Program Management Office (PMO)
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OnBase
Document Scanning
&
Image Management
Replacement
Scope Statement
Document Version 5.0: Draft
Document Date: 2014-08-14
Program Management Office (PMO)
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Revision History
Revision
Date
Revised By
1.0
2.0
3.0
4.0
2014-03-28
2014-04-09
2014-04-18
2014-04-24
Steve Prevost
Steve Prevost
Steve Prevost
Steve Prevost
5.0
2014-08-14
Steve Prevost
OnBase Project Scope
2013-04-09
Changes Made – Reasons for the
Change
Initial draft
Incorporate updates from reviewers
Incorporated updates from UPG
Added text for batch scanning of
EOBs and Patient Correspondence
Containing Multiple Patients
Added link to final version of the
Solution Design document for
Professional Billing. (p. 13)
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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 ............................................................................................ 7
Project 1A – Registration Solution ................................................................. 7
Project 1B – Charity Care Workflow .............................................................. 8
Project 1C – Clinical Records Solution ........................................................ 10
Project 1D – Billing Office Solution .............................................................. 11
Project 1E – Disaster Recovery Consulting ................................................. 13
Project 1F – Streamline Conversion ............................................................ 14
Project 2 – Pre-Arrival Services Solution ....................................................................... 16
Project 3 – Revenue Cycle Management....................................................................... 18
Detailed Scope and Deliverables ........................................................................................... 20
Registration and Clinical Record Solution ...................................................................... 20
Pre-Arrival Unit .............................................................................................................. 23
Financial Screening ....................................................................................................... 25
Out of Scope............................................................................................................................ 26
Project Assumptions .............................................................................................................. 26
Project Exclusions .................................................................................................................. 26
Project Constraints ................................................................................................................. 27
Scope Sign-off......................................................................................................................... 28
OnBase Project Scope
2013-04-09
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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.
OnBase Project Scope
2013-04-09
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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
OnBase Project Scope
2013-04-09
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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:
2:
3:
NonDiscretionary:
A discretionary project that provides significant business value or one that
is highly aligned with the strategic direction for the organization.
A discretionary project that provides moderate business value or one that is
moderately aligned with the strategic direction for the organization.
A discretionary project that provides limited business value or one that is
not aligned with the strategic direction for the organization.
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:
Core Solution
1A
Registration Solution
1B
1C
Charity Care Workflow
Solution
Clinical Records Solution
1D
Billing Office Solution
1E
DR Consulting
OnBase Project Scope
2013-04-09
Estimate Type
Amount
Time and
Materials
Time and
Materials
Time and
Materials
Time and
Materials
Time and
Materials
$ 252,306.00
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1F
Streamline Conversion
Add-on Solutions
2
Pre-Arrival Services Solution
3
Revenue Cycle
Fixed Fee
Time and
Materials
Time and
Materials
Total
$ 306,000.00
$119,880.00
$125,160.00
$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
OnBase Project Scope
2013-04-09
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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.
OnBase Project Scope
2013-04-09
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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
OnBase Project Scope
2013-04-09
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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 postdischarge/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 inbasket;
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;
c. Release of Information (“ROI”) - Software plug-in integration with Epic Print
server for integrated printing of ROI requests from Epic’s ROI application.
Software-stored documents must be linked to Epic in order to be included in
the ROI print request;
OnBase Project Scope
2013-04-09
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d. Document Exception Process - misfile errors and duplicate scans will be
managed using the Software Exceptions Workflow (“Workflow Solution”).
Corrections made through the misfile process will be executed in the Software
exceptions Workflow user interface; and
e. The Software will not systematically execute un-merging of patient
information. Un-merging will be completed as a manual re-index.
Interfaces
a. HL7 interfaces will be leveraged for both inbound and outbound data
communication with Software:
ii.
Incoming ADT interface to capture patient and encounter data from
Siemens Invision; and
iii.
Outbound MDM interface to link documents to the Epic EMR.
Content Delivery
a. Document retrieval using native client(s) of the Software;
b. Integrated single document retrieval from document hyperlinks within the
patient record in Epic’s Chart Review using the API integration between the
Software and Epic; and
c. Patient Viewer from the Epic activity button.
Third-party Application Integrations
a. Software will integrate with the following applications:
i.
GE Centricity Business;
ii.
EpicCare (ambulatory);
iii.
EpicCare (inpatient); and
iv.
