- ICD-10 Education and consulting support
- Logical data modeling
- Data requirements specification
- Business requirement development
- Scenario based testing models
- Reference implementation models
- Vendor assessment
- Claims analysis and reporting
- Reimbursement models and provider incentives
- Data quality analysis
- Taxonomy and ontology development
- Code set repository and data aggregation model development
ICD-10 EDUCATION AND CONSULTING SUPPORT [top]
HDC provides a variety of consulting services around assessment, planning, implementation and testing in support of the mandated ICD-10 migration. Services include:
Training and education at multiple levels including;
- Directors and managers
- Technical – Data warehousing, data marts, code set management, aggregation, data specification
- Clinical documentation
- Coding professionals
- Anatomy and pathophysiology
- Analysts – policy remediation and management, reporting and analytics
ICD-10 Consulting support:
- Data warehouse remediation
- Policy and Rules remediation
- Project planning, governance
- Business impact assessment
- Reference implementation modeling
- Support for test plan, test case and test data development
- Clinical Documentation Improvement
- Financial Impact analysis
- Trading partner testing
LOGICAL DATA MODELING [top]
Dr Nichols has extensive experience in the development and implementation of logical data models. He has developed a business normalization data model for EDI transactions that is an active part of the data infrastructure of one of the largest EDI software vendor in the market and which is actively a core of their product today. Dr Nichols has experience working with technical architects and physical data design staff to assure that data structures support the business needs and have the flexibility to easily accommodate new business initiatives and business intelligence needs in a robust and flexible design.
DATA REQUIREMENTS SPECIFICATION [top]
HDC has experience in developing specifications for data standards and content that can provide clear validation to assure data quality and data integrity across internal and external data exchange.
BUSINESS REQUIREMENT DEVELOPMENT [top]
Translation of business level need into documentation that is easily and consistently understood by development requires knowledge and experience of both the technical and business side. HDC has the experience to support the capture of business requirements that meet that need. Standard templates for business requirement documentation that have been tested in a wide variety of internal IT and product development environments are leveraged to provide accurate documentation of the business functional need.
SCENARIO BASED TESTING MODELS [top]
In today’s healthcare environment, dramatic changes in the healthcare delivery model and dramatic new regulatory changes creates ongoing risk with each transition. The role of testing is no longer a technical follow on to development. Testing is not required to test the business and drive design and implementation. As healthcare move into unknown territories, models must be created to test anticipated challenges often without the benefit of any historical experience. To accomplish this goal, testing must emulate this new environment by creating scenarios that have been designed to mitigate areas of high risk and high impact. These scenarios must be robust enough to assure that the intent of policies, processes, rules and system implementation function is met.
REFERENCE IMPLEMENTATION MODELS [top]
The reference implantation model (RIM) is an approach to simulating the “to be” environment in order to identify potential risks in development or system remediation early, improve development efficiency, identify unanticipated gaps in analysis and define new requirements critical to successful implementation. The reference implementation is used to reduce the chance of adverse complications of implementation similar to how a disaster drill is used to identify planning gaps and potential unanticipated risks or deficiencies in the event of some untoward event. HDC provides a model and guidance to run several selected “threads” or scenarios through and end to end cycle to accomplish this and capture the appropriate data points discovered during this “virtual implementation”.
VENDOR ASSESSMENT [top]
Assessment of you exiting vendors is critically important in those environments where organizations depend on vendors to support business critical functions. Vendor assessment is more than a survey asking if your vendor is “ready”. Vendor assessment requires an in depth look at how and when they will be ready to support your defined business needs. Confirmation of vendor readiness requires the extension of you internal scenario based testing to includes scenarios that can be run through you vendor to objectively assess the degree to which they can meet your needs given any scenario.
Evaluation of new vendors also requires the ability to align your critical business needs with vendor functionality. The assessment of new vendors also requires that you go beyond the acceptance of reported functional capabilities and demonstrate that those capabilities can meet you defined needs. HDC help you define and apply important business scenarios for you organization and use these scenarios to demonstrate vendor capabilities outside of the usual scripted product demo. HDC has experience on both the product management and development side of the industry as well as the operational or user side to help guide a thorough analysis of vendor capabilities
CLAIMS ANALYSIS AND REPORTING [top]
HDC has extensive background in claims systems development and claim processing operations. This background together with a deep knowledge of claims data standards and data structures provides unique capabilities to provide analysis and a reporting on standards claims based data for a variety or purposes
REIMBURSEMENT MODELS AND PROVIDER INCENTIVES [top]
Dr Nichols has done considerable research into provider reimbursement models that balance productivity, efficiency and quality. His background in clinical care, quality and efficiency measurement as well as extensive background in claims processing and claims analysis gives him the unique ability to understand reimbursement and care delivery in a unique way. He has worked with Milliman to develop an actuarial analysis of a “Shared Governance Model” that balances fee for service and cost incentives through a sliding scale fee schedule approach.
DATA QUALITY ANALYSIS [top]
Dr Nichols has been involved in data quality analysis in a variety for areas including:
- EDI transaction data quality analysis
- Analysis of data quality as a part of healthcare quality collaborative
- A variety of data warehousing projects
- Independent data analysis of organizations internal data
TAXONOMY AND ONTOLOGY DEVELOPMENT [top]
Dr Nichols has been involved in the study and application of healthcare related taxonomy and ontology structures for many years. He has developed prototype models of the application of ontologies to support mapping of ICD-9 to ICD-10. He has done considerable work in leveraging disease and service based taxonomies to deliver disease based and service based analysis of utilization patterns.
CODE SET REPOSITORY AND DATA AGGREGATION MODEL DEVELOPMENT [top]
Dr Nichols has experience in the design and implantation of code set repositories to maintain a wide variety for code set standards in support of both operations as well as data warehousing. He understands the need for maintenance friendly design. He has also developed flexible code level aggregation models that provides a very robust and reusable application of an unlimited number of aggregations to support data warehouses and data marts. His design models provide the ability to support very structure taxonomy models like the AHRQ clinical classification systems as well as ad hoc aggregations to support focused business needs and analytic projects.