ADDENDUM REQUEST FOR PROPOSAL (RFP)

ADDENDUM REQUEST FOR PROPOSAL (RFP) Proposal Closing: September 9, 2005 at 3:00 p.m. (Local Time) Page 1 of 1 Proposal Number: 216542/LP Date: September 1, 2005 PROPOSALS MUST BE SUBMITTED ON OR ATTACHED TO THIS SIGNED FORM RETURN PROPOSALS AS SHOWN BELOW U.S. Mail /Hand Delivery/Express Mail/Courier Service Address: (Including Federal Express, UPS, etc.): The University of Texas M. D. Anderson Cancer Center Attn: Procurement Services Department 1020 Holcombe Boulevard, Suite 230 Houston, Texas 77030 ALL PROPOSALS MUST BE SUBMITTED IN A SEALED ENVELOPE IDENTIFIED BY THE COMPANY NAME. PROPOSAL NUMBER MUST BE SHOWN ON THE LOWER LEFT HAND CORNER OF THE ENVELOPE. PROPOSALS MAY BE SUBMITTED AT ANY TIME UNTIL PROPOSAL CLOSING DATE. THE UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER RESERVES THE RIGHT TO REJECT ANY AND ALL PROPOSALS OR ANY PART THEREOF. Company Name: Mailing Address: Telephone No.: FAX No.: E-Mail Address: RESPONDENT MUST COMPLETE AND SIGN BELOW (STREET OR BOX #) (CITY) (STATE) (ZIP) / AC / AC (Authorized Signature) (DATE) (Typed or Printed Name and Title) THIS SOLICITATION ADDENDUM IS A FURTHERANCE OF A SOLICITATION AND IS NOT A CONTRACT OR AN OFFER TO CONTRACT. ADDENDUM NO. 2 Questions & Answers regarding RFP 216542/LP. - END OF ADDENDUM NO. 2 - DIRECT QUESTIONS TO: TELEPHONE (713) 794-5496 FAX (713) 792-8084 or (713) 794-4445 Lucy Calzada (Sourcing Specialist) C:\DOCUME~1\tallen\LOCALS~1\Temp\c.notes.data\RFP 216542 LP ADDEN 2.doc Rev. 12/12/02

RFP 216542/LP Questions and Answers The following are questions submitted by vendors. M.D. Anderson s responses are in blue. 1. Does this proposal require the actual transcription service to be quoted along with any software and hardware required? In other words, does the proposal encompass all aspects of the dictation/transcription workflow including the labor to produce the reports? In the Scope of Work section 2.2.2 (Software Acceptability ), the paragraph states that "the respondent is to provide software license, implementation and installation, and maintenance pricing." From this statement, it is not clear that the actual service of transcription is being requested. Clarification on this is imperative since it will make a difference as to whether Zephyr-TEC participates in this RFP or not. This RFP is looking to identify a dictation/transcription software platform which will allow us to manage the dictation piece and workflow to the transcription vendor. The actual transcription services will be follow later in another RFP to address actual outsourcing of transcription. 2. In the Scope of Work, section 2.2.3 (Vendor Questionnaire) in the first paragraph it states "for each response, indicate the number of the question to which you are responding." however none of the questions are numbered. How do we address this? State the question followed by your response or answer. 3. Our proposal would include the use of software created by two different software companies. Zephyr-TEC itself does not research, develop or manufacture either the dictation nor the speech recognition software we would be recommending. Many of the questions addressed in the Scope of Work require detailed information (and much of it proprietary) about the companies involved in the manufacture of the software as well as the software itself. After talking with both software companies, since this RFP may become a matter of public record, there is tremendous resistance to provide information about trade secrets, future features, research and development. Since Zephyr-TEC does not manufacture these softwares but is simply an agent (a value added reseller) certified to sell the software, do we in fact, have to address the various questions in the Scope of Work that relate to Research and Development, Client Information (except for references), etc.? You will want to make the statement above as your answer.

