BROWARD HEALTH ENTERPRISE TRANSCRIPTION SERVICES RFP FORMAL REQUEST FOR PROPOSAL. Q&A Addendum

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1 BROWARD HEALTH ENTERPRISE TRANSCRIPTION SERVICES RFP FORMAL REQUEST FOR PROPOSAL ADDENDUM NUMBER THREE (3) MAY 4, 2016 THIS ADDENDUM IS ISSUED PRIOR TO THE ACCEPTANCE OF THE FORMAL RFQS. THE FOLLOWING CLARIFICATIONS, AMENDMENTS, ADDITIONS, DELETIONS, REVISIONS, AND MODIFICATION FORM A PART OF THE CONTRACT DOCUMENTS ONLY IN THE MANNER AND TO THE EXTENT STATED. Q&A Addendum Q. On page 41 of the RFP, Section C. Contractor Performance Standards / Transcription Services Questions, question 12, there are two sample reports referenced related to pricing. We do not find these reports. Is this text an error, or are we missing some required material? In addition to the items listed in Section E, Pricing Proposal, and the Cost Worksheet provided as part of the RFP document, vendors must submit pricing for Sample Report A and Sample Report B provided in this Addendum. Please include this as part of your response to Section E. Q. What is Broward Health's end goal for self-documentation as a percentage of total reports completed? On pages of the RFP, current transcription volumes are listed. Selfdocumentation would obviously reduce this volume, and affect pricing service levels. This is hard to predict and will depend on the ease of use of the application and if/when the physician feels comfortable with using self-edits. Also, it will depend on the use of VR and when the physician feels comfortable. Q. The Scope of Service contains this phrase Broward Health will reject any RFP response where the vendor does not provide a Cerner integrated voice recognition solution that integrates with the Broward Health Cerner Acute Care and Ambulatory EHR, PowerChart and PowerChart Touch.. This is further elaborated on in the "Minimal Requirements List" questions 5, 8, 9, and 10, and elsewhere in the RFP. According to its website, Cerner embeds and resells Nuance technology to Cerner customers, so the solutions you are looking for would typically be purchased directly from Cerner, not Nuance or any other documentation/technology vendor. (Nuance provides technology to Cerner, and Cerner makes it available in PowerChart modules.) Given Cerner s well-documented and exclusive relationship with Nuance, what type of response are you looking for from otherwise qualified vendors? All vendors should provide their solutions and service options. Any vendor can respond to this RFP. The vendors need to demonstrate the ability to integrate with PowerChart EHR and their mobile technology solutions so Broward Health has options in the future to take advantage of those mobile Cerner integrated options for our physicians and community services.

2 Q. Section: Front End Speech Recognition Does Broward Health expect to license front end speech recognition as a site license for each hospital? Or are you going to license all workstations in all facilities for front end speech recognition individually? We need to be shown the options. We have not determined these details. That will be part of the RFP pricing and the vendors can demonstrate the cost savings of one over the other. Q. Section: Front End Speech Recognition For the purpose of capacity planning and pricing, how many clinicians will be concurrently using front end speech recognition directly into Millennium? Broward Health has approximately 1700 active medical staff providers (MD, DO, ARNP, etc.) We suggest vendors use their existing customer base in the market and compare the size of our IDN to their other customers to determine potential usage at any given time. We also provided the volumes of documents and again suggest the vendors use the data supplied to submit pricing options. Broward Health has never implemented front end speech recognition and therefore we plan to provide the physicians optional use of the front speech recognition solution. Some physicians may choose to not use speech recognition, where others may embrace the solution. Q. Back End Speech Recognition Reference/Subject: Do you offer Computer-Assisted Physician Documentation (CAPD) for your transcription and Back End Speech Recognition platforms? Can you describe specific functionality CAPD required? Our current vendors provide this service to enhance the transcription services through Back End VR services. All vendors should have the ability to provide back end services to lower costs for transcription services. Q. Section: Data Security Regarding the question How do you ensure all firewalls are properly configured? Have qualified 3rd parties performed penetration tests of your network(s) and/or home-based transcriptionists? When was the most recent such test? What were the results? Have all identified vulnerabilities been addressed? Are internal network security audits performed? What other measures do you employ to protect your network(s) and home-based transcriptionists from intruders? Does this vary by location? If so, note the exception on table DS-1. Please specify what an exception would be classified as for at-home transcriptionists. If we have a team of 40 at-home transcriptionists that will be assisting on this account, would table DS-1 need to be filled out for each workstation for the 40 transcriptionists? Detail how transcriptionist or any other device used to process PHI in any manner is secured and how is security of the information achieved? If you allow exceptions to your security policies identified how is data security achieved? Q. Regarding the question: Describe in detail the failover process to a secondary server? What is the assessed downtime to be expected to perform a failover of at least 300

