REQUEST FOR PROPOSALS FOR INTERNET BASED ELECTRONIC MEDICAL

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REQUEST FOR PROPOSALS FOR

INTERNET BASED ELECTRONIC MEDICAL RECORDS (EMR) SYSTEMS SERVICES FOR THE DEPARTMENT OF MILITARY AND VETERANS AFFAIRS

HEADQUARTERS AND SIX (6) STATE VETERANS’HOMES

ISSUING OFFICE

DEPARTMENT OF MILITARY AND VETERANS AFFAIRS (DMVA), DIVISION OF PROCUREMENT AND CONTRACTING

RFP NUMBER

6100019963

DATE OF ISSUANCE

17 NOV 11

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REQUEST FOR PROPOSALS FOR

INTERNET BASED ELECTRONIC MEDICAL RECORDS (EMR) SYSTEMS SERVICES FOR THE DEPARTMENT OF MILITARY AND VETERANS AFFAIRS

HEADQUARTERS AND SIX (6) STATE VETERANS’HOMES RFP # 6100019963

TABLE OF CONTENTS CALENDAR OF EVENTS 3 Part I—GENERAL INFORMATION [4-13] Part II—PROPOSAL REQUIREMENTS [14-20] Part III—CRITERIA FOR SELECTION [21-24] Part IV—WORK STATEMENT [25-70] APPENDIX A, RFP INFORMATION APPENDIX B, DOMESTIC WORKFORCE UTILIZATION CERTIFICATION (must be filled out and returned as part of the Technical Submittal) APPENDIX C, PROPOSAL COVER SHEET (must be filled out, signed, and returned as part of the Technical Submittal) APPENDIX D, DMVA PROTEST PROCEDURES (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX E, COST SUBMITTAL (to be completely filled out and returned as a separate portion of your proposal) APPENDIX F, TECHNICAL QUESTIONAIRE (this Excel Workbook must be filled out and returned as part of the Technical Submittal) APPENDIX G, ACTIVITIES REPORT (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX H, CLINICAL REPORTS (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX I, REHAB OPTIMA THERAPY FORMS (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX J, SLAs (SERVICE LEVEL AGREEMENTS) (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX K, UNIQUE FIELDS (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX L, ULTRA CARE FORMS (FOR INFORMATIONAL PURPOSES ONLY) APPENDIX M, IT CONTRACT TERMS AND CONDITIONS APPENDIX N, DELIVERABLES RESOURCES/RATES/HOURS (this Excel Spreadsheet must be filled out and returned as part of the Technical Submittal

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CALENDAR OF EVENTS The Commonwealth will make every effort to adhere to the following schedule:

Activity Responsibility Date

Deadline to submit Questions via email to [email protected]

Potential Offerors 30 NOV 11

Mandatory Pre-proposal Conference/site visit at Fort Indiantown Gap, Fisher Avenue, Bldg 0-47, OA Conference Room, Annville, PA 17003, from 1pm to 4pm. You must attend this pre-proposal Conference/site visit, or you cannot submit a proposal.

Issuing Office/Potential

Offerors 7 DEC 11

Answers to Potential Offeror questions posted to the DGS website (http://www.dgsweb.state.pa.us/RTA/Search.aspx) no later than this date.

Issuing Office 12 DEC 11

Please monitor website for all communications regarding the RFP.

Potential Offerors Ongoing

Sealed proposal must be received by the Issuing Office at Fort Indiantown Gap, Fisher Avenue, Bldg 0-47, Annville, PA 17003-5002, Attn: James Pearson, DMVA Procurement and Contracting, Office of Administration.

Offerors No Later than

4PM 28 DEC 11

mailto:[email protected]�

http://www.dgsweb.state.pa.us/RTA/Search.aspx�

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PART I

GENERAL INFORMATION Purpose. This request for proposals (RFP) provides to those interested in submitting proposals for the subject procurement (“Offerors”) sufficient information to enable them to prepare and submit proposals for the Department of Military and Veterans Affair’s consideration on

behalf of the Commonwealth of Pennsylvania (“Commonwealth”) to satisfy a need for INTERNET BASED ELECTRONIC MEDICAL RECORDS (EMR) SYSTEMS

SERVICES FOR THE DEPARTMENT OF MILITARY AND VETERANS AFFAIRS HEADQUARTERS AND SIX (6) STATE VETERANS’HOMES (“Project”).

I-1. Issuing Office. The Department of Military and Veterans Affairs (“Issuing Office”) has issued this RFP on behalf of the Commonwealth. The sole point of contact in the Commonwealth for this RFP shall be James Pearson, Department of Military and Veterans Affairs, Division of Procurement and Contracting, Office of Administration, Fort Indiantown Gap, Fisher Avenue, Bldg 0-47, Annville, PA 17003-5002, Email: [email protected], the Issuing Officer for this RFP. Please refer all inquiries to the Issuing Officer. I-2. Scope. This RFP contains instructions governing the requested proposals, including the requirements for the information and material to be included; a description of the service to be provided; requirements which Offerors must meet to be eligible for consideration; general evaluation criteria; and other requirements specific to this RFP. I-3. Problem Statement. The purpose of the Request for Proposal (RFP) is as follows. The Department of Military and Veterans Affairs expects to accomplish the following through this procurement: Implementation and ongoing, hosted operations of a secure, internet-based Electronic Medical Record (EMR) with 24x7 availability as specified in the requirements. Additional detail is provided in Part IV of this RFP.

