California Networks for EHR Adoption Request for Proposals: Phase I - Planning A program jointly sponsored by: Community Clinics Initiative A joint program of Tides and The California Endowment California HealthCare Foundation Blue Shield of California Foundation
Table of Contents Introduction Page Frequently Asked Questions 1 Background 2 California Networks for EHR Adoption Program 2 Grant Program Description of Grant Program 5 Grantee Selection 6 Commitment to Participation 7 Application Process 8 Proposal Narrative Instructions 9 Submission Instructions 10
California Networks for EHR Adoption Request for Proposals: Phase I - Planning A program jointly sponsored by: Community Clinics Initiative A joint program of Tides and The California Endowment California HealthCare Foundation Blue Shield of California Foundation
About Our Sponsors Blue Shield of California Foundation The Blue Shield of California Foundation was formed by Blue Shield of California, a not-for-profit corporation with more than 3.3 million members, 4,300 employees and 20 offices throughout California. The Blue Shield of California Foundation provides charitable contributions, conducts research and supports programs with an emphasis on reducing the number of uninsured, using technology to promote health and preventing domestic violence. For more information, visit the Blue Shield of California Foundation website at www.blueshieldcafoundation.org California HealthCare Foundation The California HealthCare Foundation (CHCF), based in Oakland, is an independent philanthropy committed to improving California s health care delivery and financing systems. Formed in 1996, its goal is to ensure that all Californians have access to affordable, quality health care. More information about CHCF can be found at www.chcf.org. Community Clinics Initiative The Community Clinics Initiative (CCI), a unique collaboration between Tides and The California Endowment, began in 1999 to provide resources, evidence-based programming and evaluation, and education and training to support community health centers and clinics. Through information sharing and major grants, CCI acts as a catalyst to strengthen California's community clinics and health centers to improve health outcomes in underserved communities. More information about CCI can be found at www.communityclinics.org.
Frequently Asked Questions Important Dates Letter of Intent Due online June 9, 2006 (5:00 PM PDT) Phase I Proposal Due (hard copy only) July 14, 2006 (5:00 PM PDT) Grant Awards Announced September 18, 2006 Addresses Letter of Intent: online submissions only at www2.communityclinics.org All Proposals hard copy only (Address is for both regular and overnight mailing): Tides Center California Networks for EHR Adoption Attn: Olivia Nava Presidio Building 1014 1014 Torney Avenue San Francisco, CA 94129 (415) 561-6387 Contact Information: Olivia Nava (415) 561-6387 Applicant Eligibility Criteria: The organization applying for funding must be a not-for-profit 501 (c) (3) organization headquartered in California with a mission to advance the health of underserved populations. Bidder s Conference Call Information Applicants only need to attend one of the two offered calls. While not mandatory, we strongly encourage participation if you are interested in applying for this grant. If you plan on participating in a call, please RSVP to Olivia Nava at onava@tides.org by May 22, 2006 with your name, title, and the name of the organization you represent. We will provide you with the information to participate in the call once we receive your email indicating interest. Tuesday, May 30, 2006, at 3 pm 5pm PDT Thursday, June 1, 2006, at 9 am 11am PDT Only Phase I planning grantees will be considered for Phase II implementation funding. 1
Background The Community Clinics Initiative (CCI), The California HealthCare Foundation (CHCF) and the Blue Shield of California Foundation (BSCF) have worked together over the past several years to better understand and address the potential of health IT, as well as its challenges for safety-net providers, in particular community clinics and community health centers (CCHCs) in California. We have found through research that improved information technology is a vital tool to help CCHCs operate more efficiently, make more informed decisions, increase access to care, improve chronic disease care and be stronger partners in building healthier communities. Today, less than 5% of California s community clinics and health centers have successfully adopted EHRs. A top barrier to adoption continues to be the cost of purchasing and maintaining these systems (including the expert staff to support them). Compounding the affordability factor, the current EHR vendors lack the understanding of the unique and complex needs of community clinics and generally cannot provide the level of initial and ongoing training and support required for successful adoption. These barriers to adoption and the potential to achieve economies of scale suggest that collaborative infrastructures can be important strategic solutions for ensuring consistent, sustainable, and affordable adoption. We strongly believe that one of the most effective ways to bring about widespread adoption is through the development of collaborative models of EHR adoption and support (e.g., centrally managed and centralized implementation support). The development and support of strong intermediary entities has proven successful in the use of other technology tools like accounting software and practice management systems. Organizations freed from the day-to-day management of their technology systems are better able to focus on their core mission of providing high quality care. Based on the limited solutions available today, innovative health IT initiatives that reduce the total cost of ownership, ensure tailored product functionality, and provide access to a robust level of services are required to achieve widespread adoption among community clinics in California. California Networks for EHR Adoption Program (CNEA) California Networks for Electronic Health Record (EHR) Adoption, is a program jointly sponsored by the Community Clinics Initiative - a joint project of Tides and The California Endowment, the California HealthCare Foundation and the Blue Shield of California Foundation. By providing grant funding and program support, the sponsors seek to spark innovation in health IT initiatives. Specifically, the project seeks to develop self-sustainable and scalable models to support wide EHR adoption by California s community clinics and health centers to improve the quality and efficiency of care. The purpose of the CNEA is to provide grant funding and technical assistance to develop partnerships and collaborative strategies for community-based technology models, specifically shared applications and services for Electronic Health Records (EHR). We will encourage and support the development of a limited number of centralized, sustainable and scalable networks. These models will manage critical 2
functions such as purchasing, hosting, training and maintenance of EHR systems and support their implementation within community clinics and health centers. Specifically, the EHR solution will need to support: Population management and quality initiatives including use of disease management functions and other tools to support proactive care and outreach Clinical decision support (evidence-based rules) and other features to assure timely and appropriate care Patient education, communication and self-management Collection of patient social status and other social and cultural characteristics Management of multiple payer types and program enrollment information to manage non-commercial billing, payment and reporting (including governmental requirements) E-prescribing Interface(s) (automated data flows) with practice management Automated flows of clinical laboratory results Electronic patient records It is our intent to test models that can reduce the total cost of ownership, through group purchasing and shared applications and services solutions, and can improve the quality and efficiency of chronic and preventive care provided by CCHCs. The first phase of this initiative will be to plan/design these networks, and will include a range of EHR support services. There are, however, no preferred models or assumptions about the specific EHR product to be chosen, how the entity will be structured, or what specific technology tools or vendor(s) will be included. A range of solutions and governance models have the potential to meet the overall objectives of the funding program. We are excited about this endeavor and recognize that it is ambitious in nature, and we intend to provide a high level of support to ensure success. What is a Network for EHR Adoption (NEA)? An NEA is a center that supports a single EHR installation for three or more community clinics, provides associated health IT and support services and is scalable. The delegation of health IT functions to the Network provides economies of scale that enable community clinic participants to achieve operational and health quality benefits with approximately the same or lesser level of investment than they would make as a single organization, a enables them to afford technologies and systems they could not afford to purchase individually. By providing a means for community clinics to operate with common clinical systems, the Network allows for community clinics to function within a collaborative infrastructure without losing their independence or community-based focus. 3
The Network will be responsible for: 1. Business Operations Strategy, leadership and governance Vision to support health care quality Service offering definitions and metrics Sustainability model (including funding approach) Communications and outreach 2. Technology Operations System architecture Network management (including clinic interface requirements) Security Hardware procurement and maintenance Identifying and managing EHR vendor Application hosting or management of hosting Backup, storage and archiving (lifecycle management) Software interface management with existing electronic systems 3. Service Operations Help desk support (desktop and application) Training and customized product support Implementation support (changing clinical process with IT adoption) Analytic support (quality & management reporting, clinical data analysis) User group facilitation An NEA must have a collaborative infrastructure. The services provided by the Network will be shared across the Network s participant clinics and are essential to ensure successful adoption and use of EHRs. Importantly, the governing board of the Network should allow for community clinic representation and collaborative decision making. In addition to membership fees and services paid by participants, it is anticipated that a Network will need to develop and sustain a viable business model for its ongoing support and success. Emerging Networks for EHR Adoption range along a continuum: Networks may be organized by and provide services exclusively to community clinics alternatively other Networks may grow incrementally, starting with one organization that then extends its EHR application and expertise to other users. Examples might include: Community Clinic founded not-for-profit Network A network was founded by five community health care leaders who saw collaboration as a necessary means of survival. Pooling their own resources, they formed a not-forprofit organization that has grown to include 10 member organizations. The network hosts its EHR to all participating clinics. In addition to the EHR application, the network provides a centralized Chief Information Officer and employs credentialed information systems staff dedicated to maintaining and upgrading the network's EHR and providing ongoing training and support for the system's users. Medical Group A not-for-profit medical group has begun a collaboration with a local unaffiliated community clinic to which the medical group contributes financially, assists in the hiring and training of community clinic technical and quality staff, provides access to its electronic health record and related support and shares best practice knowledge and expertise to improve overall quality, planning and efficiency of care. 4