Epic Health Information Management:
1. Chart Deficiencies (inpatient); and
2. Release of Information.
Facilities
a. The solution will be deployed at the centralized scanning points for one (1)
hospital which includes the following:
i.
University Hospital; and
b. The solution will be deployed at Health System clinics. Clinics to be identified
by UVAHS.
Project 1D – Billing Office Solution
Scope
The project will consist of initiation, discovery build, testing, training, and project
management services in association with the capture and retrieval of remittance and
correspondence documents for the billing departments (Medical Center and UPG).
OnBase Project Scope
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Correspondence and EOBs will be retrievable within the context of the patient account
within the billing systems.
Content Capture
a. Day-forward capture of billing office documents such as EOBs,
correspondence, and UPG miscellaneous documents (like for like with
current LanVision/Streamline Health solution);
b. Batch Scanning – centralized, high volume, scanning of paper EOBs,
correspondence, and UPG miscellaneous documents;
c. 835 Import – schedule required imports of EDI 835 files using the 835
Processor module with the standard XML style sheet of the Software; and
d. Electronic lockbox images or index files as required, provided by the UVAHS
or third party will be imported into the Software system leveraging the
Document Import Processor (“DIP”) module. Any content, encrypted or
proprietary, not readable by out-of-the-box (“OOTB”) DIP will require custom
development and is not included in this estimate.
Content Management
a. Correspondence document routing and management will use out-of-the-box
(“OOTB”) functionality of purchased Software (i.e. custom queries or
Workflow) to include the UPG miscellaneous documents. The services
estimate includes up to the following functionality:
i.
Five (5) custom queries; or
ii.
A single Workflow lifecycle of three (3) queues, six (6) ad-hoc or
system tasks, and two (2) notifications; and
iii.
The creation of Workflow E-forms (an electronic HTML form acting
as a document in Software) is not included in this estimate.
b. Batch Scanning of EOBs and Patient Correspondence Containing Multiple
Patients
i.
UVAHS receives EOBs and other miscellaneous billing
correspondence which may contain data for multiple
patients. Documents that contain data for Multiple patients will be
scanned to either EOB or Patient Correspondence with only Payor
and Document Date for indexing values on the document. Once
scanned, the batch will be processed with Autonomy Idol,
converting the images to text based documents to facilitate full text
searching.
ii.
A Custom Query to search by Date and Payor will be used in
addition to full text search.
Interfaces
Intentionally left blank
OnBase Project Scope
2013-04-09
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Content Delivery
a. Document retrieval using native client(s) of the Software; and
b. Application Enabler document retrieval within Siemens Invision and GE
Image Broker for the retrieval of payment documents and correspondence
associated to a patient account.
Third-party Application Integrations
a. Software will be configured for Application Enabler from up to four screens from
each of the following applications:
i.
GE Image Broker – Professional Billing; and
ii.
Siemens Invision – Hospital Billing.
Facilities
a. The solution will be deployed at two (2) billing offices for the Hospital and
Professional billing departments.
Assumptions
Intentionally left blank
Exclusions
a. Custom XML style sheets for the display of EDI 835 data are not included in
this estimate; and
b. UPG HR or other UPG departmental solution that is not like for like in today’s
use of LanVision/Streamline Health.
Note: Detailed deliverables for this solution may be found in the Solution Design
Document stored in the OnBase Image Management project’s SharePoint folder:
http://hscsproject1/PMO/OnBase/Project%20Documents/UVAHS%20PB%20-%20Solution%20Design%20FINAL.doc
Project 1E – Disaster Recovery Consulting
Scope
Disaster Recovery (“DR”) is the process by which a UVAHS creates and maintains a
redundant Software environment in which the Software can be made available and
accessible after a systemic failure. DR may also include restoration of Software data to
a primary production Software environment.

Collaborative effort between UVAHS and Hyland to identify UVAHS’s existing
technology set(s) and resource capabilities to align a Software DR strategy
that meets the UVAHS’s Recovery Point Objective (“RPO”) and Recovery
Time Objective (“RTO”);
OnBase Project Scope
2013-04-09
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Hyland will review and contribute to the Software DR Strategy Document as
needed. The Software DR strategy is a blueprint which outlines the
technologies in the DR environment. The document will identify the mutually
formulated DR strategy including technologies used and applicable Software
components (e.g. database, web server, storage, etc.);
Hyland will review and contribute to the Software DR Plan as needed. The
Software DR plan is a detailed procedure to be followed in the event of a
disaster which articulates the roles and responsibilities of UVAHS; and
Training of the Software system administrator on the fail over procedures as it
relates to Software.
