Consumer Services, Inc. (C.A.R.A.A.a.i.i.a.1) Sample Request For Proposal

Transcription

1 Electronic Medical Record Request for Proposal 6/30/2012 Consumer Services, Inc.

2 Table of Contents General Information:... 2 Overview of Consumer Services, Inc.:... 3 Business Mission... 3 Technology Vision... 3 Electronic Medical Record... 4 This Request for Proposal (RFP)... 4 Implementation Timeline... 5 Proposal Guidelines... 6 Evaluation & Selection Process... 7 Contractual Requirements... 7 Consumer Services, Inc. Service Delivery Process:... 8 Feature Modules Requirements: Consumer Management & Care Clinician Management Clinical Treatment Record Management Pharmacy Management & e-prescribing Financial & Claims Management Reports Management System & Network Management Install Base Cost Components Required Attachments Appendix RFP Behavioral Health EMR Solution 1

3 General Information: This Request for Proposal (RFP) expresses the intent of Consumer Services, Inc. to appraise an integrated electronic medical record solution to meet its information management system needs as a Behavioral Health Care Organization. The window for acceptance of responses from software solution providers closes at 5:00 PM EST on Friday, September 28th th Consumer Services, Inc. 585 Jewett Road Mason, MI Attention: Ivan Gibbs igibbs@consumerservicesinc.org RFP Behavioral Health EMR Solution 2

4 Overview of Consumer Services, Inc.: Consumer Services, Inc. is a non-profit agency headquartered in Mason, Michigan that offers statewide support for mental health services. We strive to help individuals and families who may have mental illness, developmental disabilities, addiction or cooccurring substance abuse disorders. We provide many services directly through Consumer Services, Inc., but also offer counseling and outpatient therapy at Taylor Life Center. Consumer Services, Inc. began in 2004 when Kathy Taylor took the position as chief executive officer. At that time, the organization was working with only 19 clients. Since then, Consumer Services, Inc. has grown into multi-million dollar organization helping over 4,000 clients annually. Currently, Consumer Services, Inc. provides or contracts services in 26 different Michigan counties. Today CSI provides the following categories of service: Case management Counseling & psychotherapy Crisis residential Dialectical behavior therapy Psychiatric services Supports coordination Business Mission As a cutting-edge, not for profit organization, our mission is to provide excellent, coordinated behavioral healthcare services to the children and adults of our communities, empowering them to achieve a higher quality of life. Technology Vision Consumer Services, Inc. shares the vision of the Michigan Department of Community Health (MDCH) as articulated by the Director: "When fully implemented, these Health Information Exchanges (HIE) will allow healthcare organizations within a community to instantly move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged". "The goal of the HIE concept is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care." Consumer Services, Inc. seeks to use a certified EMR in a meaningful way, to improve the safety, quality, and efficiency of delivering healthcare, and to ensure privacy. RFP Behavioral Health EMR Solution 3

5 Electronic Medical Record An electronic medical record (EMR) is further defined as an evolving concept that systematically collects electronic health information about individual patients or population. It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. In other words, CSI seeks to replace its paper based systems with an electronic system. This Request for Proposal (RFP) Consumer Services, Inc. is exploring the purchase of an integrated system solution that lends itself to the following: Ease of use by end-users Web browser or Remote Client interface Low in maintenance and administration Modular design and functionality Relational database model Flexibility and ease of input/output modifications Scalable to serve a large number of Consumers, Clinicians and locations Feature specific to delineate persons with mental illness, substance abuse, developmentally disabled and with traumatic brain injury Supports electronic data interchange (EDI) HIPAA compliance Interoperability with other systems RFP Behavioral Health EMR Solution 4

6 Implementation Timeline To satisfy its business and technology objectives, it is crucial that the selected system become operational and able to capture live data input beginning the third quarter of fiscal year Time lines for conversion, installation, trainings will be agreed upon by Consumer Services, Inc. and the selected vendor to meet the go-live. ID Milestone Start Date 1 Issue RFP to solution candidates 6/30/ Final day for submitting RFP responses 9/28/ Live respondent product demonstration & review 11/01/ Consumer Services, Inc. decides on software solution 12/31/ Communicate selection to vendor 01/12/ Conversion process analysis, design & test 03/01/ Preparation of system environment 03/01/ Software installation & system administration training 05/01/ Revision & acceptance of data conversion 06/01/ User training Consumer Services, Inc. & Providers 07/01/ Parallel run with 08/01/ System roll out go live 10/01/2013 During this period, all pertinent modules must be fully functional and must afford Consumer Services, Inc. users the benefits of increased efficiency in executing their job functions. RFP Behavioral Health EMR Solution 5