I-4. Type of Contract. It is proposed that if the Issuing Office enters into a contract as a result of this RFP, it will be a line item Purchase Order containing the IT Contract Terms and Conditions as shown in Appendix M, as attached to this RFP and as posted to the Department of General Services website as notated in Section I-9. The Issuing Office, in its sole discretion, may undertake negotiations with Offerors whose proposals, in the judgment of the Issuing Office, show them to be qualified, responsible and capable of performing the Project. I-5. Rejection of Proposals. The Issuing Office reserves the right, in its sole and complete discretion, to reject any proposal received as a result of this RFP. I-6. Incurring Costs. The Issuing Office is not liable for any costs the Offeror incurs in preparation and submission of its proposal, in participating in the RFP process or in anticipation of award of the contract. I-7. Pre-proposal Conference. The Issuing Office will hold a Pre-proposal conference/site visit as specified in the Calendar of Events. The purpose of this conference is to provide


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opportunity for clarification of the RFP. Offerors should forward all questions to the Issuing Office in accordance with Part I, Section I-8 to ensure adequate time for analysis before the Issuing Office provides an answer. Offerors may also ask questions at the conference. In view of the limited facilities available for the conference, Offerors should limit their representation to three (3) individuals per Offeror. The Pre-proposal conference is for information only. Any answers furnished during the conference will not be official until they have been verified, in writing, by the Issuing Office. All questions and written answers will be posted on the Department of General Services’ (DGS) website as an addendum to, and shall become part of, this RFP. Attendance at the Pre-proposal Conference/Site Visit is mandatory. Failure to attend the Pre-proposal Conference/Site Visit shall disqualify an Offeror from consideration for the contract to be awarded from this RFP, and its proposal will be returned unopened. Please take note in the Calendar of Events that this is also a Mandatory Site Visit. As with the Mandatory Pre-proposal Conference, failure to attend and participate in the Site Visit shall disqualify an Offeror from consideration for the contract to be awarded from this RFP, and its proposal will be returned unopened. You must confirm your attendance to [email protected] by no later than close of business (4pm) on 30 NOV 11. I-8. Questions & Answers. If an Offeror has any questions regarding this RFP, the Offeror must submit the questions by email (with the subject line “RFP #6100019963

Question”) to the Issuing Officer named in Part I, Section I-1 of the RFP. If the Offeror has questions, they must be submitted via email no later than the date indicated on the Calendar of Events. The Offeror shall not attempt to contact the Issuing Officer by any other means. The Issuing Officer shall post the answers to the questions on the DGS website by the date stated on the Calendar of Events. An Offeror who submits a question after the deadline date for receipt of questions indicated on the Calendar of Events assumes the risk that its proposal will not be responsive or competitive because the Commonwealth is not able to respond before the proposal receipt date or in sufficient time for the Offeror to prepare a responsive or competitive proposal. When submitted after the deadline date for receipt of questions indicated on the Calendar of Events, the Issuing Officer may respond to questions of an administrative nature by directing the questioning Offeror to specific provisions in the RFP. To the extent that the Issuing Office decides to respond to a non-administrative question after the deadline date for receipt of questions indicated on the Calendar of Events, the answer must be provided to all Offerors through an addendum.

All questions and responses as posted on the DGS website are considered as an addendum to, and part of, this RFP in accordance with RFP Part I, Section I-9. Each Offeror shall be responsible to monitor the DGS website for new or revised RFP information. The Issuing Office shall not be bound by any verbal information nor shall it be bound by any written information that is not either contained within the RFP or formally issued as an addendum by the Issuing Office. The Issuing Office does not consider questions to be a protest of the specifications or of the solicitation. The required protest process for Commonwealth procurements is described in Appendix D (DMVA PROTEST PROCEDURES), as attached to this RFP. I-9. Addenda to the RFP. If the Issuing Office deems it necessary to revise any part of this RFP before the proposal response date, the Issuing Office will post an addendum to the DGS


