Request for Proposal Evaluation

REQUEST FOR PROPOSAL:

ELECTRONIC HEALTH RECORD

Customer Date

Contents

REQUEST FOR PROPOSAL:........................................................................................ 1

ELECTRONIC HEALTH RECORD ............................................................................. 1

PRACTICE BACKGROUND AND INFORMATION................................................. 3

VENDOR BACKGROUND AND INFORMATION .................................................... 4

REFERENCES.................................................................................................................. 5

SYSTEM FEATURES...................................................................................................... 6

PRICING AND CONTRACTS ..................................................................................... 13

SYSTEM SUPPORT ...................................................................................................... 14

IMPLEMENTATION .................................................................................................... 16

DOCUMENTATION AND TRAINING....................................................................... 17

TECHNICAL DESIGN AND OPERATIONAL REQUIREMENTS........................ 18

PRACTICE MANAGEMENT SYSTEM INTEGRATION & OTHER INTERFACES................................................................................................................. 20

REPORT GENERATION AND TOOLS ..................................................................... 21

SECURITY...................................................................................................................... 22

HIPAA.............................................................................................................................. 23

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Practice Background and Information 1. Practice Primary Contact

• Name: • Title: • Office/Location Address: • Phone Number: • E-Mail address: • Practice’s Internet Home Page:

2. Overview of Practice

• Number of Providers (by Specialty): • Number of Clinical Support Staff: • Number off Administrative (Front Desk and Back Office): • Number of Locations: • Patient Visits per Year: • New Patients Visits per Year: • Current Number of Existing Patients:

3. OVERVIEW OF PRACTICE’S CURRENT IT ENVIRONMENT

• Number of IT Staff:

• Name of Practice Management System (include version):

• Are all locations on a PC Network:

• Is any part of your current network wireless:

4. Other Information

• Transcription is done in-house or outsourced? If outsourced please indicate vendor.

• Name all external lab systems that you receive lab results from: Source LIS % of Results

• Name any other external systems that you receive information from that you would like incorporated into your EHR

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Vendor Background and Information 1. Vendor Primary Contact

• Name: • Title: • Office/Location Address: • Phone Number: • E-Mail address: • Organization’s Internet Home Page:

2. Identify the location of the following: • Corporate Headquarters: • Field Support Offices: • Programming/Technical Support Personnel:

3. What percent of revenue did your company expend for research and development on your proposed products during the last three fiscal? What is budgeted for the current and next fiscal years?

4. List the number of employees (full time equivalents) in your organization by

category:

Category # Employees Total Employees Executives and Managers Marketing/Sales Installation Research and Development Application Support Technical Support Customer Service Other Those with clinical background:

− Physicians − RN’s − Other Clinicians

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5. Has your company acquired or merged with any other organizations in the past three years? If so, please list each organization and the purpose behind such activity.

6. Please provide your most recently completed fiscal year’s financial statements and

annual report.

7. How long has your company been in the business of developing and marketing your

products?

8. Please describe your alliances and partnerships.

References 1. What is the total number of client installations using your proposed system? 2. What is the number of client installations in practices similar in size, specialty, etc.

using your proposed system?

3. Please provide references for at least 3 clients, similar in size and general profile to

(Practice Contact) who are currently operational on the proposed system and using Practice Management System. Provide names of individuals who will have sufficient experience to speak knowledgeably concerning such issues as the implementation process, product functionality, vendor support, and documentation and training.

4. Provide specific examples of tangible benefits (Return on Investment) that can be

documented by other users/clients of your proposed system.

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System Features 1. What are the names/versions of your proposed products/applications? Briefly

describe each application’s functionality. 2. Please review the list of features and please indicate if your proposed solution has

them available, not available or planned (indicate anticipated delivery date).

EHR Features Available Not Available Planned

CLINICAL MANAGEMENT Ability to enter all demographic & registration information in Practice Management System and transfer it to EHR without any data entry needed into EHR

Ability to customize the patient demographic banner to display any number of Practice Management System fields to the clinician.

Ability to switch from one patient record to another quickly and easily

Able to organize the screen and customize tabs or modules according to user preferences

Ability to display a patient summary or “face” sheet including patient demographics, problems, medications, allergies, health maintenance, encounter listing, patient tasks, recent encounters, patient picture, and personal profile.

Has problem list with most common problems available for each physician.

Ability to add problems beyond a ICD-9 list to a recognized standard nomenclature (e.g. SNOMED CT or MEDCIN)

Ability to display and manage health maintenance alerts including chronic disease reminders per patient.

