RETURN TO: University of Wisconsin-Madison
Purchasing Services
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Madison, WI 53715-1218
Refer to Section 1 titled “SUBMITTAL INSTRUCTIONS”.
REQUEST FOR BID
All correspondence must reference the bid number.
THIS IS NOT AN ORDER
Unless otherwise noted, public openings will be on the date
and time specified. Award(s), if any, will be made as soon
thereafter as possible.
The bid abstract will be on file and is open to public inspection
only after award determination has been made.
OFFICIAL SEALED
BID NUMBER: 10-5164
AGENT: Carl Hubbard at (608) 262-6557
ISSUE DATE: June 8, 2009
FAX NUMBER: (608) 262-4467
DUE DATE: June 15, 2009
2:00 PM CST/CDT
_________________________________________________
Bid prices and terms shall be firm for a minimum of sixty (60)
days from the date of bid opening, unless otherwise specified
in this Request for Bid or negotiated by the UW-Madison
Purchasing Services.
E MAIL: chubbard@bussvc.wisc.edu
If NO BID (check here)
and return.
DESCRIPTION
10-5164 / AMENDMENT #1 / Web-based
Patient Management Tool for Medical Providers with Chronic Kidney
Disease Patients
Amendment #1 issued to: Answer questions and add Attachment G
If this amendment is not signed and returned, your bid may be disqualified.
If this amendment is not returned, it shall be assumed your original bid meets all conditions of the amendment.
All other terms and conditions remain the same. Please revise and submit your bid accordingly.
In signing this bid, we have read and fully understand and agree to all terms, conditions and specifications and acknowledge that the UWMadison Purchasing Services bid document on file shall be the controlling document for any resulting contract. We certify that we have
not, either directly or indirectly, entered into any contract or participated in any collusion or otherwise taken any action in restraint of free
competition; that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been
independently arrived at without collusion with any other bidder, competitor or potential competitor; that this bid has not been knowingly
disclosed prior to the opening of bids to any other bidder or competitor; that the stated statement is accurate under penalty of perjury.
SIGNATURE: _____________________________________________________________________________DATE ____________________
TYPE OR PRINT NAME: _____________________________________________________________________________________________
TITLE: _______________________________________________________ TELEPHONE NUMBER: (_______) _____________________
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EMAIL ADDRESS: __________________________________________________________________________________________________
1.
What are the technology requirements? i.e. language, database, etc. Can this be a .NET application with SQL Server, or Open
source, Java?
The technology used is up to the vendor. The application should make it clear why the technology used is appropriate for the
project and that it will be able to fulfill the requirements.
2. What are the required Performance Requirements that must be met by this application? (reference Section 3.7 Paragraph 3)
Please see the RFP Section 3.21 and Attachment A for details about the requirements.
3. Is there a requirement for an initial login screen to determine whether the user is an MA, Nephrologist or PCP user?
There will be an initial login screen to maintain security of the tool. Each user will be assigned as an MA, Nephrologist or PCP.
4. How are users (MA, PCP, Consulting Nephrologist) set-up and maintained? Is there a user maintenance screen?
Users will be determined at the start of the implementation phase. This can be done via setting up a user maintenance screen for
user entry by research staff or as part of the maintenance by the vendor. Please include reasons for choosing either method.
There will be little if any change in the users during the course of the implementation phase.
5. How should lost passwords be handled?
There should be an option of having it Emailed to the user.
6. Is there a single sign-on requirement?
Sign on will only be for the developed Patient Management Tool.
7. How does the system know which Dr./Nephrologist will receive the Consult request for a patient?
Each PCP will be linked with a Nephrologist for consults.
8.
Where are Consult Drafts managed after they are saved? How do you go back to an existing draft? How long are drafts
saved?
Draft consults should be accessible from the PCP home page in similar fashion to the consult box shown in the mockup. PCPs
will be able to delete draft consults from the home page otherwise they are saved until completion of the project.