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website at http://www.dgsweb.state.pa.us/RTA/Search.aspx. It is the Offeror’s responsibility to periodically check the website for any new information or addenda to the RFP. Answers to the questions asked during the Questions & Answers period also will be posted to the website as an addendum to the RFP. I-10. Response Date. To be considered for selection, hard copies of proposals must arrive at the Issuing Office on or before the time and date specified in the RFP Calendar of Events. The Issuing Office will not accept proposals via email or facsimile transmission. Offerors who send proposals by mail or other delivery service should allow sufficient delivery time to ensure timely receipt of their proposals. If, due to inclement weather, natural disaster, or any other cause, the Commonwealth office location to which proposals are to be returned is closed on the proposal response date, the deadline for submission will be automatically extended until the next Commonwealth business day on which the office is open, unless the Issuing Office otherwise notifies Offerors. The hour for submission of proposals shall remain the same. The Issuing Office will reject, unopened, any late proposals. I-11. Proposals. To be considered, Offerors should submit a complete response to this RFP to the Issuing Office, using the format provided in Part II, providing ten (10) paper copies of the Technical Submittal and one (1) paper copy of the Cost Submittal and two (2) paper copies of the Disadvantaged Business Submittal. In addition to the paper copies of the proposal, Offerors shall submit two (2) complete and exact copies of the entire proposal (Technical, Cost and Disadvantaged Business Submittals, along with all requested documents) on CD-ROM or Flash drive in Microsoft Office or Microsoft Office-compatible format. The electronic copy must be a mirror image of the paper copy and any spreadsheets must be in Microsoft Excel. The Offerors may not lock or protect any cells or tabs. Offerors should ensure that there is no costing information in the technical submittal. Offerors should not reiterate technical information in the cost submittal. The CD or Flash drive should clearly identify the Offeror and include the name and version number of the virus scanning software that was used to scan the CD or Flash drive before it was submitted. The Offeror shall make no other distribution of its proposal to any other Offeror or Commonwealth official or Commonwealth consultant. Each proposal page should be numbered for ease of reference. An official authorized to bind the Offeror to its provisions must sign the proposal. If the official signs the Proposal Cover Sheet (Appendix C to this RFP) and the Proposal Cover Sheet is attached to the Offeror’s proposal, the requirement will be met. For this RFP, the proposal must remain valid for 120 days or until a contract is fully executed. If the Issuing Office selects the Offeror’s proposal for award, the contents of the selected Offeror’s proposal will become, except to the extent the contents are changed through Best and Final Offers or negotiations, contractual obligations. Each Offeror submitting a proposal specifically waives any right to withdraw or modify it, except that the Offeror may withdraw its proposal by written notice received at the Issuing Office’s address for proposal delivery prior to the exact hour and date specified for proposal receipt. An Offeror or its authorized representative may withdraw its proposal in person prior to the exact hour and date set for proposal receipt, provided the withdrawing person provides appropriate identification and signs a receipt for the proposal. An Offeror may modify its submitted proposal prior to the exact hour and date set for proposal receipt only by submitting a new sealed proposal or sealed modification which complies with the RFP requirements.

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I-12. Disadvantaged Business Information. The Issuing Office encourages participation by small disadvantaged businesses as prime contractors, joint ventures and subcontractors/suppliers and by socially disadvantaged businesses as prime contractors. Small Disadvantaged Businesses are small businesses that are owned or controlled by a majority of persons, not limited to members of minority groups, who have been deprived of the opportunity to develop and maintain a competitive position in the economy because of social disadvantages. The term includes:

A. Department of General Services Bureau of Minority and Women Business Opportunities (BMWBO)-certified minority business enterprises (MBEs) and women business enterprises (WBEs) that qualify as small businesses; and

B. United States Small Business Administration certified 8(a) small disadvantaged business

concerns.

Small businesses are businesses in the United States which are independently owned, are not dominant in their field of operation, employ no more than 100 full-time or full-time equivalent employees, and earn less than $20 million in gross annual revenues ($25 million in gross annual revenues for those businesses in the information technology sales or service business). Socially disadvantaged businesses are businesses in the United States that BMWBO determines are owned or controlled by a majority of persons, not limited to members of minority groups, who are subject to racial or ethnic prejudice or cultural bias, but which do not qualify as small businesses. In order for a business to qualify as “socially disadvantaged,” the offeror must include in its proposal clear and convincing evidence to establish that the business has personally suffered racial or ethnic prejudice or cultural bias stemming from the business person’s color, ethnic origin or gender. Questions regarding this Program can be directed to:

Department of General Services Bureau of Minority and Women Business Opportunities Room 611, North Office Building Harrisburg, PA 17125 Phone: (717) 783-3119 Fax: (717) 787-7052 Email: [email protected]

Website: www.dgs.state.pa.us A database of BMWBO-certified minority- and women-owned businesses can be accessed at http://www.dgsweb.state.pa.us/mbewbe/VendorSearch.aspx. The federal vendor database can be accessed at http://www.ccr.gov by clicking on Dynamic Small Business Search (certified companies are so indicated).


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I-13. Information Concerning Small Businesses in Enterprise Zones. The Issuing Office encourages participation by small businesses, whose primary or headquarters facility is physically located in areas the Commonwealth has identified as Designated Enterprise Zones, as prime contractors, joint ventures and subcontractors/suppliers. The definition of headquarters includes, but is not limited to, an office or location that is the administrative center of a business or enterprise where most of the important functions of the business are conducted or concentrated and location where employees are conducting the business of the company on a regular and routine basis so as to contribute to the economic development of the geographical area in which the office or business is geographically located. Small businesses are businesses in the United States which are independently owned, are not dominant in their field of operation, employ no more than 100 full-time or full-time equivalent employees, and earn less than $20 million in gross annual revenues ($25 million in gross annual revenues for those businesses in the information technology sales or service business). There is no database or directory of small businesses located in Designated Enterprise Zones. Information on the location of Designated Enterprise Zones can be obtained by contacting:

Aldona M. Kartorie Center for Community Building PA Department of Community and Economic Development 4th Floor, Commonwealth Keystone Building 400 North Street Harrisburg, PA 17120-0225 Phone: (717) 720-7409 Fax: (717) 787-4088 Email: [email protected]

I-14. Economy of Preparation. Offerors should prepare proposals simply and economically, providing a straightforward, concise description of the Offeror’s ability to meet the requirements of the RFP. I-15. Alternate Proposals. The Issuing Office has identified the basic approach to meeting its requirements, allowing Offerors to be creative and propose their best solution to meeting these requirements. The Issuing Office will not accept alternate proposals. I-16. Discussions for Clarification. Offerors may be required to make an oral or written clarification of their proposals to the Issuing Office to ensure thorough mutual understanding and Offeror responsiveness to the solicitation requirements. The Issuing Office will initiate requests for clarification. Clarifications may occur at any stage of the evaluation and selection process prior to contract execution. I-17. Prime Contractor Responsibilities. The contract will require the selected Offeror to assume responsibility for all services offered in its proposal whether it produces them itself or by


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subcontract. The Issuing Office will consider the selected Offeror to be the sole point of contact with regard to contractual matters. I-18. Proposal Contents.