Has medication list with formulary display. Has allergy list including on-screen indicator of urgent reactions

Do you have integration to an eHealth or patient on-line solution allowing patient populations to verify their medical record, access billing status, review tests results and communicate to the

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EHR Features Available Not Available Planned

physician?

Displays notification to provider of critical lab and other test results for immediate attention with a prioritization alert

Problem lists, allergies and medications can be updated or edited and signed at any time

Has standard order sets that can be customized by each provider based on his/her favorites

Has medical necessity and duplicate checking per orderable item?

Has ability to connect orders to a result for follow-up and reconciliation?

User can review and sign results for any ordered tests and procedures

User can create test results letters Ability to send message and link to patient chart to additional non-ordering providers re: results documentation

Allows providers to fax prescriptions to pharmacy using patient’s stored pharmacy fax number

System stores patients’ preferred pharmacy phone number, fax number and address

Has prescription writing feature that records date, sig, number and directions

Has plain paper prescription printing so that product is sufficient for patient to take to pharmacy

Gives alerts when prescription conflicts with documented allergy

Gives alerts for drug-disease incompatibility (ex: beta-blocker in asthma)

Tracks drug interactions and displays alerts when conflicting medication is documented

Ability to automatically link prescription to the appropriate formulary.

Electronic transmission to pharmacies using fax, and SCRIPT standard

Have wireless PDA solution for prescription writing.

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EHR Features Available Not Available Planned

Automatically checks for coverage and eligibility through RxHub.

Ability to download medication history from RxHub to identify duplication medications and potential interactions.

Tracking of patients using specified medications Tracking of drug formularies from insurance companies (provide list of carriers and how formularies are initially provided and subsequently updated.)

Ability to customize formularies Ability to search and report on prescribed medications in case of a drug recall

Cost analysis of prescribed medications in comparison to formulary and generics

Maintains medication lists in different list for historical and current

Ability to provide alternative suggestions for medications

Has lists of providers’ most prescribed medications and dosages

Ability to perform patient population queries for decision support.

CLINICAL DOCUMENTATION Has a web-based patient interviewing software that can be incorporated into a note?

Has the ability to insert dictation markers into note for insertion of transcription. Allow providers to build a note with a combination of structured data and transcription.

Ability to capture dictation on a mobile device on an on-line or off-line mode.

Has option to dictate while navigating through the chart.

Has dictation management system with intelligent routing and tracking of the status of each dictation job.

Has an integrated transcription solution with macros, carbon copy and distribution features, and

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EHR Features Available Not Available Planned

full line-count reporting.

Ability to go paperless Has a scanning solution integrated with the EHR Have administration tools for scanning and indexing non-electronic documents.

Has ability to annotate, mark-up and sign scanned documents (e.g. ophthalmology or dermatology)

Have OCR capabilities to allowing querying scanned documents and EOBs.

Have integrated speech recognition capabilities with speech to text and command and control (navigation) features.

Demonstrated ability to eliminate transcription using templating and speech recognition.

User can review and sign notes for own visits and calls

Multiple users can review and sign all documentation

Ability to do dual routing (e.g. lab results go to a “team” for follow up)

Ability to hold records in different stages of completion

User can print entire patient record User can electronically transmit patient record within the enterprise

Has integration to Imagecast with ability single- sign on and reference features.

Has lists of providers’ most used charges per provider

Ability to provide real-time billing updates and notification back into Practice Management System without any manual intervention (e.g. changes to insurance, situational data elements, and special billing functions)

Automated tasks to remind physicians of missing charges and complete reconciliation features to the Practice Management System

Has option to carry forward review of systems, problem list, medication, etc. from last visit

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EHR Features Available Not Available Planned

Has a standardized nomenclature that is integrated with clinical documentation (e.g. SnomedCT, Medcin)?

Nomenclature is used to automatically calculate charge codes

Ability to flexibly document conditions including expanding details (severity, location, etc.) for each clinical finding.

Ability to add comment and detail to each clinical finding

Physicians can use nomenclature to build their own templates without programming or complex forms

Automatically update nomenclature monthly to each facility

Display clinical relevant terms based on current findings.

Ability to insert anatomical markups into documentation

Has the ability to document visit using pre-built templates

Has option to default review of systems information to “all normal”

WORKFLOW Has work lists/to do lists/tasks per user Ability to direct work/charts to others for completion on an “as needed” basis

Has the ability for managing triage calls with the ability to redirect to the provider

Has user-defined automatic routing of information (messages, lab results, other tests, etc.) with override capabilities

Has lists of providers’ most used problems per provider

Has lists of providers’ most used medications per provider

CLINICAL CONTENT Patient education materials for new medications Integrated evidence based guidelines (PIER) for

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EHR Features Available Not Available Planned

adult medicine

Ability to capture CME credit for usage of the guidelines.

