State of Washington Department of Labor and Industries
Centers of Occupation Health and Education
Occupational Health Management System (OHMS) Feasibility Study
March 5, 2012
FINAL (Version 4.0)
Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Status: FINAL Date: March 5, 2012 Document Control
This document represents the feasibility study analysis of the information system required to support the Department of Labor and Industries (L&I) Centers of Occupational Health and Education (COHE) as part of the state Workers’ Compensation insurance reform. The study complies with the state Office of the Chief Information Officer (OCIO) requirement for a feasibility study for level 3 projects.
Version Date Description/Changes
1.0 1/20/2012 Initial working draft of chapters I–V and initial appendices for review and comment. Preliminary, NOT EDITED version. 2.0 2/7/2012 Incorporated comments on version 1.0 draft. Updated Work Breakdown Structure. Added new chapters VI–X, XIII. Added new appendices for Vendor Survey, Washington HIE, and Risk Factor Analysis. Preliminary, NOT EDITED version. 3.0 2/20/2012 Incorporated comments on version 1.0 draft. Updated Alternatives Comparison chapter. Updated Major Alternatives Considered chapter. Added Estimated Timeframe and Work Plan chapter. Added Cost-Benefit Analysis chapter. Full Draft. EDITED, except Chapter XII – Cost Benefit Analysis 4.0 3/5/2012 Incorporated comments from version 3.0 draft. Incorporated Executive Summary. Incorporated Alternatives vs. Scope Analysis Appendix.
The anticipated audience for this report includes L&I, the OCIO, the Technology Advisory Board, and other interested stakeholders.
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TABLE OF CONTENTS
Page
I. Executive Summary ...... 1 A. Background ...... 1 B. Vision and Goals ...... 2 C. Current Situation ...... 3 D. Impacts and Organizational Effects ...... 3 E. Major Alternatives Considered ...... 4 F. Proposed Solution ...... 5 G. Estimated Time Frame and Work Plan ...... 6 H. Cost-Benefit Analysis ...... 7 I. Risk Assessment ...... 8
II. Background ...... 1 A. COHE Program Definition ...... 1 B. Emerging Best Practices ...... 4 C. Workers’ Compensation Legislative Directives ...... 4 D. Program Research ...... 5 E. Study Scope and Objectives ...... 6 F. Document Organization ...... 7
III. Goals and Objectives ...... 8 A. Vision ...... 8 B. Customers ...... 9 C. Business Service Strategy ...... 10 D. Business Service Goals ...... 11 E. Challenges and Constraints ...... 14
IV. Current Situation ...... 16 A. Organization Structure ...... 16 B. Business Operations ...... 16 C. Information Technology Environment ...... 21
V. Impacts ...... 27 A. Business Impacts ...... 27 B. Information Services ...... 28 C. Project or Initiative Impacts ...... 29
VI. Organizational Effects ...... 31 A. COHEs ...... 31 B. Health Services Analysis ...... 32
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C. Customers ...... 33 D. Information Services ...... 34
VII. Major Alternatives Considered ...... 37 A. Strategic Requirements ...... 37 B. Alternative 1 – Internal Development ...... 38 C. Alternative 2 – Internal Development/EMR Integration ...... 46 D. Alternative 3 – External Product Integrator ...... 47 E. Alternative 4 – External Product Integrator/EMR Integration 54 F. Other Alternatives Considered ...... 56
VIII. Alternatives Comparison ...... 58 A. Comparison Summary ...... 58 B. Functional Comparison ...... 59 C. Technical Comparison ...... 60 D. Schedule Comparison ...... 60 E. Cost Comparison ...... 60 F. Benefits Comparison ...... 61 G. Risk Comparison ...... 61 H. Alternatives versus Scope Analysis ...... 63
IX. Proposed Solution ...... 64 A. Business Perspective ...... 64 B. Technical Design ...... 68
X. Conformity with Agency IT Portfolio ...... 86 A. Agency Strategic Plan Conformity ...... 86 B. Agency IT Portfolio Conformity ...... 88 C. Agency Technology Vision Conformity ...... 88
XI. Project Management and Organization ...... 89 A. Project Governance Structure ...... 89 B. Project Management Structure ...... 93 C. Stakeholder Management Structure ...... 95
XII. Estimated Timeframe and Work Plan ...... 97 A. Project Approach ...... 97 B. Work Plan and Schedule ...... 108
XIII. Cost-Benefit Analysis ...... 110 A. Methodology ...... 110 B. Cost Benefit Analysis ...... 114 C. Cost Calculations and Assumptions ...... 114
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D. Benefit Analysis ...... 119 E. Key Benefits ...... 123
XIV. Risk Management ...... 134 A. Risk and Risk Management Strategies ...... 134 B. Project Oversight ...... 137
Appendix A - Glossary
Appendix B – Project Library Index
Appendix C – Project Participants Appendix D – Information Systems List Appendix E – COHE Research Study Appendix F – Work Breakdown Structure Appendix G – Health Information Exchange Summary Appendix H – Vendor Survey Appendix I – Cost-Benefit Spreadsheets Appendix J – Risk Factor Analysis Appendix K – Project Schedule Appendix L – Alternatives vs Scope Analysis
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I. EXECUTIVE SUMMARY The purpose of the Occupational Health Management System (OHMS) Feasibility Study is to explore technology alternatives to meet the needs of the Washington State Department of Labor & Industries’ (L&I’s) Centers of Occupational Health and Education (COHE) best practice programs. The OHMS project is a result of a number of workers’ compensation reform initiatives came out of Engrossed House Bill 2123, Substitute Senate Bill 5801, and Engrossed Substitute House Bill 1725 that were passes in 2011,. These bills represent some of the most dramatic changes in Washington’s workers’ compensation system since it was created back in 1911.
L&I is a diverse state agency dedicated to the safety, health and security of Washington's 3.2 million workers. The agency provides no-fault industrial insurance coverage for most employers and workers in the state. Benefits include medical treatment for workers who are injured in the course of their employment or develop an occupational disease as a result of their work activities. Workers who are unable to work due to accepted conditions related to an industrial injury or occupational disease may be eligible for partial wage replacement benefits.
A. Background Washington’s workers’ compensation system spends close to $600 million annually on medical care for injured workers. Making sure that money is spent on effective, high quality healthcare is a top priority at L&I. L&I has participated in a number of projects to test various healthcare delivery systems over the past decade to ensure best practices are followed in the delivery of occupational healthcare to injured workers.
During this time, L&I has worked in collaboration with business and labor organizations, community healthcare leaders, and the University of Washington (UW) to develop a more effective, coordinated-care, community-based approach to healthcare delivery. A pilot of this approach has been implemented statewide through the establishment of Centers of Occupational Health and Education (COHEs) and has produced demonstrable results.
There are currently four COHEs operating in Washington State. These four treat about one-third of all State Fund workers’ compensation claims. The four COHE locations operating today are:
Renton COHE (Community) - Valley Medical Center, Renton The Everett Clinic COHE (Institutional) - Everett Harborview Medical Center COHE (Institutional)- Seattle Eastern Washington COHE (Community) - St. Luke’s Rehabilitation Institute, Spokane
Currently there are two types of COHEs. An institutional COHE is where a single healthcare organization offers resources to support its providers, the injured workers seeking care, and the
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workers’ employers. A community COHE is where a sponsoring healthcare organization pulls together resources to support providers, workers, and employers in a geographically defined area.
B. Vision and Goals In addition, the legislation has also generated several goals for the agency in terms of COHE expansion and the use of a uniform and statewide COHE information management system. The overarching goals for the workers’ compensation insurance reform initiatives include the following:
Promotion for the use of best practices Reduced disability Reduced loss of income for an injured worker Increased availability of high quality medical treatment Lowered insurance costs
The COHE program’s general business service strategy has been provided below and presents each immediate beneficiary of the proposed COHE management system, referred to in this document as the OHMS.
Employer: Through improved employer engagement, employers are kept informed of their employee’s condition and the employee’s ability, or inability, to perform work responsibilities. Employers can save money by getting injured workers back to work sooner, thus limiting the impacts to their Experience Rating and insurance premiums.
Injured Worker: Improved access to healthcare providers with significant training and knowledge of occupational healthcare best practices will ensure that workers receive the best care possible and recover from their work-related injury/illness quickly and with minimal absence from work. Furthermore, the workers share a common interest with their employers—by keeping their employer’s Experience Rating down, they ultimately save money on their portion of insurance premiums, in addition to avoiding disability and being able to earn their full income to support themselves and their families.
Healthcare Provider: L&I offers several incentives for providers to participate in COHEs, including monetary and non-monetary incentives and educational encouragement for following and maintaining guidelines and procedures when handling a workers’ compensation claim. Furthermore, L&I is a good insurer, providing a competitive fee schedule, relatively fast payment, and the desire to work with providers to increase access to occupational health best practices.
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Exercising best practices allows providers to resolve injured worker issues more quickly, provide better medical care, and serve more patients.
L&I: Improvement in healthcare through best practice programs operation, provider coordination, improved injured worker engagement and access, improved care coordination and communication, and increased employer engagement are just a few of the many benefits associated with OHMS and the COHE project.
The implementation strategy or vision is to initially implement a foundational or baseline OHMS system that replaces the current provider-provided systems and encourages new organizations to operate a COHE in their geographical area or institution. OHMS would then be expanded over time to include new COHEs, new customers (Providers, Top Tier, Self-Insured), new best practices (e.g., Surgical or Orthopedic), and better integration into both the rest of L&I and the provider’s information systems via Health Information Exchange (HIE).
C. Current Situation COHEs currently educate and hold practicing providers accountable for maintaining a high-level of performance when treating injured workers. Each COHE works closely with providers, employers, injured workers, and L&I to offer an infrastructure within the healthcare community to facilitate the implementation of occupational health best practices. However, the operational consistency and disconnect that exists today from one COHE to another has become an area of concern for L&I. The agency plans to mitigate their concerns through the implementation of a standardized and uniform Web-based management system for COHE operation and monitoring.
Presently, the four existing COHE locations operate improvised in-house systems to help manage COHE operation and the overall healthcare delivery process. This tactic has proven to be not only inefficient, but also inadequate. In recognition of the expansion of provider-based best practices and incentive programs, L&I sought the expertise of Soos Creek Consulting, LLC to determine the feasibility of establishing a single-source system (OHMS) capable of delivering the functionality necessitated by COHE operations and the expanded best practice programs.
D. Impacts and Organizational Effects OHMS will have a profound impact on users both internal and external to L&I. Understanding these impacts, both direct and indirect, is imperative for managing change. From a business standpoint, COHEs, Top Tier providers, and Occupational Health Best Practices (OHBP) will have favorable impacts on internal L&I users and external users (medical providers, COHE staff, injured workers, and employers). Those impacted will include:
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External Internal COHE Staff Health Services Analysis Unit Employers Occupational Health Services Staff Self-Insured Employers Employer Services (minimal) Injured Workers Claims Managers Medical Providers Office of the Medical Director Staff Field Services Staff
The organizational effects of OHMS will impact users differently based on their purpose and dependency upon the functionality of the system. Some of the effects on various system stakeholders have been identified below.
Institutional and community COHEs stand to benefit from a unified common system; OHMS will provide COHEs with a one-stop portal for conducting COHE operations. The Health Services Analysis (HSA) unit is the core business organization within L&I for the COHE program and the OHMS project; in general this organization will be affected the most by the OHMS project and resulting system in terms of system definition, management, and coordination. Occupational Health Services (OHS) also stands to benefit from OHMS considering they will not need to add additional staff as COHEs grow and expand (this benefit is in part due to the improved efficiency OHMS will provide). Information Services (IS) staff will be impacted by OHMS in terms of development, operations, and support of a new system.
Impacts to these organizational entities and their operations include new business policies, processes and information systems, but these changes should result in more efficient and effective operations.
E. Major Alternatives Considered Information was gathered from the HSA unit, application vendors in the marketplace, and Information Services (IS) staff to identify and evaluate potential solution alternatives for OHMS. This resulted in two primary alternatives; internal application development and an external system integrator that installs and/or operates an existing application. Both of these alternatives were extended to include the option of adding interfaces to provider Electronic Medical Records (EMR) systems. The following is a list of the four alternatives considered:
Alternative 1 – Internal Development Alternative 2 – Internal Development/EMR Integration Alternative 3 – External System Integrator Alternative 4 – External System Integrator/EMR Integration
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Using criteria commonly used in similar engagements to evaluate alternative technical solutions, quantitative comparisons of the four alternatives were constructed. Since many of the rating categories are specific to the State of Washington, the ratings illustrate how the alternatives compare to each other rather than to industry benchmarks.
The highest total result indicates the most advantageous combination of functional and technical requirements, as well as consideration of schedule, benefits, risks, and costs associated with each alternative.
Comparison Weight Alternative 1 Alternative 2 Alternative 3 Alternative 4 Table Functional 200 150 160 170 180 Technical 140 129 112 95 101 Schedule 170 85 68 153 136 Cost 100 55 45 80 75 Benefits 190 91 114 152 182 Risk 200 134 127 151 151 Total: 1000 644 626 801 825
Two other alternatives were examined and dismissed as not being viable for OHMS; manual or no statewide support for the current and future COHEs and the extension of an existing L&I information systems to support the COHE and HSA requirements.
F. Proposed Solution The alternative that appears to best meet OHMs needs is Alternative 4 – External System Integrator/EMR Integration. The OHMS application is proposed to be added to L&I’s portfolio of business applications. The OHMS application will be a customer-facing application integrated with existing L&I legacy applications (i.e., LINIIS, ORION, and MIPS) and operating within the L&I SOA environment, using as many reusable SOA services as possible. The application will contain its own business logic and database to support the unique functionality of each COHE and any future business operational needs.
Initial research has identified a need for the OHMS application to be flexible and to support varying business processes (e.g., fulfilling community COHE needs as well as institutional COHE needs). Furthermore, in cooperation from the HSA business unit and the input from the Insurance Services (IS) Division business analysts, a requirements document for the OHMS application was developed. Together, they were able to create a Lightweight Analysis document, which provides high-level requirements for OHMS.
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G. Estimated Time Frame and Work Plan This alternative requires the procurement and licensing of a commercial software application, as well as system integration, implementation, and ongoing operations and support services. The overall approach is shown in the following diagram.
PROJECT MANAGEMENT Phase I Phase I Phase 0 Core Services Acquisition Operational Phase II Development Operational Phase II L&I Integration Development
July 2013 July 2014 July 2015
The above diagram shows an incremental approach that adds capabilities and functionality in annual increments.
Project Management – L&I provides project management to the overall project, coordinating efforts with the system integrator, COHE organizations, and provider organizations. The system integrator would also provide continuous project management leadership through the implementation phases of the project. Phase 0 – Acquisition – L&I will construct a request for proposal to acquire a commercial firm who will implement and support the OHMS application, acting as an external service bureau that supports COHE operations. The competitive procurement would follow the state’s guidelines for managing this type of effort, including the state’s standard contract terms and conditions and regular status reporting and independent quality assurance services. Phase 1 – Core Services Development – The selected vendor configures or develops the core applications following the established scope for Phase 1. This would include the OHMS Web services, business logic, and database services. This phase also assumes that the vendor provides COHE access to provider electronic health systems. Phase 2 – L&I Integration – This approach assumes that COHE staff will continue to interact with existing L&I portals to public-facing portals to get access to Washington industrial insurance information, managed by L&I. In this phase L&I systems information is integrated with the OHMS application, managed by the
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vendor. Claims and payment data, electronic document images, and information flows required by L&I contracts with COHEs will be supported. This phase will also establish mechanisms to push OHMS information to L&I to support contract management oversight, best practice monitoring, and research efforts.
It is assumed that future phases will continue to be implemented and released. As new best practices are identified and developed, functional changes, metrics, and new capabilities will undoubtedly need to be added in future major releases of the software.
H. Cost-Benefit Analysis The Value Measuring Methodology (VMM) was employed to determine the overall benefits of the OHMS Project. VMM is a tool developed by the Federal Government to assess the relative value and viability of different information technology efforts. The key benefits to be received from the implementation OHMS have been identified and reviewed by L&I and are listed below. A benefit can be tangible (measurable) or intangible (provides value, but is not measurable).
Tangible Benefits The study identified 17 Government Operational Value benefits of the OHMS project. These benefits are related to operational improvements within L&I based on OHMS. Highlights include:
Increasing number of Reports of Accident (ROAs) within best practice standards. Reduced number of imaged documents coming into the agency and ROA forms being entered as data. Increasing the number of claims COHE staff can intervene on. Reduction in the number of duplicate documents received by agency. Improved ability to track and implement best practices.
The study identified 3 key Government Financial Value benefits of the OHMS project based on an analysis completed for the SB5801 fiscal note. These benefits incorporate the savings occurring as a result of current and future COHE operations and while OHMS will only contribute to the savings, the benefit cannot be achieved without both expanding the number of COHEs and improving the productivity of COHE Health Services Coordinators (HSCs). The calculations include the following benefits and the annual savings and cost estimates table:
Reduction in Accident Fund Reduction in Medical Aid Fund
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COHE ANNUAL SAVINGS AND COSTS
Fiscal Accident Accident Medical Aid COHE COHE Net Year Fund Fund New Costs Savings
FY13 $4,356,000 $ 2,319,000 $213,000 $ 6,462,000
FY14 $13,068,000 $ 6,872,000 $657,000 $19,283,000
FY15 $19,554,000 $10,308,000 $981,000 $28,881,000
Intangible Benefits The study identified 4 Direct Customer Value, 2 Social Value and 4 Strategic Value benefits of the OHMS project. Highlights include:
Improved overall productivity of the state’s workforce. Improved employee quality of life. Improved confidence in the state’s Worker Compensation System. Improved evidence-based decision making.
Costs The TSB’s Feasibility Study Guidelines for Information Technology Investments references a cost-benefit analysis (CBA) spreadsheet consisting of five forms to be employed to analyze costs and benefits of each alternative. The completed forms for each alternative are summarized in the table below. A 10-year total cost of ownership period (TCO) was utilized.
Item Alternative 1 Alternative 2 Alternative 3 Alternative 4
Total Project Costs $ 9,619,062 $ 14,112,162 $ 9,106,265 $ 10,741,265 Total Benefits 102,893,500 105,286,000 102,893,500 105,286,000 TOTAL OUTFLOWS 38,216,256 36,713,987 34,215,591 49,141,048
TOTAL INFLOWS 102,893,500 105,286,000 102,893,500 105,286,000 NPV 42,655,740 45,618,353 46,579,207 36,520,844 IRR% 48.46% 53.64% 66.48% 41.25%
I. Risk Assessment Soos Creek Consulting used a standardized risk factor assessment tool that assesses 77 risk factors in 14 different categories. Each risk is scored against low, medium, and high risk cues. A
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risk index is calculated for each category and for the entire project. The risk index is the weighted average of all low, medium, and high risk factors (low = 1, medium = 2, and high = 3). Sixteen key high-level risks were identified for the OHMS project, as follows:
Risk Rationale L&I staff have resource conflicts. Business analysts, IT staffs, 6 - Resource Conflict and business program staff appear to have conflicting functional priorities. 9 - Project Manager Project manager is new to L&I and the business area. Experience Deployment dates are mandated by legislation rather than solid 12 - Convenient Date project-planning processes. Project is a large statewide project with many integration 26 - Project Size requirements. The composition of the project is now emerging. 33 - Development Schedule Very aggressive development schedule. Requirements are emerging. High-level requirements exist. No 34 - Requirements Stability complete set of requirements has been established. System not defined. Significant new functionality for agency, 37 - Design Difficulty including level of data analytics. High integration requirements to wire several different SOA 38 - Implementation Difficulty components and a lot of data integration requirements with existing legacy database systems. Team has limited technology skills. The team is currently 62 - Mix of Team Skills recruiting for key positions. 65 - Expertise with Team will likely be contract staff with little domain experience. Application Area (Domain) Complex environment will require substantial training to 68 - Training of Team support high integration requirements. 73 - Availability of Most technical positions don’t exist and will need to be Technology Expertise procured. High system integration will make system a challenge to 75 – Design Complexity maintain (e.g., SOA integration, data integration with existing systems, and business intelligence issues). 76 - Support Personnel Support staff will have to be assembled.
The level of required project oversight has been established by employing the Technology Services Bureau (TSB) standards for oversight determination. The result indicates the OHMS project will require Level 3 oversight. This oversight level requires certain actions, and governance and oversight structures. To L&I, the most significant of the oversight structures is the requirement for external quality assurance oversight and regular status reporting to the TSB.
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II. BACKGROUND The purpose of the Occupational Health Management System (OHMS) Feasibility Study is to explore technology alternatives to meet the needs of the Washington State Department of Labor & Industries’ (L&I’s) best practice programs, including Centers of Occupational Health and Education (COHE) information and business support needs. The information contained in this section presents a historical perspective of the best practice business area and the current projects being implemented under the larger workers’ compensation insurance reform. In addition, this section will introduce L&I’s rationale for a new system (OHMS) to better support the best practice program operations.
A. COHE Program Definition Washington’s workers’ compensation system spends close to $600 million annually on medical care for injured workers. Making sure that money is spent on effective, high quality health care is a top priority at L&I. To ensure best practices are followed in the delivery of occupational health care to injured workers, L&I has participated in a number of projects to test various health care delivery systems over the last 10 years.
During this time, L&I has worked in collaboration with business and labor organizations, community health care leaders, and the University of Washington (UW) to develop a more effective, coordinated-care, community-based approach to health care delivery. A pilot of this approach has been implemented in several locations through the establishment of Centers of Occupational Health and Education (COHEs) and has produced demonstrable results.
A COHE is a community-based organization that uses occupational health best practices to treat injured workers within the state. Research has shown that COHEs help injured workers return to work sooner and reduce overall claim costs. The program utilizes a combination of medical provider training, health care coordination services, financial and non-financial incentives, and mentorship to increase communication and coordination between the medical provider, employer, and injured worker, which results in reducing injured workers’ disability.
One of the key objectives of a COHE is to provide interventions early in the life of a claim. Research has shown that workers who do not return to work within three months are unlikely ever to return to meaningful employment. Key components of the COHEs success are the staff servicing them. A Health Services Coordinator (HSC) plays a crucial role in this work by coordinating everyone involved in the claim and keeping everyone focused on return to work. Additional COHE staff and their responsibilities have been included later in this section.
1. COHE Types Currently, there are two types of COHE models: Institutional and Community. The particulars have been provided below:
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Institutional COHE: A COHE where a single health care organization offers resources to support its providers, the injured workers seeking care, and the workers’ employers. Community COHE: A COHE where a sponsoring health care organization pulls together resources to support providers, workers, and employers in a geographically defined area.
COHEs work with the Occupational Health Services (OHS) unit at the Washington State Department of Labor & Industries. This unit’s programs seek to expand occupational health care best practice expertise and improve injured worker outcomes.1
2. Operational COHEs There are currently four COHEs operating in Washington State. These four treat about one-third of all State Fund workers’ compensation claims. The four COHE locations operating today are:
Renton COHE - Valley Medical Center, Renton, WA The Everett Clinic COHE - Everett, WA Harborview Medical Center COHE - Seattle, WA Eastern Washington COHE - St. Luke’s Rehabilitation Institute, Spokane, WA*
*The Spokane COHE includes the following counties: Adams, Asotin, Chelan, Columbia, Douglas, Ferry, Garfield, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Whitman, and Yakima counties.
1 University of Washington, Task 4, Report on the Outcome Evaluation for the Eastern Washington COHE (3 Counties), June 30, 2006.
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3. COHE Organizational Requirements Each COHE has staff to help fulfill the following roles. COHE staff may fulfill multiple roles.
1. COHE Medical Director: Health care provider with an active Washington State license who is focused on medical leadership and management. 2. COHE Project Director: Operational leader with project management experience who manages all of the core COHE functions and staff. 3. COHE Health Services Coordinator: Facilitator and coordinator between provider, employer, patient, union (when applicable), and claims manager. 4. COHE Community Outreach Facilitator: Staff member who encourages employers, unions, and community organizations to partner with COHE and implement best practices. 5. COHE Provider Trainer: Trainer of providers and provider staff on COHE and occupational health best practices.
Each of these roles has specific qualifications. L&I Claims Managers remain the official claims- specific adjudicative authority.2
4. COHE Best Practices L&I’s focus for COHEs is on measurable processes of clinical care that, if improved, would likely correspond to improved outcomes (e.g., early return to work). These measures and resulting outcomes have been determined to be important to key stakeholders. Currently, the following best practices have been utilized to obtain improvements in clinical care:
1st Best Practice: Provider to send a complete Report of Accident (ROA) to L&I within two business days of determining that the injury or disease is work related.
2nd Best Practice: Communicate the physical activities that the injured worker can do on an Activity Prescription Form (APF). The completed form is given to the worker to share with his or her employer and is sent to L&I and the COHE health services coordinator.
3rd Best Practice: Attending Providers in the Program (APPs)3 should call the employer if they take the injured worker off work or restrict the worker’s activities. This communication allows the employer to ask questions about restrictions, modified work, and the course of treatment and allows the provider to understand the type of work being done.
2 Amendment No. 5 to CONTRACT NO. 00C-61 for the Renton COHE, May 12, 2011. 3 Attending Providers in the Program (APPs) is the term used by L&I for a COHE registered provider.
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4th Best Practice: Barriers Assessment. APPs are encouraged to identify barriers to return to work and develop a plan to remove them.
B. Emerging Best Practices L&I is continually developing best practices for its pilots. Currently, there are two best practices being piloted, with one additional best practice under development for implementation for late 2012. These best practices continue to focus on identifying workers with a higher risk of disability and administering the appropriate intervention procedures in a timely manner.
C. Workers’ Compensation Legislative Directives In 2011, a number of workers’ compensation reforms came out of Engrossed House Bill 2123, Substitute Senate Bill 5801, and Engrossed Substitute House Bill 1725, which were passed by the Washington Legislature and signed into law by the Governor. The legislation creates a statewide Medical Provider Network (MPN), expands the number of COHEs (COHE Expansion project), prompts the adoption and expansion of occupational health best practices (Top Tier providers and new pilots), and promotes getting workers back to work faster (Washington Stay at Work or WSAW). These changes should reduce the workers’ compensation system’s overall costs and prevent double-digit rate increases. As a whole, the bills represent some of the most dramatic changes in Washington’s workers’ compensation system since it was created in 1911.
1. Statutory Requirements COHE Expansion, creation of a Top Tier network, the surgical best practices pilot (Ortho- Neuro), expansion of occupational health best practices, as well as, the creation of an electronic means of provider feedback are all in direct response to mandated legislation. Substitute Senate Bill (SSB) 5801 specifically expands the number of COHEs in the Washington State industrial insurance system with a goal of providing 100% of workers access to COHEs by 2015.4 Furthermore, COHEs are to expand community expertise in both occupational health care and disability prevention.5
Currently, all existing COHEs support their own information systems and infrastructure to manage operation. However, as the COHE program and best practices expand, and COHEs grow in size and complexity, the information systems and infrastructure that support them will also need to be expanded to eventually serve all geographical areas of Washington State. This expansion has mandated the investment for a uniform system (OHMS) to help augment COHE operations and to support providers and L&I with a tool for more effectively managing claims.
4 SSB 5801. 5 Washington State Department of Labor & Industries, Work Request K2739 Attachment B, COHE IT Expansion Project Description, Dec. 14, 2011.
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For example, in 2006 L&I piloted the Ortho-Neuro best practices, which provides for orthopedists and neurosurgeons wanting to participate in a COHE. However, the systems currently available to them do not adequately support these providers and their COHEs. This use of inadequate and improvised ‘home-grown’ systems has led L&I to seek technology alternatives - as envisioned with OHMS - to assess, measure, and report to providers more effectively today, and well into the future.
In the spirit of COHE expansion, L&I is to establish additional best practice standards for providers to qualify for a second tier (Top Tier) within the Medical Provider Network (MPN), based on demonstrated use of occupational health best practices. This Top Tier is separate from and in addition to the COHEs. Top Tier will utilize technology to assess provider achievement of best practices and generate incentive payments for exercising best practice activities while administering care of an injured worker.
As a means of monitoring performance of COHEs and Top Tier providers, L&I is in the midst of developing an electronic method of tracking evidence-based quality measures to identify and improve outcomes for injured workers at risk of developing prolonged disability. In addition, these methods are to be used when providing systematic feedback to physicians regarding quality of care, to help conduct appropriate objective evaluations of progress in the COHEs, and to allow efficient coordination of services.
The expansion and coordination of these programs with little to no increases in L&I staffing require both technology assistance to ensure appropriate supervision and resources to ensure successful implementation of these best practice approaches.
2. Occupational Health Management System Currently, the four existing COHE locations have improvised their operations using in-house systems to help manage COHEs . This tactic has proven to be not only inefficient but also inadequate. In recognition of the expansion of provider-based best practices and incentive programs, L&I sought the expertise of Soos Creek Consulting, LLC to determine the feasibility of establishing a single-source system capable of delivering the functionality necessitated by COHE operations and expanded best practice programs.
This necessity has brought about the requirements set forth in this feasibility study titled, Occupational Health Management System (OHMS) Feasibility Study Project. The resulting study will help to determine the best possible solution(s) moving L&I forward with administering best practices through improved COHE management.
D. Program Research A critical aspect of COHE operation is evaluating its success and ability to reduce the amount of workers on disability while promoting improved treatment outcomes for injured and sick
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workers. Beginning in 2002, the Renton COHE at Valley Medical Center began enrolling providers. Then, one year later, the Spokane community opened their Eastern Washington COHE at St. Luke’s Rehabilitation Institute.
As a means of determining tangible results for these two pilot COHEs, the UW Department of Environmental & Occupational Health Sciences administered an intervention evaluation at these two sites. For the intervention, UW researchers were tasked with evaluating the OHS project. Details of the research teams study and findings have been provided in Appendix E – COHE Research Study.
E. Study Scope and Objectives The scope of this OHMS feasibility study concerns itself with evaluating the “as-is” or current environment found at L&I, the desired functionality of OHMS, and identifying the best possible technology approach to attaining this desired system functionality. The following objectives were identified while conducting research for this feasibility study:
Need to identify the business needs and strategic issues by understanding the current processes utilized by OHS. Need to develop a vision for the occupational health best practice tracking system that will accomplish the current critical needs of each stakeholder and interested entity, with the flexibility for expansion and revision in the future. Need to determine the most viable solution alternative for a new information system to support the best practice programs. Need to develop a plan for implementing and managing the strategies and techniques to achieve the desired vision over the next few years. Need to promote a common understanding of the direction and vision of the overall plan and the interplay of its separate components among the management and executive personnel of each stakeholder. Need to determine the complexity of the OHMS project and to satisfy the requirements of the Office of the Chief Information Officer (OCIO) guidelines. Need to assist L&I in developing a definitive scope and design concept for the new system. This process will include the most feasible approach to determining the source of a new system and the costs and benefits (cost-benefit analysis) associated with a new system.
To meet the study objectives, this report will encompass the standard forms mandated by the OCIO guidelines. In addition, multiple other feasibility study support documents will be added to supplement OHMS criteria findings.
The feasibility study team’s efforts include:
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Reviewing background materials, existing documentation, and other related information to become familiar with the current systems used by L&I and local COHEs. Conducting high-level research within the allowable timeframe of the vendor marketplace to determine the availability of viable software, hardware, and system integration vendors providing products and services in the OHMS arena. Conducting interviews with key personnel from L&I and local COHEs in order to better understand their needs, the existing business and technical environment, as well as any future plans. Facilitating the OHMS Steering Committee meetings to discuss and debate the issues, vision, and future plan for OHMS and its service delivery approach and technology. Documenting the issues, vision, strategies, and plan components into an overall OHMS feasibility study.
The results of this review will help define the business requirements at a high level and create a conceptual design for OHMS. The requirements and conceptual design will be used to produce a list of alternative options; these alternatives will be thoroughly considered against our proposed system approach solution and discussed at great detail within our documentation and with the appropriate L&I staff to gain consensus.
F. Document Organization The remainder of this document is organized based on the content requirements for a State of Washington Information Technology Feasibility Study documented at:
http://www.ofm.wa.gov/ocio/policies/documents/feasibilitystudy.pdf
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III. GOALS AND OBJECTIVES The passage of legislation mandating the reform of the workers’ compensation system has had a significant influence on L&I and its strategic focus and direction. This legislation not only has provided a means for identifying the importance of a system like OHMS, but also has generated several goals and objectives associated with the use of a uniform and statewide COHE management tool for its users.
A. Vision The implementation strategy or vision is to initially implement a foundational or baseline OHMS system that replaces the current provider-provided systems and encourages new organizations to operate a COHE in their geographical area or institution. OHMS would then be expanded over time to include new COHEs, new customers (Providers, Top Tier, Self-Insured), new best practices (e.g., Surgical or Orthopedic), and better integration into both the rest of L&I and the provider’s information systems via Health Information Exchange (HIE). The concept is for an evolutionary approach with expansion or enhancement in each direction as on the following diagram.
Customers EMR Health • Providers Integration Information • Top Tier Exchange • Self-Insured (HIE) Integration
COHE Occupational Expansion Health Case (Geographic) Best Management Practices Functions
L&I Insurance System Best Integration Provider Practices Network Expansion
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B. Customers This subsection details the customers that will be served by OHMS. Customers have been divided into three categories to best describe the level of impact that the OHMS capabilities will have on their ability to accomplish their missions. The three categories are described below.
1. Primary Customers Entities that will be most affected by implementation of OHMS are the primary customers. These entities are characterized by the significant reliance they will place on the new technology as a primary information source in their daily routines. The primary customers are:
Health Service Coordinators (HSCs) Other COHE Staff COHE Advisors, APPs, and Ancillary Providers participating in other pilots L&I Claims Units Occupational Health Services (OHS) Unit Statewide Health care Provider Community and Staff Health care Institutions (Clinics) Business Community (Employers) Injured Workers (Employees) Self-Insured Employers/Third Party Administrators (TPAs) L&I Field Staff
It is imperative that the plan implement solutions that provide primary customers with the information and tools necessary to accomplish their missions.
2. Secondary Customers Entities identified as being only partly affected by the implementation of OHMS are categorized as secondary customers. These entities are defined by less operational reliance on information managed by the system, rather than the significant reliance characterized by primary customers. The secondary customers are:
L&I Medical Director staff L&I Employer Services staff L&I Policy and Quality Coordination staff L&I Research and Data Services Labor Trial Lawyers (for worker or employer) Workers’ Compensation Advisory Committee (WCAC) WCAC Health care Sub-Committee Provider Network Advisory Group
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University of Washington Research Team Industrial Insurance Medical Advisory Committee (IMAC) Industrial Insurance Chiropractic Advisory Committee (IICAC)
All funding and research entities are considered secondary customers in that they will use the information from OHMS for analysis.
3. Tertiary Customers Entities identified as having only a general interest in the implementation of OHMS in the state are categorized as tertiary customers. This category includes entities that will have little direct reliance on the system but will desire general informational access. The tertiary customers are:
Provider Associations Office of the Governor Legislature Other state agencies (ESD, DOC, etc.) General public (as an information customer) Media Other academic and research institutions Other countries, states, and federal government
Identification of all customers provides the OHMS feasibility study with a scope of desired impact and criteria for prioritizing specific components of the system and the implementation of the plan. For example, primary customers may reap the benefits and tangible results of OHMS more quickly than secondary customers.
C. Business Service Strategy The COHE program’s general business service strategy is presented below and identifies each immediate beneficiary.
Injured Worker: Improved access to health care providers with significant training and knowledge of occupational health care best practices will ensure that workers receive the best care possible and recover from their work-related injury/illness quickly and with minimal absence from work. Furthermore, the workers share a common interest with their employers—by keeping their employer’s Experience Rating down, they ultimately save money on their portion of insurance premiums, in addition to avoiding disability and being able to earn their full income to support themselves and their families.
Employer: Through improved employer engagement, employers are kept informed of their employee’s condition and the employee’s ability, or inability, to perform work
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responsibilities. Employers can save money by getting injured workers back to work sooner, thus limiting the impacts to their Experience Rating and insurance premiums.
Health care Provider: L&I offers several incentives for providers to participate in COHEs, including monetary and non-monetary incentives and educational encouragement for following and maintaining guidelines and procedures when handling a workers’ compensation claim. Furthermore, L&I is a good insurer, providing a competitive fee schedule, relatively fast payment, and the desire to work with providers to increase access to occupational health best practices. Exercising best practices allows providers to resolve injured worker issues more quickly, provide better medical care, and serve more patients.
Dept. of Labor & Industries (L&I): Improvement in health care through best practice programs operation, provider coordination, improved injured worker engagement and access, improved care coordination and communication, and increased employer engagement are just a few of the many benefits associated with OHMS and the COHE project.
Additional business service goals presently being addressed have been provided below.
OHS will develop and test health care best practices to be administered beyond the first 12 weeks of a claim to help reduce long-term disability. L&I will develop and implement financial and non-financial incentives for COHE providers based on progressive and measurable gains in occupational health best practices.
In the interest of moving forward with COHEs and OHMS, L&I will report to the Workers’ Compensation Advisory Committee (WCAC) and the appropriate committees of the Legislature on December 1, 2012, and annually thereafter through December 1, 2016, on the implementation of the provider network and expansion of COHEs. These reports will include a summary of actions taken, progress toward long-term goals, outcomes of key initiatives, access to care issues, results of disputes or controversies related to new provisions, and whether any changes are needed to further improve the occupational health best practice care of injured workers.
D. Business Service Goals The overall goals of the L&I insurance reform initiative (COHE expansion, top tier, surgical best practices, and emerging best practice program) include:
Promotion of the use of best practices Reduced disability Reduced loss of income for an injured worker
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Increased availability of high quality medical treatment Lowered insurance costs
The mission of the L&I COHE program is to improve injured workers’ medical recovery and prevent unnecessary disability by collaborating with health care organizations in the community to increase the quality of, availability of, and accountability for occupational health best practices. The following business goals are associated with the COHE project:
Provide access to 50% of all claimants to COHE providers by 2013. Provide access to 100% of all claimants to COHE providers by 2015. Operate at least six COHEs by July 2013. Implement Top Tier incentives for providers who use occupational health best practices by July 2013.
To support COHE expansion and operation, L&I would like to have a uniform Web-based tool for both statewide COHE providers and OHS staff. The new OHMS system will need to be centralized and more streamlined than the existing improvised system processes that are currently disparate across the four existing COHEs. This is the rationale for OHMS, supporting L&I users (HSA staff, claims managers, COHE contract managers, etc.) who will conduct administrative functions within OHMS, as well as supporting COHE users (COHE HSCs, COHE trainers and outreach staff, etc.) who will be using the system to carry out day-to-day COHE operations.
1. OHMS Development Strategy The plan is for the Occupational Health Management System to be developed and implemented in at least two distinct phases. Phase 1, (2011–2013 biennium) development of OHMS will include the following high-level requirements:6
A scalable architecture capable of leveraging existing L&I investments in a technology that will expand to meet the needs of the agency well into the future. A centralized Web-based portal case management system based upon L&I’s e- Government vision for Health Service Coordinators (HSCs) and COHE staff to effectively monitor and manage claim information. The ability to display claim-specific data replicated from LINIIS into the OHMS system without the delay of data exchanges. The ability for HSCs to place tickler(s) on a claim and to trigger reminder notices.
6 Washington State Department of Labor & Industries, COHE Expansion IT Project, Occupational Health Best Practices, Dec. 22, 2011.
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The ability for automated workflows with flags, and trigger(s) for use by internal and external users to create an efficient means of communication based on business rules and standards. The ability for system users to be able to administer and enter top priority scales (e.g., pain level and function level) based on business rules and requirements, including the initiation/monitor/assessment of the Functional Recovery Questionnaire (FRQ), as well as functionality for users to administer a variety of scales. The ability to create data stores for COHE data (e.g., ability to track alerts, triggers, work lists, record of employer data, etc.) Delivery of a standard set of predefined centralized reports that are currently being generated from data in the data warehouse. The ability to enter and modify employer data within the COHE’s employer database.
Phase 2 (2013–2015 biennium) development of OHMS will include adding new users and expanding functionality for Phase 1 users. High-level requirements associated with Phase 2 include the following:7
Expand functionality to include additional users, such as COHE advisors, participating providers and their office staff, ancillary providers treating injured workers, employers, L&I Employer Services staff, L&I Claims Managers, and Top Tier providers. Provide an integrated user experience throughout L&I systems, such as with the Claim and Account Center (CAC). Expand the ability to collect, track, and review data within the system related to treatment plans and actions taken on a claim. Expand reporting capabilities to include customized ad hoc reports for multiple users, including participating providers and L&I staff, based on the most current real-time data available, and internal reports to track when providers become eligible for L&I incentive programs. Generate updates to MIPS provider profiles based on eligibility for incentive programs (e.g., Top Tier) and the ability to calculate the incentives due to those providers. Create new document types in ORION that are viewable in the CAC, including the ability for employers to view HSC notes in the CAC separate from other medical notes and the ability for the L&I Claims Manager to view HSC notes in ORION as a new document type.
7 Washington State Department of Labor & Industries, COHE Expansion IT Project, Occupational Health Best Practices, Dec. 22, 2011.
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Expand the ability for users to add tickler(s) to the claim to alert the user when a claim needs to be revisited. Provide the ability to trigger MIPS payments based upon HSC activities and provider incentives based on treatment rules. Include the ability to manage an online centralized provider training repository that will allow L&I to more effectively monitor and track provider training activities. Provide the ability to notify employers when a Report of Accident (ROA) has been initiated by the COHE. Provide the ability to integrate with external systems like health information exchange (HIE) and electronic medical records (EMR) systems, so that their chart notes and records can be populated into L&I systems. Analyze aggregate claims data (metadata) and use business intelligence to identify injured workers at risk of disability. Compare actual provider practice with recommended workflow to identify when providers are using best practices or following L&I treatment guidelines. Offer robust user help options (may include online tutorials, wikis, or other tools).
2. Assumptions The COHE program is operating with the following assumptions:
The COHE program will meet the mandate of SSB5801 to provide 50% access to workers by 2013. Existing COHEs will continue to offer their opinions and feedback regarding COHE expansion and the refinement of occupational health best practices. Bidders will be interested in sponsoring a COHE and will respond to the RFP. The RFP will be easy for sponsoring organizations to understand. Incentives are a valid and effective way to change provider behavior. Providers stand to benefit from good COHE resources and infrastructure to achieve desired outcomes. New bidders will be able to attract providers to their COHE. All COHE providers will be part of the L&I Provider Network (with the exception of Emergency Departments that are exempt from the credentialing process at this time). Providers can be part of multiple best practice incentive programs/pilots. Successful COHEs require: Strong sponsoring organizational leadership Strong business, labor, and community involvement These elements are possible in multiple communities across Washington State
E. Challenges and Constraints
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The OHMS project and the COHE end users have a number of challenges that could impact the overall success of OHMS. Some of the issues have been included below.
There are relatively few vendors in the marketplace with applications capable of supporting all of L&I’s desired functionality for OHMS. At this time, the business requirements have been limited to high-level requirements. OHMS will likely need to utilize information from multiple L&I systems (MIPS, ORION, LINIIS, etc.) in order to deliver a seamless portal of operation to users.
In order for the program to be successful, the following constraints or dependencies will need to be addressed:
Ensure the timely assignment of a provider to a claim, since this is what identifies a claim as COHE (i.e., Network determines if provider is eligible). L&I staff will need to maintain accurate and timely enrollment in, and removal from, the Provider Network to more easily identify COHE and non-COHE claims. Potential issues may arise if incentives are not carefully managed in the OHMS system; for example, the benefit derived from not performing a “best practice” may outweigh its corresponding incentive for following that best practice. Self-insured pilot may show that it is not feasible for self-insured employers to be involved with COHE and may create new obstacles for OHMS in the future.
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IV. CURRENT SITUATION The following information details the current situation, or the “as-is” environment, for conducting operations within L&I and the processes that distinguish best practice providers from typical health care providers.
A. Organization Structure The graphic below represents the organizational structure at L&I that is in place to support the OHMS project, COHE expansion, best practice programs, and workers’ compensation reform efforts as a whole.
Judy Schurke (L&I Director)
Carole Washburn Deputy Director Beth Dupre (Assistant Director for Operations Insurance Services)
Janet Peterson Bob Lanouette (Project Director) Information Services (IS)
Diana Drylie Occupational Health Information Services (IS) Services Manager Staff (COHE & Top Tier Lead)
COHE COHE Noha Gindy COHE Contract COHE OHMS Business Lead Managers COHEs
B. Business Operations
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COHEs educate and hold practicing providers accountable for maintaining a high level of performance when treating injured/ill workers. The following are details describing the business operations as they pertain to COHE best practices and processes.
A COHE works with providers, employers, injured workers, and L&I to offer an infrastructure within the health care community to facilitate the implementation of occupational health best practices. COHE health care delivery is founded upon the following principles of operation.
1. Business Environment Workers’ compensation provides no-fault industrial insurance coverage for most employers and workers in Washington State. Benefits include medical treatment for workers who are injured in the course of their employment or who develop an occupational disease as a result of their work activities. Workers who are unable to work due to accepted conditions related to an industrial injury or occupational disease may be eligible for partial wage replacement benefits.
Workers’ compensation pays for:
Approved medical, hospital, and related services due to workplace injuries. Compensation for those who are temporarily unable to work full-time. Additional payments are being created under two separate worker’s compensation reform efforts: Washington Stay at Work (WSAW) and Structured Settlement Agreements (SSA).
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Employers must provide coverage for their employees. In return, employers normally cannot be sued for damages when a work-related injury or illness occurs.
Employees are eligible for industrial insurance benefits when a work-related injury or occupational illness occurs. When a work-related injury occurs, the employee seeks medical assistance. The injured worker and the provider fill out a Report of Accident (ROA) form, which initiates the insurance claim process within L&I. They are encouraged to use the FileFast Web portal, which allows them to fill out the form online, although they can submit a paper report. The health care provider provides treatments to the injured worker. The provider bills L&I for services rendered. L&I then pays the provider based on a standard fee schedule. L&I adjudicators review each claim for appropriate authorization, check chart notes, speak with provider offices, among other responsibilities, to ensure that the claims are legitimate.
In 2002, L&I established the first Center of Occupational Health and Education (COHE). L&I and its business and labor partners have collaborated in establishing COHEs to promote best practices and avoid preventable disability by focusing additional provider-based resources during the first 12 weeks following an injury. COHEs represent an innovative accountable care system focused on early stage claim development and intervention, and they are consistent with national health care reform efforts.
2. Business Needs The past two decades have been ones of both challenge and opportunity for workers’ compensation systems. Many states implemented reforms to try to stem rapidly rising costs or improve worker outcomes. In many cases, insurers were facing unanticipated losses and employers were calling for more reasonable and predictable costs, while the workers sought to ensure or maintain adequate benefits. Change, experimentation, and lessons learned have characterized the past 20 years.
Despite the upheaval and new directions taken, the fundamental goals of workers’ compensation systems have remained constant: (1) to provide prompt and adequate benefits to injured workers, (2) to ensure workers have timely access to quality medical care, (3) to accomplish the previous goals at reasonable costs to employers, (4) to operate an effective benefit delivery system, and (5) to finance all with well-functioning insurance mechanisms.
The Centers of Occupational Health and Education (COHEs) are placed in statute in SSB 5801. L&I must establish additional COHEs, with the goal of extending access to at least 50 percent of injured and ill workers by December 2013, and to all injured workers by December 2015. L&I must also develop additional best practices and incentives that span the entire period of recovery, not limited to the first 12 weeks.
COHEs are certified and de-certified based on the following criteria:
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Institutional leadership and geographic areas covered Occupational health leadership and education Mix of participating providers necessary to address the needs of workers Ability to meet the community’s needs in occupational health
Health care delivery organizations, including hospitals, affiliated clinics and providers, multi- specialty clinics, health maintenance organizations, and organized systems of network physicians may respond to L&I’s request for proposal, be selected, and then become a COHE.
In collaboration with L&I, providers must implement quality indicators of occupational health best practices. In addition, COHEs have a large set of benchmarked operational measures that they must meet. COHEs that do not consistently meet the benchmarks risk losing their contract.
L&I must develop and implement financial and nonfinancial incentives for COHE providers that are based on progressive and measureable gains in occupational health best practices and that are applicable throughout the worker’s care. In addition, L&I must develop electronic methods of tracking evidence-based quality measures to identify and improve outcomes for workers at risk of developing prolonged disability. These methods must also be used to provide systematic feedback to physicians regarding quality of care, to conduct appropriate objective evaluation of COHE progress, and to allow efficient coordination of services.
3. Business Finances The actual expenditures for COHE program are presented in the table below, not including the personnel costs in OHS’ parent unit Health Services Analysis (HSA).
Category 2003–2005 2005–2007 2007–2009 2009–2011 Personal Service Contracts: $803,966 $1,551,471 $1,811,041 $2,340,879 Goods and Services: $16,057 $52,205 $47,780 $8,372 Travel: $0 $7,470 $7,353 $1,135 Capital Outlays: $0 $785 $0 $215 Totals: $820,023 $1,611,931 $1,866,174 $2,350,601
4. Business Opportunities COHEs offer several business opportunities to customers. Some of the opportunities include:
Improved ability to treat injured and ill workers using occupational health best practices Increased access to care
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Better engagement between injured worker, employer, health care provider, and L&I Earlier return to work and ability to perform work-related activities sooner Lower cost of care
Based on an actuarial study of Fiscal Accident Year 2009 claims, L&I expects COHE claims to ultimately have Accident Fund costs 13.5 percent below average and Medical Aid Fund costs 8 percent below average. The assumption is that new COHEs will be able to achieve 50 percent of these savings, or 6.75 percent lower costs in the Accident Fund and 4.0 percent lower costs in the Medical Aid Fund. Therefore, overall accident year costs would be reduced. The following table shows the expected net COHE savings (savings – costs) over three years:
Fiscal Year Expected Savings 2013 $6,462,000 2014 $19,283,000 2015 $28,881,000 Total: $54,626,000
This represents substantial ongoing savings to the Workers’ Compensation Insurance Funds.
5. Business Metrics Business metrics are commonly used to measure or establish the baseline for the operation of something and use quantifiable evidence in support of its existence. In this particular case, the COHE business metrics mechanism will define the level at which the operation will be scored or evaluated, based upon observed performance. The measurement of such performance will help to determine the effectiveness of a COHE facility and its COHE participants (health care providers, employers, and injured/ill workers). Performance measures commonly will dictate areas of concern and can prompt corrective actions as beneficial to rectifying a persistent issue.
The information contained within the table8 below provides high-level business metric data and a statistical view of the State Workers’ Compensation Program.