9. How are PCPs and MAs related to each other?
Each PCP will be linked with an MA. Some MAs may be linked to more than one PCP.
10. How are patients assigned to an MA and the PCP in the application?
Patients are assigned to the MA or PCP that initially enters that patient’s data into the system. If an MA is working with multiple
PCPs they must have the option of choosing which PCP the patient belongs to.
11. How many iterations should be allowed on Consults Replies and Responses between the PCP and the Nephrologist?
Six each way.
12. Where will this application ultimately be hosted? What technology will be used?
Please see section 1.1. The tool can be hosted by the vendor or the vendor can arrange for hosting. Please state how you will do
this in the application.
13. Are there look and feel considerations? (colors, graphics, etc.)
The color and graphics have not been decided yet. This would occur via discussion with the investigators and the vendor.
14. What is the sort order for Patient care Due list? Should this be scrollable? If this is a long list of patients, should there be a
search option?
For the pilot this will be a short list that can be alphabetical.
15. Will a Guideline Logic Table be provided which links the patient data to the recommended guideline?
The guideline recommendation logic table is included in this Amendment as Attachment G of the RFP.
16. How does the application know that an actionable item under the Guideline Checklist has been completed? Should this be
time stamped? Should the individual who completed the task be listed?
The items can only be completed by entering data via the data entry page.
17. Should the application have an admin screen to ad or delete documents such as the Educational Handouts or the General
Guidelines Checklist
This is not a necessary component.
18. Should the Nephrologist be required to login with a username and password when he/she clicks on a Consult Link in order to
accommodate HIPAA?
Yes. Once they login they should be taken directly to the consult reply for the consult that generated the Email.
19. Should the Nephrologist have a way to review a list of consults given and then view details of past consults?
This is not in the scope of the RFP
20. Should the Nephrologist have the ability to respond to a PCP unsolicited?. e.g. Nephrologist sends response and then wants to
add another comment or response.
No
21. Does the application need to support multiple clinics? How are clinics set-up? How are PCPs and MAs related to clinics? Can
an MA work for multiple clinics?
The unit of importance is the PCP. There will be multiple clinics. See ques #9
22. Should the Consults Status Window in the PCP Main page be scrollable and searchable?
Sortable by headings and scrollable, but not searchable.
23. Does the application need to track when a patient record is accessed or changed and by whom?
Yes
24. Can an MA edit Patient Guidelines?
Unsure what you mean by patient guidelines. If you mean the patient guideline checklist, then yes.
25. Do the rules which create guidelines based on patient data need to be editable by an admin, or can these be built into the
application code?
Can be built in.
26. Does the Patient Care Due list need to be refreshed automatically with any new items automatically at some interval?
The tool should continually check for patients with care due as determined by the actionable items on the patient guideline
checklist.
27. Does the Consults Status list on the PCP Main page need to be refreshed automatically with any new items, automatically at
some interval?
Continually refreshed to check for status changes.
28. Should the text used in the Consult dialogues (requests, replies, etc.) be plain text or Rich text (bold, underline, fonts, italics,
etc.)
Rich text
29. Should the PCP be able to view a list of consults for a specific patient?
Yes via the tab on the patient screen. This page will simply list prior consults and clicking on the consults will allow the PCP to
see the initial consult and chain of responses.
30. Are screens or reports required which would allow items listed under Data Management Section to be viewed or printed?
This data will need to be accessible for input into a research database, but does not have to be viewed online.
31. Does the application need to maintain snapshots of data at any given time increments? i.e. If data changes under patient
record, does that change need to be documented. Does a snapshot of the previous data need to be saved?
All changes should be captured and time stamped for data analysis.
32. Are there rules which apply to the timeliness of a Nephrologist response? Should someone be alerted via Email if a response
is not received within a certain time frame?
A reminder Email should be sent if the nephrologist does not respond within 48 hours.
33. Are there considerations for back-up MAs, PHPs and Nephrologists? What if someone is on vacation or unavailable?
No
Questions regarding overall engagement and target platforms:
34. There is no discussion of hosting environments for the resulting application. Will the application be hosted by the university
or the vendor or a third party?
See answer to question #12
35. If the application is being hosted by the University or the third party, Is there a target web server and or database platform
that must be supported or is the vendor allowed to recommend a platform
See answer to question #12
36. The RFP states the need to be available for on-site visits as needed. Outside of this requirement is it safe to assume the
majority of the effort can be conducted off-site.
A.37: Yes.
Questions regarding requirements:
37. Will this application be used by multiple organizations/facilities simultaneously? If so is there a need to relate users and
patients to a facility?
The unit of importance is the PCP. Patients will be linked to PCPs and PCPs will be linked to MAs. See answer to question #9
38. The RFP discusses 3 user roles (PCPs, MAs and Nephrologists) and typical actions of each. Is it a safe assumption that the
application need to restrict the functionality that is available to each of these roles.
Yes
39. Is it reasonable to assume there could be the need for definition of new roles?
No
40. The RFP does not detail screen to support adding users and assigning roles to them, is it safe to assume that is within the
scope of this project or will that be imported in some other fashion.
See answer to question #4
41. The requirements discuss patients being assigned (linked) to PCPs and MAs but it isn’t apparent where or how this is done.
Should this be done on the New Patient Page?
Patients are assigned to the MA or PCP that initially enters that patient’s data into the system. Each PCP will only have one MA.
If an MA is working with multiple PCPs they must have the option of choosing which PCP the patient belongs to.
42. Where does the PCP specify the Nephrologists they want the consult from? Should there be a dropdown on the consult
request form to specify this?
This is determined by research staff. The PCP does not have a choice of nephrologist.
43. The proposal does not indicate if there is an existing system that you are using today. How is this process and information
managed today? Will there be information from the current process that will need to be imported to the CKD Patient
Manager Tool?
No data will need to be imported.
44. The proposal does not indicate what technology environment this product needs to operate in. Please specify the current
technology environment that CKD Patient Manager Tool will need to operate. What are the current systems or applications
that the CKD Patient Manager Tool will need to interface with?
See answer to question #1. This is a stand alone tool.
45. How many PCP’s will be utilizing this system? How many medical assistants will be utilizing this system? How many
nephrologists will be utilizing this system? How many patients will likely be in this system?
We expect 20 PCPs, 10-15 MAs, 4 Nephrologists and 80 patients.
46. Are there any data conversion needs from existing system(s) to this new tool?
No.
47. Are you looking for hosting as part of the solution for this web-based tool or this website would be hosted on the University
infrastructure?
See answer to question #12. The tool will not be hosted at the University.
48. Would the solution provide for its own login/password functionality? If yes, would user be set-up by an administrator or they
be allowed to self-register?
Users will be set by research staff, but the users can determine their own passwords.
49. RFP Section 1.1, Purpose - The proposal states that the contractor is to “arrange for housing”. Please clarify the meaning of
this phrase.
See answer to question #12
50. On the new consult page, under “desired response”, are the questions relatively static? Does specifying a yes/no value trigger
anything in the system?
The desired response categories will be static.
51. On the PCP Main page, how will the content be managed for Patient Educational Handouts and General Guideline Checklist?
How will it be uploaded to reflect changes? How will new links and content be managed?
We are not expecting changes based on the short duration of the implementation phase.
52. We are assuming there should be a login page for user to supply credential and that all user credentials will be maintained in
the system. Is this true or is some other system being used for security.
There will be a login page.
53. Preferred environment (e.g. LAMP, Windows/SQL, no preference)
See answer to question #1
54. Intended delivery mode (e.g. browser (if so specific expectations) vs. web enabled desktop application).
Browser
55. Hosting (who, where, responsible parties, costs absorbed into bid or addendum to bid)
See answer to question #12. Cost absorbed into cost proposal.