Supplies over 500 health management plans that can be customized per physician.

3. Please describe your rules or workflow engine capabilities within your EHR

application.

4. Please describe customization options (format/content) of screens, forms, reports, etc.

5. Please describe features supporting remote and/or Internet access.

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6. If your proposed solution involves a Scanning solution, describe the front end scanning software capabilities. Is this software written/maintained by your company or by a business partner?

7. Discuss handheld/wireless features of the system. 8. This Request for Proposal has been sent to _______________ and _________.

Please explain why our organization should select your product over these competitors.

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Pricing and Contracts 1. Please provide a pricing proposal for software, implementation, interfaces and

hardware as described in our profile. 2. How are your products priced (number of users, concurrent users, patient visits,

providers, per PC, etc.)? Please explain. 3. Please provide a copy of your standard contract.

4. Please explain at what point the maintenance contract begins and any hardware/software warranty or installation/acceptance period ends.

5. Do the proposed acquisition and/or ongoing maintenance/support costs include:

o Future enhancements to acquired/licensed application modules?

o Operating system and related environmental software?

o Interface maintenance?

o Architectural changes such as migration to emerging technologies and new methods of systems deployment?

o If not, describe the conditions and terms under which enhancements/new releases are made available to existing customers.

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System Support 1. What are your normal support hours (specify time zone)? Where is support staff

located? 2. Which of the following support features are available?

• Toll-free hotline • Remote monitoring • Remote diagnostics • Training tutorials • Web based support tracking

3. Do you offer 24X7 software and hardware support?

4. What is the response time for problems reported: 1) during regular business hours and

2) off-hours?

5. Describe your problem reporting software and tools. Are they available via the

Internet? Can a list of outstanding problems and enhancements by client be viewed on-line and downloaded?

6. Please list the top 5 support questions you receive from your clients.

7. Describe your support process for evaluating and fixing “bugs” or problems in your

software. How would you coordinate problem analysis and resolution with the Practice Management system vendor and other third party products?

8. Do you have user groups? If so, who sponsors the user group?

9. Do you have advisory groups? What is their membership?

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10. Please provide a guideline for the type of internal support that will be required, for

both the number of information systems personnel, by classification, and also non- information systems personnel (i.e., department-based). Please describe their roles and responsibilities.

. 11. What is the range and average for system downtime (scheduled and unscheduled) for

you clients’ systems?

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Implementation 1. Provide an overview of your implementation methodology and a sample project plan. 2. With your proposed solution are you able to implement components or modules of

the application over time? Conversely can you implement the entire solution at once? What would your organization typically recommend?

3. In what timeframe after contract signing can your resources begin the project and the

implementation start?

4. What is the typical implementation timeframe for the proposed products?

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Documentation and Training 1. Describe the documentation (both system and training) provided as part of standard

installation approach including: • Manager and user reference manuals (applications) • User operator/system administrator manuals • Hardware/OS manuals • Training manuals (initial and ongoing user self-training)

2. What documentation is provided with the system? Is the documentation available in

hardcopy and on CD-ROM?

3. How often is your documentation updated? How often are updates made available to

the user? How is documentation updated (memo, revised manuals, on-line, CD, etc.)?

4. Describe the types of training offered, i.e., end-user, systems administrator, installer,

etc. How often is training offered (as needed, or on a set calendar schedule)? Please give the duration of each class, the location of training, associated costs, and the recommended number of people that should attend training.

5. Describe your ongoing training programs. 6. Who provides the proposed product training?

7. Do you provide Physician specific training?

8. Describe the training approach for user personnel. Please describe if training is

classroom style with an instructor, one-on-one, computer-based training, self-study, etc.

9. Describe the testing database available in your systems? Can new software be loaded

and tested in the testing database before it is loaded into the live production system?

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Technical Design and Operational Requirements 1. Please provide a Systems Environment Specification that outlines the server,

networking and communication requirements of your product. 2. What year was your EHR system developed? Indicate whether the system was

internally developed or acquired from another source.

3. Describe the operating system, hardware/server platform, and database, programming

language that supports your proposed product. 4. Is your proposed product web based or client/server?

5. Describe any anticipated future application enhancements or hardware or operating system changes in detail.

6. What User Interface standards do your products use (Windows, Browser-based)?

7. Describe any regularly held seminars or user group meetings available to users of

your system. Are enhancements based on input from user group meetings? How are enhancement priorities determined?