Operating Environment FY 2010 FY2009 Employers Insured 163,000 168,000 Workers Covered 2,330,000 2,460,000 Premiums Assessed (Employers’ Portion) $1,080,000,000 $1,151,000,000 Premium Assessed (Workers’ Portion) $300,000,000 $312,000,000 Benefits Incurred $2,135,874,000 $2,348,838,000
8 Washington State Department of Labor & Industries, Workers' Compensation Services, 2010 Year in Review, January 2011.
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Claim Statistics FY 2010 FY2009 Number of Claims Filed 102,734 116,616 Number of Claims Accepted 86,184 102,440 Number of Claims Denied 12,703 14,964 Fatal Pensions Awarded 45 42 Total Permanent Disabilities Granted 1,162 1,612 Permanent Partial Disability Awards Granted 11,452 12,684 New Time Loss (Wage Replacement Claims) 22,604 26,295 Medical Only Claims Accepted 66,885 80,171 Retraining Plans Completed 1,229 1,142 Total Days Paid for Lost Work 8,121,263 7,926,800 Demographics of Accepted Claims FY 2010 FY2009 Male 66% 68% Female 34% 32% Average Age 38 38 Younger than 30 29% 32% Age 30 to 50 48% 48% Older than 50 22% 21%
C. Information Technology Environment L&I has a robust and structured information technology environment that supports its business operations. The information technology environment at L&I headquarters in Tumwater, Washington, is a mix of old, new, and everything in between. The central data store of L&I is the LINIIS system, serving as the agency’s main data repository. In addition to LINIIS are ORION, FileFast, and MIPS. ORION is L&I’s intranet-based claims management system, which includes claims imaging,, and MIPS is the medical bill payment system. LINIIS, ORION, CAC, and MIPS are the four fundamental systems that make L&I’s operations, as they are today. In support of these systems are numerous “bolt-on” applications and Web-based portals that help to augment operations not possible within LINIIS, ORION, and MIPS. L&I’s systems and support tools will be discussed in greater detail below.
1. Agency Technology Overview L&I is highly dependent on information technology for its primary business functions. The largest business systems, LINIIS and MIPS, are custom mainframe applications developed in ADABAS/NATURAL. Newer business applications rely on Web-based .NET and J2EE applications and Microsoft SQL Server. Emphasis is shifting away from building large monolithic systems to more flexible service-oriented architectures (SOAs).
L&I is currently seeking to limit the number of technologies they are invested in and, as a result, to simplify system maintenance and support. The goal is for most applications to be created as
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exposed services that are combined through the IBM Message Broker ESB and BPM toolsets, integrated through Web services, and presented through portlets hosted on the IBM WebSphere Portal Server.
With respect to the production database environment, L&I supports MS SQL databases and reporting applications. L&I has standardized on Microsoft SQL Server 2008. In addition, L&I operates ETL-based tools in support of its database functions.
In addition to the headquarters location in Tumwater, Washington, L&I offers services at 20 field office locations and two locations with L&I kiosks across Washington State. These offices are all interconnected through a statewide MPLS-based wide area network operated by the Consolidated Technology Services department. The network supports approximately 3,000 client computers running Microsoft’s Windows 7, with approximately 2,000 of those located in the headquarters building.
For the purpose of demonstration, the following graphic has been provided as an overview of L&I’s current technology.
As portrayed in the high-level graphic above, three external entities exist that will be the beneficiaries of OHMS: the employer, the injured/ill worker, and the health care provider of a COHE.
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2. Technology Architecture and Standards L&I has made the decision to migrate its systems currently hosted on the mainframe to a service- oriented architecture (SOA). SOA is a style of IT architecture in which functionality is created as distinct units (services), which are composed to implement business functions and processes. SOA encompasses a set of policies, practices, frameworks, and application infrastructure that allows for an application to possess the business functionality that is:9
Modular Distributable Clearly defined Swappable Sharable
SOA is unlike earlier IT architectures in that it seeks to create functionality (services) that directly maps to business capabilities; it places the emphasis on the definition of the services and their expression of the business rather than on technology. In SOA, services are built to represent internal business tasks and processes, while commoditized functions are introduced through externally provided services (software as a service, or “SaaS”) or vendor software. SOA allows for greater efficiency through re-use and agility. Re-use occurs when more than one business process is supported by the same service or services, and agility is a product of the relative ease through which services can be composed to provide new business capabilities.
SOA promises a technology environment that is not a stand-alone vertical “silo”—that is, data and functions are not trapped within application boundaries, reachable only through expensive and potentially intrusive integration projects. Rather, services can be consumed after construction without requiring foreknowledge on the part of the service builder, or requiring after-the-fact changes to the service. This capacity is a product of SOA defined through a set of independent, loosely coupled, yet “compose-able” services, but it comes at the cost of creating a complex services management problem.
IT architecture is fundamentally a set of principles and guidelines that are followed to produce a desired outcome. Some of the basic principles that define SOA are outlined in the next section; these principles, in turn, inform the required technology identified in the following section. (These principles are typically codified in a technical document such as an SOA Reference Architecture.)
3. Technology Direction L&I has developed an architecturally consistent set of technical standards that ensures the best alignment with agency goals and provides the most efficient use of agency resources, e.g.,
9 Washington State Department of Labor & Industries, Early Claims Technology SOA at L&I
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platforms, networks, tools, professional skills, etc. New systems are required to comply with these standards, and exceptions are considered only if the existing standard cannot meet the business or technical requirements of the project.
Solution projects are expected to use these services for the corresponding functionality:
Service Function Technology Implementation Outbound Correspondence EMC-Document Sciences xPression 3.0 Enterprise Reporting for SAP Business Objects Enterprise R2 Applications Document / Imaging Service IBM FileNet Image Manager IDM Web Services IBM FileNet Image Manager Content Services (SQL) IBM FileNet Content Services Libraries Enterprise Service Bus IBM WebSphere Message Broker Enterprise Message Bus IBM WebSphere MQ Enterprise Service Orchestration / IBM WebSphere Process Server Workflow Enterprise Application User WebSphere Portal Server Interface Enterprise Application Entitlements Shared Security in-house developed service Service Accounts Receivable (ARC) L&I Custom Accounts Receivable Service Data Exchange IBM WebSphere Partner Gateway Enterprise Business Rules Service IBM ILOG JRules Business Rules Server Enterprise Service IBM WebSphere Service Registry & Repository Registry/Repository Enterprise Service Management Oracle Enterprise Manager (Formerly AmberPoint Platform Management System) Java Application Platform IBM WebSphere Application Server Network Deployment Edition
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The solution architecture is defined in L&I’s Enterprise Architecture Standards document. The graphic below is representative of L&I’s dedication to establishing and maintaining SOA technology direction and standards of operation for OHMS.
The graphic above is reflective of the “to-be” architecture, where the yellow box (right) is a conceptual architectural view of how OHMS will interact with the existing architecture.
4. Agency Systems Overview The following graphic provides a high-level diagram of the L&I portfolio of applications. The OHMS application will be a new addition to this portfolio. Several other new applications are also planned.
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TIPS FileFast (Claim Initiation) (On‐line Initiation) Provider Credentialing
Point of Sale System (Pharm) Self‐Insured Systems
LINIIS MIPS (Claim information)
Electronic Billing System Learning Mgmt System Occupational Health Best Practice IT System
Orion Claim & Account Data Warehouse SAS/Hyperion (Imaging Repository) Center (Claim (L&I Reporting) Information) Notes 1. Green indicates a system that is coming on‐line or is new over the next 18 months. 2. Additional change: ICD‐10 for MIPS; CAC and the “My L&I” model; Data Warehouse and SAW/Settlements process.
A table has been provided as an overview of each of these systems and is available in APPENDIX D - Information Systems List.
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V. IMPACTS Most impacts documented here are associated with L&I Insurance Services. The COHE program has been in development for several years, including the current COHE program pilot sites. This section assesses the impacts associated with implementing the OHMS application. Many of the business impacts have already been realized due to the presence of ad hoc systems being utilized by existing COHEs.
OHMS will have a profound impact on users both internal and external to L&I. Understanding these impacts, both direct and indirect, is imperative for managing change. The anticipated impacts due to COHEs, Surgical Best Practice Pilot, Top Tier (providers), Emerging Best Practices, and the Medical Provider Network (MPN) and other projects are discussed below.
A. Business Impacts From a business standpoint, COHEs, Top Tier providers, and Occupational Health Best Practices (OHBP) will have favorable impacts on internal (L&I) users and external users (medical providers, COHE staff, injured workers, and employers). These impacts will require careful attention when administering change management procedures.
Those externally impacted will include:
COHE Staff
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Employers Self-Insured Employers Injured Workers Medical Providers
Those internally impacted may include:
Health Services Analysis Occupational Health Services Staff Employer Services (minimal) Claims Managers Office of the Medical Director Staff Field Services Staff
Impacts to these individuals and their operations include user interface (UI) changes with new fields and codes, process changes, and awareness.
B. Information Services COHEs, Top Tier providers, and Occupational Health Best Practices (OHBP) will be managed and administered using OHMS and other L&I systems (LINIIS, MIPS, ORION, etc.) to conduct their operations. OHMS specifically will utilize information currently collected from different systems used by L&I, and therefore will need to integrate with other existing systems to share information. These systems perform electronic imaging and management (ORION), billing and payment of a claim (MIPS), and housing of all collected information about the claim type/nature, injured worker’s occupation, employer, lost time, claims status, and the overall progress of the claim (LINIIS). This information today, to some extent, is made available through the Claim and Account Center (CAC) portal.
Impacted Applications ORION, MIPS, LINIIS, and the CAC portal will be impacted due to the operation of the current and future COHEs, Top Tier providers, and Occupational Health Best Practices (OHBP). These applications function in a tightly integrated fashion and rely upon each other to perform the claims management process. Impacts to these applications include:
Updates in LINIIS and Orion to accommodate new HSC information Updates to MIPS to accept new billing information from COHEs Updates to CAC to display new COHE information stored in LINIIS
Impacted Training Programs/Systems The L&I ORION, MIPS, and LINIIS systems and CAC portal training programs will be impacted. Impacted training IT programs/systems will require:
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Updating of training materials Planning coordination of training Conducting training Communicating about training Updating and documentation of processes Change management of transitions
Fundamentally, OHMS will, by design, offer back-end administrative processes and feature externally facing functionality through a one-stop access Web-based portal. Therefore, users, whether internal L&I staff or external users, must each receive adequate training to be able to access information and be knowledgeable about where to find exactly what they need to perform their responsibilities.
C. Project or Initiative Impacts There are a number of current projects or future initiatives underway within L&I this biennium that potentially impact or will be impacted by OHMS. These projects are identified below.
1. Medical Provider Network Project The Medical Provider Network (MPN) is outside the scope of this feasibility study; however, the MPN will have both direct and indirect impacts to COHE and the OHMS system. SSB 5801 directs L&I to create a statewide network for providers who treat injured workers. This legislation will return more workers to good health and help them get back on the job sooner after an injury by ensuring minimum standards for medical providers treating injured workers.
2. Electronic Correspondence Project L&I has an Administrative Efficiency project underway that includes electronic correspondence. This project includes only outbound communications from L&I to injured workers, employers, and other interested parties, and does not include internal secure communications needs.
3. Washington Stay at Work Project Stay at Work is a new financial incentive that encourages employers to bring their injured workers quickly and safely back to light-duty or transitional work by reimbursing them for a portion of their costs. Since the ability to help injured workers return to work is integral to the COHEs’ mission, there may be some relationship between projects. At this time it is unclear if there is a direct relationship between this project and OHMS.
4. Health Information Exchange (HIE) Initiative Long term, L&I will participate in the state HIE initiative and will be at least a recipient of
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electronic medical record (EMR) information from provider systems. This will allow for the automated population of a claim’s case file via both data and images. For OHMS, and inherently for COHEs, HIE will provide for appropriate access to injured worker medical records for claim initiation and tracking. In addition, HIE will make it possible for OHMS to share information stored inside the system to more accurately and effectively generate business triggers initiated via an EMR for more responsive and proactive claims management.
5. MY L&I L&I has an ongoing initiative titled “MY L&I” that incorporates the concepts of e-Government and provides a common look and feel to both internal- and external-facing Websites. This project could provide the basis for the desired Website design for OHMS.
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VI. ORGANIZATIONAL EFFECTS Customers and users of OHMS will benefit from this new system. The effects of the new system will impact users differently based on their purpose and dependency upon the functionality of OHMS. Some of the effects on various system stakeholders are discussed in more detail in the sections below.
A. COHEs Institutional and community COHEs stand to benefit from a unified common system. OHMS will provide COHEs with a one-stop portal for conducting COHE operations. Provided below are the anticipated organizational effects that OHMS will have on the COHEs.
1. Impact on Work Processes The COHE staff, the primary users of OHMS (in Phase 1), will be impacted through this new system. The COHEs in existence will continue their business operations but will have a new tool to use. They will need to adjust their business operations and workflows accordingly. New COHEs will need to not only learn the new system, but also implement the business processes, techniques, and practices that other COHEs have already developed. Impacts will include:
The COHE staff will have to learn the new system and tools. The COHE staff will adapt to the procedures associated with the new system. The HSC will be contacting employers, injured workers, and providers as they coordinate services using the new system. HSC staff will have access to more information that will enable them to analyze claim situations and how to best impact those situations. The new system will need to provide HSC’s with near real-time information to identify which claims need to be “touched” and how to best make use of their efforts when managing claims.
2. Training Needs The business program will require training on the new functions associated with overseeing and managing the COHE coordinated care approach to helping injured workers return to work. Since the business has been operating four pilot sites, they have already assimilated to most training needs. These include:
New contract management functions for establishing and overseeing COHE activities Accessibility to more program data to identify and implement new best practices L&I program staff to learn this new computer system The system to provide better visibility to COHE staff operations
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In general, if staff is well trained in the system, they will have better tools and information to more effectively administer and operate the COHE.
3. Job Content Through the COHE sites, L&I has established clearly defined roles and responsibilities for COHE staff. These roles and responsibilities are subject to change, but at the current moment, no significant changes are foreseen under OHMS. However, the tangible and intangible benefits of a new system are anticipated to have significant positive impacts on COHE operation, especially considering that the majority of sites are improvising with their current system operations and heavy reliance on personal judgment and information management skills.
4. Impact on Organizational Structure The new system will require additional L&I personnel that support and maintain the new system. However, if built to L&I standards, as planned, the degree of impact to existing infrastructure support and maintenance should be negligible. Information Services (IS) Help Desk and the Web Customer Support (Communications) entities will each need to support a new system and user group.
B. Health Services Analysis The Health Services Analysis (HSA) unit is the core business organization within L&I for the COHE program and the OHMS project. In general this organization (internal to L&I) will be affected the most by the OHMS project and resulting system in terms of system definition, management, and coordination. The resulting system will provide HSA staff, such as COHE contract managers, with an additional tool set for completing reports and fulfilling their daily responsibilities. In addition, HSA will benefit from the systems ability to reduce the necessity for additional staff as COHEs grow in number and expand operations. This benefit will be realized through the improved efficiency while utilizing OHMS for COHE management. Provided in the following subsections are the anticipated organizational effects that OHMS will have on HSA.
1. Impact on Work Processes The new system is expected to dramatically improve operations through increased efficiency in customer ease of access and customer engagement. Due to this improved efficiency, the new system will provide significant value to the work processes of the OHS staff.
2. Training Needs Due to the OHS unit’s anticipated dependence upon a new system, it is fair to assume that significant training on the system will be necessary. In addition, due to OHMS probable reliance and integration with existing L&I systems, some training will be required of the Medical
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Program Specialists to ensure adequate understanding of interdependencies that will exist between each system.
3. Job Content In terms of OHS job content, the new system will have several beneficial impacts and thus simplify many jobs. OHMS capabilities to help manage COHE services will inherently make more time available to OHS staff as they manage other responsibilities.
OHS staff will learn a new system and support external customers using the system. OHS staff will act as the subject matter experts and testers throughout the development project. They will have significant roles in the design, development, testing, and implementation of the new system. Generally one Full Time Equivalent (FTE) or more will be deployed to project-related activities. OHS will need to oversee the use of the system configurations such as best practice scales, business rules, etc. OHS business operations will change with the use of a new system. This will impact their workflow and standard procedures. Contract managers will have new tools to learn and new processes will have to be created to support the changes to the business program’s operations. The interaction with COHE staffs will change as a new system is implemented and used. New business processes will form as both the HSA and the COHE staff begin to use the system.
4. Impact on Organizational Structure OHS plans to increase the number of resources in the current organization in order to accommodate the additional workload associated with COHE program. No other changes are anticipated at this time.
C. Customers The list of potential customers of the COHE program and the OHMS project has been identified earlier in this document. The focus on this section is for the HSCs residing at the COHEs.
1. Impact on Work Processes The impact on customers, with regard to work processes, will be minimal if any impact exists at all. The most plausible work processes impacted will be to what extent the customer will be involved in feeding information into the system. A majority of the customer’s information will have already been input into OHMS due to the system’s dependence upon existing L&I systems that already collect and store claim information. The average customer using the new system will simply need to create and manage his/her account login information.
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2. Training Needs The customers of OHMS will require initial training on the new software. It will not require any extensive training when inquiring for information about a specific claim, given that it will utilize existing L&I applications. The tools available through the OHMS system will be rudimentary and can be easily navigated with minimal training.
3. Job Content Customers will go about their work responsibilities the same as they would without a new system in place but with the aid of the new tools. The effects on their job content will be minimal, if at all, and will only improve their current capabilities. The OHMS system will be designed to help providers and L&I better manage claims, and through improvements to these processes the customers (employers and their injured employees) stand to benefit. Benefits to external customers will include improved ease of access and increased engagement throughout the claims process.
4. Impact on Organizational Structure The new system will have minimal impact on the organizational structure of customers (employers and employees), if any at all. The new system will simply offer customers an L&I branded “look and feel” dashboard of tools that will allow for improved access to claims information and will increase the engagement levels for both injured workers and the workers’ employers.
D. Information Services Information Services (IS) staff will be impacted with the new system in terms of development, operations, and support. Provided below is the anticipated organizational effects OHMS will have on IS.
1. Impact on Work Processes The project will follow the L&I standards and use existing infrastructure to support, integrate, and extend the system to business users statewide. Impacts include:
Potentially a new set of servers will need to be installed and maintained. A new database needs to be designed and implemented. Additional traffic on the L&I and state telecommunications networks will occur. Additional disaster recovery planning and business continuity planning and configuration will be required. Potentially new software products may need to be procured and used in the overall infrastructure.
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New Service Level Agreements will need to be developed to support COHE business operations. Security of the systems will need to be planned and configured. SOA Infrastructure Services will need to be planned and configured to support the new system. These include:
Data Integration Services Data Exchange Services Security Services Reporting Services Business Rules Services Business Intelligence Services Analytic Services Web-Portal Services Data Warehouse Services
Data management staff will be impacted by implementing a new relational database. Operations will be impacted as a new system that requires operational integration into existing operation processes. The system should contribute new services to the agency’s portfolio of SOA services; new data services, analytics, and contract management services are all potential candidates.
The proposed information system contains many points of integration requiring not only construction, but also significant configuration of SOA services. However, L&I will receive many benefits by taking this approach as it will:
Improve the maintainability of the system Increase the flexibility of the system Leverage already existing resources purchased by L&I
2. Training Needs Existing or new Information Services resources will have to be trained on both OHMS as an application and the underlying supporting software or tool set(s).
3. Job Content New application services, development tools, and/or business intelligence software will require new Information Services resources and/or training of existing resources to meet the development and maintenance requirements.
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This will be a significant system development project requiring sufficient project management, system management support, and business involvement. The system will require substantial input from L&I solution architects to configure SOA services that the system will need to use. Substantial integration work with L&I systems, databases, and portals will be required. The SOA services should provide this support. However changes to existing systems, databases, and portals are likely because of the high degree of integration requirements. The L&I governance processes will have to function well to deal with the implementation of a new system. There will likely be variances and exceptions that will need to be considered. Existing applications and support staff will need to be available for consultation as the project is developed and implemented. This may cause stress as they have competing functional responsibilities. Application Development management will need to oversee the project. This will be under the Office of Financial Management/Office of the Chief Information Officer (OCIO) oversight. The project will report regularly to the OCIO and Technology Services Board. This will require substantial effort to provide ongoing project report services to stakeholders. The appropriate software development environment will need to be created that will allow the design, development, and testing of a new system. The necessary tools will need to be procured and implemented to support the project team.
4. Impact on Organizational Structure The Information Services Division will have to support the new OHMS application and services. This may impact how they are organized for maintenance, but that be determined later in the project.
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VII. MAJOR ALTERNATIVES CONSIDERED To identify and evaluate solution alternatives for OHMS, information was gathered from OHS, application vendors, and Information Services (IS) staff. This process originally identified six alternatives. From these six, further evaluation determined that two of the alternatives were considered nonviable.
The topics bulleted below are discussed in the remainder of this section. For ease of reference, some of the content of those topics addressing alternative descriptions has purposely been duplicated when it is identical to the content of one or more of the other alternatives.
Strategic Requirements. Explains the minimum or key business and technical requirements that must be met by an alternative in order to be considered a potentially viable solution.
Alternative 1 – Internal Development. Describes this alternative and details the application, hardware, software, network, and database components, as well as access, security, interface, support, and resource considerations.
Alternative 2 – Internal Development/EMR Integration. Describes this alternative, which is based on Alternative 1 but includes interfaces to some EMR systems.
Alternative 3 – External Product Integrator. Describes this hosted application service alternative and outlines the pros, cons, and approach to implementation.
Alternative 4 – External Product Integrator/EMR Integration. Describes this alternative, which is based on Alternative 3 but includes interfaces to some EMR systems.
Other Alternatives Considered. Explains the other alternatives that were considered and why they were considered nonviable. It is assumed that the desired functionality of Alternatives 1 and 3 are the same but with the understanding that the hosted application service will configurable rather than customizable. The EMR Integration option for both baseline alternatives expands the functionality significantly.
A. Strategic Requirements A viable alternative must meet the strategic or core requirements identified by L&I, as listed below in terms of general, functional, technical, schedule, and budget. This is a preliminary list of strategic requirements, and additional items will be identified as the migration or implementation plan is developed.
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1. General Requirements Must meet the project objectives and timelines identified in the Implementation of SSB5801 – Project Charter. Must be compatible with overall long-term business and information technology strategies and directions.
2. Functional Requirements Must be scalable and flexible to change as the business evolves. Must meet agreed upon scope definitions for Phase 1 and Phase 2. Ideally the OHMS system will be available to users 24 hours a day, 7 days a week, with near 100 percent uptime (actual requirements are still being determined).
3. Technical Requirements Must meet the L&I Technical Standards Profile. Must be compatible with the agency’s and state’s technology architecture. Must be Web-based. Must meet the state’s and agency’s security and privacy standards. Must have robust reporting, data analytics, and general query capabilities. Must meet UCD/Ux/Adaptive Design standards
4. Schedule Requirements Must meet the Phase 1 and Phase 2 schedule requirements for completion by FY 2015:
Phase 1 (2011–2013 biennium) will focus on COHE Staff as the key users. Phase 2 (2013–2015 biennium) includes expanding to additional users and additional workflow.
Please reference Section II of this document for a complete breakdown of Phase 1 and Phase 2 requirements.
5. Budget Requirements Project budget must fit within the existing FY2011–2013 OHMS budget estimates.
B. Alternative 1 – Internal Development Alternative 1 proposes that L&I develop and deploy the OHMS application and all necessary interfaces and components with a mix of L&I and contractor staff, using the existing agency
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software and hardware infrastructure. L&I would continue to define requirements and design, construct, test, and deploy OHMS to meet the business needs and requirements of COHE and OHS operations. L&I staff and outside contractor staff would construct the application following the L&I application development guidelines, and it would be built upon the L&I technical architecture.
1. Description of Alternative The construction of a solution developed in-house would be led by Information Services and would follow internal methodologies and technical architecture. The project would be staffed and led by L&I employees and supplemented with contractor staff. L&I would be the “general contractor” for the overall project. The scope of this alternative includes:
OHMS system managed and developed by L&I IS staff External contractors brought in on a skill basis as needed System developed using L&I internal methodologies and processes following ECS development pattern L&I maintenance and support of system after development into the future Development of the system components identified in APPENDIX F - Work Breakdown Structure Development of a Web-based application component to support the COHEs Development of best practice application and reporting components Customization of existing L&I claim front-end processing components in ECS to meet OHMS requirements Development of the changes to existing L&I systems (LINIIS and MIPS) Rework of the existing security framework Development or customization of analytical tools required to support HSA for program management and oversight.
The alternative does not include the following components:
Development of new forms in high-volume EMR/HIE systems Developments of an electronic form submission interface to EMR/HIE systems Any other integration with EMR systems
The project is expected to follow a traditional system development methodology and L&I project management practices and schedule as follows:
Project Management Project Initiation Project Planning Project Execution
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Project Closeout Requirements Definition. General Design (for both phases) Phase 1 (June 2012–June 2013) Detailed design for Phase 1 Development of Phase 1 components Testing of Phase 1 components Implement of Phase 1 components
Phase 2 (July 2013–July 2015) Detailed design for Phase 2 Development of Phase 2 components Testing of Phase 2 components Implement of Phase 2 components
2. Assumptions The following assumptions have been identified for this alternative:
L&I IS Staff have the capacity and the skills to manage and develop the system within desired timeframes. External staff with requisite skills are available to supplement L&I IS staff. OHMS would be built following the L&I SOA framework. Development occurs following the identified two project phases.
3. Advantages This alternative has a number of advantages for L&I. These include:
More predictable system development approach for agency Tighter integration with existing L&I systems Extends the L&I IS SOA library Extends L&I IS staff skill sets Business does not have to change; application is customized to business Lower overall risk
4. Disadvantages This alternative also has a number of disadvantages for L&I. These include:
Does not take advantage of existing features included with emerging vendor software Does not take advantage of health care marketplace evolution
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Locks L&I into the system support business for non-L&I users, at least for the COHE application segments Risk not shared with any vendor Implementation timeline is extremely aggressive; will likely take 6 months longer to implement Phase 1 While a custom build will meet the business requirements, custom build tends to reduce future agility and flexibility to make changes
5. Application Components The L&I OHMS application components will be developed using L&I’s standard, which is MS Visual Studio .NET and related tools in the .NET Framework. This will support development using L&I’s standard for the MS programming language (Visual Basic). The application would be built upon an MS SQL Server relational database foundation. It would be constructed using server-side Web application techniques that would enable the business user to access the application through an Internet browser.
6. Hardware/Software/Network Components Multi-tier platform architecture is recommended since components of the OHMS application will be available via the Internet. A multitier architecture uses more than one physical platform to operate and deliver an application. It provides independence between the presentation, business logic, and database levels of the application, which improves application flexibility and maintenance. In addition, a multitier architecture provides the opportunity for robust security measures that may be required.
The architecture proposed for this application includes a combined application and Web server, as well as a database server. The following hardware configurations are recommended:
Application Server Dual Intel-based processors with MS Windows operating systems » Rack-mountable servers » Redundant Array of Independent Disks (RAID) 5 with space to meet needs Database Server (MS SQL Server) Dual Intel-based processors with MS Windows operating systems » RAID 5 Web Server (Internet Information Services) » Dual Intel-based processors with Windows operating system » MS Internet Information Services (IIS) would be required Client Software (MS Operating Systems)
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Client machines accessing the application will require Web browser software. Network L&I will use the existing network that operates over the DES enterprise telecommunications backbone. Workstations would connect to the Web server through the virtual network (via an Internet Protocol address) and access the application to service Web requests.
7. Database Components The application’s production database would be developed and implemented using MS SQL Server. The database would be relational, follow state relational database standards, and comply with structured query language standards. The production database would contain all business data supporting COHE administration.
OHMS stakeholders have expressed the desire for OHMS to be capable of populating a data mart for robust reporting capabilities. The data mart would support COHE and HSC data, as well as supplemental data acquired from outside sources. The data mart would be built using an MS SQL Server database and would require additional data management and reporting tools.
8. User Access User access considerations are described below.
All application users would access OHMS via the Internet using browser software. A public Website (Access Washington, the L&I My L&I Website, etc.) would provide users with a link to the application. Web/application and database servers would receive and respond to user requests for application user interfaces (Web pages), functions, and data. The Washington State Government Network (SGN) would carry requests for data, and responses to those requests, between state government applications and systems, including the DES systems.
9. Security OHMS will follow L&I and state security standards for Web-based applications. The DIS Fortress server currently verifies user IDs and passwords for application users, encrypts data between Web browser client machines and the application, and provides additional security measures.
10. Interfaces Interface considerations are described below.
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LINIIS, for historical data FileFast/ECS, for potential claim characterization and prioritization MIPS, for billing CAC, link only Provider Systems, for optional EMR interface
11. Maintenance/Support Arrangements OHMS would be operated and monitored by DES within its dedicated server environment. All hardware required, including components for Internet and other network access such as routers and hubs, would be provided by DES. The following system-level maintenance and support services will be required for this application:
Support of the hardware, operating system, database management system, Internet server software, and other system resources in a dedicated server environment. This support includes 24/7 monitoring and response to system issues that may occur, data and system backup and recovery services, and maintenance and periodic upgrades to operating system and database software. Support of the connection to the Internet and the SGN. In addition, depending on final application design, connection may also be required to other state network resources, including the Intergovernmental Network (IGN), the state’s Internet, and L&I’s intranet.
In addition, OHMS will require periodic adjustments and upgrades to the application. These changes will include new features and functions to meet the changing business needs of COHE administration, the needs of OHMS customers, and policy changes adopted by the Washington State Legislature or L&I or HSA management. It is expected OHMS will hire consultant staff to provide this support.
12. Skill Sets The following skill sets will be required of OHMS and/or Information Services staff:
Managing information technology projects, including schedules, budgets, scope, and deliverables Procuring the services of contractors to develop OHMS, including developing an RFP and managing the RFP process if applicable Managing vendor contracts for system development and maintenance services Conducting user acceptance testing to ensure the application meets business needs and requirements Leading business change management activities, including establishing workflow and document management within the business operations cycle
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Developing and monitoring service level agreements with DES for hardware, network, and software support services
The following skill sets will be required of vendor staff hired to design and develop OHMS:
Managing information technology projects at a detailed, day-to-day level, including schedules, budgets, staff, scope, and deliverables Performing system analysis and design activities Constructing multitier application architecture and components Developing Web-based server-side applications L&I Programming using L&I Standard development tools (MS Visual Studio .NET, .NET Framework, SQL Server, and related tools) Designing and administering the database component using MS SQL Server Conducting application testing, including unit and system/integration testing Developing system and user documentation Developing and delivering user training
13. Training OHMS management may require training in managing information technology projects and procuring and managing the technical resources required to complete this project.
OHMS would provide application functions, features, and data that are more complete and detailed than those available in the current applications. Consequently, training will be required for the staff expected to use the OHMS application.
14. Resources The resources for Alternative 1 are discussed below in the context of development staff roles and responsibilities and overall implementation cost.
The staff resources that L&I would need to invest in this alternative include project governance and management resources, as well as subject matter experts (SMEs) to assist with the development of the application to support OHMS’s requirements. In addition, L&I would need to provide technical members of the development team, as described below.
Designer/Developers The designer/developers report to the development project manager. Responsibilities include: » Analyzing business processes and functional requirements and preparing appropriate documentation to communicate and validate the information
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» Participating on project teams with business users, other programmers, and analysts » Assisting in problem definition and problem resolution activities » Developing logical and physical models and designs of the application and its supporting database and transforming those models and designs into working application components » Programming application components, user interfaces, and automated functions using appropriate development tools, including Visual Studio .NET, Visual Basic, Active Server Pages, .NET, HTML, and XML » Preparing and conducting presentations of various work products » Performing quality assurance and testing tasks, developing and executing test scripts and/or test data, documenting test results, and maintaining problem logs » Maintaining and reporting status on assigned tasks on a regular basis Training/Documentation Specialist The training/documentation specialist reports to the development project manager. Responsibilities include the following: » Gaining a clear understanding of OHMS, its data, and functionality » Developing user-oriented documentation for use by professional staff, consumers, and providers » Developing and delivering a training course for professional staff » Providing a “train the trainer” session for administrative staff at OHMS headquarters so that new field staff can be trained when turnover occurs Post-Implementation Specialist The post-implementation specialist reports to the development project manager. Responsibilities include the following: » Responding to questions regarding application functionality as OHMS is implemented and piloted » Monitoring the application’s performance and stability and making appropriate adjustments as needed to respond to any system issues during the pilot period » Coordinating with the Information Services staff to respond to any system support issues that occur during the pilot period
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The methodology used to estimate the size of this effort involved identifying the key business functions and conducting a high-level estimating process. Each function was evaluated against complexity, and a standard set of metrics following industry standards for MS .NET development, which includes analysis, design, construction, testing, and implementation.
C. Alternative 2 – Internal Development/EMR Integration Alternative 2 proposes that L&I develop and deploy the OHMS application and all necessary interfaces and components with a mix of L&I and contractor staff, using the existing agency software and hardware infrastructure. L&I would continue to define requirements and design, construct, test, and deploy OHMS to meet the business needs and requirements of COHE and OHS operations. L&I staff and outside contractor staff would construct the application following the L&I application development guidelines, and it would be built upon the L&I technical architecture.
1. Description of Alternative The construction of a solution developed in-house would be led by Information Services and would follow internal methodologies and technical architecture. The project would be staffed and led by L&I employees and supplemented with contractor staff. L&I would be the “general contractor” for the overall project. The scope of this alternative includes:
Same process as above (Alternative 1) except for the development of interfaces with some EMR systems in later phase(s). L&I pays for EMR vendors to develop L&I forms and exchange using defined interface standards. Utilizes state HIE hub once it becomes available (probably after OHMS is developed) for additional EMR content (chart notes, etc.).
The project is expected to follow a traditional system development methodology and project management practices and schedule as follows:
Project Management Project Inititation Project Planning Project Execution Project Closeout Requirements Definition General Design (for both phases) Phase 1 (June 2012–June 2013) Detailed design for Phase 1 Development of Phase 1 components Testing of Phase 1 components
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Implement of Phase 1 components Phase 2 (July 2013–July 2015) Detailed design for Phase 2 Development of Phase 2 components Testing of Phase 2 components Implement of Phase 2 components Phase 2 EMR (July 2013–July 2015) Detailed design for Phase 2 EMR Development of Phase 2 EMR components Testing of Phase 2 EMR components Implement of Phase 2 EMR components
2. Assumptions The following assumptions have been identified for this alternative:
EMR vendors are willing to develop required forms and interfaces. L&I can develop new services to receive EMR information. Electronic data submission rather than form or paper submission is a long-term strategy for L&I.
3. Advantages This alternative has a number of advantages for L&I. These include:
Same as Internal Development Improved timeliness of information with EMR producing forms Better system integration and productivity for HSCs Improved business process for providers; integrated registration process rather than add on
4. Disadvantages This alternative also has a number of disadvantages for L&I. These include:
Same as Internal Development Has impact within L&I and information systems beyond scope of OHMS for form and data submission L&I does not have staff that have deep understanding of EMR systems
D. Alternative 3 – External Product Integrator Alternative 3 is focused on purchasing one or more existing applications from an external vendor and configuring and customizing the applications to meet the unique business needs and
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requirements of OHMS. As with Alternative 1 – Internal Development, the resulting application(s) would be operated by L&I. However, application support and upgrades would be provided by the vendor for Alternative 3.
This alternative requires procurement of a commercial software application(s), as well as system integration and implementation services. The competitive procurement would follow the state’s guidelines for managing this type of effort, including the state’s standard contract terms and conditions and regular status reporting and independent quality assurance services.
The health care case management and decision support application marketplace is being reviewed, and the key information was collected. Detailed profiles for selected vendors included in the survey are provided in APPENDIX H – Vendor Survey, but the initial review identified the following potential vendors:
Vendor Solutions Comments ZeOmega • Jiva is their integrated • Jiva is HIPAA and ICD- (www.ZeOmega.com) care management 10CM/PCS compliant. solution. • Built to be compliant and • A leading provider of • Maya is their Web- adaptable to a SOA Web-enabled and based platform that Architecture. rules-driven workflow automates the • Supports vacation software for integrated physician review reallocation of work care management process. queues. • Established in 2001 • Kriya (based on • Use cases available on • Approximately 250 conversation with Website. employees vendor, this solution has now been integrated with Jiva).
WellCentive, Inc. • WellCentive • WellCentive’s focus on (www.wellcentive.com) Advanced the HIE market makes them experts in the EMR • Clinical and business interfacing arena. intelligence solution • WellCentive has lots of provider experience interfacing • Established in 2005 with most of the major • Approximately 50 players in the EMR/EHR employees world, including Epic & Cerner. • Co-founder of WellCentive (Mr. Mason Beard) is also the VP of Product Development
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Vendor Solutions Comments and has his BS in Occupational Therapy. MEDecision • Alineo is a health (www.medecision.com) management platform • Leading provider of for delivering collaborative health outcome-driven case, management solutions disease, utilization, • Established in 1988 and behavioral health • Approximately 250 management. employees • Nexalign applies evidence-based analytics that identify treatment opportunities and recommend clinical best practices. • InFrame is a set of tools to facilitate the health and performance management processes for physicians and accountable care organizations (ACOs). Covisint • Covisint • A comprehensive health (www.covisint.com) ExchangeLink™ information sharing Platform platform to connect regional exchanges, physicians, providers, payers/health plans, and national organizations. • An “application” vendor- neutral exchange to aggregate and exchange data and access systems- all through AppCloud®, a single, secure marketplace for clinical and administrative applications.
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1. Description of Alternative OHMS would result from the configuration and customization of acquired applications from a vendor to meet the requirements identified by L&I. This effort would be led and staffed by the external system integrator and the L&I project/contracts manager. The application vendor(s) and system integrator would work closely with Information Services, OHS staff, and SMEs throughout the implementation and integration effort. The external system integrator would be the “general contractor” for the project and L&I would manage via a contract. The scope of this alternative includes:
Contracts with a system integrator to install, host, and operate an application vendor’s care management or care coordination system. OHMS will be hosted by application product vendor and operate via the “cloud” but will integrate or share information with L&I. OHMS would share information with L&I systems via a number of interfaces that are developed by a team of L&I and vendor staff. Development of a Request for Proposal (RFP) to select a technology business partner to provide the core OHMS applications. Customization and/or development of the system components identified in APPENDIX F - Work Breakdown Structure. Customization and implementation of a Web-based application component to support the all prospective users. Development of best practice application and reporting components. Customization of existing L&I claim front-end processing components in ECS to meet OHMS requirements. Development of the changes to existing L&I systems (LINIIS and MIPS). Development or customization of analytical tools required to support HSA for program management and oversight.
The project is expected to follow a tradition system development methodology and schedule as follows:
Request for Proposal Development Vendor Selection and Contracting Requirements Definition Prototype and Gap Analysis (for both phases) Phase 1 (October 2012–June 2013) Detailed design for Phase 1 Development of Phase 1 components Testing of Phase 1 components Implementation of Phase 1 components Phase 2 (July 2013–July 2015)
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Detailed design for Phase 2 Development of Phase 2 components Testing of Phase 2 components Implementation of Phase 2 components
2. Assumptions The following assumptions have been identified for this alternative:
Application vendors would participate via another system integrator. There are viable vendors in the marketplace that can meet OHMS requirements with some customization The vendors have the capacity to complete project within L&I timeframes. The cost of the system would be comparable to internal development.
3. Advantages This alternative has a number of advantages for L&I. These include:
Core application system demonstrable at start, have vision confirmed. Agency buys a service, not a system (capital cost versus recurring expenditure). Takes advantage of emerging vendor marketplace. Lowers overall L&I operating costs (assumed). Provides a platform that will evolve over time with multiple clients. Vendor has flexibility to manage human resources based on need. Vendor has experience with similar clients. Shared risk between L&I and system integrator. Faster speed of initial implementation. Lower initial cost and probably scaled to number of users. Vendor can leverage system assets and build system quickly.
4. Disadvantages This alternative also has a number of disadvantages for L&I. These include:
Strategy is a departure for agency. Vendor market is unknown to L&I. Vendors are not worker’s compensation specific. Business may have to conform to application in some areas. Software release schedule is in control of vendor. Potential for proprietary technology is incompatible with L&I direction. Application may be too rigid to meet user needs. May require new approach for L&I procurement.
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5. Application Components The application components would depend upon the architecture of the selected application.. The application should be built upon an MS SQL Server relational database foundation. It should be constructed using server-side Web application techniques that enable the business user to access the application through a browser.
6. Hardware/Software/Network Components The hardware architecture would depend upon the technology architecture necessary to support the selected application, but it is expected it would be required to be consistent with the existing and planned L&I technical architecture.
7. Database Components The application’s production database should be constructed and implemented using a relational database (MS SQL Server is preferred). The database would follow state database standards and comply with structured query language standards. The production database would contain all business data supporting COHE operations and administration.
8. User Access User access considerations are described below.
All application users would access OHMS via the Internet, using browser software. A public Website (Access Washington, the L&I Website, etc.) provides users with a link to the application. Dedicated Web/application and database servers would receive and respond to user requests for application user interfaces (Web pages), functions, and data. The SGN would carry requests for data, and responses to those requests, between state government applications and systems, including the DES systems.
9. Security OHMS will follow L&I and state security standards for Web-based applications. The DES Fortress server currently verifies user IDs and passwords for application users, encrypts data between Web browser client machines and the application, and provides additional security measures.
10. Interfaces The interface considerations are the same as those described above in Alternative 1.
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11. Provider Systems Maintenance/Support Arrangements OHMS would be operated and monitored by DES or L&I within its dedicated server environment. All hardware required, including components for Internet and other network access such as routers and hubs, would be provided by DES or L&I.
The following system-level maintenance and support services will be required for this application:
Support of the hardware, operating system, database management system, Internet server software, and other system resources in a dedicated server environment. This support includes 24/7 monitoring and response to system issues that may occur, data and system backup and recovery services, and maintenance and periodic upgrades to operating system and database software. Support of the connection to the Internet and the SGN. In addition, depending on application design, connection may also be required to other state network resources, including the IGN, the state’s Internet, and L&I’s intranet.
It is expected L&I will develop a service level agreement with Information Services that meets the system-level support requirements. This will specify the performance requirements of the systems, including response times, bug/fix response times, and system up time, as well as planned outages.
In addition, L&I will require periodic adjustments and upgrades to the application. These changes will include new features and functions to meet the changing business needs of administration, the needs of L&I customers, and policy changes adopted by the Washington State Legislature, L&I, or HSA management. It is expected these services will be provided by the application vendor for a cost to be negotiated.
The implementation project should include a knowledge transfer of the technical architecture and design, development, and support of the application to L&I technical staff.
L&I will expect the vendor to provide a warranty service period and to propose ongoing support and maintenance services to complement L&I operations. L&I will likely select a combination of L&I support and vendor support for maintaining the application.
All vendors contacted during the production of this report indicated they are willing to provide any level of support L&I is willing to fund.
12. Skill Sets Similar skill sets will be required of COHE, HSA, and/or Information Services staff for this alternative as those identified in Alternative 1.
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13. Training L&I HSA management will likely supply a “business area” program manager. However, the IT Project Manager for OHMS would maintain responsibility for managing the technical components of the project and procuring and managing technical resources.
The new OHMS application will provide application functions, features, and data that are more complete and detailed than those available in the current applications. Consequently, training will be required for the staff expected to use the application.
14. Resources The resources for Alternative 3 are discussed below in the context of staff required for vendor package modification and implementation, as well as overall implementation costs.
Staff The staff resources that L&I would need to invest in this alternative include project governance and management resources and SMEs to assist with the modification and integration of the application into L&I’s business environment. In addition, L&I will need to provide sufficient personnel to support the in-house operation of the vendor application.
Cost To obtain cost estimates, potential vendors are being identified and contacted via telephone. The vendors are being interviewed and asked to provide high-level planning costs based upon their implementation experience with similar scopes of work in other states.
E. Alternative 4 – External Product Integrator/EMR Integration Alternative 4 is focused on establishing a contract for applications and hosting support from an external vendor and configuring and customizing the applications to meet the unique business needs and requirements of OHMS, similar to Alternative 3. However, the resulting COHE application(s) may be operated by the vendor and be interfaced to the L&I technical environment. Application support and upgrades would be provided by the vendor. EMR integration would be included in this alternative since the applications in this arena are based on an HIE hub.
This alternative requires the procurement and licensing of a commercial software application, as well as system integration and implementation services. The competitive procurement would follow the state’s guidelines for managing this type of effort, including the state’s standard contract terms and conditions and regular status reporting and independent quality assurance services.
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The health care case management and decision support application marketplace is being reviewed, and the key information gathered so far is summarized in the table provided in APPENDIX H – Vendor Survey.
1. Description of Alternative OHMS would result from the configuration and customization of licensed and hosted application(s) from a vendor to meet the requirements identified by L&I. This effort would be led and staffed by the L&I project/contracts manager. The application vendor(s) would work closely with Information Services and OHS staff and SMEs throughout the implementation and integration effort. L&I would be the “general contractor” for the project and would manage via a contract. The scope of this alternative includes:
Contracts with a system integrator would be obtained to install and operate an application vendor’s care management or coordination system. OHMS may be hosted by application product vendor and operate via the “cloud.” Vendor product would closely integrate with health care provider major EMR systems. OHMS would share information with L&I systems via a number of interfaces that are developed by a team of L&I and vendor staff. L&I interface to EMR systems for form submission would be the same as in Internal Development/EMR Integration. Development of a RFP to select a technology business partner to provide and operate the core OHMS applications. Customization and/or development of the system components identified in APPENDIX F - Work Breakdown Structure. Customization and implementation of a Web-based application component to support the COHEs. Development of best practice application and reporting components. Development of the changes to existing L&I systems (LINIIS and MIPS). Development of interfaces between the new application and L&I systems. Development or customization of analytical tools required to support HSA for program management and oversight. Development or configuration of L&I forms in high-volume EMR systems. Development or configuration of electronic submission interface to EMR systems.
The project is expected to follow a traditional system development methodology and schedule as provided below. This also assumes that the Phase 2 components and be implemented in parallel with the EMR interface(s) and do not affect the general schedule.
RFP Development Vendor Selection
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Requirements Definition Service Level Agreement Prototype and Gap Analysis (for both phases) Phase 1 (October 2012–June 2013) Configuration of Phase 1 components Testing of Phase 1 components Implementation of Phase 1 components Phase 2 (July 2013–July 2015) Configuration and/or development of Phase 2 components Testing of Phase 2 components Implementation of Phase 2 components Phase 2 EMR (July 2013–July 2015) Configuration and/or development of Phase 2 EMR components Testing of Phase 2 EMR components Implementation of Phase 2 EMR components
2. Assumptions The following assumptions have been identified for this alternative:
Application vendor would participate via another system integrator. Application vendor systems currently have interfaces with some EMR systems. There are viable vendors in the marketplace that can meet OHMS requirements with some customization. The vendors have the capacity to complete project within L&I timeframes. The cost of the system would be comparable to Internal Development/EMR Integration alternative.
3. Advantages This alternative has a number of advantages for L&I. These include:
Same as External Product Integrator Better application view for COHEs and HSC Assumed access and improvement for providers
4. Disadvantages This alternative also has a number of disadvantages for L&I. These include:
Same as External Product Integrator
F. Other Alternatives Considered
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Two other alternatives were examined and dismissed as not being viable for OHMS. The alternatives are described below, with the reasons they were considered nonviable.
1. Manual or No Centralized System Support This is the alternative of manual or no statewide support for the current and future COHEs. Each COHE would be responsible for their manual processes and technology support. There would be no statewide system. This alternative does not meet the requirements of SSB 5801 and was therefore rejected as an alternative.
2. Extend Existing L&I Application The basis of this alternative is to extend the ECS, CAC, or ORION systems and their functionality to support the COHE and HSA requirements. None of these systems, with the exception of CAC, was designed to support external users, and therefore none meets the functional requirements. Furthermore, L&I at this point has not expressed an interest in extending these applications. Thus, this alternative was rejected for those reasons.
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VIII. ALTERNATIVES COMPARISON This section provides a quantitative comparison of the identified major alternatives. Using criteria commonly used in similar engagements to evaluate alternative technical solutions, comparisons of the four viable alternatives were constructed. Since many of the rating categories are specific to the State of Washington, the ratings illustrate how the alternatives compare to each other rather than to industry benchmarks. The alternatives are reiterated below for ease of reference.
Alternative 1 – Internal Development Alternative 2 – Internal Development/EMR Integration Alternative 3 – External System Integrator Alternative 4 – External System Integrator/EMR Integration
A. Comparison Summary Below is a table of summary findings based upon the six criteria areas used for this comparison. The highest average result indicates the most advantageous combination of functional and technical requirements, as well as consideration of schedule, benefits, risks, and costs associated with each alternative.
Comparison Weight Alternative 1 Alternative 2 Alternative 3 Alternative 4 Table Functional 200 150 160 170 180 Technical 140 129 112 95 101 Schedule 170 85 68 153 136 Cost 100 55 45 80 75 Benefits 190 91 114 152 182 Risk 200 134 127 151 151 Total: 1000 644 626 801 825
The chart below graphically presents the overall comparison on a column chart. The sum total of the individual score determines the overall height of the column compared to the weight maximum total available.
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1200
1000
800
Risk 600 Benefits Cost Schedule 400 Technical Functional 200
0 Internal Internal External Product External Product Development Development/EMR Integrator Integrator/ EMR Integration Integration Weight Alternative 1 Alternative 2 Alternative 3 Alternative 4
B. Functional Comparison The table below compares functional categories for the four alternatives. A rating of 5 indicates the alternative provides the most functionality, and a rating of 1 indicates it provides the least functionality.
Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Meets HSC requirements 5 5 4 4 Meets best practice 4 4 5 5 requirements Meets HSA analysis 4 4 3 4 requirements Meets provider 2 3 5 5 requirements Total: 15 16 17 18
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C. Technical Comparison The table below compares technical categories for the four alternatives. A rating of 5 indicates the alternative provides the most compatible and extendable technical solution, and a rating of 1 indicates it provides the least.
Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Meets L&I standards 5 4 3 3 Compatible with L&I 5 4 3 3 architecture framework Provides for extensible 3 3 4 5 applications Leverages existing 5 4 2 2 technical infrastructure Leverages existing security 5 5 5 5 standards Total: 23 20 17 18
D. Schedule Comparison The table below compares schedule categories for the four alternatives. A rating of 5 indicates the alternative achieves the most advantageous schedule, and a rating of 1 indicates it achieves the least.
Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Meets Phase 1 timeline 3 2 5 4 Meets Phase 2 timeline 3 2 5 4 Beats Phase 1 timeline 2 2 4 3 Beats Phase 2 timeline 2 2 4 5 Total: 10 8 18 16
E. Cost Comparison The table below compares cost categories for the four alternatives. A rating of 5 indicates the alternative requires the least cost, and a rating of 1 indicates it requires the most cost.
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Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Cost to meet strategic 3 2 4 4 requirements Cost to meet all 2 3 4 4 requirements Potential cost to meet 3 2 4 3 unidentified requirements Total cost of ownership through fiscal year 3 2 4 4 (FY) 2022 Total: 11 9 16 15
F. Benefits Comparison The following table compares or rates the benefits for the four alternatives, using the benefits approach categories outline in Chapter XII later in this report. A rating of 5 indicates the alternative provides the most benefit, and a rating of 1 indicates it provides the least benefit.
Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Government Operational 3 3 4 5 Government Financial 3 3 4 4 Direct Customer 2 3 4 5 Social 2 3 4 5 Strategic 2 3 4 5 Total: 12 15 20 24
G. Risk Comparison The table below compares risk categories for the four alternatives. A rating of 5 indicates the alternative provides the least risk, and a rating of 1 indicates it provides the most risk.
