Yolande Calhoun
Chris Davis, M.D.
Kyle Johnson
Joanne Rimac
Natalie Schwartz, M.D.
Med. Inf. 408
Project #2
February 8, 2011
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Introductions
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Statement of the Problem– Chris
Core Objectives– Chris
Technical Requirements– Yolande
Administrative Information-Joanne
Cost Requirements-Kyle
Referenced Documents– Joanne
Deliverables– Natalie
Proposal Format-Natalie
Terms and Conditions-Natalie
Submission and Decision Deadlines- Chris
Delphi Method- Kyle
Questions
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Statement of the Problem
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Statewide HIO Service Area
Remaining % hospitals &
Physician s in community
Or rural settings
State Capital
70% of all hospitals & 55% of physician in
State Capital Metro area
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Provide the state with a Health Information
Exchange (HIE) in order to:
◦ Improve the quality, safety, and efficiency of
healthcare.
◦ Reduce healthcare disparities.
◦ Improve coordination of care.
◦ Ensure security of personal health information.
◦ Engage patients and families.
◦ Improve population and public health.
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A Vendor is being sought to partner with
Statewide HIO to provide:
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HIE infrastructure.
HIE software.
Implementation.
Ongoing service to support the HIE.
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Objectives
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Exchange of clinical information in a standard
format, such as Continuity of Care Document (CCD)
Exchange of clinical messaging and referrals
The ability to connect to the following entities
through virtual or HL7 gateways:
◦ Hospitals
◦ Physician offices
◦ State Public Health agencies (for immunization, syndromic
surveillance and reportable lab registries)
◦ ePrescribing entities
◦ Payers
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Provide HIPAA compliant security of clinical
information
Conform to national standard vocabularies and
code sets
Provide technology which delivers high availability
of HIE services
Provide the ability to connect to HIEs in other
regions, states, and with a National Health
Information Network (NHIN)
Support the information technology needs of the
HIO (internet, email, web services)
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Provide an electronic consent repository
Provide directory services for providers, payers,
and public health entities
Provide Public Key Infrastructure (PKI) to allow for
more sophisticated secondary authentication
Provide the ability to electronically submit quality
reporting to state and federal agencies
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Technical Requirements
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Example HIE Technical Framework - Axolotl
CRISP-Axolotl Arch: 5/25/10
 Architecture
◦ Business
◦ Application
◦ Data
◦ Technical
◦ Security
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Registry and Directory Services
Person and Entity Identification
Record Locator and Search Services
Identity Management
Consent Management
Secure Data Transport
Data De-Identification and Aggregation
Analytics
Referral Services
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EHR Systems
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Allscripts/Misys
McKesson
Epic
eClinicalWorks
MEDITECH
NextGen
GE Centricity
Cerner
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Event-driven service interfaces
Multiple protocols and standards (including legacy HL7)
Client API technologies
Message oriented middleware
Asynchronous, loosely coupled interfaces
Kinds of Interfaces
Table 1
Table 2
Message Standards and Transport
Protocols
Clinical Terminology Standards
CCD
CPT
CCR
HCPCS
DICOM
ICD -9/10
EDI X12 – Administrative transactions
LOINC
HL7 V2.x
RxNorm
Hl7 V3
SNOMED-CT
NCPDP
SOAP (Web Services)
SSL/TLS
XML
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Compliance with and Support for encryption,
networking and connectivity standards
specified by the ONC
“Single Sign On” approach
User Provisioning
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Unique User IDs for each user
Role based security
Automated workflow
Encryption on passwords
Capability to reset passwords
Log all data access and transmission events
Administrative Information
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 Required
experience within the last two
years
 Prime vendor in the operation of 3 HIE’s
 Provide basic HIE components
 Conform to National Standards
 Comply with privacy and security
requirements
The Intent to Bid
5:00 P.M. CST March 2,
2011.
Closing Date for
Proposals
5:00 P.M. CST April 15,
2011
Selection Criteria
Score
Price of the system
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Vendor respondent experience
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Vendor qualifications meet the Minimum
Requirements stated in the RFP
Response to requests for additional
information from vendor respondent
Scalability of the proposed system to meet
future growth of the HIE
Vendor respondent ability to provide all
aspects of the RFP:
Infrastructure, design and host services
Usability of the system for end-users and IT
staff maintenance within the
HIE
Vendor References
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Total Score
100
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15
15
10
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Cost Requirements
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Implementation Costs
◦ All vendors to provide
 Implementation costs will include:
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Hardware
Software
Implementation labor
Maintenance labor
Software maintenance
Other
- Upgrades
- Shipping
- Handling
- Training
- Travel
◦ Total cost of ownership
 Multi-year TCO model requested for period of proposal (typically 5 or 7
years)
 TCO will be recorded in the HIE RFP TCO & Pricing spreadsheet
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Software Pricing
◦ All vendors to provide pricing for:
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License fees
Subscription fees
3rd party software
Annual software maintenance or subscription fees
◦ Vendors are asked to describe pricing methodology. Will price be
based on:
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Concurrent users
# of physicians
# of encounters
Some other metric?