3 connections?, in this context, does the term connection mean a dictation session? If not, what does the term connection mean? Yes, how long would it be for the physicians to be back on line should a downtime occur. Q. Our company operates 2 separate data centers. To provide complete fault tolerance, VPN s would need to be established from Broward Health to both data centers. Is this dual connectivity possible? We can have multiple VPN s, however we cannot guarantee the fault tolerance of the application utilizing multiple VPN s and will only allow access to datacenters located in the United States.

4 SAMPLE REPORT A History and Physical Name: SMITHAA, RICHARD Unit: 4WST MR#: Hos Svc: SSP Acct.# Adm. Date: 03/28/2016 Dict. Dr: MARYBETH JANESY-SMITHS, MD History and Physical Broward Health Coral Springs CHIEF COMPLAINT: Ascites. HISTORY: The patient is a 55-year-old male with a known history of recurrent ascites secondary to end-stage liver disease. The patient reports since his last hospitalization, he was doing okay, and he started feeling some abdominal distention on Friday, and just took it easy over the weekend, but it continued to increase in terms of the abdominal distention and the pain. No fevers, no chills. He has had decreased appetite. No nausea, no vomiting. The patient came to the emergency room for evaluation. In the emergency room, he was noted to have a temp of 98.1, initial blood pressure 162/81, the patient had no other complaints. PAST MEDICAL HISTORY: Significant for alcoholic liver cirrhosis, endstage liver disease with recurrent ascites, GERD, anemia of chronic disease. PAST SURGICAL HISTORY: Multiple paracenteses, orthopedic procedures at the age of 18 secondary to MVA. ALLERGIES: NO KNOWN DRUG ALLERGIES. FAMILY HISTORY: Significant for hypertension. MEDICATIONS AS OUTPATIENT: He takes folic acid 1 mg before meals, Lasix 40 twice a day, spironolactone 100 twice a day, omeprazole 20 daily, and multivitamin 1 tablet daily, SOCIAL HISTORY: The patient does smoke about a pack a day. Past history of alcohol use. Nothing current now. Occasionally smokes marijuana. Lives with his family. GI doctor is Dr. Gupta. REVIEW OF SYSTEMS: He denies any headache. No changes in vision or hearing. No. No thyroid problems. Denies any chest pain. No. No new cough, phlegm. No fevers. No chills. He just feels the abdominal bloatedness, distention. No problems with the urine, burning, discomfort or blood. No changes in the stool. No diarrhea. No constipation.

5 PHYSICAL EXAMINATION: GENERAL: The patient was awake, alert, no acute respiratory distress. VITAL SIGNS: Temperature 98.1, pulse of 100, blood pressure 145/74, respiratory rate of 20, saturating 100% on room air. HEART: S1, S2. Regular rate and rhythm. No murmurs. LUNGS: Bilateral breath sounds. No wheezing. No rhonchi. No rales. ABDOMEN: Soft, distended. No significant pitting edema. No gross focal neurological deficit. HEENT: Pupils were equal and reactive. Extraocular motion intact. Bilateral tympanic membranes clear. No oral lesions. NECK: Supple. No palpable nodes. LABORATORY: White count is 4, hemoglobin 8.2, platelets of 138. Sodium 132, potassium 3.9, glucose of 114, BUN of 16, creatinine of 1. Total bili of 2 and lipase of 35. ASSESSMENT: 1. Patient with recurrent ascites, admitted for recurrent ascites with end-stage liver disease. 2. Chronic thrombocytopenia secondary to liver disease. 3. Chronic hyponatremia. 4. Chronic anemia. PLAN: 1. Patient will be admitted as observation. Will arrange for Interventional Radiology for paracentesis. GI will be consulted. Most likely, if stable, patient will be discharged tomorrow. 2. SCDs for DVT prophylaxis. MARYBETH JANESY-SMITHS, MD KJ:MODL D: 03/28/ :51:41 T: 03/28/ :17:14 Job: /Voice Job:999999