A. Confidential Information

. The Commonwealth is not requesting, and does not require, confidential proprietary information or trade secrets to be included as part of Offerors’ submissions in order to evaluate proposals submitted in response to this RFP. Accordingly, except as provided herein, Offerors should not label proposal submissions as confidential or proprietary or trade secret protected. Any Offeror who determines that it must divulge such information as part of its proposal must submit the signed written statement described in subsection c. below and must additionally provide a redacted version of its proposal, which removes only the confidential proprietary information and trade secrets, for required public disclosure purposes.

B. Commonwealth Use

. All material submitted with the proposal shall be considered the property of the Commonwealth of Pennsylvania and may be returned only at the Issuing Office’s option. The Commonwealth has the right to use any or all ideas not protected by intellectual property rights that are presented in any proposal regardless of whether the proposal becomes part of a contract. Notwithstanding any Offeror copyright designations contained on proposals, the Commonwealth shall have the right to make copies and distribute proposals internally and to comply with public record or other disclosure requirements under the provisions of any Commonwealth or United States statute or regulation, or rule or order of any court of competent jurisdiction.

C. Public Disclosure

. After the award of a contract pursuant to this RFP, all proposal submissions are subject to disclosure in response to a request for public records made under the Pennsylvania Right-to-Know-Law, 65 P.S. § 67.101, et seq. If a proposal submission contains confidential proprietary information or trade secrets, a signed written statement to this effect must be provided with the submission in accordance with 65 P.S. § 67.707(b) for the information to be considered exempt under 65 P.S. § 67.708(b)(11) from public records requests. Financial capability information submitted in response to Part II, Section II-7 of this RFP is exempt from public records disclosure under 65 P.S. § 67.708(b)(26).

I-19. Best and Final Offers.

A. While not required, the Issuing Office reserves the right to conduct discussions with Offerors for the purpose of obtaining “best and final offers.” To obtain best and final offers from Offerors, the Issuing Office may do one or more of the following, in any combination and order:

1. Schedule oral presentations; 2. Request revised proposals;

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3. Conduct a reverse online auction; and 4. Enter into pre-selection negotiations.

B. The following Offerors will not be invited by the Issuing Office to submit a Best and

Final Offer: 1. Those Offerors, which the Issuing Office has determined to be not responsible or

whose proposals the Issuing Office has determined to be not responsive. 2. Those Offerors, which the Issuing Office has determined in accordance with Part III,

Section III-5, from the submitted and gathered financial and other information, do not possess the financial capability, experience or qualifications to assure good faith performance of the contract.

3. Those Offerors whose score for their technical submittal of the proposal is less than 70% of the total amount of technical points allotted to the technical criterion. The issuing office may further limit participation in the best and final offers process to those remaining responsible offerors which the Issuing Office has, within its discretion, determined to be within the top competitive range of responsive proposals.

C. The Evaluation Criteria found in Part III, Section III-4, shall also be used to evaluate the Best and Final offers.

D. Price reductions offered through any reverse online auction shall have no effect upon the

Offeror’s Technical Submittal. Dollar commitments to Disadvantaged Businesses and Enterprise Zone Small Businesses can be reduced only in the same percentage as the percent reduction in the total price offered through any reverse online auction or negotiations. I-20. News Releases. Offerors shall not issue news releases, Internet postings, advertisements or any other public communications pertaining to this Project without prior written approval of the Issuing Office, and then only in coordination with the Issuing Office. I-21. Restriction of Contact. From the issue date of this RFP until the Issuing Office selects a proposal for award, the Issuing Officer is the sole point of contact concerning this RFP. Any violation of this condition may be cause for the Issuing Office to reject the offending Offeror’s proposal. If the Issuing Office later discovers that the Offeror has engaged in any violations of this condition, the Issuing Office may reject the offending Offeror’s proposal or rescind its contract award. Offerors must agree not to distribute any part of their proposals beyond the Issuing Office. An Offeror who shares information contained in its proposal with other Commonwealth personnel and/or competing Offeror personnel may be disqualified. I-22. Issuing Office Participation. Offerors shall provide all services, supplies, facilities, and other support necessary to complete the identified work, except as otherwise provided in this Part I, Section I-22. Chief Information Officer, DMVA Bureau of Information Technology,

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shall be the point of contact for all IT related information or questions. Purchasing Agent, Supervisor in Charge of Services, DMVA Division of Procurement and Contracting shall be the Contracting Officer for this project and shall be the point of contact for any contractual questions related to this project. All questions must be submitted in writing in accordance with the requirements of this RFP. No questions and answers are official until posted to the Department of General Services website as an official flyer, as an attachment to the RFP. No office space will be provided by DMVA to the awarded Contractor. The awarded Contractor will be required to provide its’ own office space for this project.