Assumptions
UVAHS is responsible for the following:
a. Determine and document the Recovery Point Objective (“RPO”) and
Recovery Time Objective (“RTO”) for Software DR;
b. Provide third-party vendors and/or subject and technical matter experts as
required (e.g. Epic, Citrix, etc.);
c. Communicate to Hyland the Software production environment (e.g.
RDBMS platform, support hardware, web and application servers, and
integration with third party applications);
d. Develop and own the Software DR Strategy Document with contributions
by Hyland;
e. Develop and own the Software DR Plan with contributions by Hyland;
f. Setup, configuration, management, and support of hardware or technology
outside Software, as well as the Software itself, associated with the DR
plan;
g. Implementation, testing, and maintenance of the DR plan;
h. Management of the failover event which includes bringing the appropriate
systems on-line; and
i. Copying of the Software database and Disk Groups to DR location(s).
Exclusions
a. DR Testing and/or Validation;
b. High availability (“HA”) consulting services; and
c. Installation and/or configuration (i.e. setup) of Software or third party
hardware and/or software to support the DR strategy.
Project 1F – Streamline Conversion
Scope
a. Conversion of up to twenty-six million five hundred thousand documents
(26,500,000) from Streamline Health (“Legacy System”) AccessAnyWare and
FolderView repositories to the OnBase Software Solution/ integration to Epic;
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b. Legacy System contains up to six thousand and two hundred (6,200)
gigabytes of magnetic storage space in total amongst FolderView and
AccessAnyWare;
c. Legacy System documents are categorized in up to two hundred and
seventeen (217) document types across both FolderView and
AccessAnyWare;
i.
Mapping rules for both systems will be defined in the Conversion
Specification document.
ii.
Mapping of folders from FolderView to OnBase will be limited to up to
two levels, as defined by UVAHS.
d. Estimate allows for up to ten percent (10%) of growth in document volume;
e. Legacy System uses a standard relational database (Oracle 10gR2);
f. All files that are part of converted documents will be imported into the
Software application in their current format:
g. All documents are TIFF Images, ASCII text, PDF, or MS Office application
formats.
h. The project will be performed in a single phase, comprised of two (2) bulk
loads of static documents (“Production Conversion”) from two sources,
AccessAnyWare and FolderView repositories, and two (2) supplemental
conversions of newly added and/or active documents occurring after an
agreed upon cutoff date (“Delta Conversion”);
i. Hyland will integrate historical content for AccessAnyWare documents to
UVAHS’s EMR as defined in the Functional Specification document resulting
from the discovery project phase:
i.
Historical chart records will be created within the Software to support
Patient Viewer functionality;
ii.
Provide an ASCII text translation file containing mappings between
Legacy System document identifier and document identifier in the
Software for the purpose of updating hyperlinks within the EPIC
application, as defined in the Functional Specification Document; and
iii.
Timeline for integration of content to EMR may or may not coincide
with key project milestones/deliverables defined in this proposal, and
will be mutually agreed-upon and documented in the project plan.
Assumptions
a. The linkage between the metadata in the legacy system database and the
physical files representing the pages of each document is identifiable within
the Legacy System database;
b. Hyland will migrate a single copy of the latest revision of each document into
the Software;
c. All physical files being migrated from the Legacy System to the Software are
accessible on the UVAHS network by UNC path on magnetic storage for
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AccessAnyWare, but for FolderView this may not be possible and must be
evaluated for Oracle data files; and
d. Conversion process will include migration of text-based
annotations/signatures based on the business requirements gathered during
discovery. The approach will be documented in the Conversion Functional
Specification Document:
i.
Hyland will convert text-based annotations in accordance with mutually
agreed upon and documented business requirements;
ii.
Location or positional relevance to the document page will not be
maintained during the conversion process; and
iii.
The annotation text will be pulled directly from the database and will be
placed in a Software sticky note.
Exclusions
a. In cases where the legacy viewer manipulates the view of these files, it is
possible that they have a different visual representation within
OnBase. Alteration of the physical format of the files for any purpose,
including alteration to mimic legacy viewer logic, is not included within this
proposal;
b. Hyland will not be responsible for verifying the correctness or integrity of
document metadata, or the quality of image files associated with the Legacy
System; and
c. Hyland will not be responsible for enhancing or modifying such documents or
document metadata, (e.g., rotating documents, enhancing image quality, or
correcting metadata), or for converting audit history metadata unless explicitly
stated otherwise in the Conversion Specification Document.
d. Orphaned physical files with no associated database record will not be
converted.