56. Scale (number of participating providers and patients) and Timeline for their decision-making.
See answer to question #45
57. Expected duration of usability testing by IE students prior to implementation.
3-4 weeks.
58. Means of delivering educational modules (e.g. flash, video, proprietary tool) and responsibility for production of modules. If
responsibility falls within scope, how many modules?
Educational modules are informational not interactive. See Attachment A deliverable D
59. Is this for UW Health System PCPs or will it be open to others?
A.59: The system should work with either.
60. Section 3.3 - Term of Contract states: “the work under this contract is expected to be completed in 90 days….”. Does this
refer to 90 calendar days or 90 working days?
This will be used by PCPs from 4 different healthcare systems. 90 days refers to calendar days.
61. Section 4.6 - under Programming states: “Provide example URLs that demonstrate the work done in these areas”. Since the
relevant projects we are citing in our proposal relate primarily to medical applications, and several have HIPPA compliance
requirements, it may not be feasible to provide URLs that the University can directly access. Can sample screen shots for
applications similar to the one the University is seeking be substituted? If so, would that substitution likely result in fewer
points be awarded during the evaluation process?
Screen shots can be substituted if URLs are not open access, but the actual scope of the work and functionality must be clear.
62. In Attachment B – Cost Proposal Form: The form requests that we provide costs for additional services, over and above the
original project work, but does not specify what additional services may be required. Could you please elaborate on what
types of services may be required?
A.62: Programming or consulting services.
63. Would there be a place where administrators can create/manage logins for users?
See answer to question #4
64. Would there be a preferences page where users can set/reset their passwords?
See answer to question #48.
65. Are the user interfaces in the Excel file to be treated as a method used for describing the requirements or are vendors bound
by that interface design.
Vendors are bound to that interface design.
66. In what format will KDOQI Guidelines be available? Is that available from a third party or will it have to be entered into the
system. Will it also include the PCP education pages and reference links? If so, in what format?
The guidelines are defined in the guideline recommendation logic table. The Patient Guideline Checklist Page will have links to
the PCP education pages. The “General Guideline Checklist” will be provided as a list. They will contained on a separated page
that will need to have links to physician education pages (Attachment A Deliverables ID)
67. When are actionable items computed/recomputed for a patient?
These should be computed on a continuing basis since many of the actionable items are linked to date of last lab test.
68. For how long do disabled actionable items show up in the Disabled List?
Forever
69. Where does PCP select a Nephrologist to send the consult to?
Determined by research team prior to implementation phase. PCP does not decide.
70. Would there be a place for Nephrologists to see their past consults? Can they send additional information if needed or the
only way for them to get to the past consults is if they get another question from the PC? It looks like the only way for a
Nephrologist to look at past consults is to open the patient first.
This is not a requirement of the RFP.
71. Several of the mock ups have a button to route the user to the main menu. Is this intended to be the PMT ‘home page’ for the
system?
Main menu is the home page for that particular user type (MA, Nephrologist or PCP)
72. Will users (MAs, PCPs, Nephs) be located in different clinics or located within one clinic?
The tool will be used by providers throughout Wisconsin.
73. Will this application be hosted in a UW data center? Or that of a third party vendor?
See answer to question #12
74. The application as described in the RFP will be built as a Proof-of-Concept (POC). During the POC will it be used to track
‘live’ patient data?
This will be tracking ‘live’ patient data.
75. Who will be responsible for administration of the web application? Should an admin user be considered a fourth type of user
in the system (in addition to PCPs, Medical Assistants, and Nephrologists as user types)?
The vendor can decide if the application will include an administrative user for entering initial PCPs, MAs and Nephrologists or if
the vendor will enter that data. Please be clear in the application which will occur.
76. RFP document states that "the electronic guideline checklist will use a logic structure that determines what care the patient is
due". Where does this logic structure come from, and how will the web application utilize it, to determine what care to assign
to patients?
