Audacious Inquiry - Capabilities

Audacious Inquiry's current customer base includes state agencies and state-designated entities for HIE, federal agencies, hospitals and large integrated delivery networks (IDNS), national payers, as well as private-sector clients in the financial services, education, and non-profit sectors. Its project mix is weighted towards stable, long-term client relationships with some shorter-term, deliverable-based engagements.

Our track record of completing projects and providing high-quality deliverables on time and on budget is exemplary. The Ai team employs an overall management approach founded on processes defined in the internationally recognized and federal government-endorsed Project Management Institute (PMI) Body of Knowledge. This approach ensures that all required tasks are planned and completed according to schedule, budget, and to the highest professional standard as measured by predetermined and mutually understood performance standards, processes, and procedures. The number of critical software solutions that AI has developed or procured for its clients—and that continue to be relied upon—serves as strong evidence of the success and repeatability of our approach.

Read our case studies to learn more.

The team boasts more than fifty years of collective experience in the healthcare industry, having worked on a range of projects in multiple states with a wide array of objectives, technologies and stakeholders. This includes over four years of working for the Chesapeake Regional Information System for our Patients (CRISP), the state-designated entity for HIE in Maryland. Ai worked for the president of this organization on health IT projects for five years prior to the incorporation of CRISP. Very few firms nationally offer a comparable level of experience designing and implementing statewide HIE programs.

Team members actively participate in federally-sponsored health IT policy and standards development bodies (HL7, HITSP, IHE, NHIN and NHIN Direct) and includes a co-author of the NHIN Exchange specifications and a founding architect of one of the market’s established HIE infrastructure providers. The team has designed and developed systems that work with data and transport interoperability standards using HL7, HIPAA (EDI), XDS.b, PIX/PDQ, and CCD.

Ai has verifiable past experience in the following areas:

Health IT project and program management
Health information exchange subject matter experts—strategy, infrastructure design, and deployment
Health information systems interoperability, interfaces, message routing, and master patient indexes
Patient engagement and personal health record system development; officially recognized Microsoft HealthVault™ consultant
EHRs—technology implementation, clinical workflow mapping, and forms development
Strategy formulation, stakeholder communication and workgroup facilitation

More broadly, Ai has a wealth of experience and knowhow in the Enterprise Application Integration (EAI) and Systems Integration space, which will be valuable to the winning MERP team. AI team members have invested substantial time and effort designing and implementing system integration solutions using BizTalk Server, SQL Server Integration Services (SSIS), and Windows Communication Foundation (WCF) for customers in healthcare, education, and government.

Visit the case studies section of our site to learn more about Ai's work in health information systems.

As an IBM Valued Plus Partners, Ai brings a wealth of IBM Initiate master data management, or MDM, consulting and implementation experience. Not only has Ai been the key drivers and implementers of Maryland's successful HIE's MDM implementation, the company has shown a wide breath of experience implementing MDM solutions across a wide range of projects. The AI team's expertise in implementing and consulting on MDM projects related to the healthcare, federal agencies and other private sector organizations is second only to IBM itself.

Ai's MDM expertise includes:

Data analysis, data modeling and data architecture
Systems integrations
Enterprise architecture
Initiate MDM implementation skills
Senior software engineers - custom development
Custom report generation skills
Integrating MDM solutions into the enterprise
Long term and short term technical support
Project managers with specific MDM implementation skills and experience

Want the very best? The Ai team members' broad knowledge and experience within their specific industries allow for tailored, successful and expertise-driven solutions, throughout the MDM project lifecycle.

AI is currently offering the following services for IBM Initiate MDM implementations:

Program and project management
Pre-implementation data analysis
Custom development tailored to business requirements
- Report development
- Application development
User-interfaces, engine call outs (ECOs), monitoring solutions
Implementation services
- Start to finish services provided with a team to deliver project management, implementation consulting, data analysis, process consulting
Install base services
- IBM Initiate MDM upgrades
- Post go-live MDM system analysis
- Add-a-source/add-an-attribute
- Source integration
Technical support/assistance
Process and data governance consulting

Visit the case studies section of our site to learn more about Ai's work in master data management.

ENS delivers real-time hospitalization alerts to support care coordination

Encounter Notification System (ENS) delivers real-time ADT information about a patient’s medical services encounter, for instance at the time of hospitalization, to a permitted recipient with an existing relationship to the patient, such as a primary care provider
ENS promotes care coordination and is a revenue-driving service for statewide HIEs
ENS is designed to integrate with existing ADT feeds and query-based HIE infrastructure
ENS makes encounter notifications less expensive, more broadly available, and more consistent than most current notification services

ENS alerts include patient, facility, and encounter information, and can include a link to the HIE

The ENS technical design leverages existing HIE infrastructure to streamline and reduce the cost of implementation

ENS relies only on existing ADT feeds and a Master Patient Index (MPI). If an existing Direct capability exists, ENS can also integrate with that Direct installation to package outbound notifications.