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Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Technology Risk Employs technology with which the state is 5 4 3 3 familiar Proven technology 5 3 5 5 Application support staff geographically close to 3 3 2 2 application Stores sensitive data 4 4 3 3 within local control Adequate security 4 4 4 4 measures in place Project Management
Risk Experience with OHMS 2 2 4 4 type systems Available application 2 2 3 4 design Custom development 2 2 3 4 (custom is riskier) Ongoing Support Risk Vendor stability 3 3 4 4 Data center stability 5 5 5 5 Ability to customize 5 5 4 3 application Coordination between system support and 3 3 4 4 application support Availability of Information Services 3 3 5 5 staff to support system in the future Development Risk Proven solution 2 3 4 5
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Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Time to implement 3 2 5 4 Organizational Risk Change management; 2 2 3 3 impact on customers Ability to obtain data 3 3 2 2 from other state systems Total: 57 54 64 64
H. Alternatives versus Scope Analysis APPENDIX L – Alternatives vs. Scope Analysis, presents an analysis of the four alternatives against the Phase 1 and Phase 2 requirements presented in the OHMS Development Strategy - section III.D.1.
Category Alternative 1 Alternative 2 Alternative 3 Alternative 4
Phase 1 Totals 35 42 30 38 Phase 2 Totals 51 64 57 73 TOTALS 86 106 87 111
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IX. PROPOSED SOLUTION This feasibility study focuses on establishing an information system that will allow L&I to better manage its COHEs and to better support and service the staff that are coordinating care for injured and ill workers, to help them return to work more quickly and safely. The OHMS application is proposed to be added to L&I’s portfolio of business applications. The OHMS application will be a customer-facing application integrated with existing L&I legacy applications (i.e., LINIIS, ORION, and MIPS) and operating within the L&I SOA environment, using as many reusable SOA services as possible. The application will contain its own business logic and database to support the unique functionality of the COHE and future business operations.
The OHMS application solution is first described below from a business point of view, then from a technical architecture point of view. Furthermore, the proposed solution is only detailed as a high-level conceptual design, thus satisfying the needs of the feasibility study. Additional requirements, both by definition and as a physical design, still remain to be accomplished, which are outside the scope of this feasibility study.
A. Business Perspective The OHMS application will be a centralized statewide tool that will support coordinated care and future HSA operations and business users, as illustrated in the graphic below.
COHE Best Practices Business Operations
1 ‐ 2 ‐ HSC Work Report COHE Queue 5 ‐ Of Claims Claim 1 Return Accident Classification Claim 2 to Work Process Claim 3 ……. Workplace Injury Payments 3 - Best Practice Operations 1. Assess Barriers 2. Track and Record Activity & Contacts 3. Track and Record Interventions and Outcomes 4. Resolve Barriers to RTW
4 ‐ Best Practice Monitoring (HSA)
Claims Intake COHE Performance Outcome Interventions Incentives Review Contracts Monitoring Analysis
Claims Worker Compensation Insurance System Insurance Management Administered by L&I Payments
WORKING DRAFT
As illustrated above, COHE staff (particularly the Health Services Coordinator, or HSC) and L&I OHS staff will be the primary consumers of OHMS data as they continually monitor the
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COHE program and seek additional best practice activities. This next section describes the application from the COHE and OHS points of view.
1. COHE Business Users COHE staff will have access to all of the following, but it is assumed that OHMS will be the principal COHE resource:
OHMS Application – This application will support coordinated care services provided principally by the HSC and will serve as the primary portal for administering COHE functions. CAC Portal – This provides COHE staff access to L&I claim and payment information. FileFast Portal – This portal enables the entry of the Report of Accident (ROA). Provider Express Billing – This portal provides a means for the COHE to bill L&I for HSC claim specific services that they perform. Provider Systems – Many COHEs will have access to the institutional electronic medical records systems and billing systems. This will enable them to monitor injured worker treatments, review medical records, and prescriptions.
Injured workers and providers each provide a section of a completed Record of Accident (ROA) form to initiate a claim. This claim form can then be messaged into the LINIIS claims management system via either the FileFast or the TIPs10 claims intake systems (employers have an ROA submission option using CAC). This process will initiate the OHMS application to then access, compile, and analyze these ROA claims, prioritize them through a triaging process, and place them in a work queue for COHE HSCs. This triage process of prioritization will identify those claims, based upon information found in the ROA, information known about the employer, restrictions, and injured workers that have the best value (in terms of intervention through best practices) for the HSC to coordinate. If a claim is not initially identified as one that would benefit from HSC intervention, but later on does meet criteria, that claim will also need to be placed on the work queue for the HSC. The HSC will work from his/her work queue in selecting injured worker cases to handle.
COHE HSCs will access the OHMS application through a Web browser featuring various services that can be accessed through drop-down menus. The HSC will be able to initiate work based upon the OHMS work queue, which will contain a list of claims. From here the HSC selects the claim, and OHMS provides a dashboard pertaining to the selected injured worker. This dashboard will summarize activities associated with a claim of its type, provide best practice gauges and indicators, and display planned follow-up activities. From this dashboard the HSC will be able to view the ROA, list of prior activities, contacts (employer, Third Party
10 TIPS allows providers to mail or fax Reports of Accidents (ROAs) to L&I, where a data entry operator enters the ROA data. This is an entry point into the LINIIS Claims Management System.
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Administrator, etc.), interventions, and related documents from the ORION system to help administer best practices. This dashboard will be the HSC launch pad for coordinating care.
The HSC will review a claim ROA and in some cases may have access to perform additional research using medical information from the providers’ EMR/EHR system (access will be typical for some institutional COHE HSCs, but not common among community COHE HSCs). The HSC will also have the option of gathering claim information found in the CAC application. Furthermore, utilizing OHMS, HSCs will encourage health care providers to use best practices such as:
Contacting the employer Conducting assessments to determine barriers to return to work (RTW) and treatment plans Administering scales and proposed interventions
The HSC will record these and other related activities, contacts, interventions, notes, and will schedule events and follow-up activities within the OHMS application.
The OHMS application will include the ability for HSCs to set alerts and notifications for claims that they are working. For example, alerts can be set for treatment completion or when an injured worker misses treatments. Automatic notifications can be set for scheduled events and follow-up activities.
COHE program directors will act as one set of system administrators and will be able to access HSC work queues and monitor activity to help balance staff workloads.
The OHMS application will provide tools for setting up training events (e.g., provider training on the dashboard), registering participants, and recording attendance and education credits. Reports will be provided to help provide appropriate views to administer training activities.
The application will also include a billing function that will aggregate HSC billable activities and present detailed invoices to the L&I Provider Express Billing portal. This will allow submission of bills directly into the L&I MIPS system to expedite and simplify COHE billing and payment.
L&I, through the use of OHMS, will provide a secure communication portal that will allow the COHE staff to communicate with L&I OHS staff, L&I claims managers, and medical providers. The communication portal will be HIPAA compliant and secure so that patient-specific information can be shared.
The OHMS application will include robust reporting tools that will provide reports to the COHE and OHS. This information will include details of claims handled, contacts, interventions, and other information that can be filtered by claim, provider, or clinic.
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A COHE best practice dashboard will provide best practice gauges and indicators that allow COHE program and medical directors to review their overall aggregate performance in providing best practice coordinated care to injured workers. This dashboard will have drill-down capability by HSC, provider, clinic, or claim. It will also provide performance measures to analyze best practice outcomes from various program dimensions.
2. L&I OHS Staff OHS staff will provide oversight to the COHE staff that will be using the OHMS system. The OHS staff will be responsible for managing the system’s configuration and support data. OHS contract managers will be able to oversee the COHE business operations through reviewing performance reports and auditing specific claims—in particular, a specific claim an HSC may be working at the time of the audit.
The OHS staff members currently fulfill their responsibilities by utilizing their access to the LINIIS, ORION, and MIPS applications. They too will require access to the OHMS application to manage configuration of data, administer access privileges, and perform other systems configuration administrative tasks. Examples of such OHS responsibilities include:
Adding new COHEs and related staff to OHMS Administering/adding best practice business rules Adding new scales and accompanying business rules Maintaining training configuration parameters, control tables, and related business rules Supporting data through ongoing maintenance
OHS staff will have access to a menu of operational reports that will initiate performance and informational reports for all aspects of the system. These, along with the reports they receive from L&I internal applications, will assist them in administering and overseeing the program.
OHS staff will have access to the secure communications service so they can send and receive HIPAA compliant messages containing patient information and medical records.
OHS managers can access the COHE work queues, maintained in OHMS, to monitor activity and observe work queue volumes. They will also have access to the training records to oversee training performance.
3. HSA Best Practices Research Periodically OHMS information will be loaded into the L&I data warehouse to support research activities such as performance measures and reporting. The research staff will use existing L&I tools, such as Hyperion, SAS, and other available tools, to conduct data mining activities to
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determine trends, identify correlations between services and outcomes, and spot risk factors or additional HSC triggers. This research will result in adjustments to the COHE program and the addition/modification of triggers for services. The OHMS application will be configured to support these new findings.
B. Technical Design The general design of the application is shown in the following diagram.
There are two major domains: One includes the COHE business operations (depicted in the yellow box), and the other is the L&I operations (depicted in the green box). Employers and providers will continue to access the L&I claims management system, using CAC for querying claims information and FileFast to file a Report of Accident (ROA).
The OHMS application will include unique business logic and maintain its own database. This database will help OHMS to manage and support the adding and editing of HSC activities such as contacts, notes, appointments, next steps, and other related information.
The application will utilize reusable SOA services that will be wired to the OHMS applications. L&I’s databases containing claims, payment, documents, and other existing business information will be integrated so that the OHMS application can access existing L&I data content without replicating and storing the content in its own database. An important SOA service will be the implementation of the future Health Information Exchange (HIE) that will allow medical
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provider systems to send EMR/EHR information to L&I. OHMS will provide access to this information on the injured worker dashboard in future phases.
1. Solution Architecture Overview The proposed solution design will have the following components as described in the diagram below.
OHMS Web Services – Services that will support the user interface that will operate on the Web browser. L&I Portals – Portals to external and internal L&I applications. OHMS Business Logic – The functional elements of the OHMS application that will support business operations. OHMS Database Services – The business data that will be retained in a relational database. SOA Services – Common reusable services that will be configured and wired to the OHMS application to support certain functional aspects of the system. Technology Infrastructure – The physical computing equipment upon which the application will operate.
OHMS Web Services L&I Portals Knowledge Provider OHMS CAC Portal Express Billing LINIIS ORION Management Web‐Services FileFast On –Line Help MIPS TIPS Services Portal
OHMS Business Logic SOA Services Web Portal Services Claim Scales Prioritization Management Secure Contract HSC Activity Communications Management Billing Work Flow Services Contact Communication Management Document Business Rules Intervention Training Management Services Tracking Management Event/ Activity Best Practices Business Analytics Tracking Performance OHMS Database Services Report Generator Claimant Claim Data Data Warehouse External Data Intervention (Keys) Services Exchange Health Information HSC Activity Best Practice Performance L&I Data Integration Exchange Service*
Technology Infrastructure Database & Network Security Servers Storage Services Services
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The following sections present information about each of these solution services.
2. OHMS Web Services The OHMS application will be a Web-based application developed using the IBM WebSphere application server that is the L&I common SOA service for delivering dynamic Web pages to business users. The WebSphere product will control dynamic application Web pages that will display data retrieved from the OHMS database and L&I legacy databases on the Web browser. Users will navigate among several structured pages using an integrated menu system. The application will have a work queue for prioritizing claims, thus assisting HSCs to choose which claims to provide coordinated care for and to record information about their activities, creating a detailed record about each unique claim. In addition, HSCs will have the ability to add, change, inquire about, and delete certain types of information recorded in the OHMS system. However, users will not be able to change or delete data from L&I’s mainframe systems. In other words, if L&I were to display LINIIS data for a claim, the user would not be able to change or delete that data.
The following graphic demonstrates the structure of the OHMS application user interface (UI).
Best Practice Performance Dashboard
Claims Injured Worker HSC Activity Work Queue Dashboard HSC Interventions HSC Contacts Community CAC Outreach tools Portal FRQ Tool/ Scales ORION Doc Viewer HSC Notes
Barriers to RTW Reports & Queries
Work Lists COHE COHE Invoices Billing Interface
ONLINE HELP. Training Courses Knowledge User Manual, WIKI Training FAQ Training Dashboard Enrollment
Training Credits
Application User Interface
In addition to the dynamic Web page services, access to information management systems will also be available.
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Knowledge Management – A wiki or similar product is a Website whose users can add, modify, or delete its content via a Web browser, using a simplified markup language or a rich-text editor. A wiki facility will be used to provide information about implementation of best practices, specialty treatment information, and other information that will support COHE and HSA operations. Online Help – Context-sensitive help, an online user manual, and frequently asked questions may be accessible to online users. OHMS will use the standard facilities L&I recommends for this type of information.
The HSA administrative staff will have access to the OHMS application, and the following diagram illustrates the application screens for HSA administration.
OHMS HSA Application View
Search Injured Worker COHE Statewide Dashboard Claims (Same as COHE) Work Queue COHE Contracts
COHE Staff (HSC) Contract Performance Dashboard Administration Incentives Dashboard
Best Practices Best Practice Performance Training Training Configuration Dashboard Configuration
Training Courses COHE Advisors Training Dashboard Training Scales Enrollment Reports & Queries Training Credits LINIIS MIPS Best Practices & ONLINE HELP. ORION Knowledge User Manual, WIKI FAQ
The OHMS application HSA view allows access to many of the same Web screens as does the COHE view. However, several administrative screens are provided to assist the HSA staff in managing the configuration of the application. For example, they can configure best practice services, training system parameters, and define standard scales.
3. L&I Portals L&I has several application portals that are collections of dynamic user screens that support business operations. Some portals are customer facing, while others support only L&I internal
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operations. The OHMS solution uses the applications as is. Each application can be accessed concurrently in separate windows. Key information (e.g., claim number) can be transferred between portals using the Web pages, without having to modify the underlying application. The following table describes each of these portals.
Portal Facing Description
CAC Customer Claim and Account Center: Provides access to claims and payment information. Also provides access to claims documentation residing inside ORION. FileFast Customer This is a relatively new system that captures and processes only a small percentage (phone and Web filings) of the total claims volume, but the system is expected to grow dramatically over time. FileFast has a claims intake Website. Captures ROA and initiates claims. Provider Customer L&I billing Website that allows providers to send bills (single or multiple) for L&I Express payment processing. Billing TIPS L&I Only Allows providers the ability to mail/fax ROAs to L&I. TIPS is a service that enters the data and initiates a claim in LINIIS. ORION L&I Only Provides access to claims details and claims-related document images. ORION includes all documents that have been filed and are indexed to the claim. LINIIS L&I Only L&I insurance and claims system. Legacy application that manages all insurance claims. MIPS L&I Only Legacy insurance bill payments systems. MIPS includes several subsystems that support the insurance payment process. OHMS Customer and The OHMS application will support the COHE staff and other best practice L&I providers who coordinate care for injured workers and the L&I staff who oversee COHE operations and contracts. Data L&I Only The data warehouse provides L&I staff with access to claims and payment Warehouse information to support ad hoc reporting, research, and data mining activities.
4. OHMS Business Logic Initial research has identified a need for the OHMS application to be flexible and to support varying business processes (e.g., fulfilling community and institutional COHE needs). In cooperation with the OHS business unit, the Insurance Services (IS) Division business analysts have been developing a requirements document for the OHMS application. Together, they have created a Lightweight Analysis document, which provides high-level requirements. The Project Scope Document and Project Charter also define business functionality, sorted into Phases I and II.
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Business Requirements The following list of requirements has been distilled from these sources. These requirements will be expanded and refined as the requirements analysis process proceeds. However, they represent the key functional capabilities the system will support.
Provide claims dashboard and drill down. Triage COHE claims (HSC). Identify and flag at risk claims. Maintain scales associated with claims; capture claim scales. Maintain work lists and workflows. Track Return to Work (RTW) barriers. Capture and track outcomes/completions. Produce L&I reporting to COHE staff and providers. Receive COHE reports per contract. Enroll/deactivate COHE advisors. Enroll/deactivate HSC. Track COHE advisor consultations. Track employer/worker/L&I staff contacts. Capture Functional Recovery Questionnaire. Track HSC activity, interventions, notes, treatment plans, and reminders. Track COHE contract information. Access L&I claims images and claim information using CAC. Submit HSC billing and documentation. Track training enrollment and education credits. Administer training courses and credits. Recognize and track incentives. Provide report generation capability (SOA). Provide business analytics facility (SOA). Facilitate integration between OHMS, CAC, and ORION. Provide Web-based application portal (SOA). Provide secure method for exchanging worker data (HIPAA) (SOA). Utilize existing L&I system services, portals, and information (SOA). Use maintainable business rules (SOA). Track provider referrals from providers both inside and outside a COHE. Provide online help, access to policies, FAQs, etc. Provide automated notification of employers when ROAs are received.
HSA Use Cases The OHMS application will need to support a number of use cases in order to provide OHS with appropriate administrative functions. A use case is a list of steps, typically defining interactions between an actor and a system. The following diagram (on the next page) illustrates candidate
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use cases for HSA staff. The yellow boxes indicate where SOA services will be used to configure and support that application component.
HSA Use Cases
HSA Administration HSA Reporting Administer COHE Report COHE Activity Statistics Administer COHE Contracts Report Provider Statistics Administer COHE Staff (HSC) Report Claimant Statistics) Administer COHE Incentives Report Incentives Administer COHE Best Practices Report COHE Billing & Activity Administer Training Configuration Report COHE Advisor Consultation Administer Scales Report COHE/ Provider Training Administer COHE Advisors Miscellaneous Manage Best Practice Wiki System Initiated Manage Specialty Knowledge Wiki Triage Claims – Worklist Classify Administer Online Help and FAQ Notify Employers of ROA Receipt Administer WAC Wiki Provide Analytics Tools Receive COHE Report Data Access to ORION Produce L&I Report to COHE Alert High Risk Claims Receive EMR data from provider
Note that the application will have several automated processes shown in the System Initiated box (lower left). Daily the system will need to analyze incoming ROAs, prioritize them against business rules, and place them into the appropriate work queues for HSC activity. This will include breaking the claims out and assigning them to COHEs based on catchment area and also assigning a claim severity or risk indicator for high-valued existing and new claims based upon contributing claim characteristics.
Another automated function of the system will be automatically sending a notification to the employer that an ROA has been filed for one of their employees.
Many application components will operate using SOA components (indicated by yellow boxes). The SOA tools will be wired to the application and configured to support business operations. For example, all reports will be configured using the BOXI report generation facility. All external data interfaces will use SOA common data exchange functions, L&I legacy data will be
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retrieved by using SOA data application program interfaces, and documents from ORION will be retrieved using SOA reusable access modules.
COHE Use Cases During Phase 1, the primary user for the application is the COHE HSC, who will be providing coordinated care for claims to enable injured workers to return to work as quickly as possible. Claims information will “feed” OHMS from the LINIIS application, which is driven by the intake process (i.e., FileFast or TIPS), where the ROAs are recorded and a claim record is initiated. This process will also identify new risk factors and determine if a claim is a transfer to a participating provider. As the HSC works a particular case, he or she records his/her activities, contacts made, interventions made, barrier assessments, work lists, and activity prescriptions.
The following diagram identifies the COHE Use Cases. These functions include HSC activity- tracking functions, training administrative functions, reports and queries, and other miscellaneous functions.
As the functional requirements are developed, additional use cases will be identified, and the use cases will be defined in more detail.
Several of the use cases that were defined in the OHS set of use cases are automated application processes that will affect the COHE business operations. The Triage Claims – Work List Classify will examine the incoming and existing claims and distribute them to the COHE HSC, based upon catchment area and characteristics of the ROA and claim information. This function will result in a prioritized work queue of claims assignment to a COHE HSC. An automated function will send notification to an employer when an employee files a ROA.
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COHE Use Cases
COHE Functions COHE Reporting Record Claimant Scales Report Scales Record Contacts Report Contacts Records RTW Barriers Report RTW Barriers Manage Work list & Workflows Report Interventions Record Provider Intervention Report Outcomes and Completion Records HSC Notes/ Reminders Report HSC Actiivity Track Provider Referrals Report HSC Biilling Record HSC Activity Report FRQs Bill HSC Activity with Documents Report Activity Presecriptions Record FRQ Report Training Registration Record Activity Prescriptions Report Training Credits Generate Reports - Ad hoc Schedule Events and Follow-ups Record COHE Advi. Consultation Record COHE Scales Maintain Employer Data COHE Miscellaneous Provide Claims Dashboard COHE Training Send Secure EMail View Claims Related Documents Administer Training Configuration Query Claims, Payments, Workers Administer Training Registration Research Claims - CAC Administer Training Credits
Yellow Boxes indicate SOA Functions The COHE functions provide the basic tools the HSCs will use to record their activities and support their business operations.
COHE reporting will be supported by several types of reports that will be made available to the COHE staff to better manage and conduct their business operations. COHE training will support the provider with adequate training requirements to get their staff up to speed quickly in using OHMS.
As mentioned above, the application will be integrated with the LINIIS and MIPS systems. The system dashboard described above will include information provided by the OHMS application in addition to claims information gathered from the L&I legacy applications, databases, and document management systems.
5. OHMS Database Services
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Information is at the core of all OHMS activities. The following conceptual information model shows the information entities that the OHMS application needs to maintain. The green boxes represent information that L&I already captures in the legacy systems. The salmon colored boxes are new data that the OHMS application will need to support.
Conceptual Information Model
Employer Sc ales Medical Pr ovid er Provider Profile Claim Pr ovid er Claim Emplo yer Wo rk er Co ntr a ct Contact Sc ales Barriers to RTW Is sues Educat ion Cre dit Wo r k Lis t Report of Pr ovid er Accident Servic e L&I Training Claims Do cu ment s (Treatments) Event s COHE Pr ovid er HSC No tes COHE I nce nt ives Contract Pr ovid er L&I Int ervention Incentives Hea lth Services Functional Referral Co or din at or s Re cov er y Questionnaire HSC Reminder Metadata Legend HSC Activit y HSC Co nta cts OHMS Information Best Pract ices Legacy Information MIPS Payment Training Information On e ‐ to‐many Pre scr iption s
Act ivity Prescription
The following table describes each of the information entities. The “Home” column indicates where the data resides. Several data elements will be captured and stored in the OHMS database.
Data Entity Home Description Activity OHMS A structured set of injured worker activities, goals, and Prescription Form therapies discussed with a provider that will aid the injured (APF) worker in being rehabilitated and returning to work. Barriers to RTW OHMS Records issues that must be addressed for the injured worker to return to work and the treatment plan to move the claim forward. Best Practices OHMS The standard list of best practices for treating and managing injured worker situations. Claim Legacy All information associated with an injury occurrence or occupational disease for a worker. This will follow existing
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insurance systems processes and data structures. Claims Documents ORION Claims-related documents that are supplied to L&I by the providers or others and are stored in the ORION document management system. Includes the ROA, all medical records, correspondence, and other documents that pertain to a claim. Claims Scales OHMS The actual scale measurement, corresponding to standard scales, assigned to an injured worker claim. A claim can have several scales. The same scale may be provided multiple times for an injured worker, as conditions change. COHE OHMS Centers of Occupational Health and Education employ HSC staff and have contracts with L&I to provide best practice coordinated care for injured workers within a geographic area. COHE Contract OHMS The contract between a COHE and L&I. The contract specifies the terms and conditions for providing coordinated best practice service to injured workers. Education Credit OHMS Credit that a provider receives for attending COHE and /or L&I best practice training provided by the COHE. Employer Legacy Hires employees and pays worker compensation premiums. Employer Contact Legacy The contact person at the workplace who should be notified when an employee is injured and who coordinates return-to- work plans. The employer contact is usually the person whom COHE and L&I staff will deal with regarding L&I claims. Functional OHMS A questionnaire used by the provider as a tool to assess an Recovery injured worker case and to help identify barriers for returning Questionnaire the worker to employment. Health Services OHMS Staff that provide coordinated care for injured workers. HSCs Coordinator work for the COHE. HSC Activity OHMS Standardized activities the HSC performs in coordinating care for an injured worker. These activities represent services that L&I will pay the COHE to perform. HSC Contacts OHMS Record of HSC contacts made with employers, workers, providers, and L&I staff (i.e., claims manager). HSC Notes OHMS Case notes taken by an HSC in coordinating care for an injured worker case. HSC Reminders OHMS Reminders to HSC staff to follow up on claim services and activities.
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Issues Legacy Adjudication issues identified by a claims manager for a claim. L&I claims managers review each claim and approve the insurance payments to the provider and the worker. L&I Incentives MIPS The table of L&I allowable incentives. Medical Provider Legacy Medical services organizations and practitioners who provide services to injured workers. COHEs may be a type of a provider. Metadata OHMS Data about data. Defines the properties and attributes of data maintained in business systems. Represents a data dictionary of each table, data element, data structure, and types. Used in developing reports and queries. Also used to develop data exchanges with external systems and internal access to data. MIPS Payment MIPS Payments made to providers (including COHEs) for allowable services rendered to injured workers. Prescriptions MIPS Pharmaceutical prescriptions issued to an injured worker that are reimbursable by L&I. Provider Contact Legacy The provider’s designated contact person for L&I and HSC contact purposes. Provider Incentives Legacy Premiums or bonuses paid to providers for performing best practice activities within specified timeframes. Provider OHMS Recommendations given to the provider regarding the treatment Interventions and work list activities associated with treating an injured worker. COHE medical directors, consulting physicians and HSC staff may recommend interventions to providers. Provider Profile Legacy Information about the provider, including their contact information, the medical specialty, and credential information. Provider Service Legacy Medical services provided to the injured worker for which (Treatments) providers receive payments from the insurance fund. The services constitute a variety of billable activities that providers may perform for the injured worker. Direct medical treatments are examples of these services. Referral Legacy A request by one medical provider for the injured worker to see another medical provider, usually a specialist, to provide additional medical treatments to the injured worker. Report of Accident Legacy A document detailing the basic information about a work- related accident. Includes sections that are completed by the employee, the employer, and the provider. When L&I receives
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the ROA, a claim is initiated. Scales OHMS Standard medical metrics that gauge various aspects of a worker’s injury and recovery process. Training Events OHMS Specific events, offered by the COHE or L&I, to provide training to providers. Work List OHMS Depicts claims assigned to a specific entity (HSC, COHE, provider, etc.). Worker Legacy The employee who works for an employer and pays worker compensation premiums. When an employee is injured on the job, a claim is initiated for the injured worker.
OHMS Conceptual Data Schema The following diagram provides the conceptual information model for the OHMS database. This eliminates all entities found in other L&I databases. This will constitute the business data that is the basis for the OHMS application.
The application will be built using a relational database following L&I database and infrastructure standards. The green boxes, with dashed line borders, indicate existing L&I data entities, stored in existing systems, for which the OHMS application will maintain only index information. The actual data will be pulled from L&I existing data structures through the SOA data integration services.
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As additional requirements are identified and future data design activities occur, this conceptual data model will evolve into a fully developed physical database schema. A data dictionary of metadata will be maintained to support data exchanges and importing and exporting information.
6. SOA Services The solution architecture places significant emphasis on following SOA patterns and using reusable SOA services. L&I SOA is evolving with some services being very mature and in production, while other services are new, immature, and being learned. Some SOA services will need to be built for this project, which will benefit future projects and L&I initiatives. The OHMS project solution architect will work with the L&I SOA architecture team to coordinate the wiring together and configuration of SOA services to support the OHMS application. The following SOA services will be used for the OHMS application. Other services may be also used as the need is identified.
Use SQL Analytical Services and SQL Reporting Services to support Analytics business analytics Business Rules IBM ILOG JRules Business Rules Server will be used to define business Engine rules that will support business application processes. Data Access L&I has created standard data access services (API) to query key information
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Services objects such as claims, payment, and images. OHMS will use these access services to acquire existing legacy data. Data Exchange Use Web sphere Partner Gateway – Secure FTP to support external data exchange with providers and external partners. Document/Image L&I has implemented document management associated with the ORION Workflow application. They have standard services to access the enterprise images and associated indexes. The enterprise document management system uses FileNet. L&I uses IBM FileNet Image Manager IDM Web Services, IBM FileNet Image Manager Content Services (SQL), and IBM FileNet Content Services Libraries. Health Information This service has not been developed. It will support receiving electronic Exchange (Future) medical information using XML and following National Information Exchange Model (NIEM) standards. Report Generation L&I uses the BOXI reporting service that provides a Web-based reporting environment in which reports can be created, edited, made available for others to view, or distributed onward, e.g., via email. Research Tools L&I uses several products, including Oracle Hyperion, SAS Analytics, and other business intelligence projects. Secure Access The Consolidated Technology Services provides a Web-based firewall to Washington (SAW) secure state Web-based business transactions. Secure Use secure data transmission services to send secure email. This will allow Communication L&I, COHE staff, and providers to exchange information through email processes that are secure and HIPAA compliant. Telecommunications All messaging will use the L&I telecommunications network that operates over the state telecommunications network. This network provides secure and reliable connectivity. Virtual Server The OHMS application will operate on an L&I standard Windows-based server, operating in a Windows environment. The server will be broken into Web, application, and data layers. The database will operate within the L&I MS SQL database environment. Web Portal Use IBM WebSphere tools to support user-facing, Web user interfaces. The interface will incorporate the standardization concepts and methodologies associated with the L&I “eGov” and “My-L&I” initiatives and development methodologies.
7. Technology Infrastructure The OHMS application will operate within the existing technology infrastructure.
Web and Application Servers (Windows) The majority of the agency’s legacy N-Tier applications are executed on a “Web server farm” comprised of several multiprocessor, Intel-based platforms located at DES. Microsoft Windows services are used for application services, integrating LINIIS, Claim and Account
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Center (CAC), and imaging processes, using IBM WebSphere MQ plus other application services.
Application Services Infrastructure Most of the agency’s existing services are Java-based and are hosted on a variety of vendor- specific versions of Tomcat, JBOSS, and WebSphere Application Server. These existing systems will be transitioned to the new standard WebSphere Application Server (WAS) Network Edition platform for the new SOA service infrastructure. The table below lists the existing services and their corresponding platforms.
L&I Enterprise Services Implementation Platforms System Platform FileNet P8 WebSphere Application Server WebSphere Portal Server WebSphere Application Server Network Deploy Edition Doc Sciences xPression WAS 6.1 WebSphere Partner WAS 6.1 Gateway
Future Web Facing Service (Portal) The Web Facing Service (WFS) will be built on the WebSphere Portal Server framework that supports JSR-168, JSR-286, and WS-RP portlets. WFS will use portal technology to create function and role-based user interfaces for Web-based applications. In addition to Active Directory, the WFS will be designed to operate with the SAW and Shared Security services.
Desktop/Office Automation The agency has standardized on Microsoft Windows 7 for its standard desktop computing platform. The Microsoft Office suite provides the core office automation functions of word processing, spreadsheet, and presentation graphics. Microsoft Outlook, with Exchange, is used for electronic mail and calendaring. Attachmate’s myExtra! Enterprise v7.11 is used to emulate the 3270 terminal sessions required to access the agency’s mainframe applications. A wide variety of other Windows-based office automation products are used, depending upon the individual needs of the employee or group.
Database The agency has several large database systems that support L&I’s business applications. The following database management systems (dbms) are currently in use by production business applications:
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Database Purpose SQL 2008 (Windows) Strategic data warehouse platform Rochade (Windows) Strategic metadata repository SQL Server 2008 Strategic platform for new applications (Windows)
Integration Middleware The agency’s Enterprise Application Integration (EAI) infrastructure is based on using standardized XML messages transported across a secure, reliable messaging infrastructure (message-oriented middleware, or MOM). IBM’s Websphere MQ (formerly MQ Series) provides the message transport and Websphere Message Broker performs message routing (e.g. publish/subscribe, fan-in/fan-out, rules-based routing, etc.).
Network Infrastructure The L&I telecommunications system will be used to deliver the application to COHE users operating in COHE Offices statewide.
LAN – The Tumwater headquarters location has a switched Gigabit Ethernet fiber backbone with switched 100Mb Ethernet (copper) to the desktop. Routing is accomplished via Cisco layer 2 and 3 switches. Servers are connected via switched 100Mb, multiple 100Mb, or 1000Mb (1Gb) connections. New Nexus 7000 switches are being installed in the L&I Data Center and will be operational Summer 2012. These switches will replace the agency’s current Cisco 6509 core switches. Each of the 20 field offices has a Cisco layer 3 Ethernet switch and desktops connected to local services at 100Mb. WAN – All field offices connect back to the Department of Enterprise Services (DES) OB2 building through the statewide MPLS backbone. Each field office connects to the WAN via a Cisco router and a dedicated 10MB circuit. Maximum office throughput across the WAN is 10Mb/sec. The Tumwater headquarters network is connected to the DIS data center via a dedicated 200 Mbps circuit. This circuit connects the L&I network to DIS hosted services such as the IBM mainframe, Web application servers, and Exchange e-mail servers. Storage Network – L&I has a significant storage infrastructure with both Storage Area Networks (SAN) and Network Attached Storage (NAS) components with approximately 30 terabytes of storage. The Brocade Fiber Channel SAN connects all of the agency’s midrange computers to a Hitachi disk array server, while the NAS servers are directly attached to the Gigabit Ethernet backbone. iSCSI SAN technology is currently being evaluated. Network Services – Network authentication, login, directory, file, print, DNS, and WINS servers are all implemented on multiprocessor, Intel-based platforms
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using the Windows 2003/2008 operating system. All of these servers are located either at the Tumwater headquarters building or in remote field offices. External Access – Agency employees can access applications via a DIS managed Virtual Private Networking (VPN) service or a Citrix/Terminal Server session for access to centralized desktop type applications. Those needing only remote access to Exchange can use Outlook Web Access. External customers and partners can conduct business with the agency in a variety of ways. An increasing number of applications are accessible from the agency’s Website. Data exchange with external entities is accomplished via the IBM WebSphere Partner Gateway.
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X. CONFORMITY WITH AGENCY IT PORTFOLIO In compliance with the Washington State Technology Services Board (TSB), L&I has constructed, and continues to maintain, its policy-mandated IT Portfolio on the agency’s intranet. The requirements for Portfolio-based IT management are documented in policies, standards, and guidelines. These have been defined below.
Policies – Brief statements of TSB direction with respect to the planning and management of information technology. Standards – The degree or level of requirements that agencies must follow. Like policies, standards are mandatory unless specific permission for a variation is given by the TSB. Guidelines – Optional but recommended course of actions. Guidelines are “how to” documents that describe ways for agencies to comply with policies and standards. Unlike policies and standards, guidelines are not mandatory. They may be followed to the extent that agency management finds them useful.
The following topics are discussed in the remainder of this section:
Agency Strategic Plan Conformity – Explains how OHMS supports the overall agency business strategic plan. Agency IT Portfolio Conformity – Explains how OHMS complies with L&I’s IT Portfolio. Agency Technology Vision Conformity – Explains how OHMS will assist L&I to achieve the business goals outlined in the technology vision statement.
A. Agency Strategic Plan Conformity Investment in OHMS goes beyond just supporting L&I’s Information Services Division’s strategic technology-related efforts for moving L&I forward during these challenging times. The OHMS system will touch on most, if not all, of the agency’s strategic goals. The following goals have been developed to help deliver both tangible and intangible benefits and are endorsed by the L&I director.
1. Goals The following business goals were identified in the L&I IT Strategic Plan:11
Goal 1: Make Washington workplaces safer. Goal 2: Administer one of the premiere workers’ compensation organizations in the nation in quality of service, benefits, and costs.
11 L&I Information Services Strategic Plan 2009–2013, October 2008.
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Goal 3: Reduce workers’ compensation fraud and abuse; shrink the underground economy. Goal 4: Protect public safety and property; support the economic well-being of individuals and businesses. Goal 5: Achieve high performance through efficiency, innovation, and accountability.
To accomplish these goals, L&I has taken a proactive role in advocating for best practices of quality medical care, improved management of medical costs, and increased financial and non- financial incentives for health care providers.
2. Objectives As mentioned above, OHMS will support many of L&I’s strategic goals, some directly and others indirectly. To that extent, this section lists the strategies and measures for objective 5.3, which Information Services is primarily responsible for. Activities listed in the Information Services Tactical Plan have been aligned with the agency’s goals and objectives. This shows the link between the work that Information Services does and the strategic goals and objectives of the agency.
Objective 5.3: Develop and align information technology to support our strategic direction and make effective management decisions.
In support of the objective above, the following strategies have been identified:
Enable business agility by moving to an information technology architecture that is more flexible and responsive. Improve the security and reliability of business applications and IT infrastructure. Improve the quality and availability of information for making critical business decisions.
In support of the strategies above, the following measures have been identified:
Increase shared service reuse by 10% each year. Increase availability of mission-critical business applications to 99.99% of scheduled service hours. Establish an alternate IT facility for disaster recovery. Reduce the time required to locate records for public disclosure requests. Increase the amount of historical data available to agency decision makers.
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B. Agency IT Portfolio Conformity L&I’s IT Portfolio is expanding under legislative mandates for Engrossed House Bill 2123, Substitute Senate Bill 5801, and Engrossed Substitute House Bill 1725 passed by the 2011 Washington Legislature and signed into law by the Governor. Referred to as the Workers’ Comp Reform, several tactical projects have been planned and/or are already underway.
In addition to the OHMS project, L&I is in the process of expanding COHEs and their operations, developing a Medical Provider Network (MPN), establishing the Washington Stay at Work (WSAW) project, and carrying out the Structured Settlements Agreement project, just to name some of the Workers’ Comp Reform efforts currently in place. These projects, including the OHMS undertaking, all strongly adhere to the repertoire of projects that precede them and will continue to follow OCIO and TSB policies, standards, and guidelines for compliance and conformity to fit within L&I’s strategic direction and vision.
C. Agency Technology Vision Conformity L&I’s Strategic Plan and the Information Services Division’s Strategic Plan coincide and resonate with the intent to advance the agency through innovation and creative problem identification and resolution. Both documents echo the goals and objectives for safety, service, and value and can be seen in the projects currently being planned and executed. The OHMS system’s relationship to the agency’s IT Portfolio and Enterprise Architecture can best be described through the conformity statements below:
The solution to be developed to track evidence-based quality measures and outcomes for the best practice program is in line with the existing service-oriented architecture (SOA) of the agency. The planned investment leverages existing investments through the continued use of the recently implemented SOA infrastructure. Hardware platforms at DES, SOA tools, and utility software will be utilized. The investment helps position the agency in its continued progress to the new Enterprise Architecture.
Striking a balance between business and technology, OHMS will deliver the functionality to move L&I into a position to better manage the quality of health care being delivered to injured and ill workers more quickly and diligently. In doing so, customers will benefit from improvements throughout the claims management cycle.
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XI. PROJECT MANAGEMENT AND ORGANIZATION The management of the OHMS project will be critical to its success. This statement may seem obvious, but project management and organization are often aspects of a project that can easily break down, or worse, become low on a list of project priorities. For the OHMS project difficult decisions will have to be made, and staff will have to be well positioned and sufficiently informed to make these decisions. For that purpose, the following sections will detail the specifics of a well-structured organization and the necessary management of resources as they pertain to the OHMS project.
A. Project Governance Structure The governance structure for the 5801 Program and the OHMS project will need to clearly dictate the roles and responsibilities of its members and hold each individual accountable for decisions made upon their behalf or their group’s behalf. In addition, a uniform understanding of OHMS goals and objectives needs to be established early on during the planning stages of the project and maintained throughout the project development cycle. This uniform understanding applies not just to the project’s governance members, but to agency staff as well. This will provide the support and general accountability needed for the project’s overall success.
The graphic below outlines the approach to project governance for SSB5801 and to the OHMS project in a general sense.12
12 Heide Cassidy, Washington State Department of Labor & Industries, Implementation of SSB5801 - Project Charter, July 19, 2011.
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1. Roles and Responsibilities The following table of roles and responsibilities will help to ensure that timely decisions can be made at critical junctures of the project’s progress.
Role Participant(s) Responsibility Executive Project Beth Dupre Identifies strategic vision Sponsor Ensures that the project supports strategic business technology goals Sets the mandate and scope for the project Approves issue resolution Dedicates skilled resources to the project Conveys project importance to agency and external groups Provides “go/no go” decisions Approves changes in functionality, cost, or completion date Steering Committee Judy Schurke - Identifies the strategic value of the Members Permanent system and ties the technology member, voting back to a business initiative or rights service that benefits the organization as a whole Victoria Kennedy - Permanent member, Ensures that the project supports voting rights division business goals Carole Washburn- Ensures that the mandate and Permanent member, scope for the project are met voting rights Leverages the success of the Bob Lanouette- project through dedicated resource Permanent member, support, timely issue resolution, voting rights and priority of the project goals Beth Dupre- Conveys project importance to Permanent member, internal and external groups voting rights, chair Provides overall project guidance Ernie LaPalm - Approves and recommends major Permanent member, deliverables to executive sponsors voting rights Recommends budget allocations Janet Peterson -
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Role Participant(s) Responsibility Participant and Coordinates resources and shifts contributor, no resources or schedules when voting rights necessary to ensure availability of Leah Hole-Curry - self and staff Participant and contributor, no voting rights Heide Cassidy- Regular participant and contributor, no voting rights Mick Barnes - Regular participant and contributor, no voting rights Geoff Kohles - Regular participant and contributor, no voting rights Project Team Members - as needed for participation, no voting rights Project Director Janet Peterson Provides executive leadership Participates in steering committee meetings Provides insight and help to make critical decisions about the project and its direction Project Manager Janelle Baldwin Provides project management in accordance with L&I project management methodology Provides progress reports to the Information Services assistant director, the Information Services CIO, and the Information Services Planning and Project Office’s manager Monitors the project schedule
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Role Participant(s) Responsibility Ensures the project meets expectations Ensures the project follows department development standards Determines project resource requirements and ensures stakeholder involvement Ensures plans are developed to successfully implement the system Escalates issues not resolvable within the project, to an appropriate level of management for resolution Communicates with external customers and business staff Chief Information Bob Lanouette Resolves escalated issues Officer Infrastructure Manager Participates on the core team Internal Applications Ensures that the project supports Manager strategic business direction Reviews deliverables IT Project Team Owns data and application architecture content Promotes Enterprise Architecture in their section Represents support area in architecture activities (COHE) Business Diana Drylie Participates in steering committee Project Manager meeting Ensures business issues are resolved Ensures the business stakeholders’ communication needs are part of the project communications plan Reviews stakeholder communications with Project
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Role Participant(s) Responsibility Manager to ensure project information is accurate Provides input regarding the project planning effort Works with business to document workflows and processes Identifies project risks
2. Decision-Making Process The decision-making process identifies the types of decisions to be made, the individuals and organizations responsible, the expected response timing, and escalation paths. Expeditious response to decision requests is required to ensure project targets are met. Typical decision- making and problem escalation procedures have been identified below:
Project Manager – The project manager is responsible for day-to-day decisions requested by the project team. The project manager may escalate decisions to the project director if necessary. Project Director – The project director is responsible for the overall project vision, direction, and oversight. The project director may escalate decisions to the executive sponsor and/or the steering committee if necessary. Executive Sponsor – The executive sponsor is responsible for decisions and approvals requested by the project director. The executive sponsor may escalate decisions to the steering committee if necessary. Steering Committee – The steering committee is responsible for decisions requested by the executive sponsor.
B. Project Management Structure The OHMS project is sponsored and will be governed by an executive sponsor and an executive steering committee. The executive steering committee will meet regularly to review the project’s status. The steering committee will be responsible for ensuring that the project has sufficient resources assigned to support a successful implementation, and will make key decision on major project issues or project scope boundaries. The executive sponsor, key business executives, Information Services management and the project manager will participate on this committee along with Quality Assurance.
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13
1. Project Management Qualifications L&I utilizes a standard project performance tracking methodology and reporting process. This includes a detailed monthly project tracking and status report. The standard report includes several key performance indicators. The performance indicators are:
Schedule (including tracking key project milestones) Budget Scope Risk Issues
Each performance indicator has associated standard and objective criteria for rating/scoring that dimension. In addition, the report provides additional detail and narrative for each of the performance areas.
The performance and status reports are regularly reviewed by Information Services management staff, project sponsors, and stakeholders. This ensures timely recognition of any performance
13 Washington State Department of Labor & Industries, Medical Provider Network/COHE Expansion (Occupational Health Best Practices Tracking System), July 22, 2011.
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problems. In addition, planned corrective actions are reviewed and monitored for their effectiveness.
All oversight project reports are available to the OCIO representative by accessing the agency’s IT Portfolio Website.
2. Project Team Organization The specifics of the project team organization will be provided later.
3. Quality Assurance Strategies Independent Quality Assurance (QA) will be used for the OHMS project. Expectations are that the QA consultant will have fundamental knowledge in the following areas through prior experience, training, or certification in methodologies, processes, and standards:
Audits and Reviews (Assessments) Issue and Risk Management Requirements Specification Application Development Configuration Management
The QA process and consultant will focus on evaluating the project planning, execution, deliverables, and risks. When issues and risks to project scope, schedule, and budget are identified, the QA consultant will develop and present recommended mitigation approaches. The QA consultant will develop QA plans in collaboration with the project sponsor, project director, and project manager. The QA plans will document the process, methodology, tasks, timelines, deliverables, and associated roles and responsibilities.
The QA consultant will participate in executive steering committee meetings and will produce monthly QA reports that include findings, risks, and recommendations. The QA consultant will attend project meetings, conduct interviews, review project planning and other project deliverables to assist in identification of project risks and recommendations. The QA consultant will report to the Project Management Offices (PMO) manager, project sponsors, and for the project manager.
C. Stakeholder Management Structure The OHMS project will be highly visible across its stakeholder community and will introduce new automated functionality to accompany the implementation of new best practices. Its stakeholders include the primary and secondary customers identified in Chapter II. The relationships among these groups, and between them and HSA and L&I, will require careful coordination to ensure the project is perceived as successful for all.
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The communication process addresses the information needs of management, stakeholders, and project team members, and ensures they receive continuous input about the project’s purpose and progress. The process identifies what information needs to be communicated to whom and how frequently, what media will be employed, and who will be responsible. Furthermore, sufficient and effective communications are necessary to ensure project stakeholders understand project goals and objectives and are kept current on a project’s progress.
The list below identifies the different types of communication that will be significant to the OHMS project success.
Informal Communications – Communication on a day-to-day basis so there will be no surprises. All project issues, potential changes, anticipated schedule or budget slippage, etc. will be brought to the attention of the OHMS project manager when identified and prior to documentation via a status report or other formal communication. Communication of Work Products and Deliverables – Communication of project work products, deliverables, and other information pertinent to the project. Access to this material will be determined by the OHMS project manager. Communication of Team Status Reports – Status reports should be generated in electronic format and provided to the project manager. The report will be organized by Work Plan and Schedule phase/task, and will include hours worked, accomplishments, issues, and issue resolution progress since the last report. Steering Committee Meetings – Steering committee meetings allow for good discussion, present materials, and evaluate the project’s progress along with any issues. External Organization Communication – Steps should be taken early in the project to define an effective methodology for external communication; these efforts should be undertaken by the OHMS project director and project manager.
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XII. ESTIMATED TIMEFRAME AND WORK PLAN This section proposes a migration approach and pattern for implementing Alternative #4 External Product Integrator/EMR Integration, the chosen alternative solution. It describes the migration approach and provides a high-level work plan and schedule.
A. Project Approach This section proposes how L&I can migrate to the proposed solution. It presents a phased approach for implementing the computer system incrementally. The migration strategy is based upon Alternative 4 – External System Integrator/EMR Integration. This approach focuses on establishing a contract for applications and hosting support from an external vendor and configuring and customizing the applications to meet the unique business needs and requirements of OHMS, as described in the proposed solution. The resulting COHE application(s) would be operated by the vendor and be interfaced to the L&I technical environment through existing L&I portals. Application support and upgrades would be provided by the vendor. EMR integration would be included in this alternative since the applications in this arena are based on an HIE hub. This approach tightly couples the COHE HSC with provider information systems and loosely couples the application with L&I systems. The following diagram depicts this approach.
Alternative 4 – External System Integrator/EMR Integration
OHMS Application/EMR Integration
OHMS Web Services Electronic Health Systems L&I Services Knowledge OHMS FileFast Management Provider Provider Web‐Services Portal On –Line Help Portal(s) Express CAC Services Billing Portal Business Logic TIPS Claim Scales Health Information & Data Prioritization Management LINIIS Contact HSC Activity Results Management Management Billing MIPS Intervention Communication Order Management Tracking ORION Event/ Activity Training Decision Support Tracking Management Contract Electronic Communications & Management Best Practices Connectivity Health Information Exchange Service Database Services Patient Support Claimant L&I Claim Data Business Analytics Intervention (Keys) Administrative Processes Data Warehouse HSC Activity Services Best Practices Reporting
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1. Overall Strategy This alternative requires the procurement and licensing of a commercial software application, as well as system integration, implementation, and ongoing operations and support services. The overall approach is shown in the following diagram.
PROJECT MANAGEMENT Phase I Phase I Phase 0 Core Services Acquisition Operational Phase II Development Operational Phase II L&I Integration Development
July 2013 July 2014 July 2015
The above diagram shows an incremental approach that adds capabilities and functionality in annual increments.
Project Management – L&I provides project management to the overall project, coordinating efforts with the system integrator, COHE organizations, and provider organizations. The system integrator would also provide continuous project management leadership through the implementation phases of the project. Phase 0 – Acquisition – L&I will construct a request for proposal to acquire a commercial firm who will implement and support the OHMS application, acting as an external service bureau that supports COHE operations. The competitive procurement would follow the state’s guidelines for managing this type of effort, including the state’s standard contract terms and conditions and regular status reporting and independent quality assurance services. Phase 1 – Core Services Development – The selected vendor configures or develops the core applications following the established scope for Phase 1. This would include the OHMS Web services, business logic, and database services depicted in the OHMS Application/EMR Integration graphic, presented above.
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This phase also assumes that the vendor provides COHE access to provider electronic health systems. Phase 2 – L&I Integration – This approach assumes that COHE staff will continue to interact with existing L&I portals to public-facing portals to get access to Washington industrial insurance information, managed by L&I. In this phase L&I systems information is integrated with the OHMS application, managed by the vendor. Claims and payment data, electronic document images, and information flows required by L&I contracts with COHEs will be supported. This phase will also establish mechanisms to push OHMS information to L&I to support contract management oversight, best practice monitoring, and research efforts.
It is assumed that future phases will continue to be implemented and released. As new best practices are identified and developed, functional changes, metrics, and new capabilities will undoubtedly need to be added in future major releases of the software.
2. Phase 0 – Acquisition L&I needs to conduct market research to determine the availability of vendors that can provide coordinated care tools and services to support the COHE business operations. This may include conducting a market survey and inviting vendors to show L&I their systems. This may occur concurrent to the development of the RFP.
