CLEAN INFECTION HOSPITAL. Acquisition & Implementation of a Hospital-Acquired Infection Control System. Proposal Release Date: 01 June 2010

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1 CLEAN INFECTION HOSPITAL REQUEST FOR PROPOSAL Acquisition & Implementation of a Hospital-Acquired Infection Control System Proposal Release Date: 01 June 2010 Proposal Due Date: 01 August 2010 Barbara Antuna Ronald Healy Chad Hodge Andrew James Mel Ocampo

2 I. OBJECTIVES DESCRIPTION OF CURRENT SITUATION Clean Infection Hospital is a leading 300 bed health care organization that provides a broad range of medical services to a diverse, statewide population. This project aims to institute automated controls in tracking and reporting hospital acquired infections (HAIs) and diseases. The hospital currently uses a best of breed approach for its information systems, but does not have an enterprise electronic health record (EHR). The microbiology department is organized around a laboratory information system (LIS). Current infection control and tracking is performed using a mix of electronic and manual reporting. STATEMENT OF PURPOSE The purpose of this document is to solicit proposals from prospective vendors to provide an information technology solution to our problem of tracking and reporting hospital acquired infections. Your organization has been selected to receive this. You are asked to submit a formal proposal that addresses each specific section in detail. DESCRIPTION OF PROBLEM The Centers for Medicare and Medicaid Services has deemed that the additional costs incurred for managing never events, such as healthcare acquired infections (including Ventilator Acquired Pneumonia, Central Line Associate Bloodstream Infections[1], and Urinary Tract infections secondary to Foley catheters), will no longer be reimbursed [2]. Given that about 30% of Clean Infection Hospital s revenue comes from Medicare, we face a significant reduction in reimbursement unless we are able to track hospital acquired infections (HAI s) and implement infection minimizing processes. While much of the executive, administrative, and clinical leadership at Clean Infection Hospital understands the needs to update and improve our current surveillance system, a significant number of the physicians on our medical staff disagree. They feel current protocols are adequate and don t believe their departments are the source of any problem. The Intensive Care Unit physicians and nurses, however, are supportive of the new initiative. Our strategy will be to implement the new system in the ICU and build upon its successes, which can subsequently be leveraged throughout the hospital. It should be noted that any new surveillance tool must, therefore, be scalable to meet expanding needs. Aside from the concerns of decreasing reimbursements from Medicare, Clean Infection Hospital aims to provide the very best in quality healthcare to our patients. We are aware that healthcare organization performance measures are increasingly being provided to the public [3]. We are concerned that low performance scores will negatively impact both the confidence of our patients in our organization and the sense of job satisfaction that our employees have. Confidential RFP Page 2 of 12

3 SUPPORTING DOCUMENTATION A primarily automated infection control system will be built to report morbidity as well as mortality identifiable to hospital infections. It will generate pre- and post-implementation metrics to determine the success of the project as well as identify areas where improvements are required. The surveillance system will react proactively to infection clusters, and provide clinical decision support at the point of care for high risk patients. Future capabilities will include identification of high risk surgical patients and MRSA patients. The system will be report capable, interface with our current systems and interface with public health and CDC systems. All reporting must be objective, consistent, and reproducible. A careful analysis of Clean Infection Hospital for the year of 2009 revealed that 3.6% (or 676 of 18,879) of our patients developed HAI s as measured by the standardized Nosocomial Infection Marker (NIM) Scoreboard [4]. This translated into a 14% increase in length of stay for each patient with an HAI. The most common NIM was the urinary tract infection secondary to Foley catheter placement (31.7%). Despite our best efforts using current systems and workflows, our HAI rates have remained stubbornly consistent [5]. PERCENT OF HOSPITAL ACQUIRED INFECTIONS PER ANNUM HAI Rate GOALS Our goal will be to improve the quality of patient care provided by our institution, decrease operating costs involved in infection tracking and reporting, minimize the impact of Medicare s never event reimbursement policy, and participate in state-wide public health infection reporting initiatives. The initial phase of implementation will be launched in our 24 bed Intensive Care Unit and the system will target the following HAIs. a. Ventilator Acquired Pneumonia Confidential RFP Page 3 of 12

4 b. Central Line Associated Bloodstream Infections c. Urinary Tract Infections secondary to Foley Catheters Subsequent phases of implementation will expand the system to include each department within Clean Infection Hospital. It will also include the identification of patients colonized with Methicillin Resistant Staphylococcus Aureus (MRSA), and high risk pre-surgical patients. Our organization also seeks to take advantage of revenues through alternate sources such as the Agency for Healthcare Research and Quality opportunities [6] and Meaningful Use requirements as provided by the American Recovery and Reinvestment Act of 2009 [7]. II. TECHNICAL REQUIREMENTS INTERFACES TO CURRENT SYSTEMS While our facility does not have a hospital-wide enterprise EMR at present, we have been preparing to implement one for the last year. We have a Pharmacy Information System (PIS), Radiology Information System (RIS), Laboratory Information System (LIS), and an Emergency Department Information System (EDIS). All of our current systems send data to the interface engine and interface with the data bus to receive data as needed. Since we have all our main systems working with an interface engine, we require the vendor system to integrate via the interface engine as well. The main interface engine orchestrates the communication among all the disparate systems and properly formats and enhances messages as necessary. Specifically, the interface engine translates HL7 v2 messages that we receive from the hospitals main ADT (Admission Discharge Transfer) feeds, and routes the messages as necessary to the data bus for the applications in need of that data. In addition to allowing HL7 v2, the interface engine is also able to receive and translate DICOM messages that come from the RIS. This main interface engine is also where we receive our lab results from reference laboratories such as LabCorp or Quest. This main interface engine also allows for feeds from PHRs such as Microsoft HealthVault, or Google Health. The interface engine then translates and forwards the messages to our organizations data bus. The data bus is a clearinghouse of all the clinical data in our organization. The data bus houses both the Master Patient Index (MPI), as well as the Clinical Data Repository (CDR). Confidential RFP Page 4 of 12

5 LIS RIS PIS EDIS CDR Data Bus MPI HIS Interface Engine PHRs Ref Lab 3 rd party RAD 3 rd party pharmacies Figure 1- Clean Infection Hospital IT Architecture DATABASE REQUIREMENTS Since our organization is using an interface engine, it is not important that the vendor be able to interact with the databases directly. However, the software may need a database table that can work with the system for storing data and performing analyses prior to raising alerts. Currently, our organization has licenses for the following two types of databases: Oracle 10g, and Microsoft SQL Server Our organization can also setup any open source database, such as mysql, or SQLLite if necessary. COMMUNICATIONS AND NETWORK STRUCTURE Our organization has several different networks within our organization. At best, we can achieve 1 Gbps on our dedicated T1 line. At our worst, we can achieve a 100 Mbps. The HAI vendor must be able to operate in the lowest common denominator, which is 100 Mbps. If more is required, then we will have to set aside more rack space at our highspeed data center in order to achieve the higher 1 Gbps. Doing so will incur additional costs. Confidential RFP Page 5 of 12

6 GOVERNMENT STANDARDS Vendor software should adhere to HIPAA standards in protecting patient health records and security on protected health information. Please indicate vendor software compliance to the federal mandated laws and regulation. RELIABILITY OF SYSTEM Our data center requires at least a 95% uptime over a 24 hour time period. Our center has full instrumentation, and will need to interface with the HAI vendor s software to view its resource usage and other critical performance counters. Errors and warnings should be written to the systems event log in the case of a system failure. Confirmation of this ability will be verified at a site visit of an existing client. Patches and upgrades from the vendor need to be able to be applied in the early morning hours so that clinical users of the system will be minimally impacted. We plan to install the client software for this application at every bedside. This means that the system will need to be able to support up to 300 concurrent users without affecting performance negatively. HOST COMPUTER As noted in the communications and network structure section above, we have a dedicated high speed data center that we can use to host the HAI software. We can either purchase a new server for the sole purpose of hosting the software, which needs to be included in the total price, or we can install it on a server already in use and share its resources. Ideally, the software will be able to run on a server running Windows Server 2003 or later. Alternatively, we can create a virtual server to host the software on using Microsoft Virtual Server or later. Here is our standard server configuration that should be met by the vendor. 1. Windows Server 2003, or Microsoft Virtual Server 2. Wide area network (WAN), a high-speed internet connection (the equivalent of a T1 line with at least 1.5 Mbps in the server-to-client direction) and up to 1Gbps, and adequate bandwidth to serve simultaneous database requests from all member facilities 3. Pentium D, or Core 2 duo processor 4. 4 GB RAM GB of hard disk space. III. ADMINISTRATIVE INFORMATION RESPONDENT QUALIFICATIONS It is strongly recommended that potential vendors carefully select the individuals in their respondent teams based on a working knowledge of the proposed application, previous experience with successful implementations, and an ability to provide current deliverable solutions and processes. Please note that Clean Infection Hospital is seeking a system that works as currently engineered rather than one that offers promises for the future. Confidential RFP Page 6 of 12

