C O R E C O M P E T E N C I E S Counts Documenting Coding Billing Military Health System (MHS) Information Management and the Requirements Process Andrew B. Cornell, Sr. , FACHE For: Ms. Ruth Rosen, Deputy IM, Mt. B TMA/IMD 1 September 2005 MEPRS Conference 2005
C O R E C O M P E T E N C I E S Counts Fundamentals Documenting Coding Billing • Question: What do you get when you automate a really poor business process? • Answer: A really fast poor business process! • Have you ever seen the MHS automate a poor system? MEPRS Conference 2005 2
C O R E Counts “On” Versus “In” Documenting Coding Billing C O • In his book, e. Myth, Michael Gerber states that M many businesses fail not because their P entrepreneurial owners do not work hard in the E system, rather they fail to work on the system. T E • Too often well intentioned people work hard in their jobs but not on integrating how their N functions integrate to optimize the business of C the enterprise I E MEPRS Conference 2005 S 3
C O R E C O M P E T E N C I E S Counts Cost and Workload Assignment Today Documenting Coding Billing MTF/DTF Personnel Data • Uniform Chart of Account Personnel System (UCAPERS) • Standard Personnel Management System (SPMS) • EAS Stand Alone (EAS-SA) Financial Data • Standard Finance System (STANFINS) • Standard Accounting Reporting System/Field Level (STARS/FL) • Air Force Base Standard Accounting System (AFBAS) Workload Data • Composite Health Care System (CHCS) • Ambulatory Data Module (ADM) • Workload Management System for Nursing-Army (WMSN-A) EAS IV Central Repository • Interfaces • Reports EAS IV • Unit Cost Tables • Workcenter Costs • Workload/Performan ce Do. D MTF/DTF REPORTS Executive Information/Decision Support System (EI/DS) MEPRS Conference 2005 4
C O R E C O M P E T E N C I E S Counts Cost and Workload Assignment Interfaces Documenting Coding Logistic s Data STANFINS (Army) DMLSS (Do. D) Billing EAS SA Personnel System (Air Force) UCAPERS (Army) SPMS (Navy) O & M Expenses STARS/FL (Navy) FINANCIAL PERSONNEL O & M Expenses FTE, Salary Expenses Expense Allocation Data (Monthly) EI/DS/(Do. D) Repositories CRIS (Air Force) ADM (Do. D) = Projected for EAS IV O & M Expenses Ambulatory CPT Data Patient Acuity Data WMSN-A (Army) WORKLOAD Outpatient/Ancilla ry Workload Support FTE, Salary Expenses ADM Data CHCS (Do. D) DMHRSi (Do. D) CHCS II (Do. D) MEPRS Conference 2005 5
C O R E C O M P E T E N C I E S Counts Current Workflow Processes Documenting Coding Billing SADR/ SIDR MDR ADM EAS WAM PGU I CHCS II CCE MEPRS Conference 2005 6
C O R E C O M P E T E N C I E S Variation 1 on Current Business Processes Counts Documenting A Possibility Coding Billing Primary Business Process DMLSS Ancillaries 1 Initial Documentation CHCS I/II EWSR Patient Outcome Provider CCE 3 Approved/ Final Documentation CHCS I/II CMBB 2 Edited Documentation CHCS I/II CDR EAS CDW(OLAP) *Theater and Infrastructure cover entire process. By: Work Ctr, Facility, CPT, DRG (Dx), Provider EI/DS MEPRS Conference 2005 7
C O R E C O M P E T E N C I E S Variation 2 on Current Business Processes Counts Documenting A Possibility Coding Billing Primary Business Process DMLSS EW SR 1 Initial Documentation CHCS I/II Ancillaries Provide r Patient Outcome 3 Approved/ Final Documentation 2 Edited Documentation CHCS I/II CCE CHCS I/II CMBB EAS CDW By: Work Ctr, Facility, CPT, DRG (Dx), Provider EI/DS (OLAP) *Theater and Infrastructure cover entire process. MEPRS Conference 2005 8
C O R E C O M P E T E N C I E S Counts IM Presentation Objectives Documenting Coding Billing • Become informed about the MHS Information Management (IM) and Information Technology organizational structure • Gain an overview of the MHS IM functional requirements development process (RDP) • Be able to submit requests for changes and improvements in MHS automated information systems (AIS) • Understand how your submissions are reviewed, tracked, and implemented MEPRS Conference 2005 9
MHS IM/IT Program Counts Documenting Management Oversight Structure Information Management C OTheater Functional (IM) Steering Committee (07/08) M P Director, E Information Management T E Access to Care N Provision of Care Population Health C Improvement Manage the Business I E S Assistant Secretary of Defense (Health Affairs) TRICARE Executive Committee (09/SES) Information Management (IM) Proponent Committee (08/SES) Coding Billing Information Technology (IT) Program Review Board (06/SES) MHS Chief Information Officer Program Executive Officer MHS IT Organization Medical Readiness C O R E TRANSCOM Command Control Evacuation System Theater Medical Information Program Clinical Information Tech Program Office Defense Medical Logistics Standard Support Resources Information Tech Program Office Executive Information/ Decision Support MEPRS Conference 2005 Technical Infrastructure 10 10