The acquisition phase includes the activities to solicit competitive proposals from commercial vendors for implementing the OHMS capabilities and provide connectivity to provider electronic medical records systems. The following diagram illustrates the typical procurement process.
Solicitation Evaluation Selection Define scope of services Receive Proposals Conduct Vendor Contracting Develop RFP Screen Proposals Demonstrations and Site Release RFP Prepare Contract Project Score Proposals Visits Conduct Pre-Proposal Facilitate Consensus Calculate Final Scoring Negotiate Contract Execution Conference Scoring Review Best and Final Offer Sign Contract Answer Vendor Questions Select Finalist Vendors
Sponsor Vendor Visit
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Under this approach, L&I would contract with a solution provider for an OHMS application that will provide information systems support to COHE staff. The procurement process will follow state procurement standards and guidelines.
L&I would contract with the OHMS application provider for:
OHMS application software, documentation, and perpetual use licenses for all COHEs in the state Application hosting and support services to sustain the application and acquisition of the technical hardware and software that host the application Implementation of interfaces to enable interoperability with common provider electronic medical records systems Implementation of interfaces as needed in the COHEs Engineering, acquisition, and deployment assistance to support the effective implementation of adequate computing and network infrastructure Training in the use, administration, and maintenance of the application Data conversion to support implementation and continuity of operations Infrastructures and protocols to support tests of each version and implementation of the application Implementation support Application maintenance, release management, and support Help Desk services Extended warranties
In addition, L&I will procure services in ancillary contracts to support:
Quality Assurance – Independent quality assurance services to oversee systems development and deployment activities. Supplemental Personnel Service – Additional business or technical staff to augment L&I and solution provider staff as needed during the project.
Many of these ancillary procurement efforts will occur early in the project’s life cycle. However, some procurement activities may occur later.
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3. Phase 1 – Implement Core Services In Phase 1 L&I and the vendor acquire resources and establish the agreements and organization needed to configure the OHMS application for deployment in COHEs around the state. In Phase 2, L&I, COHE representatives, and the application provider will team up to develop or configure the application for deployment and verify that the configured application operates as expected. Phase 1 is independent of whatever application has been acquired. If L&I selects a single commercial software application, then the commercial application provider will provide systems integration services.
Phase 1 involves analysis, planning, design, integration, development, conversion, testing, and other activities to establish, configure, and test the data, technology infrastructure, applications, and business processes that enable the effective use of OHMS. This Phase 1s organized in a structured framework to address all these activities. This overall framework is shown graphically in the following diagram.
PROJECT MANAGEMENT
Design Business Changes Design New Business Processes Plan User Training Develop User Training Train Users
Define Design Specification Build Application Determine Interfaces Build Interfaces & Data Exchanges Specification
Define SOA Services Configure SOA Services User Statewide Define Integration Points Integrate System Services Acceptance System Test Implementation Integration Data Acquisition Plan Setup and Configure Application Data Test Design Statewide Tables Build Statewide Codes Table
Install Development Server Install Computer Infrastructure
Design Network Install Network
Stakeholder Communication
This section discusses this structured framework in more detail, addressing:
Project Management
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Business Integration Application Preparation SOA Integration Data Preparation Implement Technology Infrastructure System Integration Testing User Acceptance Testing Stakeholder Communication
This framework will be employed in Phase 2 of the implementation to develop the tasks to be undertaken. It is also important to note that some of the activities in Phase 2 will be performed before Phase 1 is completed in order to provide sufficient lead time and opportunity for communication for the COHEs and the provider community.
Project Management Project management plans, organizes, controls, and leads project activities to achieve project outcomes. L&I will provide a qualified project manager who will oversee the work of all L&I staff, COHE staff, and the solution provider as they configure and customize the application to meet Washington COHE business operational needs.
This project will follow the Project Management Institute (PMI) methodology and Project Management Body of Knowledge (PMBOK) guidelines where appropriate and generate the prescribed artifacts and control points identified in that methodology.
L&I project management will manage the program aspects of the overall project, coordinating project activities with other L&I initiatives, coordinating project governance and communication activities, and integrating the solution provider plans with L&I associated projects. The solution provider will manage their staff and resources as they provide integration activities and coordinate with the L&I project manager for participating L&I and COHE resources.
Project management ensures that appropriate planning occurs so that the implementation follows an orderly process. The plans include project work plans that define the project plan and schedule. These plans include those related to project operations, human resource management, quality management, communication, risk management, and procurement management. As the project progresses, the project managers update and report the progress against these plans.
Project management responsibilities include planning and initiating management of changes to activities to prepare the L&I and local COHEs to assimilate the changes associated with the new implementation. This will be a coordinated activity with the solution provider and the local COHEs.
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Business Integration As with any application implementation, the purpose of OHMS is to optimize operations. This includes establishing standard operating procedures for COHEs and the L&I OHS. It also includes development of training, user documentation, and a knowledge base to support COHE operations. Planning how the business will use the OHMS application is a critical component to this implementation process. OHS and the COHEs will need to continue to collaborate in planning business integration.
L&I, COHE representatives, and the solution provider will work together to define how COHE staff will use the application to support operations. This effort will begin with early communication with and training of L&I, COHE managers, and staff on the application and its functions. This will prepare these individuals to make informed decisions about how the application can integrate into standard COHE operations.
L&I will continue to work with a COHE working group consisting of representatives from each COHE. This working group will consider tactical and operational policy issues and make recommendations to the executive steering committee, who will establish the policy. L&I will include subject matter experts (SMEs) on the project team.
Each COHE will need to integrate its business processes and procedures with the new OHMS. Each COHE staff member will use the OHMS application to perform his or her specific task. Integrating the business and the technology will be critical to a successful implementation.
Design Business Changes – The solution provider will work with L&I, COHE managers, and COHE staff to plan a process for defining standard operational procedures for how the local COHEs will use the application to support business operations. It is anticipated that they will develop a small number of standard application configurations to support a corresponding set of standard practices (i.e., institutional or community-based COHE models). The team will develop plans that manage these standard configurations and practices. Train Process Designers – The solution provider will train L&I and COHE managers and staff to configure and use the new OHMS application. This will prepare these team members to make well-informed design decisions related to business processes, application configuration, conversion, and training. Design New Business Processes – L&I and COHE managers and staff will work with the solution provider to design, define, and document each statewide business process and identify unique local processes. This OHMS business process team will need to address how process standards and local practices will be created, managed, and supported over the long term. The results of this effort will be shared statewide to the COHE working group to inform them early, obtain early feedback, and garner their support.
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Develop User Training – The solution provider will develop the training curriculum and materials that will support the user training and business integration activities. Train Users – L&I, with support from the solution provider, will train L&I business staff and other systems users in how to use the application and how to integrate it into their specific work patterns. The solution provider must train L&I staff early so they know how the application works. However, training for local COHEs should take place concurrently with the implementation. COHE users will need different styles and forms of training. Medical directors and managers may simply require orientation, while operational staff may need in-depth training. Online Help – L&I business staff and the solution provider will develop online help capabilities, frequently asked questions, and best practice information that will support COHE operations.
The outcome of these activities is to prepare the COHE staff and to structure operational procedures to be able to use the OHMS application effectively and efficiently to conduct the work of the COHEs. While business integration is performed within the configuration and validation phases, business integration should begin as early as possible to enable COHEs to prepare to assimilate the OHMS. Reengineering business processes can take substantial time, particularly when many COHEs are involved.
Application Preparation Preparing the OHMS application for implementation includes a progression of activities to configure and customize the software to readily roll out and implement in each of the COHEs. The application will support Washington COHE operations and provide required interfaces with L&I internal systems and external provider partners.
The solution provider and L&I will configure the application to support basic Washington COHE operations. Later phases will allow local COHEs to configure the system to better integrate with L&I industrial insurance systems and extend integration opportunities with provider EMR systems. Activities include:
Define Change Specification – The solution provider will work with L&I and COHE managers and staff to develop a specification of how the solution provider will configure standard configurations and customize the application to operate in Washington COHEs. The solution provider will explain how its application functions and works and determine how it needs to be configured or modified to support business operations. The application will support the scope of functionality defined previously. Determine Interface Specification – The solution provider will develop data exchange and interface specifications for how the application will interact with: Provider EMR applications
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COHE contract information exchanges Tailor Application – The solution provider will make the necessary configuration and customization changes to the application so that it supports Washington COHE operations and business rules, meeting the specifications outlined above. Build Interfaces – The solution provider will build interfaces to an L&I Information Networking Hub to support the exchange of data with other L&I applications and services. The solution provider will also develop interfaces with external provider EMR partners.
At the close of this effort, the solution provider will have an OHMS application ready for rollout in the pilot COHE and subsequent COHEs. This application is ready for testing in the validation effort.
SOA Integration The solution provider will have their own architecture that will need to be examined. L&I architecture services and the solution provider’s services will need to be identified and configured to host the OHMS application. Activities include:
Define SOA Service – The solution provider will need to identify their available architectural services and L&I’s architectural services and develop a plan for integrating both architectures. Because the intent is for the solution provider to host the application, fewer L&I services will be required. However, potential opportunities exist to use some of the L&I services as points of integration. Implement SOA Services – The solution provider will need to configure its architectural services and work with L&I to configure integration services to support the OHMS application, sharing of data, and other functional needs of the application. Define Integration Points – The solution provider will identify integration points with the provider EMR applications and with L&I industrial insurance systems. Integrate System Services – The services will be constructed and/or configured to support the OHMS application and COHE business operations.
The outcome of these activities is to integrate the solution provider’s architecture with the provider’s EMR and L&I’s architecture as appropriate.
Data Preparation The solution provider will work with L&I to establish an initial database configuration, including all information configurations and rules needed to support the COHE business operations. These activities include:
Define Data Acquisition Specification – The solution provider will work with the L&I and COHE management and staff to confirm and refine a data acquisition
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strategy. Information about the COHES, case information, and contractual information needs to be captured and inserted into the new system database. Based on this strategy, the solution provider will develop a data acquisition specification that will define how the current COHE information contained in the L&I databases, local databases, and other data sources will be captured and inserted into the database format for the new database that supports the solution provider’s OHMS application. Design Statewide Codes Tables – The solution provider, in cooperation with L&I and COHE management and staff, will define the standard static codes tables and other configuration control data that will support the application and business operations. This process will likely include defining table-driven business rules and electronic correspondence and form templates. Create Initial Database – The solution provider will construct the programs to create the new database from the current information sources to the new format and organization required for the new OHMS application database. This construction follows the data acquisition specification that the solution provider prepared earlier. Build State-wide Codes Tables – The solution provider will work collaboratively with L&I to populate the codes tables. This includes defining business rules and providing correspondence and COHE-specific information and data.
The outcome of these activities is that a database environment will be ready to support the use of the COHE application.
Implement Technology Infrastructure The solution provider will implement the physical computer servers, databases, and network connectivity.
Install Development Servers – The solution provider will work with L&I technical staff to implement the technical infrastructure to support the initial development activities. This involves implementing the computer servers and integrating them, where appropriate, with existing L&I infrastructure resources. Design Network – The solution provider will design the network connectivity between the new application’s technical infrastructure and the L&I systems and networks that support COHEs statewide. This will also require the identification of network capacity requirements for the new OHMS application operating in locations throughout the state. The solution provider will work with L&I technical staff to confirm the effectiveness of this design and refine it. Install Computer Infrastructure – The solution provider, working with L&I technical staff, will install the computer infrastructure to support the testing, training, and production environments for the new OHMS application. The computer infrastructure will need to support the initial pilot implementation as
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well as be expandable to support the incremental rollout to other COHEs statewide. Install Network – The solution provider, working with L&I technical staff, will install the network connections between the new application and the L&I network and initiate related services. L&I will integrate the network into the existing statewide network, enabling statewide connectivity to the new COHE application tools. Train Technical Staff – The solution provider will train L&I staff on how to support, maintain, and operate the OHMS application, database, technical infrastructure, and networking components. Knowledge transfer will consist of formal education, classes, and hands-on experience working with the application, database, information exchanges and interfaces, infrastructure, and other systems components.
The outcome of these activities will be a technical infrastructure that will support the OHMS application as it is tested and implemented in an incremental deployment process. Testing will be staged throughout the development process as components are built.
Systems Integration Test Once the application has been certified and OHMS is configured, customized, and ready for implementation, the solution provider will conduct a comprehensive systems test. The integration test ensures that all of the systems components work together. The solution provider will document and correct all defects and deficiencies that are identified through the systems integration test. The outcome of this process is a validated system that works as an integrated whole. L&I and the solution provider will next submit the OHMS application to user acceptance testing.
User Acceptance Test A test team comprised of L&I Quality Assurance and COHE management and staff will conduct a comprehensive user acceptance test of the application. The solution provider, in collaboration with the test team, will develop a User Acceptance Test Plan and process to thoroughly exercise and test the OHMS application. The testing program will validate that the application meets all requirements, documented in the requirements traceability matrix, and that the OHMS application can function properly in the Washington COHE context.
L&I Quality Assurance will lead a team to construct business scenarios comparable to normal COHE operations and design and construct user acceptance test cases. The test team will execute the test cases and document the results.
The solution provider will correct all defects and provide functionality to correct any deficiencies. The systems will be retested (regression test) to ensure that the system continues to
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operate correctly. L&I will repeat this cycle until the solution provider corrects all defects and testing produces no substantive defects identified by the test team.
The outcome of this process is a validated OHMS application that L&I is ready to deploy into the pilot implementation environment.
4. Phase 2 – L&I Integration Development In this phase, which conforms to the scope document for Phase 2, the solution provider will provide integration with L&I systems. This will enable the COHE staff to have better access to L&I insurance claims data, besides what is available through the CAC portal.
Points of integration may include:
Integration of data for COHE contract management Better integration of claims intake data, including ROAs and APF Business analytics for monitoring best practice activities and outcomes Providing information feeds to the L&I data warehouse to support research activities Access to document images contained in the ORION system now accessible from CAC system Streamlined COHE activity billing to L&I MIPS and COHE sponsoring organization systems
This approach to implementing the new capabilities will follow a structured development pattern, managed by the solution provider. The features will be planned, designed, configured and developed, and tested (System and UAT). A rigor similar to that described in Phase 1 will be followed in this phase.
B. Work Plan and Schedule An initial project management task will be to develop an overall project management plan, following standard project management practices for the entire project. This section provides a framework for the project.
1. Work Plan and Schedule The work plan consists of the tasks and activities that are necessary to deliver the system and to prepare the COHE business to use the system. APPENDIX K – Project Schedule, is a high-level work plan and schedule for conduct of each of the three phases of the project.
Each phase follows a traditional systems development methodology consisting of design, construction, system testing, user acceptance testing, and implementation. The phases are
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designed to be one year in duration with the expectation of delivering specific functionality with each phase.
2. Key Project Milestones The project consists of a progression of deliverables. The following table shows the deliverables and their scheduled dates, based upon an April 2, 2012, start date. The last column, “Key Milestone” identifies which key deliverables will identify the overall progress of the project.
Task Task Name Finish Major Milestones Project Management Mon 7/6/15 PM- Phase 1 Project Management Phase 1 Mon 7/1/13 Project Charter Mon 4/16/12 Project Management Plan Mon 4/2/12 Project Execution Mon 7/1/13 Phase 1 Project Management End Mon 7/1/13 PM- Phase 2 Project Management Phase 2 Mon 7/6/15 Project Charter Mon 7/15/13 Project Management Plan Mon 7/1/13 Phase 2 Project Management End Mon 7/6/15 Phase 0 Acquisition Phase Mon 10/1/12 Release RFP Mon 6/11/12 Vendor Proposals Received Mon 8/13/12 Apparent Successful Vendor Mon 9/10/12 Contract Mon 10/1/12 Phase 1 Core Services Development Mon 7/1/13 Design Developed Mon 11/26/12 OHMS System Configured and Ready for Mon 3/4/13 Testing OHMS System Ready for UAT Mon 4/8/13 User Acceptance Mon 6/3/13 System Goes Live Mon 7/1/13 Phase 2 Integration with EMR and L&I Tue 6/30/15 Design Developed Mon 11/4/13 Phase 2 System ready for Testing Mon 8/25/14 Phase 2 System ready for UAT Testing Mon 11/17/14 User Acceptance Mon 4/6/15 System Goes Live Tue 6/30/15 Project End Tue 6/30/15
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XIII. COST-BENEFIT ANALYSIS The Cost-Benefit Analysis (CBA) was performed to determine the costs of the OHMS project. The topics listed below are addressed.
Methodology – Documents the methodology or approach used to complete the CBA using ISB guidelines. Cost-Benefit Analysis – Presents the summary results of the CBA for each alternative and provides full lifecycle costs of the chosen alternative. Cost Calculations and Assumptions – Identifies the costs and costing assumptions over a total cost of ownership period of 11 years in the CBA. Benefits – Provides a description of the approach employed to gather OHMS benefits and the details of those benefits identified and included in the CBA.
A. Methodology The Washington State Information Services Board’s (ISB) Feasibility Study Guidelines for Information Technology Investments contains a set of CBA forms for use in comparing the costs and benefits of solution alternatives. The full set of completed forms have been included in APPENDIX I- Cost-Benefit Spreadsheets. A set of CBA forms were created for each of the four alternatives considered in this study.
1. CBA Model Structure The structure of each alternative CBA set follows a similar format consisting of linked worksheets. The five ISB forms are supported by additional forms that provide necessary detail for support. The CBA follows a “straight line” valuation technique. For this reason, annual inflation factors for revenue and expenses have not been included. This enables easy identification of changes in the model. The structure of the worksheets is shown in the diagram below.
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The following table provides a brief description of each worksheet. Each worksheet is assigned a unique number for reference purposes.
Form Description CBA1 Contains the CBA by presenting cash outflow (from CBA3 – Summary, ISB Form 1 – Summary, Cost Operations Incremental Cost of Project) and cash inflows (from CBA5 – Benefit and Cash Flow Benefits Cash Flow Analysis). It also calculates the net present value, Analysis payback period, and other financial ratios. CBA2 Compiles the onetime project costs into state object codes by fiscal year. This ISB Form 2 – Project Detail worksheet feeds CBA4 – Current versus Proposed Method Operations Costs Cost Flow Analysis and is fed by PRJ – Project Cost Estimate. CBA3 Shows the net ongoing operations cost changes, comparing the current ISB Form 3 – Summary, program costs against the proposed program costs identified in CBA4 – Operations Incremental Cost of Current versus Proposed Method Operations Costs. Project CBA4 Provides the detail for current program costs (from CPC – Current Program ISB Form 4 – Current versus Costs) and proposed program costs (from PPC – Proposed Program Costs). Proposed Method Operations This worksheet feeds CBA3 – Summary, Operations Incremental Cost of Costs Project. CBA5 Provides a cash flow for tangible benefits identified in the study. This ISB Form 5 – Benefits Cash worksheet feeds CBA1 – Summary, Cost Benefit and Cash Flow Analysis. Flow Analysis
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Form Description CPC Contains the current program costs of the COHE program. It is a compilation Current Program Costs of the allotted FY 2012 budget for HSA that is allocated to COHE Administration. PPC Presents the projected cash flow for the new proposed cost of operations Proposed Program Costs based upon the alternative selected. This worksheet contains agency and division indirect overhead costs and feeds the CBA4 – Current versus Proposed Method Operations Costs. PRJ Presents the detailed one-time cost estimates for the project costs. It feeds the Project Cost Estimate CBA2 – Project Detail Cost Flow Analysis. Other Worksheets Other worksheets are provided, as needed for some options to provide detailed costs to provide supporting detail.
2. CBA Index A set of CBA forms were created for each of the four alternatives considered. The costs are based upon several assumptions, which are defined within each alternative CBA and by using standard or common variables. The following table is an index to the CBA worksheets that are included in APPENDIX I, which contains all the cost analysis forms and assumptions:
Tab Name Appendix TOC Table of Contents I-1 Summary Summary of Alternatives I-2
Alternative 1 – Internal Development CBA1 (0) ISB Form 1 – Summary, Cost Benefit and Cash Flow Analysis I-3 CBA2 (0) ISB Form 2 – Project Detail Cost Flow Analysis I-4 CBA3 (0) ISB Form 3 – Summary, Operations Incremental Cost of Project I-5 CBA4 (0) ISB Form 4 – Current versus Proposed Method Operations Costs I-6 CBA5 (0) ISB Form 5 – Benefits Cash Flow Analysis I-7 CPC (0) Current Program Costs I-8 PPC (0) Proposed Program Costs I-9 PRJ (0) Project Cost Estimate I-10 Build (0) Build Cost Estimate I-11
Alternative 2 – Internal Development/EMR Integration CBA1 (1) ISB Form 1 – Summary, Cost Benefit and Cash Flow Analysis I-12 CBA2 (1) ISB Form 2 – Project Detail Cost Flow Analysis I-13 CBA3 (1) ISB Form 3 – Summary, Operations Incremental Cost of Project I-14
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Tab Name Appendix CBA4 (1) ISB Form 4 – Current versus Proposed Method Operations Costs I-15 CBA5 (1) ISB Form 5 – Benefits Cash Flow Analysis I-16 CPC (1) Current Program Costs I-17 PPC (1) Proposed Program Costs I-18 PRJ (1) Project Cost Estimate I-19 Build (1) Build Cost Estimate I-20
Alternative 3 – External Product Integrator CBA1 (2) ISB Form 1 – Summary, Cost Benefit and Cash Flow Analysis I-21 CBA2 (2) ISB Form 2 – Project Detail Cost Flow Analysis I-22 CBA3 (2) ISB Form 3 – Summary, Operations Incremental Cost of Project I-23 CBA4 (2) ISB Form 4 – Current versus Proposed Method Operations Costs I-24 CBA5 (2) ISB Form 5 – Benefits Cash Flow Analysis I-25 CPC (2) Current Program Costs I-26 PPC (2) Proposed Program Costs I-27 PRJ (2) Project Cost Estimate I-28
Alternative 4 – External Product Integrator/EMR Integration CBA1 (3) ISB Form 1 – Summary, Cost Benefit and Cash Flow Analysis I-29 CBA2 (3) ISB Form 2 – Project Detail Cost Flow Analysis I-30 CBA3 (3) ISB Form 3 – Summary, Operations Incremental Cost of Project I-31 CBA4 (3) ISB Form 4 – Current versus Proposed Method Operations Costs I-32 CBA5 (3) ISB Form 5 – Benefits Cash Flow Analysis I-33 CPC (3) Current Program Costs I-34 PPC (3) Proposed Program Costs I-35 PRJ (3) Project Cost Estimate I-36
Variables, Assumptions, Revenue and Cost of Collection Forecast, Variables and Indirect Overhead I-37 CBAI Instructions: Cost-Benefit and Feasibility Analysis Forms 1 through 5 I-38
3. Common Variables The CBA contains variables that provide standard costs throughout the CBA model.
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Item Value Unit Comments Expert Systems Staff $180 Hour IT expert contractor staff at local rates. Journey Systems Staff $100 Hour IT journey contractor staff at local rates. Junior Systems Staff $85 Hour IT junior contractor staff at local rates. Project Manager Contractor $150 Hour Senior project manager at local rates. Quality Assurance Contractor $150 Hour Quality assurance contractor at local rates. L&I Project Manager $78,900 Year ITS5, range 66, step L. L&I ITS4 $69,348 Year ITS3, range 58, step L. L&I ITS5 $76,536 Year ITS3, range 58, step L. L&I SME $64,740 Year ITS3, range 58, step L. Benefits Percent 27.6% Percentage Standard percentage of classified salaries. Cost of Workstation $3,200 Each Business User Workstation. Cost of Developer Workstation $1,895 Each Developer workstation and development tools. MS Office License $200 Each Annual cost of MS Office per workstation. Goods and Services $300 Staff Year Costs for office supplies. Server Cost $32,000 Each Includes hardware, operating software, and all peripheral cables and connections.
B. Cost Benefit Analysis The costs and benefits are summarized and compared in EXHIBIT I, which follows this page. This exhibit shows the overall cost-benefit equation of each alternative over a 10-year TCO period.
C. Cost Calculations and Assumptions The following sections provide a summary of the cost calculations and estimates that were used for each of the 4 alternatives.
1. Alternative 1 – Internal Development The premise of this alternative is that L&I will build a custom application using both internal and contracting resources complying with the department’s technology architecture standards and methodologies. The L&I-led project would define requirements; design, construct, and test an application; facilitate implementation; and provide ongoing support and maintenance.
L&I would need to supplement its internal staff with contract analysts and designers. The project would also have to implement any new hardware and development software licensing to meet capacity requirements.
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The costs for this alternative are presented in EXHIBIT II, which follows this page. The worksheets for this alternative are in APPENDIX I – Cost-Benefit Spreadsheets (I3-I10). The following table contains an explanation of the cost assumptions that were used to develop each worksheet:
Form Cost Assumptions Appendix ISB Form 1 – The ISB worksheet calculates the cash flows in this worksheet. CBA1(0) Summary, Cost I-3 Benefit and Cash Flow Analysis ISB Form 2 – This worksheet is fed by worksheet I-10 and automatically CBA2(0) Project Detail Cost calculates. I-4 Flow Analysis ISB Form 3 – This worksheet is automatically calculated from worksheet I-6. CBA3(0) Summary, Operations I-5 Incremental Cost of Project ISB Form 4 – This worksheet is automatically calculated from I-8 and I-9. CBA4(0) Current versus I-6 Proposed Method Operations Costs ISB Form 5 – Full benefits are included. CBA5(0) Benefits Cash Flow I-7 Analysis Current Program Costs This worksheet contains the current program costs of the COHE I-8 program. It uses actual costs for program administration staff and year-to-date incentive payments to the 4 COHEs.
Proposed Program Includes the ongoing maintenance of the purchased software I-9 Costs licenses.
Project Cost Estimate A full-time L&I project manager to oversee the overall project I-10 starting in October 2011. Two SMEs are included for 42 months to develop requirements, interpret program prototypes and assist with testing. 2 internal development staff. One an ITS5 and the other an ITS4 starting July 2012. A contract senior project manager works under the direction of the L&I project manager to manage the development team starting midway through next fiscal year. A number of contract programmer analysts for system development for 3 years with a variety of skill sets costed out based on level of expertise. Independent quality assurance contractor for just over 3 years is provided (60 hours per month). A communications budget is included for communications to
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Form Cost Assumptions Appendix COHEs and external stakeholders (FY 2012 – $2,000; FY 2013 – $5,000). Software licensing IBM services software ($600,000) for increased throughput. Travel is budgeted for training and working with COHEs ($17,000). Six developer workstations and five regular workstations are budgeted. Build Cost Estimate The build estimate is an estimate of the hours to design, construct, I-11 and test the application that is used to identify the number of staff that is needed to construct a new OHMS application. The approach used is to identify the business functions (modules) and the number of units that will be developed. Each module is assigned a complexity factor (1 to 5). Standard hours are defined for analysis (40 hours), design (80 hours), construct (120 hours), and test (80 hours). The number of units × the complexity ÷ 5 × standard hours provides the estimated hours required for each line item estimate. The total estimated hours are nearly 40,000 hours. The worksheet also divides the workload between the various skill sets of contractor analyst/designers/programmers.
2. Alternative 2 – Internal Development/EMR Integration The premise of this alternative is that L&I will extend the scope of Alternative 1 by integrating with multiple EMR systems in order to achieve some the long-term benefits identified later in this chapter.
The costs for this alternative are presented in EXHIBIT III, which follows this page. The worksheets for this alternative are in APPENDIX I – Cost-Benefit Spreadsheets (12-20). The following table contains an explanation of the cost assumptions that were used to develop each worksheet:
Form Cost Assumptions Appendix ISB Form 1 – The ISB worksheet calculates the cash flows in this worksheet. CBA1(1) Summary, Cost I-12 Benefit and Cash Flow Analysis ISB Form 2 – This worksheet is fed by worksheet I-15 and automatically CBA2(1) Project Detail Cost calculates. I-13 Flow Analysis ISB Form 3 – This worksheet is automatically calculated from worksheet I-18. CBA3(1) Summary, Operations I-14 Incremental Cost of Project ISB Form 4 – This worksheet is automatically calculated from I-17 and I-18. CBA4(1)
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Form Cost Assumptions Appendix Current versus I-15 Proposed Method Operations Costs ISB Form 5 – Full benefits are included. CBA5(1) Benefits Cash Flow Additional benefits for electronic submission of ROA and other I-16 Analysis documents. Current Program Costs Same as alternative 1. I-17 Proposed Program Same as alternative 1. I-18 Costs
Project Cost Estimate Purchase of forms development within primary EMRs within I-19 the state by EMR vendor. Additional hours for L&I contractor staff to program the receiving EMR interface into existing L&I systems.
Build Cost Estimate Similar to Alternative 1 except additional hours for L&I EMR I-20 receiving system. The total estimated hours are nearly 43,000 hours.
3. Alternative 3 – External Product Integrator Alternative 3 is focused on purchasing one or more existing applications from an external vendor and configuring and customizing the applications to meet the unique business needs and requirements of OHMS. The resulting application(s) would be hosted and operated by the vendor under a service level contract. Application support and upgrades would be provided by the vendor for Alternative 2.
The costs for this alternative are presented in EXHIBIT IV, which follows this page. The worksheets for this alternative are in APPENDIX I – Cost-Benefit Spreadsheets (I21-I28). The following table contains an explanation of the cost assumptions that were used to develop each worksheet:
Form Cost Assumptions Appendix ISB Form 1 – The ISB worksheet calculates the cash flows in this CBA1(2) Summary, Cost worksheet. I-21 Benefit and Cash Flow Analysis ISB Form 2 – This worksheet is fed by worksheet I-27 and automatically CBA2(2) Project Detail Cost calculates. I-22 Flow Analysis ISB Form 3 – This worksheet is automatically calculated from worksheet I- CBA2(2) Summary, Operations 23. I-23 Incremental Cost of Project
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Form Cost Assumptions Appendix ISB Form 4 – This worksheet is automatically calculated from I-26 and I- CBA3(2) Current versus 27. I-24 Proposed Method Operations Costs ISB Form 5 – Full benefits are included. CBA4(2) Benefits Cash Flow I-25 Analysis Current Program Costs Same as alternative 1. CBA5(2) I-26 Proposed Program Similar to alternative 1 but includes long-term maintenance of I-27 Costs purchases software.
Project Cost Estimate Purchases application software license over a 3 year I-28 period. Contracts for vendor configuration, customization and implementation of product. Provides for internal contractors to develop receiving services from vendor system. Provides for software maintenance from vendor over life of analysis. Provides for software hosting services of application by vendor.
4. Alternative 4 – External Product Integrator/EMR Integration This alternative is essentially the same as Alternative 3 – External Product Integrator. The difference is that the third-party vendor would also implement the application with interfaces to major EMR systems supported in the state.
The costs for this alternative are presented in EXHIBIT V, which follows this page. The worksheets for this alternative are in APPENDIX I – Cost-Benefit Spreadsheets (I29-I36). The following table contains an explanation of the cost assumptions that were used to develop each worksheet:
Form Cost Assumptions Appendix ISB Form 1 – The ISB worksheet calculates the cash flows in this CBA1(3) Summary, Cost worksheet. I-29 Benefit and Cash Flow Analysis ISB Form 2 – This worksheet is fed by worksheet I-35 and automatically CBA2(3) Project Detail Cost calculates. I-30 Flow Analysis ISB Form 3 – This worksheet is automatically calculated from worksheet I- CBA3(3) Summary, Operations 32. I-31
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Form Cost Assumptions Appendix Incremental Cost of Project ISB Form 4 – This worksheet is automatically calculated from I-34 and I- CBA4(3) Current versus 35. I-32 Proposed Method Operations Costs ISB Form 5 – Full benefits are included. CBA5(3) Benefits Cash Flow Additional benefits for electronic submission of ROA and I-33 Analysis other documents. Current Program Costs Same as alternative 1. I-34 Proposed Program Similar to alternative 1 but includes long-term maintenance of I-35 Costs purchases software.
Project Cost Estimate Purchases application software license over a 3 year I-36 period. Contracts for vendor configuration, customization and implementation of product. Provides for internal contractors to develop receiving services from vendor system. Provides for software maintenance from vendor over life of analysis. Provides for software hosting services of application by vendor. Contracts for EMR interface software to be included with vendor application software.
D. Benefit Analysis The OHMS key benefits have been identified, reviewed, and approved by L&I and are presented below, along with an explanation of the approach utilized to identify the benefits. A benefit can be tangible (measurable) or intangible (provides value but is not directly measurable). Descriptions, detailed calculations, and proposed future measures are provided for tangible benefits, as well as for those benefits determined to be intangible.
It should be noted that the benefits included in this business case will not be fully achieved until complete implementation of OHMS.
1. Benefits Summary The table on the next page summarizes the OHMS project benefits by type and provides a view of who will realize these improvements. The benefits are grouped by the Value Measuring Methodology categories. The order of the benefits is not an indication of their overall value or importance to L&I or the citizens of Washington.
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Benefits Summary Table
General Business/ OHMS Project Expected Benefit Public L&I Provider Employer Employee Government Operational Value – Tangible Benefits Benefit #1 – Increasing number of Reports of Accident (ROAs) within best
practice standards Benefit #2 – Receiving Activity Prescription Forms (APFs) electronically
as data Benefit #3 – Reduced number of imaged documents coming into the
agency and ROA forms being entered as data Benefit #4 – Reduction in the number of duplicate documents received by
agency
Benefit #5 – Automatic notification of claims status changes
Benefit #6 – Increasing the number of claims COHE staff can intervene on Benefit #7 – Being able to have secure electronic communications between
claim stakeholders Benefit #8 – Having COHE data in L&I systems and available to Claims
Managers during the adjudication process Benefit #9 – Provide better and timelier coordination between COHE
providers and WSAW program through HSC intervention
Benefit #10 – Reduction of duplicate or redundant communications Benefit #11 – Improved ability for the agency to sort claims and educate
employers and workers
Benefit #12– Improve a Provider’s ability to track claims
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Benefits Summary Table
General Business/ OHMS Project Expected Benefit Public L&I Provider Employer Employee Benefit #13 – Coordination of treatment for injuries by having real-time reporting through EMRs Benefit #14 – Improved ability to track and implement best practices Benefit #15 – Increased visibility for monitoring best practice programs Benefit #16 – Improved ability to identify provider training issues and resolve them Benefit #17 – Improved ability to provide timely feedback to medical providers Government Financial Value – Tangible Benefits
Benefit #18 – Reduction in Accident Fund
Benefit #19 – Reduction in Medical Aid Fund
Benefit #20 – Reduction in Trust Fund Direct Customer Value – Intangible Benefits Benefit #21 – Improved health care delivery for both employees and employers
Benefit #22 – Reduced need for retraining employees
Benefit #23 – Increased ability to sustain employee’s income over lifetime Benefit #24 – Improved understanding of claims process and accurate setting of expectations
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Benefits Summary Table
General Business/ OHMS Project Expected Benefit Public L&I Provider Employer Employee Social Value – Intangible Benefits
Benefit #25 – Improved overall productivity of the state’s workforce
Benefit #26 – Improved employees’ quality of life Strategic Value – Intangible Benefits Benefit #27 – Improved confidence in the state’s workers’ compensation system
Benefit #28 – Improved evidence-based decision making
Benefit #29 – Improved accuracy and consistency in applying policies
Benefit #30 – Reduced time to implement new policies and processes
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2. Approach The Value Measuring Methodology was employed to determine the overall benefits of the OHMS Project. The Value Measuring Methodology is a tool developed by the Federal Government to assess the relative value and viability of different information technology efforts. Since government entities are not motivated solely by economic factors, the Value Measuring Methodology not only provides an evaluation model that includes classic components such as operational efficiency and cost effectiveness, but also considers other, less tangible components of the technology effort. A complete explanation of the Value Measuring Methodology is available at:
www.cio.gov/documents/ValueMeasuring_Methodology_HowToGuide_Oct_2002.pdf
The table below describes the five value factors in the Value Measuring Methodology.
Value Factor Definition Examples Government Operational Benefits that are related to Reduced time for injured improving operational worker or provider to submit efficiency or enabling future ROA and APF initiatives Government Financial Direct financial benefits to Reduction in state Medical government agencies Aid Fund Direct Customer Benefits to individuals or Improved quality of health groups that result from the care received for injured implementation of the system worker Social Benefits that apply to society as Improved health care for a whole injured workers Strategic Benefits realized through Improved accuracy, speed, attainment of organizational or and completeness of agency strategic objectives information from claims
E. Key Benefits The key benefits attributed to the OHMS project and overall COHE Program have been presented in the sections below. These benefits have been aligned using the Value Measuring Methodology value factors.
1. Government Operational Value (Tangible) Government Operational Value benefits are order–of-magnitude improvements realized in current government operations and processes and in laying the groundwork for future initiatives.
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Benefit #1 – Increasing number of Reports of Accident (ROAs) within best practice standards. Increases in the number of ROAs submitted to L&I within the best practice standard of 2 business days will benefit the agency due to improved capabilities for determining eligibility and validity of a claim. Ability to initiate a claim more quickly and accurately allows providers to begin appropriate treatment more swiftly. Administering the most appropriate treatments based upon ROA input and best practice guidelines will allow an injured worker to return to work as soon as is appropriate.
Benefit #2 – Receiving Activity Prescription Forms (APFs) electronically as data. Through EMR system integration, providers will be able to submit APFs electronically with data fields of information, rather than imaged APFs. Electronically submitted APFs with data fields of information will benefit the agency by reducing their dependence upon paper. Having the APF data allows L&I to build business rules based on restrictions and pay particular attention to the small percentage of claims that can, if left untreated, lead to long term disability.
Benefit #3 – Reduced number of imaged documents coming into the agency and ROA forms being entered as data. The agency, like most of health care, is very paper-dependent; currently L&I receives a majority of claim-related information in the form of paper where the process of imaging and indexing claim documentation is very labor and cost- intensive. The OHMS system will provide users with the capability for data to be directly loaded into system databases where it can be shared more easily and ultimately reduce the quantity of, and dependence upon, scanned images for managing a claim.
Benefit #4 – Reduction in the number of duplicate documents received by agency. Reducing the number of duplicate documents received from employers, providers, and injured workers can cut down on claim file sizes (e.g. a provider submits an ROA form through FileFast and also faxes and/or mails a copy of the form). Increased access and engagement of submitting parties can help coordinate communication and integration among each claim stakeholder and simplify the process of finding particular information on a claim more quickly. The reduction of duplicated documents will allow OHMS users to easily access information more quickly and easily.
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Benefit #5 – Automatic notification of claims status changes. OHMS will allow for automatic notification and update of a claims status in real- time for OHMS users. Automatic notification of a health care provider’s assessment of an injured workers ability to Return to Work (RTW) will allow HSCs, Claims Managers, and other OHMS users to promptly take appropriate actions to notify employers and to promote a return to work plan for that injured worker. Automatic notification of status changes are vital to the claim process and will ultimately benefit the agency by reducing response times. OHMS will help to automate the process of claims notifications through the bringing together of OHMS users onto a single notification platform.
Benefit #6 – Increasing the number of claims COHE staff can intervene on. The OHMS system will benefit users through its capacity to allow for configuration of business rules to automatically track claim data and translate large amounts of constantly changing data into triggers and alerts for COHE staff. OHMS calendar function will help users manage their actions and processes in a well-defined workflow of activities. OHMS ability to track evidence-based quality measures will help to identify and improve outcomes for injured workers.
Benefit #7 – Being able to have secure electronic communications between claim stakeholders. Secure communication among OHMS users will improve the claim management process by improving engagement and access to information among all parties. L&I currently lacks the ability to ensure secure communication, and so this OHMS capability could be the first step in ensuring it agency wide. Open, yet secure, communication is instrumental for the coordination of claims and will ultimately provide improved sharing of information; a cornerstone of the OHMS effort.
Benefit #8 – Having COHE data in L&I systems and available to Claims Managers during the adjudication process. Role-based access to a single system portal containing provider information, employer information, and injured worker information all in one place will greatly improve the agency’s ability to monitor a claim and a medical provider’s adherence to best practices. OHMS ability to integrate and interface with provider systems will allow a Claims Managers access to pertinent claim information. Claims Managers ability to coordinate efforts with and contact COHEs and providers will improve decision making during the adjudication and claim management process.
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OHMS will provide the agency with the ability to capture more claim information in agency systems for adjudication; this will include data on Self-Insured patients, making it possible for self-insured employers to become more involved beyond just at a pilot scale.
Benefit #9 – Provide better and timelier coordination between COHE providers and WSAW program through HSC intervention. HSC coordination of particular claims will provide for earlier coordination with field staff. Earlier coordination will provide field staff with richer information about COHE claim intervention. Expands the amount of tracking and information on COHE claims, interventions, and outcomes.
Benefit #10 – Reduction of duplicate or redundant communications. Coordination of providers, injured workers, employers, and the agency will reduce the amount of duplicate communication, allowing for simultaneous efforts without redundant work being performed. Improved access and engagement of all claim stakeholders will help to streamline efforts and keep everyone informed about new information made available for a claim. Streamlined efforts will help to expedite the claim process and get injured workers the health care they need. Reduction in the amount of redundant work will greatly increase the amount of time and resources available for claim management. Reduction in duplication lessens the opportunity for employer confusion.
Benefit #11 – Improved ability for the agency to sort claims and educate employers and workers. Improved ability to sort claims using data elements (e.g. employer of injury, diagnostic condition, industry, etc.) will allow the agency to develop training modules for workers and employers. Educating employers about contributing factors that escalate their premiums can be beneficial to agency and employers. Allows L&I to analyze metadata to better understand trends in claim history. Data and business analytics tools for OHMS will allow for the query of clustered claims and provide for a window into contributing factors.
Benefit #12 – Improve a Provider’s ability to track claims. OHMS will provide the benefit of ‘keeping everyone in the loop’ of an injured worker’s progress and the provider’s actions.
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COHE and L&I staff will have tools to better identify at-risk injured workers and identify and apply appropriate best practices. OHMS interfacing ability with EMRs and HIEs will allow for a one-stop point of access and data input for providers to populate the OHMS database.
Benefit #13 – Coordination of treatment for injuries by having real-time reporting through EMRs. OHMS capability for providing real-time information through interfaces with external provider systems will have significant benefits for all parties. Real-time reporting, through the use of OHMS, will be instrumental for users to help orchestrate and plan the treatment of injured workers. Improved capacity for reporting with OHMS will benefit users both internal to the agency as well as external. Leveraging the Health Information Exchange will improve L&I’s claims management processes by helping to coordinate the treatment of injured workers using real-time EMR data. OHMS will allow COHEs and L&I to integrate with provider EMRs and extract more complete information in a timely manner including the ability to integrate with provider information processes, cut down on extraneous information/letters, and extract information as data rather than images that allows business rules to be built (e.g., APF as data instead of image). Allows the surgical best practices program to integrate additional best practices in less time because provider offices are integrated. Allows L&I to expand best practices to include more impactful practices because the agency will have data rather than images (e.g., L&I would like to measure if providers referring to surgeons do so appropriately and many of those documents are imbedded in provider providers EMRs).
Benefit #14 – Improved ability to track and implement best practices. OHMS will improve L&I’s ability to track and implement best practices through proactive monitoring of providers and injured workers health care. OHMS will promote an increase in the number of providers who have adopted occupational health best practices. OHMS will provide L&I with the tools it needs to actively implement new best practices and deploy more best practices as the COHE program expands. OHMS will provide L&I with the tools it needs to actively refine and implement risk factors for disability and develop new triggers for best practice interventions. The improved ability to track best practices will allow for L&I to be more actively engaged and for providers to be more accountable for an injured workers health care.
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Benefit #15 – Increased visibility for monitoring best practice programs. Allows L&I to automatically evaluate providers eligible for top tier and to automatically track and re-evaluate providers, when appropriate, for continued eligibility in top tier. Allows more timely top tier provider feedback and for easier communication of top tier providers to self-insurance. Allows the top tier program to scale more quickly.
Benefit #16 – Improved ability to identify provider training issues and resolve them. Improved ability to administer provider training guidelines and standards will decrease training issues, and provide for more transparency when issues do arise. The improved ability to identify provider training issues early is a benefit to all claim stakeholders, since the issue can be resolved before it becomes a problem. OHMS will allow a COHE to train more providers in a more timely way with more detailed feedback (ex: ROA completeness reporting available ad-hoc). Expands L&I’s ability to track best practices through something other than billing.
Benefit #17 – Improved ability to provide timely feedback to medical providers. Timely provider feedback will allow for the agency and medical provider to mitigate potential issues and avoid problems that could compound over time if gone unchecked. Timely feedback to providers can help to identify high risk claims and appropriate interventions based on the risk of the claim (e.g., provide actionable feedback to providers).
2. Government Financial Value Benefits in the Government Financial Value category (e.g., cost savings, cost avoidance) are those realized by the government, including financial benefits received by the managing or sponsor agency, as well as other agencies.
Benefit #18 – Reduction in Accident Fund The agency estimates a total State Fund claim volume of 90,016 in Fiscal Year 2013. L&I assumes that COHE expansion will result in an additional 6,000 COHE claims annually starting in FY 2013, an additional 12,000 COHE claims annually starting in Fiscal Year 2014, and an additional 9,000 COHE claims annually starting in Fiscal Year 2015. Based on an actuarial study of Fiscal Accident Year 2009 claims, L&I expects COHE claims to ultimately have Accident Fund costs 13.5 percent below average. This assumes that new COHEs
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will be able to achieve 50% of these savings, or 6.75% lower costs in the Accident Fund. Therefore overall accident year costs would be reduced.
COHE Accident Year Costs Reduced
% Lower Costs Accident Fund Medical Aid Fund
FY13 0.45 0.27 FY14 1.35 0.80 FY15 2.02 1.20
The expected incurred losses for Fiscal Year 2013 are $968,000,000 in the Accident Fund resulting in the COHE Net Savings identified in the table below.
COHE ANNUAL SAVINGS AND COSTS
Fiscal Accident Accident Medical Aid COHE COHE Net Year Fund Fund New Costs Savings
FY13 $4,356,000 $2,319,000 $213,000 $6,462,000
FY14 $13,068,000 $6,872,000 $657,000 $19,283,000
FY15 $19,554,000 $10,308,000 $981,000 $28,881,000
Benefit #19– Reduction in Medical Aid Fund The agency estimates a total State Fund claim volume of 90,016 in Fiscal Year 2013. L&I assumes that COHE expansion will result in an additional 6,000 COHE claims annually starting in FY 2013, an additional 12,000 COHE claims annually starting in Fiscal Year 2014, and an additional 9,000 COHE claims annually starting in Fiscal Year 2015. Based on an actuarial study of Fiscal Accident Year 2009 claims, the agency expects COHE claims to ultimately have Accident Fund costs 13.5 percent below average. This assumes that new COHEs will be able to achieve 50% of these savings, or 4.0% lower costs in the Medical Aid Fund. Therefore overall accident year costs would be reduced. The expected incurred losses for Fiscal Year 2013 are $859,000,000 in the Medical Aid Fund resulting in the COHE Net Savings identified above.
Benefit #20 – Reduction in Trust Fund The reduction in Accident Fund and Medical Aid Funds should also result in some tangible savings in the Worker’s Compensation Trust Fund.
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3. Direct Customer Value Direct Customer Value Benefits are those benefits directly realized by users or multiple user groups. Users may include, but are not limited to, employees, other agencies, and citizens. While Direct Customer Value Benefits may have some tangible values, there are limited data sources to develop a reasonable tangible cost for these benefits. Due to the limited data sources or an inability to accurately calculate a benefit value, the State of Washington has chosen to reflect these benefits in more general terms.
Benefit #21 – Improved health care delivery for both employees and employers. Improved health care for Washington’s 3.2 million workers strongly adheres to the agencies mission of “Keeping Washington Safe and Working.” OHMS ability to expedite and coordinate the care of an injured worker will greatly decrease the likelihood or duration of time-loss and therefore help to keep employers risk factors and ratings down. Lower employer risk factors help to minimize premiums for both them and their employees. An injured workers ability to return to work more quickly will allow them to avoid gaps in work and avoid loss of wages (statistically, workers that are out of work in excess of 3 months or more, are less likely to return to full-time employment). Workers that can return to work with minimal absence following an injury have a greater likelihood of maintaining a good working relationship with their employers and colleagues.
Benefit #22 – Reduced need for retraining employees. OHMS and the best practice programs ability to provide improved health care to injured workers will limit the need for temporary staff to help fill gaps at the workplace. Injured workers capable of quickly returning to work without significant absence can benefit employers by minimizing potential drops in productivity. Reducing the need for re-training a new employee following the injury of a worker can decrease the need for other employees to take on additional job duties to cover for the missing worker and therefore reduce potential conflicts at the workplace.
Benefit #23 – Increased ability to sustain employee’s income over lifetime. Gaps in employment due to an injury can be costly to an employee’s earnings and can pose an adverse effect over an entire lifetime on potential earnings.
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Benefit #24 – Improved understanding of claims process and accurate setting of expectations. The OHMS system will benefit its user by clearly defining expectations and managing those expectations. OHMS will help to administer several claims processes (communication, access, health care delivery, best practices implementation, etc.). OHMS system users will have clearly defined roles and responsibilities; this will reduce the amount of redundant work. Better understanding of the claims process and an accurate setting of expectations will allow OHMS systems users to proactively utilize system tools to better manage day-to-day activities. Allows the COHEs to reach out to a larger group of employers in a more automated way so that employers (and their TPAs) feel more engaged.
4. Social Value Benefits in the Social Value category are those not related to direct users (e.g., society as a whole). Social Value Benefits may have the most value to the entire COHE Program and the citizens of Washington. While Social Value Benefits may have some tangible values, there are limited data sources to develop a reasonable tangible cost for these benefits. Due to the limited data sources or an inability to accurately calculate a benefit value, the State of Washington has chosen to reflect these benefits in more general terms.
Benefit #25 – Improved overall productivity of the state’s workforce. Currently, identifying claims in need of interventions by an HSC are dependent upon that HSCs professional judgment. OHMS will provide guidance and recommend claims in need of attention to its users, which will take a lot of the ‘guess work’ out of the claims coordination by creating standard work processes.. Having the ability to quickly and easily access claim information in one system (OHMS) will increase the availability for staff working a claim to focus their attention on making informed decisions and increase productivity. OHMS ability to automate a lot of the current workflow activities will allow for system users to focus more of their attention on managing the claim proactively and ensuring the injured worker’s barriers to return to work are resolved in a timely manner.
Benefit #26 – Improved employee quality of life. Injured workers will benefit from improved health care treatment and improved quality of life.
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Quality of life is improved because they are able to retain their position at their employer of injury.
5. Strategic Value Strategic Value Benefits move organizations closer to achieving their strategic goals, the priorities established by the governor, and legislative mandates. While Strategic Value Benefits may have some tangible values, there are limited data sources to develop a reasonable tangible cost for these benefits. Due to the limited data sources or an inability to accurately calculate a benefit value, the State of Washington has chosen to reflect these benefits in more general terms.
