request for proposal coastal family health center ehr...

Request for Proposal Coastal Family Health Center

EHR Implementation Project

Questions due by 4th February 2013

Responses due by 18 February 2013

Please submit all questions to Stacey Curry [email protected], with

the subject of either ‘RFP Question’ or ‘RFP Response’.

Coastal Family Health Center 1046 Division Street Biloxi, MS 39530

mailto:[email protected]_______

Coastal Family Health Center Request for Proposal

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Contents

Contents ........................................................................................................................................................ 2

Revision History ............................................................................................................................................ 4

Definition of Acronyms ................................................................................................................................. 4

1. Introduction .......................................................................................................................................... 6

1.1 Overview of Coastal Family Health Center ................................................................................... 6

1.2 Overview of Current Systems Environment .................................................................................. 6

1.3 Scope of Project ............................................................................................................................ 6

2. Statement of Purpose ........................................................................................................................... 7

2.1 Overall Business Objectives .......................................................................................................... 7

2.2 Key Project Deliverables ............................................................................................................... 7

3. Submission Instructions ........................................................................................................................ 8

3.1 Method of Response ..................................................................................................................... 8

3.2 Expected Timeline for Procurement ............................................................................................. 8

3.3 Compilation Instructions ............................................................................................................... 9

4. Vendor Required Information ............................................................................................................... 9

5. Functional System Requirements ....................................................................................................... 10

5.1 Key Functionalities of the EHR System ....................................................................................... 10

5.2 Health Information Management & Reporting Capabilities ....................................................... 10

5.3 System Administration ................................................................................................................ 10

6. Pricing Structure.................................................................................................................................. 10

7. Terms and Conditions ......................................................................................................................... 11

7.1 Confidentiality ................................................................................................................................... 11

7.2 Preparation Costs ........................................................................................................................ 11

7.3 Governing Law/Venue ................................................................................................................ 11

7.4 Formal Presentation ................................................................................................................... 12

7.5 Acceptance or Rejection ................................................................................................................... 12

7.6 Contract Provisions ........................................................................................................................... 13

Appendix A – Vendor Information .............................................................................................................. 14


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Appendix B – Key Functionalities of the EHR System ................................................................................. 15

B.1 Certification ............................................................................................................................. 15

B.2 Core System Features ............................................................................................................. 15

B.3 Infrastructure .......................................................................................................................... 18

B.4 Provider Workflow .................................................................................................................. 18

B.5 Standards ................................................................................................................................ 20

B.6 Interfaces ................................................................................................................................ 21

B.7 Implementation ...................................................................................................................... 22

B.8 On-going Support & Maintenance .......................................................................................... 23

Appendix C – Health Information Management & Reporting Capabilities ................................................. 25

C.1 Registry and Care Management ............................................................................................. 25

C.2 Data Collection & Reporting ................................................................................................... 27

C.3 HIE Inbound ............................................................................................................................ 28

C.4 HIE Outbound ......................................................................................................................... 29

Appendix D – System Administration ......................................................................................................... 31

Appendix E – Pricing Structure.................................................................................................................... 35

Appendix F – Supporting Documentation ................................................................................................... 36


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Revision History Version Version Date Author Comments

V2 1/28/2013 CFHC For Publication

Definition of Acronyms

ACRONYM Definition

ACOG American Congress Of Obstetricians And Gynecologists

ADT Admit Discharge Transfer

AL1 Patient Allergy Information

ASP Active Server Pages

CCD Continuity Of Care Document

CDA Clinical Document Architecture

CDS Clinical Decision Support

CDT Current Dental Terminology

CFHC Coastal Family Heath Center

CMS Centers For Medicare & Medicaid Services

CPOE Computerized Physician Order Entry

CPT Current Procedural Terminology

CVX Codes For Vaccines Administered

DG1 Diagnosis Information

DSM Diagnostic And Statistical Manual Of Mental Disorders

E & M Evaluation & Management

EHR Electronic Health Record

ELINCS EHR-Lab Interoperability And Connectivity Specification

e-Rx Electronic Prescribing

FQHC Federally Qualified Health Center

FTE Full Time Employee

GNOHIE Greater New Orleans Health Information Exchange

H & P History And Physical

HIE Health Information Exchange

HITSP Healthcare Information Technology Standards Pane

HL7 Health Level Seven Defined Standard Functional Model

HPI History Of Present Illness

ICD International Classification Of Disease

IHE Integrating The Healthcare Enterprise

LOINC Logical Observation Identifiers Names And Codes

MDM Medical Document Management

MFN Master Files Change Notification Message

MIIX Mississippi Immunization Information Exchange

MPI Master Patient Index


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ACRONYM Definition

MRN Medical Record Number

MS-HIN Mississippi Heath Information Network

MU Meaningful Use

NCQA National Committee For Quality Assurance

NHIN National Health Information Network

OBR Observation Request

OBX Observation Segment

ONC-ATCB Office Of The National Coordinator's Authorized Testing And Certification Body

ORM Order

ORU Observation Result

PCMH Patient Centered Medical Home

PM Practice Management

PQRS Physician Quality And Reporting System (Formerly PQRI)

