RFP#: Issue Date: October 16, 2014

Transcription

1 RFP#: Request for Proposals Electronic Medical Record Issue Date: October 16, 2014 Response Due Date: December 12, 2014 tony

2 Copyright Notice This document is fully copyright protected by the Newfoundland and Labrador Request for Proposal Electronic Medical Record ii

3 TABLE OF CONTENTS Introduction... 1 Electronic Medical Records... 1 Purpose... 1 Newfoundland and Labrador s Health Care Stakeholders... 2 Provincial Healthcare Current State... 5 Program Scope... 8 EMR Program... 8 Request for Proposal Deliverables... 8 Electronic Medical Record Product(s)... 8 Expected Professional and Managed Services... 8 EMR Interoperability... 9 Proposal Requirements and Content Executive Summary Corporate Profile Project Governance Respondent (s) Profile Technical Capability Maturity and History of Product Corporate References Implementation, Training, Support, and Team Resources EMR Requirements Components Required For Submission EMR Functional and Technical Requirements Primary Health Care EMR Content Standard Requirements EMR Solution Demo Financial Proposal Cost Summary Template Evaluation of Proposals Evaluation Process Evaluation Criteria Respondent Selection Process Oral Presentations/Demonstrations/Site Visits Request for Proposal Electronic Medical Record iii

4 Identification of Preferred Respondent Additional Phases of Work Vendor Debriefing RFP Process and Estimated Timetable Schedule of Events Intent to Bid Questions and Additional Information Proposal Submission Guidelines General Format of Submission Style Presentation Ordering and Titles of Content Sections Supporting Materials Mandatory Requirements RFP Terms and Conditions, and Contract Template Attachment A Functional and Technical Requirements Attachment B - PHC EMR CS Priority Subset and CFPLs_June Attachment C Financial Proposal Attachment D Acknowledgement of Terms and Conditions Appendix A MCP Electronic Billing Specifications Appendix B Acronyms/Definitions Appendix C CIHI Supplemental Documentation Appendix D Supplementary Information to the RFP Request for Proposal Electronic Medical Record iv

5 Introduction Electronic Medical Records An Electronic Medical Record (EMR) is a comprehensive electronic record of a patient s health information, held within a single office or clinic. The use of electronic medical records will bring an important primary care component of the health system into the development of the Newfoundland and Labrador Electronic Health Record (NL EHR). This notion is also emphasized in Infoway s strategic statement about development and investment in foundational components for the next decade, where the integration of the EMR with the EHR is considered fundamental: Enabling seamless communication across the continuum of care and into communitybased settings. This would include integrating primary care physicians, specialists, and community care facilities (e.g. through EMRs). 1 Approximately nine per cent of physicians in Newfoundland and Labrador have electronic medical records in their clinics. The Department of Health and Community Services (DoHCS) is examining options for a provincial electronic medical records program to encourage physicians within clinics to incorporate them into their practices. EMRs are designed to deliver a number of tools that help doctors provide patient care, manage their practices and are an important source of a jurisdictional Electronic Health Record (EHR). The use of EMRs by physicians will improve the availability of information for direct patient care and thereby improve the quality of patient care. An EMR in a physician s office will maintain patient encounter notes, problem lists, immunizations, vitals, the ability to enter/print prescription renewals, notification of drug alerts, lab test results, billing and scheduling, and the ability to view patient information in other components of the EHR. The successful implementation of an EMR solution, from a business perspective, will streamline clinical workflow and provide a tool for patient care in a private and secure manner that enables all physicians in a clinic to gain the benefits of an EMR. Patient safety, privacy, quality of care, and process efficiencies are important business drivers and support key health priorities established by Provincial Health System Stakeholders. Purpose The Newfoundland and Labrador (the Centre), on behalf of the DoHCS, is seeking the services of interested organizations to provide a commercial off-the shelf (COTS) product and the associated professional and managed services to implement an EMR solution. The Department reserves the right to select one (1) or multiple (1+) vendors. The Respondents are expected to provide relevant information for a cohesive approach to implementing and supporting an EMR solution. They should have a solid understanding of product integration, testing, data migration, training, transitioning, security, ongoing supports 1 Canada Health Infoway, 2015: Advancing the Next Generation of Health Care in Canada.