Number of physicians dictating on the system: Total Number of Dictators? 800-1000 Average dictation time per report? 8 minutes Total Number of dictators at any given time? Have 60 ports currently Please specify worktypes required for Edit/transcribe? There are 31 types, all require edit/transcribe. What turnaround time is required by worktype? Stats-2 hours, routine- 12 to 24 hours depending on type. In the RFP it states the volume as 284,960 lines per month. Should are response on pricing for dictation/editing/transcribe be for 50% of that volume? On page 8, the RFP states that that up to 50%of the current volume will go to vendor of choice, with high potential for future increase. In other words, 150,000 lines per month is the volume we can expect? In the RFP it states the volume could grow substantially. For system sizing purposes, are we to assume the ceiling, as defined by current totals, would be 284,960 lines per month? These are the correct current numbers; these do not include growth at MDACC. At 450 listed beds, the amount of transcription seems lower than expected. Is this a departmental solution being asked for or the total hospital and clinic? Yes, inpatient and outpatient are represented. For what purpose are we told the 4 6 FTE s associated with transcription? Their major function is the correct errors. Clarification, all pricing should include dictation and editing/transcribe? If your system offers both capabilities, with significant cost saving bundled.

I am confused because in the Scope of Work, Section 3 --- Pricing Schedule, it says that the respondent is requested to provide 2 quotes: one for a hosted model and one for a non-hosted model. The hosted model specifies that it include " MT" labor, which I assume is medical transcription labor. Is that correct? yes, some vendors can separate, some can not Wouldn't that be a request for proposal for outsourced transcription service? yes, and we will at a later date Our solution is a very interesting one and it is quoted by the hour of actual dictation. From the statistics provided in the Scope of Work Section 1.5- Departmental Statistics, you show the total number of transcribed 65 character lines per month in 2004 was 284,960 lines per month. Does M.D. Anderson have any statistics about the actual length of the voice files? average of 8 minutes If so, can we get that information as soon as possible? The proposal is requesting ongoing support and system maintenance/upgrade pricing. M.D. Anderson does not specify the type of support that they would like to have. Do they expect support 24 hours, seven days a week? yes Or are there specific working hours during which M.D. Anderson expects support? 24/7 In several places the RFP talks about delivery of the system configured and ready, what operating system, what network, etc. In that case, we would actually have to quote the servers. Is M.D. Anderson also requesting we quote servers (actual hardware) for this project? No, we traditionally would provide our own compatible hardware, unless you require a unique spec which we would certainly want to know about. I am unfamiliar with the HUB plans. Is there a web site where I can go and get additional information about these plans? Our proposal does not actually call for any subcontracting (except if we are requested to provide information/pricing for outsourced transcription), but it appears that we must fill out the both the HUB subcontracting plan as well as a self performance HUB subcontracting plan. Is that correct? Yes, it is mandatory that there be a HUB plan on all bids greater than $100,000.00. If these documents are not in the bid package, your bid will be rejected. If you need more information regarding the HUB process and documents, please call our HUB Associate, Claudia Booth, at 713-745-8353.

First of all, there are normally three (3) components involved in this, and one is a dictation system. In regards to the Dictation System, we are going to need to know certain parameters. 1. Currently doctors pick up a telephone or dictate station and access the system to dictate. We would need to know how many people are going to need to be able to pick up a phone and access the dictation system at the same time. 800-1000 caregivers, currently have 60 ports available 2. We are also going to need to know how many dictate stations you have and the model, so that some vendors who cannot work with those models can replace those. Currently all use the phone system. 3. We are going to need to know the following information on transcriptionists: Currently outsourced to approximately 60 transcriptionists, varies by workload, new vendor will be required to support any fluctuations we may have. -Total number of transcription workstations -Total number of transcriptionists currently on the system at any one time -Total number of transcriptionists on-site- none -Total number of remote transcriptionists 4. We will need to know the total number of hours of storage and the length of time you would like to keep the voice recording after it is typed, and how many minutes of recording you receive in a day/week/month. 24 hours immediate, one month long term 5. We will need to know how many people need access to the Management Console to look up work, to prioritize, to run reports, (and you may have to list how many different things each of those people are going to need to do because this is often priced separately per function with some vendors). As the RFP states we have 4 to 6 persons in HIM with that function as support and troubleshoot errors. 6. Possibly, number of concurrent management consoles being used at any one time. Even though you have 40 people that need to use it, how many would ever need to do it at the same time. How many on-site and how many remote? 4-6 onsite, currently 60 transcriptionists outsourced remote 7. Will you be in need of any PDA devices? No, have our own. Your system must function with MedAptus PDA How many? If the number of people is different from the number of devices, we will need to know that information. Some vendors price it per person, some vendors price it per PDA, and some vendors do it concurrently or a combination or these. How many would be using it at any one time. Additionally, we need to know if you would like to pull the patient schedule down to the