8. How often do your clients receive new releases? How is the client supported during these releases? How much system downtime is typically required during these upgrades? How many levels of software releases are supported for the proposed product?

9. Please provide a copy of your Quality Assurance Guidelines for testing new software

releases.

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10. Do all online submitted entries update all locations where a data element is stored at the same time? Identify any exceptions where there may be a timing delay or there is a requirement for duplicate entry of data.

11. Describe the system backup process. Can backup be completed in a dynamic mode

so that the system can be operational 24 hours per day? What backup schedule do you recommend? Describe the automated backup features that allow rapid and unattended system and data backup operations on a user-scheduled basis.

12. Can the system be configured to support improved fault tolerance and system

recovery (e.g., mirrored disk drives/servers)?

13. Discuss data archiving and restoring from archive within all applications of the

software. What are the capabilities in restoring from archive? What tools/media are used for archiving data?

14. Does your proposed solution have the ability to work with Microsoft Windows 95/98, 2000, XP, Windows NT Workstation, PocketPC 2002 and XP for Tablets?

15. If it is not addressed in the System Environment Specification, identify the minimum

desktop, tablet and PDA configuration requirements.

16. Please provide a recommended hardware configuration. The configuration should

include adequate requirements for production, testing, and training environment databases.

17. Discuss the user remote access (i.e. dial-in vs. internet) capabilities of your systems solution, including view-only vs. full function.

18. Please list the names of any technology companies that your organization is partnered

with, the nature of your relationship and the value that it brings to your proposed solution and ultimately to our organization.

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Practice Management System Integration & Other Interfaces 1. Does your proposed solution interface/integrate with Practice Management System

(version xxx) product? If so, at how many customer sites is it in production 2. Please explain how your proposed system(s) would interface/integrate with Practice

Management System (version xxx) product. 3. Please describe the process in which disputes over the interface between your solution

and the Practice Management System application. 4. Describe your overall approach to developing, testing, implementing, and upgrading

system interfaces to the Practice Management System application. 5. Is your solution HL7 compliant? If so, which version of HL-7? 6. Describe your overall approach to developing, testing, implementing, and upgrading

system interfaces to other third party systems. 7. Discuss any limitations/issues regarding your willingness or ability to

interface/integrate your product with foreign automated systems. .

1. Please indicate if you offer an Interface Engine product and/or describe your

experience with third party interface engine products and the software products you’ve proposed.

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Report Generation and Tools

1. Does your system have an ad-hoc report writer utility with access to all databases and data elements (including user defined fields)? • If so, is this a third-party package? • Is the same report writer used for all applications? If not, indicate the differences. • Are all data elements available for report writing?

2. Can third-party report writer software be used to access information within your

system? 3. Please describe your reporting capabilities. How much technical knowledge is

required for a general user responsible for analytical reporting? 4. Can your clients do ad hoc reporting without vendor assistance? Can non-IT users

utilize the ad hoc reporting tool? What type of special training is needed for your report writer tool?

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Security 1. Discuss your approach to data/information security, especially with regards to

Internet technologies. Is it consistent with the latest industry approaches for encryption and authentication?

2. Does the system support log-on capabilities by:

• User ID/password • Smart card, proximity card, or token device • Other security controls/devices including biometrics (describe) • Secure remote access (describe methods – Citrix, dial-up, Internet – and extent of

functionality – complete, view only) 3. Does the system have functionality to accommodate multiple users on a common

workstation with easy log-off/log-on capabilities? 4. Does the system require the user to change his/her password at set intervals? Can

Information Technology staff set intervals for password changes to an organization’s specifications?

5. Describe how system access can be configured to limit user access to patient records

and functionality based on their role in the organization (i.e., role-based access). For example, can access to patient financial, billing, and medical records information be restricted to only those clinical or administrative staff that have a need to know the information?

6. Does the system log all activity to provide a complete audit trail of the specific user,

patient, function accessed, date/time and data change. Are record accesses and edits easily reportable by patient and employee?

7. Does the system have a function that will automatically “log off” users? How is this

function controlled?

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8. Does the application date/time mark encounters closed/completed and prevent further changes?

HIPAA 1. How is your organization preparing for software changes required by the pending

HIPAA legislation? 2. Indicate if your product is/will be compliant with the following HIPAA application

security requirements: • Access Controls • Audit Controls • Data Authentication • Entity Authentication (including unique user IDs, Automatic Logoff)

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