PV1 Patient Visit Information

RCM Revenue Cycle Management

REF Patient Referral

RF1 Referral Information

RFP Request For Proposal

ROS Review Of Systems

RRI Return Referral Information

SaaS Software-As-A-Service

SAML Security Assertion Markup Language

SIU Schedule Information Unsolicited

SNOMED Systematized Nomenclature Of Medicine

SRM Schedule Request Message

SSO Single Sign-On

UDS Uniform Data System

URL Uniform Resource Locator

USPSTF U.S. Preventive Services Task Force

VPN Virtual Private Network

VXU Unsolicited Vaccination Record Update

XDS.b Cross-Document Sharing


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1. Introduction

1.1 Overview of Coastal Family Health Center

Coastal Family Health Center, Inc. is a comprehensive, federally qualified health center serving residents of all ages, races and ethnicities, with or without insurance, for the Gulf Coast communities for more than 30 years. CFHC encompasses nine health centers across Hancock, Harrison and Jackson counties, along with two mobile units, two school clinics and an upcoming Pediatric health center in Biloxi slated to open in January 2013. CFHC employs approximately 45 providers and over 200 staff members. Comprehensive services at CFHC include: adult internal medicine, family practice, pediatrics, women’s health, WIC (Women, Infants and Children), dental care, optometry, mental and behavioral health, HIV care, pharmacy, social services and medication assistance, Spanish and Vietnamese translators, and transportation assistance. Private insurance, Medicare, Medicaid, and CHIP are accepted, and CFHC offers sliding fee discounts based on family size and income. CFHC also offers reduced pricing on pharmaceuticals for the patients.

1.2 Overview of Current Systems Environment

The current EMR system is a client/server based system with off-site data repositories in data centers

located in Hattiesburg, MS and Birmingham, AL. The primary data center is at the Hattiesburg location

with nightly local data backup and replication to Birmingham. The current data repository contains

approximately 700GB of data that has been accumulated over the previous 5 years. Client machines are

PC’s that provide additional office functionality with laptops provided for on-call physicians and

administrative staff and a VPN is provided for out of network, remote connections. Clinic policies

prevent patient level information from being stored on the PC.

1.3 Scope of Project Coastal Family Health Center (CFHC) is releasing this RFP for the procurement of a healthcare

information management system. This system will be inclusive of electronic health records, practice

management, and revenue cycle management. CFHC is seeking responses for a fully integrated system

from which care coordination efforts can be maximized, sustainability efforts can be realized and quality

improvement efforts can be driven.

The chosen EMR will be implemented to include all clinic locations. The implementation will be done

Center- wide in order to minimize disruption to normal clinic operation. The chosen EMR must provide

features and functions to help facilitate the attainment of both CMS Meaningful Use Attestation (Stages

1-3), and NCQA Patient-Centered Medical Home certification (Level 3). These features and functions

must be present in the initial EMR and should not require any additional hardware, software or program

development.


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Phases of the project will include the following at a minimum:

Project Startup – Initial Assessments and Planning

Data Migration – Information from existing EHR & PM transferred.

Implementation – Pilots and Rollouts

Ongoing Support and Maintenance - Resolution of software and training related

issues; maintenance of current versions of software and training materials.

2. Statement of Purpose

2.1 Overall Business Objectives Through implementation of a comprehensive electronic health records (EHR) system, CFHC intends to

achieve the following objectives:

Streamline and standardize workflow between sites and specialties.

Implement quality improvement and operational efficiency programs made

possible through data gathered through the system.

Improve the coordination of care by enhancing interoperability among internal

business units and external partners in care.

Maximize the integration of primary and behavioral health care.

Maximize revenue cycle through a fully integrated system.

Attest to all Meaningful Use requirements (Stages 1-3).

Implement NCQA PCMH standards throughout the organization in order to

meet and sustain level 3 recognition requirements.

Automate report generation, including comprehensive UDS reports & Ryan

White reports.

2.2 Key Project Deliverables Milestones for this project will remain on a time schedule that must be adhered to by the vendor with

the winning bid. These timelines are set and unmovable due to constraints outside the control of CFHC.

Milestone #1 Request for Proposal Published

Milestone #2 Responses received

Milestone #3 Vendor Demonstrations

Milestone #4 Contract Completion

Milestone #5 Implementation Plan Approved


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Milestone #6 Training Started

Milestone #7 Data Migration Completed

Milestone #8 Super users trained

Milestone #9 Go-Live Started

Milestone #10 Go-Live Completed

3. Submission Instructions

3.1 Method of Response Please note that not following any of these instructions may lead to disqualification, with discretion of

this disqualification left to CFHC.

In order to submit a response, email the file to [email protected]. This must be a single

file, and no larger than 2 MB, and in .pdf format.

It is required to use tables and forms provided within this RFP. Word or Excel versions can be emailed

upon request.

While not required, it is appreciated to receive a letter of intent by February 4th 2013.

Any questions concerning this RFP must also be submitted in writing on or before 5:00 PM Central Time on the question due date (February 4th 2013 5 PM CST). Please submit questions with ‘RFP Questions’ in the subject line. One document with responses to all questions received will be emailed out to all that submit a notification or letter of intent. For responses, please submit the .pdf file as an attachment with ‘RFP Response’ in the subject line.

Where possible, please number pages and label header or footer with Vendor Name and Document

Title.