See the guideline recommendation logic table. The tool will compare patient data to the logic table.
77. RFP states that Emails are sent to nephrologists and/or PCPs, to indicate electronic consultations to review:
a. Is guaranteed Email delivery a requirement here? How should the app handle a failure to deliver an
Email?
Notification of the PCP if failed.
b. Are PCPs/Nephrologists allowed to modify their Email address within the system that is being used to
send the Email?
No. These will be set at the start of the implementation phase and only be changed by the research team.
c. Is there a dedicated Exchange server (or other similar server) responsible for handling Email transport
that the application will be able to use?
No.
78. The application appears to have new patients assigned to a PCP through the "New Consult" screen. How will the application
handle patients that change PCPs?
Patients are assigned to a PCP at initial data entry of the patient. See answer to question #10. The tool does not have to handle
patients changing PCPs.
79. Will the application allow deletion of patients and their data?
Data can be deleted from the individual patient data entry page. Patients will not be able to be deleted.
80. How will the "brief PCP educational modules" be incorporated into the electronic guideline checklist? Specifically, how will
the application determine which modules to display (or not display) on a patients' information?
See attachment A Deliverable I D.
81. Should the Desired Response check boxes appear in the screen mock-up of “Reply to Continuing Consult” (N-C2 v.3)
screen? They currently do not appear on there; however, they appear in “Reply to New Consult” (N-C1 v.3) screen.
Either way is acceptable.
82. Likewise, the Desired Response check boxes do not appear on the “Consult Answer” (PCP-C2 v.3) screen.
They should not appear on that screen.
83. Will MA, PCP, Nephrologist, and Admin users all login to the application over the Internet or will they be inside of a UW
firewall when they login?
All logins will be over the internet.
84. In section II. Data Management of Attachment A… Are items 3 – 7 reports that must be created within the system?
These do not have to be created as reports. The data needs to be dumped in a format worked out with the project statistician to the
research database. Data dumps will have to occur monthly and at completion of the study.
85. Are there any reporting or query requirements that will enable Nephrologists or PCP’s to query and view the Consult
Replies/Requests they’ve made in the past?
No querying is necessary. See answers to question #29, #69 and #19
86. Attachment ‘A’: Under ‘Patient Management Tool’, it is stated that the PMT must be HIPAA compliant since it will house
patient data. One of the requirement of HIPAA compliancy is to obtain patient consent in form of signature. Will this tool be
used to capture patient’s signature electronically or selected and qualified patient data sub-set will be provided from some
external patient data source?
Patient consent will not be handled by the tool.
87. Attachment ‘A’: Under ‘Patient Management Tool’, paragraph 3 –‘ Brief PCP educational modules….’ Will these modules
be text and images based or will have an audio/video requirement?
Text and image.
88. Attachment ‘A’: Under ‘Patient Management Tool’, paragraph 6 –‘ The tool must have….’ – Is there a requirement of rolling
up and archiving? Will there be a need on drill down capability based on screens? (Who used screen ‘x’?)
Yes. Each screen use by each user will need to be captured.
89. Attachment ‘A’ – C (4) – Is a separate administration/user interface required to manage physician education pages links?
Generally speaking, wherever there is a link requirement identified, is there a need for managing such links through
administration/user interface?
The links will be almost completely stable throughout the study period. See ques #4 about administrator interface.
90. Attachment ‘A’ – E(2) – The confirmation message needs to be the system generated delivery notification or an actual read
receipt? It is assumed that the messages will be delivered using a back-office E-mail system. Is this assumption correct? If so,
what is the back-office E-mail system (Microsoft Office?) ? If not, then will a web-mail delivery service be sufficient for this
requirement (there may be some security concerns with web mail delivery system)
System generated delivery notification. Web-mail delivery will be sufficient since no patient data will be sent by Email.
91. Will there be any additional requirements of alert notifications (for example, a message was not read by the addressee after X
number of hours or a response was not received within specific period then someone needs to be notified)?