Project 2 – Pre-Arrival Services Solution
Scope
Hyland will provide services for the discovery and implementation of a Pre-Arrival
Services solution for the UVAHS. The focus of this solution is on the generation of
required checklists for the visibility and validation pre-arrival services which should
occur in advance of a patient encounter. This includes validation of patient
demographic information, insurance authorizations, payment information and appeals.
The system will automatically escalate checklists with significant issues to those
responsible for oversight of the process.
Checklists will be created on a daily basis driven by information gathered from the
UVAHS’s various systems. This compilation of information will provide visibility to
knowledge workers to determine that all patients which are due to be seen have been
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properly processed in advance of the encounter and are in compliance with not only the
facilities requirements but also with any insurance requirements.
The checklist solution to be provided will encompass the following areas:
a. Pre-Arrival Unit Activities: verification of patient demographic
information, patient contact, pre-payment requests, prior authorization;
b. Insurance Carrier Referrals: verification and/or determination of referral
and authorization, patient notification of determination, denials,
physician notification of determination;
c. Medicare Secondary Payor Questionnaire: obtain and validate
secondary payer information; and
d. Appeals and Denials: manage review and notification of status of
appeals and denials.
The checklist solution will additionally allow for visibility to management to ensure
activities are completed in a timely manner through the managed distribution of work to
the appropriate personnel, as well as the ability to report on key metrics to verify and
improve performance.
Assumptions
This proposal is based upon the below assumptions being true. If for some reason
these assumptions prove not to be true, this could result in a scope change and may
have an impact on the proposed cost and timeline to deliver.
a. UVAHS will commit a minimum of eight (8) working hours per day to testing
the Solution during the UVAHS Testing Support phase, which may be
performed by multiple UVAHS personnel;
b. Checklist solution will automatically ingest scheduling and registration
information via real time HL7 messaging from UVAHS’s system;
c. Checklist solution will automatically ingest batch information from UVAHS’s
eDischarge and ClearQuote systems;
d. Checklist solution will monitor time sensitive timeframes;
e. Checklist solution will allow for identifying of priority items;
f. HTML forms will be utilized for the checklist solution;
g. Checklist solution will allow for the distribution of checklists according to
UVAHS’s defined rules, including manual assignment or reassignment;
h. Checklist solution includes the ability to create standard composed letters;
Hyland will create up to ten (10) standard letter templates;
i. Hyland will provide four (4) hours of train-the-trainer services to train on the
configuration of additional letter templates as required by the UVAHS;
j. Checklist solution assumes patient chart structure already is configured and
in place;
k. Hyland will create up to five (5) checklists with up to ten (10) checklist items;
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l.
Hyland will provide four (4) hours of train-the-trainer services to train on the
configuration of additional checklists as required by the UVAHS;
m. The email addresses of any business users who should receive emails should
be already compiled and readily available to the solution engineer;
n. UVAHS should have a clear understanding of the roles and responsibilities of
the business process; and
o. UVAHS is expected to identify any exception processing during discovery
sessions which are not already accounted for. Additional configuration effort
will be required based on these requirements.
Exclusions
The following areas are considered out of scope for the purposes of this estimate:
a. Patient Admission checklists such as IV Safety, Surgical Safety, Treatment
Guidelines, etc.;
b. Case Management; and
c. Discharge Planning.
Project 3 – Revenue Cycle Management
Scope
Hyland will provide services for the discovery and implementation of a Hyland Software
solution using the OnBase Revenue Cycle Management (“RCM”) integration for
Siemens Invision and GE Centricity. The solution will provide the capabilities for
automated payment processing for both systems, accounting treasury reconciliation
with one bank, and receivables management used to adjudicate denials and accounts
receivable patient accounts.
Content Capture
a. Day-forward capture of billing office documents such as Explanation of
Benefits (“EOBs”) and correspondence;
b. Batch Scanning – centralized, high volume, scanning of paper EOB’s and
correspondence;
c. Advanced Capture (OCR) data lift for high-volume documents for up to six (6)
payers; and
d. EDI electronic document high volume processing for up to four (4) payers.