ENS relies on three core activities

Patient Attribution
- Practices upload patient rosters in Excel format
- Justification of patient panel and “active” patient list required
- Panels can also be auto-generated from ADT messages for hospitals seeking to subscribe to patients they discharged in the previous 30 days
Alert Preferences
- Users define the types of messages they want to receive (trigger event selection) and the frequency
Notification Output
- Direct: Alerts are sent via the Direct standard into a Direct inbox or an application that supports Direct messages. Non-secure email alerts can also be sent notifying providers to check their inbox.
- HL7: Alerts are sent in an HL7 format to an end user application that can consume these alerts. These can be sent via SFTP, Web Services, VPN, or another secure connectivity method.
- Web Services: Alerts can be sent via other web service calls defined by the customer

* ENS participants have the option to develop a policy framework for the use of ENS and definition of “active” patients, or apply AI’s recommended policy

ENS supports care coordination and regulatory compliance

Today, providers and others with care coordination responsibility may not know when one of the their patients is admitted to a hospital, or they may find out well after the hospital event
ENS supports hospital communication with PCPs and care managers to promote care coordination and reduce readmissions

ENS helps hospitals comply with CMS A-0133
- “The patient has the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.”

ENS provides ambulatory providers with a tool to capture new CPT TCM codes

CMS recently approved two new CPT transitional care management (TCM) codes to reflect non face-to-face care management work involved in primary care

Code	Required elements	Reimbursement in facility setting (approximate)	Reimbursement in non-facility setting (approximate)
99495	Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge	$135	$164
99496	Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge	$198	$231

Reimbursements to begin Jan 1, 2013
CMS estimates that providers will provider the post-discharge TCM service for 5.7 million discharges in 2013, and AMA RUC estimates that 2 million of these codes will be billed each year

ENS is a critical tool for providers to capture new
payments, which are likely to exceed $300M in 2013

The Ai ENS solution delivers a strong competitive advantage

Configurable to integrate with various MPI solutions
Does not rely on the PCP in an ADT message (often missing or inaccurate) for patient-provider attribution, but rather creates panels from practice-provided patient lists for accurate attribution for patients for whom the provider has expressly requested notifications
Recipients can request the type of messages (ER visits only, Admissions, Discharges, All of the above, etc.), and the frequency that they arrive (real-time, daily, weekly, etc.)
Alerts can be sent via Direct messages -- supporting rapid on-boarding and driving Direct volumes and utilization
Supports outbound alerts into other hub technologies or EHRs in the form of HL7 messages for an integrated user experience
Alerts contain clinically relevant information meaningful for care (reason for visit, discharge diagnosis, discharge disposition)
Configurable alerts so that specialists can select to only receive alerts regarding their specialty (according to ICD9 codes, etc.)

Ai’s ENS experience includes building the CRISP ENS solution for the state of Maryland

Since 2008, AI has been leading efforts at CRISP, Maryland’s statewide HIE
CRISP receives all ADT messages from every hospital in Maryland
AI built and manages CRISP’s ENS, which went live in August 2012
The CRISP deployment of ENS currently serves:
- 8 organizations
- 31 practice locations
- 471 providers
- 211,000 patients

Audacious Inquiry uses available open-source and commercial products to facilitate the rapid development of modern web applications. We have verifiable past experience in completing complex projects within the federal government and the private sector. With more than a dozen web applications successfully deployed in the last four years, Ai believes that there are three primary drivers of a successful outcome: 1) the quality and comprehensiveness of the plan, including the detailing in advance of all known goals, requirements, risks, and dependencies; 2) the commitment and initiative of all members of the project team; and 3) the project management methodologies used to create a tight feedback loop among all project stakeholders, including but not limited to the contractor, the client, and end users.

The following are among our core competencies:

Customer concept development, functional requirements gathering, technical specification development, and graphics design
Standards-based development: .Net, Microsoft IIS, Microsoft SQL Server, DotNetNuke
Integration with external scientific content databases and GIS mapping systems
Mobile content syndication, Android operating system application development, and iPad development
Training and transition services to fulltime staff for ongoing operations
Customer engagement and web 2.0
Transmission and storage of sensitive data and protected health information
Federal government-specific requirements, including Section 508 compliance and agency- and department-wide technical and visual guidelines

Visit the case studies section of our site to learn more about Ai's work in web applications.

Audacious Inquiry offers a range of analytical consulting services that, for many client engagements, are complementary to our other business lines. They include:

Statistical analyses of marketing programs and objectives
Business intelligence and dashboarding
Data mining and analysis, including of health care claims data
Customer lifetime value assessments, pricing analyses, strategy formulation
Supported by Dr. David Bell, marketing professor at the Wharton School of the University of Pennsylvania

Visit the case studies section of our site to learn more about Ai's work in analytical services.