C O R E C O M P E T E N C I E S Purpose of the IM Requirement Development Process (RDP) Counts Documenting Coding Billing “The purpose of the IM RDP is to document guidelines and procedures in support of the Director, IM, in the execution of a centralized process to clearly define, document, analyze, and manage functional requirements at appropriate times in the AIS life cycle. The IM RDP is a repeatable, consistent, and traceable process that supports the MHS stakeholders. ” MEPRS Conference 2005 11
C O R E C O M P E T E N C I E S Overview of the IM RDP Counts Documenting Coding MEPRS Conference 2005 Billing 12
C O R E C O M P E T E N C I E S Information Management Requirements Development Process (RDP) Counts Documenting Coding Billing Five Phases: MEPRS Conference 2005 13
C O R E C O M P E T E N C I E S Requirements Development Process - Operational View Counts Documenting Coding MEPRS Conference 2005 Billing 14 14
C O R E C O • M P E • T E N • C I E S Your Role in the Requirements Process Counts Documenting Coding Billing Think about your business activities: – – Is a change needed to an existing Military Health System (MHS) automated information system (AIS)? Do you have a requirement for a new MHS IM capability? Document your recommended change on an issue paper IAW Do. D 6010. 13 (MEPRS Manual), Chapter 5, and pass it to your Service MEPRS POC. When the MMIG validates recommended changes, they will then pass them to TMA/IM using the required Requirements Development Process (RDP) form MEPRS Conference 2005 15
C O R E C O M P E T E N C I E S Common Submission Types Counts Documenting Coding Billing • System change request (SCR) – Changing a current requirement or adding a new requirement in an existing automated information system (AIS) • System incident report (SIR) – Notifying that an error has been observed in hardware, software, documentation, or other AIS-related item • Maintenance change request (MCR) – Requesting routine change in the ongoing operation of an AIS (e. g. , update to a common database table) • Capability gap – Identifying a new requirement for functionality that does not currently exist (e. g. , a requirement resulting from a new legislative mandate or Do. D policy) MEPRS Conference 2005 16
RDP SCR/SIR Flow C O R E Counts Functional Documenting Proponent Functional Users (Validate & Prioritize) Status ide tus Sta /SIR SCR vide Pro SCR Submission Information Management IM/ SRWG SCR Submission SIR (re-categorized SCR) Development Prepare RDS Inputs or RFCS SCR Services Assignment SIR Incl. MMIG POC SCR Submission PM/ CCB . . . us tat RS SCR/ SIR Coding UBO, UBU, MMIG, Billing SC Info only Submission POs Submission SCR Submission C O M P Help E Desk SIR T E SCR N Tier 3 SIR (Developer) C I E S v Pro MHS Requirements Repository Budgetary Process 17
C O R E C O M P E T E N C I E S Counts Functional Proponent Documenting Coding Billing • A recognized authority, representing a MHS functional activity, empowered to review and recommend actions regarding change submissions and other requirements • Usually represented by a work group composed of TMA, Army, Navy, and Air Force medical representatives • Examples: – Uniform Business Office (UBO) Work Group – Unified Biostatistical Utility (UBU) Work Group – MEPRS Management Improvement Group (MMIG) 18
C O R E C O M P E T E N C I E S Submissions Tracking Counts Documenting Coding Billing • All Submissions are maintained in the MHS Requirements Repository (DOORS) with supporting documentation with access available via DOORSnet • With each submission, TMA/IM staff check the DOORS database to ensure there is no duplication of this requirement in the MHS MEPRS Conference 2005 19
C O R E C O M P E T E N C I E S Counts After Prioritization Documenting Coding Billing • After the Submission is prioritized for funding, the IM staff will ensure all supporting documentation is prepared to move the submission forward in the process (whether current year or within the POM): • Time is a critical decision; current year requirements can end up worked through the process but be unfunded. • Requirements management includes significant additional supporting documentation. – Architecture: Operational Views – Request for Cost, Scheduling, and Implementation – Place in the POM Document to be presented to the Functional Integration Work Group (FIWG). MEPRS Conference 2005 20
C O R E Counts Challenges Documenting Coding • Many Agendas are in Play Billing C – BRAC O – CHCS I Transformation M P – Joint Military Medical Command E –. . . T E • Most Productive Course of Action: Reengineer Business Processes to be as efficient and N effective as possible regardless of the “politics” C I that might be at play E MEPRS Conference 2005 21 S
C O R E C O M P E T E N C I E S Counts Documenting Summary Coding Billing • The Military Health System has a standardized process for functional requirements management • You have an important role in submitting requests through your Service MMIG POC to improve automated information systems and to identify other AIS-related requirements • For additional information contact imit_reqs@tma. osd. mil or Manage the Business (Mt. B) at ruth. rosen@tma. osd. mil MEPRS Conference 2005 22
C O R E C O M P E T E N C I E S Counts Documenting Coding Billing Questions? MEPRS Conference 2005 23