6 and associated costs. Ideally the Respondents should bring a mix of specialized skills, proven methodologies, and best practices gained from planning, designing, implementing, training and supporting projects of similar scope and complexity in one or more Canadian jurisdictions. Subject to further approval, it is anticipated the EMR solution that is acquired through this RFP will be deployed initially for approximately 300 physicians across the Province. While the Province is currently targeting 300 fee-for-service physicians for its initial rollout, the exact size of the initial deployment will be determined at a later time, depending on factors such as the viability of the chosen vendor solution, the implementation plan and the vendor s capacity and the degree to which these and other factors align with the environment in the Province. It is anticipated that this initial deployment will provide the basis for a larger, Province-wide deployment through future initiatives. The governance of the EMR program has not yet been finalized and will be the subject of an agreement between Government and Newfoundland and Labrador Medical Association (NLMA). Once the governance of the EMR is defined, it will be shared with the selected vendor(s). The Province has been a leader in the development and implementation of jurisdictional Electronic Health Records through initiatives such as the first Infoway blueprint-compliant Client Registry, the implementation of the new Infoway-sponsored CeRX messaging standard in its Provincial Pharmacy Network and the current development of the iehr/labs project. The EMR solution sought though this RFP will play a critical role in harnessing full value of the Province s existing EHR investment, and is an exciting opportunity for both the Province and the successful vendor to demonstrate the full value of the pan-canadian EHR blueprint. Newfoundland and Labrador s Health Care Stakeholders In Newfoundland and Labrador there are several organizations tasked with the creation and support of provincial ehealth initiatives. The following is an overview of some of the key stakeholders involved in this venture. Department of Health and Community Services The Department provides a lead role in policy, planning, program development, and support to the four Regional Health Authorities (RHAs) and other mandated health and community service agencies. The Department also monitors and provides feedback as appropriate to the RHAs and agencies with respect to program implementation, accountability issues and health and community outcomes. The Department ensures the province benefits from best practices, standards and guidelines prevalent in other jurisdictions through representing the health interests of Newfoundlanders and Labradoreans in all intergovernmental discussions, initiatives and agreements and by partnering and collaborating with other departments of the Government of Newfoundland and Labrador, governments in other jurisdictions and the Federal Government. Newfoundland & Labrador Medical Association A division of the Canadian Medical Association (CMA), the Newfoundland and Labrador Medical Association (NLMA) is the voice of organized medicine in Newfoundland and Labrador. The Association represents the views of the physicians of the province with governments, the media and the general public. It also advocates on behalf of all patients for a fair and equitable health Request for Proposal Electronic Medical Record 2

7 care system in Newfoundland and Labrador and Canada. The NLMA represents the political, clinical and economic interests of the province s medical profession. Practicing physicians, residents and students enrolled at Memorial University s Faculty of Medicine are eligible for membership in the Association. The province s Medical Act requires that all practicing physicians hold membership in the Association as a condition of licensure. Newfoundland and Labrador The Centre was created by the Government of Newfoundland and Labrador in 1996 with a mandate to develop a comprehensive and secure province-wide Health Information Network (HIN). As an agency of the Crown, the Centre provides information to health professionals, the public, researchers, and health system decision makers to improve the health of the population of Newfoundland and Labrador. The Centre has been a pioneer in supporting the vision of an interoperable, standards-based EHR for the province, in alignment with pan-canadian EHR standards and architecture. The Centre has established an aggressive goal of implementing all funded components of the EHR, with active adoption by all authorized users. Regional Health Authorities Effective April 1st, 2005, the Province reorganized its healthcare delivery system into four (4) RHAs; Labrador-Grenfell Health, Western Health, Central Health and Eastern Health. The RHAs represent the salary based physician community and provide a full continuum of integrated health and community services, including public health, long-term care, community services, hospital care, and various provincial programs and services. Request for Proposal Electronic Medical Record 3

8 Figure 1: Regional Integrated Health Authorities The following list of metrics is meant to provide an idea of the size of Newfoundland and Labrador s Health Care environment: Is spread over 405,720 square kilometers incorporating two (2) time zones The population estimate for Newfoundland and Labrador for 2013 was 527,000 The number of practicing Physicians in Newfoundland and Labrador, as of 2013, was 1,155 The number of Nurse Practitioners currently in Newfoundland and Labrador is approximately Registered Nurses with a practicing license were employed in nursing in the Province as of 2010 Request for Proposal Electronic Medical Record 4