6 SAMPLE REPORT B Name: CASH, STEVEN Unit: 4NRT MR#: Hos Svc: MED Acct.# Surgery: 03/28/2016 Dict. Dr: STEPHEN DOE-STIRS, MD Operative Report Broward Health Coral Springs SURGEON: STEPHEN DOE-STIRS, MD PREOPERATIVE DIAGNOSIS: Right ureteral calculus. POSTOPERATIVE DIAGNOSIS: Right ureteral calculus, plus hypospadias. PROCEDURE: Cystoscopy, right ureteroscopy, laser lithotripsy, stone extraction, retrograde pyelogram, and stent placement. ASSISTANT: None. ANESTHESIA: General. ANTIBIOTICS: Levaquin. DRAINS: 6-French variable-length right ureteral stent. SPECIMEN: Right ureteral calculus. COMPLICATIONS: None. INDICATION FOR PROCEDURE: The patient is a 46-year-old gentleman who presented with right colic. He had a distal ureteral stone. After extensive counseling of his options, the patient opted for endoscopic management of his stone disease. PROCEDURE IN DETAIL: After informed consent was obtained, patient was brought back to the operating room, was identified both verbally and by his identification bracelet. After induction of appropriate anesthesia and administration of antibiotics, the patient was placed in relaxed dorsal lithotomy position. Care was taken to assure that all pressure points were padded and joints were flexed no more 90 degrees. Genitalia was prepped and draped in the usual sterile fashion. Time-out for patient safety was performed. A 22-French rigid cystoscope was attempted to cannulate the urethra. At that point, it was noted that the patient had penile hypospadias. I was able to probe the true lumen with a Sensor wire. At this point, the 21-French cystoscope was backloaded onto the wire and advanced into the urethra. The remainder of the urethra was

7 within normal limits. Bladder outlet was mildly occlusive. Bladder capacity was adequate. Ureteral orifices were identified bilaterally in normal position and morphology. Scout fluoroscopy showed the stone in a very similar position to the KUB. Sensor wire was used to cannulate the right ureteral orifice. This was advanced proximal to the stone and into the collecting system. I attempted to place the rigid ureteroscope alongside the wire. The ureteroscope did not appear like it would pass. As such, the inner cannula of the 8/10 ureteral access sheath was used to gently dilate the ureteral orifice. At this point, the rigid ureteroscope was passed into the orifice. There was an area of narrowing and edema just distal to the stone. I could see the stone above the area of the narrowing. I was able to cannulate the narrowing with a second Sensor wire and the rigid ureteroscope passed over the wire proximal to the narrowing. At this point, the stone was encountered. The 365 micron laser fiber was introduced. The stone was fragmented into clinically insignificant pieces. The largest of this was then grasped atraumatically with a 0-tip Nitinol basket. As the stone fragment was removed, I was able to visualize the ureter. There was no sign of injury to the ureter. No clinically significant stone debris within the ureter. The only finding of note was the preexisting narrowing of the lumen and edema just distal to where the stone had been. At this point, the 5-French open-ended catheter was passed over the Sensor wire. Retrograde pyelogram was performed which showed no filling defects within the renal collecting system or proximal ureter. It did appear to be a hydronephrotic system. A 6-French variablelength stent was then placed under cystoscopic and fluoroscopic guidance. A good curl was seen in the collecting system and a good curl within the bladder. Bladder was evacuated, cystoscope was removed. Patient was awoken from anesthesia without incident, transferred to the PACU in good and stable condition. The patient will be discharged home whenever deemed safe by the primary team. Will plan for stent removal. STEPHEN DOE-STIRS, MD NS:MODL D: 03/28/ :31:22 T: 03/28/ :51:53 Job: /Voice Job: