bay hospital - weeblyjennabarber2014.weebly.com/uploads/2/7/1/9/27190777/cdigrouprfp.pdf · bay...

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Bay Hospital

Request for Proposal

Clinical Document Improvement

Prepared by:

Jenna Barber

Stefanie Dioso

Paul Jriyasetapong

James Murray

Proposal Release Date: November 5th

, 2013

Proposal Due Date: January 15th

, 2014

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Introduction: Bay Hospital is a 300-bed not-for-profit community hospital and trauma center,

located in the heart of the Tri Valley. We are honored to serve what we believe is the best

community in California; safe, clean, family-focused and a great place to live and work. We are

committed to improve the health of our community through compassion and excellence in

healthcare services. We provide:

Acute Rehabilitation

Behavioral Health Unit

Bone Density Diagnostic

Definitive Observation Unit

Cancer Care

Clinical Laboratory Services

Emergency Department

Gastrointestinal Lab Services

Inpatient & Outpatient Surgery

Intensive Care Unit

Maternity Services

Oncology Services

Outpatient Rehabilitation Services

Pathology Services

Breast Imaging Center

Smoking Cessation Program

Telemetry Care

Trauma Services

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Transitional Care

Wound Care Center

Background: The entire US healthcare system will make the required move from ICD-9 to ICD-

10 October 2014. Transitioning to ICD-10 is mandatory for everyone that is covered by the

Health Insurance Portability Accountability Act (HIPAA), but does not affect CPT coding for

outpatient procedures and physician resources. This change will be one of the leading, most

expensive and chanciest conversions that healthcare executives and their staff will be involved in

because it will affect every clinical and financial system as a whole. Organizations around the

country are preparing for this significant transition on how providers will be coding and

documenting for new billing regulations. Many provider workflows will have to be altered to

comply with the new requirements. Clinical documentation is a large piece of the puzzle to

implementing ICD-10. Clinical Documentation is defined as “documentation in the medical

record of a patient’s symptoms, diagnosis and treatment plan (including lab and other test

requests and results), and all procedures and services provided, is a critical step in the claims

revenue cycle (AMA, 2013). Clinical Documentation is not only critical for patient care but also:

• Serves as a legal document

• Enables quality review checks

• Validates the patient care provided

• Ensures well documented medical records reduce the re-work of claims processing

• Complies with CMS, Tricare and other payer’s guidelines and procedures

• Improves coding, billing and reimbursement by increasing accuracy and decreasing denials

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To support the ICD-10 implementation, healthcare facilities nationwide are ramping up with

development of education plans, and implementing EHR systems that will help enable a smooth

transition (CMS 2013). Our Healthcare Institution needs to lay the foundation for the transition

to and implementation of ICD-10 projects. Our senior leadership steering committee and board

of directors understand the impact of this change on the organization. Both groups have

expressed the importance of testing and compliance prior to the deadline to limit the cases where

reimbursement will be withheld. The Medical Informatics team will lead the coordination efforts

alongside Health Information Management, Coding, Business Services, Clinical IT and Finance

departments to implement an approved CDI application.

Purpose of RFP: The purpose of this document is to solicit proposals for our hospitals

application for Clinical Documentation Improvement with the implementation of ICD-10. Our

Healthcare Institution will select an EHR technology vendor that can provide a Clinical

Documentation Improvement solution to enable a smooth transition to ICD-10. Clinical

Documentation Assessments must be complete to determine the adequacy of documentation to

support the necessary level of detail essential with ICD-10-CM. To achieve this, the project

needs to accomplish the following objectives:

Recognize areas in ICD-10-CM that include new terms for clinical documentation

Specify areas in ICD-10-CM that enable improved data capture if more specific

conditions are documented

Discuss methods to employ education to providers and support staff

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Describe how documentation affects quality measure reporting and reimbursement

processes

Identify how to get buy-in from the Physician/Executive Team

Automate the identification and clarification of missing, conflicting, or nonspecific

physician documentation related to diagnosis and procedures.

Support accurate diagnostic and procedural coding by concurrently reviewing patient

charts for completeness and accuracy (MLN, 2013)

Scope of Requested Services: The guidelines provided shall be followed with primary attention

given to items that have been outlined in the inclusion list below. In consideration of the

aggressive timeline, the future state strategy can be achieved and the items included in the

exclusion list shall be considered post implementation.

Included

Creating a multidisciplinary task force to assess and review current policies and

procedures to submit claims and identify gaps to ensure compliance with detailed clinical

documentation for ICD-10 claims.

A new department based on AHIMA’s Hybrid Staffing Model will be created to support

the CDI Project.

Training appropriate staff throughout the project

Analyzing internal practice business process Example: patient flow, documentation, and

billing) to determine what would need to be changed if ICD‐10 was required.

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Contacting each vendor, heath plan, device manufacturer, and other trading partner to

determine what changes they are making and how they will help support the practice

through the conversion

Setting up a sensible time schedule to make changes without disrupting the practice.

Updating systems and documentation to handle ICD‐10‐CM

Reviewing membership in health plans

Assuring that all staff understand and implement the changes

Managing associations with entities to assure that the transition is moving according to

plan

Create testing scripts that can be duplicated internally to assure that they work correctly

Testing with all trading partners

Making the final transition

Creating and publishing project dashboard up to transition and CDI improvements post

transition

Educating staff on the new functionality and how to use it effectively

Identify super users and physician champions that will be able to assist staff members

during the transition

Readiness Assessment (Current Environment):

Hospital Operations : A review of the Hospital Operations including elements from

elements of the patient transaction cycle, from patient access and authorization protocols,

to clinical documentation and coding, to claims creation and submission.

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Physician Practice : An assessment and interview with physician champions to obtain a

better understanding of current practice. Communication will also need to occur with the

Physician IT Committee to convey the impact of ICD-10 and the impact of the workflow

changes.

Staff Assessment : An assessment of the staff will be required to determine overall

training needs, and competency of the coding, billing, and patient access staff. Advanced

training, including moderate understanding to use and interpret ICD-10 CM utilization

management staff, nursing, hospital ancillary staff, revenue cycle operations, patient

financial services, and related management.

Systems/Technology Assessment (Current Environment):

Bay Hospital will be requesting an external assessment that analyzes the organization’s

IT resources. The goals of the external assessment will be to identify and inventory the

systems, applications, and databases that captures, retains, or reports on an ICD-9 code.

A recommendation will be required to project what types of system changes will be made

in the conversion ICD-10. In addition, there may be systems that are not currently

capturing ICD-9 but will be involved in reporting ICD-10.

Excluded

There will be no changes to CPT or HCPCS codes. Due to recent changes in the HIM

Department, the organization will not pursue outsourcing the coders and front line staff. No

major system changes in the EMR modules will be approved if they impact the CPOE or other

enterprise level project. Other items out of scope include:

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Any clinical documentation changes

Change in coding practices and processes

Revenue cycle processes and changes

Other organization revisions made during the transition

Vendor Experience/Requirements: In order to deliver a direct assessment between the various

vendors, a standardized RFP Response form has been provided along with this RFP. Please

complete the questionnaire below. This form will be the only means whereby data provided by

your organization can be compared to that of other vendors.

Vendor Background and Financial Information

i. Company Name and Headquarter base. Please state your nearest

locations.

ii. Company Goals

iii. Year the company was established, significant mergers, acquisitions and

sell-offs

iv. Public or privately owned

v. Bankruptcy/legal issues

vi. Research and Development Investment (total amount/percentage of sales)

vii. Status of Certification

Please state what differentiates and makes your product better than products from other

competitors.

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Please answer the questions below and provide any needed URLs or

Examples when possible.

1. System/Application

1.1. List successful projects that have been implemented with your system at healthcare

institutions. Provide a customer list and references that can be contacted based on the similar

features that our organization is looking into and those who have the latest software.