3.2 Expected Timeline for Procurement

Release of RFP 28th January 2013

Notification of Intent & Questions Due 4th February 2013

RFP Questions Answered by 11th February 2013

mailto:[email protected]


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Responses Due 18 February 2013

Notification for Required Demonstration 11th March 2013

Required Demonstrations W/C 25th March 2013

Final Decision Made TBA

3.3 Compilation Instructions

For submission, please follow the order below: Format

A. Vendor Information 1 table

B. Key Functionalities of the EHR System 8 tables

1. Certification

2. Core System Features

3. Infrastructure

4. Provider Workflow

5. Standards

6. Interfaces

7. Implementation

8. Ongoing Support & Maintenance

C. Health Information Management & Reporting 4 tables

1. Registry & Care Management

2. Data Collection & Reporting

3. HIE Inbound

4. HIE Outbound

D. System Administration 1 table

E. Pricing Structure 1 table

F. Supporting Documentation* undefined

*Please see supporting documentation instructions in Appendix F.

4. Vendor Required Information

Required: Appendix A – Vendor Information tables to be completed.


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Supporting Documentation* Additional general information about the vendor may be submitted with the supporting documentation. Reference information or other examples may also be submitted in this section.

*Please see supporting documentation instructions in Appendix F

5. Functional System Requirements

5.1 Key Functionalities of the EHR System

Required: Appendix B – Key Functionalities of the EHR System tables to be completed.

Supporting Documentation* Please include a complete hardware specification list (if applicable), connectivity/bandwidth requirements, and a list of medical and non-medical devices that your company provides connectivity to. Also include an overview of your implementation methodology and a sample project plan consistent with the size of CFHC.


5.2 Health Information Management & Reporting Capabilities

Required: Appendix C – Health Information Management & Reporting Capabilities tables to be

completed.

5.3 System Administration

Required: Appendix D – System Administration table to be completed.

6. Pricing Structure

Required: Appendix E – Pricing Structure table to be completed.

Supporting Documentation* If desired, in addition, a generic proposal of pricing can be submitted with RFP Response in the

Supporting Documentation section. This must be in addition to the table in Appendix E.



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7. Terms and Conditions

Note: This is a request for proposal only, and not a request for service. The vendor must bear all costs of

preparing this RFP. Respondents are acknowledging agreement to these terms and conditions with

submission of a response.

7.1 Confidentiality

The RFP will be used for the sole benefit of CFHC, and responses will be used to provide information to CFHC as part of the procurement process. Upon receipt by CFHC, all responses, inquiries, or correspondence relating to or in reference of this RFP, and all other materials, reports, charts, displays, schedules, exhibits, and other documentation submitted by the vendors shall become property of CFHC. As a recipient of funds from public and private sources, CFHC is subject to strict accountability and reporting requirements. Any response or other information submitted by a respondent to CFHC is subject to disclosure by CFHC as required by law or agreement. CFHC makes no agreements or representations of any kind, and expressly disclaims any requirement to maintain the confidentiality of any information provided to CFHC in response to this RFP.

7.2 Preparation Costs

Any costs incurred by the vendor in preparing, submitting, or presenting responses are the sole

responsibility of the vendor. CFHC shall not be responsible for reimburse any costs incurred including,

but not limited to, travel, lodging, or supplies.

7.3 Governing Law/Venue

The Vendors will comply with all federal, state and local laws, regulations, ordinances, guidelines, permits and requirements applicable to providing services pursuant to the RFP and final negotiated agreement, if applicable, and will be solely responsible for obtaining current information on such requirements.


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7.4 Formal Presentation

If the submission is deemed a good candidate, on-site demonstrations will be required. Not all

responders will be invited to demonstrate their product. These demonstrations will occur during the

week of February 26th, 2013 and are mandatory.

7.5 Acceptance or Rejection

CFHC reserves the right to make or not make an award based solely on the proposals, or to discuss

further with one or more of the Vendors. Award will be upon what is most advantageous to CFHC and

will take into consideration price and the other evaluation factors set forth in this RFP or as allowed by

law.

A response to a RFP is not a bid and does not commit CFHC to accept a proposal. The RFP process

provides the opportunity to negotiate with prospective Vendors. This RFP is not an order and does not

commit CFHC to pay for any costs incurred in the preparation or submission of any quotation or

proposal or to procure the materials or supplies hereunder. Quantities used herein to estimate

responses may or may not reflect actual quantities used or needed, and do not commit CFHC to order

specified estimated quantities. Any offers accompanied by terms and conditions that are in conflict with

this RFP may be considered unacceptable.

Vendors may be disqualified for situations or conditions as determined appropriate by CFHC, in its sole discretion, including, but not limited to the following:

Collusion between a CFHC employee/representative and the Vendor.

The Company, any sub-provider or Vendor, is in litigation with CFHC.

Vendor in arrears on any existing contract or having defaulted on previous contract.

Lack of competency as revealed by pertinent factors, including but not limited to, experience and equipment, financial statement and questionnaires.

Incomplete work that in the judgment of CFHC will prevent or hinder the prompt completion of additional work awarded.

Vendor has failed to perform in a satisfactory manner on a previous contract.

Conflict of interest with CFHC.

Offerings of gifts and/or bribes to any CFHC employee/representative.

Non-compliance with CFHC rules for Vendors/visitors.

Failure to respond to all or part of the RFP’s stated requirements, request for information, or other data required by CFHC within this RFP.


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Identified on the Federal Government Health and Human Services (HHS) List of Excluded Individual / Entities (LEIE); Identified on any of the 50 States Medicaid Excluded Provider List; or the federal government terrorist list.