7 IMPORTANT DATES Release of RFP June 1, 2010 Clarification Meetings July 1-8, 2010 Response Deadline August 1, 2010 Award of Contract September 1, 2010 Project Completion December 31, 2010 CLARIFICATION AND INFORMATION REQUESTS Responses to this RFP are to be provided according to the specifics contained within this document. Additional information may be included, however, it must be clearly delineated as supplemental. Clarifying questions and formal responses are to be directed to: Dr. Andrew James, CMIO c/o of Clean Infection Hospital, 1234 No Infection Way, Happy Town, CO (502) Please note that in a spirit of transparency and fairness, all clarifying questions and subsequent responses will be made available to each vendor. SCHEDULED MEETING INFORMATION WITH POTENTIAL RESPONDENTS In order to provide an opportunity for personal introductions and questions, meeting times will be arranged with potential respondents beginning July 1, The meeting period will close one week later on July 8, Please contact our administrative assistant Mrs. A. P. Ointment at (502) to schedule an appropriate time. Preliminary meetings will be conducted with Dr. Andrew James and representatives of the administrative, executive, and medical staffs. PROPOSAL SELECTION CRITERIA Selection criteria will be based upon the clarity of the responses, the ability of the vendor to currently fulfill each requirement, the vendor s experience within the industry, and the cultural fit of the vendor and contracting organizations. Clean Infection Hospital recognizes that a close working relationship based on kept promises and mutual respect will ensure success of the project. Please note that during the RFP period, Clean Infection Hospital will also be exploring inhouse solutions to its infection never event improvement initiative. Our information technology and information system departments will have the opportunity to submit proposals to our stated requirements. Confidential RFP Page 7 of 12

8 OTHER ADMINISTRATIVE INFORMATION All communications with Clean Infection Hospital are strictly confidential. Materials are not to be distributed to others beyond your organization without our explicit consent. If in the event you decline to respond to this RFP we ask that all copies of this RFP and any other communications either be destroyed or returned. IV. COST REQUIREMENTS PRICING DELINEATION Clean Infection hospital is utilizing this RFP process to secure a vendor that will assist us in implementation of an easily configurable infection control information system. We will select the vendor that provides the most cost effective solution to our need and whose customer service and post-implementation product life cycle support will be superior to the rest. Price quoted must be valid for the next 6 months. As such, we request that all vendors submit the RFP with a clear delineation of direct & indirect costs associated with the system purchase, installation, and maintenance which will help us determine the total cost of ownership (TCO), related to procurement, but not limited, of the following items over the next 5 years. Implementation 1. system software 2. data integration, transfer and translation 3. data transfer and translation downtime 4. interface integration 5. project consultancy 6. training and education of staff 7. implementation tools development 8. software configuration and customization, including licensing for both stated users and unlimited users 9. maintenance and upgrades Products 1. Hardware: vendors will be required to submit pricing for defined hardware, operating systems and infrastructure components, such as servers, routers, PCs etc. Please use the attached spreadsheet for cost breakdown based on hardware requirements. We understand that each vendor has different hardware requirements; therefore, the spreadsheet is for the general purpose of cost analysis and comparison among vendors pricing. We reserve the right to choose vendors from whom we would like to purchase the hardware. Please quote the configuration as identified along with a quote for your preferred configuration. Confidential RFP Page 8 of 12

9 2. Software: vendors must quote software price for standard off the shelf software. Customization and other additions should be allocated under services/software customization. RESOURCES CIH intends to rely on the labor resources provided by the vendor. As such, please estimate the cost of number of hours expected for implementation within each category as listed in RFP.xls COST JUSTIFICATION Vendors must provide justification for price quoted for products and services. Best and final offer must include direct and indirect cost. Prices should be competitive and reflect fair market value. PHASE PRICING We request that vendors provide a cost breakdown according to phases of the project, such as system design & development, configuration, implementation, roll out and testing and go live. TYPE OF DEVELOPMENT CONTRACT AVAILABLE We request that vendors provide us with the type of development contracts available for the following Software development licenses and services Hardware products and its related licenses and warranties ALTERNATIVE SOLUTIONS COST ANALYSIS We request that vendors provide us with an alternative solution cost analysis related to all aspects of the project that are above and beyond fair market value, and which must be procured and utilized to accomplish functionality and have a good strategic fit of the system with the existing infrastructure. V. REFERENCED DOCUMENTS We request that the vendors provide us with referenced documents regarding performance and functionality of their system within existing health care enterprises. Vendors must submit documents that verify integration and compatibility of their software with standards such as HL7, SNOMED CT, LOINC, etc. All literature related to the products must be submitted with the proposal. VI. REQUIRED DELIVERABLES Confidential RFP Page 9 of 12