9 Canada Health Infoway Canada Health Infoway (Infoway) is an independent not-for-profit corporation created by Canada s First Ministers in 2001 to foster and accelerate the development and adoption of Electronic Health Record (EHR) systems with compatible standards and communications technologies. Funded by the Government of Canada, Infoway works with the country s ten provinces and three territories to implement private, secure EHR systems, enabling best practices and successful projects in one region to be shared or replicated in other regions. Infoway s vision is one of a high-quality, sustainable and effective Canadian healthcare system supported by a pan-canadian health infrastructure that provides residents of Canada and their healthcare providers with timely, appropriate and secure access to the right information whenever and wherever they enter the healthcare system. Respect for privacy is fundamental to this vision. In accordance with its mandate, Infoway is co-investing with the provinces and territories to support their efforts to significantly increase the number of clinicians adopting and using an EMR. The architectural vision of Infoway is expressed in the Electronic Health Record Solution (EHRS) Blueprint. The EHRS Blueprint presents the business and technical architecture for an interoperable EHR (iehr) framework across Canada. This architecture has been established in a collaborative setting where all key stakeholder groups involved in the healthcare industry participated to validate and approve the constructs that it promotes. It is, therefore, a pan- Canadian vision for the creation of EHR infostructures (EHRi) and it is used as a criterion for investments by Infoway. The EHRS Blueprint can be accessed or downloaded by registering at the Infoway Knowledge Portal at Provincial Healthcare Current State The Provincial Healthcare current state is comprised of numerous applications and associated infrastructure. The current state described below is not meant to be exhaustive in nature but rather a focus on the systems that pertain to EMR integration concentrating on the EHR and specific core provincial health care systems. Newfoundland and Labrador Electronic Health Record The Centre, through strategic planning activities, has developed a vision for a provincial personspecific EHR that will provide access to complete patient information at the point of care. The EHR Strategy is defined in a multi-phase roadmap to ensure that the provincial strategy remains current and continues to deliver high value for the Newfoundland and Labrador health system. The EHR solution architecture is built using leading technologies, best practices and industry standards. The solution is comprised of components that lay the foundation necessary to develop an overall jurisdictional EHR. These components include: Health Information Access Layer (HIAL), the Drug Information System (DIS), the Shared Health Record (SHR), the Jurisdictional Laboratory Information System (JLIS), the iehr Viewer, as well as the Client, Provider, and Location Registries. Additionally, the solution provides a robust Data Warehousing (DW) component. Communications with the solution is through a series of interfaces and Application Programming Interfaces (APIs) utilizing HL7 (v2 and v3) messaging standards. Request for Proposal Electronic Medical Record 5

10 Health Information Access Layer The HIAL acts as an abstract layer to integrate Point of Service (PoS) applications with the EHR. It is comprised of service components, service roles, information models, and messaging standards required for the exchange of EHR Data and the execution of interoperability profiles between EHR Services. It is aligned with the Canada Health Infoway EHR Blueprint version 2, employing a full Service Oriented Architecture (SOA) which allows services to be integrated into an overall health solution using Pan-Canadian standards. Drug Information System The Newfoundland and Labrador DIS is the provincial domain repository of prescribed and dispensed medications. It contains a patient specific medication profile. The DIS is part of the Province of Newfoundland and Labrador s EHR. It supports the province in its vision of improving the quality, safety, and delivery of patient care for the citizens of Newfoundland and Labrador by providing more complete and timely pharmaceutical information to healthcare providers. Client Registry The Client Registry (CR) is a provincial information system of patient demographic registration information collected by the RHAs, community pharmacies, the Department of Health and Community Services and MCP. Anyone in Newfoundland and Labrador using the health services in a hospital, a long-term care facility, or receiving a community health service are included within the CR, whether they are a resident, former resident, or visitor. Provider/Location Registry The Provider Registry (PR) is the single source of information about licensed health professionals authorized to use the Newfoundland and Labrador EHR. The PR also includes a location table, used to provision service location information. Data Warehouse The DW provides an infrastructure for storing, analyzing and reporting on data extracted from the EHR. The infrastructure provides data warehousing for data that will be used for health system use including such activities as public health reporting. Data is fed to the DW using an extraction, transformation and loading (ETL) capability. Core Healthcare Systems The following components comprise the core systems as they relate to EMR and these Provincial systems currently utilize elements of the EHR. MCP The Newfoundland and Labrador Medical Care Plan (MCP) is a comprehensive plan of medical care insurance designed to cover the cost of physician services for residents of the province. The current billing model supports both Fee-for-Service and an Alternate Billing System. MEDITECH MEDITECH is an integrated Health Information System (HIS) used across the province s RHAs. All of the province s hospitals, many of the health care facilities and programs, and the NL Public Request for Proposal Electronic Medical Record 6