Description of Grant Program Phase I This initiative will support up to three years of activities and operations, separated into two distinct phases: planning and implementation. The first phase (planning) of the CNEA will focus on developing a robust plan for implementation. The initiative will provide the following support: Up to six 6-month planning grants will be awarded at a maximum funding level of $50,000 per project Planning support and assistance including: o Virtual meetings to inform the planning process o Ongoing coaching from a consultant to help track the planning process To accomplish these goals for the planning phase, the grantee will be responsible for producing the following deliverables: A business plan detailing the budget and how the Network will be funded and sustained A clear strategy for the development of the Network A robust implementation work plan detailing the timeline, roles of partners, tasks to be accomplished, and resources needed Phase II Phase II of the project will build upon the planning phase and work with a subset of the initial grantees to support the development and implementation for up to three Networks for EHR Adoption. To enable successful implementation, the initiative will provide the following support to each grantee: Up to 1 million dollars over a 30 month period Technical support and assistance, which will be defined based upon the findings from the planning phase. Support and assistance will be tailored to meet the needs of each project. Current RFP The focus of this RFP is Phase I, the planning phase of the initiative. Only applicants who are selected and complete Phase I will be eligible for Phase II of the initiative. While only a small number of grants will be made, we believe these investments can ultimately impact the majority of clinics in the state. 5
Grantee Selection Grants will be made to organizations with a clear vision of an integrated model for delivering HIT services to CCHCs. Selected grantees will also have a proven record of leading and participating in multi-stakeholder collaborations and a realistic plan for developing and sustaining the new collaborative effort. We expect to invest in programs that are ambitious in scope and have applicability to a broad range of clinics throughout the state. Grantees will be expected to devote significant staffing and resources to the program to ensure long-term sustainability and success. To be eligible, the project must include at least three (3) separate California-based community clinic corporations or health centers that meet the criteria described in the Grantee Eligibility section found on page 8. Selected grantees will be expected to have the following in place to ensure successful planning, development and implementation of an EHR Network: 1. A clear governance and decision-making model to support a shared application and services solution 2. A clear vision to support or enhance a technology solution that meets the unique needs of CCHCs. 3. Demonstrated organizational leadership including a shared vision among the management team, in particular the clinical leadership and Board of Directors. 4. Demonstrated financial strength and capacity, access to matching funds, and the commitment to achieve a sustainable economic model to provide future support and scalability beyond the CNEA program funding. The funds available through this program are insufficient to fully purchase and implement an EHR for clinics. Therefore it is the expectation of this project that grantees and their partners will be responsible for financing hardware, software, personnel and other aspects needed for the implementation and support of such a system. In addition, the funders are seeking to develop robust business models with these Networks for EHR Adoption to allow them to be sustained beyond the grant funding. 6
Commitment to Participation While the initiative will provide customized technical assistance and support to grantees to help achieve successful health IT Networks, grantees must commit to the following activities for the duration of the project: Assign a team lead to manage the program Create and manage a multi-disciplinary project plan, including plans to implement a core EHR solution for an initial set of pilot clinics with the capacity and a plan to scale up to a larger number of clinics over time Manage the EHR among and for all project participants Outsource to vendors or increase staff as necessary to meet the program requirements including technical support for hardware and software, implementation and ongoing support Procure and manage the health IT vendor relationship(s): negotiate pricing/licensing, upgrades, modifications and interfaces Support clinical users including training, user groups, templates, desktop and help desk functions Support plans for clinical redesign and tasks within participating clinics to optimize health IT use Develop a business model to extend these services to other community clinics at a competitive price that will sustain the solution beyond the initial development stage Communicate regularly with the CNEA project team and prepare regular and quarterly status reports Program Evaluation The project funders will engage an outside evaluator to assess the status and impact of the California Networks for EHR Adoption Program. All grantees and their participating partners and vendors are required to participate in the program evaluation. We believe that evaluation is a vital component of the learning process for both the grantees and the broader community. Failure to participate in the program evaluation may compromise future funding. Resource Center and Learning Community The project funders will work with the California Networks for EHR Adoption grantees to create a resource center for information sharing and to create a Learning Community. The Learning Community will provide grantees the opportunity to network, share experiences and to document lessons learned. Grantees are expected to benefit from the exchange of their experience with community leaders, innovators, and clinicians. 7