10 1. Online documentation and help features are necessary in the hospital infection control system. Vendors should provide the documentation both in hard copies and online as needed for hospital training on the new software. 2. Software should be installed at the most two (2) months before the target go-live date to allow time for validation and training on users who will be involved with the new system. It is expected that any bugs or issues related with the software must be resolved within the two (2) month period. 3. Training will be conducted by the vendor and all necessary materials must be provided to key hospital staff. The methodology should be that hospital trainers are expected to acquire the knowledge of the new system and subsequently transfer their knowledge to other users. 4. Vendors should specify beforehand through their response to the RFP what additional hardware and equipment are needed in the implementation of the new system. Cost of the equipment should also be specified and alternate options should be disclosed, e.g. purchase, lease, or lease to own. 5. Vendors must indicate the period of warranty for the system and which cost will be absorbed by the vendor and which will be expended by the hospital. Suggested warranty for the new system is one (1) year. 6. Vendors must disclose in the RFP if other development and test tools are necessary to implement and support the new system. Please indicate how and where these tools are procured and whether these are included in the acquisition cost of the software or are added cost to the hospital. VII. PROPOSAL FORMAT This RFP is a solicitation for information regarding the purchase, implementation and maintenance of an infection control system for Clean Infection Hospital (CIH). Our objectives are: Identify the software that will best fit to our business requirements Identify the best vendor that will help our organization to accomplish our goal. Purchase and implement the software including any redesign necessary to function smoothly with the new system The purpose of this section is to obtain additional information beyond the RFP questionnaire. TECHNICAL PROPOSAL This section of your response should detail the necessary hardware required for your software. In addition, supplemental software should be detailed. Descriptions of interfaces should be provided along with proposed system architecture. Database requirements and proposed network structures should be detailed. Necessary host and client computer requirements should be listed. MANAGEMENT PROPOSAL Confidential RFP Page 10 of 12

11 A project manager will be provided by both the supplier and CIH. Activities will include the development of an implementation strategy, development of a modification/security/conversion/administration plan, implementation plan, project timeline with task management and tracking, as well as project meetings and documentation. PRICING PROPOSAL This section should detail how you price your product. It should include price of purchase as well as costs associated with training users and technical personnel. This proposal should reflect unlimited user license of the software without restrictions on the number of installations. This proposal should include costs for any associated products necessary for your system to be efficient. The warranty period should be stated and how it s related to the maintenance and support agreement. STATEMENT OF WORK Vendors must define the extent of work and scope for which the software is acquired and installed at the hospital. Please indicate the necessary activities that will be carried out by the vendor or its representatives and those that will be executed by the hospital staff. Cost estimates of this work by the vendor must be specified, whether the costs are inclusive of the acquisition of the new software. SUPPLEMENTAL INFORMATION As noted in the RFP spreadsheet, we request that vendors submit financial reports technical credentials, resumes and references. VIII. SUBMISSION AND DECISION SCHEDULES FINAL DATE FOR PROPOSAL SUBMISSION All vendors must submit their response by July 1, Failure to submit by the specified date signifies that the vendor is not interested in bidding. EXPECTED DATE OF SELECTION Vendor selection will be announced to all participating vendors by August 1, 2010 after careful assessment and deliberation by CIH. Vendors will be individually contacted by CIH s procurement officer to discuss each response and a system demonstration will be requested. SELECTION CRITERIA We will use a selection criteria based on a 100 point scale (technology = 30 points, management of implementation of system = 30 points and lowest cost = 40 points). Contract will be awarded to the vendor who scores the highest points. Proposals will be accepted based on initial offer, but are subject to enter into discussion later. Confidential RFP Page 11 of 12

12 SCHEDULE FOR COMPLETION OF WORK The winning bidder will be requested a schedule to describe activities required to install, retrofit and interface the new system with CIH s hospital system. The schedule will include training and system certification by CIH as to acceptability of the new system for live implementation. Specific dates on completion of work must be indicated. CIH target completion of work for the new system is December 31, See for example Thank you to Providence Alaska Medical Center for providing sample figures 6 For an example of a current grant opportunity studying healthcare associated infection prevention, please see 7 Department of Health and Human Services Centers for Medicare & Medicaid Services; 42 CFR Parts 412, Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule. Pp. 1837, 1892 Confidential RFP Page 12 of 12