I-23. Term of Contract. The term of the contract will commence on the Effective Date. The contract will be effective for three (3) years from the date that the contract is awarded, fully executed, and the awarded contractor is given notice to proceed. The Issuing Office will fix the Effective Date after the contract has been fully executed by the selected Offeror and by the Commonwealth and all approvals required by Commonwealth contracting procedures have been obtained. The selected Offeror shall not start the performance of any work prior to the Effective Date of the contract and the Commonwealth shall not be liable to pay the selected Offeror for any service or work performed or expenses incurred before the Effective Date of the contract.

It is DMVA’s intention to enter into a three (3) year contract with two separate one (1) year renewal options. I-24. Offeror’s Representations and Authorizations. By submitting its proposal, each Offeror understands, represents, and acknowledges that:

A. All of the Offeror’s information and representations in the proposal are material and important, and the Issuing Office may rely upon the contents of the proposal in awarding the contract(s). The Commonwealth shall treat any misstatement, omission or misrepresentation as fraudulent concealment of the true facts relating to the Proposal submission, punishable pursuant to 18 Pa. C.S. § 4904.

B. The Offeror has arrived at the price(s) and amounts in its proposal independently and

without consultation, communication, or agreement with any other Offeror or potential offeror.

C. The Offeror has not disclosed the price(s), the amount of the proposal, nor the

approximate price(s) or amount(s) of its proposal to any other firm or person who is an Offeror or potential offeror for this RFP, and the Offeror shall not disclose any of these items on or before the proposal submission deadline specified in the Calendar of Events of this RFP.

D. The Offeror has not attempted, nor will it attempt, to induce any firm or person to refrain

from submitting a proposal on this contract, or to submit a proposal higher than this proposal, or to submit any intentionally high or noncompetitive proposal or other form of complementary proposal.

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E. The Offeror makes its proposal in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive proposal.

F. To the best knowledge of the person signing the proposal for the Offeror, the Offeror, its

affiliates, subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency and have not in the last four years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bidding or proposing on any public contract, except as the Offeror has disclosed in its proposal.

G. To the best of the knowledge of the person signing the proposal for the Offeror and

except as the Offeror has otherwise disclosed in its proposal, the Offeror has no outstanding, delinquent obligations to the Commonwealth including, but not limited to, any state tax liability not being contested on appeal or other obligation of the Offeror that is owed to the Commonwealth.

H. The Offeror is not currently under suspension or debarment by the Commonwealth, any

other state or the federal government, and if the Offeror cannot so certify, then it shall submit along with its proposal a written explanation of why it cannot make such certification.

I. The Offeror has not made, under separate contract with the Issuing Office, any

recommendations to the Issuing Office concerning the need for the services described in its proposal or the specifications for the services described in the proposal.

J. Each Offeror, by submitting its proposal, authorizes Commonwealth agencies to release

to the Commonwealth information concerning the Offeror's Pennsylvania taxes, unemployment compensation and workers’ compensation liabilities.

K. Until the selected Offeror receives a fully executed and approved written contract from the Issuing Office, there is no legal and valid contract, in law or in equity, and the Offeror shall not begin to perform.

I-25. Notification of Selection.

A. Contract Negotiations. The Issuing Office will notify all Offerors in writing of the

Offeror selected for contract negotiations after the Issuing Office has determined, taking into consideration all of the evaluation factors, the proposal that is the most advantageous to the Issuing Office.

B. Award. Offerors whose proposals are not selected will be notified when contract

negotiations have been successfully completed and the Issuing Office has received the final negotiated contract signed by the selected Offeror.

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I-26. Debriefing Conferences. Upon notification of award, Offerors whose proposals were not selected will be given the opportunity to be debriefed. The Issuing Office will schedule the debriefing at a mutually agreeable time. The debriefing will not compare the Offeror with other Offerors, other than the position of the Offeror’s proposal in relation to all other Offeror proposals. An Offeror’s exercise of the opportunity to be debriefed does not constitute nor toll the time for filing a protest (See Section I-27 of this RFP). I-27. RFP Protest Procedure. The RFP Protest Procedure is on the DGS website at http://www.dgsweb.state.pa.us/comod/ProtestProcedures.doc. The DMVA RFP Protest Procedure is attached to this RFP (Appendix D) and is available via the DMVA website at www.dmva.state.pa.us. A protest by a party not submitting a proposal must be filed within seven days after the protesting party knew or should have known of the facts giving rise to the protest, but no later than the proposal submission deadline specified in the Calendar of Events of the RFP. Offerors may file a protest within seven days after the protesting Offeror knew or should have known of the facts giving rise to the protest, but in no event may an Offeror file a protest later than seven days after the date the notice of award of the contract is posted on the DGS website. The date of filing is the date of receipt of the protest. A protest must be filed in writing with the Issuing Office.

I-28. Information Technology Bulletins.

This RFP is subject to the Information Technology Bulletins (ITB’s) issued by the Office of Administration, Office for Information Technology (OA-OIT). ITB’s may be found at http://www.portal.state.pa.us/portal/server.pt?open=512&objID=416&PageID=210791&mode=2 All proposals must be submitted on the basis that all ITBs are applicable to this procurement. It is the responsibility of the Offeror to read and be familiar with the ITBs. Notwithstanding the foregoing, if the Offeror believes that any ITB is not applicable to this procurement, it must list all such ITBs in its technical submittal, and explain why it believes the ITB is not applicable. The Issuing Office may, in its sole discretion, accept or reject any request that an ITB not be considered to be applicable to the procurement. The Offeror’s failure to list an ITB will result in its waiving its right to do so later, unless the Issuing Office, in its sole discretion, determines that it would be in the best interest of the Commonwealth to waive the pertinent ITB.