11 Health Laboratory obtain their core clinical and administrative systems services from multiple instances of the MEDITECH. Diagnostic Imaging and Picture Archiving and Communications System (DIPACS) The DIPACS system enables filmless capture and transmission of a patient s radiology test results across the province. The DIPACS technology aligns with Newfoundland and Labrador s ongoing efforts to create an integrated EHR across all healthcare stakeholder levels, programs, and services. DIPACS contributes to an electronic longitudinal record for all health interactions of a patient in their lifetime. HEALTHe NL Viewer The HEALTHe NL Viewer provides multi-domain display of patient data contained in the domain repositories. It is utilized by care providers without an integrated EHR PoS application. Clinical Data Repository (CDR) Expected to be operational in early 2015, the CDR is comprised of the two new domain repositories, JLIS and SHR. These repositories are populated with laboratory results; patient encounter data, clinical reports and DI reports generated from the tertiary care HIS system (MEDITECH). The CDR is composed of the Jurisdictional Laboratory Information System (JLIS) and Shared Health Record (SHR) repositories, further explained in the following paragraphs. Shared Health Record The Shared Health Record (SHR) provides the means for sharing all person-specific, clinically relevant data not held in other domain repositories. It will receive information from MEDITECH systems managed by the RHA. The initial set of records will include Patient Encounter Information, Clinical Reports, and Diagnostic Imaging (DI) Reports. Allergies and immunizations are already stored by the Pharmacy system and will not be included in the SHR. Jurisdictional Laboratory Information System The Lab Information System will store lab results that have been forwarded from the RHA MEDITECH system(s). It is not intended to provide the full laboratory order/collect/result lifecycle; however, it may consume and store lab order status messages. Results stored in JLIS will be of the following type: o o o o General Labs (Chemistry, Immunology and Haematology) Blood Bank (Donor and Transfusion Management) Microbiology Pathology Request for Proposal Electronic Medical Record 7

12 Program Scope EMR Program Ensuring the delivery of components, services and the adoption of the selected vendor(s) solution so that business requirements are fulfilled is the primary objective of the EMR Program. This will require a substantial amount of collaboration, cooperation, planning and execution between the selected vendor(s) and stakeholders. Implementing, configuring, training, supporting and the related services for the EMR Solution, per clinic will be the responsibility of the selected Vendor(s). Request for Proposal Deliverables The deliverables for this Request for Proposal (RFP) are covered in the following sections; Electronic Medical Record Product(s) Expected Professional and Managed Services EMR Interoperability Electronic Medical Record Product(s) The Centre is looking for a COTS product for its EMR solution. The EMR product refers to the set of components that will be implemented by the selected vendor(s) to eligible physicians in the province. The Department reserves the right to select one (1) or multiple (1+) vendors. The product or product suite must meet the EMR requirements as detailed in section 4.0 of this RFP. A summary of expected functionality is listed below; EMR Solutions will achieve a high degree of integrated clinical functionality and practice management support EMR Solutions and services will achieve a high degree of security and privacy protection EMR Solutions and services will enable the controlled sharing of data across the continuum of care EMR Solutions will be capable of achieving Interoperability with the key systems (e.g. MCP, Provincial CR, Provincial EHR, HIS (MEDITECH) systems) EMR Solutions and services will support standards that align with those established or being developed by the pan-canadian EHR standards collaboration process Expected Professional and Managed Services The selected vendor(s) will be required to provide the personnel and services necessary to implement and support a complete EMR offering to eligible physicians. The services, resources and related costs of this offering must be detailed in Attachment C, the Financial Proposal Template, and included as part of the response to this RFP. For the purposes of this RFP the key assumption is the deployment of an Application Service Provider (ASP) model delivering a centralized Practice Management/Electronic Medical Record system. The expectation is an ASP model hosted and operated internally by the Request for Proposal Electronic Medical Record 8

13 Province with the Respondent responsible for providing Tier 2 Support, ongoing support for application upgrades and support for any EMR connectivity, interoperability or upgrade projects. The information gathered in the RFP response should allow the Province to create a viable implementation plan with an estimated number of Physicians to which the solution can be deployed. However, it is the intent of the Centre to investigate alternative models that may bring product or operational enhancements that benefit clinical functionality. It is requested the vendor provide a brief summary of potential hosting capabilities, as they satisfy the requirements identified in this RFP, to allow the Centre to entertain the potential for additional value to the project and program. The following constraints would apply should a vendor based hosting solution be negotiated; Data must reside in Canada Data Centre support must be provided wholly by a Canadian entity Must not inhibit interoperability (i.e. EHR, MCP.) The Financial Template will provide consistency for Respondents when documenting the proposed financial cost of the solution. It will also allow the Department to properly evaluate a complete solution cost as it pertains to a common approach. The financial information the Centre requires for its review has been separated into One-Time Services (e.g. hardware, configuration, initial training ) and On-Going Services (e.g. new releases, upgrades/patches ). The Financial Proposal Template further outlines the costs and it is expected that resources will be indicated where applicable. EMR Interoperability Interoperability between the EMR and other clinical data sources is essential to providing quality information to support health care. Implementation of terminology and connectivity standards will support integration between health systems such as the EHR, and MEDITECH and will support the provision of improved health care. The integration requirements for the EMR are delineated by integrated systems, and described in the following subsections: MCP Billing Newfoundland and Labrador EHR Point-to-Point Interfaces MCP Billing The current billing model supports both Fee-for-Service and an Alternate Billing System. Fee-for- Service describes a type of claim where the provider bills a specific code and dollar amount for an individual service (i.e. a general assessment). These claims are billed per individual patient identity numbers (PINs). The Alternate Billing System describes a type of claim where the provider bills a rate per time. While this type of claim is not billed per patient, there are circumstances where some claims do require the patient identity numbers in the form of a patient log. Request for Proposal Electronic Medical Record 9

14 MCP's specifications for electronic file transmissions are outlined in Appendix A. This document contains specifications for the electronic submission of dental, medical, and host medical fee for service (FFS) claims and alternate billing system (ABS) claims to MCP and the receipt of turnaround documents (TADs), letters, and remittance data from MCP. Newfoundland and Labrador EHR The Newfoundland and Labrador jurisdiction has been implementing components of the EHR since 2001 starting with the CR which has formed the corner stone of the system. The Centre developed the Pharmacy Network Vendor Implementation Standards (VIS) which is the NL implementation of the pan-canadian standards. This is, in addition to the implementation guides published by the CeRx, Client Registry and Provider Registry standards initiatives, in line with Canada Health Infoway s national standards for Electronic Health Records. The purpose of the Newfoundland and Labrador Vendor Implementation Standards is to specify the minimum technical standards that PoS software is required to support in order to be considered compliant with the functional requirements of the EHR. These standards include a common set of evolving specifications for use by all PoS software vendors wishing to develop or modify HL7v3 applications to work with the Newfoundland and Labrador EHR. A copy of the NL VIS is available upon request via electronic mail at procurement@nlchi.nl.ca. The Centre has also deployed an integration engine for instances where HL7V3 was not chosen as the communication methodology. This integration engine can support other message types, once negotiated and approved by the Centre. A conceptual diagram of existing and potential integration of the EMR can be seen below, followed by a description of relevant components for EMR integration. Request for Proposal Electronic Medical Record 10

15 EMR integration with the EHR must be done efficiently and effectively to provide valued data to the EMR client in a manner that is useful to the provision of care. This must include timeliness and integrity factors when devising the final solution. Although all EHR domains are not fully operational at this time, integration will eliminate the need for multiple point-to-point interfaces with disparate HIS systems. It is envisioned that the EHR will become a complete longitudinal health record for patients, and will require information from the EMR to accomplish that goal. The EHR registries (CRS, PRS) and repositories (JLIS, SHR, DIS) can be accessed utilizing HL7 messaging. To meet the requirements for EHR integration the EMR will have to interface with the EHR repositories through one or more of the following approaches; Health Information Access Layer The HIAL currently supports HL7v3 messages for DIS, CR and PR integration. The HIAL, as the central processing point for all Newfoundland and Labrador EHR transactions, provides a communications bus and numerous common services that support accessing EHR data. At a high level, the HIAL brokers the interactions between the PoS systems and all data repositories of the EHR. Client Registry Request for Proposal Electronic Medical Record 11

16 The Client Registry currently supports HL7V3 and HL7V2 messages for client identification and update. The CR supports a HL7V3 interface and several legacy interfaces still using a variety of HL7V2 message standards. To meet the requirements for EHR integration we require a solution that has the ability to integrate with the CR. The CR provides the capability to resolve the multiple identifiers that may be used across multiple systems to identify a single client. The CR is the authoritative source of the unique identifier to be used by the EHR (e.g. the Enterprise Client Identifier (ecid)). The ecid is an internally generated identifier available to the systems that communicate with and inside an EHR. This process ensures that the management of client identifiers between systems that participate in the EHR is properly managed, and that data integrity challenges associated with client identification merge/unmerge and link/unlink operations can be adequately managed within the EHR. Provider and Location Registry The Provider Registry currently supports HL7V3 messages for Provider/Location identification and update. The PR/LR provides the unique identification of care providers and provider locations. The PR provides consistent, timely and accurate information about healthcare providers and how they can be contacted for communication and information exchange. The LR function provides for the unique identification of all locations in Newfoundland and Labrador where health services are provided. The PR/LR is accessed by PoS systems via the HIAL using HL7v3 messages. The PR, an essential component of the EHR, contains information supplied by the regulatory organizations for each profession. Drug Information System The DIS provides a community medication profile for clients. The DIS also stores allergy and immunization information for clients. The DIS provides decision support capabilities by monitoring prescriptions against the patient s active medications and their personal profile. Point of Service (PoS) systems such as the Pharmacy Practice Management Systems (PPMS) and the Care Provider Portal (CPP) integrate with the DIS Domain via the HIAL using HL7v3 CeRx messages. Jurisdictional Laboratory/Shared Health Record Information System The iehr/labs project will implement domain repositories for Lab and the Shared Health Record data with additional HL7V2 PUT messages, currently being developed. The sharing of clinical data in the SHR will align with pan-canadian terminology, and messaging standards where appropriate for the sharing of clinical data in the SHR domain. The JLIS/SHR can be made available to PoS systems using multiple approaches that will be arranged with each PoS system. The JLIS repository will initially be populated with laboratory results generated from MEDITECH HIS systems that include (but are not limited to) Laboratory, Microbiology, Pathology, and Blood Bank transaction modules. Picture Archiving and Communication System The PACS architectural solution involves the integration and interaction of the PACS infrastructure architecture across regions, and the creation of a single provincial solution. A single, central repository of all diagnostic images and report results is available as part of the PACS solution. Integration with the PACS solution is envisioned to provide access to the digital images, and not the related report, which is currently captured in the HIS system. Integration Engine Integration Request for Proposal Electronic Medical Record 12