7 Proposal Guidelines Consumer Services, Inc. intends to contract for a fully functional integrated software solution(s) to satisfy its need for an electronic medical records system. It is expected that respondents to this RFP already have a developed system solution that has successfully gone through the development and testing cycles and is available for immediate use at the times specified in this RFP. Integrated may include multiple solution packages with full data sharing and integration capability. The principal respondent must be responsible for all maintenance and technical support during the product life cycle. The point of entry may be a single platform and CSI only expects to communicate and coordinate with the primary vendor. The company undertakes to bear no liability or cost associated with the preparation of a response to this RFP. Additionally, Consumer Services, Inc. reserves the right to abort the procurement process at any time, subject to the specifics of any duly executed contract that may be entered into during this period. RFP Behavioral Health EMR Solution 6

8 Evaluation & Selection Process The evaluation and selection process will commence on, October 1, Providers whose systems appear to best suit the needs of Consumer Services, Inc. will be contacted to arrange for live demonstrations of the functionalities and capabilities of their systems. Each response to this proposal request will be graded based upon the appropriateness of the answers and comments to the questions posed in the later section of this document. Consumer Services, Inc. will use a weighted average methodology, the top five (5) responses that scores the highest, based upon questions outlined under the Feature Module section will be selected for further review. Module ID Module Name 1.0 Consumer Management & Care 2.0 Clinician Management 3.0 Clinical Treatment Record Management 4.0 Pharmacy Management & e-prescribing 5.0 Financial & Claims Management 6.0 Security Management 7.0 Reports Management 8.0 System & Network Management 9.0 Install Base Additionally, responses will be graded based upon the following factors: Stability of respondent company o Financial statements o Available support & maintenance o Quality customer service Support and maintenance infrastructure Client referrals Costs of proposed system solution Overall proposal presentation Subsequent to the review and evaluation of the RFP responses, respondents will be invited to provide a live demonstration of the capabilities of the proposed system as described in the RFP. Such demonstration can be done in person or using internet technology. Contractual Requirements Consumer Services, Inc. will require both a purchase agreement as well as a system support agreement from the selected solution provider. Payment terms will be indexed to achievement of specific milestones. Final payment will be made subsequent to system go live and system review/acceptance. CSI will incur no liability for the cost of the production of this RFP submission. RFP Behavioral Health EMR Solution 7

9 Consumer Services, Inc. Service Delivery Process: Referral Sources: Community Mental Health Private Insurance Self-Referrals (Walk-Ins) Intake & Assessment: Demographic collected and/or verified Collect Insurance information Schedule Initial Assessment Submit Insurance Verification to Billing Specialist Create routing slip / ticket Orientation, Consents and Release of Info completed Assessment completed including recommendations for services Progress note of Initial Appointment is completed Treatment Planning and Delivery: Pre-planning meeting, Input into Individual Plan of Service (IPOS) scheduled / completed IPOS and Transition Plan completed Authorizations for planned services verified / requested Service Delivery completed per authorizations Web Denis verification prior to each session (outpatient) Progress Note of each session Reauthorization requests as necessary Quarterly Reviews of IPOS Coordination of Care with other treatment providers Periodic Assessment of Service Needs Discharge Planning completed when episode of service is completed Billing and Claims Processing Routing ticket completed by Provider Manually match billing claim to authorization Encounter entered in Billing software Claim Electronically Uploaded to Insurance Company or Paper claim generated and mailed Payment made along with EOB from Insurance Company Payment auto posted or manually uploaded to billing software Allocation Report Created Payment made to Provider RFP Behavioral Health EMR Solution 8

10 Feature Modules Requirements: Please answer the following questions. Should you choose to provide a more detailed response/comment to any question above, please do so on a separate sheet of letter sized copy paper limit individual comment to 10 printed lines with no more than 3 comments per page. State clearly, at the top of the page, the ID and page number for the question to which your responses pertain. 1.0 Consumer Management & Care ID Feature Yes No 1.1 Gathers and maintains Consumer demographics? 1.2 Gathers and maintains Consumer financial data? 1.3 Gathers and maintains Consumer related/responsible party demographics? 1.4 Can the system maintain the incomes for each related/responsible party? 1.5 Can the system calculate consumer/responsible party ability to pay, Medicaid Spend Down? 1.6 Can the system maintain ongoing balances for co-payment/deductible? 1.7 Can the system track service deductibles? 1.8 Ability to pay based on easily changeable sliding fee scale? 1.9 Can the system maintain HSA and spend down per Consumer? 1.10 Maintains multiple insurance Payer per Consumer? 1.11 Does the system create and maintain payer rules? 1.12 Ability to generate periodic Accounts Receivable statement per Consumer? 1.13 Facilitates & maintains Consumer intake/assessments? 1.14 Establishes basic clinical care profile for Treatment Planning? 1.15 Records & maintains progress notes for Consumers? 1.16 Does the system allow input of diagnostic scores and assessments? 1.17 Are there any in-built diagnostic tools or assessments that are included in the software solution? 1.18 Can the system accommodate serving 5,000 consumers within a month? 1.19 Is the system capable of identifying Consumers from multiple data fields? 1.20 Can the system maintain multiple profiles of a Consumer record? 1.21 Are there alerts to warn of duplicate records? 1.22 Does the system maintain Patient consent for release of information? Page 9