7.6 Contract Provisions

The services to be provided under the contract shall commence and terminate on mutually agreed upon

dates. Terms for early termination shall be included in the final agreement as negotiated by the parties.

The Vendors may not use subcontractors to perform the services described in the RFP without the

express prior written consent of CFHC. The Vendors will include provisions in its subcontracts requiring

its subcontractors to comply with the applicable provisions of the RFP, to indemnify CFHC, and to

provide insurance coverage for the benefit of CFHC in a manner consistent with the RFP. The Vendor

will cause its subcontractors, agents, and employees to comply, with applicable federal, state and local

laws, regulations, ordinances, guidelines, permits and requirements and will adopt such review and

inspection procedures as are necessary to assure such compliance.

The RFP may be withdrawn at any time by CFHC prior to execution of an agreement.

Any agreement depends upon the continued availability of appropriated funds and expenditure

authority from the Legislature for the intended purpose. If for any reason the Legislature fails to

appropriate funds or grant expenditure authority, or funds become unavailable by operation of law or

federal funds reductions, the agreement will be terminated by CFHC. Termination for any of these

reasons is not a default by the State nor does it give rise to a claim against CFHC.


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Appendix A – Vendor Information

General Information

Company Name

Address of Headquarters

Address of branch in Mississippi (if applicable)

Company Goals

Key employees and length of tenure

Number of years as EHR vendor

Please list any company merges, acquisitions, and sell-offs and year completed.

Is the company Public or Privately Owned?

Have there been any Bankruptcy/Legal Issues?

If so, please include under which name the bankruptcy was filed and when, or any pertinent lawsuits, closed or pending, filed against the company.

Number of entities actively using the software.

How many of these entities are multi-site?

Breakdown of entity by site # and by provider # (1-5, 6-9, >10)

How many of these sites are Primary care? FQHCs? Ryan White? Behavioral Health?

How many entities have de-installed any vendor systems over the past two (2) years? Please specify which systems and why?

How many providers supported by this vendor have attested Meaningful Use Stage 1?

How many sites and providers supported by this vendor have been NCQA PCMH Level 1 recognized? Level 2 recognized? Level 3 recognized?

Which southeastern states does your product have a presence?

For those states, list # of install sites by specialty and size, and provide a list of southeastern reference sites, including FQHCs.

Please provide references that are available for contact that most relate to this facility, including references for listed specialists.

Please provide name, address and contact information of a facility for a site visit that most resembles this clinic and its requirements.

Does this vendor hold user group meetings?

Please list the frequency of user group meetings.

Does the vendor use customer participation in requirements-gathering stages of system development?

How is customer feedback, such as requests for new requirements, handled?

Product Information

Product Name

Product Version #


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Appendix B – Key Functionalities of the EHR System

B.1 Certification

ONC-ATCB # :

Stage 1 Certification Date

Stage 2 In-progress? Projected Date if Available

B.2 Core System Features

Topic Required Functionality Included

Available with cost

Custom Development

required

Future Development/ Not Available

Associated Costs

Master Patient Index

EHR works in conjunction with an electronic MPI

MPI is Accessible across sites

MRN assigned for each patient MPI is integrated with the EHR and PM.

Integrated Practice Management

Does the PM component require a separate login? Integrated with the EHR and MPI. ICD-9, ICD-10, CPT codes, DSM-IV, and DSM-V can be inactivated Does the RCM component require a separate login?

Billing

Real-Time Electronic insurance eligibility checking Accommodation for multiple sliding fee scales

Electronic claims submission Automatic generation of E&M codes for providers

Claims scrubbing Automatic Remittance manager


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Available with cost

Custom Development

required


Associated Costs

Charges sent are batched by site Charges can be overridden by an Admin user Generation of patient statements, with accommodation of a payment plan Ability for cashier and/or clerical supervisor to run end-of-day report showing providers in his/her clinic that have charges not sent for that day Alerts to providers and the billing department for unbilled charges Duplicate charges are blocked from being entered Standard billing reports, RVU capabilities, including end-of-day reports, and unlocked encounters.

Templates/Patterns (Developed to comply with all approved clinical protocols prior to training and go-live.)

Templates/patterns are used for documentation (If no

templates are used, please explain the workflow of the system and how requirements are fulfilled.) Pre-loaded evidence based templates/patterns Implemented on a system level ALL information is structured and reportable Customizable on a system level Customizable on a provider level

Ease of Use

Automatic Saving of information (If this is done through a mechanism

or sequence, please explain.) Flexible input methods (ex: dictation, pick list) Easy navigation (scroll, page down, etc.)

Searchable Discrete Data Fields (Clinical)

Body Mass Index (calculated)

Body Mass Index (percentile)


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Available with cost

Custom Development

required


Associated Costs

Immunizations

Risk Assessment Data (e.g. smoking)

Screening Tests

Counseling

Over-the-counter medications, supplements and alternative therapies

Prescribed medications

Searchable Discrete Data Fields (Demographic)

Searchable patient information in discrete fields (e.g. patient demographics, including OMB standards for race/ethnicity contact information, preferred method of contact, email and multiple telephone options; legal guardian/health care proxy; presence of advanced directives; care giver)

Personal provider/doctor

Patient language preferences


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B.3 Infrastructure

Topic Yes/No List associated costs.