Content Management
a. Paper and electronic (EDI) EOBs captured will be interfaced via ANSI 835 file
format export using the Software integration engine (Linker) into Siemens
Invision and GE Centricity;
b. Scanned EOB’s will route for indexing and RCM processing based off of the
barcode on the Batch ticket;
c. Electronic EOB’s will route through RCM processing via EDI Processor;
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d. Captured patient account data will display through the RCM Software’s
Report Manager and Data Analytics applications; and
e. Patient accounts with outstanding balances will route to Software’s
Receivables Management workflow for account follow-up and disposition.
Interfaces
a. RCM ANSI 835 file export interface to Siemens Invision and GE Centricity.
Content Delivery
a. Document retrieval using native client(s) of the Software; and
b. Data reporting and analytics using the Software Report Manager.
Third-party Application Integrations
a. Software will integrate with the following applications:
i.
Siemens Invision
ii.
GE Centricity
Facilities
a. The solution will be deployed at two (2) billing offices for the Hospital and
Professional billing departments.
Assumptions
This proposal is based upon the below assumptions being true. If for some reason
these assumptions prove not to be true, this could result in a scope change and may
have an impact on the proposed cost and timeline to deliver.
a. UVAHS is responsible for identifying Software master tables, including but
not limited to, PPRemarkReference, PPRemarkCodeMaster,
PPTransactionConfig, PPPlanCode, PPActionCodeConfig, PPPayor,
PPInsuranceCompany, PPPayorInsuranceCompanyXRef;
b. UVAHS is responsible for providing daily/weekly patient import
demographics file from Siemens Invision and GE Centricity for account
lookup and validation;
c. UVAHS will provide scanning hardware prior to services work performed
on the EOBs for OCR processing by Hyland; and
d. UVAHS will provide sample EOB documents to be configured for all
payers prior to services work performed by Hyland.
Exclusion
Custom XML style sheets for the display of EDI 835 data are not included in this
estimate.
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Detailed Scope and Deliverables
Note: Unless otherwise stated, all scope and deliverables below will be implemented in
Phase I to coincide with the opening of the Battle Building (approximately July 1, 2014).
Phase II deliverables are noted text and will be detailed at a later date within this
document.
Registration and Clinical Records Solution
The current version of the Registration and Clinical Records Solution may be found in
the project’s SharePoint site: Registration and Clinical Records Solution
1) Business Requirement: Capture and Retrieval of Registration Documents from
Siemens A2K3
a) Registration users, from within Siemens A2K3 Registration System, will scan
non-clinical registration documents to their corresponding document types
though the OnBase Front Office Scanning (FOS) module which will be initiated
via Application Enabler.
2) Business Requirement: Disconnected Scanning for Mobile Mammography and Field
Clinics
a) Mobile Mammography and Field Clinic end users capture Registration
documents while working remotely and off line. To facilitate the secure capture
of Registration Documents, these users will utilize the OnBase Disconnected
Scanning Module.
3) Business Requirement: Viewing of Registration Documents from GE / Centricity
Business System (UPG)
a) Billing and Collections Staff from within GE / Centricity Business System will view
Registration Documents using Application Enabler.
4) Management of Long Term Signature (LTS) Cards
a) The Long Term Signature Card (LTS) is pertinent to billing activities and is active
for the life of the patient unless the card was signed by a parent or guardian for
those patients under the age of 18. When the patient reaches the age of 18, a
new LTS must be captured.
5) Mask Insurance Cards Greater than 180 Days Old
a) UVAHS requires Registrars to scan insurance cards for all patients that don’t
have scans of current insurance cards. As a reminder to the Registrars, UVAHS
would like to hide previously scanned insurance cards with a Scan Date greater
than or equal to 180 days of age. A script will be used to hide previously
scanned insurance cards.
6) Capture of Digital Photographs
a) Photographs captured via digital cameras will be saved to a network file share
with restricted access. Photographers will delete images from the camera after
the images are saved to the file share. OnBase will sweep the share file on a yet
to be determined scheduled basis and bring the images into a scan queue for
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indexing. Upon import to OnBase, the images will be deleted from the file share.
An HIS supervisor or an authorized representative with approved security rights
will access the indexing queue and index the photographs to the appropriate
patient encounter using the Encounter Reverse Auto-fill Look Up. Once the
batch has been fully indexed, the batch will move to the waiting QA Queue. After
the batch has been QA’d the batch will commit and an MDM^T02 will be sent to
Epic to create a link in Epic to the scanned image.
