based

training (HealthIT.gov, 2013).

Training for super-users (a.k.a. “train the trainer”) to develop in-house experts and

training resources (HealthIT.gov, 2013).

A system that monitors the training progress of all users and allows users to give

feedback regarding your system and the training itself.

5 Costs

Please insure that your proposal covers ALL costs associated from being awarded this business.

Please provide costs for the following scenarios:

Hosted/SaaS solution.

GVMH data center located solution

Costs should include any of the applicable items listed below, as well as any items you foresee

that are not mentioned here. Please identify and indicate all one-time costs and recurring costs

over the expected life of the proposed solution. If any costs associated with implementation are


not included in your pricing those costs must be specifically identified and explained as part of

your response.

4.

5.1 Software

List all proprietary software. Each component or module should be listed separately.

List all third party software required. Each component should be listed separately.

Provide detail regarding types of licensing and associated fees (e.g. enterprise, per

seat, per server, etc.).

Provide software maintenance terms and costs. Identify which items are required or

optional, as well as the term, calculation method, and annual increase amounts.

5.2 Hardware/Storage/Network

List all required hardware, storage devices, and associated operating systems or

software required.

List any specialized printing, scanning, or other devices required.

List any common off the shelf items required.

List all network and data communication devices required.

List all maintenance terms and fees associated with any hardware/storage/network

devices.

5.3 Implementation and Support Services

List all fees associated with installation, configuration, hosting, project management,

implementation services, integration services, data conversion, training services,

travel expenses, third party data, support fees, etc.


All such fees should be provided with supporting documentation, including rate,

quantity, estimated duration, and incidental expenses.

5.4 Training

Please provide pricing for any and all training you provide for your product. We prefer a

blended learning model.

Costs for all training materials, including any physical materials, training

software, learning management system access, instructor time, and use of off-site

training facilities.

Costs involved in modifying and/or customizing the training materials to match

any modifications and/or customizations made to the software to meet our needs.

6 Administrative

The following is a list of contact information and

6.1 Technical Contact

Any questions concerning technical specifications or Statement of Work (SOW)

requirements must be directed to:

Name Steve Ballou, IT Director

Address 2nd Street Clinton, MO 64735

Phone 660.647.2147

FAX 660.351-6190

Email [email protected]

mailto:[email protected]


6.2 Contractual Contact

Any questions regarding contractual terms and conditions or proposal format must be

directed to:

Name Kyle Adkins


Phone 660.647.2147

FAX 660.647.2160


6.3 Proposal Submittal Contact

All proposals, confidentiality agreements, and any other materials related to the RFP

should be directed to:

Name Mike Gaul


Phone 660.647.2147

FAX 660.647.2160


6.4 Due Dates

A written confirmation of the Vendor’s intent to respond to this RFP is required by

__________ (see schedule in section 3.4). All proposals are due by 17:00 CST. Any

proposal received at the designated location after the required time and date specified for

receipt shall be considered late and non-responsive. Any late proposals will not be

evaluated for award.


Appendix A – Vendor Information

Question Response

Company Name

Address of Headquarters

Number of years as a Medical Coding vendor

Number of years integrating NLP into Coding

software

Has your product won any awards or received

any certifications? (KLAS, HIMSS, etc)

Please list any company mergers, acquisitions,

and sell-offs and year completed

How many employees do you have?

Is the company Public or Privately owned?

Have there been any bankruptcy/legal issues?

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

How many of these entities are multi-site?

How many of these entities are licensed as

long term acute care?

Please list your top three “WOW factors”

based on client satisfaction data

Do you have a formal users group?

Please provide references that are available for

contact


Appendix B – Functional & Technical Requirements

Item

# Area Functionality Y/N Comments

1 HIM Are multiple groupers allowed

based on payor requirements?

List any limitations.

2 HIM Does system support workflow

creation for coding?

3 HIM Can the system support computer

assisted coding?

4 HIM Is NLP Integrated or is it an add-

on?

5 HIM Does the system provide support

and updates for ICD-9 codes and

ICD10?

6 HIM Can ICD9 & ICD10 be used

concurrently?

7 HIM Does your system suggest both

ICD-9 and ICD-10-CM/PCS

codes simultaneously in one

view for the coders?

8 HIM Does your system handle

outpatient codes for ICD-9 and

ICD-10? If so, for which

departments?

9 HIM Does your system generate early

warning indicators when there

might be insufficient

documentation for ICD-10

coding?

10 HIM Does your system suggest both

ICD-9 and ICD-10-CM/PCS

codes simultaneously in one

view for the coders?


11 HIM Does the system provide support

and regulatory updates for CPT,

DRG, APC, HCPCS?

12 HIM Does the system include a DRG

grouper?

13 HIM If a DRG grouper is included, are

updates provided?

14 HIM Does the system include an

OP/APC grouper?

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?

16 HIM Can we load historical MPI from

previous system?

17 HIM Does the system allow for users

to establish special studies to

support clinical data collection

where applicable?

18 HIM Can each facility define which

types of ROI requests need to be

written to a disclosure log?

19 HIM Can alerts be established when

multiple ROI requests are

received from same auditing

entity (ie QIO/RAC)?

20 HIM Does your system provide any

tools that would assist with RAC

audits and tracking?

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.


22 Interfaces Have you interfaced with another

Clinical Information System? If

yes, please provide the names of

the other systems.

23 Interfaces Have you interfaced with another

Patient Financial System? If yes,

please provide the names of the

other systems.

24 Interfaces Do you have experience with the

InteGreat ICChart EMR?

25 Interfaces Regarding ADT interfaces – do

you specifically allow an

inbound ADT interface to create

a patient encounter?

26

27 Audit Do audit logs track actual

activity that has been changed?