Comments

Hosting Models

Client (CFHC) Hosted

Client-Server

Software-as-a-Service (SaaS)

Cloud-based

Operating System

Windows Supported

Mac Supported

Linux Supported

Hardware

Desktop PC

List if a certain hardware vendor (s) is preferred.

Laptop

Tablet

Smart Phone

Thin-client

Supporting Functionality

Integrated Scanner

Fax Server

Demonstrated TeleHealth Capability

B.4 Provider Workflow

Topic Required Functionality Included Available with cost

Custom Development or Interface

Required


Associated Costs

Family Practice/Internal Medicine

Patient Education Materials

CPOE

Structured Format HPI

Structured Format ROS

Graphical tracking of vitals

Familial Associations

Create Individual Care Plan

Pediatrics Patient Education Materials

Pediatric Immunizations


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Required


Associated Costs

Component

Allows for multi-patient (sibling) visits without having to close & re-open chart

Behavioral Health

Patient Education Materials Create a combined treatment plan for all patients that meet mental health standards that include physical and behavioral health Individual, family and group, and psychoeducational (non-billable) charting Allows for multi-patient charting without having to close & re-open chart Should allow for off-site therapeutic interventions

Full 5 Axis DSM Coding Allows charts to be marked as 'confidential' Allows charts to be marked for all providers to be notified when viewing patient chart (ex: high-risk, non-compliant)

Incorporate and score screening/assessment tools

Ability to imbed and score, provider and patient administered behavioral health scales.

Ability to graph scores and scales.

Optometry


CPOE

Templates or forms for visits

Optometry ICD & CPT codes

Imaging Integration

Dental


CPOE


CDT codes


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Required


Associated Costs

Imaging Integration

OB/Gyn Patient Education Materials ACOG Required Fields in Template

Infectious Disease Patient Education Materials


e-Rx

Surescripts affiliation

Dosing calculator included

Medication Reconciliation Medication History stratified from e-Rx History

Drug Formulary Checks

Prescribe from the EHR Receive Refill Requests through EHR

Ancillary Components Laboratory Component

Pharmacy Component

B.5 Standards

Topic Required Functionality Yes/No Customization Required?

List any associated costs if not included.

ICD and DSM Codes

ICD-9 Codes Supported? DSM-IV Codes Supported? ICD-10 Codes ready for use? DSM-V Codes ready for use?

Clinical Vocabulary, Drug Information and Standards

SNOMED

First Data Bank

Medispan

Multum

Standard Reports

UDS

PQRS

ACOG

Meaningful Use Dashboard


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Ryan White Data Report

PCMH Toolkit

B.6 Interfaces

Yes/No $

Topic Required Functionality

Bid

irec

tio

nal

Inte

rfac

e C

om

ple

te

Un

idir

ecti

on

al

Inte

rfac

e C

om

ple

te

Ab

sorb

s

info

rmat

ion

in a

stru

ctu

red

fo

rmat

Dev

elo

pm

ent

in

pro

gres

s

Futu

re w

ork

/ N

ot

Ava

ilab

le

Cu

sto

m w

ork

req

uir

ed

Ad

dit

ion

al c

ost

s -

setu

p

Ad

dit

ion

al c

ost

s -

mai

nte

nan

ce

Laboratory System Interface

LabCorp

Quest

DaVita

Health Information Exchanges

MS-HIN

GNOHIE

Supports Direct (NHIN)

Immunization Registry

MIIX (Mississippi)

Other Immunization Registry

Syndromic Surveillance Mississippi Syndromic Surveillance

Other Integratable with Allyn Welch EKG.


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B.7 Implementation

Topic Yes/No or Describe solution.

Included? Or list associated costs where applicable.

Comments

Timeline

Can your organization accommodate a Summer, Fall 2013 go-live?

Can your organization begin this work in February 2013?

If not, please list when this is possible.

What is the average timeline for data migration with a customer coming from another system? Does this include patient balance, demographics, insurance information, and medical records?

What is the typical implementation timeframe for the proposed products to go live?

Project/Implementation Manager

Is a Project/Implementation Manager provided?

Does this person handle sales? Does this person handle customer service?

Does this person handle go-live support? Does your implementation support include workflow and process improvement assistance?

Is this person on-site for go-live?

For what period of time is this person accessible prior to go-live?

For what period of time is this person accessible after go-live?

Is there any other on-site go-live support available?

Is there any remote go-live support available?

Testing

Who conducts system testing?

When is system testing conducted?

What does the testing consist of?

Training

What model of training is used?

Is on-site training available?

List the price for additional hours. List any included hours.

Is remote web-based training available?

List the price for additional hours. List included hrs.


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Included? Or list associated costs where applicable.

Comments

Are online resources, learning communities and user guides available? What kind of training is provided after updates or upgrades?

Is super user training available for

each site prior to training and go-

live?

General Services & Consulting

Billing services available?

Integration services available?

Legal services available?

Business process services available?

B.8 On-going Support & Maintenance


Included? Or list associated costs where applicable. Comments

Account Management

Does the client receive assignment of an account manager?

Same Account Manager after Go-Live?

What is the average # of facilities supported per account manager?

List avg. #

Does this person triage support for the client?

Does this person have the ability to escalate issues with a phone call?

Is the client required to submit a ticket for an issue or request?

If so, in what ways can a ticket be submitted?

What is the average time for resolution on a ticket?

General Support

What methods of support are available?