1.2. Describe the architecture of the System in specific terms, including hardware and software

required, both recommended, and optional. Also indicate what add-on software products are

available. Clearly note which parts of the software are included with the installation.

Descriptions should include a high level diagram.

1.2. Describe the installation and integration steps necessary to implement the System.

1.4. Specify hardware platforms, including possible clustering options. It is anticipated that

the hardware will be purchased separately.

1.7. Please describe the recommended and optional storage system requirements and

configuration.

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1.8. List all third-party components (e.g., web application server, RDBMS, Java) required by the

System. Indicate those components that can be upgraded independently of System software

releases, and those that cannot.

1.9. Identify all communication protocols supported by the software, including any private

extensions. Include any ports that must be dedicated to the System. What secured connections

are supported for what aspects of the System?

1.10. List all operating systems (including versions) on which the host System may be run. When

the software is upgraded, for which operating systems is it first made available?

1.11. List all operating Systems (including versions) supported for client applications used for

System administration, database maintenance, or user access.

1.12. List all web browsers supported, specify version numbers and operating system.

1.13. Are there any plug-ins required to run your product in a web browser? Are optional plug-in

tools available for user or administrative use?

1.14. Where do the images reside in the System? Do they need to reside on the same server as

the image server application?

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1.15. Are there any technical or performance limitations when using external storage that is

accessible to the image server application (i.e. SMB mapped drives, NFS mount,)

1.16. Describe all known factors that may negatively affect System performance.

1.17. Does the System use methods for process prioritizing and load balancing? Describe

them.

1.18. Do you have existing benchmarking data?

1.19. Define the scalability and performance benchmarks determined for the System, and provide

details of the latest benchmark testing.

1.20. If applicable, describe how state or session information is maintained and transmitted, and

how the number of concurrent users or sessions are determined. Provide recommended space

allocation per user for storage of personalized or other user specific data.

1.21. What, if any, is the limit on the number of concurrent user sessions supported by the

System? What, if any, is the limit on active staff sessions supported by the System? If there are

limits, describe what happens when either of these limits are reached (e.g., users are prevented

from starting new sessions).

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1.22. Describe all instances when the System may be unavailable for staff or user access, (e.g.

during software updates, database loads, data encoding). Describe how the size of databases

impacts such required outages.

1.23. Identify all methods for batch import and exports, including processes that are scheduled

directly with job scheduling tools, and processes that can be executed real time within the

System.

1.24. Describe the supported processes of backup and recovery. Describe whether and how

backups run during normal use of the System, and where there is any impact on performance.

1.25. Describe the process for installing a new release of the application. Describe how local

modifications to interfaces, data structures, etc., are maintained during an application version

upgrade, and which local modifications must be reapplied after such an upgrade.

1.26. Describe performance monitoring tools and options available within the System. Do these

tools implement the SNMP protocol?

1.27. How are software bugs reported and tracked? Describe in detail the mechanisms for

reporting, tracking, and disseminating information on outstanding problems.

1.28. How is the software enhancement process managed?

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1.29. Describe the company’s support for prior releases. When does the company discontinue

support of a prior release?

1.30. On average how many major releases of the product are there in a calendar year? On

average, how often do patches or minor updates occur?

2. Database

2.1. Identify and discuss all components and objects that are stored by the System. Include

application data, repository data, user data, security data, application logic, program code, stored

procedures, and so on. Specify which are stored within System databases and which must be

stored outside of System databases. Indicate which are optionally stored within or outside of the

System.

2.2. If applicable, describe the database System(s) used for each component of the System.

2.3. Does the license allow for internal or external manipulation of the data or schema in the

database?

2.4. Supply the schema used by the database System. Indicate which aspects of the schema are

used for data, security, metadata, etc.

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2.5. Describe the application's logging capabilities and options. What events must be logged and

which may optionally logged? How often can logs be refreshed? What tools are available for log

scanning or for real-time monitoring for intrusion detection?