◦ Vendors asked to provide future pricing for licenses associated with
growth of the HIO
 Discounted, tiered pricing structure
 Determine future license increments to be purchased (e.g. 10, 50, 100
licenses)
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Professional Services
◦ All vendors are requested to provide total labor hours and dollars
required to implement and support the HIE solution.
◦ Professional Service costs will include:
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Implementation hours & dollars
Post implementation hours & dollars
Non-IT labor hours & dollars
Titles and roles needed for implementation and support
◦ Vendors will submit a complete project plan
◦ Vendors will record professional services costs in HIE RFP TCO &
Pricing spreadsheet
◦ (Reminder to vendors to plan for a two-phase approach to
implementation)
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Hardware or Hosting Costs
◦ All vendors have been requested to submit both a self-hosted &
remote hosted hardware approach
◦ Provide technical configuration for both models
◦ Provide cost comparison for both models
◦ Record costs in HIE RFP TCO & Pricing Spreadsheet
Referenced Documents
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Axolotl©
Epic©
Medicity©
RelayHealth©
Deliverables
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Documentation
Software
Training
Hardware and Equipment
Warranty
Development and Test Tools
Proposal Format
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Cover Letter
Response to Pricing
Table of Contents
Statement of Work
Response to Company Information/
Viability
Response to Technical Requirements
Appendices:
Response to Standards Support and
Commitment
Response to Provider Workflow
Response to Hosting
Response to Implementation and Support
Response to Vision for State “X”
Response to Experience and References
• Financial Report
• Technical Diagrams
• Resource Resumes
• Pricing Spreadsheets
• Acceptance of Terms
• Standard Contract
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Company overview
Organizational chart
Profile of senior management
Anticipated change of ownership
# Employees focused on HIE solution
Certificate of Insurance
Disclosure of actual/ potential conflicts of interest
Subcontractor Relationships:
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Organization name
Area outsourced
Partnership length
Name of previous successful effort together
% of total effort
Finance Sheets
Financial Background
Gross and net revenues in 2008, 2009, 2010
Current litigation issues, litigations
over the past 5 years
Bankruptcies filed
Projected revenue in 2011
% of revenue attributable to HIE solution
Current investigations by
governmental agencies
Most recent annual report and 10 K form
Committed projects in the next 12-18 months
with anticipated revenues over $100K
Audited financial statements for 2009 and 2010
• Income statement
• State of Cash Flow
• Balance Sheet
• Opinion statement of independent CPA
• Current Dun and Bradstreet Comprehensive Insight Plus
Report
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Describe the process of the provider’s ability
to access, publish, and consume HIE data
from within the EMR.
Are there any provider organization
requirements for their EMR’s to access,
publish, and consume data from your HIE
solution?
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Does the vendor have the ability to host the
solution?
Does the vendor have an existing relationship
with a host provider?
Description of the suggested hosting
approach
How the hosting solution will impact
implementation timelines and cost
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Core Infrastructure Roll-Out
Data Source and Participation Integration
Support and Training
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Company’s experience in the development
and implementation of all HIE’s of similar
 Size
 Scope
 Complexity
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Names of three HIE customers
 Client references
 Site visits
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List of All HIE Projects
Names
Status of each implementation
Project descriptions
Launch and production dates
Products installed
Deployment status
Relevant metrics around their successes
Approximate # organizations and providers attached to each project
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Understanding of the objectives of this Statewide HIE
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Major activities that must be performed
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Solution to all service and system requirements
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High level work plan
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Work Breakdown Structure
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Milestone-based Project Schedule
Terms and Conditions
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Proposal Response
Confidentiality
Formal Contract
Maintaining Pricing
Cost of Proposal Preparation
Applicable Law
Submission and Decision Schedules
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Description
Date
RFP Release Date
February 11, 2011
Intent to Respond Due Date
March 2, 2011
Vendor Questions and Clarification
Requests Due
March 16, 2011
RFP Due Date
April 15, 2011
RFP Selection Committee Review
Complete
May 29, 2011
Vendor Demonstrations
May 30 – June 16, 2011
Award Announcement
July 1, 2011
Delphi Method
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Statewide HIO continues to find the Delphi methodology
useful as a framework for decision making
The Delphi process was used specifically to determine:
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Technical requirements
Pricing information and spreadsheets
Proposal response formats
Submission and decision schedule
Features and functions questionnaire
Various experts from HIO committees were used to create
the sections of the RFP. The Delphi process was used to
collaborate and make decisions about the final request for
proposal document.
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