List all available methods. List associated costs if any methods are not included.

Are there resources available for customers to download?

List all available resources. List associated costs if any resources are not included.


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Is there a phone line available to call for general questions and support? (where the customer will not have to wait for a returned call)

What is the average wait time on this line?

Does this phone line require submission of a ticket?

What are the hours of customer support through each method?

System Maintenance

Major upgrades are distributed how often?

Patches or updates are distributed how often?

Is confirmation required from the site prior to upgrade or patch?

Are these applied remotely or on-site?

What is the expected release date for the next version requiring a different platform or operating system upgrade?

List expected date or 'N/A'

Are ALL upgrades included in pricing model?

List pricing if applicable. How often are patient education and other evidence-based materials updated?


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Appendix C – Health Information Management & Reporting Capabilities

C.1 Registry and Care Management

Topic Required Functionality Included Available

with cost

Custom Development

required


Associated Costs

Patient Tracking/Registry

Built-in patient registry for quality measure reporting to evaluate outcomes by disease, condition, test, exposure, etc.

Layered query capability of the registry

Registry can be queried automatically in a scheduled batch mode

User can create and save custom reports in the registry

Registry is pre-loaded with disease-specific conditions

Query for patients needing preventative care

Patient Correspondence

Automatic sending of patient reminders

Patient reminders sent based on patient preference (phone, email, mail, text)

Reminders can be sent in bulk

Patient Correspondence customized on a system level

Patient Correspondence customized on a user level Patient Correspondence applied to a set of patients from a registry

Clinical Decision Support and Care Management

Built in CDS from USPSTF

CDS is updated on a regular basis Pre-loaded Evidence-based templates for medical and behavioral health Customizable based on patient demographics (ex: pediatric vs. adult parameters) Modes of CDS (ex: alerts, notification of outlier values through color indicator, etc) Template alerts for outstanding documentation, care/treatment plan reviews/updates, and pending encounters per standards of care Ability to create brief care “pop-up” messages in patient’s record


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with cost

Custom Development

required


Associated Costs

Ability for other clinical team members to view pending notes or information to open encounters

Drug-drug and drug-allergy Checks

Pre-loaded Care Plans are available

Care Plans can be customized

Pre-loaded Order Sets are available

Order Sets can be customized

Pre-loaded Flow Sheets are available

Flow Sheets can be customized

Internal referrals are tracked for compliance using structured data

External referrals are tracked (manually or auto.) using structured data

System displays who took vitals, social history, etc.

System displays growth charts

System displays and calculates BMI percentile

Patient Portal

Patient Portal is available

Patient Portal training materials are available for patients

Patient Portal is available in multiple languages Educational material is displayed in the portal

Provider orders are displayed in the portal

Test and lab results are displayed in patient portal Medication refills can be requested in patient portal

Medical Records can be requested in the patient portal

Diagnosis history is displayed in the portal Patient demographic and insurance information can be entered in the portal and imported into the EHR as structured data

Patients can communicate with providers and staff via the portal


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with cost

Custom Development

required


Associated Costs

Patients can schedule, re-schedule, or cancel appointments via the portal

Outstanding balances can be paid in the portal

Allergies, past medical history, family history, etc. can be updated in the portal and imported into the EHR as structured data

C.2 Data Collection & Reporting


with cost

Custom Development

required


Associated Costs

Stratification

Stratification by demographic information

Stratification based on provider

Stratification based on location

Stratification based on high/low risk patient status

Stratification based on diagnosis

Visit Types

Reporting based off of duplicate patient visits

Reporting based off of unique patient visit types

Relational Capability

Financial/operational data reported with clinical data

Demographic data reported with clinical data

Demographic data reported with financial/operational data

Demographic, clinical, and operational data reported using a single query

De-identified and identified reports

System attributes

Does the product run off a third party solution?

Does the product require a separate module?


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with cost

Custom Development

required


Associated Costs

Is there training provided on this module?

Are there advanced modules to allow for greater reporting capabilities?

Are standard reports included? Which ones?

C.3 HIE Inbound

Topic

Preferred Message & Trigger Do You Consume this Message?

YES, as Shown (Give Version)

Message, Version, & Trigger?

If not now, when?

Receive ADT Messages

ADTAA01 Hospital Admission

ADTAA03 Hospital Discharge

ADTAA04 Emergency Registration

ADTAA08 Demographic Update

ADTAA40 Patient Merge

Receive HL7 Lab Results as Structured

Data

ORUAR01 Store discrete value and text fields

Can consume LOINC test and analytic codes (required for Public Health MU reporting)

Can use SNOMED-encoded results

Appropriately handle HL7 "no growth" and "preliminary" result messages and update the order status appropriately (OBR Result Status = I, S, A, P - and, depending upon usage, R).

Receive HL7 Radiology Report

ORUAR01 Receive Radiology Report as HL7 ORU or MDM and file into the proper place in the EHR.

Receive Corrected and Canceled HL7 Result

Messages

Appropriately handle HL7 result correction messages (OBR Result Status = C) and order cancel messages received (OBR Result Status = X) and update the order status appropriately based on the message.