7) Psychology and Neuropsychology Access to Sensitive Documents via OnBase
Patient Viewer
a) The OnBase Patient Viewer allows HIS departments, physicians, and clinical
staff to view all medical documents associated with a client’s MRN or MPI
(Master Patient Index). When integrated with an electronic medical record (EMR)
system, the OnBase Patient Viewer retrieves medical records from OnBase
using client information provided in the third-party system. Users with
appropriate privileges also can search for client records from within the OnBase
Client when the EMR system is unavailable.
b) The OnBase Patient Viewer directly accessed in OnBase will be primarily utilized
by Psychology and Neuropsychology end users to facilitate the viewing of
sensitive documents not linked to Epic.
c) The OnBase Patient Viewer (chart) configuration includes customizable folder
tabs that will each be mapped to include the applicable document types as
determined UVAHS.
8) Capture and Indexing of Documents by Health Information Systems and Culpeper
Medical Associates
a) Documents with Patient Labels
i) Indexing of documents with patient labels will be facilitated by Automated
Indexing using Advanced Capture. Predefined forms and rules, combined
with a powerful processing engine, make it possible to quickly classify and
index scanned documents. Automating document indexing eliminates the
bottleneck associated with manually indexing high volumes of structured
business documents. Advanced Capture processing can be more accurate
and much faster than manual data entry. Employees spend their time more
effectively, validating or correcting questionable values only when needed,
while letting the Advanced Capture processor perform the mundane task of
document indexing.
ii) These documents will be scanned into a predefined Automated Indexing scan
queue where the documents will be processed and indexed by the values
read from the data on the documents.Documents with Document Type
Barcodes
b) Documents with Document Type Barcodes
i) Indexing of document with a Document Type barcode will be scanned into a
Barcode Processing Scan queue. Document type values will be read from
the barcode and applied to the document.
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c) Loose Documents
i) Documents without Document Type Barcode labels or those without uniformly
placed Patient Data will be scanned to a general Scan Queue from which end
users will manually select the Document Type and then utilize the MRN and
CSN auto-fill keyword sets to fully index the documents.
ii) External records will be indexed to a static value of “0000” with corresponding
patient level keyword values. Upon receipt of the MDM in Bridges, the static
CSN / Account Number will trigger the creation of a scan only encounter.
d) Viewing of Scanned Documents in Epic
i) Once the documents have been indexed and QA’d, the documents will enter
an OnBase workflow. On a scheduled, yet to be determined basis, workflow
will generate and send an HL7 MDM^T02 message through the interface
engine to Epic Bridges where a hypertext link will be generated in the patient
record.
9) Document Corrections
a) The Document Correction Workflow Process utilizes various functions of OnBase
Workflow and relies on actions performed by the end user. Any user who can
view a document may trigger a document to be sent to the Document Correction
Workflow by clicking the button appearing in OnBase viewer. The HIS user may
perform various actions, based on the corrections process which needs to take
place. During this process, documents will be corrected within OnBase, and the
corrections will be reflected within Epic.
10) Billing Correspondence Document Capture
a) EOBs with checks are scanned by Bank of America and forwarded to PFS for
posting. These are currently scanned to folder view in Streamline. This
process will be defined in Phase 2.
11) Quality Assurance
a) Scanned and indexed batches will enter the ‘Awaiting QA Review’ queue for
verification of image quality and validation of keyword values. This step could
potentially be eliminated after a period of time if a sufficient level quality is
present in the batches being presented for QA review.
12) Hospital Billing Correspondence Workflow
a) Billing correspondence including but not limited to Denials, Authorizations,
Attorney Letters, etc. unrelated to patient payments arrive in the Financial
Services Office and are researched for Patient Name, MRN and name of
Representative to work the document, which is hand written on the documents.
13) Outpatient Pharmacy Document Capture and Retrieval
a) UVAHS Outpatient Pharmacies assist patients (and non-patients) with obtaining
discounted prescription medication through Pharmaceutical Assistance Programs
provided by various Pharmaceutical Companies. Application forms and
supporting documentation are scanned and indexed to the patient level, and are
not linked to Epic. Pharmacy users also reference some (but not all) existing
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supporting documentation already captured through the UVAHS Financial
Screening Process.
b) Future state will include the capture of Mail Order documents to support
Medicare Audits.
c) Pharmacy users will scan to a specific Pharmacy Indexing Queue in OnBase.