Nephrologists will receive a reminder Email if they do not answer a consult within 48 hours.
92. Is there any anticipation of future ‘work flow requirements’ between the PCPs, medical assistants, and nephrologists?
No
93. Is there a requirement for specific platform (Oracle vs. Microsoft SQL etc.)?
See answer to question #1
94. Is there an anticipation of data presentation using charts and graphs?
No
95. Are more elements expected to be added to the management metrics described in Attachment ‘A’ Section II – Data
Management (1-8)
It is possible, but not in the scope of the RFP.
96. Can the work be done remotely?
There will be required face to face meetings, but it is expected that most of the work will be done remotely.
97. Do you have a bug database for QA to log bugs?
No
98. Will the QA team assigned to the project writing test specs, test plans and test cases?
Test cases and test plans will be written. It is expected that the vendor will run the test cases and export the data for verification
as part of the scope of the RFP.
99. Is there a specific program language you want the management tool running in or is it up to us to decide? (EX: java, ASP,
PHP, Perl or Python)
See answer to question #1.
100. How many consultants do you need after the 90 day completion date?
Specify your plan in the application.
101. Do they want encryption of patient data to protect privacy? We do this for our other medical patient mgmt tool.
Yes
102. Warnings wire frame - What is the difference between exit and cancel button?
Cancel returns the user to that page that they were working on.
103. Educational Blurb - Is this a pop up window?
This can not be a pop-up that would be blocked by typical pop-up blockers.
104. For rollover pop-ups, do they want a tooltip to show (which only shows for several seconds or do they need a more elaborate
AJAX style bubble to show the information?
AJAX
105. Interactive/PT specific Guidelines - How is the guideline checklist populated? Do we code in business logic to present
guidelines based on data values? Will there be a definition of rules that we will code into the system to be able to generate the
guideline? For instance, is the guideline driven off the patient's lab results, patient vitals, and current medical problems? If lab
X is higher than 7.2 and lab Y is pos and pt age is > 62 and gender is female, present these guidelines. See guideline
recommendation logic table, Attachment G.
106. Resources / Education - Will we be storing a repository of medical literature related to certain medical conditions for the
generic guideline? For instance, it the patient has CKD Stag2, then show all articles for that stage of the disease.
No. The information will be linked specifically to the guideline items.
107. Data Maintenance - Do we need to create screens to maintain some data (User profiles, generic guidelines and checklists). As
the guidelines change (from the national kidney foundation or the National institute of health), should we assume the system
will require an update at the code level to adjust to the new guidelines?
See answer to question #4. Changing guidelines in not part of the RFP.
108. Page logging - Do they want any reporting of screen visits or is this just for audit purposes? Do we need to also log specific
activities beyond page visit? In our other application, I track that you visited the page and that you clicked to changed the
patient's demographics.
This all needs to be logged and linked to the individual user.
109. Audit/ Triggers - Do they want triggers on key patient data? We capture before and after views of a row when it is
edited/deleted, etc. The triggers are at the DB level so we can capture changes made to this data whether you do so through
the application or directly changing data in the DB. This is a protection and auditing measure.
All changes should be captured and time stamped for data analysis.
110. Will there also be an admin user role to manage the users and other maintenance concerns?
See answer to question #4
111. How do they envision segregating patient data? Will there be the concept of a medical practice where multiple physicians
belong to a single practice and those patients can only be seen by members of that practice? Or will each PCP/MA that logs
in create patients that just belong to them? When they send a patient to the nephrologists, do they choose from all
nephrologists in the system? Or will there be relationships between nephrologists and PCPs?
See answer to questions #7, #9, #10, #21, #41, #42.
112. What happens if the assigned nephrologists is not available? Do we need to provide for the consult to be sent to a different
nephrologists?
No.
113. Can the PCP withdraw or cancel a consult sent to the nephrologists?
They can delete a pending consult, but not one that is already sent.