5. Metadata Requirements

5.1. Can you describe how your product supports and integrates metadata (both technical and

descriptive)? Please indicate if your product has the ability to input, modify or import metadata.

Are there batch processing tools provided to assist in these functions?

5.2. What Metadata formats are supported?

5.3. Can a custom schema be used? Will the System support more than one schema

concurrently?

6. Support and Documentation

6.1. Can you describe the support options available for your product?

6.2. Is your documentation available online? Is there a knowledgebase for the product?

6.3. Provide list of the user groups and ask to attend a meeting.

7. Integration

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7.1. Indicate how this application could be integrated with other software or application systems

including electronic medical record.

7.2. Indicate any other applications or services with which this application can integrate or

interface

7.3 Please describe the integration capabilities and methods. Describe standards in use. Please

list SOA, web service, point to point, and others.

8. Security

8.1. Describe the System's support for network transport encryption (e.g. SSL), either for front-

end connections to Web interface, or for tunneled connections between application components

on different hosts.

8.2. Describe procedures in place to support timely notification and remediation of security

problems.

8.3. If System components run on different hosts, how easy is it to identify, change, and secure

the network routes between them (e.g. to identify and change port numbers for firewall

configuration)?

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8.5. What procedures are in place for secure and monitored access to hosts and applications?

8.6. Identify any other security controls provided in the System

8.7. Describe the model used for content security; including what security and access control

functions (including granularity of privileges) are available to users

9. System Administration

9.1. Describe the available System Administration and interface.

9.2. Describe how delegated administrators are able to differentiate and secure levels of access

across the System. Define the levels of granularity of authorization.

10. Development Environment

10.1. How are development licenses provided? Are there separate licensing issues/fees for server

tools and SDK client-side development tools?

10.2. Describe all application programming interface (API) or software development kits

(SDK)

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10.3. Which programming languages do you support? Which language bindings do you support

(e.g. http, Java, SOAP) 10.4. How many functions are available in the SDK? Do you provide

sample source code and documentation?

10.5. What API functions are there for creating or manipulating metadata objects?

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Functional User Requirements/Features

Available

Custom

Developed

Future

Development

Not

Available

Chart Completion/Deficiency Analysis

Can the organization define the intervals

for analysis?

For chart deficiency/delinquency analysis

does the system allow reporting?

(Standard and/or ad-hoc)

Can delinquency reports be sent to

physicians/clinicians in electronic and

paper formats?

Does the system allow you to define or

detail all deficiencies by provider?

Does the system allow the organization to

list all records by the deficiency type?

Can deficiency analysis be conducted at

the time the patient is prepared for

discharge from the facility?

Does the system support dictation systems

that allow transcribed reports to be easily

and efficiently completed?

Does the system allow for end-user

notification for incomplete/missing

information?

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Coding/Transaction Standards

Does the system support ICD-10-CM/ICD-

10-PCS in addition to ICD-9-CM?

Does the system use General Equivalence

Mappings for example, between ICD-10-

CM/PCS and ICD-9-CM or SNOMED CT

and ICD-9-CM?

Is the system compliant with the Version

5010 transaction standard?

Health Record Output and Disclosure

Does the system allow a seamless view of

all component subsystems of the EHR at

the patient level and at the date of service

encounter level for purposes of disclosure

management?

Does the system provide the ability to

define the formal health records or reports

for disclosure purposes?

Does the system allow flagging of VIP

patients and confidentially of these patients

on corresponding reports?

Does the system produce an accounting of

disclosure?


create reports and generate reports in

specified order?


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customize reports?

Does the system allow for redaction and

the ability to redact patient information

from larger reports?

Authentication

Does the system authenticate principals

before accessing the system?

Does the system require authentication

mechanisms and securely store that

information?

If user names and passwords are used,

does the system require password strength

rules, and no reuse of prior passwords?

Does the system have the ability to

suspend or lock a session after a period of

inactivity or after a series of invalid log-in

attempts?

Access Controls


create and update sets of security access-

control permissions based on the user's

role and scope of practice?