11 2.0 Clinician Management ID Feature Yes No 2.1 Does the system facilitate and maintain provider profile for more than 400 Providers simultaneously? (i.e. license, Taxonomy, CEU, certifications) 2.2 Does the system facilitate Provider credentialing and privileging? 2.3 Is there a facility to maintain a flag of questionable Provider behavior and/or credentials? 2.4 Does the system perform usage and performance analysis for Providers? 2.5 Does the system establish and maintain details of Provider contracts? 2.6 Does the system maintain menu of credentialed and contracted services per Provider? 2.7 Does the system generate periodic rendered services report by Provider? 2.8 Does the system facilitate establishing multiple payment methods per Provider? 2.9 Does the system calculate billable services by Provider? 2.10 Does the system allow for the electronic transfer of data to external medical providers? 2.11 Does the system support speech recognition and dictation technology? 3.0 Clinical Treatment Record Management ID Feature Yes No 3.1 Generates a central view face sheet of Consumer treatment and care? 3.2 Ability to display and manage health information alerts per Consumer? 3.3 Maintains primary Diagnostics to be shared by Treatment Teams? 3.4 Is there any Clinical Care wizards or user defined templates in the system? 3.5 Ability to automatically check for coverage and eligibility for services? 3.6 Does the system provide any type of decision support for treatment? 3.7 Can the system allow user defined clinical outcome measurements? 3.8 Does the system track clinical progress for consumers? 3.9 Does the system allow for user defined work flows and flags? 3.10 Can Appointment frequencies and amounts be scheduled from Treatment Plan and level of care? 3.11 Can an External Resource Provider referral be tracked within the system? 3.12 Can Authorization balance be tracked for each scheduled appointment? Page 10

12 3.13 Can the scheduler be interfaced/linked to other 3 rd party messaging systems? 3.14 Does the system allow Clinicians to enter free text and notes? 3.15 Does the system maintain a log of Consumer prescriptions and allergies? 3.16 Does the system facilitate care coordination with external providers like Primary Care Physician (PCP)? 3.17 Does the system record, maintain and track Assessment, treatment plan, and progress notes in a systematic way? 3.18 Does the system maintain an electronic chart for each Consumer? 3.19 Does the system have feature for accepting and maintaining electronic signatures? 3.20 Is the system capable of interfacing with scanning technology for documents and signatures? 3.21 Does the system allow paper documents to be scanned to its database? 3.22 Can multi-page documents be scanned to Consumer s chart? 3.23 Does the system provide decision support protocols on diagnosis and treatment options? 3.24 Does the system maintain ICD-9 Diagnosis code? 3.25 Does the system crosswalk from ICD-9 to DSM-IV 3.26 Is your solution HL7 compliant? 3.27 Does the system maintain electronic versions of Consumers consents and release of information? 3.28 Does the system interoperate with speech recognition technology like Dragon Naturally Speaking? 3.29 Can the system populate a field from one clinical document to another using a selection feature? 4.0 Pharmacy Management & e-prescribing ID Feature Yes No 4.1 Can the system maintain a drug formulary? 4.2 Does the system have the ability to perform M.A.P.S? 4.3 Does the system maintain drug costing data? 4.4 Does the system maintain Consumer profile data including allergies, current medication usage? 4.5 Does the system provide access to software updates that provide information about drug interaction, allergies and duplicate therapy? 4.6 Does the system support varying dosage scheduling methods? 4.7 Maintain Consumer prescription data including: number of days supply, dosage and frequency? 4.8 Does the system provide medication usage and analysis reports? 4.9 Does the system provide alerts for allergies and typical diagnosis? Page 11