114. Are there any reporting needs?
The website does not have to have reports. The data should be available for download per Attachment A Deliverables II.
115. Attachment A states "Based on the usability testing the tool will undergo minor changes. It will then be implemented by
PCPs for 6 months to test for proof of concept and changes in PCP knowledge and self-efficacy regarding CKD. " Is the
Proposal to include only the initial build prior to usability testing? Or should it include rough time estimation for usability
testing, training, and changes up until implementation by the PCPs? Or, if neither is correct, what should the Proposal include
in this regard?
The proposal should include time for changes up until the implementation.
116. Are there any forms that are being sent outside the tool which have specific requirements? If so, which forms and what are
the compliance requirements?
No.
117. Is there the possibility of concurrent changes by users? If so, should this be allowed?
This is highly improbable, but can be allowed.
118. Is there a hosting (if external) preference or requirement? IF so, please explain. (e.g. WI Host, server environment…etc)
See answer to question #12.
119. Is there a programming language preference? IF so, please explain.
See answer to question #1
120. How many concurrent users are anticipated to be using this application?
See answer to question #45. It is unlikely to have more than 5 people using the tool at any one time.
121. Is all required information in the tool to be manually input by the 3 types of user? If not, please explain any requirements to
access or draw from any other systems.
Yes
122. What is, if applicable, the required timeframe to completion or due date for the initial usability testing?
60 calendar days
123. What is, if applicable, the required implementation date for the PCP implementation?
90 calendar days
CKD Guideline Checklist Logic Table
Guideline Recommendation
1) Medications to give
ACE/ARB
ASA unless
contraindicated
2) Unsafe medications to
avoid
NSAIDs
IV contrast dye
Gadolinium MRI contrast
Metformin
Phospho-soda bowel prep
Logic
Message
Medication “ACE” and “ARB”
checked no
Medication “ASA” checked no
Consider starting patient on an ACE inhibitor or
ARB
Consider starting patient on ASA
Medication “NSAID” checked
yes
No logic – appears on reminder
list
No logic – appears on reminder
list
Medication “Metformin” is
checked yes
No logic – appears on reminder
list
Consider discontinuing NSAID
No Cr entered for past year
No urine protein/microalbumin
and urine creatinine entered for
past year
Check serum creatinine. Last checked ___
Check spot urine microalbumin and creatinine.
Last checked ___
No hemoglobin entered for past
year
No calcium entered for past year
No phosphorous entered for past
year
No PTH entered for past year
Check Hemoglobin. Last checked ___
Consider discontinuing Metformin
3) Labs to check
Cr/ GFR – annually
Urine
microalbumin/creatinine ratio
– annually
Hemoglobin – annually
Calcium– annually
Phosphorous– annually
PTH– annually
25 (OH) Vitamin D annually
Lipid panel – annually
4) Abnormal lab values
Hemoglobin <12
No vitamin D entered for past
year
No total cholesterol and LDL
entered for past year
Hemoglobin < 12 and no
TSAT available
Hemoglobin < 10
Hemoglobin <10 and
TSAT < 20%
Hemoglobin <10
Hemoglobin <10 and
TSAT > 20%
Check serum calcium. Last checked ___
Check serum phosphorous. Last checked ___
Check serum intact parathyroid horomone
(PTH). Last checked ___
Check 25(OH) Vitamin D. Last checked ___
Check lipid panel. Last checked ___
Patient Hemoglobin ____
- Perform age appropriate anemia
workup if not already done