Application Process Eligibility The organization applying for funding must be a not-for-profit 501 (c) (3) organization headquartered in California. Examples of eligible organizations include, but are not limited to: a clinic consortium, a stand-alone technical services organization, a single clinic looking to extend its technology to other parties, or a current hosting site, such as a hospital or provider organization. How to Apply The California Networks for EHR Adoption program will identify grantees through a four step process including an Informational Call, Letter of Intent (LOI), Submission of a full proposal and site visits (as needed). Step 1 Participate in a Bidders Conference Call Interested organizations should plan to participate in an informational teleconference. Applicants only need to attend one of the two offered calls. While not mandatory, we strongly encourage participation if you are interested in applying for this grant. For those interested in participating, please send an email to Olivia Nava at onava@tides.org with your name, title, and the name of the organization you represent. We will provide you with the information to participate in the call once we receive your email indicating interest. Step 2 Submit a Letter of Intent (LOI) LOIs must be submitted online at www2.communityclinics.org Interested organizations must submit a Letter of Intent that is no longer than one page. Letters of Intent will include the following information: Contact information Vision and overarching strategy for the project including how the network would support community clinics List of project partners (including community clinics) The purpose of the LOI is to provide us with information about the level of interest in the initiative and an overview of the various strategies being proposed. To be eligible for the Phase I planning grant, applicants must submit both a Letter of Intent and a full proposal. Please assume that if you submit an on-line LOI by the June 9 deadline, you are automatically eligible to submit a full proposal. No formal proposal invitations will be made. Step 3 Submit a Full Proposal: Phase I The RFP will focus on Phase I of the project, the planning phase, which will last no longer than 6 months from the date of award. Following the planning phase, a decision will be made about whether an additional proposal is necessary to progress to the second phase of the initiative. Step 4 Site Visits (as needed) If additional questions arise after the proposal is submitted, site visits or follow-up phone calls may be completed in late July or August to evaluate the level of organizational readiness and commitment to the proposed solution. 8
Proposal Narrative Instructions After submitting an on-line LOI, applicants should proceed to submit a full proposal. The proposal narrative should be limited to 10 pages and include the following: Lead Organization and Its Partners 1. Provide a description of the lead organization and partner organizations to be involved in the project. This should include both clinic partners and any for-profit vendors or partners, if identified. Describe your role in the community that you serve, your governance structure and leadership team. 2. What is the history of collaboration with the partners in the project? 3. What experience have you had with Health IT projects and managing large, multi-partner initiatives? Project 1. Describe your vision and objectives for the EHR solution you are proposing. Include a description of how a successful implementation could potentially impact the health of your community in the future. 2. What experience have you had with quality improvement and measurement, and how will the initiative further quality objectives? 3. Define the roles of partners in supporting the vision and strategy. 4. Describe how this partnership would be created and sustained and how matching resources (staff & funds) could be provided. If relevant, attach any existing planning documents. 5. What barriers and challenges to implementing and sustaining your project do you anticipate? How can the initiative best support you in addressing these challenges? 6. Describe your capacity to fulfill the program requirements including participation in a learning community and evaluation. Required Attachments (attachments are not included in the 10 page limit) 1. Organizational Budget 2. Attach any existing documents and business models that may provide insight into the current project if you are underway 3. Audited Financial Statements from the last 2 years 4. A list of your Board of Directors and their affiliations Project Timeline Activity Dates RSVP for Bidders Conference Call May 22, 2006 Bidders Conference Call May 30, 2006 (3 pm 5pm PDT) Bidders Conference Call June 1, 2006 (9 am 11am PDT) Letter of Intent Due online June 9, 2006 (5:00 PM PDT) Phase I Planning Proposal Due July 14, 2006 (5:00 PM PDT) Site Visits and Follow-up Calls July 15 August 31, 2006 Grant Recipients Announced September 18, 2006 9
Submission Instructions Letter of Intent (LOI) Deadline 5 p.m. June 9, 2006 On-line submissions only at www2.communityclinics.org All organizations must submit an online Letter of Intent in order to be eligible to submit a full proposal. Proposals Due Deadline 5 p.m. July 14, 2006 Please submit three (3) copies of the proposal packet. All CNEA Proposals must be in hard copy format only. Faxed or emailed submissions will not be considered. Proposals must be received at the address below NO LATER THAN 5 p.m. ON FRIDAY, JULY 14, 2006. Tides Center California Networks for EHR Adoption Attn: Olivia Nava Presidio Building 1014 1014 Torney Avenue San Francisco, CA 94129 (415) 561-6387 If you have questions, please contact: Olivia Nava Program Associate (415) 561-6387 onava@tides.org 10