13 4.10 Is the system capable of doing electronic prescribing? 5.0 Financial & Claims Management ID Feature Yes No 5.1 Will the system calculate Consumer ability to pay? 5.2 Can the system maintain alerts and update assessments of consumer s ability to pay? 5.3 Can the system create 3 rd party billing & invoicing? 5.4 Can the system submit 837 claims to payers? 5.5 Can the system facilitate sliding fee scales for Consumers? 5.6 Can the system detail and track Consumer Accounts Receivable? 5.7 Can the system detail and track 3 rd party accounts receivable? 5.8 Can the system maintain and manage 3 rd party payer rules for reimbursements? 5.9 Does the system facilitate waterfall billing? 5.10 Can the system generate and track invoices throughout the system? 5.11 Does the system have the capability to submit and receive billing electronically? 5.12 Does the system detail and track accounts payable throughout the system? 5.13 Does the system pull data for Provider Payment from the Authorized services file? 5.14 Does the system maintain a listing of claims not paid? 5.15 Does the system have the capability to produce output data for third party General Ledger systems? 5.16 Is the system capable of maintaining Patient account receivables balance? 6.0 Security Management ID Feature Yes No 6.1 Can objects be secured at a group level? 6.2 Can the system create and maintain security at the Treatment Team level by consumer? 6.3 Does the system time stamp and maintain a log of all access & administrator user activities? 6.4 Does the system require users to change password at set intervals? 6.5 Can Consumer records be shared across different Clinicians/Providers? 6.6 Does the system have differential security controls? 6.7 Are there security measures in place at the Treatment Team level? Page 12

14 6.8 Can security be maintained at the Consumer record level? 6.9 Is the system able to maintain a record of all user activity throughout the system? 6.10 Does the system maintain consumer consents and proxy directives? 6.11 Will the system automatically log-off users during idle time? 6.12 Is the system HIPAA compliant? 6.13 Are the security contexts integrated with Active Directory? 7.0 Reports Management ID Feature Yes No 7.1 Does the system come with its own report writing tool? 7.2 Does the system support use of a 3 rd party s report writing tool? 7.3 Can a user define and create his/her specialized report? 7.4 Does the system accept and process 834 from Third Party Payers? 7.5 Is the system capable to produce outbound 837 to third parties? 7.6 Can the system accept and process inbound 835 transactions? 7.7 Are there performance management and utilization reports that accompany the modules? 7.8 Are reports embedded into the system modules? 7.9 Can reports be sent electronically to other non-system users? 7.10 Can the system output report data in CSV or text format? 8.0 System & Network Management ID Feature 8.1 Application programming language? 8.2 Application database management system? 8.3 What year was your EMR developed? 8.4 Is your EMR solution web based or client/server? 8.5 What browsers are supported by your EMR solution? 8.6 Recommended solutions operating system Server? 8.7 Recommended solutions operating system Clients? Page 13

15 8.8 What is the system s recommended maximum number of concurrent users? 8.9 Do you hold regular user group meetings or workshops? 8.10 What are your support hours? ID Feature Yes No Num 8.11 Does the system architecture support remote user access? 8.12 Does the system lend itself to remote system administration? 8.13 Can the system be accessed through a terminal server? 8.14 Can the system accommodate the importation of data from a 3 rd party product? 8.15 Is the system capable of exporting data to 3 rd party products? 8.16 Will the system operate properly on a Windows 2008 platform? 8.17 Is your solution certified by Commission for Health Information Technology (CHIT)? 9.0 Install Base ID Feature Yes No Num 9.1 Is the software currently being used by more than 3 Behavioral Health Care Providers? 9.2 Is the system being used by any Practice Management Providers? 9.3 Is the system being used by any client maintaining electronic records for more than 10,000 Consumers? 9.4 Do you maintain any client installations in the state of Michigan? 9.5 Do you maintain any client installations in the state of Arizona? 9.6 Do you maintain any client installations in the state of Florida? 9.7 Are any of your current clients using Windows 2008 Server? 9.8 Do any of your clients use the proposed solution over a wide area network? 9.9 Is the proposed solution publishable through the world wide web? 9.10 Will you participate in a program/source code escrow? Page 14

16 Cost Components Please provide cost breakout as per above modular approach, where applicable. Additionally, include support and maintenance costs with descriptions. Items Price Notes Data Conversion Training Base install Additional Modules Licensing matrix Annual Support & Maintenance Required Attachments 1. Audited financial statements for the previous two years of operation 2. Profile of Senior Executives, Technical and Support staff 3. Contact information for three (3) Clients using the proposed solution that can be chosen to call to reference 4. A cost proposal in a separately sealed envelope 5. Marketing brochure and/or DEMO CD where possible 6. Web address to demo or trial version or proposed solution Page 15

17 Appendix Computer-based Patient Record (CPR): An electronic form of individual patient information that is designed to provide access to complete and accurate patient data. EMR: An electronic medical record (EMR) is further defined as an evolving concept that systematically collects electronic health information about individual patients or population. It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. HL7: This communication standard guides the transmission of health related information. HL7 allows the integration of various applications, such as hospital census, order entries, and patient accounting, into one system. HIPAA: Acronym for Health Information Portability Act. This sets the broad standards for privacy & security and standardized transactions in health care practices. RHIO: Regional Health Information (RHIO) and Health Information Exchange (HIE) are often used interchangeably. RHIO is a group of organizations with a business stake in improving the quality, safety, and efficiency of healthcare delivery. RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative at the Office of the national Coordinator for Health Information Technology (ONCHIT). Page 16