17 The NL EHR Integration Engine can support HL7V3 or HL7V2 messaging. The current integration engine can be used for alternate integration approaches, from those previously specified, with the appropriate negotiation and approval of the Centre, in support of delivering the most effective and efficient EMR solution. Point-to-Point Interfaces In the interim the EMR solution may have to establish point-to-point interfaces. Two sources of clinical data that may be required for integration would be MEDITECH and PACS, and integration efforts may vary from Region to Region, as the EHR deployment continues. MEDITECH In the province today, the instances and versions of MEDITECH are: Eastern Health: Avalon and Peninsula instances have been consolidated and have migrated to Labrador-Grenfell Health: Labrador-Grenfell North System and Labrador-Grenfell South System have migrated to Eastern Health Western Region: One instance, version Central Region: Central East System have been migrated with Central West System resulting in 1 instance, version Request for Proposal Electronic Medical Record 13

18 Proposal Requirements and Content This section outlines the requirements and RFP content that the Centre will use to evaluate the Respondent s business, proposed solution and a description of how it meets the more detailed requirements. In addition to the specific requirements, responses will be evaluated on their quality, clarity and briefness. The Respondent should use the following checklist to ensure that all submission requirements have been fulfilled and to cross reference the location within their RFP response. Respondents must complete all sections. Submission Requirement RFP Reference Attachment and Respondent Cross Reference Executive Summary (not to exceed 3-4 pages) 3.1 N/A Corporate Profile (attach references as an appendix) 3.2 Implementation, Training, Support, and Team Resources 3.3 EMR Requirements 4.0 Functional and Technical Requirements Attachment A Primary Health Care EMR Content Standards Attachment B EMR Solution Demo N/A Financial Proposal 5.0 Attachment C Acknowledgement of Terms and Conditions 9.0 Attachment D Executive Summary Provide a short summary of the key features of the proposal, and a general description of how your proposed solution(s) aligns with Program Scope described in this RFP. Identify any advantages which are unique to your proposed solution and why it is best suited for a Newfoundland and Labrador EMR. Corporate Profile This requirement provides the Centre with the information needed to evaluate the Respondents business with regard to initiating and maintaining a long term relationship with the supplier(s) Request for Proposal Electronic Medical Record 14

19 during the implementation and ongoing support of the key components of the overall EMR project. Respondents must respond to each of the specific requirements indicated in this section. Project Governance Preference will be given to the solution that provides an effective project structure while efficiently delivering the requirements during implementation and ongoing support. Respondents must describe their project governance strategy for their proposed solution, including, yet not limited to: How the project team will ensure the appropriate review and resolution of issues encountered within the project implementation How it will ensure that required approvals and direction for the project is obtained at appropriate stages of the project How it will ensure the implementation of necessary policies and standards as they apply to Newfoundland and Labrador How it will provide leadership for the management and operations of the EMR project How communication will flow to the appropriate stakeholders throughout the project Respondent (s) Profile Prime (or Sole) Respondent Profile The Respondent must present a concise corporate profile highlighting: A summary of the Respondent s experience relative to the scope of this RFP and proposed solution A brief profile of the Respondent, or Consortium members, if applicable (# of staff, years in business, core competencies) A description of any third-party alliances/relationships (as it pertains to the solution being proposed) Any recent mergers or acquisitions involving the product line of the proposed solution A description of the Respondent s financial viability and sustainability (e.g. necessary financial information to perform a financial analysis of the Respondent s company ) Any additional corporate information that the Respondent considers pertinent to add value to their response Technical Capability Strong technical capability is fundamental to implementing an EMR initiative. The Respondent must indicate how their technical capabilities will benefit the project through their proposed resources, use of additional subject matter experts, best practices, standards involvement, training, knowledge transfer Request for Proposal Electronic Medical Record 15