Does the system inactivate a user and

remove the user's privileges without

deleting the user's history?

Does the system have the ability to record

all authorization actions?

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Does the system allow only authorized

users access to confidential information?

Does the system prevent users with read

only privileges from printing or

copying/writing to other media?

Does the system define and enforce system

and data access rules for all EHR system

resources?

Does the system restrict access to patient

information based on location?

Does the system track restrictions?

Does the system have the ability to track

viewed records without significant effect

on speed?

Does the system allow for electronic

access to specified patients for external

reviewers?

Emergency Access Controls

Does the system allow emergency access

regardless of controls or established user

levels, within a set time parameter?

Does the system define emergency access

for overriding controls for emergency

access while specifying these

circumstances?

Before granting a user emergency access,

does the system require validation?

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Can a report be generated of all emergency

access use?


review a user's emergency access

privileges?


generate an after-action report to trigger

follow-up of emergency access use?

Information Attestation

Does the system provide the ability for

attestation of EHR content by properly

authenticated and authorized users?


associate and maintain all

authors/contributors with their content if

there are multiple contributors?

If the EHR content was attested to by

someone other than the author, does the

system maintain all authors and

contributors?


show the credentials and the name of the

author(s) and the attester, as well as the

date and time of attestation?

Data Retention, Availability, and Destruction

Does the system provide the ability to store

and retrieve health record and clinical

documents according to organizational

policy and to include unaltered inbound

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data?


identify specific EHR data for deletion and

allow for the review and confirmation of

selected items before deletion occurs?


destroy EHR data/records so that data are

not retrievable according to policy and

legal retentions periods, and is a certificate

of destruction generated?

Record Preservation


identify records that must be preserved

longer than normal and a reason for

preservation?


generate a legal hold notice identifying

whom to contact for questions when a user

attempts to alter a record on legal hold or

an unauthorized user attempts to access a

record on legal hold?


secure data/records from unauditable

alteration or unauthorized use for

preservation purposes?


merge and unmerge records?

Does the system allow a record to be

locked so that no changes can be made

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after a specified time?

Minimum Metadata Set and Audit Capability for Record Actions

Does the system capture and retain the

date, time stamp, and user for every

object/data creation, modification, view,

deletion, or printing/export of any part of

the medical record?

Does the system retain who has viewed the

record?

Does the system retain who has recorded a

change and the change history?

Does the system retain a record of the

source of nonoriginated data?

Does the system retain the medical record

metadata for the legally prescribed time

frame?

Does the system include the minimum

metadata set for a record exchanged or

released?

Pending State

Does the system apply a date and time-

stamp each time a note is updated?

Does the system display and notify the

author of pending notes?

Does the system allow the ability to

establish a time frame for pending

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documents?

Does the system clearly identify pending

notes?

Does the system allow the author to

complete, edit, or delete the pending note

for a patient?

Amendments and Corrections


correct, amend, or augment a note or

entry?


indicate whether the change was a

correction, amendment, or augmentation?

Does the system record and display the

date and time stamp of the modification?

Does the system clearly indicate a record

has been changed?

Does the system provide a link or clear

direction to the original entry/note?

Does the system retain all versions?

Does the system disseminate updated

information to providers that were initially

autofaxed?

Documentation Succession Management and Version Control

Does the system manage the succession of

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documents?

Does the system retain all versions when a

change is made?

Does the system indicate there are prior

versions?

Does the system indicate the most recent

version?

Retracted State

Does the system allow for removing a

record or note from view?

Does the system allow a retracted

note/record to be accessed?

Does the system allow the user to record

the reason for retraction?

Does the system allow for notification of

the viewers of the data to present correct

information?

Data Collection and Reporting

Does the system allow preset targets to

have real-time data collection and progress

measurement against them?

Does the system produce reports as related

to AR?

Does the system have the ability to track

clinical decision-making alerts?

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Does the system comply with meaningful

use reporting requirements?

Patient Financial Support

Is your proposed solution fully integrated

or able to interface with the patient

financial system?