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PART II

PROPOSAL REQUIREMENTS Offerors must submit their proposals in the format, including heading descriptions, outlined below. To be considered, the proposal must respond to all requirements in this part of the RFP. Offerors should provide any other information thought to be relevant, but not applicable to the enumerated categories, as an appendix to the Proposal. All cost data relating to this proposal and all Disadvantaged Business cost data should be kept separate from and not included in the Technical Submittal. Each Proposal shall consist of the following three separately sealed submittals:

A. Technical Submittal, which shall be a response to RFP Part II, Sections II-1 through II-8;

B. Disadvantaged Business Submittal, in response to RFP Part II, Section II-9; and

C. Cost Submittal, in response to RFP Part II, Section II-10.

The Issuing Office reserves the right to request additional information which, in the Issuing Office’s opinion, is necessary to assure that the Offeror’s competence, number of qualified employees, business organization, and financial resources are adequate to perform according to the RFP. The Issuing Office may make investigations as deemed necessary to determine the ability of the Offeror to perform the Project, and the Offeror shall furnish to the Issuing Office all requested information and data. The Issuing Office reserves the right to reject any proposal if the evidence submitted by, or investigation of, such Offeror fails to satisfy the Issuing Office that such Offeror is properly qualified to carry out the obligations of the RFP and to complete the Project as specified. II-1. Statement of the Problem. State in succinct terms your understanding of the problem presented or the service required by this RFP. II-2. Management Summary. Include a narrative description of the proposed effort and a list of the items to be delivered or services to be provided. II-3. Work Plan. Describe in narrative form your technical plan for accomplishing the work. Use the task descriptions in Part IV of this RFP as your reference point. Modifications of the task descriptions are permitted; however, reasons for changes should be fully explained. Indicate the number of person hours allocated to each task. Include a Program Evaluation and Review Technique (PERT) or similar type display, time related, showing each event. If more than one approach is apparent, comment on why you chose this approach.

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II-4. Prior Experience Include experience in Electronic Medical Records (EMR) Services; The offeror should include prior experience with EMR Services of a similar size and scope. Experience shown should be work done by individuals who will be assigned to this project as well as that of your company. Studies or projects referred to must be identified and the name of the customer shown, including the name, address, and telephone number of the responsible official of the customer, company, or agency who may be contacted.

II-5. Personnel. Include the number of executive and professional personnel, analysts, auditors, researchers, programmers, consultants, etc., who will be engaged in the work. Show where these personnel will be physically located during the time they are engaged in the Project. Information should be included for key personnel to include but not limited to Program Director, Project Manager, Technical Leads, Functional Leads and Economic/Financial Officer. Offeror should provide Organizational Structure and any Partnership Structure that will apply to this project. Offeror should list any companies as part of their proposed Vendor Team and their role within the project (i.e, Developer, Installer, Financial, etc.), include the employees names and, through a resume or similar document, the Project personnel’s education and experience in Electronic Medical Records Systems; Indicate the responsibilities each individual will have in this Project and how long each has been with your company or partnered company. Identify by name any subcontractors you intend to use and the services they will perform. II-6. Training. If appropriate, indicate recommended training of agency personnel. Include the agency personnel to be trained, the number to be trained, duration of the program, place of training, curricula, training materials to be used, number and frequency of sessions, and number and level of instructors. II-7. Financial Capability. Describe your company’s financial stability and economic capability to perform the contract requirements. Provide your company’s financial statements for the past three fiscal years. If your company is a publicly traded company, please provide a link to your financial records on your company website; otherwise, provide three (3) years of your company’s financial documents such as audited financial statements or recent tax returns. Financial statements must include the company’s Balance Sheet and Income Statement or Profit/Loss Statements. Also include a Dun & Bradstreet comprehensive report if available. The Commonwealth reserves the right to request additional information it deems necessary to evaluate an Offeror’s financial capability. II-8. Objections and Additions to IT Contract Terms and Conditions. The Offeror will identify which, if any, of the terms and conditions (contained in Appendix M) it would like to negotiate and what additional terms and conditions the Offeror would like to add to the IT Contract Terms and Conditions. The Offeror’s failure to make a submission under this paragraph will result in its waiving its right to do so later, but the Issuing Office may consider late objections and requests for additions if to do so, in the Issuing Office’s sole discretion, would be in the best interest of the Commonwealth. The Issuing Office may, in its sole discretion, accept or reject any requested changes to the IT Contract Terms and Conditions. The Offeror shall not request changes to the other provisions of the RFP, nor shall the Offeror request to completely substitute its own terms and conditions for Appendix M. All terms and conditions

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must appear in one integrated contract. The Issuing Office will not accept references to the Offeror’s, or any other, online guides or online terms and conditions contained in any proposal. Regardless of any objections set out in its proposal, the Offeror must submit its proposal, including the cost proposal, on the basis of the IT Contract Terms and Conditions set out in Appendix M. The Issuing Office will reject any proposal that is conditioned on the negotiation of the IT Contract Terms and Conditions set out in Appendix M or to other provisions of the RFP as specifically identified above. II-9. Disadvantaged Business Submittal.

