Medical software development services. The Health and Social Care Information Centre (HSCIC) wishes to commission a service from an external supplier.
The National Casemix Classifications Service develops clinical grouping methodologies and software products that enable the NHS to record clinical activity and, in turn, support reimbursement of clinical activity through Payment by Results (PbR).
The predominant classification system being developed is Healthcare Resource Groups (HRGs). Healthcare Resource Groups (HRGs) are standard groupings of clinically similar treatments which use comparable levels of healthcare resource. In their most basic form HRGs are groups of ICD-10 diagnoses and OPCS procedures that have similar resource implications.
The design, implementation and support of HRGs is the main function of the Casemix service. In order to pay hospitals accurately for work they carry out, a tariff needs to be assigned to each diagnosis and procedure code in use (currently ICD-10 codes for diagnoses, OPCS 4.5 for procedures), HRGs are designed to bring together diagnoses or procedures that are of similar resource use and are clinically coherent and meaningful.
Under the Payment by Results (PbR) government policy, these classifications are used as a currency to provide a mechanism whereby NHS trusts can be appropriately reimbursed for providing healthcare services.
The development of HRGs is cyclical. Each year a revision process is executed to revise the current version where necessary and every few years a major revision process takes place to ensure that the classification keeps pace with the continuous modernisation of the NHS.
HRG4 has been developed to:
a) Reflect changes in clinical practice and costs
b) Increase coverage by introducing HRGs to new clinical areas
c) Introduce the concept of ‘setting independence’
d) Increase the statistical performance of HRGs by introducing elements such as unbundling and improved complication and comorbidity splits
e) Incorporate the improved identification and classification of procedures using updated OPCS codes
f) Enable more accurate analysis of healthcare needs within the service
In order to facilitate the above services the HSCIC requires a supplier to construct a user friendly, secure and auditable solution to:
1 Develop, test and deliver multiple (expected to be 4 per year) HRG4 local Groupers (“Groupers”) in line with the supplied specifications. This could be either a new development or as amendments or updates to an existing product as required;
2. Provide ongoing support for the products produced including resolution of bugs or issues in live products;
3. Provide a mechanism for the acceptance of additional, Grouper-related commissions from the National Casemix Service, on a call-off basis, for the delivery of additional products and / or services.