Once the documents have been scanned, the batch will move to an Awaiting
Indexing Queue. The user will then access the queue and index the individual
documents in the batch to a Document Type. To apply patient level keyword
values to the document, the user will use the reverse Patient Auto-fill Keyword
look up. Once the batch has been fully indexed the batch will move to QA. After
completion of QA, the document will be committed to the OnBase database. No
HL7 MDM^T02 message will be sent to Epic. If Pharmacy agrees to the
recommended Document Type changes, the scan queue can be configured to
default the document type, eliminating the need for the user to manually select
the document type.
d) To facilitate the retrieval of Pharmaceutical Assistance Applications and
supporting documentation, a custom Query will be built to return all documents
for a specific patient within a specific date range.
14) OnBase Solution Configuration
a) The following OnBase environments will be implemented to synchronize with
analogous environments for Epic:
i) OnBase Production (OnBasePRD)
ii) OnBase Test (OnBaseTST)
b) Additional environments, such as training environments, that are to utilize
scanning and viewing should be attached to TST.
c) An AutoFill Keyword Set is a configuration of Keyword Types that includes a
Primary Keyword Type and one or more secondary Keyword Types. A value
entered into the Primary Keyword Type field during indexing of a Document
triggers the population of the remaining secondary Keyword Values. The auto-fill
tables will be populated by information sent via ADT HL7 messages from
A2K3/ADT. The table will consist of patient level and encounter level information
with the MRN and (Account) CSN as the primary keywords respectively.
i) MR – Patient AFKS
ii) MR – Encounter AFKS
iii) PAU Checklist AFKS
iv) Billing
Pre-Arrival Unit
The current version of the Solution Requirements Document for the Pre-Arrival Unit may
be found in the project’s SharePoint site: Solution Requirements Document - PAU
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1) Solution Summary
a) The Pre-Arrival Unit at UVAHS works within the system to verify insurance
eligibility and benefits, obtain pre-authorizations and referrals, validate patient
demographic information prior to a patient receiving service. The solution
provides the software to support the PAU process and meet the following goals:
i) reduce printing and administration efforts by interfacing with A2K3 using HL7
ii) reduce sorting time and work prioritization by establishing business rules for
electronic work balancing
iii) provide increased visibility into the PAU process at a given point in time
iv) reduce insurance payment denials by reducing information loss (losing paper
or checklists)
v) ability to evaluate process effectiveness and provide information needed to
make process improvement decisions
vi) provide information that allows financial risk to be assessed by process
participants
vii) provide method to communicate more efficiently and effectively to the front
desk
2) Capture/Import
a) For the PAU process data is captured from HL7 message that are sent from
A2K3. The messages are processed into electronic forms that are evaluated by
business rules.
3) Electronic forms are used to take the HL7 data that is messaged from A2K3 to
OnBase and allows the data to be processed by Workflow. Workflow will translate
the data into objects that are presented to users for processing. Users will not
interact with this form.
4) PAU Process Summary
a) The Pre-Arrival Unit at UVAHS works within the system to verify insurance
eligibility and benefits, obtain pre-authorizations and referrals, validate patient
demographic information prior to a patient receiving service. Appointments are
scheduled in A2K3 and an HL7 message is sent to the system. The system
receives scheduled appointment information and determines if the appointment
needs to be processed through the concierge PAU model*. Appointments that
need to be processed through the workflow will be presented to PAU Coordinator
with a corresponding checklist related to the service level. The PAU coordinator
will complete all assigned tasks and the Sr. PAU Coordinator will complete all
authorization tasks.
b) Once all tasks are completed for a checklist, the checklist is complete and the
appointment processing for the PAU is complete. A summary document is
generated containing the result of PAU processing. The appointment is archived.
c) An HL7 message from A2K3 is received to update the Date of Service on an
appointment. The message updates the archived appointment record.
d) *Additional models may be added. The solution will provide the ability to scale to
other model types and will allow for checklist/task administration.
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Financial Screening
The current version of the Solution Requirements Document for Financial Screening
may be found in the project’s SharePoint site: Solutions Requirements Document Financial Screening
1) Financial Screening Process
a) University of Virginia Health System (UVAHS) patient’s deliver Financial
Assistance applications and supporting documents to Patient Financial Services
(PFS) representatives via email, fax or in physical paper form. The PFS Assistant
or Eligibility Specialist scans or imports the patients’ Financial Assistance
application and/or supporting documents into the system. The system links the
application and/or supporting documents to an application instance associated by
MRN. The PFS Supervisor assigns the application and/or supporting documents
to an Eligibility Specialist for review. When necessary, the PFS Supervisor
reassigns the application and/or supporting documents to an Eligibility Specialist
for review.
b) Capture/Import
i) Patient Financial Services receives financial assistance applications and/or
supporting documents via email, fax or physical paper. Applications and/or
supporting documents are scanned into the system and identified using
barcode technology. Applications and/or supporting documents that are
imported into the system are pre-indexed by the PFS Assistant or Eligibility
Specialist for identification purposes. The PFS Supervisor and Eligibility
Specialist may also manually import and index miscellaneous documents,
applications and/or supporting documents.
c) Management
i) The system must log and track the activities and actions that are taken on
applications and/or supporting documents in the financial screening process.
