e4 SERVICES WHITE PAPER
Simply Innovate.
Minimizing Financial Risk in
Computer Assisted Coding
Strategies for Ensuring an On Time and
On Budget Implementation
Abstract
Hospitals are looking to Computer Assisted Coding (CAC) solutions to help prepare for ICD-10,
chiefly to minimize the anticipated productivity decreases, and prepare for the massive
number of new codes and coding scenarios. Natural Language Processing (NLP) technology
fueling CAC solutions is promising, and vendors have produced compelling use cases and
proofs of concept. However, early adopters of the technology have a different reality. Poorly
executed project plans have caused go-live delays and cost overruns. Lack of vendor
guidance on the development of test plans, including priming the NLP engine, have resulted in
lengthy IT issues lists. Coding productivity has decreased and forced many organizations into
adding staff for extended periods of time at additional costs.
There is a better way to implement CAC solutions. e4 subject matter experts in CAC, project
management, software testing and coding have defined a strategy to help organizations
minimize their financial risk in deploying these solutions, with a proven track record of
success.
CAC Services Contact
Michelle Wieczorek, RN, RHIT, CPHQ
EMAIL: [email protected]
TELEPHONE:
814-580-0369
Minimizing Financial Risk in Computer Assisted Coding
Strategy One: Establish a Project Governance
Structure for Quick Decisions
A LEAN Governance Model for Project Management, with a skilled Program
Director that has a singular focus on mitigating the risk associated with the
project timeline and deliverables is a best practice. LEAN Governance works
well for managing any IT project, but it is especially pertinent for a CAC
project, where the stakeholders are vast and the impact of decisions are felt
broadly by the organization. The financial risk associated with project delays is
great. The ability to assemble a group of decision makers with urgency when a
risk has been identified, has proven to be of great value in proactively
“Tim is invested in our CAC
project and I trust him to
reach out on my behalf to get
things done. Without the
effort of e4, we would not
have met our projected live
date.”
managing vendor project teams and reduced unnecessary scope changes.
LEAN Governance Model
Kim Murawski, MHA, RHIA
Director of HIM
PinnacleHealth Hospitals
Stakeholders
Medical Staff
Revenue Cycle
IT
Quality &
Performance
Ancillaries
Work Teams
Program Director
· CPOE
· MD Documentation
· Nursing Documentation
· IT
· Planning
· Education
· Communication
Medical Staff
Delta Team:
· Stakeholder Champions
· Clear Major Roadblocks - Fast
· Real-Time Strategic Decision Making
· Effective Alignment and Communication
· Commitment to Standard Work
IT
Delta Team
HIM/CDI
Vendor
Operations
Executive Sponsors
Executive Steering Committee
Figure 1 - LEAN Governance Model
Copyright © 2015 e4 Services
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Minimizing Financial Risk in Computer Assisted Coding
Strategy Two: Define your Testing Strategy and
Resource Requirements Early
Many CAC deployments become crippled by discovery of issues post go-live.
These not only impact coding productivity, but have sometimes resulted in
vacating the CAC platform. Many vendors are not experts at testing their own
software, especially in each unique environment.
Test plans provided by vendors are boiler
plate at best, when they are provided at all.
Testing software is expensive and high risk. Without coding feedback provided
during testing, the NLP engine may produce many false positive findings, and
may miss findings in documents to which the engine has not been sensitized.
This results in poor productivity and accuracy for coders, prolonged go-lives,
and expensive post-live support that was not budgeted as part of the
implementation.
One way to mitigate risk is to consider the plan for testing of your software as
part of the contract review process. Consider adding a resource to your
contracting team that has experience testing CAC software to ensure
adequate protections in your contract. Outsourcing testing of software,
including training and tuning of the NLP engine is another strategy which can
minimize risk.
e4 experienced coders are veterans of CAC deployments and can be
economically added to your resource plan and begin to test, train and fine tune
your CAC solution. We create a user-ready system for coders on day one.
Michelle Wieczorek, RN, RHIT, CPHQ, a Senior Consultant at e4 with over 5
years’ experience working with multiple CAC vendors, recommends that clients
insist vendors allow coders to begin to train the NLP engine as early as the
interfaces are turned on in the test environment. “It is important to make the
expectation clear as part of the contracting process so that there are no
surprises as to what is actually being validated as part of the User Acceptance
Testing.”
Copyright © 2015 e4 Services
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Minimizing Financial Risk in Computer Assisted Coding
Strategy Three: Establish Fully Dedicated Resources to
your CAC Deployment
CAC deployment is one of the most complex projects any IT or HIM
Department can undertake. Yet competing organizational priorities often
make resource allocation to the project less than optimal. Coupled with the
current inexperience in the vendor space, under resourced projects create a
project laden with resource conflicts.
e4’s experienced CAC Project Managers, with true subject matter expertise
gained through multiple CAC implementations, will work on your behalf, and
will mitigate your risks. We will provide you with consistent subject matter
expertise to guide these complex projects from start to finish.
Client-side Project Management is valuable in terms of providing ownership of
your overall CAC project work plan and managing all project communication
through a single point of contact. e4 is your steady hand with a singular focus
on mitigating the risks to the project timeline.
“e4 helped Reading Health System with an organized approach with the
CAC implementation. Due to the implementation of our EHR, we didn’t have
the bandwidth to project manage ourselves, so e4 stepped in and did a
great job for us. There was a lot of work needed with our document imaging
partner and e4 also did a great job with vendor management. e4 kept the
project on time and on budget. My e4 team was very professional and truly
did an outstanding job ensuring our success!”
Cindy Henry, RHIA
Corporate Director, Health Information Management at Reading Health System
For more information on e4’s approach to CAC implementation strategies,
please call us at 814-580-0369 or email us [email protected]
Copyright © 2015 e4 Services
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