Receive HL7 Text Reports: (e.g. H&P,

ECG, Discharge Summary, Colonoscopy

Report, Progress Notes)

MDMAT02: Original + content

MDMAT04: Status change + content

MDMAT06: Addendum + content

MDMAT08: Edit + content

MDMAT10: Replace + content

ORUAR01: Alternative method for receiving text reports (result status is in OBR)

Receive HL7 Referral Request

REFAI12 Delivered to Provider in-box (should be able to handle RF1, DG1, AL1, OBR, and OBX segments). ORMAO01 may be used as an alternative.

Indicate which message & trigger


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Topic

Preferred Message & Trigger Do You Consume this Message?


Message, Version, & Trigger?

If not now, when?

Receive HL7 Referral Response

RRIAI12 Acknowledge Referral Request sent from the EHR (see HL7 Messages outbound)

Receive HL7 Request for Appointment

SRMAS01 Request New Appointment (please note if message is routed to the in-box, or whether the EHR can auto-book and acknowledge with an SIUAS12.

Receive and Consume Summary of Care Document (CCD)

Receive and store a CCD C32 document as specified in the CDA Release 2.1 as further refined by HITSP in its component specification.

List the C32 sections supported.

Consume the discrete and textual sections of a CCD C32 document as specified in the CDA Release 2.1 as further refined by HITSP in its component specification.

Consume the discrete and textual sections of the CCD as detailed in the CCD specification available at http://www.interopwe.ora/documents/request.html including current medications.

Receive CCD via Direct Project standards

Receive CCD via IHE XDS.b standards as a Document Consumer

C.4 HIE Outbound

Topic Preferred Message & Trigger Do you produce this Message?


Message, Version, &

Trigger?

If not now, when?

Send Patient Encounter. Person Maintenance, and Patient Merge ADT Message

ADTAA04 Register Patient, Automatically generated upon completion of a registration process.

ADTAA04 (additional detail) EHR provides a mechanism for the user to mark a visit as "protected" and will transmit the protected status at the patient level in the PV1 segment.

ADTAA08 Update Patient Info

ADTAA31 - Person Update

ADTAA40 - Merge Patient

Create and Send Order ORMAO01 Create and transmit a properly formatted HL7 order (lab, radiology, other ancillary services).

For laboratory orders, the California "ELINCS" specification is supported

The ORM message allows a minimum of 3 "Copy to" providers

Create and sendHL7 Master File Updates for Providers and Locations

MFNAM02 Add/change/deactivate provider

MFNAM05 Update location

Create and Send Appointment

SIUAS12 (May be used to determine if the patient referenced in the appointment has information in the HIE)

http://www.interopwe.ora/documents/request.html


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Topic Preferred Message & Trigger Do you produce this Message?


Message, Version, &

Trigger?

If not now, when?

Notification

Create and Send Referral Request

REFAI 12 Provide for the automatic transmission of the referral message. ORMAO01 also accepted at this time.

Indicate which message & trigger

Create and Send Referral Response

RRIAI12 Acknowledge Referral Request

Create and Send HL7 Result Records to Document in-Office or Reference Testing

ORUAR01 Laboratory

ORUAR01 Radiology/ Ultrasound

MDM AT02 Transcription

Send Text Reports: (e.g. H&P, Visit Summary, Progress Notes, Chart Notes, Consult Notes)

MDMAT02: Original + content

MDMAT04: Status change + content

MDMAT06: Addendum + content

MDMAT08: Edit + content

MDMAT10: Replace + content

ORUAR01: Alternative method for sending text reports (result status is in OBR)

Create & Send Immunization Messages.

VXUAV04 (2.3.1 or 2.5.1 required for MU) Code Set CVX - Vaccines Administered, July 30, 2009 version

Automatically Trigger Creation of the CCD

Provide a configurable ability to automatically create and transmit the CCD. For details on the CCD, see specification below.

List all events that can trigger production of the CCD.

Single Sign-on (SSO) with HIE

EHR produces a SAML 2.0 authentication token certifying the user when calling out to the HIE.

EHR provides authorization criteria as required by California within the SAML token.

Transfer Context and Control to HIE within EHR

EHR provides the ability to view content from an external web-based source such as an HIE within the framework of the EHR (e.g. a window inside the EHR), and will transfer the context of viewing to the external source through the URL as defined by the external source.

Provide specifics of capabilities including context objects transferred.

Create and Send CCD Create the discrete and textual sections of a CCD C32 document as specified in the CDA Release 2.1 as further refined by HITSP in its component specification.

List the C32 sections supported.

Create and transmit to the HIE a properly formatted CCD based on the CCD specification at http://www.interopw2.orc/documents/request.html.

Send CCD via Direct Project standards.

Send CCD via IHE XDS.b standards as a Document Source or Integrated Document Source Repository.

Providing Electronic Summary to Patients

If via a CCD, the EHR provides a viewer or style sheet so that the patient can read the contents of the electronic file provided. If not a CCD, please note what standard and format is used (e.g. CCR, Blue Button, text-only, etc.).


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Appendix D – System Administration

Topic Required Functionality Yes/No or Describe solution.


Authentication

System authenticates principals (i.e., users, entities, applications, devices, etc.) before accessing the system and prevent access to all non-authenticated principals System requires authentication mechanisms and can securely store authentication data/information If user names and passwords are used, the system requires password strength rules that allow for a minimum number of characters and inclusion of alphanumeric complexity, while preventing the reuse of previous passwords, without being transported or viewable in plain text Ability to terminate or lock a session after a period of inactivity or after a series of invalid log-in attempts

Access Controls

Ability to create and update sets of access-control permissions granted to principals (i.e., users, entities, applications, devices, etc.) based on the user's role and scope of practice Ability to record and report all authorization actions System allows only authorized users access to confidential information System prevents users with read and/or write privileges from printing or copying/writing to other media System allows only authorized users access to customization of templates, flow sheets, etc.) System defines and enforces system and data access rules for all EHR system resources (at component, application, or user level, either local or remote)

Ability to restrict access to patient information based on location (e.g., nursing unit, clinic, etc.)