Benefit #27 – Improved confidence in the state’s Worker Compensation System. Being injured on the job can be detrimental to an injured worker’s outlook on life, however having optimism and confidence in Washington State’s Workers’ Compensation system can help workers keep faith in a speedy recovery. Ease of access, increased transparency of care, and active engagement throughout the claims process are some of the key initiatives for the OHMS system. Increased confidence and reliability in health care delivery are at the foundation of the COHE program and best practices implementation, and will continue to improve with the implementation of OHMS. OHMS will standardize COHE management, which is currently done manually, and will ultimately advance the Washington Workers’ Compensation system. OHMS will increase the number of sponsoring organizations interested in becoming a COHE. OHMS will allow for the surgical best practices program to scale more quickly to the needs of users.
Benefit #28 – Improved evidence-based decision making. Evidence-based decision support will allow medical providers to work collectively with other claim stakeholders and to make informed decisions about an injured worker’s care and how to best manage their treatment. Improvements on behalf of the COHE program, by way of the OHMS system, will benefit users tasked with making time-sensitive decisions about a claim. Improvement in the ability to collect, analyze, and triage a claim quickly will allow for injured workers, employers, providers, and the agency to quickly understand all of the contributing factors of a claim. OHMS will aid in advising users of what steps need to be taken to ensure a seamless process of claim management.
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Benefit #29 – Improved accuracy and consistency in applying policies. Consistency in the COHE program will help to mitigate issues and ensure seamless and uniform care within Institutional and Community COHEs. Eliminating the need for potential new COHE sponsors to develop their own systems to support the HSC role can avoid potential accuracy and consistency policy issues. Increased transparency and interaction among contributing parties will improve the accuracy of information gathered (e.g. providers contribute health charts, employers contribute RTW info and contact info, agency provides best practices guidance and policies for actions, etc.). Will allow L&I to automatically evaluate providers eligible for surgical best practices pilot, and to automatically track and re-evaluate providers’.
Benefit #30 – Reduced time to implement new policies and processes. The use of a uniform system like OHMS by all COHEs will reduce the amount of time to implement new policies and processes used to govern COHE operations. Ease of access and engagement of OHMS users will help to implement the emerging best practices that COHEs will need to use in managing new policies and processes. Collaboration among COHEs using a uniform system will provide for improved health care delivery and better care coordination.
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XIV. RISK MANAGEMENT It is critical to the successful implementation of the recommended solution that potential risks be identified and communicated, a risk management strategy be developed and implemented, and appropriate quality assurance and project oversight be acquired. The following topics are discussed in the remainder of this section:
Risks and Risk Management Strategies – Defines identified risks for the implementation of the recommended solution and provides risk-level estimates.
Project Oversight – Utilizes the Washington State standard published by the TSB to determine the level of oversight required for implementation of the recommended solution.
A. Risk and Risk Management Strategies Soos Creek Consulting uses a standardized risk factor assessment that assesses 77 risk factors in 14 different categories. Each risk is scored against low, medium, and high risk cues. A risk index is calculated for each category and for the entire project. The risk index is the weighted average of all low, medium, and high risk factors (low = 1, medium = 2, and high = 3).
1. Risk Overview The risk assessment is contained in Appendix I – Risk Factor Analysis. The following table provides a summarization of the risk evaluation for each risk category. The “Other” column includes risks that cannot be determined. Program management is the overall management of the several project components that make up the initiative. Project management is the specific management of a specific project component, such as the technical development project, or the business preparation project.
Summary Risk Assessment
Category # Low # Medium # High Other Count Index Mission and Goals 2 1 0 1 4 1.33 Program 2 2 2 0 6 2.00 Management Decision Drivers 3 0 1 0 4 1.50 Organization 1 5 0 0 6 1.83 Management Customers/Users 1 4 0 0 5 1.80
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Summary Risk Assessment
Category # Low # Medium # High Other Count Index Project 3 3 2 0 8 1.88 Characteristics Product Content 0 3 3 0 6 2.50 Deployment 2 1 0 1 4 1.33 Development 6 2 0 0 8 1.25 Process Development 2 1 0 2 5 1.33 Environment Project 0 3 0 0 4 1.75 Management Team Members 2 4 3 1 10 2.11 Technology 1 1 1 1 4 2.00 Maintenance and 0 0 2 1 3 3.00 Support Total 26 30 14 7 77 1.83
The following bar chart provides a different view of the same data highlighting the risk profile.
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2. High Risks The following table discusses the high risk items.
Risk Rationale 6 – Resource Conflict L&I staff have resource conflicts. Business analysts, IT staffs, and business program staff appear to have conflicting functional priorities. 9 - Project Manager Project manager is new to L&I and the business area. Experience 12 - Convenient Date Deployment dates are mandated by legislation rather than solid project-planning processes. 26 - Project Size Project is a large statewide project with many integration requirements. The composition of the project is now emerging. 33 - Development Schedule Very aggressive development schedule. 34 - Requirements Stability Requirements are emerging. High-level requirements exist. No complete set of requirements has been established. 37 - Design Difficulty System not defined. Significant new functionality for agency, including level of data analytics. 38 – Implementation High integration requirements to wire several different SOA Difficulty components and a lot of data integration requirements with existing legacy database systems. 62 - Mix of Team Skills Team has limited technology skills. The team is currently recruiting for key positions. 65 - Expertise with Team will likely be contract staff with little domain experience. Application Area (Domain) 68 - Training of Team Complex environment will require substantial training to support high integration requirements. 73 - Availability of Most technical positions don’t exist and will need to be Technology Expertise procured. 75 – Design Complexity High system integration will make system a challenge to maintain (e.g., SOA integration, data integration with existing systems, and business intelligence issues). 76 - Support Personnel Support staff will have to be assembled.
Some of these risks are inherent to the project. Many can be mitigated as the project progresses.
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B. Project Oversight The level of required project oversight is established by employing the OCIO standards for oversight determination. The standards include multiple matrices supporting the quantitative analysis of an information technology project on the basis of project severity and project risk. The standards can be referenced in Appendix A of the OCIO publication, Information Technology Portfolio Management Standards.
The Project Severity Level Matrix and the Project Risk Level Matrix each consist of four category columns. Each column contains multiple attributes that may or may not apply to the project being rated. Each attribute is aligned with a rating of high, medium, or low.
The appropriate attributes for the recommended solution implementation project were determined for each matrix. Then a weighted formula was employed to calculate the project’s severity level and risk level based on the attributes selected. The highest attribute rating within a category determines the rating for the category.
1. Project Severity Level The Project Severity Level Matrix is used to gauge the impact of the project in the following categories:
Impact on clients Visibility Impact on state operations Failure or nil consequence
The table below presents the completed Project Severity Level Matrix for implementation of the recommended solution. The table is followed by the scoring formula and calculation of the project’s severity level.
Project Severity Level Matrix
Categories Impact on State Failure or Nil Rating Impact on Customers Visibility Operations Consequence Direct contact with Highly visible to Statewide or Inability to meet citizens, political public, trading partners, multiple agency legislative mandate or subdivisions, and political subdivisions, involvement/impact. agency mission. service providers, and legislature. Initial mainframe Loss of significant including benefits High Likely subject to acquisitions or network federal funding. payments and hearings. acquisitions. transactions. System processes sensitive/confidential data (e.g., medical information, Social
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Security numbers, credit card numbers). Indirect impacts on Some visibility to Multiple divisions or Potential failure of citizens through the legislature, trading programs within aging systems. management systems partners, or public that agency. that support decisions the system/program Medium that are viewed as supports. important by the public. May be subject to Access by citizens legislative hearing. for information and research purposes. Agency operations Internal agency Single division. Loss of opportunity only. only. Improve or expand for improved service delivery or efficiency. Low Not likely to be existing networks or subject to hearings. mainframes with similar Failure to resolve technology. customer service complaints or requests.
Rating Number of Severity Level Based Rating Weight Categories Score on Total Score High 3 X 2 = 6 09 + High Medium 2 X 4 = 8 05 – 08 Medium Low 1 X 2 = 2 00 – 04 Low Total Score: 16
The severity level for this project is High.
2. Project Risk Level The Project Risk Level Matrix is used to gauge the impact of the project in the following categories:
Functional impact on business processes or rules Development effort and resources Technology Capability and management
The table below presents the completed Project Risk Level Matrix for implementation of the recommended solution. The table is followed by the scoring formula and calculation of the project’s risk level.
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Project Risk Level Matrix
Categories Functional Impact on Business Processes Development Effort Capability and Rating or Rules and Resources Technology Management Significant change Over $5 million Emerging. Minimal executive to business rules. Development and Unproven. sponsorship. Replacement of implementation exceeds Two or more of the Agency uses ad hoc mission critical system. 24 months.* following are new for processes. Multiple Requires a second agency technology staff Agency and/or organizations involved. decision package. or integrator, or are new vendor track record Requires extensive * Clock starts after to the agency suggests inability to and substantial job feasibility study or architecture: mitigate risk on project, training for work project approval and programming language; requiring a given level High groups. release of funding. operating systems; of development effort. database products; development tools; data communications technology. Requires PKI Certificate. Complex architecture, greater than two tiers. Moderate change to Under $5 million New in agency with Executive sponsor business rules. but over agency third-party expertise knowledgeable but not Major enhancement delegated authority. and knowledge transfer. actively engaged. or moderate change of 12 to 24 months for One or more of System integrator mission critical system. development and technologies listed under contract with Medium complexity implementation.* above are new for agency technical Medium business process(es). * Clock starts after agency development participation. staff. Requires moderate feasibility study or Agency and/or job training. project approval and vendor record indicates release of funding. good level of success but without the structure for repeatability. Insignificant or no Within agency Standard, proven Strong executive change to business delegated authority. agency technology. sponsorship. rules. Under 12 months for Agency and vendor Low complexity development and have strong ability to business process(es). implementation after mitigate risk on a Some job training feasibility study.* development project. could be required. * Clock starts after Project staff uses Low feasibility study or documented and project approval and repeatable processes for release of funding. tracking status, problems, and change. Agency or vendor is Capability Maturity Model (CMM) Level 3 equivalent or above.
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Severity Level Number of Risk Level Based Levels Weight Categories Score on Total Score High 3 X 4 = 12 09 + High Medium 2 X 6 = 12 05 – 08 Medium Low 1 X 4 = 4 00 – 04 Low Total Score: 28
The risk level for the recommended solution implementation project is High.
3. Required Project Oversight The level of oversight required for the OHMS project was determined by entering the results of the project severity level and project risk level calculations into the Project Oversight Level Matrix below. Where the calculations intersect, the level of oversight necessary for the project is identified.
Project Oversight Level Matrix
High Severity Level 2 Oversight Level 2 Oversight Level 3 Oversight
Medium Severity Level 1 Oversight Level 2 Oversight Level 2 Oversight
Low Severity Level 1 Oversight Level 1 Oversight Level 1 Oversight
Low Risk Medium Risk High Risk
The recommended solution implementation project requires Level 3 Oversight.
4. Level 3 Oversight Level 3 is the TSB’s highest level of oversight. It requires certain actions and governance and oversight structures for implementation of projects with severity and risk levels similar to those of the recommended solution implementation project. To L&I, the most significant of the oversight structures are the requirements for external quality assurance oversight and regular status reporting to the TSB.
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Appendix A Glossary
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Appendix A - Glossary
Acronym Definition A&DM Application & Data Management ACP Architectural Change Proposal APF Activity Prescription Form APP Attending Providers in the Program ARC Accounts Receivable and Collections BIIA Board of Industrial Insurance Appeals BPM Business Process Management C&PS Computing and Production Services CAC Claim and Account Center CM Claims Manager CNSS Computing Network and Support Services COHE Centers of Occupational Health & Education CPT Code Current Procedural Terminology CRUD Create, Report, Update and Delete CSI Client Systems Integration DOSH Division of Occupational Safety and Health DT&CS Desktop Technology and Customer Support E/M Evaluation and Management EAI Enterprise Application Integration EAO Enterprise Architecture Office ECS Early Claim Solutions ER/ED Emergency Room ERC Experience Rating Calculation ERTW Early Return to Work FAST Financial & Administrative Services Team FRI Functional Recovery Intervention FRQ Functional Recovery Questionnaire
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Acronym Definition HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act HSA Health Services Analysis HSC Health Services Coordinator ICD International Classification of Diseases IDM Integrated Document Management IEC Initial Evaluation and Coordination IMIS Integrated Management Information System IS Information Services ISSO Information Services Security Office IT Information Technology ITPPA IT Planning, Projects & Architecture IW Injured Worker L&I Labor & Industries LIMS Laboratory Information Management System LINIIS Labor & Industries Industrial Insurance System LUCI Look Up Claims Images MIPS Medical Information & Payment System NetOps Network Operations OFM Office of Financial Management ORCA Online Reporting and Customer Access ORION Organized Information Online OSHA Occupational Safety and Health Administration PAC Penalties, Appeals & Collections PAIRS Permit and Inspection System PDRTS Public Disclosure Request Tracking System PMO Project Management Office PP&A Planning, Projects & Architecture PPD Permanent Partial Disability
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Acronym Definition PPM Planning & Portfolio Management PT Physical Therapy ROA Report of Accident – report filled out when worker is injured RTS Referral Tracking System RTW Return to Work SHAP Safety & Health Assurance Programs SHARP Safety & Health Applications & Research for Prevention SIEDRS Self-Insurance Electronic Data Reporting System SOA Service-Oriented Architecture SSB5801 Substitute Senate Bill 5801 TEC The Everett Clinic TPAs Third Party Administrator TPD Total Permanent Disability TTD Temporary Total Disability UW University of Washington WIN WISHA Information Network WISHA Washington Industrial Safety and Health Act
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Appendix B Project Library Index
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Appendix B – Project Library Index
Attendees: Diana Drylie, Noha Gindy, Diana Sisson and Kate Cashman, Washington State Department of Labor & Industries, COHE Case Management Initial Scope Discussion, Dec. 5, 2011. Beacon Community of the Inland Northwest, Status and Future Plans - Presentation, Dec. 19, 2011. Bob Lanouette, Washington State Department of Labor & Industries, Information Services Strategic Plan 2009-2013, Oct. 2008. BUSINESS AND LABOR ADVISORY BOARD, CENTER OF OCCUPATIONAL HEALTH AND EDUCATION (COHE), Meeting, March 18, 2011. BUSINESS AND LABOR ADVISORY BOARD, EASTERN WASHINGTON CENTER OF OCCUPATIONAL HEALTH AND EDUCATION (COHE), ST. LUKE’S REHABILITATION INSTITUTE, L&I Contract_No. 02C-30-4: MEETING AGENDA, March 18, 2011. Carol Murphy, CSC, Global Business Solutions, System Integration & Development SOA Governance - Best Practices & Lessons Learned, 2009. Drylie, Diana; Washington State Department of Labor & Industries, Provider Network Advisory Group, Top Tier Provider Criteria - PowerPoint Slides, October 13, 2011. Guidelines for 2009-2011 Legislative Sessions - Estimating Information Technology Fiscal (budget) Impacts, Information Technology Professional Services Technical Service Category Descriptions, Washington State Department of Information Services Heide Cassidy, Washington State Department of Labor & Industries, Project Charter, July 19, 2011. L&I OHS Team, Washington State Department of Labor & Industries, AGENDA: Faux COHE Advisors’ Meeting***Template*** L&I OHS Team, Washington State Department of Labor & Industries, Attending Provider in the Program (APP) Toolkit***Template*** L&I OHS Team, Washington State Department of Labor & Industries, COHE Consolidated Toolkit, August 20, 2011. L&I OHS Team, Washington State Department of Labor & Industries, Center of Occupational Health & Education (COHE) Provider Orientation – Part I of IV, August 17, 2011. L&I OHS Team, Washington State Department of Labor & Industries, Center of Occupational Health & Education (COHE) Provider Orientation – Part II of IV, August 17, 2011. L&I OHS Team, Washington State Department of Labor & Industries, Center of Occupational Health & Education (COHE) Provider Orientation – Part III of IV, August 17, 2011. L&I OHS Team, Washington State Department of Labor & Industries, Center of Occupational Health & Education (COHE) Provider Orientation – Part IV of IV, August 17, 2011. L&I OHS Team, Washington State Department of Labor & Industries, Center of Occupational Health and Education (COHE) Provider Orientation Script, August 23, 2011.
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L&I OHS Team, Washington State Department of Labor & Industries, COHE Enrollee- Disenrollee List_Example L&I OHS Team, Washington State Department of Labor & Industries, COHE PROGRAM FEE SCHEDULE, July 2011. L&I OHS Team, Washington State Department of Labor & Industries, COHE Program: Action Plan – 2011-2013,***Template*** L&I OHS Team, Washington State Department of Labor & Industries, COHE Quarterly Status Report Claims per HSC***Example***, Oct. 2011. L&I OHS Team, Washington State Department of Labor & Industries, COHE Quarterly Status Report Claims per HSC***Template***, Oct. 2011. L&I OHS Team, Washington State Department of Labor & Industries, COHE System Overview, COHE Systems High Level Functional Definition, Dec. 29, 2010. L&I OHS Team, Washington State Department of Labor & Industries, Heath Services analysis Occupational Health Best practice information technology briefing, May 10, 2011. Parker, Debbie; Washington State Department of Labor & Industries, COHE Program: Action Plan – 2011-2013,(Sept. 30, 2011)***Sample***
Peterson, Janet; Drylie, Diana; Gindy, Noha; Campbell, Susan; Horrell, Carole; Aviles, Gustavo; Guillierie, Renee, Washington State Department of Labor & Industries, Implementation of Top Tier of Provider Network - Project Charter, Oct. 7, 2011. Prepared By: ANITA AUSTIN, Washington State Department of Labor & Industries, Centers of Occupational Health and Education (COHE) Expansion - Project Charter ***signed***, Aug. 15, 2011 Prepared By: ANITA AUSTIN, Washington State Department of Labor & Industries, Centers of Occupational Health and Education (COHE) Expansion - Project Charter, Dec. 20, 2011 Prepared by: JUDY MALAMPHY, Washington State Department of Labor & Industries, Medical Provider Network/COHE Expansion (Occupational Health Best Practices Tracking System), July 22, 2011. Provider Reporting Example Provider Training Tracking Example Renton Business and Labor Advisory Board, Valley Medical Center, Quarterly Meeting, August 2, 2011. Sample of Audience Summary, Mar. 21, 2011. Sample of Purpose and Characteristics_Program Measures, Jan. 13, 2011. Senators Kohl-Welles, Holmquist Newbry, Conway, and Kline, State of Washington 62nd Legislature 2011 Regular Session, SUBSTITUTE SENATE BILL 5801, (Feb. 21, 2011). Smith-Weller, Fulton-Kehoe, Egan, University of Washington, Task 7A, Process Evaluation of the Harborview Medical Center Seed Center of Occupational Health and Education, (Nov. 13, 2008). State of Washington, Required Annual Contract Performance Review - Template Systems Summary, Feb. 8, 2011.
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Tomas, Howard, STATE OF WASHINGTON OFFICE OF THE INSURANCE COMMISSIONER (OIC), Health care Administrative Expense Analysis Blue Ribbon Commission Recommendation #6 (Nov. 26, 2007), http://www.insurance.wa.gov/consumers/documents/BRC_Efficiencies_Report.pdf WA-ORCA-BPM, Technical Architecture Review & Recommendations Washington State Department of Labor & Industries, Early Claims Solution (ECS) Technology (Includes Appendix A-NERO Project Charter), January 25, 2011. Washington State Department of Labor & Industries, Early Claims Solution Claims Physical Data Model, July 15, 2010. Washington State Department of Labor & Industries, Early Claims Solution Physical Systems Architecture, March 18, 2010. Washington State Department of Labor & Industries, Early Claims Solution System Conceptual Model and Technical Direction, Dec. 8, 2009. Washington State Department of Labor & Industries, E-Gov Projects Schedule, Jan. 2012. Washington State Department of Labor & Industries, Light Weight Analysis Document COHE Expansion IT Project (Occupational Health Best Practices),Jan. 26, 2012. Washington State Department of Labor & Industries, My L&I Concept Presentation Washington State Department of Labor & Industries, Regional HSC Meeting (Tukwila, WA), Jan. 24, 2012. Washington State Department of Labor & Industries, Screen-Shot for “My L&I” example (craighome4_5) Washington State Department of Labor & Industries, Screen-Shot for “My L&I” example (Isabella - homepage_3) Washington State Department of Labor & Industries, Screen-Shot for “My L&I” example (isabella_messagecenter3_2) Washington State Department of Labor & Industries, Screen-Shot for “My L&I” example (Tom - homepage2_4) Washington State Department of Labor & Industries, 2007 Annual Report, published: Dec. 2007. Washington State Department of Labor & Industries, 2011 Calendar Washington State Department of Labor & Industries, 2011 Information Services Impact Statement, Feb. 2, 2011. Washington State Department of Labor & Industries, 2011 Information Services Impact Statement, Feb. 2, 2011. Washington State Department of Labor & Industries, 2011-13 Biennial Budget Request Information Technology Concept Paper Addendum - IS Assessment, April 28, 2010. Washington State Department of Labor & Industries, 2011- 13_Project_Portfolio_Tracking_Dashboard, August 2011. Washington State Department of Labor & Industries, 5801-S.PL
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Washington State Department of Labor & Industries, Activity Prescription Form. Washington State Department of Labor & Industries, Advisor Application Center of Occupational Health & Education (COHE) Program Washington State Department of Labor & Industries, Assessment of L&I’s Imaging System & Workflow (RFP) Washington State Department of Labor & Industries, Big Picture Data Map Washington State Department of Labor & Industries, BusinessFunctionalRequirementsCOHEupdate01062012 (Jan 5, 2012). Washington State Department of Labor & Industries, Centers of Occupational Health & Education (COHE), Performance Measures Summary, May 27, 2011 Washington State Department of Labor & Industries, COHE APP Disenrollment (for cause) Washington State Department of Labor & Industries, COHE contact list 12_2011update for distribution Washington State Department of Labor & Industries, COHE Expansion Budget Plan, June 14, 2010. Washington State Department of Labor & Industries, COHE Expansion IT Project, Occupational Health Best Practices, Dec. 22, 2011. Washington State Department of Labor & Industries, COHE Program - Quality Improvement - Project Wrap-Up Report***Sample*** Washington State Department of Labor & Industries, COHE Program - Quality Improvement - Project Wrap-Up Report***Template*** Washington State Department of Labor & Industries, COHE Program Contract Management Requirements, HIGH LEVEL COHE CALENDAR Washington State Department of Labor & Industries, COHE Program Future Planning Performance Measures Functional Specification – COHE Level, April 12, 2011. Washington State Department of Labor & Industries, COHE Program Future Planning Provider Performance Measures Functional Specification, October 20, 2011. Washington State Department of Labor & Industries, COHE Program, Quality Improvement Project Plan***Sample*** Washington State Department of Labor & Industries, COHE Program, Quality Improvement Project Plan***Template*** Washington State Department of Labor & Industries, COHE Program, Report Training, Oct. 11, 2011. Washington State Department of Labor & Industries, COHE, Community Outreach Local Media Example Washington State Department of Labor & Industries, COHE, Community Outreach Patient Brochure Inside Text Example Washington State Department of Labor & Industries, COHE, Community Outreach Patient Brochure Outside Text Example
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Washington State Department of Labor & Industries, COHE, Community Outreach Provider Office Plaque Example (Spokane; St. Luke’s Rehabilitation Institute) Washington State Department of Labor & Industries, COHE, Comparison Group Reporting Example Washington State Department of Labor & Industries, COHE, Faux COHE Comparison Group Reporting Example Washington State Department of Labor & Industries, COHE, Faux COHE Provider Reporting Example Washington State Department of Labor & Industries, COHE, Health Services Coordinator (HSC) Toolkit Washington State Department of Labor & Industries, COHE, Health Services Coordinator Systems, Oct. 17, 2010 Washington State Department of Labor & Industries, COHE, Health Services Coordinator Systems, Oct. 8, 2010. Washington State Department of Labor & Industries, COHE, HSC Case Note Example Washington State Department of Labor & Industries, COHE, HSC Case Note Template
Washington State Department of Labor & Industries, Community Outreach Business and Labor Minutes Example 2, Renton Center of Occupational Health and Education (COHE) Washington State Department of Labor & Industries, Conceptual Data Model _diagram Washington State Department of Labor & Industries, Context Diagram - COHE Case Management System Washington State Department of Labor & Industries, Decision Package, Oct. 7, 2011. Washington State Department of Labor & Industries, EAO-Home Washington State Department of Labor & Industries, Early Claims Solution Physical Systems Architecture, March 18, 2010. Washington State Department of Labor & Industries, Early Claims Technology SOA at L&I Washington State Department of Labor & Industries, Employers’ Guide to Industrial Insurance in Washington State Washington State Department of Labor & Industries, Enterprise Application Development Architecture Standards, March 1, 2010. Washington State Department of Labor & Industries, Enterprise Application Non-Functional Requirements Checklist, April 28, 2009. Washington State Department of Labor & Industries, Faux COHE Quarterly Performance Reporting, Nov. 1, 2011. Washington State Department of Labor & Industries, Four Week Assessment - Barriers to Work (RTW) form, March 17, 2008. Washington State Department of Labor & Industries, Health Services Coordinator (HSC) Toolkit Washington State Department of Labor & Industries, Health Services Coordinator (HSC) Toolkit CAC Abbreviations & Acronyms
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Washington State Department of Labor & Industries, Health Services Coordinator (HSC) Toolkit Glossary of Workers’ Compensation Terms Washington State Department of Labor & Industries, Health Services Coordinator Manual, Centers of Occupational Health and Education, July 1, 2011. Washington State Department of Labor & Industries, HIGHEST-APPLICATION REPORT- ALL-APPLICATIONS Washington State Department of Labor & Industries, HSC Duties Washington State Department of Labor & Industries, HSC flowchart2 for director Washington State Department of Labor & Industries, HSC Triggers for Touch, August 17, 2010.
Washington State Department of Labor & Industries, IDM Enterprise Services, Application Solution Architecture (Including Exception Requests) Washington State Department of Labor & Industries, Impacts (diagram). Washington State Department of Labor & Industries, INFORMATION SERVICES - L&I Future Technology (LIFT) Project, LNI Architecture Patterns, Sept. 28, 2007. Washington State Department of Labor & Industries, INFORMATION SERVICES - L&I Future Technology (LIFT) Project, LNI Architecture Patterns, Sept. 28, 2007. Washington State Department of Labor & Industries, K889-3_Harborview_COHE_Final Contract, May 12, 2011. Washington State Department of Labor & Industries, L&I CHIROPRACTIC CONSULTANT APPLICATION Washington State Department of Labor & Industries, L&I Provider Account Application Supplement for Attending Providers in the Center of Occupational Health & Education (COHE) Program Washington State Department of Labor & Industries, L&I Provider Account Application Supplement for Health Services Coordinator (HSC) in the Center of Occupational Health & Education (COHE) Program Washington State Department of Labor & Industries, L&I Technical Environment Washington State Department of Labor & Industries, Light Weight Analysis Document For COHE Project, Jan. 5, 2011. Washington State Department of Labor & Industries, Light Weight Analysis Document For COHE Project, January 5, 2011 Washington State Department of Labor & Industries, LNI COHE Fiscal Note Washington State Department of Labor & Industries, LNI COHE Info Sys Impact Statement Phase 1 Washington State Department of Labor & Industries, LNI COHE Info Systems Impact Statement Phase 2 Washington State Department of Labor & Industries, LWAverification_Noha_010312, Jan. 3, 2012.
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Washington State Department of Labor & Industries, Medical Provider Network, COHE Expansion, REFORMS, Workers’ Compensation – Handout, (Nov. 2011). Washington State Department of Labor & Industries, Modified Phase 2 – From Light Weight Analysis and Flip Charts Washington State Department of Labor & Industries, Notice of Program Disenrollment Washington State Department of Labor & Industries, OCCUPATIONAL HEALTH SERVICES PILOT PROJECT Whitepaper, Nov. 27, 2000 Washington State Department of Labor & Industries, Organization Chart, Nov. 3, 2011. Washington State Department of Labor & Industries, ORION_Architecture_v1_0 Washington State Department of Labor & Industries, Phase 1 - scope from Diana-Noha Nov. 17, 2011. Washington State Department of Labor & Industries, Project Portfolio Washington State Department of Labor & Industries, Provider Application F248-011-000 Washington State Department of Labor & Industries, REPORT OF INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE Washington State Department of Labor & Industries, REPORT OF INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE Washington State Department of Labor & Industries, REPORT OF INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE Washington State Department of Labor & Industries, Service Oriented Architecture 101, Nov. 3, 2009. Washington State Department of Labor & Industries, Service Oriented Architecture 201, November 17, 2009. Washington State Department of Labor & Industries, Spokane COHE Handout (System Description). Washington State Department of Labor & Industries, State of Washington Industrial Insurance Fund Statutory Financial Information Report For the Fiscal Years Ended June 30, 2010 and 2009. Washington State Department of Labor & Industries, Strategic Plan, Nov. 2011. Washington State Department of Labor & Industries, Structured Settlement Agreements (SSA)_Project Charter Washington State Department of Labor & Industries, TECHNICAL STANDARDS PROFILE, October 21, 2011. Washington State Department of Labor & Industries, Washington Stay at Work (WSAW)_Project Charter Washington State Department of Labor & Industries, Washington Workers’ Compensation System, 2010 Year in Review, Jan. 2011. Washington State Department of Labor & Industries, Work Request K2739 Attachment B_COHE IT Expansion Project Description
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Washington State Department of Labor & Industries, Work Request K2739 Attachment B_COHE IT Expansion Project Description Washington State Health care Authority and the Health Information Infrastructure Advisory Board, Washington State Health Information Infrastructure: Final Report and Roadmap for State Action, December 1, 2006. Washington State legislation, SUBSTITUTE SENATE BILL 5064, May 4, 2005. Weekly Claim List_Example Weekly Time-Loss List_Example What has changed (HSC’s) Wickizer, Franklin, Plaeger-Brockway, Mootz, The Milbank Quarterly, Improving the Quality of Workers’ Compensation Health care Delivery: The Washington State Occupational Health Services Project, Volume 79 Number 1, (2001). Wickizer, Thomas, University of Washington, Deliverable 5, Updated Report on the Outcome Evaluation for the Western Washington COHE, (April 9, 2007). Wickizer, Thomas, University of Washington, Task 4, Report on the Outcome Evaluation for the Eastern Washington COHE (3 Counties), (June 30, 2006). Wickizer, Thomas, University of Washington, Task 5, Centers of Occupational Health and Education: Final Report on Outcomes from the Initial Cohort of Injured Workers, 2003-2005, (April 22, 2007). Wickizer, Thomas, University of Washington, Task 7B, Evaluation of the Everett Clinic Seed COHE: Impact of a Limited HSC Intervention, (June 19, 2009). Wickizer, Thomas, University of Washington, Task 9, Report on the Outcomes for Eastern Washington COHE, Expansion Counties, (May 7, 2009). Wickizer, Thomas, University of Washington, Tasks 4 and 5, Report on the Outcomes of the Original COHEs’ Later Cohorts, (Nov. 3, 2008).
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Appendix C Project Participants
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Appendix C – Project Participants
Participant Title/Role Ahrens, Karen Health Service Analysis (Contract Manager) Arakawa , Kim Health Service Analysis (Contract Manager) Arlow, Jacqueline IS Core Teams EAS/MIPS Dev Mgr Baldwin, Janelle COHE Expansion Project Manager Campbell , Susan Health Service Analysis (Contract Manager) Cashman, Kathryn Senior Business Analyst Information Services (Enterprise Architecture Office Colson , Cindy (EAO)) Criss, Brian Web Services Mgr (Communications) Web Services Delaplane, Mark Info Tec S/a S 6 (EAO) (IS Enterprise Architect) Drylie, Diana (Occupational Health Services) Manager Occ Health Svcs Dupre, Beth Assistant Director Insurance Services Med Prog Spec 3 Health Service Analysis (HSA Technical Edgington, Melody Operations/Electronic Billing) Franklin , Gary Office of the Medical Director (Medical Director) Gindy , Noha Health Service Analysis (Contract Manager) Goldsby, Teresa Web & Claims – IT Prg Mgr Web Hanson , John IS Core Teams (Shared Applications) Hitchings, Chuck Med Pg Sp 2 Horrell, Carole Health Service Analysis (Contract Manager) Jackson , Andy Information Services (Data Management Team) Lanouette, Bob Information Services (Assistant Director) Malamphy, Judith IT Spec 5 (MIPS Manager) Moore, Kim Project Teams (Medical Provider Network) Information Services (DOSH, SHARP, Legal Services, Newman , Al SHIMS/IMIS) Peterson, Karen Prog Mgr Spc Pr (Insurance Services Special Projects) Peterson, Janet Health Service Analysis (HSA) Pgr Mgr (HSA Manager) Stoneking, Vincent PMO Manger
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Appendix D Information Systems List
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Appendix D – Information Systems List
System Description PMP Washington’s Prescription Monitoring Program (PMP) improves public health and provides better patient care. Practitioners will have access to patient information before they prescribe or dispense drugs. The information provided will allow a practitioner to look for duplicate prescribing, possible misuse, drug interactions, and other potential concerns. By having this information available before prescribing or dispensing, practitioners can provide improved care to their patients. CAC The Claim and Account Center (CAC) is a secure Website that gives employers, workers, and providers better tools to deal with their claims and accounts without waiting to hear from L&I. At L&I’s online Claim and Account Center customers can: Check the status of a workplace injury View claim documents and L&I’s notes about the claim See if a time-loss check has been issued Find out if L&I has authorized treatment or paid a bill Check the status of an employer account Check your rates and classification Check your account balance View summaries of your estimated and actual losses Send information to L&I Send L&I a secure message Complete the employer’s Report of Accident Update work status if off work or returning to work Protest a claim decision Change worker’s address or phone
NOTE: Workers’ compensation claims from employees of self-insured businesses and claims for crime victims are not available in the Claim and Account Center. COHE The Occupational Health Management System (OHMS) supports COHE AKA OHMS and provider best practice program business activities. This is the system that is the subject of this feasibility study. Data Warehouse The L&I data warehouse provides access to claims and payment information to support reporting and business analytic activities. PEB Provider Express Billing (PEB) is a free and secure way to submit or adjust bills electronically and receive remittances through Secure Access Washington (SAW). FileFast This Web-based application allows injured workers and providers to
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complete an electronic copy of the Report of Accident. This is an online entry point into the LINIIS Claims Management System. Learning This is a future system that will manage training of providers. L&I and Management COHEs provide educational opportunities to providers to train them in System occupational health best practices. The systems will manage training events and track training credit for providers. LINIIS Labor and Industries Industrial Insurance System. Processes all industrial insurance claims. MIPS Medical information payment system. This system processes the bills received from medical providers for services rendered to claimants and makes payment to the providers. Approximately $580 million in payments are processed in MIPS annually. MIPS pays ALL providers, including vocational and other retraining expenses (taxi, airline, and bus fares, equipment purchase for job modifications, etc.). Pharmacy Point of Pharmacies may submit their bills through hard copy billing. However, Sale pharmacies are encouraged to bill L&I using the POS system for all prescriptions, including those prescribed during the initial visit. All pharmacy bills will be processed and edited through the POS system regardless of how they are submitted. ORION The Organized Information Online (ORION) application consists of two major subsystems: BPM (business process management) claims integrated desktop and IDM (integrated document management) imaging systems.
BPM – Claims integrated desktop consists of several work lists and screens that allow claims managers to manage their claims using their desktop. Work lists included are for “my claims,” phone calls, mail, new report of accidents, suspended bills, suspended payments, and utilization review requests. There are also shared work lists for groups that share work items.
Other functions include: notifications requested, claim details, query into claim image files, queues for faxing and printing, responding to secure messages, authorizing time-limited access, first three days time loss, supervisor tools and workload management tools, and reports.
IDM – Imaging includes a client/server imaging system that automates the capture, indexing, retrieval, and output of paper documents and correspondence of state industrial insurance claims using electronic disk storage. Document retrieval, including electronic online access and storage, is the main component of the imaging system used by most users. The scanning and indexing functions comprise a second
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subsystem that supports the system. The system also provides components to fax and print documents from client application and to receive faxes or generate paper or microfiche copies of claim files through other subsystems.
Scan/index functions include indexing, complete indexing, re-indexing, document manipulation, splitting documents, and QA validation. Provider This system will register and manage the credentialing of providers that Credentialing serve Washington injured workers. SAS/Hyperion SAS is an integrated system of software products provided by SAS Institute Inc. that enables programmers to manipulate data and supports statistical analysis and data mining of a set of data.
Hyperion Performance Suite is vendor application software purchased from Hyperion, most commonly used for data warehouse reporting, researching, and developing executive information systems (EIS). L&I uses Hyperion to extract data and SAS to conduct statistical analysis on the data. SIEDRS (Self- L&I developed a computer system named SIEDRS (pronounced Insurance “ciders”) to receive and store self-insured claim data. Electronic Data The system allows L&I to compile more data on self-insured claims, Reporting System) especially in the areas of claim payments, claim costs, and injury information for medical-only claims. The data, and other self-insured claim information from L&I systems, are used to create the SIEDRS Reports, which L&I publishes quarterly. The SIEDRS Reports provide L&I with data to better answer questions about the performance of the self-insured community as a whole. And self-insurers can use these reports to compare their own workers’ compensation data against the overall performance of the Washington State self-insured community. TIPS Providers can mail or fax Reports of Accidents (ROAs) to L&I, where a staff data entry operator enters the ROA data. This is an entry point into the LINIIS Claims Management System.
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Appendix E Program COHE Study
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Appendix E – COHE Research Study
A critical aspect of COHE operation is measuring its success and ability to reduce the amount of workers on disability while promoting improved treatment outcomes for injured workers. Thus, beginning in 2002 the Renton COHE at Valley Medical Center began enrolling providers. Then, one year later, Spokane opened their Eastern Washington COHE at St. Luke’s Rehabilitation Institute.
As a means of determining tangible results for the COHEs, the UW Department of Environmental & Occupational Health Sciences administered an intervention evaluation at these two pilot sites. For the intervention, UW researchers were tasked with evaluating the OHS project. Details of the research teams study and findings have been provided in the paragraphs that follow.
C. RENTON COHE AT VALLEY MEDICAL CENTER The Renton pilot site developed a COHE to recruit providers (attending doctors) for the pilot, oversee care, and conduct quality improvement activities. The Renton COHE began recruiting providers in March 2002 and started treating patients in July 2002.
UW researchers assessed disability, satisfaction, employment, and cost outcomes of patients treated by COHE providers relative to outcomes of patients treated by a comparison group of non-COHE providers working within the same Renton pilot area. Their research defined the 12- month period beginning July 2003 as the evaluation year and tracked patients, on average, for 15 months. Information gathered also included patient data from a baseline period representing July 2001 through June 2002. These data, along with other data representing patient age, gender, injury type, and provider type, were used to perform multivariate statistical analysis.
Their final evaluation was based upon analysis of 22,544 cases treated in the evaluation year: 10,725 COHE cases and 11,819 comparison-group cases. The COHE cases derive from 119 attending doctors recruited for the pilot, who treated workers during the evaluation year. The comparison group consists of all providers (845) who were known to be attending doctors in the workers’ compensation system in the pilot area.
The measures for the evaluation derived from L&I administrative data include:
% of total cases that went on disability (time loss) % of cases on disability at different time points post claim receipt, e.g., 90 days, 180 days, or 360 days Duration of disability measured in days from claim receipt Disability costs Medical costs Total costs (sum of medical and disability costs)
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As part of the evaluation, UW researchers analyzed other measures obtained from specially designed surveys. These measures include:
Worker satisfaction with health care Worker employment outcomes Provider satisfaction
Researchers conducted a series of analyses to assess the effects of the COHE. These analyses primarily involved comparison of measures for COHE cases and comparison-group cases for the evaluation year.
The evaluation found important differences favoring the COHE in disability measures, employment outcomes, and medical and disability costs. At the same time, COHE patients were just as satisfied with their care as (comparison-group) patients treated by non-COHE providers. Further, the provider survey indicated that the majority of COHE providers were satisfied with the pilot, felt their ability to treat injured workers had improved, and reported greater willingness to treat more injured workers.
Major findings regarding disability and employment outcomes include:
COHE patients had lower incidence of (time loss) disability: 16.0% versus 20.7%. A smaller proportion of COHE compensable cases were on time loss at 180 days and 360 days: 16.8% versus 21.5%, and 7.7% versus 10.8%, respectively. COHE patients on time loss, on average, had fewer days of disability: 85.7 days versus 104.6 days. COHE patients with carpal tunnel syndrome on time loss had fewer days of disability: 69.1 days versus 126.2 days. COHE patients and non-COHE patients were equally satisfied with regard to perceived quality of care, coordination of care, difficulty in obtaining care, and related satisfaction measures. COHE patients were 55% more likely to return to work for the same employer they worked for at the time of their injury. COHE patients were 65% more likely to be working at the time of the survey (approximately 6 months after claim receipt).
The favorable findings with regard to disability were partly responsible for reduced medical and disability costs among COHE patients:
Among all (22,544) cases treated in the evaluation year, COHE patients experienced lower medical costs per claim and lower disability costs per claim: $1,780 versus $2,167 and $710 and $1,210, respectively.
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The evaluation’s multivariate statistical analysis estimated savings in cost per claim associated with the COHE of approximately $401. Aggregate net savings, based upon 10,700 patients treated in the evaluation year and administrative costs borne by L&I of $190,000, are $4,100,700, or $383 per case.
Worker treatment through the Renton COHE led to a substantial reduction in disability incidence and duration, which was associated with improved employment outcomes. These improved disability and employment outcomes also led to significant cost savings. These outcomes were achieved without sacrificing provider choice or diminishing patient satisfaction with health care.
D. EASTERN WASHINGTON COHE AT ST. LUKE’S REHABILITATION INSTITUTE To conduct the evaluation on the effects of a COHE, the University of Washington team employed the same analysis measures as were used during the Renton COHE evaluation. The Eastern Washington COHE evaluation was based upon analysis of 11,526 cases treated in the evaluation year: 7,162 COHE cases and 4,364 comparison-group cases. Treatment of the 7,162 COHE cases was provided by 177 health care providers recruited for the pilot who submitted one or more claims during the evaluation year. The comparison group consisted of all health care providers who were not participating in the COHE and who were delivering medical care to injured workers in the pilot area. For the evaluation year, there were 451 such health care providers.
Major findings regarding disability and cost outcomes include:
For all cases treated in the evaluation year (11,526), COHE injured workers, including those with back pain diagnoses, had lower incidence of (time loss) disability: 15.1% versus 21.5%. For compensable cases (2,020), the proportion of COHE and comparison-group cases on long-term time loss (180-day or 365-day) was similar, but COHE cases treated by “high volume” providers were less likely to be on disability 365 days after claim receipt: 2.2% versus 14.0%. For compensable cases, there were no significant differences in mean or median disability days for COHE cases as compared to comparison-group cases. For cases treated in the hospital emergency department, there were no significant differences between COHE cases and comparison-group cases with regard to incidence of time loss or, among compensable cases, the proportion of workers on long-term disability. COHE cases and non-COHE cases were equally satisfied with regard to perceived quality of care, coordination of care, difficulty in obtaining care, and related satisfaction measures.
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Among all (11,526) cases treated in the evaluation year, COHE cases experienced lower medical cost per claim and lower disability cost per claim: $1,643 versus $2,138 and $610 and $930, respectively. The evaluation’s multivariate statistical analysis estimated savings in cost per claim associated with the COHE of approximately $475. Aggregate net savings based upon 7,000 injured workers treated through the COHE, including annual COHE administrative costs of $190,000 supported by L&I, would be approximately $3,135,000 or $447 per case.
As a result of their assessment, the evaluation team determined that the incidence of disability (time loss) to be lower for COHE cases than comparison-group cases, and this difference, in part, resulted in lower medical and disability costs for COHE cases. However, COHE cases for which workers had carpal tunnel syndrome showed no difference in disability. The worker satisfaction surveys administered as part of the evaluation indicated that COHE injured workers were as satisfied with the care they received as comparison-group injured workers and achieved similar employment outcomes. Data gathered through a provider survey indicated that the majority of COHE providers who responded were satisfied with the pilot, felt their ability to treat injured workers had improved, and reported greater willingness to treat more injured workers in the future.
In conclusion, the team identified that one of the important apparent effects of the Eastern Washington COHE was that it showed signs of lowering the incidence of disability among workers, including workers with back pain diagnoses. This reduced disability incidence led to a corresponding reduction in medical and disability costs. These outcomes were achieved without sacrificing provider choice or diminishing worker satisfaction with health care. Opportunities to improve outcomes for workers treated in emergency rooms and with carpal tunnel syndrome exist.
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Appendix F Work Breakdown Structure
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Appendix F – Work Breakdown Structure
Note: To be used for system definition and cost estimating
1. MANAGEMENT
1.1 Project Management 1.1.1 Scope 1.1.1.1 Phase 1 1.1.1.2 Phase 2 1.1.1.3 Phase 2I 1.1.2 Schedule 1.1.3 Project Resources 1.1.3.1 Project Manager
1.1.3.1.1 Project Support/Technical Writer 1.1.3.2 Development Vendor
1.1.3.2.1 Lead Architect 1.1.3.2.2 SOA Architect 1.1.3.2.3 Application Systems Analyst Designer 1.1.3.2.4 Programmers 1.1.3.2.5 DBA 1.1.3.2.6 Trainers 1.1.3.3 L&I Architect Team
1.1.3.3.1 Solution Architect (Liaison) 1.1.3.4 Web Design Team
1.1.3.4.1 User Experience Developer 1.1.3.4.2 User Experience Designer 1.1.3.4.3 Usability Specialist 1.1.3.4.4 User Researcher 1.1.3.5 L&I Business Subject Matter Experts
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1.2 Project Oversight 1.2.1 Independent Quality Assurances 1.3 Operations and Maintenance 1.3.1 Technical Application Support 1.3.2 SOA Configuration Support
2. INFRASTRUCTURE
2.1 Data Center (L&I Standard) 2.2 Hardware 2.2.1 Desktop 2.2.1.1 Computer (L&I Standard) 2.2.1.2 Network Connection (L&I Standard) 2.2.1.3 Printer (L&I Standard) 2.2.2 Environments 2.2.2.1 Development
2.2.2.1.1 Service Management 2.2.2.1.2 Enterprise Service Bus 2.2.2.1.3 Business Rules Management 2.2.2.1.4 Solution Server 2.2.2.1.5 SOA User Interface Server 2.2.2.1.6 Imaging 2.2.2.1.7 Entitlement Management 2.2.2.2 Test
2.2.2.2.1 Service Management 2.2.2.2.2 Enterprise Service Bus 2.2.2.2.3 Business Rules Management 2.2.2.2.4 Solution Server 2.2.2.2.5 SOA User Interface 2.2.2.2.6 Imaging 2.2.2.2.7 Entitlement Management 2.2.2.3 Pre-Production
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2.2.2.4 Production 2.2.3 Servers 2.2.3.1 Windows Servers (Can Be Virtualized)
2.2.3.1.1 Web Server (2) 2.2.3.1.2 Business Application Server (2) 2.2.3.1.3 Database Server (2) 2.2.3.1.4 Development Server 2.2.3.1.5 Testing/QA Server 2.3 Network 2.3.1 L&I Network 2.3.2 L&I Public Network Operating through Secure Access Washington 2.4 Storage 2.5 Security and Privacy 2.6 Facilities 2.7 Software 2.7.1 Desktop Software 2.7.1.1 Windows (L&I Standard) 2.7.1.2 Internet Explorer (L&I Standard) 2.7.1.3 MS Office (L&I Standard)
2.7.1.3.1 MS Word 2.7.1.3.2 MS Excel 2.7.1.4 Business
2.7.1.4.1 Business Analyst 2.7.1.4.2 Subject Matter Experts 2.7.2 Server Software
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2.7.2.1 MS Windows (L&I Standard) 2.7.2.2 MS Enterprise SQL Server (L&I Standard) 2.7.2.3 .Net Visual Studio (L&I Standard) 2.7.3 Application Licensed Software 2.7.3.1 FileNet Client
3. APPLICATION FRAMEWORK
3.1 Security (L&I Service) 3.2 OHMS Application 3.2.1 Access Layer 3.2.2 User Interface 3.2.2.1 Internal User Access through the AquaLogic Portal and JSR-168 Portlets 3.2.2.2 Browser Applications
3.2.2.2.1 Standard Web Browser 3.2.3 Process Layer 3.2.4 Business Function Layer 3.2.4.1 Composite Services 3.2.4.2 Atomic Services 3.2.4.3 Custom Business Logic 3.2.4.4 Rules Engine (WebSphere ILOG JRules) 3.2.5 Application Services Layer 3.2.5.1 Data Services 3.2.5.2 Framework Services
3.2.5.2.1 Image Search, Storage, and Retrieval 3.2.5.2.2 Generation of Correspondence 3.2.5.2.3 Workload Tracking and Management 3.2.5.2.4 Rules Engine Interface
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3.2.5.3 Other Services 3.2.5.4 Custom Business Logic 3.2.6 Enterprise Service Bus 3.2.6.1 Service Mediation 3.2.6.2 Message Transformation 3.2.6.3 Message Routing 3.2.7 Service Communication and Transport 3.2.8 Data Access 3.2.8.1 API for Typical CRUD Operations 3.2.8.2 Communications with Legacy Systems Will Use WebSphere Message Broker 3.2.9 System Layer 3.2.9.1 OHMS Database 3.2.9.2 ECS Database 3.2.9.3 LINIIS SQL Replication Database 3.2.9.4 ECS Rules Base 3.2.9.5 LEGACY Systems
3.2.9.5.1 LINIIS 3.2.9.5.2 ORION 3.2.9.5.3 MIPS 3.2.10 Support and Systems Management Layer 3.2.10.1 Quality of Service
3.2.10.1.1 Service Management 3.2.10.1.2 Entitlement Management 3.2.10.1.3 Policy Management 3.2.10.2 Service Registry and Repository 3.2.10.3 Logging, Audit, and Reporting
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4. WEB PORTAL SERVICES
4.1 General Portal Framework (L&I Standard) 4.2 COHE and HSC View 4.2.1 OHMS Portal 4.2.2 CAC Portal 4.2.3 Provider Payment Express 4.2.4 FileFast 4.2.5 [Provider Systems] Portal 4.3 HSA View (Includes Contract Management) 4.3.1 CAC Portal 4.3.2 ORION Portal 4.3.3 OHMS Portal 4.3.4 LINIIS 4.3.5 MIPS 4.4 Claims Manager View 4.4.1 LINIIS Portal 4.4.2 MIPS Portal 4.4.3 ORION Portal 4.4.4 OHMS Portal (For COHE 6 Claims Managers) 4.5 Provider View 4.5.1 CAC Portal 4.5.2 FileFast Portal 4.5.3 Provider Express Billing Portal 4.5.4 OHMS (Phase 2) 4.6 Employee View 4.6.1 FileFast Portal 4.6.2 CAC Portal 4.7 Employer View 4.7.1 FileFast Portal
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4.7.2 CAC Portal
5. APPLICATION SERVICES
5.1 Claim Prioritization 5.1.1 Claims Work list Prioritization/Triage 5.1.2 Claims Automated Risk Assessment 5.1.3 Workflow and Triggering Service 5.1.3.1 Manage Alerts/Notification Rules 5.1.3.2 Manage Workflow Queues 5.1.3.3 Provide Workflow Snapshot (Management) 5.2 Contract Management Service (L&I) 5.2.1 Manage Best Practice Services 5.2.2 Manage L&I Incentives (MIPS) 5.2.3 Manage HSC Enrollment (MIPS) 5.2.4 Manage Provider Enrollment (MIPS) 5.2.5 Manage APP Enrollment (Same as Provider) 5.2.6 Manage COHE Advisor Enrollment (MIPS) 5.2.7 Manage COHE Enrollment & Parameters (Contract) 5.2.8 Track Top Tier Providers (OHMS -> MIPS) 5.2.9 Manage COHE Incentives 5.2.10 Submit HSC Billing and Documentation 5.2.11 Manage Employer Information 5.2.11.1 Maintain Employer Contacts 5.3 Contact Management (L&I and COHE Staff) 5.3.1 Track Employer Contacts 5.3.2 Track Employee Contacts 5.3.3 Track APP Contacts 5.3.4 Query Employer Information 5.3.5 Query Worker Information
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5.3.6 Query APP Information 5.3.7 Query Provider Information 5.3.8 Query COHE Advisors Information 5.3.9 Query HSC Information 5.4 Electronic Communications 5.4.1 Secure Email Communication 5.4.1.1 HIPAA Compliant 5.5 Case Management (HSC) 5.5.1 Display Best Practice Performance Dashboard 5.5.2 Track RTW Barriers 5.5.3 Track Work List & Workflows 5.5.4 Track Employee Notes 5.5.5 Manage Activity Prescription 5.5.6 Track Provider Intervention 5.5.7 Track Outcomes and Completions 5.5.8 Track Provider Referrals (LINIIS) 5.5.9 View Claim Related Documents (From ORION) 5.5.10 Query Claims Issues (LINIIS) 5.5.11 Query Employee Treatments (LINIIS) 5.5.12 Query Provider Services (LINIIS/ MIPS) 5.5.13 Query Provider Prescriptions (LINIIS) 5.6 Event Activity Tracking 5.6.1 Track Provider Incentives (MIPS) 5.6.2 Track COHE Advisor Consultations 5.6.3 Track HSC Activity 5.6.4 Track Functional Recovery Questionnaire 5.6.5 Capture Activity Prescriptions 5.6.6 Alert High-Risk Claim
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5.7 Subscription and Notification 5.7.1 Subscription Service 5.7.2 Notification Service 5.8 Scale Management 5.8.1 Manage Scales Table 5.8.2 Apply Scales to Injured Workers (Automated) 5.9 Reporting Service 5.9.1 L&I Reporting to COHE 5.9.1.1 Weekly Reporting to COHE 5.9.1.2 Monthly Reporting to COHE 5.9.1.3 Quarterly APP Reporting 5.9.2 COHE Reporting to L&I 5.9.3 Support Reports 5.9.3.1 List of COHES 5.9.3.2 List of HSC 5.9.3.3 HSC Activity Report 5.9.3.4 Claims with HSC Activity 5.9.3.5 APP Report 5.9.3.6 Provider – Employee Report 5.9.3.7 Injured Worker Scales 5.9.3.8 Provider Scales Aggregate 5.9.3.9 COHE Scales Aggregate 5.9.3.10 Claim Detail Report 5.9.3.11 List of ROAs 5.9.3.12 List of Functional Recovery Questionnaires 5.9.3.13 Employee Work List 5.9.3.14 RTW Report 5.9.3.15 HSC Contacts Report
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5.9.3.16 HSC Reminder Report 5.9.3.17 HSC Intervention Report 5.10 Learning Service 5.10.1 Manage Training Classes 5.10.2 Manage Training Enrollment 5.10.3 Track Provider Training Credit 5.10.4 ELearning Reporting 5.10.4.1 Training Class Schedule 5.10.4.2 Training Enrollment Reports 5.10.4.3 HSC Training Credit Report 5.10.4.4 COHE Staff Training Report 5.10.4.5 Training Delivery by COHE 5.10.4.6 Provider Training Report 5.10.4.7 Training Negative Report 5.11 Knowledge Management Service 5.11.1 Best Practices 5.11.2 Specialty Knowledge Management 5.11.3 Medical Terminology 5.11.4 Standard Medical Codes 5.11.5 Standard Rates Tables 5.11.6 WAC Rules 5.12 Help Service 5.12.1 Online Help 5.12.2 Frequently Asked Questions 5.12.3 Incident Tracking 5.12.4 Wiki Best Practices 5.13 Business Intelligence 5.13.1 COHE Activity Statistics (Monthly, Quarterly, Annually)
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5.13.2 Provider Activity Statistics 5.13.3 Employee Statistics 5.13.4 Claims Trends 5.13.5 Provide Claims Dashboard and Drill Down
6. REPORTING TOOLS
6.1 Decision Support 6.2 Crystal Reports
7. EXTERNAL SYSTEM CHANGES
7.1 LINIIS 7.1.1 Data Changes 7.1.2 Application Changes 7.2 MIPS 7.2.1 Data Changes 7.2.2 Application Changes 7.3 ORION 7.3.1 Data Changes 7.3.2 Application Changes 7.3.3 New Document Types 7.4 CAC 7.4.1 Data Changes 7.4.2 Application Changes 7.4.3 Security Upgrade 7.5 Data Warehouse 7.5.1 Historical Data 7.5.2 Data Extracts
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8. INTERFACES
8.1 Replication Process New Data Stores 8.2 LINIIS 8.2.1 Claims Information 8.3 MIPS 8.3.1 Payments 8.4 MPN 8.4.1 Provider Registration 8.5 CAC 8.5.1 Claims 8.6 ORION 8.6.1 Claims Images 8.6.2 Claims 8.7 FILEFAST 8.7.1 ROA 8.8 Provider 8.8.1 HIE 8.9 Provider Express Billing 8.9.1 Employee Billing 8.9.2 HSC Activity
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Appendix G Health Information Exchange in Washington
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Appendix G – Health Information Exchange in Washington
Health information exchange (HIE) is a term used to describe the sharing of data among enterprise trading partners, rather than just within a single enterprise. In Washington State the health care community has been working for years toward the improvement of patient outcomes and reduced costs. However, one of the main barriers to progress remains: the inability to easily share health information between and among health organizations. This barrier proves especially complex considering patient information can be so fragmented across hundreds of enterprises, and thus making it difficult for any one enterprise to significantly improve their performance without engaging with their trading partners.14
In response to this conundrum health information exchange (HIE) has become a top priority among many in the health care community. Furthermore, HIE can be attributed for much of the recent health care legislation and the pursuit for a solution that will allow for organizations to appropriately share data externally, while enhancing the use of this information internally.