The original create date drives the timeline and the new supporting document
create/scan date drives how documents are prioritized in the financial
screening process.
2) Financial Screening Process – Admit Patient Process
a) A University of Virginia Health System (UVAHS) patient is admitted and applies
for financial assistance. The UVAHS Admit Representative enters the application
and/or supporting documentation information into the UVAHS Patient Financial
Services (PFS) line-of-business system. The UVAHS Admit Representative
sends the admit application and/or supporting documents to the PFS Assistant.
The PFS Assistant scans the admit application and/or supporting documents into
the system. The system sends the admit application and/or supporting
documents to an Eligibility Specialist for review. The admit application and/or
supporting documents follow the standard financial screening process. The admit
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application and/or supporting documents are managed by the Eligibility Specialist
and system based on discharge date since the patient was admitted to a UVAHS
facility. The admit applications are removed from the financial screening process
90 days past the discharge date. The admit applications are stored in the system
archive.
b) Capture/Import
i) Patient Financial Services receives admit financial assistance applications
and/or supporting documents in physical paper form, email or fax.
Applications and/or supporting documents are scanned into the system and
identified using barcode technology. Applications and/or supporting
documents that are imported into the system are pre-indexed by the PFS
Assistant or Eligibility Specialist for identification purposes.
ii) The applications and/or supporting documents are indexed by the PFS
Assistant or Eligibility Specialist upon import into the system. The PFS
Supervisor and Eligibility Specialist may also manually import and index
miscellaneous documents, applications and/or supporting documents.
Phase II
Lock box – scanning operations, Bank of America, EOB, patient payments
Out of Scope
Out of Scope items are items that will not be implemented during either Phase I or
Phase II of the UVAHS implementation.
 Signature Pad Interface
 Signature Deficiencies for Epic
 Integration with Esker Fax Server
Project Assumptions
No workflow changes in Phase I
AccessAnyWare pointers to Epic will not change
Solutions developed by Hyland Systems and implemented at UVAHS will be compatible
with any future implementations of Epic applications; e.g., Resolute and Cadence.
Exclusions
System will not perform any duplicate checking for applications.
Project Exclusions
Fax server
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UPG Human Resources – workflow changes are out of scope
Configuration of Software modules not required to meet the solution requirements
scoped herein and are slated for a future project, include but are not limited to:
Advanced Capture, Autonomy Idol, Business Rules Engine, Business Activity
Monitoring, Workview, Document Composition, Records Management, and, Document
Retention;
Back file data load (e.g. EMPI, encounter) or imaging services from legacy system(s) or
file storage location(s);
Workflow solutions unless otherwise described in the Project Areas section;
Generation of custom reports using the Report Services module; and
High availability Software consultation, configuration, or testing.
Project Constraints
List specific project constraints associated with the project scope that limits the team’s
options; i.e., predefined budget, imposed date or schedule milestones that are issued by
the UVAHS or performing organization.
The Phase I Go Live date is to be completed no later than the opening of the Battle
Building (currently scheduled for July 1, 2014). The Go Live will ideally coincide with the
Epic 2014 Upgrade scheduled for June 28, 2014
The Phase II implementation is to be completed no later than December 31, 2014 to
coincide with the end of maintenance support for Streamline Health AccessAnyWare
enterprise content management solution.
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Scope Sign-off
Don DeMarco, Program Management Office Director
Date
Scottie Frey, Administrator, Health Information Services
Date
Sean Jackson, UPG Chief Information Officer
Date
Keith Perry, Administrator, Health System Technology Services
Date
Richard Pott, UPG Director of Information Technology
Date
Mark Pulczinski, Associate Chief, Revenue Cycle
Date
Rick Skinner, Chief Information and Technology Officer
Date
Benton Turner, Administrator, Ambulatory Services
Date
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