Ability to track restrictions Ability to track/audit viewed records without significant effect on system speed System allows for electronic access to specified patients/encounters for external reviewers

Ability to amend or correct coding errors on encounters for former employees

Emergency Access Controls

System allows emergency access regardless of controls or established user levels, within a set


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time parameter

Defines the acceptable circumstances in which the user can override the controls for emergency access, as well as require the user to specify the circumstance System requires a second level of validation before granting a user emergency access? Ability to generate a report of all emergency access use Ability to periodically review/renew a user's emergency access privileges Ability to generate an after-action report to trigger follow-up of emergency access use

Data Retention, Availability, and Destruction

Ability to store and retrieve health record data and clinical documents for the legally prescribed time or according to organizational policy and to include unaltered inbound data Ability to identify specific EHR data for destruction and allow for the review and confirmation of selected items before destruction occurs Ability to destroy EHR data/records so that data are not retrievable in a reasonably accessible and usable format according to policy and legal retentions periods, and is a certificate of destruction generated

Metadata & Auditing Capabilities

System captures and retains the date, time stamp, and user for every object/data creation, modification, view, deletion, or printing/export of any part of the medical record

System retains a record of the viewer

System retains a record of the author of a change

System retains a record of the change history System retains a record of the source of non-originated data System retains the medical record metadata for the legally prescribed time frame in accordance with the organizational policy System includes the minimum metadata set for a record exchanged or released

Amendments & Corrections

System allows the author to correct, amend, or augment a note or entry System allows the author to indicate whether the change was a correction, amendment, or augmentation System records and displays the date and time stamp of the change


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System provides a clear indicator of a changed record System provides a link or clear direction to the original entry/note

System retains all versions System disseminates updated information to providers that were initially auto-faxed

Health Record Output

System allows a unified view of all component subsystems of the EHR at the individual patient level and at the date of service encounter level for purposes of disclosure management (including the ability to print and generate electronic output) System provides the ability to define the records or reports that are considered the formal health record for a specified disclosure or disclosure purposes System allows VIP patients to be flagged and listed confidentially on corresponding reports (i.e., employees, local officials) System produces an accounting of disclosure, reporting at a minimum the date and time a disclosure took place, what was disclosed, to whom, by whom, and the reason for disclosure System provides the ability to create hard copy and electronic output of report summary information and to generate reports in both chronological and specified record elements order System provides the ability to include patient identifying information on each page of electronically generated reports and provide the ability to customize reports to match mandated formats System allows for redaction and recording the reason, in addition to the ability to redact patient information from larger reports

Chart Completion

Organization can define the intervals for aging analysis (e.g., 7-days, 14-days, 21-days, etc.) System allows for standard and ad-hoc reporting for chart deficiency/delinquency analysis Delinquency reports can be sent to physicians/clinicians in electronic (e.g., e-mail or fax) and paper formats (letters) System allows you to define or detail all deficiencies by provider, by area of deficiency, or other combinations (e.g., group practices, etc.) System allows the organization to list all records (charts) by the deficiency type


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Deficiency analysis can be conducted at the time the patient is prepared for discharge from the facility System supports most industry standard dictation systems to allow transcribed reports to be easily and efficiently completed System allows for end-user notification when information identified as incomplete/missing is completed


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Appendix E – Pricing Structure

Licensing How is the product licensed?

Are licenses purchased per user?

Define ‘user’ if it relates to the licensing model (i.e., FTE, all clinical staff, etc).

How does the system licensing account for residents, part time clinicians, midlevel providers, students, and contract providers?

Can user licenses be reassigned when a workforce member leaves?

If licensing is determined per workstation, do handheld devices count towards this licensing?

Is system access based on individual licensing, concurrent, or both?

What does each license actually provide?

For modular systems, does each module require a unique license?

In concurrent licensing systems, when are licenses released by the system (i.e., when the workstation is idle, locked, or only when user logs off)?

One Time Fees One time implementation fees:

Training fees:

Consulting fees:

Discounts (available discounts such as those based on participating as a beta site)

Initial year costs (include all fees for license, use, access, etc.)

For x providers:

For each additional provider:

Please provide the pricing algorithm used to calculate this cost.

Ongoing annual costs (include all fees for maintenance, support, use, access, etc.)

For x providers:

For each additional provider:

Please provide the pricing algorithm used to calculate this cost. Also, please provide your policy regarding price increases.

Five (5) year cost of ownership

Please indicate the estimated TCO ("total cost of ownership") for the product over a 5 year period.

Training fees:


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Appendix F – Supporting Documentation

Please submit any applicable supporting documentation in the order below.

1) General Vendor Information

2) Reference Documentation

3) Hardware Spec. List

4) List of Medical and Non-Medical Devices

5) Connectivity/Bandwidth Requirements

6) Implementation Methodology

7) Sample Project Plan

8) Generic Pricing Proposal

9) Other Additional Information

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