E. HITECH The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of the American Recovery and Reinvestment Act of 2009 and was signed into federal law on February 17, 2009. HITECH is being administered on behalf of the Department of Health and Human Services (HHS) by the Office of the National Coordinator for Health Information Technology (ONC) and provides billions of dollars to help expand the use of health information.
The shared notion is that health information technology helps save lives and lower costs. To that extent, HITECH accomplishes four major goals that advance the use of health information technology (HIT), such as electronic health records by:15
Requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care. Investing $20 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health information.
14 OneHealthPort Website, http://onehealthport.com/index.php, accessed February 3, 2012. 15 Health Information Technology for Economic and Clinical Health Act, Committees on Energy and Commerce, Ways and Means, and Science and Technology, January 16, 2009.
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Saving the government $10 billion, and generating additional savings throughout the health sector, through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care. Strengthening federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of health IT.
As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.16
In Olympia, a new law was enacted to accelerate the secure exchange of “high value” health data, including lab results, medications, immunizations, diagnostic images, and more. The law directs the Washington State Health care Authority (HCA) to designate a private sector organization to lead implementation of HIE, OneHealthPort.17
F. OneHealthPort
In response to both the federal grant opportunity and state law, the Health care Authority (HCA) has designated OneHealthPort to serve as the lead HIE organization in the State of Washington. In this role, OneHealthPort is responsible for:
Leading initial development of HIE in a manner that will comply with the new state law (SB 5501 is now part of the Revised Code of Washington, Chapter 41.05) Satisfying the grant objectives of the federal Health HITECH Act Attracting private and public sector stakeholders to invest and participate in HIE
OneHealthPort is a health technology management organization created in 2002 by local health care organizations to streamline and accelerate the exchange of business and clinical information in the Northwest. OneHealthPort is not compensated for its work as lead HIE organization; it is funded through the support of the Washington Health care Forum and its board of directors.18
To date, several organizations have already contracted with the HIE and are making preparations to exchange transactions; these organizations will be included in each update and posted on the OneHealthPort Website. 19 As organizations join the HIE, they will be added to the Website so
16 Health Information Technology for Economic and Clinical Health Act, Committees on Energy and Commerce, Ways and Means, and Science and Technology, January 16, 2009. 17 OneHealthPort Website, http://onehealthport.com/index.php, Accessed February 3, 2012. 18 OneHealthPort Website, http://onehealthport.com/index.php, Accessed February 3, 2012. 19 OneHealthPort Website, http://onehealthport.com/index.php, Accessed February 3, 2012.
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trading partners (and those interested in joining the HIE) know who is participating and what transactions they are prepared to exchange.
Below is a list of HIE participants as of November 2011.
(GRAPHIC PROVIDED BY ONEHEALTHPORT)
G. NwHIN The Nationwide Health Information Network, formerly known as National Health Information Network (NHIN), is an initiative for the exchange of health care information. This initiative is being developed under the watch of the U.S. Office of the National Coordinator for Health Information Technology (ONC). The ONC has been facilitating development of the NwHIN, which will tie together health information exchanges, integrate delivery networks, pharmacies, government, labs, providers, payers, and other stakeholders into an all-encompassing network of information sharing.20
One of the distinguishing characteristics of a health care system that participates in the NwHIN is the acquisition of an OID, or an organizational identifier. The OID is issued by the ONC and allows the individual health care system or vendor to receive and send messages to trusted entities within the NwHIN. This information travels through an interface such as the NwHIN Connect, or some other custom built application like Mirth Connect built in a Java user interface (UI).
20 Office of the National Coordinator for Health Information Technology (ONC) Website, http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&cached=true&objID=1200, Accessed Febrary 3, 2012.
4016.001\OHMS Feasibility Study\4.0 G-3 FINAL sooscreekconsulting.com 3/5/2012 Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
NwHIN is being built entirely on open source code utilizing the Java platform. This tactic is strategic in that it provides for greater facilitation of technical information, particularly through the use of forums, and potentially the ONC. The hope is that providing this information online to potential health care systems or vendors increases the chances for utilization of such a technology.21
H. Near Future HIE Trading Partners The OneHealthPort HIE team continues to work closely with several organizations across the State of Washington as they prepare to join the HIE. Overlake Hospital Medical Center, MultiCare Health System, Seattle Children’s, Evergreen Hospital Medical Center, Department of Health, Premera Blue Cross, Wenatchee Valley Medical Center, Kadlec Health System, Kennewick General Hospital, Our Lady of Lourdes Hospital, Yakima Memorial Hospital, and Inland Imaging are several of these organizations exploring the best ways to leverage their technology investments through HIE. In addition to making connections to local trading partners, many of these organizations are also facilitating conversations in their immediate trading communities to use HIE to extend connectivity and information exchange beyond their traditional care service areas. On the national front, OneHealthPort is actively working with LabCorp to coordinate HIE connectivity.22
21 Connect Community Portal Website, http://www.connectopensource.org/, accessed February 3, 2012. 22 OneHealthPort Website, http://onehealthport.com/index.php, accessed February 3, 2012.
4016.001\OHMS Feasibility Study\4.0 G-4 FINAL sooscreekconsulting.com 3/5/2012 Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Appendix H Vendor Survey
4016.001\OHMS Feasibility Study\4.0 H-0 FINAL sooscreekconsulting.com 3/5/2012 WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-1
Company Products/Solutions Company Facts Partners Focus
*Corporate Headquarters: Epic makes software for mid-size and large medical EPIC EpicCare Ambulatory Core 1979 Milky Way groups, hospitals and integrated healthcare EMR & Verona, Wisconsin 53593 organizations – working with customers that include http://www.epic.com/ No mention of partners on their site community hospitals, academic facilities, children's EpicCare Inpatient Core *Founded in 1979 organizations, safety net providers and multi-hospital EMR systems. Our integrated software spans clinical, access and revenue functions and extends into the home.
We (Cerner) are transforming health care by *BMC eliminating error, variance and waste for health care *CareFusion providers and consumers around the world. Our *Cerner employs over 8,000 *CDW solutions optimize processes for health care Cerner *23 offices around the globe *Dell organizations ranging from single-doctor practices to PowerChart *Approximately 5,400 associates are based in *HP http://www.cerner.com/ entire countries, for the pharmaceutical and medical the Kansas City metro, home of Cerner’s *IBM device industries, and for the field of health care as a World Headquarters. *Oracle whole. Our solutions are licensed by more than 9,000 *Sprint facilities worldwide. The organizations we serve include hospitals, Meditech is a wholly owned *Medical Information Technology, Inc., or ambulatory care centers, physicians' offices, long term MEDITECH MEDITECH 6.0 platform subsidiary, LSS Data Systems, and MEDITECH . care and behavioral health facilities, and home health one corporate partner, MEDITECH http://www.meditech.com/ *Westwood, Massachusetts, USA organizations. South Africa.
Beacon Community of the Inland Northwest (BCIN) is *California, USA (Head Office) >Rhapsody Integration using technology (Orion Health Technology group) to 225 Santa Monica Boulevard, 10th Floor, improve health care for type 2 diabetes patients Engine Santa Monica CA 90401 HP, Oracle, Phillips, Initiate, Stratus Orion Health Technologies throughout the Inland Northwest. Led by INHS, BCIN Technologies, NextGate, Emdeon, >Orion Health Hospital is one of 17 communities across the country selected http://www.orionhealth.com/ *NextGate - Orion partner responsible for RX Hub, Intel. >Health Information by the U.S. Department of Health and Human Services Beacon Community work in treating type 2 to serve as pilot communities for eventual wide-scale Exchange (HIE) diabetes patients throught Inland Northwest. use of health information technology.
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-2
Company Products/Solutions Company Facts Partners Focus *Since 1995
- Medical Bill Review *Sacramento, CA 95827 - Utilization Review Toll Free: 888-290-1911 Allied Managed Care - Medical Case Mgmt Local: 916- 563-1911 www.alliedmanagedcare.co Medical Case Management No mention of partners on their site - Medical Provider Network/PPOs - May not be focused enough on Case Mgmt *Allied Managed Care m - Owns "AIMS" - Acclamation Insurance Mgmt 900 Fort Street Mall, Suite 1000 Services Honolulu, HI 96813 Local: 808-534-1977 CaseManagement.com, Inc. was organized in 1999 to provide a case management system for the benefit of Case Management.com *Headquarters in Charlotte, North Carolina No partners mentioned on their site patients, case managers, health care providers, E-Reports *Since 1999 www.casemanagement.com insurers, employers, employees, and consumers of health care services.
*Ingenix (part of UnitedHealth Group - consulting) *McKesson Corp (consulting) *Care Mgmt *Milliman Care Guidelines *Case Mgmt CASENET *Headquarters in Bedford, MA (guidelines) *Disease Mgmt Case Management *Public company (board of directors) *Emmi Solutions (patient www.casenetinc.com *Utilization Mgmt experience) *Extended Enterprise *FICO Blaze Advisor (rules) *Jaspersoft (business intellegence) *CloverETL (data evaluation)
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-3
Company Products/Solutions Company Facts Partners Focus
*Company is IMA Technologies *Headquarters in Sacramento, CA *Company since 1990; software since February 1994. Casetrakker *2.2 million in sales in 2009 *Milliman Care Guidelines *Case Mgmt CaseTrakker *25 employees *McKesson Consulting *Article mentions that their focus is customized www.casetrakker.com *Microsoft (technology partner) solutions that ensure flexibility *General Contact Information: IMA Technologies Corporation 990 Reserve Drive, Suite 200 Roseville, CA 95678
*Cincinati, OH headquarters *Microsoft (tech partner) * Regulation Compliance *Started in 1993 *CaseAccess (ASP partner) *Utilization Mgmt *6.9 million in sales in 2009 CH Mack Q Continuum System's and *Milliman Care Guidelines *Case Mgmt *20 employees www.chmack.com MedCompass™ (guidelines partner) *Automated Workflow *McKesson (consulting/integration *Administrative Processes partner) *Disease Mgmt
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-4
Company Products/Solutions Company Facts Partners Focus - Headquarters in Wayne, PA - Business Objects (SAP) - Focus seems to be providers - Since 1988 (technology partner) - Estimated annual sales is $45 million in 2009 - Oracle (technology partner) - 250 employees - FairIsaac (financial operations) - Top Down Systems (technology partner) - InterSystems (Cache systems - provider portal) Medecision, Inc. InFrame™ and Alineo® - Milliman Care Guidelines www.medecision.com and Nexalign® (guidelines) - Thomson Reuters (data analysis) - Verisk Health (data analysis) - NaviNet (EMR) - NextGen (Health Quality Measures) - FIS (payment technology) - Availity (paperless processes for providers) - Headquarters in Auburn, CA (Northern CA) - The CaseiS lManaement i ( i Society of ) - Case Mgmt - Since 1983 America - Utilization Mgmt TCS Healthcare - McKesson Consulting - Disease Mgmt Acuity Advanced Care® - Milliman Care Guidelines - Population Mgmt & Stratification www.tcshealthcare.com - Life: WIRE (chronic disease) - Prevention & Wellness Programs - Thomson Reuters (data analysis) - Outcomes Reporting - SAP (technology partner)
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-5
Company Products/Solutions Company Facts Partners Focus - US Headquarters in Virginia, but has offices - HP - Social services software in Dublin, Toronto, Frankfurt, UK, Sidney, and - IBM India. - Oracle Social Assistance - Acutate Family Services - CRC Disability & Workers' Compensation - Accenture Client: WorkSafeBC - CAI (Health and Human Services WorkSafe SA Computer Aid, Inc.) Employment CRM Healthcare Cúram Business - ciber www.curamsoftware.com Application Suite - Connvertex - eSystems - Keane - MajescoMastek - Quartech - Redmane - Sierra - Sylogix - Unisys *Chat w/ a sales Rep function/option on 163 partmers. Pick one… Software; CRM Microsoft Dynamics CRM website* http://crm.dynamics.com/en- Microsoft Dynamics CRM 877-276-2464 us/home cloud computing, CRM Salesforce.com Force.com (customized http://www.salesforce.com case tracking)
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-6
Company Products/Solutions Company Facts Partners Focus Lots of partners is assumed, although Infor is the third largest provider of enterprise >Approximately 8,000 employees not clear from Website. applications and services, helping 70,000 customers in >120 offices in 36 countries 164 countries improve operations, drive growth and >70,000 customers worldwide quickly adapt to changes in business demands. Infor Infor >Implementation and support in 164 countries offers deep industry-specific applications and suites, Epiphany (CRM) >2,300 developers engineered for speed, using ground-breaking http://www.infor.com/ >2,400 consulting experts technology that delivers a rich user experience, and >1,300 support professionals flexible deployment options that give customers a >1,100 channel partners choice to run their businesses in the cloud, on- premises or both.
Streamlining processes, enabling collaboration, Demo: (http://www.covisint.com/web/guest/for-states- Covisint DocSite™ PQRS and improving the quality of care across the and-hies) (Physician Quality healthcare continuum. Solutions for:Hospitals & Health COVISINT Reporting System) SystemsStates & HIEsPhysicians http://www.covisint.com/web/g uest/home Covisint ExchangeLink™ Platform
AppCloud®
Cielo MedSolutions is a leading provider of healthcare software for ambulatory care Cielo - Med Solutions providers. http://www.cielomedsolutions.c Cielo Clinic tool om/default.asp
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-7
Company Products/Solutions Company Facts Partners Focus The firm is a private, wholly owned subsidiary Health Dialog is a leading provider of care of Bupa, a global health and care company of management, healthcare analytics, and decision Health Dialogue more than $12 billion in revenues support. Population Insight - headquartered in London, England. Health http://www.healthdialog.com/M Dialog provides population analytics, Analytics Tool ain/default interactive decision aids, and healthcare decision programs to over 17 million people around the world. Corporate Headquarters: MedAssurant, Inc., is a leading technology-enabled 4321 Collington Road health care solutions provider focused on the Bowie, Maryland 20716 importance of health care data and its ability to drive *Claims Payment and dramatic, objective improvement in clinical and Integrity *MedAssurant has spent 13 years and quality outcomes care management and financial significant resources developing, innovating, performance throughout the health care community. and honing a suite of technologies designed to Proprietary health care datasets, aggregation and *Care Coordination and Med Assurant bring meaningful improvements in health care. analysis capabilities, combined with a national Enhancement From data integration toolsets and industry- infrastructure of leading-edge technology, clinical http://www.medassurant.com/P leading data warehouse architectures, to prowess and deep human resources, empower ages/default.aspx advanced analytics and predictive modeling, MedAssurant’s advanced generation of health care *Healthcare Data Insights MedAssurant’s technologies inform the assessment and improvement solutions. Driven by a identification of gaps in care, quality, and data mission to improve today’s health care landscape, the *Clinical & Quality accuracy to drive highly targeted insight and employees of MedAssurant proudly apply care, informed intervention – providing an end-to- ingenuity and dedication to delivering a new approach Outcomes end platform to bring meaningful improvement to health care touching more than 100 million on a national scale – with patient-specific Americans – one driven by data and insight – one precision. resulting in meaningful action.
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-8
Company Products/Solutions Company Facts Partners Focus *100 Mansell Court East, Suite 625, Roswell, http://www.wellcentive.com/partners At Wellcentive, our mission is to enable healthcare GA 30076 | 877-295-0886 / organizations of all sizes to focus on delivering the best possible care each and every day, while Vendors: Epic, Cerner, Covisint, improving profitability and efficiency. Stakeholders etc…. throughout the healthcare industry are adopting Well Centive Payers: Priority Health, Humana technology that facilitates connection, communication, WellCentive Connect Labs: robust analysis and reporting, and continual quality http://www.wellcentive.com/ Health Systems: improvement. By understanding the needs of the HIE present and anticipating the imperatives of tomorrow, we offer integrated healthcare intelligence solutions that empower healthcare organizations to become the future of healthcare.
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-9
Company Products/Solutions Company Facts Partners Focus ZeOmega, founded in 2001, is a leading 3M, AVAYA, healthwise, ZeOmega is a leading provider of web-enabled and provider of automated workflow solutions and McKesson, Milliman- Care rules-driven workflow software for integrated care integrated content for healthcare management. Guidelines, etc. management. Our software solutions transform Our web-based solutions are used in private traditional episodic-based care management into a and public healthcare and workers' proactive and collaborative population healthcare compensation programs. management paradigm. We provide solutions that enable an integrated and collaborative management of members' health through electronic health record (EHR) enabled care plans, point of care tools, decision support, care analytics, and configurable workflows for care management. We build solutions to facilitate collaboration *Kriya - Workers’ Comp among stakeholders enabling clients to Zeomega System implement disparate health care management strategies for overall improvement in quality of http://www.zeomega.com/ care, member satisfaction and cost savings. *Jiva With our strong healthcare domain expertise, emphasis on integrated information management and decision support for population and benefits management, we are the right technology partner for health plans, disease management organizations, patient- centered medical homes (PCMH), medical management organizations, third-party administrators (TPA), and other organizations providing medical and care management services.
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-10
Company Products/Solutions Company Facts Partners Focus QlikTech was founded on the belief that business intelligence (BI) should be about business users. Founded in Lund, Sweden in 1993 Traditional BI solutions have become bloated, Over 22,000 Customers in more than 100 complex software stacks, leaving users confused and Countries frustrated. For 18 years, QlikTech has focused on Over 1,000 Employees Worldwide simplifying decision making for business users across QlikView Headquartered in Radnor, organizations. We pioneered new approaches to QlikView PA, USA accessing, managing, and interacting with data. Our http://www.qlikview.com/ QlikView Business Discovery platform is recognized as a groundbreaking solution. Combined with a relentless focus on customer success and a vibrant, passionate user community, it’s no wonder more than 22,000 companies in over 100 countries use QlikView, with an industry-leading 96% satisfaction t
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 VENDOR SURVEY APPENDIX H-11
Company Products/Solutions Company Facts Partners Focus Distribution solutions. We are the largest No mention of partners on their site McKesson is dedicated to delivering the vital pharmaceutical distributor in North America, medicines, medical supplies and information distributing one-third of the medicines used technologies that enable the health care industry to every day. We supply more than 40,000 U.S. provide patients better, safer care. pharmacy locations, from Wal-Mart to the Department of Veterans Affairs to community McKesson is made up of many businesses, all serving pharmacies and hospitals. McKesson is also the health care industry. one of the leading medical supply companies and distributes medical-surgical supplies and homecare supplies.
Technology solutions. We develop and install McKesson healthcare information technology systems that http://www.mckesson.com/en_u InvestiClaim eliminate the need for paper prescriptions and s/McKesson.com/ paper medical records. Our software and hardware are used in more than 70% of the nation's hospitals with more than 200 beds. Our hospital information system solutions include electronic health record system (EHR) and clinical decision support system such as Interqual. McKesson's Healthcare IT division also serves diverse areas within the health industry by offering solutions such as pharmacy automation and medical claims management software.
4016.001\OHMS Vendors v4 (xls)||Vendor List sooscreekconsulting.com Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Appendix I Cost-Benefit Spreadsheets
4016.001\OHMS Feasibility Study\4.0 I-0 FINAL sooscreekconsulting.com 3/5/2012 WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-1 WORKSHEET: TOC
Tab Name Appendix TOC Table of Contents I-1 Summary Summary of Alternatives I-2
Alternative 1 - Internal Development CBA1 (0) Form 1 - Summary, Cost Benefit and Cash Flow Analysis I-3 CBA2 (0) Form 2 - Project Detail Cost Flow Analysis I-4 CBA3 (0) Form 3 - Summary, Operations Incremental Cost of Project I-5 CBA4 (0) Form 3 - Summary, Operations Incremental Cost of Project I-6 CBA5 (0) Form 5 - Benefits Cash Flow Analysis I-7 CPC (0) Current Program Costs Worksheet I-8 PPC (0) Proposed Program Costs Worksheet I-9 PRJ (0) Project - One Time Change Cost Worksheet I-10 Build(0) Build In-House Application High-Level Estimate of Effort I-11 Alternative 2 - Internal Development/EMR Integration CBA1 (1) Form 1/ Summary, Cost Benefit and Cash Flow Analysis I-12 CBA2 (1) Form 2/ Project Detail Cost Flow Analysis I-13 CBA3 (1) Form 3/ Summary, Operations Incremental Cost of Project I-14 CBA4 (1) Form 3/ Summary, Operations Incremental Cost of Project I-15 CBA5 (1) Form 5/ Benefits Cash Flow Analysis I-16 CPC (1) Current Program Costs Worksheet I-17 PPC (1) Proposed Program Costs Worksheet I-18 PRJ (1) Project - One Time Change Cost Worksheet I-19 Build(1) Build In-House Application High-Level Estimate of Effort I-20 Alternative 3 - External Product Integrator CBA1 (2) Form 1/ Summary, Cost Benefit and Cash Flow Analysis I-21 CBA2 (2) Form 2/ Project Detail Cost Flow Analysis I-22 CBA3 (2) Form 3/ Summary, Operations Incremental Cost of Project I-23 CBA4 (2) Form 3/ Summary, Operations Incremental Cost of Project I-24 CBA5 (2) Form 5/ Benefits Cash Flow Analysis I-25 CPC (2) Current Program Costs Worksheet I-26 PPC (2) Proposed Program Costs Worksheet I-27 PRJ (2) Project - One Time Purchase Cost Worksheet I-28 Alternative 4 - External Product Integrator/EMR Integration CBA1 (3) Form 1/ Summary, Cost Benefit and Cash Flow Analysis I-29 CBA2 (3) Form 2/ Project Detail Cost Flow Analysis I-30 CBA3 (3) Form 3/ Summary, Operations Incremental Cost of Project I-31 CBA4 (3) Form 3/ Summary, Operations Incremental Cost of Project I-32 CBA5 (3) Form 5/ Benefits Cash Flow Analysis I-33 CPC (3) Current Program Costs Worksheet I-34 PPC (3) Proposed Program Costs Worksheet I-35 PRJ (3) Project - One Time Purchase Cost Worksheet I-36
Variables Standard Variable Assumptions I-37 CBAI DES CBA Instructions I-38
Exhibit I Summary Cost Benefit Analysis Exhibit II Alternative 1 - Internal Development Exhibit III Alternative 2 - Internal Development/EMR Integration Exhibit IV Alternative 3 - External Product Integrator Exhibit V Alternative 4 - External Product Integrator/EMR Integration
4016.001\OHMS CBA v4 (xls)||TOC sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-2 Worksheet Summary
Summary – Comparison of Alternatives
Alternative 2 - Internal Alternative 4 - External Alternative 1 - Internal Development/EMR Alternative 3 - External Product Integrator/EMR Item Development Integration Product Integrator Integration
21-Mar-12
Total Project Costs$ 9,619,062 $ 14,112,162 $ 9,106,265 $ 10,741,265 Total Benefits$ 102,893,500 $ 105,286,000 $ 102,893,500 $ 105,286,000 TOTAL OUTFLOWS$ 38,216,256 $ 36,713,987 $ 34,215,591 $ 49,141,048 TOTAL INFLOWS$ 102,893,500 $ 105,286,000 $ 102,893,500 $ 105,286,000 Net Present Value$ 42,655,740 $ 45,618,353 $ 46,579,207 $ 36,520,844 Pay Back Period Years 1111
4016.001\OHMS CBA v4 (xls)||Summary sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-3 WORKSHEET: CBA1 (0)
Form 1 - Summary, Cost Benefit and Cash Flow Analysis Alternative 1 - Internal Development 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL TOTAL OUTFLOWS 623,188 6,731,547 8,576,701 9,158,741 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 38,216,256 TOTAL INFLOWS 0 0 3,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500 NET CASH FLOW 623,188 6,731,547 5,239,201 811,259 12,743,320 12,743,320 12,743,320 12,743,320 12,743,320 12,743,320 INCREMENTAL NPV NA (6,699,224) (11,225,043) (10,557,619) (572,894) 8,936,368 17,992,808 26,617,989 34,832,447 42,655,740 Cumulative Costs NA 7,354,735 15,931,437 25,090,178 27,277,857 29,465,537 31,653,217 33,840,896 36,028,576 38,216,256 Cumulative Benefits NA 0 3,337,500 13,307,500 28,238,500 43,169,500 58,100,500 73,031,500 87,962,500 102,893,500
Cost of Breakeven Period - yrs.* NPV $ IRR % Capital Non- Discounted Discounted 5.00% 5 42,655,740 48.46%
* - "Non-Discounted" represents breakeven period for cumulative costs and benefits (no consideration of time value of money). * - "Discounted" considers effect of time value of money through incremental Net Present Value.
4016.001\OHMS CBA v4 (xls)||CBA1 (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-4 WORKSHEET: CBA2 (0)
Form 2 - Project Detail Cost Flow Analysis Alternative 1 - Internal Development 21-Mar-12
FISCAL COSTS, PROJECT FY FY FY FY FY FY FY FY FY FY DEVELOPMENT Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL Salaries and Wages (A) 135,711 377,856 377,856 377,856 0000001,269,279 Employee Benefits (B) 44,310 123,370 123,370 123,370 000000414,420 Personal Service Contracts (CA) 125,000 1,788,587 2,673,941 1,474,430 0000006,061,958 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0 000000015,870 Hardware Maintenance (EE) 0 0 0 0000000 0 Software Rent/Lease (ED) 0 150,000 300,000 600,000 0000001,050,000 Software Maintenance & Upgrade (EE) 0 0 0 0000000 0 DP Goods/Services (EL) 0 0 0 0000000 0 Goods/Services Not Listed (E) 525 1,500 1,500 1,500 0000005,025 Travel (G) 2,000 5,000 5,000 5,000 00000017,000 Hardware Purchase Capitalized (JC) 0 320,000 0 0000000320,000 Software Purchase Capitalized (JC) 0 0 0 0000000 0 Hardware Purchase - Non. Cap (KA) 1,925 3,575 0 00000005,500 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P) 0 0 0 0000000 0 Software Lease/Purchase (P) 0 300,000 300,000 1,200,000 0000001,800,000 Other (specify) ( ) 0 0 0 0000000 0 TOTAL DEVELOPMENT 311,821 3,091,408 3,787,667 3,788,156 00000010,979,052
Notes: 1) See Project Cost Estimate
4016.001\OHMS CBA v4 (xls)||CBA2 (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-5 WORKSHEET: CBA3 (0)
Form 3 - Summary, Operations Incremental Cost of Project Alternative 1 - Internal Development 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL OPERATIONS INCREMENTALCOSTS OF PROJECT (Per Form 4 - Column C) Salaries and Wages (A) 135,711 377,616 445,877 445,877 68,021 68,021 68,021 68,021 68,021 68,021 1,813,206 Employee Benefits (B) 44,310 167,440 199,563 199,563 76,193 76,193 76,193 76,193 76,193 76,193 1,068,031 Personal Service Contracts (CA) 127,072 2,311,003 3,533,178 2,927,032 1,451,353 1,451,353 1,451,353 1,451,353 1,451,353 1,451,353 17,606,401 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0000000015,870 Hardware Maintenance (EE) 0 0000000000 Software Rent/Lease (ED) 0 150,000 300,000 600,000 600,000 600,000 600,000 600,000 600,000 600,000 4,650,000 Software Maintenance & Upgrade (EE) 0 0000000000 DP Goods/Services (EL) 0 0000000000 Goods/Services Not Listed (E) 0 (22,335) (22,303) (22,335) (22,335) (22,335) (22,335) (22,335) (22,335) (22,335) (200,979) Travel (G) 0 9,320 24,720 12,448 12,448 12,448 12,448 12,448 12,448 12,448 121,174 Hardware Purchase Capitalized (JC) 0 320,000 00000000320,000 Software Purchase Capitalized (JC) 0 0000000000 Hardware Purchase - Non. Cap (KA) 1,925 3,575 000000005,500 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P) 0 0000000000 Software Lease/Purchase (P) 0 300,000 300,000 1,200,000 0000001,800,000 Other (specify) ( ) 0 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 TOTAL OPERATIONS 311,367 3,640,139 4,789,035 5,370,585 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 27,237,204
TOTAL OUTFLOWS 623,188 6,731,547 8,576,701 9,158,741 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 2,187,680 38,216,256 CUMULATIVE COSTS 7,354,735 15,931,437 25,090,178 27,277,857 29,465,537 31,653,217 33,840,896 36,028,576 38,216,256 (1) Total Outflows the sum of Fiscal Total Operations and Total Development from Form2. (2) Total Outflows carried to Form1
4016.001\OHMS CBA v4 (xls)||CBA3 (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-6 WORKSHEET: CBA4 (0)
Form 4 - Current versus Proposed Method Operations Costs Alternative 1 - Internal Development 21-Mar-12
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Salaries and Wages (A) 286,816 422,527 135,711 286,816 664,432 377,616 286,816 732,693 445,877 286,816 732,693 445,877 286,816 354,837 68,021 Employee Benefits (B) 90,789 135,099 44,310 90,789 258,229 167,440 90,789 290,352 199,563 90,789 290,352 199,563 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 1,297,511 127,072 1,170,440 3,481,443 2,311,003 1,170,440 4,703,617 3,533,178 1,170,440 4,097,472 2,927,032 1,170,440 2,621,792 1,451,353 Communications (EB) 0 2,000 2,000 0 5,000 5,000 0 5,000 5,000 0 5,000 5,000 00 0 Hardware Rent/Lease (ED) 00 0 0 15,870 15,870 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 0 150,000 150,000 0 300,000 300,000 0 600,000 600,000 0 600,000 600,000 Software Maintenance & Upgrade (EE) 00 0 00 0 00 0 00 0 00 0 DP Goods/Services (EL) 00 0 00 0 00 0 00 0 00 0 Goods/Services Not Listed (E) 25,231 25,231 0 25,231 2,896 (22,335) 25,231 2,928 (22,303) 25,231 2,896 (22,335) 25,231 2,896 (22,335) Travel (G) 13,336 13,336 0 13,336 22,656 9,320 13,336 38,056 24,720 13,336 25,784 12,448 13,336 25,784 12,448 Hardware Purchase Capitalized (JC) 00 0 0 320,000 320,000 00 0 00 0 00 0 Software Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Hardware Purchase - Non. Cap (KA) 0 1,925 1,925 0 3,575 3,575 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 0 350 350 0 650 650 0 1,000 1,000 0 1,000 1,000 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 0 300,000 300,000 0 300,000 300,000 0 1,200,000 1,200,000 00 0 Other (specify) ( ) 00 0 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 1,897,979 311,367 1,586,612 5,226,751 3,640,139 1,586,612 6,375,646 4,789,035 1,586,612 6,957,197 5,370,585 1,586,612 3,774,291 2,187,680 FTE'S 4.50 6.64 2.14 4.50 9.89 5.39 4.50 10.98 6.48 4.50 10.98 6.48 4.50 5.98 1.48
FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Salaries and Wages (A) 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 Employee Benefits (B) 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 Communications (EB) 00 0 00 0 00 0 00 0 00 0 Hardware Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 0 600,000 600,000 0 600,000 600,000 0 600,000 600,000 0 600,000 600,000 0 600,000 600,000 Software Maintenance & Upgrade (EE) 00 0 00 0 00 0 00 0 00 0 DIS Goods/Services (EL) 00 0 00 0 00 0 00 0 00 0 Goods/Services Not Listed (E) 25,231 2,896 (22,335) 25,231 2,896 (22,335) 25,231 2,896 (22,335) 25,231 2,896 (22,335) 25,231 2,896 (22,335) Travel (G) 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 Hardware Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Software Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Hardware Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 3,774,291 2,187,680 1,586,612 3,774,291 2,187,680 1,586,612 3,774,291 2,187,680 1,586,612 3,774,291 2,187,680 1,586,612 3,774,291 2,187,680 FTE'S 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48
4016.001\OHMS CBA v4 (xls)||CBA4 (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-7 WORKSHEET: CBA5 (0)
Form 5 - Benefits Cash Flow Analysis Alternative 1 - Internal Development 21-Mar-12
OFM FY FY FY FY FY FY FY FY FY FY TOTAL TANGIBLE BENEFITS Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Hard $ Revenues (specify) (revenue codes) 000000000 0 0 0 Reimbursements (specify) (object codes) 000000000 0 0 0 Cost Reduction (specify) (1) (object codes) 000000000 0 0 0 0 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 Soft $ 0 Cost Avoidance (specify) (object codes) Medical Aid Fund Reduction 1,159,500 3,436,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 35,519,500 Accident Fund Reduction 2,178,000 6,534,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 67,374,000 Trust Fund Reduction 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 TOTAL INFLOWS 0 0 3,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500 CUMULATIVE BENEFITS 0 3,337,500 13,307,500 28,238,500 43,169,500 58,100,500 73,031,500 87,962,500 102,893,500 (1) Reflect all Cost Reduction Benefits except Operations reductions (which are reflected in Cost of Operations). (2) Total Inflows carries to Form1 (3) Impact of OHMS system contribution on overall benefits: 50%
4016.001\OHMS CBA v4 (xls)||CBA5 (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-8 WORKSHEET: CPC (0)
Current Program Costs Alternative 1 - Internal Development 21-Mar-12
Line # Item Obj/Sub Obj FY 2012 FY 2013 FY 2014 FY 2015 Total Notes 1 Salaries and Wages (A) 286,816 286,816 3 2 Employee Benefits (B) 90,789 90,789 3a Personal Service Contracts - Admin (CA) 1,170,440 1,170,440 2 3b Personal Service Contracts - Incentive (CA) - - 4 Communications (EB) - 5 Hardware Rent/Lease (ED) - 6 Hardware Maintenance (EE) - 7 Software Rent/Lease (ED) - 8 Software Maintenance & Upgrade (EE) - 9 IT Goods/Services (EL) - 10 Goods/Services Not Listed (E) 25,231 25,231 11 Travel (G) 13,336 13,336 12 Hardware Purchase Capitalized (JC) - 13 Software Purchase Capitalized (JC) - 14 Hardware Purchase - Non. Cap (KA) - 15 Software Purchase - Non. Cap (KA) - 16 Hardware Lease/Purchase (P) - 17 Software Lease/Purchase (P) - 18 Other (specify) ( T ) - - 19 TOTAL 1,586,612 - - - 1,586,612 20 21 FTEs (HSA) 4.50 4.50
Notes (1) From budget office, costs for HSA COHE group for FY2011. (2) No incentive costs in FY2011, all included in Admin (3) Based on HSA labor distribution. Only includes COHE Operations
4016.001\OHMS CBA v4 (xls)||CPC (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-9 WORKSHEET: PPC (0)
Proposed Program Costs Alternative 1 - Internal Development 21-Mar-12 Number of COHEs 4 6 8 10 10 10 10 10 10 10 Obj/ Sub Line # Item Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages - Program (A) 286,816 286,576 354,837 354,837 354,837 354,837 354,837 354,837 354,837 354,837 3,412,087 2 Employee Benefits - Program (B) 90,789 134,859 166,982 166,982 166,982 166,982 166,982 166,982 166,982 166,982 1,561,505 1 Salaries and Wages - IT (A) 135,711 377,856 377,856 377,856 ------1,269,279 2 Employee Benefits - IT (B) 44,310 123,370 123,370 123,370 ------414,420 3 Personal Service Contracts - Admin (CA) 10,000 2,500 1,250 1,250 1,250 1,250 1,250 1,250 1,250 1,250 22,500 4 Personal Service Contracts - Incentive (CA) 1,162,511 1,690,355 2,028,426 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 23,233,838 5 Personal Service Contracts - IT (CA) 125,000 1,788,587 2,673,941 1,474,430 ------6,061,958 5 Communications (EB) 2,000 5,000 5,000 5,000 ------17,000 6 Hardware Rent/Lease (ED) - 15,870 ------15,870 7 Hardware Maintenance (EE) ------8 Software Rent/Lease (ED) - 150,000 300,000 600,000 600,000 600,000 600,000 600,000 600,000 600,000 4,650,000 9 Software Maintenance & Upgrade (EE) ------10 IT Goods/Services (EL) ------11 Goods/Services Not Listed (E) 25,231 2,896 2,928 2,896 2,896 2,896 2,896 2,896 2,896 2,896 51,327 12 Travel (G) 13,336 22,656 38,056 25,784 25,784 25,784 25,784 25,784 25,784 25,784 254,536 13 Hardware Purchase Capitalized (JC) - 320,000 ------320,000 14 Software Purchase Capitalized (JC) ------15 Hardware Purchase - Non. Cap (KA) 1,925 3,575 ------5,500 16 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 ------3,000 17 Hardware Lease/Purchase (P) ------18 Software Lease/Purchase (P) - 300,000 300,000 1,200,000 ------1,800,000 19 Other (specify) ( T ) - 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 20 TOTAL 1,897,979 5,226,751 6,375,646 6,957,197 3,775,541 3,775,541 3,775,541 3,775,541 3,775,541 3,775,541 43,110,819 21 21 FTEs IT 1.75 5.00 5.00 5.00 ------22 FTEs (HSA) 4.89 4.89 5.98 5.98 5.98 5.98 5.98 5.98 5.98 5.98 TOTAL 6.64 9.89 10.98 10.98 5.98 5.98 5.98 5.98 5.98 5.98
Notes (1) Additional FTE for HSA in FY2014. (2) FY2013-FY2015 cost estimated based on COHE Financial Model - Program Level (3) FY2012 based on Current Program Costs Worksheet (4) Assumes 20% increase in incentive in FY2014
4016.001\OHMS CBA v4 (xls)||PPC (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-10 WORKSHEET: PRJ (0)
Project Cost Estimate Alternative 1 - Internal Development 21-Mar-12
FY FY FY FY FY FY FY FY FY FY Line # Item Obj/Sub Obj 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Total 1 Salaries and Wages (A) - 2 L&I Project Manager 59,175 78,900 78,900 78,900 295,875 2 L&I Business Staff 76,536 153,072 153,072 153,072 535,752 3 L&I IT Staff 145,884 145,884 145,884 437,652 4 - 5 Total Salaries and Wages (A) 135,711 377,856 377,856 377,856 ------1,269,279 6 Employee Benefits (B) 44,310 123,370 123,370 123,370 414,420 7 8 Personal Service Contracts (CA) - 8 Feasibility Study 100,000 100,000 9 Project Management - - - - 10 Expert Systems Staff 571,196 866,314 466,477 1,903,986 11 Journey System Staff 734,395 1,113,832 599,756 2,447,982 12 Junior Systems Staff 407,997 618,795 333,198 13 Quality Assurance 25,000 75,000 75,000 75,000 250,000 14 Total Personal Services (CA) 125,000 1,788,587 2,673,941 1,474,430 ------4,701,968 15 - 16 Communications (EB) 2,000 5,000 5,000 5,000 17,000 17 Hardware Rent/Lease (ED) 15,870 15,870 18 Hardware Maintenance (EE) - 19 Software Rent/Lease (ED) 150,000 300,000 600,000 1,050,000 20 Software Maintenance & Upgrade (EE) - 21 DP Goods/Services (EL) - 22 Goods/Services Not Listed (E) 525 1,500 1,500 1,500 5,025 23 Travel (G) 2,000 5,000 5,000 5,000 17,000 24 Hardware Purchase Capitalized (JC) 320,000 320,000 25 - 26 Total Hardware Purchased - 320,000 - - 320,000 27 Software Purchase Capitalized (JC) - 28 - 29 Total Software Purchase (JC) ------30 Hardware Purchase - Non. Cap (KA) 1,925 3,575 5,500 31 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 3,000 32 Hardware Lease/Purchase (P) - 33 Software Lease/Purchase (P) 300,000 300,000 1,200,000 1,800,000 34 Other (specify) ( T ) - 35 TOTAL 311,821 3,091,408 3,787,667 3,788,156 ------9,619,062 36 37 Project FTEs 1.75 5.00 5.00 5.00
4016.001\OHMS CBA v4 (xls)||PRJ (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-11 Worksheet: Build (0) Alternative 1 - Internal Development Items Units Complexity (1-5) Analysis (40) Design (80) Construct (120) Test (60) Total Application Framework 1324 48 72 36 184 Security (L&I Service) 2 4 64 128 192 96 486 OHMS Application 5 4 160 320 480 240 1,209 Web Portal Services 1324 48 72 36 184 General Portal Framework (L&I Standard 12 4 384 768 1,152 576 2,896 COHE and HSC View 10 4 320 640 960 480 2,414 HSA View (Includes Contract Manageme 5 3 120 240 360 180 908 Claim Manager View 5 3 120 240 360 180 908 Provider View 2 3 48 96 144 72 365 Employee View 2 3 48 96 144 72 365 Employer View 2 3 48 96 144 72 365 Application Services 1324 48 72 36 184 Claim Prioritization 5 5 200 400 600 300 1,510 Contract Management Service (L&I) 3 4 96 192 288 144 727 Contract Management (L&I and COHE st 2580 160 240 120 607 Electronic Communications 1 5 40 80 120 60 306 Case Management (HSC) 3 4 96 192 288 144 727 Event Activity Tracking 3 3 72 144 216 108 546 Subscription and Notification 3 4 96 192 288 144 727 Scale Management 3 3 72 144 216 108 546 Reporting Service 5 4 160 320 480 240 1,209 Learning Service 1 3 24 48 72 36 184 Knowledge Management Service 5 2 80 160 240 120 607 Help Service 5 2 80 160 240 120 607 Business Intellegence 5 5 200 400 600 300 1,510 Reporting Tools 1324 48 72 36 184 Decision Support 5 5 200 400 600 300 1,510 Decision Reporting 5 5 200 400 600 300 1,510 External System Changes 1324 48 72 36 184 LINIIS 3 5 120 240 360 180 908 MIPS 3 5 120 240 360 180 908 ORION 1 3 24 48 72 36 184 CAC 1 3 24 48 72 36 184 Data Warehouse 5 3 120 240 360 180 908 Interfaces 1324 48 72 36 184 Replication process New Data Stores 5 3 120 240 360 180 908 LINIIS 5 5 200 400 600 300 1,510 MIPS 2 5 80 160 240 120 607 MPN 1 5 40 80 120 60 306
4016.001\OHMS CBA v4 (xls)||Build (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-11 Worksheet: Build (0) Items Units Complexity (1-5) Analysis (40) Design (80) Construct (120) Test (60) Total CAC 1 5 40 80 120 60 306 ORION 1 3 24 48 72 36 184 FileFast 1 3 24 48 72 36 184 Provider 1 3 24 48 72 36 184 Provider Express Billing 1 3 24 48 72 36 184 Common Functions 10 4 320 640 960 480 2,414 - - - - - Reports 50 2 800 1,600 2,400 1,200 6,052 -
TOTAL HOURS 196 5,256 10,512 15,768 7,884 39,420 FTE 2.74 5.48 8.21 4.11
35% Expert Staff 331,128.00 662,256.00 993,384.00 496,692.00 2,483,460 45% Journey Staff 275,940.00 551,880.00 827,820.00 413,910.00 2,069,550 25% Junior Staff$ 118,260.00 $ 236,520.00 $ 354,780.00 $ 177,390.00 886,950 TOTAL COST $ 725,328 $ 1,450,656 $ 2,175,984 $ 1,087,992 $ 5,439,960
Distribution Phase 1 30% 1,577 3,154 4,730 2,365 11,826 Phase 2 70% 3,679 7,358 11,038 5,519 27,594 Total 5,256 10,512 15,768 7,884 39,420
Phase 1 30%$ 217,598 $ 435,197 $ 652,795 $ 326,398 $ 1,631,988 Phase 2 70%$ 507,730 $ 1,015,459 $ 1,523,189 $ 761,594 $ 3,807,972 Total Cost$ 725,328 $ 1,450,656 $ 2,175,984 $ 1,087,992 $ 5,439,960
Notes: 1) Units are the number of units (screens sets or reports or data stores) 2) Complexity is the estimate on a scale of 1 to 5, where 3 is the norm. The complexity is divided by 5 and multiplied by the number of hours for each function per unit. 3) Analysis is the function of defining requirements and building preliminary specifications. A normal unit should require 40 hours. 4) Design is the development of a design specification and screen and report layouts. A normal unit should require 80 hours. 5) Construction is the development of software code. A normal unit should require 120 hours to construct. 6) Testing is the unit, systems, and user acceptance testing required from the programmer analyst. A normal unit should require 60 hours to test. 7) Common Functions includes common architectural components to support the overall application. 8) It is estimated that 50 reports will be required. 9) Distribution spreads hours and costs between Analyst/Designer and Programmer Analyst by development year 10) Application will be built using MS .Net and Visual Basic including application builders where practical.