A. Disadvantaged Business Information.

1. To receive credit for being a Small Disadvantaged Business or a Socially Disadvantaged Business or for entering into a joint venture agreement with a Small Disadvantaged Business or for subcontracting with a Small Disadvantaged Business (including purchasing supplies and/or services through a purchase agreement), a Offeror must include proof of Disadvantaged Business qualification in the Disadvantaged Business Submittal of the proposal, as indicated below:

a) A Small Disadvantaged Businesses certified by BMWBO as an MBE/WBE must provide a photocopy of their BMWBO certificate.

b) Businesses certified by the U.S. Small Business Administration pursuant to Section 8(a) of the Small Business Act (15 U.S.C. § 636(a)) as an 8(a) Small Disadvantaged Businesses must submit proof of U.S. Small Business Administration certification. The owners of such businesses must also submit proof of United States citizenship.

c) All businesses claiming Small Disadvantaged Business status, whether as a result of BMWBO certification, or U.S. Small Business Administration certification as an 8(a) small disadvantaged business, must attest to the fact that the business has no more than 100 full-time or full-time equivalent employees.

d) All businesses claiming Small Disadvantaged Business status, whether as a result of BMWBO certification, or U.S. Small Business Administration certification as an 8(a) small disadvantaged business, must submit proof that their gross annual revenues are less than $20,000,000 ($25,000,000 for those businesses in the information technology sales or service business). This can be accomplished by including a recent tax return or audited financial statement.

2. All businesses claiming status as a Socially Disadvantaged Business must include in the Disadvantaged Business Submittal of the proposal clear and convincing evidence to establish that the business has personally suffered racial or ethnic prejudice or cultural bias stemming from the business person’s color, ethnic origin or gender. The submitted evidence of prejudice or bias must:

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a) Be rooted in treatment that the business person has experienced in American society, not in other countries.

b) Show prejudice or bias that is chronic and substantial, not fleeting or insignificant.

c) Indicate that the business person’s experience with the racial or ethnic prejudice or cultural bias has negatively impacted his or her entry into and/or advancement in the business world.

BMWBO shall determine whether the Offeror has established that a business is socially disadvantaged by clear and convincing evidence.

3. In addition to the above verifications, the Offeror must include in the Disadvantaged Business Submittal of the proposal the following information:

a) Those Small Disadvantaged Businesses submitting a proposal as the Offeror, must include a numerical percentage which represents the total percentage of the work (as a percentage of the total cost in the Cost Submittal) to be performed by the Offeror and not by subcontractors and suppliers. b) Those Small Disadvantaged Businesses submitting a proposal as a part of a joint venture partnership, must include a numerical percentage which represents the total percentage of the work (as a percentage of the total cost in the Cost Submittal) to be performed by the Small Disadvantaged Business joint venture partner and not by subcontractors and suppliers or by joint venture partners who are not Small Disadvantaged Businesses. Offeror must also provide:

1) The amount of capital, if any, each Small Disadvantaged Business joint venture partner will be expected to provide. 2) A copy of the joint venture agreement signed by all parties. 3) The business name, address, name and telephone number of the primary contact person for the Small Disadvantaged Business joint venture partner.

c) All Offerors must include a numerical percentage which represents the total percentage of the total cost in the Cost Submittal that the Offeror commits to paying to Small Disadvantaged Businesses as subcontractors. To support its total percentage DB subcontractor commitment, Offeror must also include:

1) The dollar amount of each subcontract commitment to a Small Disadvantaged Business; 2) The name of each Small Disadvantaged Business. The Offeror will not receive credit for stating that after the contract is awarded it will find a Small Disadvantaged Business.

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3) The services or supplies each Small Disadvantaged Business will provide, including the timeframe for providing the services or supplies. 4) The location where each Small Disadvantaged Business will perform services. 5) The timeframe for each Small Disadvantaged Business to provide or deliver the goods or services. 6) A signed subcontract or letter of intent for each Small Disadvantaged Business. The subcontract or letter of intent must identify the specific work, goods or services the Small Disadvantaged Business will perform and how the work, goods or services relates to the project. 7) The name, address and telephone number of the primary contact person for each Small Disadvantaged Business.

d) The total percentages and each subcontractor commitment will become contractual obligations once the contract is fully executed.

e) The name and telephone number of the Offeror’s project (contact) person for the Small Disadvantaged Business information.

4. The Offeror is required to submit two copies of its Disadvantaged Business Submittal. The submittal shall be clearly identified as Disadvantaged Business information and sealed in its own envelope, separate from the remainder of the proposal.

5. A Small Disadvantaged Business can be included as a subcontractor with as many prime contractors as it chooses in separate proposals.

6. An Offeror that qualifies as a Small Disadvantaged Business and submits a proposal as a prime contractor is not prohibited from being included as a subcontractor in separate proposals submitted by other Offerors.

B. Enterprise Zone Small Business Participation.

1. To receive credit for being an enterprise zone small business or entering into a joint venture agreement with an enterprise zone small business or subcontracting with an enterprise zone small business, an Offeror must include the following information in the Disadvantaged Business Submittal of the proposal:

a) Proof of the location of the business’ headquarters (such as a lease or deed or Department of State corporate registration), including a description of those activities that occur at the site to support the other businesses in the enterprise zone.

b) Confirmation of the enterprise zone in which it is located (obtained from the local enterprise zone office).

c) Proof of United States citizenship of the owners of the business.