20 Respondents must describe how they foster competence and indicate where they contribute to the success of the industry through participation in associations, committees, forums, collaboration, etc. and how they are applied to similar projects in the following areas: Competence with health solution development and implementation Demonstrated compliance of products, solutions and services with pan-canadian standards and protocols as set out in Infoway s EHRS Blueprint relating to architecture and interoperability standards as approved by the Infoway EHR Standards Collaboration Process (per Infoway s EHRS blueprint and Privacy and Security Architecture (PSA) Best practices from previous EMR implementation engagements Best practices from previous e-health integration engagements (EHR, HIS, LIS integrations) Subject matter expertise in EMR solution systems at pan-canadian level Standards expertise (HL7) and pan Canadian EHR standards, Integrating the Healthcare Enterprise (IHE) profiles, Transport Layer Interoperability (TLI), Terminology, etc.) Infrastructure planning, business continuity Understanding of provincial level (NL) e-health privacy and security requirements Maturity and History of Product The Centre requires that the solution will be built upon an existing COTS package. To address this, Respondents must provide appropriate information in support of their proposed solution as being a proven, stable and continuously improving solution applicable to the Centre s needs. As well respondents are asked to provide: Product release schedule and patch management strategy Number of end users of deployed operational instances Number of production installations of the version of software being proposed Number of Canadian installations Experience with conversion/migration of existing EMR Vendor solutions Description of the product s five (5) year roadmap and how the proposed solution fits within the overall strategy of pan-canadian standards initiatives Corporate References Respondents must provide a minimum of three (3) written corporate references for whom they have completed a similar project. Provide the following information for each of the three (3) referenced projects: Client name and address Contact name/title and phone number Typical involvement/role in past projects Brief description of nature of project, scope, and services rendered Request for Proposal Electronic Medical Record 16

21 Implementation, Training, Support, and Team Resources Implementation This section provides the Centre with information with which to evaluate how the Respondent s approach to pre-implementation, implementation and post implementation will meet the needs of a NL EMR implementation. Respondents will be evaluated on how well they fit, integrate their skills and expertise, leverage knowledge of other stakeholders and contribute to the overall success of the initiative. As described below, the project will break the work down into major stages common to all teams on the project. Each stage is intended to build upon the functionality of the overall solution. As each is completed and tested, additional functionality is elaborated upon and planned for the next stage, until the solution is fully tested and deployed. Specific to your proposed solution, the response must include a work plan that indicates timeframes as they relate to a standard EMR implementation. Responses to this section will be evaluated based on the Respondent s overall project approach, completeness and quality of the proposed work plan, confirmation that they can provide resources at the appropriate times as well as any constructive feedback or suggestions that (based on your experience) should be considered to improve the timeline without compromising quality. The Respondent must briefly describe the following topics as they relate to an EMR implementation: Dependencies Key risks, their possible impact and mitigation strategies Key assumptions Constraints Critical success factors The Respondent must describe the methodology they would follow in performing their responsibilities. Training Training is a significant factor for a successful EMR implementation and its continued usage. The Respondent must describe in detail a training plan as it pertains to; Pre-implementation training approach/timing/agenda by role, components, clinic end user types (e.g. Physician, billing admin, etc) Go-live training and onsite support (e.g. face-to-face), training reinforcement, per key components, timelines Training approach/agenda for designated train-the-trainer support staff covering all EMR components required for in-house support Request for Proposal Electronic Medical Record 17

22 The on-going training approach (e.g. refresher training, version upgrades, new functionality, and additional integration) In the above training types indicate the specific end user types (e.g. physician, admin), proposed schedules (e.g. proposed duration of training per clinic), number of resources proposed, flexibility of training sessions (e.g. weekend and evening, onsite and offsite), and training methods (e.g. instructor lead courses, computer based training, online web instruction, and other training reinforcement tools). The Respondent should indicate training capacity as per a standard deployment (e.g. estimate of how many Physicians can be trained in a month). As a deliverable, material must be made available to the Province for the purpose of on-going training and education. All costs associated with the recommended training approach must be specified in the Financial Proposal worksheet. The Centre reserves the right to carry out periodic audits of training courses, programs, and documentation delivered by the Vendor to clinicians and end-users in the province. Should conditions arise that would cause the Centre to question the accuracy of subject matter expertise or training methodology the Centre maintains the right to work collaboratively with the Vendor to alter training materials for assurance of quality training. Support Pre-implementation support, implementation support, and post-implementation support are critical to adoption and continued usage of an EMR solution. Please summarize your support structure as outlined below; Describe the Help Desk Services provided Describe your process for communicating, prioritizing, and addressing application problems of varying severity levels Identify severity levels, response times, and expected time to correct issues for each level and escalation processes for emergency technical support Identify the solution s software release strategy and approach to identifying prioritizing, managing, and distributing patches Identify how security and stability of the environment is maintained and supported (e.g. vendor testing and approval on the application of operating system updates) Describe your approach to gaining user agreement and approval of enhancements prior to deployment of major software versions or upgrades Describe your ability to support additional environments (e.g. development, staging, etc ) Team Resources Respondents must describe how they would structure and resource their teams for success. Responses will be evaluated based on the appropriate team size, effective use of resources and plan to perform work onsite and/or remotely. Highlight situations where resources have worked together on similar related projects. Request for Proposal Electronic Medical Record 18