PDA with an interface. Download software may be required by some vendors and could be based by concurrent, by users or by workstations. 8. We need to know on your current system if you have ever experienced busies so we know if more access is needed. Rarely. 9. We need to know whether you want to replace any existing dictate stations or any areas where doctor s sign reports, and if you would like to plug a microphone in to that PC and use it to dictate. We would need to know how many workstations, how many doctor s at one time may be using those stations for concurrent licensing, and how many doctor s total would want to use that (because some systems are priced per individual). Unknown, as will depend on Physician acceptance of new dictation software. Additionally, if any of those stations would require barcode capability from a PC to dictate. We also need to know if any of the dictate stations currently have barcodes that they are using or if you have barcodes hooked up to any of the telephones that physicians use to dictate. No. That is a pretty good scenario for the hardware. You may want to ask what a duplicate dictation server would cost you, if you would require a back-up server. Some vendors are going to charge as much as the first server, however, some vendors will not. But it is a good option to plan for. On the Transcription Text Package: 1. Is this going to be all outsourced or is it a combination of in-house and outsourced? Outsourced Again, we will need to know the number of total transcriptionists, how many of those are remote, and how many people other than transcription would need to view and print reports (such as clerks or coders). See previous answers question 3. 2. We need to know, out of all the reports you do, how many of those are faxed, how many of those are E-mailed, and the number of years you want to store these reports on-line. 5 per day faxed or emailed, reports are currently stored indefinitely. 3. Whether you want to have patient demographic interface (which it appears from the RFP you do), whether you want to upload that to another system after or before signature. Upload to TRAN unsigned, internal system DMS takes it from that point. 4. Whether you want a chart deficiency interface to update your chart deficiencies automatically. Chart deficiencies are handled through DMS, internal System. Whether if we uploaded to the main hospital system, and they sign in the hospital system, whether you want us to get transcription a copy back with all the changes in the event you would have to re-distribute that, either

by fax, print, or E-mail, or so you always have it in the future to copy and paste in to new reports should that patient come back in. The information that we will need to know is the number of workstations using Front- End, such as radiology, would they be working at; and how many would be working at any one time? Depends on the acceptance of Physicians of dictation software, since none are currently using. To reiterate: Total number of workstations? none Total number in use at any given time? 60 ports Also need to know: Total number of physicians 800-1000, because then again, vendors will price it by workstation or by physician, or concurrent, or by combination. For Back-End we will need to know what the number of half (½) your active staff; this is a good figure to use for Back-End licenses. The reason you want to look at the maximum quantity is because normally there is a price break as the quantity gets higher and you can save yourself quite a bit of money. Also, we will need to know the turn-around time you would expect and the number of reports that would represent going through the speech recognition engine, and whether you want a priority speech recognition server versus having everything go through one server. This is all calculated based on the number of users and how much work you are sending to it on a daily/weekly/monthly basis. Therefore, they can calculate the hardware needed to support this as well as the Dictation and Typing Package Hardware. Are you open to purchasing all the equipment even though you are outsourcing, thereby giving you control over who get the dictation to type? The cost is typically less per line if you own the hardware. You will want to present that option in your response, if it is truly cost effective.