28 Audit Are audit logs available to track

what users have viewed and or

edited in the system?

29 Audit Are audit logs available to track

any user who has printed and or

exported patient data from the

system?

30 Audit Does the system provide reports

on encoder and CAC utilization

and productivity?

31 Audit Does the system provide coder

productivity statistics?

32 Audit Does the system support the

ability to build quality audit

alerts for management review?

33 Reporting Does system provide standard

revenue and usage reports with


YTD information flexed by

hospital/provider FTE.

34 Reporting Does the system allow for ad-hoc

reporting?

35 Reporting Are all data elements captured

within the system available from

a reporting perspective? Please

list any limitations.

36 Reporting Does the system provide roll-up

reporting from single facilities,

grouping of facilities and

corporate wide?

37 Reporting Are clients able to directly access

backend production database for

creating own custom queries and

reports?

38 Reporting Does the system provide the

ability to export data to MS

Office applications?

39 Reporting Does the system provide the

ability to restrict access to reports

by employee role?

40 System Is your system available in a

SaaS model?

41 System Is your system available in a

hosted model?

42 System Can your system be located in

our data center?

43 System If hosted at our data center, what

technical and hardware

requirements are needed for your

product?

44 System Is there a limit to the number of

financial classes allowed?



payor codes allowed?


patient types allowed?


adjustment and payment codes

allowed?

48 System Does the system allow users to

access enterprise and facility-

specific reports from remote

locations?

49 System Please provide a description of

how the system would support a

centralized management model

for multiple facilities?

50 System Does the system run multiple

locations on a single relational

database? If so, please describe

how security functions for

corporate users?

51 System Does system support the

technical requirements set forth

in HIPAA and the HITECH act?

52 System Does vendor adhere to standards

of ICD9/ICD10, LOINC, CPT,

SNOMED?

53 System Has your CAC/NLP product

been certified by an authorized

certification body? If so, please

list all certifications achieved.

54 System Do you provide 24/7 customer

support?

55 System Where is your support center

located?


56 System Does the system support online

help function/feature within the

application?

57 System How often are software releases

scheduled?

58 System How often is your product

updated? How are they

deployed?

59 System Is downtime required for

software releases? If yes, please

provide average down time.

60 System Describe your disaster recovery

plans including the protection of

source code as well as patient

data.

61 System How are customer requests for

enhancements handled?

62 System Describe your flexibility in

customizing base product for

hospital specific rules and alerts.

63 System Does vendor allow for a separate

test system at no cost?

64 System Does the system provide

configurable error checking on

data entered?

65 System Is the system accessible through

mobility devices?

66 System-

Implementation

& Training

Does the system provide for a

separate training system? If yes,

is there a cost associated?

67 System-

Implementation

& Training

For implementation and training

do you utilize a third party

partner? If so please provide the

partner name.


68 System-

Implementation

& Training

What is the typical time frame

for installation of a site?

69 System-

Performance

What are the performance and

accuracy benchmarks we can

expect from the NLP engine?

70 System-

Performance

What are the performance and

accuracy benchmarks we can

expect from the CAC system?

71 System-

Performance

Have these performance

benchmarks been met in

organizations similar to ours?

72 System-

Performance

Have these performance

benchmarks been met in

organizations that are larger than

ours?

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.)?

74 Users/Security Can passwords be configured to

expire in a configurable amount

of time?

75 Users/Security Does the system provide self-

service password reset

functionality?

76 Users/Security Does system allow for users to

be set up once and then granted

access to all facilities required?

77 Users/Security Does system allow for creation

of master roles to be assigned

when creating new user?

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

concurrent users allowed to

access system?


Appendix C – Training Plan

Question Response

Do you offer instructor-led classroom

training?

Do you have classroom training

facilities?

Do you offer online/CBT training?

Do you offer interactive/hands-on

training in a simulated live

environment?

Do you customize your training to

match any system customizations that

are required?

Do you offer an LMS or other system

to track training progress?

Is all of your training available to us

throughout the term of our software

license agreement?

Do you offer training specific to

major system updates?

When can we begin training our end-

users?


Appendix D – Abbreviations

ADT Admit Discharge Transfer

APC Ambulatory Payment Classification

APC Ambulatory Payment Category

CAC Computer Assisted Coding

CPT Current Procedural Terminology

DRG Diagnosis-Related Group

FTE Full Time Equivalent

HCPCS Healthcare Common Procedure Coding System

HIPAA Health Insurance Portability and Accountability Act

HITECH Health Information Technology for Economic and Clinical Health

ICD International Classification of Diseases

LOINC Logical Observation Identifiers Names and Codes

MPI Master Patient Index

NLP Natural Language Processing

OP Outpatient

QIO Quality Improvement Organization

RAC Recovery Audit Contractor

ROI Return on Investment

SaaS Software as a Service

SNOMED Systemized Nomenclature of Medicine

YTD Year To Date


References

Freifeld, L. (2013). 5 Tips for a Successful Training Program. Training Magazine. Retrieved

from: http://www.trainingmag.com/content/5-tips-successful-training-program

The Most Effective Training Techniques. (2014). Training Today. Retrieved from:

http://trainingtoday.blr.com/employee-training-resources/How-to-Choose-the-Most-Effective-

Training-Techniques

How should I train my staff?. (2013). HealthIT.gov. Retrieved from:

http://www.healthit.gov/providers-professionals/faqs/how-should-i-train-my-staff

http://www.trainingmag.com/content/5-tips-successful-training-program

http://trainingtoday.blr.com/employee-training-resources/How-to-Choose-the-Most-Effective-Training-Techniques

http://trainingtoday.blr.com/employee-training-resources/How-to-Choose-the-Most-Effective-Training-Techniques

http://www.healthit.gov/providers-professionals/faqs/how-should-i-train-my-staff

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