23 The Respondents must provide a detailed organization chart of the areas applicable to their solution indicating anticipated roles, and addressing the efficient flow of information regarding project activities to all stakeholders. The Respondent must indicate where and when the Department s or other external resources (i.e. OCIO, NLCHI...) will be required to support the delivery of the proposed solution. Request for Proposal Electronic Medical Record 19

24 EMR Requirements Components Required For Submission The EMR Requirements are segregated into three (3) distinct sections; EMR Functional and Technical Requirements (Attachment A) Primary Health Care EMR Content Standards Data Elements (Attachment B) EMR Solution Demo EMR Functional and Technical Requirements The Respondents must complete the EMR Functional and Technical Requirements Matrix according to the instructions provided. This matrix has been provided to enable Respondents to reply with minimal effort. The columns provided are as follows: The Reqr. ID column is a unique requirement reference number. Ensure this reference number is maintained in your submission The Category column is the general class of the specific requirement The Subcategory column is a division that has common but differentiating characteristics from the larger category The Requirement column states the needs of the EMR Solution Implementation project. Each requirement is numbered for reference purposes and proposals must retain this numbering sequence for referencing purposes and clarity The Priority column contains an indication of the importance of the requirement: o o o o Mandatory - the solution must offer this capability, minimum qualifications, or acceptable level of response High - these requirements are important for a successful implementation Medium - a solution that offers these requirements would be preferred Low - this is a nice to have feature or it could be a future consideration The Response column is included to enable the Centre to assess the functionality of the proposed solution and to determine how well it fits the requirements. Please indicate by entering one of the following on the appropriate line: o o o (F) Full - Full capability for this requirement is currently provided by the Respondent s proposed solution (P) Partial - Partial functionality is currently provided or functionality is not exactly as described, however the system may be able to be modified or enhanced to comply. Please provide comments clarifying your answer and indicate if additional costs are required (N) No - The proposed solution is unable to comply in any way The Context/Comments column provides two functions; o This column will initially provide Respondents with examples or clarifications associated with a requirement, if applicable Request for Proposal Electronic Medical Record 20

25 o This same column is also for the Respondent to describe any additional information or functionality and will allow the Respondent to elaborate when a Partial (P) has been indicated for a requirement Note: If additional space is required, please note this in the Comments section and attach the relevant documentation referencing the requirement number. If applicable, provide high-level diagrams to clarify your response. Primary Health Care EMR Content Standard Requirements The PHC EMR content standard (PHC EMR CS) is a specification of key concepts, value sets and data models that describes a subset of priority data elements in EMRs. For PHC, this means that important data content (for example health conditions, reason for visit and interventions) can be collected in the EMR and be made available in a standardized format for multiple uses. There is a need to implement an EMR content standard to ensure that the necessary standardized information is available to support clinical and health system uses, with the overall goal of improving access, quality, outcomes and chronic disease prevention and management. In addition, Clinician-Friendly Pick Lists (CFPL) are a constrained list of clinician-friendly terms mapped to an appropriate code system, aimed at supporting adoption of the PHC EMR CS Priority Subset. When implemented at the point of care, the Priority Subset and CFPLs will increase the availability of structured, coded data in EMRs and will support quality improvement at the practice level and health system management. Pick lists are presently under development at CIHI for release in September There are 45 priority data elements that form the core of the PHC EMR CS Priority Subset. The elements were identified as directly supporting priority performance measurement for clinicians and decision-makers. The focused scope of the Priority Subset and associated CFPLs is expected to facilitate implementation and support the availability of comparable PHC information at the practice and the system level. Relevant PHC Reference Sets have also been identified to support coded, structured data in EMRs. Approximately one-fourth are demographic data elements that capture information on the patient, clinician and clinic, and another one-fourth are encounterspecific data elements. The remaining data elements relate to other patient care activities, such as medications, diagnostic imaging and referrals. Lastly, data models and technical guidance have been developed to support implementation of the PHC EMR CS Priority Subset elements. Conceptual and logical data models were developed to provide an overview of primary health care business entities (e.g. Client, Health Service Event) and the relationships between these entities. The data models were structured with the Client at the centre to reflect the needs of patient-centric health care. The Respondents must complete the PHC EMR CS Requirements Matrix according to the instructions provided. This matrix has been provided to enable Respondents to reply with minimal effort. The columns provided are as follows: The UI column is a unique ID for each of the data elements. Ensure this unique ID is maintained in your submission The Data Element Common Name is the common or business name of the data element that may be better understood by a non-technical reader Request for Proposal Electronic Medical Record 21