4016.001\OHMS CBA v4 (xls)||Build (0) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-12 WORKSHEET: CBA1 (1)
Form 1 - Summary, Cost Benefit and Cash Flow Analysis Alternative 2 - Internal Development/EMR Integration 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL TOTAL OUTFLOWS 913,848 5,175,393 8,427,895 9,220,773 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 36,713,987 TOTAL INFLOWS 0 0 3,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000 NET CASH FLOW (913,848) (5,175,393) (5,090,395) 749,227 12,985,820 13,203,320 13,203,320 13,203,320 13,203,320 13,203,320 INCREMENTAL NPV NA (5,564,565) (9,961,840) (9,345,449) 829,281 10,681,802 20,065,155 29,001,682 37,512,660 45,618,353 Cumulative Costs NA 6,089,241 14,517,136 23,737,909 25,900,589 28,063,269 30,225,948 32,388,628 34,551,308 36,713,987 Cumulative Benefits NA 0 3,337,500 13,307,500 28,456,000 43,822,000 59,188,000 74,554,000 89,920,000 105,286,000
Cost of Breakeven Period - yrs.* NPV $ IRR % Capital Non- Discounted Discounted 5.00% 1 45,618,353 53.64%
* - "Non-Discounted" represents breakeven period for cumulative costs and benefits (no consideration of time value of money). * - "Discounted" considers effect of time value of money through incremental Net Present Value.
4016.001\OHMS CBA v4 (xls)||CBA1 (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-13 WORKSHEET: CBA2 (0)
Form 2 - Project Detail Cost Flow Analysis Alternative 2 - Internal Development/EMR Integration 21-Mar-12
FISCAL COSTS, PROJECT FY FY FY FY FY FY FY FY FY FY DEVELOPMENT Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL Salaries and Wages (A) 135,711 377,856 377,856 377,856 0000001,269,279 Employee Benefits (B) 44,310 123,370 123,370 123,370 000000414,420 Personal Service Contracts (CA) 125,000 2,103,120 3,076,066 1,757,882 0000007,062,068 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0 000000015,870 Hardware Maintenance (EE) 0 0 0 0000000 0 Software Rent/Lease (ED) 0 150,000 300,000 600,000 0000001,050,000 Software Maintenance & Upgrade (EE) 0 0 0 150,000 000000150,000 DP Goods/Services (EL) 0 0 0 0000000 0 Goods/Services Not Listed (E) 525 1,500 1,500 1,500 0000005,025 Travel (G) 0 0 0 0000000 0 Hardware Purchase Capitalized (JC) 0 320,000 0 0000000320,000 Software Purchase Capitalized (JC) 0 0 1,000,000 1,000,000 0000002,000,000 Hardware Purchase - Non. Cap (KA) 1,925 3,575 0 00000005,500 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P) 0 0 0 0000000 0 Software Lease/Purchase (P) 0 300,000 300,000 1,200,000 0000001,800,000 Other (specify) ( ) 0 0 0 0000000 0 TOTAL DEVELOPMENT 309,821 3,400,941 5,184,792 5,216,608 00000014,112,162
Notes: 1) See Project Cost Estimate
4016.001\OHMS CBA v4 (xls)||CBA2 (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-14 WORKSHEET: CBA3 (0)
Form 3 - Summary, Operations Incremental Cost of Project Alternative 2 - Internal Development/EMR Integration 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL OPERATIONS INCREMENTALCOSTS OF PROJECT (Per Form 4 - Column C) Salaries and Wages (A) 135,711 308,268 376,529 376,529 68,021 68,021 68,021 68,021 68,021 68,021 1,605,162 Employee Benefits (B) 44,310 144,798 176,921 176,921 76,193 76,193 76,193 76,193 76,193 76,193 1,000,105 Personal Service Contracts (CA) 297,072 797,416 1,384,237 1,977,603 1,451,353 1,451,353 1,451,353 1,451,353 1,451,353 1,451,353 13,164,443 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0000000015,870 Hardware Maintenance (EE) 0 0000000000 Software Rent/Lease (ED) 0 0000000000 Software Maintenance & Upgrade (EE) 0 0 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 DP Goods/Services (EL) 0 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 Goods/Services Not Listed (E) 0 (22,335) 77,698 77,666 77,666 77,666 77,666 77,666 77,666 77,666 599,022 Travel (G) 2,000 14,320 29,720 17,448 12,448 12,448 12,448 12,448 12,448 12,448 138,174 Hardware Purchase Capitalized (JC) 120,660 4,890 00000000125,550 Software Purchase Capitalized (JC) 0 500,000 1,000,000 1,000,000 0000002,500,000 Hardware Purchase - Non. Cap (KA) 1,925 3,575 000000005,500 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P) 0 0000000000 Software Lease/Purchase (P) 0 0000000000 Other (specify) ( ) 0 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 TOTAL OPERATIONS 604,027 1,774,451 3,243,104 4,004,165 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 22,601,826
TOTAL OUTFLOWS 913,848 5,175,393 8,427,895 9,220,773 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 2,162,680 36,713,987 CUMULATIVE COSTS 6,089,241 14,517,136 23,737,909 25,900,589 28,063,269 30,225,948 32,388,628 34,551,308 36,713,987 (1) Total Outflows the sum of Fiscal Total Operations and Total Development from Form2. (2) Total Outflows carried to Form1
4016.001\OHMS CBA v4 (xls)||CBA3 (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-15 WORKSHEET: CBA4 (0)
Form 4 - Current versus Proposed Method Operations Costs Alternative 2 - Internal Development/EMR Integration 21-Mar-12
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Salaries and Wages (A) 286,816 422,527 135,711 286,816 595,084 308,268 286,816 663,345 376,529 286,816 663,345 376,529 286,816 354,837 68,021 Employee Benefits (B) 90,789 135,099 44,310 90,789 235,587 144,798 90,789 267,710 176,921 90,789 267,710 176,921 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 1,467,511 297,072 1,170,440 1,967,855 797,416 1,170,440 2,554,676 1,384,237 1,170,440 3,148,042 1,977,603 1,170,440 2,621,792 1,451,353 Communications (EB) 0 2,000 2,000 0 5,000 5,000 0 5,000 5,000 0 5,000 5,000 00 0 Hardware Rent/Lease (ED) 00 0 0 15,870 15,870 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 00 0 00 0 0 90,000 90,000 0 270,000 270,000 0 375,000 375,000 DP Goods/Services (EL) 00 0 00 0 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 25,231 25,231 0 25,231 2,896 (22,335) 25,231 102,928 77,698 25,231 102,896 77,666 25,231 102,896 77,666 Travel (G) 13,336 15,336 2,000 13,336 27,656 14,320 13,336 43,056 29,720 13,336 30,784 17,448 13,336 25,784 12,448 Hardware Purchase Capitalized (JC) 0 120,660 120,660 0 4,890 4,890 00 0 00 0 00 0 Software Purchase Capitalized (JC) 00 0 0 500,000 500,000 0 1,000,000 1,000,000 0 1,000,000 1,000,000 00 0 Hardware Purchase - Non. Cap (KA) 0 1,925 1,925 0 3,575 3,575 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 0 350 350 0 650 650 0 1,000 1,000 0 1,000 1,000 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 00 0 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 2,190,639 604,027 1,586,612 3,361,063 1,774,451 1,586,612 4,829,715 3,243,104 1,586,612 5,590,777 4,004,165 1,586,612 3,749,291 2,162,680 FTE'S 4.50 6.64 2.14 4.50 9.89 5.39 5 10.98 6.48 4.50 5.98 1.48 4.50 5.98 1.48
FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Salaries and Wages (A) 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 Employee Benefits (B) 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 1,170,440 2,621,792 1,451,353 Communications (EB) 00 0 00 0 00 0 00 0 00 0 Hardware Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 DIS Goods/Services (EL) 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 25,231 102,896 77,666 25,231 102,896 77,666 25,231 102,896 77,666 25,231 102,896 77,666 25,231 102,896 77,666 Travel (G) 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 13,336 25,784 12,448 Hardware Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Software Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Hardware Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 3,749,291 2,162,680 1,586,612 3,749,291 2,162,680 1,586,612 3,749,291 2,162,680 1,586,612 3,749,291 2,162,680 1,586,612 3,749,291 2,162,680 FTE'S 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48
4016.001\OHMS CBA v4 (xls)||CBA4 (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-16 WORKSHEET: CBA5 (0)
Form 5 - Benefits Cash Flow Analysis Alternative 2 - Internal Development/EMR Integration 21-Mar-12
OFM FY FY FY FY FY FY FY FY FY FY TOTAL TANGIBLE BENEFITS Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Hard $ Revenues (specify) (revenue codes) 000000000 0 0 0 Reimbursements (specify) (object codes) 000000000 0 0 0 Cost Reduction (specify) (1) (object codes) 000000000 0 0 0 0 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 Soft $ 0 Cost Avoidance (specify) (object codes) Medical Aid Fund Reduction 1,159,500 3,436,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 35,519,500 Accident Fund Reduction 2,178,000 6,534,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 67,374,000 Trust Fund Reduction 0 Consolidated EMR Benefits 217,500 435,000 435,000 435,000 435,000 435,000 2,392,500 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 TOTAL INFLOWS 0 0 3,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000 CUMULATIVE BENEFITS 0 3,337,500 13,307,500 28,456,000 43,822,000 59,188,000 74,554,000 89,920,000 105,286,000 (1) Reflect all Cost Reduction Benefits except Operations reductions (which are reflected in Cost of Operations). (2) Total Inflows carries to Form1 (3) Impact of OHMS system contribution on overall benefits: 50%
4016.001\OHMS CBA v4 (xls)||CBA5 (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-17 WORKSHEET: PPC (0)
Proposed Program Costs Alternative 2 - Internal Development/EMR Integration 21-Mar-12 Number of COHEs 4 6 8 10 10 10 10 10 10 10 Obj/ Sub Line # Item Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages - Program (A) 286,816 286,576 354,837 354,837 354,837 354,837 354,837 354,837 354,837 354,837 3,412,087 2 Employee Benefits - Program (B) 90,789 134,859 166,982 166,982 166,982 166,982 166,982 166,982 166,982 166,982 1,561,505 1 Salaries and Wages - IT (A) 135,711 377,856 377,856 377,856 ------1,269,279 2 Employee Benefits - IT (B) 44,310 123,370 123,370 123,370 ------414,420 3 Personal Service Contracts - Admin (CA) 10,000 2,500 1,250 1,250 1,250 1,250 1,250 1,250 1,250 1,250 22,500 4 Personal Service Contracts - Incentive (CA) 1,162,511 1,690,355 2,028,426 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 23,233,838 5 Personal Service Contracts - IT (CA) 125,000 2,103,120 3,076,066 1,757,882 ------7,062,068 5 Communications (EB) 2,000 5,000 5,000 5,000 ------17,000 6 Hardware Rent/Lease (ED) - 15,870 ------15,870 7 Hardware Maintenance (EE) ------8 Software Rent/Lease (ED) - 150,000 300,000 600,000 600,000 600,000 600,000 600,000 600,000 600,000 4,650,000 9 Software Maintenance & Upgrade (EE) - - - 150,000 300,000 300,000 300,000 300,000 300,000 300,000 1,950,000 10 IT Goods/Services (EL) ------11 Goods/Services Not Listed (E) 25,231 2,896 2,928 2,896 2,896 2,896 2,896 2,896 2,896 2,896 51,327 12 Travel (G) 13,336 22,656 38,056 25,784 25,784 25,784 25,784 25,784 25,784 25,784 254,536 13 Hardware Purchase Capitalized (JC) - 320,000 ------320,000 14 Software Purchase Capitalized (JC) - - 1,000,000 1,000,000 ------2,000,000 15 Hardware Purchase - Non. Cap (KA) 1,925 3,575 ------5,500 16 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 ------3,000 17 Hardware Lease/Purchase (P) ------18 Software Lease/Purchase (P) - 300,000 300,000 1,200,000 ------1,800,000 19 Other (specify) ( T ) - 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 20 TOTAL 1,897,979 5,541,284 7,777,771 8,390,649 4,075,541 4,075,541 4,075,541 4,075,541 4,075,541 4,075,541 48,060,929 21 21 FTEs IT 1.75 5.00 5.00 5.00 ------22 FTEs (HSA) 4.89 4.89 5.98 5.98 5.98 5.98 5.98 5.98 5.98 5.98 TOTAL 6.64 9.89 10.98 10.98 5.98 5.98 5.98 5.98 5.98 5.98
Notes (1) Additional FTE for HSA in FY2014. (2) FY2013-FY2015 cost estimated based on COHE Financial Model - Program Level (3) FY2012 based on Current Program Costs Worksheet (4) Assumes 20% increase in incentive in FY2014
4016.001\OHMS CBA v4 (xls)||PPC (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-18 WORKSHEET: CPC (0)
Current Program Costs Alternative 2 - Internal Development/EMR Integration 21-Mar-12
Line # Item Obj/Sub Obj FY 2012 FY 2013 FY 2014 FY 2015 Total Notes 1 Salaries and Wages (A) 286,816 286,816 3 2 Employee Benefits (B) 90,789 90,789 3a Personal Service Contracts - Admin (CA) 1,170,440 1,170,440 2 3b Personal Service Contracts - Incentive (CA) - - 4 Communications (EB) - 5 Hardware Rent/Lease (ED) - 6 Hardware Maintenance (EE) - 7 Software Rent/Lease (ED) - 8 Software Maintenance & Upgrade (EE) - 9 IT Goods/Services (EL) - 10 Goods/Services Not Listed (E) 25,231 25,231 11 Travel (G) 13,336 13,336 12 Hardware Purchase Capitalized (JC) - 13 Software Purchase Capitalized (JC) - 14 Hardware Purchase - Non. Cap (KA) - 15 Software Purchase - Non. Cap (KA) - 16 Hardware Lease/Purchase (P) - 17 Software Lease/Purchase (P) - 18 Other (specify) ( T ) - - 19 TOTAL 1,586,612 - - - 1,586,612 20 21 FTEs (HSA) 4.50 4.50
Notes (1) From budget office, costs for HSA COHE group for FY2011. (2) No incentive costs in FY2011, all included in Admin (3) Based on HSA labor distribution. Only includes COHE Operations
4016.001\OHMS CBA v4 (xls)||CPC (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-19 WORKSHEET: PRJ (0)
Project Cost Estimate Alternative 2 - Internal Development/EMR Integration 21-Mar-12
FY FY FY FY FY FY FY FY FY FY Line # Item Obj/Sub Obj 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Total 1 Salaries and Wages (A) - 2 L&I Project Manager 59,175 78,900 78,900 78,900 295,875 2 L&I Business Staff 76,536 153,072 153,072 153,072 535,752 3 L&I IT Staff 145,884 145,884 145,884 437,652 4 - 5 Total Salaries and Wages (A) 135,711 377,856 377,856 377,856 ------1,269,279 6 Employee Benefits (B) 44,310 123,370 123,370 123,370 414,420 7 8 Personal Service Contracts 1 (CA) - 8 Feasibility Study 100,000 100,000 9 Project Management 120,000 120,000 120,000 360,000 10 Expert Systems Staff 627,707 952,022 512,627 2,092,356 11 Journey System Staff 807,052 1,224,028 659,092 2,690,172 12 Junior Systems Staff 448,362 680,016 366,162 1,494,540 13 Quality Assurance 25,000 100,000 100,000 100,000 325,000 14 Total Personal Services (CA) 125,000 2,103,120 3,076,066 1,757,882 ------7,062,068 15 - 16 Communications (EB) 2,000 5,000 5,000 5,000 17,000 17 Hardware Rent/Lease (ED) 15,870 15,870 18 Hardware Maintenance (EE) - 19 Software Rent/Lease (ED) 150,000 300,000 600,000 1,050,000 20 Software Maintenance & Upgrade (EE) 150,000 150,000 21 DP Goods/Services (EL) - 22 Goods/Services Not Listed (E) 525 1,500 1,500 1,500 5,025 23 Travel (G) - 24 Hardware Purchase Capitalized (JC) 320,000 320,000 25 - 26 Total Hardware Purchased - 320,000 ------320,000 27 Software Purchase Capitalized 2 (JC) 1,000,000 1,000,000 2,000,000 28 - 29 Total Software Purchase (JC) - - 1,000,000 1,000,000 ------2,000,000 30 Hardware Purchase - Non. Cap (KA) 1,925 3,575 5,500 31 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 3,000 32 Hardware Lease/Purchase (P) - 33 Software Lease/Purchase (P) 300,000 300,000 1,200,000 1,800,000 34 Other (specify) ( T ) - 35 TOTAL 309,821 3,400,941 5,184,792 5,216,608 ------14,112,162 36 37 Project FTEs 1.75 5.00 5.00 5.00
Notes (1) Overall development costs increased for EMR Interfaces (2) Pays for EMR vendors to develop ROA and APF forms within their EMR. (3) Pays for Interface of forms from EMR to L&I.
4016.001\OHMS CBA v4 (xls)||PRJ (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-20 Worksheet: Build (1) Alternative 2 - Internal Development/EMR Integration Items Units Complexity (1-5) Analysis (40) Design (80) Construct (120) Test (60) Total Application Framework 1324 48 72 36 184 Security (L&I Service) 2 4 64 128 192 96 486 OHMS Application 5 4 160 320 480 240 1,209 Web Portal Services 1324 48 72 36 184 General Portal Framework (L&I Standard 12 4 384 768 1,152 576 2,896 COHE and HSC View 10 4 320 640 960 480 2,414 HSA View (Includes Contract Manageme 5 3 120 240 360 180 908 Claim Manager View 5 3 120 240 360 180 908 Provider View 2 3 48 96 144 72 365 Employee View 2 3 48 96 144 72 365 Employer View 2 3 48 96 144 72 365 Application Services 1324 48 72 36 184 Claim Prioritization 5 5 200 400 600 300 1,510 Contract Management Service (L&I) 3 4 96 192 288 144 727 Contract Management (L&I and COHE st 2580 160 240 120 607 Electronic Communications 1 5 40 80 120 60 306 Case Management (HSC) 3 4 96 192 288 144 727 Event Activity Tracking 3 3 72 144 216 108 546 Subscription and Notification 3 4 96 192 288 144 727 Scale Management 3 3 72 144 216 108 546 Reporting Service 5 4 160 320 480 240 1,209 Learning Service 1 3 24 48 72 36 184 Knowledge Management Service 5 2 80 160 240 120 607 Help Service 5 2 80 160 240 120 607 Business Intellegence 5 5 200 400 600 300 1,510 Reporting Tools 1324 48 72 36 184 Decision Support 5 5 200 400 600 300 1,510 Decision Reporting 5 5 200 400 600 300 1,510 External System Changes 1324 48 72 36 184 LINIIS 3 5 120 240 360 180 908 MIPS 3 5 120 240 360 180 908 ORION 1 3 24 48 72 36 184 CAC 1 3 24 48 72 36 184 Data Warehouse 5 3 120 240 360 180 908 Interfaces 1324 48 72 36 184 Replication process New Data Stores 5 3 120 240 360 180 908 LINIIS 5 5 200 400 600 300 1,510 MIPS 2 5 80 160 240 120 607 MPN 1 5 40 80 120 60 306
4016.001\OHMS CBA v4 (xls)||Build (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-20 Worksheet: Build (1) Items Units Complexity (1-5) Analysis (40) Design (80) Construct (120) Test (60) Total CAC 1 5 40 80 120 60 306 ORION 1 3 24 48 72 36 184 FileFast 1 3 24 48 72 36 184 Provider 1 3 24 48 72 36 184 Provider Express Billing 1 3 24 48 72 36 184 Common Functions 10 4 320 640 960 480 2,414
EMR Interfaces ROA Interface 3 5 120 240 360 180 908 APF Interface 3 5 120 240 360 180 908 Chart Note Interface 5 5 200 400 600 300 1,510 Communications Interface 2 5 80 160 240 120 607 - - - - - Reports 50 2 800 1,600 2,400 1,200 6,052 -
TOTAL HOURS 209 5,776 11,552 17,328 8,664 43,320 FTE 3.01 6.02 9.03 4.51
35% Expert Staff 363,888.00 727,776.00 1,091,664.00 545,832.00 2,729,160 45% Journey Staff 303,240.00 606,480.00 909,720.00 454,860.00 2,274,300 25% Junior Staff$ 129,960.00 $ 259,920.00 $ 389,880.00 $ 194,940.00 974,700 TOTAL COST $ 797,088 $ 1,594,176 $ 2,391,264 $ 1,195,632 $ 5,978,160
Distribution Phase 1 30% 1,733 3,466 5,198 2,599 12,996 Phase 2 70% 4,043 8,086 12,130 6,065 30,324 Total 5,776 11,552 17,328 8,664 43,320
Phase 1 30%$ 239,126 $ 478,253 $ 717,379 $ 358,690 $ 1,793,448 Phase 2 70%$ 557,962 $ 1,115,923 $ 1,673,885 $ 836,942 $ 4,184,712 Total Cost$ 797,088 $ 1,594,176 $ 2,391,264 $ 1,195,632 $ 5,978,160
Notes: 1) Units are the number of units (screens sets or reports or data stores) 2) Complexity is the estimate on a scale of 1 to 5, where 3 is the norm. The complexity is divided by 5 and multiplied by the number of hours for each function per unit. 3) Analysis is the function of defining requirements and building preliminary specifications. A normal unit should require 40 hours. 4) Design is the development of a design specification and screen and report layouts. A normal unit should require 80 hours. 5) Construction is the development of software code. A normal unit should require 1200 hours to construct.
4016.001\OHMS CBA v4 (xls)||Build (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-20 Worksheet: Build (1) Items Units Complexity (1-5) Analysis (40) Design (80) Construct (120) Test (60) Total 6) Testing is the unit, systems, and user acceptance testing required from the programmer analyst. A normal unit should require 60 hours to test. 7) Common Functions includes common architectural components to support the overall application. 8) It is estimated that 50 reports will be required.
4016.001\OHMS CBA v4 (xls)||Build (1) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-21 WORKSHEET: CBA1 (2)
Form 1 - Summary, Cost Benefit and Cash Flow Analysis Alternative 3 - External Product Integrator
21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL TOTAL OUTFLOWS 1,208,141 3,478,131 6,377,339 7,318,401 2,638,930 2,638,930 2,638,930 2,638,930 2,638,930 2,638,930 34,215,591 TOTAL INFLOWS 0 0 3,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500 NET CASH FLOW (1,208,141) (3,478,131) (3,039,839) 2,651,599 12,292,070 12,292,070 12,292,070 12,292,070 12,292,070 12,292,070 INCREMENTAL NPV NA (4,305,378) (6,931,306) (4,749,829) 4,881,330 14,053,862 22,789,607 31,109,364 39,032,942 46,579,207 Cumulative Costs NA 4,686,272 11,063,612 18,382,013 21,020,943 23,659,872 26,298,802 28,937,732 31,576,661 34,215,591 Cumulative Benefits NA 0 3,337,500 13,307,500 28,238,500 43,169,500 58,100,500 73,031,500 87,962,500 102,893,500
Cost of Breakeven Period NPV $ IRR % Capital Non- Discounted Discounted 5.00% 6 46,579,207 66.48%
* - "Non-Discounted" represents breakeven period for cumulative costs and benefits (no consideration of time value of money). * - "Discounted" considers effect of time value of money through incremental Net Present Value.
4016.001\OHMS CBA v4 (xls)||CBA1 (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-22 WORKSHEET: CBA2 (2)
Form 2 - Project Detail Cost Flow Analysis Alternative 3 - External Product Integrator 21-Mar-12
FISCAL COSTS, PROJECT OFM FY FY FY FY FY FY FY FY FY FY DEVELOPMENT Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL Salaries and Wages (A) 135,711 308,508 308,508 308,508 0 0 0 0 0 0 1,061,235 Employee Benefits (B) 44,310 100,728 100,728 100,728 0 0 0 0 0 0 346,493 Personal Service Contracts (CA) 295,000 275,000 525,000 525,000 0 0 0 0 0 0 1,620,000 Communications (EB) 2,000 5,000 5,000 5,000 0 0 0 0 0 0 17,000 Hardware Rent/Lease (ED) 0000000000 0 Hardware Maintenance (EE) 0000000000 0 Software Rent/Lease (ED) 0 500,000 ######## ####### 0 0 0 0 0 0 2,500,000 Software Maintenance & Upgrad (EE) 0 0 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 DP Goods/Services (EL) 0 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 Goods/Services Not Listed (E) 4,433 4,554 0 00000008,987 Travel (G) 2,000 5,000 5,000 5,000 0 0 0 0 0 0 17,000 Hardware Purchase Capitalized (JC) 120,660 4,890 0 0000000125,550 Software Purchase Capitalized (JC) 0 500,000 ######## ####### 0 0 0 0 0 0 2,500,000 Hardware Purchase - Non. Cap (KA) 0000000000 0 Software Purchase - Non. Cap (KA) 0000000000 0 Hardware Lease/Purchase (P) 0000000000 0 Software Lease/Purchase (P) 0000000000 0 Other (specify) ( ) 0000000000 0 TOTAL DEVELOPMENT 604,114 ####### ######## ####### 475,000 475,000 475,000 475,000 475,000 475,000 11,606,265
4016.001\OHMS CBA v4 (xls)||CBA2 (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-23 WORKSHEET: CBA3 (2)
Form 3 - Summary, Operations Incremental Cost of Project Alternative 3 - External Product Integrator 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL OPERATIONS INCREMENTAL COSTS OF PROJECT (Per Form 4 - Column C) Salaries and Wages (A) 135,711 308,268 376,529 376,529 68,021 68,021 68,021 68,021 68,021 68,021 1,605,162 Employee Benefits (B) 44,310 144,798 176,921 176,921 76,193 76,193 76,193 76,193 76,193 76,193 1,000,105 Personal Service Contract (CA) 297,072 797,416 1,384,237 1,977,603 1,452,603 1,452,603 1,452,603 1,452,603 1,452,603 1,452,603 13,171,943 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0000000015,870 Hardware Maintenance (EE) 00000000000 Software Rent/Lease (ED) 00000000000 Software Maintenance & U (EE) 0 0 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 DP Goods/Services (EL) 0 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 Goods/Services Not Listed (E) 25,231 2,896 102,928 102,896 102,896 102,896 102,896 102,896 102,896 102,896 851,327 Travel (G) (9,894) 2,426 17,826 5,554 554 554 554 554 554 554 19,231 Hardware Purchase Capita (JC) 107,324 (8,446) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (7,812) Software Purchase Capita (JC) 0 500,000 1,000,000 1,000,000 0000002,500,000 Hardware Purchase - Non (KA) 1,925 3,575 000000005,500 Software Purchase - Non. (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P)00000000000 Software Lease/Purchase (P) 00000000000 Other (specify) ( ) 0 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 TOTAL OPERATIONS 604,027 1,774,451 3,243,104 4,004,165 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 22,609,326
TOTAL OUTFLOWS 1,208,141 3,478,131 6,377,339 7,318,401 2,638,930 2,638,930 2,638,930 2,638,930 2,638,930 2,638,930 34,215,591 CUMULATIVE COSTS 4,686,272 11,063,612 18,382,013 21,020,943 23,659,872 26,298,802 28,937,732 31,576,661 34,215,591 (1) Total Outflows the sum of Fiscal Total Operations and Total Development from Form2. (2) Total Outflows carried to Form1
4016.001\OHMS CBA v4 (xls)||CBA3 (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-24 WORKSHEET: CBA4 (2)
Form 4 - Current versus Proposed Method Operations Costs Alternative 3 - External Product Integrator 21-Mar-12
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary) Salaries and Wages (A) 286,816 422,527 135,711 286,816 595,084 308,268 286,816 663,345 376,529 286,816 663,345 376,529 286,816 354,837 68,021 Employee Benefits (B) 90,789 135,099 44,310 90,789 235,587 144,798 90,789 267,710 176,921 90,789 267,710 176,921 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 1,467,511 297,072 1,170,440 1,967,855 797,416 1,170,440 2,554,676 1,384,237 1,170,440 3,148,042 1,977,603 1,170,440 2,623,042 1,452,603 Communications (EB) 0 2,000 2,000 0 5,000 5,000 0 5,000 5,000 0 5,000 5,000 00 0 Hardware Rent/Lease (ED) 00 0 0 15,870 15,870 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 00 0 00 0 0 90,000 90,000 0 270,000 270,000 0 375,000 375,000 DP Goods/Services (EL) 00 0 00 0 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 0 25,231 25,231 0 2,896 2,896 0 102,928 102,928 0 102,896 102,896 0 102,896 102,896 Travel (G) 25,231 15,336 (9,894) 25,231 27,656 2,426 25,231 43,056 17,826 25,231 30,784 5,554 25,231 25,784 554 Hardware Purchase Capitalized (JC) 13,336 120,660 107,324 13,336 4,890 (8,446) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) Software Purchase Capitalized (JC) 00 0 0 500,000 500,000 0 1,000,000 1,000,000 0 1,000,000 1,000,000 00 0 Hardware Purchase - Non. Cap (KA) 0 1,925 1,925 0 3,575 3,575 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 0 350 350 0 650 650 0 1,000 1,000 0 1,000 1,000 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 00 0 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 2,190,639 604,027 1,586,612 3,361,063 1,774,451 1,586,612 4,829,715 3,243,104 1,586,612 5,590,777 4,004,165 1,586,612 3,750,541 2,163,930 FTE'S 4.50 7.89 3.39 4.50 8.89 4.39 4.50 9.98 5.48 4.50 9.98 5.48 4.50 5.98 1.48
FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary) Salaries and Wages (A) 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 Employee Benefits (B) 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 Personal Service Contracts (CA) 1,170,440 2,623,042 1,452,603 1,170,440 2,623,042 1,452,603 1,170,440 2,623,042 1,452,603 1,170,440 2,623,042 1,452,603 1,170,440 2,623,042 1,452,603 Communications (EB) 00 0 00 0 00 0 00 0 00 0 Hardware Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 DIS Goods/Services (EL) 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 Travel (G) 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 Hardware Purchase Capitalized (JC) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) Software Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Hardware Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 1,586,612 3,750,541 2,163,930 1,586,612 3,750,541 2,163,930 1,586,612 3,750,541 2,163,930 1,586,612 3,750,541 2,163,930 1,586,612 3,750,541 2,163,930 FTE'S 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 (1) FY__ Column (c) for each Cost Code carried to Form3
4016.001\OHMS CBA v4 (xls)||CBA4 (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-25 WORKSHEET: CBA5 (2)
Form 5 - Benefits Cash Flow Analysis Alternative 3 - External Product Integrator 21-Mar-12
BENEFITS OFM FY FY FY FY FY FY FY FY FY FY TOTAL TANGIBLE BENEFITS Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Hard $ Revenues (specify) (revenue codes) 000000 0 Increase Tax Revenue 0 Increased Revenue Through Efficiency 0 0 0 0 Reimbursements (specify) (object codes) 000000000 0 0 0 0 Cost Reduction (specify) (1) (object codes) 000000000 0 0 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 Soft $ 0 Cost Avoidance (specify) (object codes) 000000000 0 0 Medical Aid Fund Reduction 1,159,500 3,436,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 35,519,500 Accident Fund Reduction 2,178,000 6,534,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 67,374,000 Trust Fund Reduction 0 0 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 TOTAL INFLOWS 003,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500
4016.001\OHMS CBA v4 (xls)||CBA5 (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-26 WORKSHEET: CPC (2)
Current Program Costs Alternative 3 - External Product Integrator 21-Mar-12
Line # Item Obj/Sub Obj HSA Total Notes 1 Salaries and Wages (A) 286,816 286,816 2 Employee Benefits (B) 90,789 90,789 (3) 3a Personal Service Contracts - Admin (CA) 1,170,440 1,170,440 3b Personal Service Contracts - Incentive (CA) - 4 Communications (EB) - - 5 Hardware Rent/Lease (ED) - - 6 Hardware Maintenance (EE) - - 7 Software Rent/Lease (ED) - - 8 Software Maintenance & Upgrade (EE) - - 9 DP Goods/Services (EL) - - 10 Goods/Services Not Listed (E) - - (1) 11 Travel (G) 25,231 25,231 12 Hardware Purchase Capitalized (JC) 13,336 13,336 13 Software Purchase Capitalized (JC) - - 14 Hardware Purchase - Non. Cap (KA) - - 15 Software Purchase - Non. Cap (KA) - - 16 Hardware Lease/Purchase (P) - - 17 Software Lease/Purchase (P) - - 18 Other (specify) ( T ) - - 19 TOTAL 1,586,612 - - - 1,586,612 20 21 FTEs 4.50 4.50 22 23 Notes 24 (1) From budget office, costs for HSA COHE group for FY2011. 25 (2) No incentive costs in FY2011, all included in Admin 26 (3) Based on HSA labor distribution. Only includes COHE Operations
4016.001\OHMS CBA v4 (xls)||CPC (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-27 WORKSHEET: PPC (0)
Proposed Program Costs Alternative 2 - Internal Development/EMR Integration 21-Mar-12 Number of COHEs 4 6 8 10 10 10 10 10 10 10 Obj/ Sub Line # Item Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages - Program (A) 286,816 286,576 354,837 354,837 354,837 354,837 354,837 354,837 354,837 354,837 3,412,087 2 Employee Benefits - Program (B) 90,789 134,859 166,982 166,982 166,982 166,982 166,982 166,982 166,982 166,982 1,561,505 1 Salaries and Wages - IT (A) 135,711 308,508 308,508 308,508 ------1,061,235 2 Employee Benefits - IT (B) 44,310 100,728 100,728 100,728 ------346,493 3 Personal Service Contracts - Admin (CA) 10,000 2,500 1,250 1,250 1,250 1,250 1,250 1,250 1,250 1,250 22,500 4 Personal Service Contracts - Incentive (CA) 1,162,511 1,690,355 2,028,426 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 23,233,838 5 Personal Service Contracts - IT (CA) 295,000 275,000 525,000 525,000 ------1,620,000 5 Communications (EB) 2,000 5,000 5,000 5,000 ------17,000 6 Hardware Rent/Lease (ED) - 15,870 ------15,870 7 Hardware Maintenance (EE) ------8 Software Rent/Lease (ED) ------9 Software Maintenance & Upgrade (EE) - - 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 10 IT Goods/Services (EL) - - 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 11 Goods/Services Not Listed (E) 25,231 2,896 102,928 102,896 102,896 102,896 102,896 102,896 102,896 102,896 851,327 12 Travel (G) 15,336 27,656 43,056 30,784 25,784 25,784 25,784 25,784 25,784 25,784 271,536 13 Hardware Purchase Capitalized (JC) 120,660 4,890 ------125,550 14 Software Purchase Capitalized (JC) - 500,000 1,000,000 1,000,000 ------2,500,000 15 Hardware Purchase - Non. Cap (KA) 1,925 3,575 ------5,500 16 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 ------3,000 17 Hardware Lease/Purchase (P) ------18 Software Lease/Purchase (P) ------19 Other (specify) ( T ) - 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 20 TOTAL 2,190,639 3,361,063 4,829,715 5,590,777 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 38,475,441 21 21 FTEs IT 3.00 4.00 4.00 4.00 ------22 FTEs (HSA) 4.89 4.89 5.98 5.98 5.98 5.98 5.98 5.98 5.98 5.98 TOTAL 7.89 8.89 9.98 9.98 5.98 5.98 5.98 5.98 5.98 5.98
Notes (1) Additional FTE for HSA in FY2014. (2) FY2013-FY2015 cost estimated based on COHE Financial Model - Program Level (3) FY2012 based on Current Program Costs Worksheet (4) Assumes 20% increase in incentive in FY2014
4016.001\OHMS CBA v4 (xls)||PPC (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-28 WORKSHEET: PRJ (2)
Project Cost Estimate Alternative 3 - External Product Integrator 21-Mar-12 Line # Item Note Obj/Sub Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages (A) - 2 L&I Project Manager 1 59,175 78,900 78,900 78,900 295,875 3 L&I Business Staff 2 76,536 153,072 153,072 153,072 535,752 4 L&I IT Staff 2 76,536 76,536 76,536 229,608 5 - 6 Total Salaries and Wages (A) 135,711 308,508 308,508 308,508 ------1,061,235 7 Employee Benefits 3 (B) 44,310 100,728 100,728 100,728 346,493 8 9 Personal Service Contracts (CA) - 10 Feasibility Study 150,000 150,000 11 RFP Development 120,000 50,000 170,000 11 Contractor Interface Development 250,000 250,000 500,000 12 Vendor Project Management 50,000 100,000 100,000 250,000 13 Vendor Implementation Services 100,000 100,000 100,000 300,000 14 Vendor Customization Services - - - 15 Quality Assurance 25,000 75,000 75,000 75,000 250,000 16 Total Personal Services (CA) 295,000 275,000 525,000 525,000 ------1,620,000 17 - 18 Communications 9 (EB) 2,000 5,000 5,000 5,000 17,000 19 Hardware Rent/Lease (ED) - 20 Hardware Maintenance (EE) - 21 Software Rent/Lease (ED) - 22 Software Maintenance & Upgrade (EE) 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 23 IT Goods/Services (Hosting) (EL) 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 24 Goods/Services Not Listed 10 (E) 4,433 4,554 8,987 25 Travel (G) 2,000 5,000 5,000 5,000 17,000 26 Hardware Purchase Capitalized 11 (JC) 120,660 4,890 125,550 27 - 28 Total Hardware Purchased 120,660 4,890 ------125,550 29 Software Purchase Capitalized (JC) 500,000 1,000,000 1,000,000 2,500,000 30 - 31 Total Software Purchase (JC) - 500,000 1,000,000 1,000,000 ------2,500,000 32 Other (specify) ( T ) - 33 TOTAL 604,114 1,203,680 2,134,236 2,314,236 475,000 475,000 475,000 475,000 475,000 475,000 9,106,265 34 35 Project FTEs 3.00 4.00 4.00 4.00
NOTES (See Assumption Variables for multipliers) 1) Includes one full time L&I Project Manager 2) Includes two subject matter experts assigned to the project for three years 3) Benefits = Salary X Benefits Percent 4) Assumes one contract project manager (systems integrator) for 24 months 5) Includes a budget for communication with internal and external stakeholders
4016.001\OHMS CBA v4 (xls)||PRJ (2) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-29 WORKSHEET: CBA1 (2)
Form 1 - Summary, Cost Benefit and Cash Flow Analysis Alternative 4 - External Product Integrator/EMR Integration
21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL TOTAL OUTFLOWS 2,378,580 5,198,571 8,903,841 9,128,841 3,921,869 3,921,869 3,921,869 3,921,869 3,921,869 3,921,869 49,141,048 TOTAL INFLOWS 0 0 3,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000 NET CASH FLOW (2,378,580) (5,198,571) (5,566,341) 841,159 11,226,631 11,444,131 11,444,131 11,444,131 11,444,131 11,444,131 INCREMENTAL NPV NA (6,980,572) (11,788,986) (11,096,962) (2,300,603) 6,239,183 14,372,313 22,118,152 29,495,140 36,520,844 Cumulative Costs NA 7,577,151 16,480,992 25,609,833 29,531,702 33,453,571 37,375,440 41,297,309 45,219,179 49,141,048 Cumulative Benefits NA 0 3,337,500 13,307,500 28,456,000 43,822,000 59,188,000 74,554,000 89,920,000 105,286,000
Cost of Breakeven Period NPV $ IRR % Capital Non- Discounted Discounted 5.00% 1 36,520,844 41.25%
* - "Non-Discounted" represents breakeven period for cumulative costs and benefits (no consideration of time value of money). * - "Discounted" considers effect of time value of money through incremental Net Present Value.
4016.001\OHMS CBA v4 (xls)||CBA1 (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-30 WORKSHEET: CBA2 (2)
Form 2 - Project Detail Cost Flow Analysis Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12
FISCAL COSTS, PROJECT OFM FY FY FY FY FY FY FY FY FY FY DEVELOPMENT Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL Salaries and Wages (A) 135,711 308,508 308,508 308,508 0000001,061,235 Employee Benefits (B) 44,310 100,728 100,728 100,728 000000346,493 Personal Service Contracts (CA) 295,000 300,000 550,000 550,000 0000001,695,000 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 000 0000000 0 Hardware Maintenance (EE) 000 0000000 0 Software Rent/Lease (ED) 0 750,000 1,250,000 1,250,000 0000003,250,000 Software Maintenance & Upgrad (EE) 0 0 135,000 360,000 487,500 487,500 487,500 487,500 487,500 487,500 3,420,000 DP Goods/Services (EL) 0 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 Goods/Services Not Listed (E) 4,433 4,554 0 00000008,987 Travel (G) 2,000 5,000 5,000 5,000 0000017,000 Hardware Purchase Capitalized (JC) 120,660 4,890 0 0000000125,550 Software Purchase Capitalized (JC) 0 750,000 1,250,000 1,250,000 0000003,250,000 Hardware Purchase - Non. Cap (KA) 000 0000000 0 Software Purchase - Non. Cap (KA) 000 0000000 0 Hardware Lease/Purchase (P) 000 0000000 0 Software Lease/Purchase (P) 000 0000000 0 Other (specify) ( ) 000 0000000 0 TOTAL DEVELOPMENT 604,114 2,228,680 3,704,236 3,929,236 587,500 587,500 587,500 587,500 587,500 587,500 13,991,265
4016.001\OHMS CBA v4 (xls)||CBA2 (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-31 WORKSHEET: CBA3 (2)
Form 3 - Summary, Operations Incremental Cost of Project Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12
FY FY FY FY FY FY FY FY FY FY GRAND 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 TOTAL OPERATIONS INCREMENTAL COSTS OF PROJECT (Per Form 4 - Column C) Salaries and Wages (A) 135,711 308,268 376,529 376,529 68,021 68,021 68,021 68,021 68,021 68,021 1,605,162 Employee Benefits (B) 44,310 144,798 176,921 176,921 76,193 76,193 76,193 76,193 76,193 76,193 1,000,105 Personal Service Contract (CA) 1,467,511 1,992,855 3,173,042 3,173,042 2,623,042 2,623,042 2,623,042 2,623,042 2,623,042 2,623,042 25,544,704 Communications (EB) 2,000 5,000 5,000 5,000 00000017,000 Hardware Rent/Lease (ED) 0 15,870 0000000015,870 Hardware Maintenance (EE) 00000000000 Software Rent/Lease (ED) 00000000000 Software Maintenance & U (EE) 0 0 270,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,790,000 DP Goods/Services (EL) 0 0 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 Goods/Services Not Listed (E) 25,231 2,896 102,896 102,896 102,896 102,896 102,896 102,896 102,896 102,896 851,295 Travel (G) (9,894) 2,426 5,554 5,554 554 554 554 554 554 554 6,959 Hardware Purchase Capita (JC) 107,324 (8,446) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (13,336) (7,812) Software Purchase Capita (JC) 0 500,000 1,000,000 1,000,000 0000002,500,000 Hardware Purchase - Non (KA) 1,925 3,575 000000005,500 Software Purchase - Non. (KA) 350 650 1,000 1,000 0000003,000 Hardware Lease/Purchase (P)00000000000 Software Lease/Purchase (P) 00000000000 Other (specify) ( ) 0 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 TOTAL OPERATIONS 1,774,467 2,969,891 5,199,605 5,199,605 3,334,369 3,334,369 3,334,369 3,334,369 3,334,369 3,334,369 35,149,783
TOTAL OUTFLOWS 2,378,580 5,198,571 8,903,841 9,128,841 3,921,869 3,921,869 3,921,869 3,921,869 3,921,869 3,921,869 49,141,048 CUMULATIVE COSTS 7,577,151 16,480,992 25,609,833 29,531,702 33,453,571 37,375,440 41,297,309 45,219,179 49,141,048 (1) Total Outflows the sum of Fiscal Total Operations and Total Development from Form2. (2) Total Outflows carried to Form1
4016.001\OHMS CBA v4 (xls)||CBA3 (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-32 WORKSHEET: CBA4 (2)
Form 4 - Current versus Proposed Method Operations Costs Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Current Project (to summary) Salaries and Wages (A) 286,816 422,527 135,711 286,816 595,084 308,268 286,816 663,345 376,529 286,816 663,345 376,529 286,816 354,837 68,021 Employee Benefits (B) 90,789 135,099 44,310 90,789 235,587 144,798 90,789 267,710 176,921 90,789 267,710 176,921 90,789 166,982 76,193 Personal Service Contracts (CA) 0 1,467,511 1,467,511 0 1,992,855 1,992,855 0 3,173,042 3,173,042 0 3,173,042 3,173,042 0 2,623,042 2,623,042 Communications (EB) 0 2,000 2,000 0 5,000 5,000 0 5,000 5,000 0 5,000 5,000 00 0 Hardware Rent/Lease (ED) 00 0 0 15,870 15,870 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 00 0 00 0 0 270,000 270,000 0 270,000 270,000 0 375,000 375,000 DP Goods/Services (EL) 00 0 00 0 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 0 25,231 25,231 0 2,896 2,896 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 Travel (G) 25,231 15,336 (9,894) 25,231 27,656 2,426 25,231 30,784 5,554 25,231 30,784 5,554 25,231 25,784 554 Hardware Purchase Capitalized (JC) 13,336 120,660 107,324 13,336 4,890 (8,446) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) Software Purchase Capitalized (JC) 00 0 0 500,000 500,000 0 1,000,000 1,000,000 0 1,000,000 1,000,000 00 0 Hardware Purchase - Non. Cap (KA) 0 1,925 1,925 0 3,575 3,575 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 0 350 350 0 650 650 0 1,000 1,000 0 1,000 1,000 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 00 0 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 416,172 2,190,639 1,774,467 416,172 3,386,063 2,969,891 416,172 5,615,777 5,199,605 416,172 5,615,777 5,199,605 416,172 3,750,541 3,334,369 FTE'S 4.50 7.89 3.39 4.50 8.89 4.39 4.50 9.98 5.48 4.50 9.98 5.48 4.50 5.98 1.48
FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) (c) = (b)-(a) Incremental Incremental Incremental Incremental Incremental Effect of Effect of Effect of Effect of Effect of (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project (a) (b) Project OPERATIONS COSTS Obj. Codes Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary)Current Project (to summary) Salaries and Wages (A) 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 286,816 354,837 68,021 Employee Benefits (B) 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 90,789 166,982 76,193 Personal Service Contracts (CA) 0 2,623,042 2,623,042 0 2,623,042 2,623,042 0 2,623,042 2,623,042 0 2,623,042 2,623,042 0 2,623,042 2,623,042 Communications (EB) 00 0 00 0 00 0 00 0 00 0 Hardware Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Hardware Maintenance (EE) 00 0 00 0 00 0 00 0 00 0 Software Rent/Lease (ED) 00 0 00 0 00 0 00 0 00 0 Software Maintenance & Upgrade (EE) 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 0 375,000 375,000 DIS Goods/Services (EL) 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 0 100,000 100,000 Goods/Services Not Listed (E) 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 0 102,896 102,896 Travel (G) 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 25,231 25,784 554 Hardware Purchase Capitalized (JC) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) 13,336 0 (13,336) Software Purchase Capitalized (JC) 00 0 00 0 00 0 00 0 00 0 Hardware Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Software Purchase - Non. Cap (KA) 00 0 00 0 00 0 00 0 00 0 Hardware Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Software Lease/Purchase (P) 00 0 00 0 00 0 00 0 00 0 Other (specify) ( ) 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 0 2,000 2,000 TOTAL OPERATION COSTS 416,172 3,750,541 3,334,369 416,172 3,750,541 3,334,369 416,172 3,750,541 3,334,369 416,172 3,750,541 3,334,369 416,172 3,750,541 3,334,369 FTE'S 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48 4.50 5.98 1.48
4016.001\OHMS CBA v4 (xls)||CBA4 (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-33 WORKSHEET: CBA5 (2)
Form 5 - Benefits Cash Flow Analysis Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12
BENEFITS OFM FY FY FY FY FY FY FY FY FY FY TOTAL TANGIBLE BENEFITS Object Codes 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Hard $ Revenues (specify) (revenue codes) 000000 0 Increase Tax Revenue 0 Increased Revenue Through Efficiency 0 0 0 0 Reimbursements (specify) (object codes) 000000000 0 0 0 0 Cost Reduction (specify) (1) (object codes) 000000000 0 0 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 Soft $ 0 Cost Avoidance (specify) (object codes) 000000000 0 0 Medical Aid Fund Reduction 1,159,500 3,436,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 5,154,000 35,519,500 Accident Fund Reduction 2,178,000 6,534,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 9,777,000 67,374,000 Trust Fund Reduction 0 Consolidated EMR Benefits 217,500 435,000 435,000 435,000 435,000 435,000 2,392,500 0 0 0 Other (specify) (object codes) 000000000 0 0 0 0 0 0 0 TOTAL INFLOWS 003,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000
4016.001\OHMS CBA v4 (xls)||CBA5 (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-34 WORKSHEET: CPC (2)
Current Program Costs Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12
Line # Item Obj/Sub Obj HSA Total Notes 1 Salaries and Wages (A) 286,816 286,816 2 Employee Benefits (B) 90,789 90,789 (3) 3a Personal Service Contracts - Admin (CA) 1,170,440 1,170,440 3b Personal Service Contracts - Incentive (CA) - 4 Communications (EB) - - 5 Hardware Rent/Lease (ED) - - 6 Hardware Maintenance (EE) - - 7 Software Rent/Lease (ED) - - 8 Software Maintenance & Upgrade (EE) - - 9 DP Goods/Services (EL) - - 10 Goods/Services Not Listed (E) - - (1) 11 Travel (G) 25,231 25,231 12 Hardware Purchase Capitalized (JC) 13,336 13,336 13 Software Purchase Capitalized (JC) - - 14 Hardware Purchase - Non. Cap (KA) - - 15 Software Purchase - Non. Cap (KA) - - 16 Hardware Lease/Purchase (P) - - 17 Software Lease/Purchase (P) - - 18 Other (specify) ( T ) - - 19 TOTAL 1,586,612 - - - 1,586,612 20 21 FTEs 4.50 4.50 22 23 Notes 24 (1) From budget office, costs for HSA COHE group for FY2011. 25 (2) No incentive costs in FY2011, all included in Admin 26 (3) Based on HSA labor distribution. Only includes COHE Operations
4016.001\OHMS CBA v4 (xls)||CPC (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-35 WORKSHEET: PPC (0)
Proposed Program Costs Alternative 2 - Internal Development/EMR Integration 21-Mar-12 Number of COHEs 4 6 8 10 10 10 10 10 10 10 Obj/ Sub Line # Item Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages - Program (A) 286,816 286,576 354,837 354,837 354,837 354,837 354,837 354,837 354,837 354,837 3,412,087 2 Employee Benefits - Program (B) 90,789 134,859 166,982 166,982 166,982 166,982 166,982 166,982 166,982 166,982 1,561,505 1 Salaries and Wages - IT (A) 135,711 308,508 308,508 308,508 ------1,061,235 2 Employee Benefits - IT (B) 44,310 100,728 100,728 100,728 ------346,493 3 Personal Service Contracts - Admin (CA) 10,000 2,500 1,250 1,250 1,250 1,250 1,250 1,250 1,250 1,250 22,500 4 Personal Service Contracts - Incentive (CA) 1,162,511 1,690,355 2,028,426 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 2,621,792 23,233,838 5 Personal Service Contracts - IT (CA) 295,000 300,000 550,000 550,000 ------1,695,000 5 Communications (EB) 2,000 5,000 5,000 5,000 ------17,000 6 Hardware Rent/Lease (ED) - 15,870 ------15,870 7 Hardware Maintenance (EE) ------8 Software Rent/Lease (ED) ------9 Software Maintenance & Upgrade (EE) - - 90,000 270,000 375,000 375,000 375,000 375,000 375,000 375,000 2,610,000 10 IT Goods/Services (EL) - - 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 11 Goods/Services Not Listed (E) 25,231 2,896 102,928 102,896 102,896 102,896 102,896 102,896 102,896 102,896 851,327 12 Travel (G) 15,336 27,656 43,056 30,784 25,784 25,784 25,784 25,784 25,784 25,784 271,536 13 Hardware Purchase Capitalized (JC) 120,660 4,890 ------125,550 14 Software Purchase Capitalized (JC) - 500,000 1,000,000 1,000,000 ------2,500,000 15 Hardware Purchase - Non. Cap (KA) 1,925 3,575 ------5,500 16 Software Purchase - Non. Cap (KA) 350 650 1,000 1,000 ------3,000 17 Hardware Lease/Purchase (P) ------18 Software Lease/Purchase (P) ------19 Other (specify) ( T ) - 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 18,000 20 TOTAL 2,190,639 3,386,063 4,854,715 5,615,777 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 38,550,441 21 21 FTEs IT 3.00 4.00 4.00 4.00 ------22 FTEs (HSA) 4.89 4.89 5.98 5.98 5.98 5.98 5.98 5.98 5.98 5.98 TOTAL 7.89 8.89 9.98 9.98 5.98 5.98 5.98 5.98 5.98 5.98
Notes (1) Additional FTE for HSA in FY2014. (2) FY2013-FY2015 cost estimated based on COHE Financial Model - Program Level (3) FY2012 based on Current Program Costs Worksheet (4) Assumes 20% increase in incentive in FY2014
4016.001\OHMS CBA v4 (xls)||PPC (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-36 WORKSHEET: PRJ (2)
Project Cost Estimate Alternative 4 - External Product Integrator/EMR Integration 21-Mar-12 Line # Item Note Obj/Sub Obj FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total 1 Salaries and Wages (A) - 2 L&I Project Manager 1 59,175 78,900 78,900 78,900 295,875 3 L&I Business Staff 2 76,536 153,072 153,072 153,072 535,752 4 L&I IT Staff 2 76,536 76,536 76,536 229,608 5 - 6 Total Salaries and Wages (A) 135,711 308,508 308,508 308,508 ------1,061,235 7 Employee Benefits 3 (B) 44,310 100,728 100,728 100,728 346,493 8 9 Personal Service Contracts (CA) - 10 Feasibility Study 150,000 150,000 10 RFP Development 120,000 50,000 170,000 11 Contractor Interface Development 250,000 250,000 500,000 12 Vendor Project Management 75,000 125,000 125,000 325,000 13 Vendor Implementation Services 100,000 100,000 100,000 300,000 14 Vendor Customization Services - - - 15 Quality Assurance 25,000 75,000 75,000 75,000 250,000 16 Total Personal Services (CA) 295,000 300,000 550,000 550,000 ------1,695,000 17 - 18 Communications 9 (EB) 2,000 5,000 5,000 5,000 17,000 19 Hardware Rent/Lease (ED) - 20 Hardware Maintenance (EE) - 21 Software Rent/Lease (ED) - 22 Software Maintenance & Upgrade (EE) 135,000 360,000 487,500 487,500 487,500 487,500 487,500 487,500 3,420,000 23 IT Goods/Services (Hosting) (EL) 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 800,000 24 Goods/Services Not Listed 10 (E) 4,433 4,554 8,987 25 Travel (G) 2,000 5,000 5,000 5,000 17,000 26 Hardware Purchase Capitalized 11 (JC) 120,660 4,890 125,550 27 - 28 Total Hardware Purchased 120,660 4,890 ------125,550 29 Software Purchase Capitalized (JC) 750,000 1,250,000 1,250,000 3,250,000 30 - 31 Total Software Purchase (JC) - 750,000 1,250,000 1,250,000 ------3,250,000 32 Other (specify) ( T ) - 33 TOTAL 604,114 1,478,680 2,454,236 2,679,236 587,500 587,500 587,500 587,500 587,500 587,500 10,741,265 34 35 Project FTEs 3.00 4.00 4.00 4.00
NOTES (See Assumption Variables for multipliers) 1) Includes one full time L&I Project Manager 2) Includes two subject matter experts assigned to the project for three years 3) Benefits = Salary X Benefits Percent 4) Assumes one contract project manager (systems integrator) for 24 months 5) Includes a budget for communication with internal and external stakeholders
4016.001\OHMS CBA v4 (xls)||PRJ (3) sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 APPENDIX I-37 Variables and Assumptions WORKSHEET: VARIABLES
Item Value Unit Agency Name Department of Labor and Industries Project Title Occupational Health Management System Feasibility Study Expert Systems Staff 180 Hour Journey System Staff 150 Hour Junior Systems Staff 90 Hour Analyst Designer 100 Hour Programmer 100 Hour Project Manager 150 hour QA 150 hour LNI PM 78900 Year LNI SME 64740 Year LNI ITS4 69348 Year LNI ITS5 76536 Year Benefits PCT 32.7% Percent Cost of workstation 1100 Each Cost of developer WADS Workstation 1895 Each Printers 1500 Each Server 32000 Each MS Office Pro 200 Each IBM licenses for increased throughtput 300000 Year Goods and Services 300 staff year Personnel Charge 0.070% classified salary Personnel Charge 246 FTE/Year Cost of Capital 5.00%
4016.001\OHMS CBA v4 (xls)||Variables sooscreekconsulting.com Feasibility Study Guidelines Instructions FINAL 3/02/2012 APPENDIX I-38 WORKSHEET: CBAI
Instructions: Cost Benefit and Feasibility Analysis Form 1 through Form 5 203-R1 Form 1/ Summary Summary Cost Benefit and Cash Flow Analysis Form 2/ Cost Analysis Project Detail Cost Flow Analysis Form 3/ Summary Operations Incremental Cost of Project Operations Incremental Costs of Project (Form 3-Column C) Form 4/ Current versus Proposed Operations Costs Current Method versus Proposed Method Operations Costs Form 5/ Benefits Analysis Benefits Cash Flow Analysis
The five electronic forms are stored as worksheets in CBAFORMS.XLS. The worksheet function is not available in prior versions of Microsoft Excel and other spreadsheets, and may be unreadable. Call MOSTD if assistance is needed.