- Check Iron and TIBC to calculate
TSAT
- If TSAT <20% replete Fe
Patient Hemoglobin __
- Replete Iron
1. ferrous sulfate 325 mg
tablets, 2 to 4 tablets/day
2. Consider Ascorbic Acid 250500 mg daily with ferrous
sulfate
3. Recheck Hgb once Iron
repeleted
Patient Hemoglobin __
- Consider starting erythropoietin
stimulating agent (ESA)
- Link to guidelines for starting
ESA
- Consider e-consult to help with anemia
management
Patient 25 (OH) Vitamin D is ____
- Consider treatment with Ergocalciferol
50,000 IU per week x 4 weeks then
50,000 IU per month x 5 months
- Recheck 25 (OH) Vitamin D level after
6 months
- Monitor serum phosphorous and
calcium every 3 months while on
Vitamin D therapy
Patient 25 (OH) Vitamin D is ____
- Consider treatment with Ergocalciferol
50,000 IU per month x 6 months
- Monitor serum phosphorous and
calcium every 3 months while on
Vitamin D therapy
Patient serum phosphorous is ____
- Consider dietary phos restriction and
phos binders with meals
- Consider e-consult
25 (OH) Vitamin D <15
ng/mL
25 (OH) Vitamin D <15
25 (OH) Vitamin D <30
ng/mL
25 (OH) Vitamin D >15 and
<30
Phosphorous > 4.5
Phosphorous > 4.5
PTH >70 pg/mL
PTH > 70 and no 25 (OH)
Vit D level
PTH > 70 and 25 (OH) Vit
D < 30
Patient has an elevated PTH ____
- Check 25 (OH) Vitamin D
Patient has an elevated PTH ____ with
low 25(OH) Vitamin D ____
- Consider treatment with Ergocalciferol
50,000 IU per month x 6 months
- Monitor serum calcium and
phosphorous every 3 months while on
Vitamin D therapy
- Recheck PTH and 25 (OH) Vitamin D
after repletion
PTH >70 pg/mL
PTH > 70 and 25 (OH) Vit
D > 30
Ca >10.2 mg/dL
Ca >10.2
Patient has an elevated PTH ____ with
high 25(OH) Vitamin D ____
- Consider treatment with active Vitamin
D Sterol (initial doses):
1) Calcitriol, 0.25 micrograms per
day
2) Alfacalcidol, 0.25 micrograms
per day
3) Doxercalciferol, 2.5 micrograms
3 times per week
4) Paracalcitol, 1 microgram per
day
- Monitor serum calcium and
phosphorus at least every month for 3
months
Patient serum calcium is high ____
If appropriate:
- Decrease calcium supplementation
- Change to non-calcium based phos
PTH >70 pg/mL
Ca <8.5 mg/dL
Ca <8.5
LDL Cholesterol > 100
LDL Cholesterol > 100
Triglycerides >500
Triglycerides >500
5) Associated Disease
Management
Diabetes Mellitus – Hgb A1C
< 7.0
Hypertension – SBP <130
Hgb A1C > 7.0
Hypertension – DBP < 80
DBP > 80
6) Counseling
Smoker
7) Preserve Vascular Access
Avoid blood draws, IV, or
PICC in non-dominant arm
Blood draws and IV in hand
veins if possible
No subclavian central lines.
Internal Jugular central lines
preferred.
SBP > 130
Tobacco use current
checked
No logic – appears on
reminder list
No logic – appears on
reminder list
No logic – appears on
reminder list
binders
- Decrease dose of Vitamin D
supplementation
Patient serum calcium is low ____
If patient has symptoms of
hypocalcemia or PTH is > 70:
- Consider treatment with calcium salts
- If still low consider treatment with
active Vitamin D sterols.
Patient LDL cholesterol is above goal
___
- Consider treatment per algorithm (The
word “algorithm “ is a link to a web site)
Patient triglyceride level is above goal
___
- Consider treatment per algorithm (The
word “algorithm “ is a link to a web site)
Patient Hgb A1C is great than goal ____
- Attempt to reach goal as able
Patient blood pressure is higher than
goal ____
- Consider increasing therapy using
table (The word “table “ is a link to a
web site)
Patient blood pressure is higher than
goal ____
- Consider increasing therapy using
table (The word “table “ is a link to a
web site)
Patient is currently smoking
- Consider smoking cessation
interventions