Can patient information easily identify

details that refer to the patient account?

Can HIPPA compliant transaction

documents/reports such as UB-04 or CMS

1500 be electronically captured, stored,

and retrieved?

Patient Portals

Does the system allow for electronic

patient access?

Health Information Exchange

Does the system enable participation in

local health information exchange

initiatives?

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References/Site Visits: The vendor should provide references the facility can contact/visit based

on product features and functions most suitable to the facility. It is preferable to find host sites

that are using the same version of the EMR as the sites facility as well as those using the latest

versions of the proposed software)

Terms and Conditions (Including Cost and Time):

- Price: The vendor should provide the price of the proposed solution, broken down by

application/module, including licensing fees. Cost of Ownership (breakdown over a certain

number of proposed contract years)

- Other Costs (hardware, maintenance, upgrades, implementation, consultation and support

fees, post-implementation training and services, travel, etc.) All pricing figures should reflect

a five year cost. Show costs for each of the five years for each cost element, as well as a total

five year cost of ownership.

- Discounts (what discounts are available such as being a beta site or open to hosting future

site visits)

- Invoicing (details with a breakdown of the fee schedule and for each)

o Vendor must comply with the following invoicing schedule

25% license cost due at contract signing

50% of license cost due at delivery

25% of license cost due at acceptance

Professional services to be billed as rendered with terms of Net 60

- Return on Investment (potential ROI figures)

- Acceptance Period

The vendor should outline the terms for validating the product after implementation, during

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go-live, and post go live. Testing scripts and validation documentation should be

documented along with details of the refund policy.

Evaluation Criteria: This request for proposal was created to provide Bay Hospital with the

ability to make as determination of which potential vendor will best satisfy the requirements of

the needed CDI application. The purpose and goal of this process is to ensure consistency and

impartiality in the approach to determine the most qualified respondents to the RFP. The

evaluation entails reviewing, evaluating, and scoring in five or six phases, at Bay Hospital’s

discretion. See the scoring matrix below:

Phase Points Percentage Subsection Point

Management

Proposal

600 20%

Experience 150

Approach 450

Technical Proposal 900 20%

Business Solution 350

Technical 200

Approach 350

Function Features 900 40%

Previous RFI

Responses

600 20%

Total 3000 100%

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Proposed Submittal Instructions: Proposals must be submitted to the below address no later

than the date specified. All information must be complete. Corrections must be initiated by

individual signing the offer. The proposal title, number, opening date and time must be clearly

indicated. Bay Hospital reserves the right to reject any or all proposals received and to negotiate

with any or all prospective vendors on amendments to proposals.

Please submit to:

CDI Team Member

Clinical Applications Analyst, Information Services

(123) 456-7890

[email protected]

Responses will be due on 1/15/2014 by 5:00 PM PST.

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References

AHIMA.org (2013) RFI/RFP Template

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=

bok1_047959

AMA.org (2013) Clinical Documentation. Retrieved from http://www.ama-

assn.org//ama/pub/physician-resources/practice-management- center/claims-revenue-

cycle/clinical-documentation.page

Humphreys, S. “Closing the Gap: Six Steps to Assess Your Organization’s ICD-10 Readiness”.

Retrieved from http://www.beaconpartners.com/closing-gap-six-steps-assess-your-

organization%E2%80%99s-icd-10-readiness

MLN, 2013. ICD-10 Basics. Retrieved from http://www.cms.giv/outreach

andeducation/outreach/npc/downloads/2013-08-22- CD10- NPC.pdf

http://www.ama-assn.org/ama/pub/physician-resources/practice-management-%20center/claims-revenue-cycle/clinical-documentation.page



http://www.cms.giv/outreach%20andeducation/outreach/npc/downloads/2013-08-22-%20%20%20%20CD10-%20%20%20NPC.pdf

http://www.cms.giv/outreach%20andeducation/outreach/npc/downloads/2013-08-22-%20%20%20%20CD10-%20%20%20NPC.pdf

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