In Microsoft Excel, navigate between sheets by clicking on the Forms tabs in the lower left of the spreadsheet display. You may need to customize printed output for your computer configuration. Data input cells in the electronic spreadsheet are displayed in blue.
Forms: Form 1 requires entering the fiscal years, the agency name, the project title and option, and the Cost of Capital (see below for accessing the Cost of Capital). Form 2, Form 4, and Form 5 require input. Form 3 requires no data input. The form labeled Instructions provides directions on completing the forms.
The Analysis: You will need to gather the costs and benefits of each viable alternative considered. These are the options under analysis, and ideally each should undergo a full CBA. Completing Form 1 through Form 5 for each alternative will provide the costs and benefits necessary to select the best option.
Note: Net Present Value is incorporated for financial decision-making purposes only and should not be used to define funding levels in future years of a project.
The option to “do-nothing” has costs and benefits, too. The costs of doing-nothing are the costs of operations and maintenance, over time as currently performed or as anticipated, and are used in this analysis in Form 3 and Form 4, Operations Incremental Costs of Project, and Current versus Proposed Method Operations Cost. Completing Form 3 and Form 4 can provide the costs of the option of doing-nothing.
This distinction is important in completing Form 3 and Form 4 in the spreadsheet. Attention needs to be paid to the method of implementation, particularly to the time of operational cut-over, for example, whether in parallel or sequential. The current operational costs used in Form 3 are the costs of continuing to do business as now performed, and the project operational costs are the costs of operation as if the project were implemented. The net difference between these two operational methods is the operational net cost/benefit, not the costs of operating both systems in parallel or concurrently.
4016.001\OHMS CBA v4 (xls)||CBAI sooscreekconsulting.com Feasibility Study Guidelines Instructions FINAL 3/02/2012 APPENDIX I-38 WORKSHEET: CBAI
The cost code structure used throughout the analysis is the State of Washington Office of Financial Management’s (OFM) code. These are used for consistency with the state’s budgeting requirements and their use provides comprehensive budget analysis. Use of the codes is desirable but not mandatory. For more information on the OFM budget and cost codes structures, contact OFM. Using the state fiscal year calendar (July through June) will provide consistency with state fiscal and biennial budgeting cycles.
Instructions: 1. Open the spreadsheet and go to Form 1. Enter your agency, project/option title, and fiscal years relevant to this option. These fields show in blue. Your entries will carry forward to the remaining forms.
2. Go to Form 2. Enter each year’s estimated development costs in Form 2, Project Detail Cost Flow Analysis. Development costs typically occur in the first years of the project. Using the state fiscal year calendar (July through June) will provide consistency with state fiscal and biennial budgeting cycles. 3.Go to Form 4, Current versus Proposed Method Operations Cost. Enter each fiscal year’s costs of operations of the current method of doing business and the proposed method of doing business. Complete columns (a) and (b) for each fiscal year. Column (c) is the calculated difference between the current operations cost for that fiscal year, and proposed operations cost, if the project were implemented, for that fiscal year. The proposed operations costs are defined as if the project were implemented, not as if the current and proposed methods were parallel operations.
The Operations Incremental Costs of the Project may be negative or positive. A negative result in column (c) means the project is actually less expensive to operate than the current operational method. A more likely view of the project may have initially high but diminishing project costs as production stabilizes.
These i ncremen tltal cos ts are cal cu ltdflated for eac hfih fisca l year by cos t co de an dbttlfd by total for thtthat year. Eac hfih fisca l year ’s tttotalil incrementltal costs are carried forward to Form 3, Operations Incremental Costs of Project.
4. Enter a description and the amounts of other benefits of the proposed project in Form 5, Benefits Cash Flow Analysis. These may include cost avoidance, cost reduction, increased revenue, or tangible public benefits. The spreadsheet will calculate the sum of revenue, reimbursements, cost avoidance, and so forth.
5. On Form 1, enter the Cost of Capital (equivalent to the interest rate paid by state government to finance borrowing), under the heading “Cost of Capital”. Contact the State Treasurer’s Office, Division of Development Management for the current cost of capital. The rate of 6.25% is supplied in this spreadsheet, but is modifiable.
Repeat the above process for each viable alternative considered to the current way of doing business.
4016.001\OHMS CBA v4 (xls)||CBAI sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 EXHIBIT I SUMMARY TEN-YEAR COST BENEFIT ANALYSIS
Alternative 2 - Internal Alternative 4 - External Alternative 1 - Internal Development/EMR Alternative 3 - External Product Integrator/EMR Item Development Integration Product Integrator Integration Current Program Costs$ 15,866,115 15,866,115 $ 15,866,115 $ 15,866,115 Proposed Program Costs 43,110,819 38,475,441 $ 38,475,441 $ 38,550,441 Program Cost Variance (a) 27,244,704 22,609,326 22,609,326 22,684,326
Project Costs (b) 10,979,052 14,112,162 $ 11,606,265 $ 10,741,265 Benefits (c) 102,893,500 105,286,000 $ 102,893,500 $ 105,286,000 Total CBA Cash Flow (c-a-b) 64,669,744 68,564,513 68,677,909 71,860,409 Cumulative Cash Flow$ 64,669,744 68,564,513 $ 68,677,909 $ 71,860,409
Net Present Value$ 42,655,740 45,618,353 46,579,207 36,520,844 Pay Back 1 1 1 1
IRR% 48.46% 53.64% 66.48% 41.25%
4016.001\OHMS CBA v4 (xls)||Exhibit I sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 EXHIBIT II ALTERNATIVE 1 - INTERNAL DEVELOPMENT SUMMARY COST BENEFIT ANALYSIS
Item FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total Current Program Costs$ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 15,866,115 Proposed Program Costs 1,897,979 5,226,751 6,375,646 6,957,197 3,775,541 3,775,541 3,775,541 3,775,541 3,775,541 3,775,541 43,110,819 Program Cost Variance (a) 311,367 3,640,139 4,789,035 5,370,585 2,188,930 2,188,930 2,188,930 2,188,930 2,188,930 2,188,930 27,244,704
Project Costs (b) 311,821 3,091,408 3,787,667 3,788,156 00000010,979,052 Benefits (c) 0 0 3,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500 Total CBA Cash Flow (c-a-b) (623,188) (6,731,547) (5,239,201) 811,259 12,742,070 12,742,070 12,742,070 12,742,070 12,742,070 12,742,070 64,669,744 Cumulative Cash Flow $ (623,188) (7,354,735) (12,593,937) (11,782,678) 959,393 13,701,463 26,443,533 39,185,604 51,927,674 64,669,744
Net Present Value $ 42,655,740 Pay Back 1
4016.001\OHMS CBA v4 (xls)||Exhibit II sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 EXHIBIT III ALTERNATIVE 2 - INTERNAL DEVELOPMENT/EMR INTEGRATION SUMMARY COST BENEFIT ANALYSIS
Item FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total Current Program Costs$ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 15,866,115 Proposed Program Costs 2,190,639 3,361,063 4,829,715 5,590,777 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 38,475,441 Program Cost Variance (a) 604,027 1,774,451 3,243,104 4,004,165 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 22,609,326
Project Costs (b) 309,821 3,400,941 5,184,792 5,216,608 00000014,112,162 Benefits (c) 0 0 3,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000 Total CBA Cash Flow (c-a-b) (913,848) (5,175,393) (5,090,395) 749,227 12,984,570 13,202,070 13,202,070 13,202,070 13,202,070 13,202,070 68,564,513 Cumulative Cash Flow $ (913,848) (6,089,241) (11,179,636) (10,430,409) 2,554,161 15,756,231 28,958,302 42,160,372 55,362,442 68,564,513
Net Present Value$ 45,618,353 Pay Back 1
4016.001\OHMS CBA v4 (xls)||Exhibit III sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 EXHIBIT IV ALTERNATIVE 3 - EXTERNAL PRODUCT INTEGRATOR SUMMARY COST BENEFIT ANALYSIS
Item FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total Current Program Costs$ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 15,866,115 Proposed Program Costs 2,190,639 3,361,063 4,829,715 5,590,777 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 38,475,441 Program Cost Variance (a) 604,027 1,774,451 3,243,104 4,004,165 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 22,609,326
Project Costs (b) 604,114 1,703,680 3,134,236 3,314,236 475,000 475,000 475,000 475,000 475,000 475,000 11,606,265 Benefits (c) 0 0 3,337,500 9,970,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 14,931,000 102,893,500 Total CBA Cash Flow (c-a-b) (1,208,141) (3,478,131) (3,039,839) 2,651,599 12,292,070 12,292,070 12,292,070 12,292,070 12,292,070 12,292,070 68,677,909 Cumulative Cash Flow $ (1,208,141) (4,686,272) (7,726,112) (5,074,513) 7,217,557 19,509,628 31,801,698 44,093,768 56,385,839 68,677,909
Net Present Value$ 46,579,207 Pay Back 1
4016.001\OHMS CBA v4 (xls)||Exhibit IV sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY 3/02/2012 EXHIBIT V ALTERNATIVE 4 - EXTERNAL PRODUCT INTEGRATOR/EMR SUMMARY COST BENEFIT ANALYSIS
Item FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 Total Current Program Costs$ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 1,586,612 $ 15,866,115 Proposed Program Costs 2,190,639 3,386,063 4,854,715 5,615,777 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 3,750,541 38,550,441 Program Cost Variance (a) 604,027 1,799,451 3,268,104 4,029,165 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 2,163,930 22,684,326
Project Costs (b) 604,114 1,478,680 2,454,236 2,679,236 587,500 587,500 587,500 587,500 587,500 587,500 10,741,265 Benefits (c) 0 0 3,337,500 9,970,000 15,148,500 15,366,000 15,366,000 15,366,000 15,366,000 15,366,000 105,286,000 Total CBA Cash Flow (c-a-b) (1,208,141) (3,278,131) (2,384,839) 3,261,599 12,397,070 12,614,570 12,614,570 12,614,570 12,614,570 12,614,570 71,860,409 Cumulative Cash Flow $ (1,208,141) (4,486,272) (6,871,112) (3,609,513) 8,787,557 21,402,128 34,016,698 46,631,268 59,245,839 71,860,409
Net Present Value$ 36,520,844 Pay Back 1
4016.001\OHMS CBA v4 (xls)||Exhibit V sooscreekconsulting.com Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Appendix J Risk Factor Analysis
4016.001\OHMS Feasibility Study\4.0 J-0 FINAL sooscreekconsulting.com 3/5/2012 WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBILITY STUDY03/02/2012 Risk Factor Analysis APPENDIX J‐0
Risk Scorecards Washington Labor & Industries Centers for Occupational Health and Education Project Name Feasibility Study Prepared By Soos Creek Consulting Date 2-Feb-12 Version 1.0
Summary Risk Assessment Category # Low # Medium # High Other Count Index Mission and Goals 2 1 0 1 4 1.33 Program Management 2 2 2 0 6 2.00 Decision Drivers 3 0 1 0 4 1.50 Organization Management 1 5 0 0 6 1.83 Customers/Users 1 4 0 0 5 1.80 Project Characteristics 332 0 8 1.88 Product Content 0 3 3 0 6 2.50 Deployment 2 1 0 1 4 1.33 Development Process 6 2 0 0 8 1.25 Development Environment 2 1 0 2 5 1.33 Project Management 0 4 0 0 4 2.00 Team Members 2 4 3 1 10 2.11 Technology 1 1 1 1 4 2.00 Maintenance and Support 0 0 2 1 3 3.00 Total 25 31 14 777 1.84
7 6 5 4 3 # Low 2 # Medium 1 # High 0 Other
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes Mission and Goals 1 Project Fit to Customer Directly supports customer Indirectly impacts one or Does not support or relate 1 Central to program mission. Organization organization mission more goals of customer. to customer organization and/or goals. mission or goals.
2 Project Fit to Provider Directly supports provider Indirectly impacts one or Does not support or relate 1 Provider is not yet known. Organization organization mission more goals of provider. to provider organization and/or goals. mission or goals.
3 Customer Perception Customer expects this Organization is working Project is mismatch with 1 COHE have asked for a statewide organization to provide on project in area not prior products or services system to support their operations. this product. expected by customer. of this organization.
4 Work Flow Little or no change to Will change some aspect Significantly changes the 1 Will require changes to HSC work flow. or have small effect on work flow or method of business operations including work flow. organization. responsibilities to capture activity related data. Program Management 5 Goals Conflict Goals of projects within Goals of projects do not Goals of projects are in 1 Business goals are complimentary. the program are supportive conflict, but provide little conflict, either directly or of or complimentary to direct support. indirectly. each other.
6 Resource Conflict Projects within the Projects within the Projects within the 1 L&I staff have resource conflicts. program share resources program schedule program often need the Business analysts, IT staffs, and without any conflict. resources carefully to same resources at the same business program staff appear to avoid conflict. time (or compete for the have conflicting functional same budget). priorities. 7 Customer Conflict Multiple customers of the Multiple customers of the Multiple customers of the 1 Institutional COHEs have different program have common program have different program are trying to drive needs than community based needs. needs, but do not conflict. it in very different COHEs. directions.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 8 Leadership Program has active Program has person or Program has no leader, or 1 Project manager has competing program manager who team responsible for program manager concept functional priorities. coordinates projects. program, but he or she is is not in use. unable to spend enough time to lead effectively.
9 Program Manager Program manager has Program manager has Program manager is new 1 Project manager is new to L&I and Experience deep experience in the some experience in to the domain. the business area. domain. domain, is able to leverage subject matter experts.
10 Definition of the Program Program is well defined, Program is well defined, Program is not well 1 Business has a strong concept of with a scope that is but unlikely to be handled defined or carries how the project will operate. manageable by this by this organization. conflicting objectives in organization. the scope. Decision Drivers 11 Political Influences No particular politically Project has several Project has a variety of 1 Stakeholder community agree with driven choices being politically motivated political influences or and support the approach for made. decisions, such as using a most decisions are made COHES. vendor selected for behind closed doors. political reasons rather than qualifications.
12 Convenient Date Date for delivery has been Date is being partially Date is being totally 1 Deployment dates are mandated by set by reasonable project driven by need to meet driven by need to meet legislation rather than solid project commitment process. marketing demo, trade marketing demo, trade planning processes. show, or other mandate show, or other mandate; not related to technical little consideration of estimate. project team estimates.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 13 Use of Attractive Technology selected has Project is being done in a Project is being done as a 1 L&I has clearly defined SOA and Technology been in use for some time. sub-optimal way, to way to show a new technology standards and methods leverage the purchase or technology or as an excuse for deploying the application. development of new to bring a new technology technology. into the organization.
14 Short Term Solution Project meets short-term Project is focused on short- Project team has been 1 Program is being designed to need without serious term solution to a explicitly directed to support long-term program needs. compromise to long-term problem, with little ignore the long-term outlook. understanding of what is outlook and focus on needed in the long term. completing the short-term deliverable. Organization Management 15 Organization Stability Little or no change in Some management change Management or 1 L&I appears to be organizationally management or structure or reorganization organization structure is stable. expected. expected. continually or rapidly changing. 16 Organization Roles and Individuals throughout the Individuals understand Many in the organization 1 The business program does not Responsibilities organization understand their own roles and are unsure or unaware of understand key information their own roles and responsibilities, but are who is responsible for technology strategies and practices. responsibilities and those unsure who is responsible many of the activities of of others. for work outside their the organization. immediate group.
17 Policies and Standards Development policies and Development policies and No policies or standards, 1 Policies and standards are merging standards are defined and standards are in place, but or they are ill-defined and for COHE program. carefully followed. are weak or not carefully unused. followed. 18 Management Support Strongly committed to Some commitment, not Little or no support. 1 Leadership committed to the project success of project. total. but they have several other project running concurrently.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 19 Executive Involvement Visible and strong Occasional support, No visible support; no 1 Governance structure includes support. provides help on issues help on unresolved issues. executive involvement. when asked. 20 Project Objectives Verifiable project Some project objectives, No established project 1 Project scope is in place. Some objectives, reasonable measures may be objectives or objectives parameters may not be reasonably requirements. questionable. are not measurable. scoped. Customers/Users 21 User Involvement Users highly involved with Users play minor roles, Minimal or no user 1 High user involvement. project team, provide moderate impact on involvement; little user significant input. system. input.
22 User Experience Users highly experienced Users have experience Users have no previous 1 Insurance services have experience in similar projects; have with similar projects and experience with similar implementing projects in this specific ideas of how have needs in mind. projects; unsure of how domain area. needs can be met. needs can be met.
23 User Acceptance Users accept concepts and Users accept most Users do not accept any 1 Users have different needs and have details of system; process concepts and details of concepts or design details not seen a system design. is in place for user system; process is in place of system. approvals. for user approvals.
24 User Training Needs User training needs User training needs Requirements not 1 Training will be required for considered; training in considered; no training yet identified or not relatively small group. Application progress or plan in place. or training plan is in addressed. needs to be intuitive to use with development. little training requirements.
25 User Justification User justification User justification No satisfactory 1 Justification has been provided by complete, accurate, sound. provided, complete with justification for system. the business. Some question about some questions about applicability and rollout exist. applicability. Project Characteristics
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 26 Project Size Small, non-complex, or Medium, moderate Large, highly complex, or 1 Project is a large statewide project easily decomposed. complexity, not decomposable. with many integration requirements. decomposable. The composition of the project is now emerging. 27 Reusable Components Components available and Components available, but Components identified, 1 L&I has developed a SOA library of compatible with approach. need some revision. need serious modification many reusable components. for use. However, some components are not yet mature. 28 Supplied Components Components available and Components work under Components known to fail 1 Most SOA components are directly usable. most circumstances. in certain cases, likely to available. Some custom be late, or incompatible development is needed. with parts of approach.
29 Budget Size Sufficient budget Questionable budget Doubtful that budget is 1 Sufficient budget is allocated. allocated. allocated. sufficient. Additional funding may be available. 30 Budget Constraints Funds allocated without Some questions about Allocation in doubt or 1 Funding available without any constraints. availability of funds. subject to change without unreasonable constraints. notice. 31 Cost Controls Well established, in place. System in place, weak in System lacking or 1 L&I has mature accounting systems. areas. nonexistent. 32 Delivery Commitment Stable commitment dates. Some uncertain Unstable, fluctuating 1 Committed dates, but IS does not commitments. commitments. know whether they can meet the dates. 33 Development Schedule Team agrees that schedule Team finds one phase of Team agrees that two or 1 Very aggressive development is acceptable and can be the plan to have a schedule more phases of schedule schedule. met. that is too aggressive. are unlikely to be met.
Product Content 34 Requirements Stability Little or no change Some change expected Rapidly changing or no 1 Requirements are emerging. High expected to approved set against approved set. agreed-upon baseline. level requirements. No complete set (baseline). of requirements have been established.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 35 Requirements All completely specified Some requirements Some requirements only in 1 Requirements are a combination of Completeness and Clarity and clearly written. incomplete or unclear. the head of the customer. functional and non-functional requirements. 36 Testability Product requirements easy Parts of product hard to Most of product hard to 1 Heavy integration requirements will to test, plans underway. test, or minimal planning test, or no test plans being challenge testing processes. being done. made. 37 Design Difficulty Well defined interfaces; Unclear how to design, or Interfaces not well defined 1 System not defined. Significant new design well understood. aspects of design yet to be or controlled; subject to functionality in business analytics . decided. change. 38 Implementation Difficulty Content is reasonable for Content has elements Content has components 1 High integration requirements to this team to implement. somewhat difficult for this this team will find very wire several different SOA team to implement. difficult to implement. components and a lot of data integration requirements with existing legacy database systems.
39 System Dependencies Clearly defined Some elements of the No clear plan or schedule 1 Some ambiguity in some SOA dependencies of the system are well for how the whole system services and products. project and other parts of understood and planned; will come together. system. others are not yet comprehended. Deployment 40 Response or other Readily fits boundaries Operates occasionally at Operates continuously at 1 Capacity not yet established. Performance Factors needed; analysis has been boundaries. boundary levels. General assumption have been done. established. 41 Customer Service Impact Requires little change to Requires minor changes to Requires major changes to 1 Consistent with Pilot COHE customer service. customer service. customer service approach operations. Some new business or offerings. operations will emerge. 42 Data Migration Required Little or no data to Much data to migrate, but Much data to migrate; 1 Little data migration will be migrate. good descriptions several types of data or no required. Pilot COHEs have available of structure and good descriptions of what systems. use. is where.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 43 Pilot Approach Pilot site (or team) Pilot needs to be done Only available pilot sites 1 PILOT COHEs have been available and interested in with several sites (which are uncooperative or cooperative. participating. are willing) or with one already in crisis mode. that needs much help.
Development Process 44 Alternatives Analysis Analysis of alternatives Analysis of alternatives Analysis not completed, 1 Feasibility is considering complete, all considered, complete, some not all alternatives alternatives. assumptions verifiable. assumptions questionable considered, or or alternatives not fully assumptions faulty. considered.
45 Commitment Process Changes to commitments Changes to commitments Changes to commitments 1 Governance process is in place. in scope, content, schedule are communicated to all are made without review L&I has standard change are reviewed and approved involved. or involvement of the management and commitment by all involved. team. approval process.
46 Quality Assurance QA system established, Procedures established, No QA process or 1 L&I has a quality assurance process Approach followed, effective. but not well followed or established procedures. that includes integration and effective. business testing and acceptance.
47 Development Correct and available. Some deficiencies, but Nonexistent. 1 Documentation about SOA services Documentation available. is limited. 48 Use of Defined Development process in Process established, but No formal process used. 1 Clear IT development and Development Process place, established, not followed or is architectural standards and methods effective, followed by ineffective. are in place. team. 49 Early Identification of Peer reviews are Peer reviews are used Team expects to find all 1 Standard procedures for defect Defects incorporated throughout. sporadically. defects with testing. identification.
50 Defect Tracking Defect tracking defined, Defect tracking process No process in place to 1 L&I has standard defect tracking consistent, effective. defined, but inconsistently track defects. processes in place. used.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 51 Change Control for Work Formal change control Change control process in No change control process 1 Formal change processes will be Products process in place, followed, place, not followed or is used. implemented and followed. effective. ineffective. Development Environment 52 Physical Facilities Little or no modification Some modifications Major modifications 1 Facilities are adequate. needed. needed; some existent. needed, or facilities nonexistent. 53 Tools Availability In place, documented, Available, validated, some Invalidated, proprietary or 1 Tool sets are defined. However, an validated. development needed (or major development Integrated development minimal documentation). needed; no documentation. environment will need to be established for the project. 54 Vendor Support Complete support at Adequate support at Little or no support, high 1 Unknown reasonable price and in contracted price, cost, and/or poor response needed time frame. reasonable response time. time.
55 Contract Fit Contract with customer Contract has some open Contract has burdensome 1 Unknown has good terms, issues which could document requirements or communication with team interrupt team work causes extra work to is good. efforts. comply. 56 Disaster Recovery All areas following Some security measures in No security measures in 1 Assumed to be part of the agency's security guidelines; data place; backups done; place; backup lacking; business continuity and disaster backed up; disaster disaster recovery disaster recovery not recovery as a system is implemented recovery system in place; considered, but procedures considered. using their standard services. procedures followed. lacking or not followed.
Project Management (PM) 57 PM Approach Product and process Planning and monitoring Weak or nonexistent 1 Some planning in place. Substantial planning and monitoring need enhancement. planning and monitoring. project management plans and in place. processes need to be put into place.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 58 PM Experience PM very experienced with PM has moderate PM has no experience 1 PM has reasonable experience, but similar projects. experience or has with this type of project or is new to L&I. L&I governance experience with different is new to project structures are complex. types of projects. management.
59 PM Authority Has line management or Is able to influence those Has little authority from 1 The L&I approach gives Project official authority that elsewhere in the location in the managers adequate authority. enables project leadership organization, based on organization structure and Requires matrix management skills effectiveness. personal relationships. little personal power to interacting with complex business influence decision-making and technology organizational and resources. structures.
60 Support of the PM Complete support by team Support by most of team, No visible support; 1 Support for project manager appears and of management. with some reservations. manager in name only. to be reasonable.
Team Members 61 Team Member In place, little turnover Available, some turnover High turnover, not 1 The project has experienced some Availability expected; few interrupts expected; some available; team spends turnover with business analysts for firefighting. firefighting. most of time fighting fires. being assigned to another project.
62 Mix of Team Skills Good mix of disciplines. Some disciplines Some disciplines not 1 Team has limited technology skills. inadequately represented. represented at all. The team is currently recruiting for key positions. 63 Team Communication Goals and status clearly Team communicates some Team members rarely 1 Communication is reasonable. communicated between of the information some of communicate clearly with the team and rest of the time. each another or with organization. others who need to be informed. 64 Application Experience Extensive experience in Some experience with Little or no experience 1 Team is not yet assembled team with projects like similar projects. with similar projects. this.
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 65 Expertise with Application Good background with Some experience with No expertise in domain in 1 Team will likely be contract staff Area (Domain) application domain within domain in team or able to team, no availability of with little domain experience. development team. call on experts as needed. experts.
66 Experience with Project High experience. Average experience. Low experience. 1 Adequate knowledge and Tools understanding of project tools. 67 Experience with Project High experience. Average experience. Low experience. 1 Complex project with many Process stakeholders and multiple governance structures. 68 Training of Team Training plan in place, Training for some areas No training plan, or 1 Complex environment, will require training ongoing. not available, or training training not readily substantial training to support high planned for future. available. integration requirements.
69 Team Spirit and Attitude Strongly committed to Willing to do what it takes Little or no commitment to 1 Reasonable team morale exists. success of project; to get the job done. the project; not a cohesive cooperative. team. 70 Team Productivity All milestones met, Milestones met, some Productivity low, 1 Most long-term milestones being deliverables on time, delays in deliverables, milestones not met, delays met. Some deliverables appear out productivity high. productivity acceptable. in deliverables. of order. Technology 71 Technology Match to Technology planned for Some of the planned Selected technology is a 1 Reasonable technology match. Project project is good match to technology is not well poor match to the problem customers and problem. suited to the problem or or customer. customer. 72 Technology Experience of Good level of experience Some experience with the No experience with the 1 Unknown Project Team with technology. technology. technology.
73 Availability of Technology experts Experts available Will need to acquire help 1 Most technical positions don't exist Technology Expertise readily available. elsewhere in the from outside the and will need to be procured. organization. organization. 74 Maturity of Technology Technology has been in Technology is well Technology is leading 1 Technology is well understood. use in the industry for understood in the industry. edge, if not "bleeding Some SOA services are being quite some time. edge" in nature. developed and lack maturity. Maintenance and Support
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Risk Factors Medium Risk Cues Medium Risk Cues High Risk Cues Line Low Medium High N/A Need info TBD Notes 75 Design Complexity Easily maintained. Certain aspects difficult to Extremely difficult to 1 High system integration will make maintain. maintain. system a challenge to maintain. (i.e., SOA integration, data integration with existing systems, and Business intelligence issues.)
76 Support Personnel In place, experienced, Missing some areas of Significant discipline or 1 Support staff will have to be sufficient in number. expertise. expertise missing. assembled. 77 Vendor Support Complete support at Adequate support at Little or no support, high 1 Unknown reasonable price and in contracted price, cost, and/or poor response needed time frame. reasonable response time. time.
4016.001\OHMS RiskAnalysis v4 (XLS)||Analysis sooscreekconsulting.com Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Appendix K Project Schedule
4016.001\OHMS Feasibility Study\4.0 K-0 FINAL sooscreekconsulting.com 3/5/2012 WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBLITY STUDY 3/05/2012 APPENDIX K Estimated Schedule and Work Plan Page 1 of 4
ID Task Task Name Finish 012 2013 2014 2015 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 1 Key Milestone Project Start 4/2/12 2 PM Project Management 7/6/15 3 PM- Phase 1 Project Management Phase I 7/1/13 4 Project Initiation 4/16/12 5 Project Initiation Activities 4/16/12 6 Project Charter 4/16/12 4/16 7 Project Planning 6/11/12 8 Project Planning Activities 6/11/12 9 Project Management Plan 4/2/12 4/2 10 Project Execution 7/1/13 11 Project Execution Activities 6/12/12 12 Project Status Reports 7/1/13 13 Project Status Reports 4 6/12/12 6/12 14 Project Status Reports 5 7/10/12 7/10 15 Project Status Reports 6 8/14/12 8/14 16 Project Status Reports 7 9/11/12 9/11 17 Project Status Reports 8 10/9/12 10/9 18 Project Status Reports 9 11/13/12 11/13 19 Project Status Reports 10 12/11/12 12/11 20 Project Status Reports 11 1/8/13 1/8 21 Project Status Reports 12 2/12/13 2/12 22 Project Status Reports 13 3/12/13 3/12 23 Project Status Reports 14 4/9/13 4/9 24 Project Status Reports 15 5/14/13 5/14 25 Project Status Reports 16 6/11/13 6/11 26 Buffer 7/1/13 27 Phase I Project Management End 7/1/13 7/1 28 PM- Phase 2 Project Management Phase II 7/6/15 29 Project Initiation 7/15/13 30 Project Initiation Activities 7/15/13 31 Project Charter 7/15/13 7/15 32 Project Planning 8/12/13 33 Project Planning Activities 8/12/13 34 Project Management Plan 7/1/13 7/1 35 Project Execution 6/15/15 36 Project Execution Activities 6/15/15 37 Project Closeout 7/6/15 38 Phase II Project Management End 7/6/15 7/6
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ID Task Task Name Finish 012 2013 2014 2015 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 39 Phase 0 Acquisition Phase 10/1/12 40 Research Procurement 6/11/12 41 0.1 Prepare RFP 6/11/12 42 Define Scope of Services 4/30/12 43 Develop RFP 6/11/12 44 Release RFP 6/11/12 6/11 45 Solicit Responses 8/13/12 46 Vendor Proposals Received 8/13/12 8/13 47 0.2 Evaluation 9/10/12 48 Apparent Successful Vendor 9/10/12 9/10 49 0.3 Contracting 10/1/12 50 Contract 10/1/12 10/1 51 Phase 1 Core Services Development 7/1/13 52 I.1 Planning Phase 11/26/12 53 Design Business Changes 11/26/12 54 Plan User Training 10/22/12 55 Defines Systems Design Specification 11/12/12 56 Determine Interfaces Specifications 10/22/12 57 Define SOA Services 10/22/12 58 Define Integration Points 10/29/12 59 Data Conversion Plan 10/29/12 60 Design State Tables 10/29/12 61 Install Development servers 10/29/12 62 Design Network 10/29/12 63 Design Developed 11/26/12 11/26 64 I.2 Implementation Activities 3/4/13 65 Design New Business Processes 12/24/12 66 Develop User Training 12/24/12 67 Train Users 1/21/13 68 Build Application 3/4/13 69 Build Interfaces and Data Exchanges 2/18/13 70 Configure SOA Services 1/7/13 71 Integrate System Services 1/7/13 72 Clean up and Convert data 1/21/13 73 Build State Codes Data 12/24/12 74 Install Computer Infrastructure 1/21/13 75 Install Network 12/10/12 76 OHMS System Configured and Ready for Testing 3/4/13 3/4
4016.001\OHMS Project Schedule\4.0 sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBLITY STUDY 3/05/2012 APPENDIX K Estimated Schedule and Work Plan Page 3 of 4
ID Task Task Name Finish 012 2013 2014 2015 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 77 I.3 Systems Integration Testing 4/8/13 78 Conduct Systems Integration Test 4/1/13 79 Repair/ Fix 4/8/13 80 OHMS System Ready for UAT 4/8/13 4/8 81 I.4 User Acceptance Testing 6/3/13 82 Plan UAT 4/22/13 83 Conduct UAT 6/3/13 84 User Acceptance 6/3/13 6/3 85 I.5 Statewide Implementation 7/1/13 86 Plan Implementation 6/17/13 87 Implement System 7/1/13 88 System Goes Live 7/1/13 7/1 89 Phase 2 Integration with EMR and L&I 6/30/15 90 II.1 Planning Phase 11/4/13 91 Design Business Changes 9/23/13 92 Plan User Training 7/22/13 93 Defines Systems Design Specification 11/4/13 94 Determine Interfaces Specifications 11/4/13 95 Define SOA Services 7/22/13 96 Define Integration Points 7/29/13 97 Data Conversion Plan 7/29/13 98 Design State Tables 7/29/13 99 Design Developed 11/4/13 11/4 100 II.2 Implementation Activities 8/25/14 101 Design New Business Processes 11/5/13 102 Develop User Training 12/30/13 103 Train Users 2/24/14 104 Build Application 7/14/14 105 Build Interfaces and Data Exchanges 7/14/14 106 Configure SOA Services 12/16/13 107 Integrate System Services 8/25/14 108 Phase II System ready for Testing 8/25/14 8/25 109 II.3 Systems Integration Testing 11/17/14 110 Conduct Systems Integration Test 11/17/14 111 Repair/ Fix 9/29/14 112 Phase II System ready for Testing 11/17/14 11/17 113 II.4 User Acceptance Testing 4/6/15 114 Plan UAT 12/1/14
4016.001\OHMS Project Schedule\4.0 sooscreekconsulting.com WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES FINAL OCCUPATIONAL HEALTH MANAGEMENT SYSTEM FEASIBLITY STUDY 3/05/2012 APPENDIX K Estimated Schedule and Work Plan Page 4 of 4
ID Task Task Name Finish 012 2013 2014 2015 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 115 Conduct UAT 4/6/15 116 User Acceptance 4/6/15 4/6 117 II.5 Statewide Implementation 6/30/15 118 Plan Implementation 5/4/15 119 Implement System 6/30/15 120 System Goes Live 6/30/15 6/30 121 Project End 6/30/15 6/30
4016.001\OHMS Project Schedule\4.0 sooscreekconsulting.com Washington Department of Labor & Industries Occupation Health Management System (OHMS) Feasibility Study
Appendix L Alternatives vs. Scope Analysis
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR PHASE 1 1.2.1.1 Utilizes L&I architecture See Alternative 1 External to L&I See Alternative 3 A scalable architecture and investments EMR interface will Dependent upon the EMR interfacing leveraging existing L&I Reuses some ECS expand L&I SOA external vendor’s component should have investments in technology components and services services solution and architecture no impact that will expand to meet the Reuses some of L&I’s needs past 2013 to 2015 investments and beyond. 4 5 2 3 1.2.1.2 Application will utilize a See Alternative 1 OHMS dependent upon See Alternative 3 A centralized browser centralized browser EMR interface should the vendor’s solution EMR interface should based front end portal case Capable of case expand L&I’s case and user interface expand L&I’s case management system based management management Probably an external management on L&I’s E-Government functionality information system (web service) information Vision for HSCs and Compliant with “MY linked to L&I web site COHE Staff to monitor and L&I” E-Government Reuses some of L&I’s manage Phase 1 specified vision investments L&I claim information. Case management should expand L&I current suite 4 5 2 3
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.1.3 Application based on See Alternative 1 Dependent upon the See Alternative 3 The ability to display ECS design pattern Potential interface vendor’s specific Potential interface claim-specific data Reuse LINIIS web component that shares application component that shares replicated from LINIIS into services interface some LINIIS data with Provides adequate some LINIIS data with the OHMS system without EMR systems access to LINIIS data EMR systems the delay of data (via CAC) exchanges. Vendors have expressed the ability and willingness to replicate external data into application database 3 4 2 3 1.2.1.4 Dependent upon L&I See Alternative 1 Vendor product(s) See Alternative 3 The ability for HSCs to staff development EMR interface provides contain ability to place EMR interface provides place tickler(s) on a claim Ability to integrate with ability to integrate ‘ticklers’ on a claim ability to integrate and to trigger reminder other L&I systems triggers into Provider’s triggers into Provider’s notices. systems systems Limited to Claims and Higher level of COHE created data – coordinated care Limited EMR data functionality based on EMR data. 4 4 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.1.5 Dependent upon L&I See Alternative 1 Vendor product(s) See Alternative 3 The ability for automated staff development EMR interface provides contain ability to place EMR interface provides workflows with flags, and Ability to integrate with ability to integrate ‘ticklers’ and/or flags on ability to integrate trigger(s) for use by other L&I systems triggers and flags into a claim triggers and flags into internal and external users Provider’s systems as Vendor products support Provider’s systems as to create an efficient means well as L&I systems business rules well as L&I systems of communication based on Vendor products able to business rules and integrate with L&I standards. communication systems 4 5 3 4
1.2.1.7 Assumed following ECS See Alternative 1 Vendor products provide See Alternative 3 The ability to create data development approach EMR interface has no this capability EMR interface has no stores for COHE data (e.g., and technology impact Data stores may have to impact ability to track alerts, be modified to meet L&I triggers, work lists, record of employer data, etc.). 5 5 5 5
1.2.1.8 Assumed following ECS See Alternative 1 Vendor products provide See Alternative 3 Delivery of a standard set development approach EMR interface has no this capability EMR interface has no of predefined centralized and technology impact Reports may have to be impact reports that are currently modified to meet L&I Higher value being generated from data information based upon in the data warehouse. actual case EMR data 4 4 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.1.9 To be developed as part See Alternative 1 Vendor products provide See Alternative 3 The ability to enter and of OHMS Potential sharing of this capability or can Potential sharing of modify employer data Not shared with MIPS EMR data on employers provide easily EMR data on employers within the COHE’s by design employer database. 4 5 4 5
1.2.1.6 This function of the See Alternative 1 Vendors all have some See Alternative 3 The ability for system users OHMS application will The EMR interfacing HIE and EMR The EMR interfacing to be able to administer and be dependent upon EMR component will have a interfacing /integration component will have a enter top priority scales interfacing, FRQ survey significant impact on experience and therefore significant impact on (e.g., pain level and and engagement of the this approach, and may are prepared to deliver this approach, and may function level) based on attending physician, but not even be possible on this functionality not even be possible business rules and is feasible assuming L&I without it requirement without it requirements, including the is willing to build it with initiation/ this spec monitor/assessment of the FRQ, as well as functionality for users to administer a variety of scales. 3 5 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR Phase 2 1.2.2.1 Expansion of user base See Alternative 1 Additional user licenses See Alternative 3 Expand functionality to Development of Could provide internal into product Could provide internal include additional users additional views EMR users with access Additional security EMR users with access including: COHE Advisors, Additional security to OHMS data without profiles to OHMS data without participating providers, profiles another system another system ancillary providers, top tier More business providers, employers, L&I integration with provider staff (claims managers and coordinated care and employer services). referred providers are likely 3 4 4 5 1.2.2.2 Internal development See Alternative 1 Not integrated See Alternative 3 Provide an integrated user Expansion of single user EMR users could get experience Potential integration experience throughout L&I interface access to L&I data from External system with EMR systems, such as with the EMR However, this moves Claim and Account Center center of gravity for user (CAC). experience from being claims centric to provider data centric 5 3 2 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.3 Internal development See Alternative 1 Base system may See Alternative 3 Expand ability to integrate EMR interfacing provide in Phase 1 EMR interfacing scales with additional capability will likely Custom development capability will likely workflow, referrers, trends, have some influence on beyond base system have some influence on trigger(s) and alerts. this requirement in the TBD this requirement in the sense that scales, sense that scales, referrals, etc., will be referrals, etc., will be almost exclusively be almost exclusively be dependent upon provider dependent upon provider input, and EMRs could input, and EMRs could be the gateway for that be the gateway for that provider input provider input 4 5 4 5
1.2.2.4 Internal development See Alternative 1 Vendor solutions likely See Alternative 3 Expand the ability to COHE data entry EMR interfacing have the capacity to EMR interfacing collect, track, and review capabilities will directly perform this ability capabilities will directly data within the system impact this requirement Ability for their solution impact this requirement related to treatment plans due to availability of to collect the right in a good way due to and actions taken on a real-time data from information at the availability of real-time claim. EMRs being available to preferred time would data from EMRs being OHMS users most likely be a available to OHMS customization users requirement Better integration with EMR suggests more direct access to scales data 4 5 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.5 Internal development See Alternative 1 Vendor capability See Alternative 3 Expand reporting Expansion on Phase 1 EMR interface provides Expansion of user base External vendors and capabilities to include capabilities information to provider to additional providers, their customized ad hoc reports systems Top Tier, Self-Insured for multiple users, including participating providers and L&I staff, based on the most current real-time data available, and internal reports to track when providers become eligible for L&I incentive programs. 4 5 4 5 1.2.2.6 Internal development See Alternative 1 Billing for provider See Alternative 3 Generate updates to MIPS Modifications to MIPS services and incentives provider profiles based on Development of will provide visibility on eligibility for incentive incentive rules in OHMS activity and program programs (e.g., Top Tier) effectiveness. and the ability to calculate the incentives due to those providers. 4 4 4 4
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.7 Internal development See Alternative 1 Interface development See Alternative 3 Create new document types Modification to CAC EMR interface could by vendor EMR interface could in ORION that are likely move HSC notes to Utilize HIE standards move HSC notes to viewable in the CAC, Modifications to ORION provider system L&I develop SOA provider system including the ability for likely service HSC has access to employers to view HSC OHMS Provider View providers document notes in the CAC separate OHMS Claims Manager management system. from other medical notes View and the ability for the L&I Claims Manager to view HSC notes in ORION as a new document type. 4 5 4 5
1.2.2.8 Internal development See Alternative 1 Vendor systems can See Alternative 3 Expand the ability for users and/or configuration EMR data availability provide tickers, EMR interface might be to add tickler(s) to the This sort of functionality could prove vital to this notifications, etc. able to be integrated claim to alert the user when will already exist, only requirement during Configured by L&I with provider systems a claim needs to be now it will need to be phase 2 of OHMS revisited. expanded rollout Expand the ability for users to add tickler(s) to a claim to alert system users of a claim needing to be revisited 4 5 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.9 Internal development See Alternative 1 Might be part of vendor See Alternative 3 Provide the ability to OHMS tracks events and EMR or HIE interface standard systems EMR or HIE interface trigger MIPS payments generated invoices could utilize vendor Billing module would utilize vendor based upon HSC activities billing systems for purchased billing systems for and provider incentives transactions transactions based on treatment rules. 2 4 4 5 1.2.2.10 External training system See Alternative 1 Undetermined See Alternative 3 Include the ability to procured by L&I EMR interfacing could Could use external EMR interfacing could manage an online Configured by HSA and potentially make this training system procured potentially make this centralized provider COHE staff requirement easier to by L&I requirement easier to training repository that will Linked to OHMS satisfy if systems have Configured by HSA and satisfy if systems have allow L&I to more training included COHE staff training included effectively monitor and Linked to vendor system track provider training activities. 4 5 3 5 1.2.2.11 Internal development See Alternative 1 Assumed part of vendor See Alternative 3 Provide the ability to notify Part of OHMS No EMR benefit notification system No EMR benefit unless employers when a ROA notification system use EMR notification has been initiated by the system COHE.
4 4 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.12 Internal development New L&I HIE hub Vendor packages See Alternative 3 Provide the ability to New SOA services purchased provide capability to EMR interfaces included integrate with external Use of state HIE hub Timeline under L&I integrate with HIE hub in package or HIE hub systems like health Timeframe uncertain control Some vendors provide Interfaces configured information exchange HIE hub (HIE) or electronic medical records (EMR) systems, so that their chart notes and records can be populated into L&I systems. 2 4 4 5 1.2.2.13 Use L&I data warehouse See Alternative 1 Vendor packages See Alternative 3 Analyze aggregate claims and research tools EMR data could expand provide some BI EMR included in some data (metadata) and use Use L&I BI tools overall data set in data capability vendor packages and business intelligence to warehouse May have to add-on a reporting suites identify injured workers at data mart with BI tools Data can be exported to risk of disability. to meet needs L&I or third party researchers 3 4 4 5
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR 1.2.2.14 Internal development See Alternative 1 Vendor packaged See Alternative 3 Compare actual provider The availability of EMR solution offerings The availability of EMR practice with recommended data readily available to appeared to provide the data readily available to workflow to identify when L&I could provide the ability for some analysis L&I could provide the providers are using best window needed to tools but to what extent window needed to practices or following L&I adequately assess a is still unclear at this adequately assess a treatment guidelines. providers ability and/or point providers ability and/or willingness to operate Further analysis of willingness to operate within COHE guidelines vendor solutions (such within COHE guidelines for level of service and as presentations, for level of service and care delivery and to solution demos, RFI, care delivery and to actively demonstrate RFP process) would actively demonstrate best practices reveal this info best practices 3 4 4 5 1.2.2.15 Internal development See Alternative 1 Included in vendor See Alternative 3 Offer robust user help Internal standards EMR interface will not products EMR interface will not options (may include online External utilities linked affect this requirement Configured by L&I affect this requirement tutorials, wikis, or other to system External utilities linked tools). L&I population and to system configuration L&I population and configuration 3 3 4 4
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Alternative 2 Alternative 4 Alternative 1 Alternative 3 Internal Development External Systems Integrator PHASE Internal Development External Systems Integrator w/ EMR w/ EMR Phase 1 Totals 35 42 30 38 Phase 2 Totals 51 64 57 73 TOTALS 86 106 87 111
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