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d) Certification that the business employs no more than 100 full-time or full-time equivalent employees.

e) Proof that the business’ gross annual revenues are less than $20,000,000 ($25,000,000 for those businesses in the information technology sales or service business). This can be accomplished by including a recent tax return or audited financial statement.

f) Documentation of business organization, if applicable, such as articles of incorporation, partnership agreement or other documents of organization.

2. In addition to the above verifications, the Offeror must include in the Disadvantaged Business Submittal of the proposal the following information:

a) The name and telephone number of the Offeror’s project (contact) person for the Enterprise Zone Small Business.

b) The business name, address, name and telephone number of the primary contact person for each Enterprise Zone Small Business included in the proposal. The Offeror must specify each Enterprise Zone Small Business to which it is making commitments. The Offeror will not receive credit for stating that it will find an Enterprise Zone Small Business after the contract is awarded or for listing several businesses and stating that one will be selected later.

c) The specific work, goods or services each Enterprise Zone Small Business will perform or provide.

d) The total cost amount submitted in the Offeror’s cost proposal and the estimated dollar value of the contract to each Enterprise Zone Small Business.

e) Of the estimated dollar value of the contract to each Enterprise Zone Small Business, the percent of the total value of services or products purchased or subcontracted that each Enterprise Zone Small Business will provide.

f) The location where each Enterprise Zone Small Business will perform these services.

g) The timeframe for each Enterprise Zone Small Business to provide or deliver the goods or services.

h) The amount of capital, if any, each Enterprise Zone Small Business will be expected to provide.

i) The form and amount of compensation each Enterprise Zone Small Business will receive.

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j) For a joint venture agreement, a copy of the agreement, signed by all parties.

k) For a subcontract, a signed subcontract or letter of intent.

3. The dollar value of the commitment to each Enterprise Zone Small Business must be included in the same sealed envelope with the Disadvantaged Business Submittal of the proposal. The following will become a contractual obligation once the contract is fully executed:

a) The amount of the selected Offeror’s Enterprise Zone Small Business commitment;

b) The name of each Enterprise Zone Small Business; and

c) The services each Enterprise Zone Small Business will provide, including the timeframe for performing the services.

II-10. Cost Submittal. The information requested in this Part II, Section II-10 shall constitute the Cost Submittal. The Cost Submittal shall be placed in a separate sealed envelope within the sealed proposal, separated from the technical submittal. The total proposed cost shall be broken down into the following components: SEE APPENDIX E (COST SUBMITTAL). Offerors should not include any assumptions in their cost submittals. Please refer to the Cost Proposal requirements contained in Part IV of this RFP document. If the Offeror includes assumptions in its cost submittal, the Issuing Office may reject the proposal. Offerors should direct in writing to the Issuing Office pursuant to Part I, Section I-8, of this RFP any questions about whether a cost or other component is included or applies. All Offerors will then have the benefit of the Issuing Office’s written answer so that all proposals are submitted on the same basis. II-11. Domestic Workforce Utilization Certification. Complete and sign the Domestic Workforce Utilization Certification contained in Appendix B of this RFP. Offerors who seek consideration for this criterion must submit in hardcopy the signed Domestic Workforce Utilization Certification Form in the same sealed envelope with the Technical Submittal.

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PART III

CRITERIA FOR SELECTION III-1. Mandatory Responsiveness Requirements. To be eligible for selection, a proposal must be:

A. Timely received from an Offeror;

B. Properly signed by the Offeror. III-2. Technical Nonconforming Proposals. The two (2) Mandatory Responsiveness Requirements set forth in Section III-1 above (A-B) are the only RFP requirements that the Commonwealth will consider to be non-waivable. The Issuing Office reserves the right, in its sole discretion, to (1) waive any other technical or immaterial nonconformities in an Offeror’s proposal, (2) allow the Offeror to cure the nonconformity, or (3) consider the nonconformity in the scoring of the Offeror’s proposal. III-3. Evaluation. The Issuing Office has selected a committee of qualified personnel to review and evaluate timely submitted proposals. Independent of the committee, BMWBO will evaluate the Disadvantaged Business Submittal and provide the Issuing Office with a rating for this component of each proposal. The Issuing Office will notify in writing of its selection for negotiation the responsible Offeror whose proposal is determined to be the most advantageous to the Commonwealth as determined by the Issuing Office after taking into consideration all of the evaluation factors. III-4. Evaluation Criteria. The following criteria will be used in evaluating each proposal:

A. Technical: The Issuing Office has established the weight for the Technical criterion for this RFP as 50 % of the total points. Evaluation will be based upon the following in order of importance: Understanding the Problem Soundness of Approach Offeror Qualifications (to include a minimum of three references for projects of a similar Size and Scope) Hosting Facilities Personnel Qualifications B. Cost: The Issuing Office has established the weight for the Cost criterion for this RFP as 30 % of the total points. C. Disadvantaged Business Participation: BMWBO has established the weight for the Disadvantaged Business (DB) Participation criterion for this RFP as 20 % of the total points. Evaluation will be based upon the following in order of priority:

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Priority Rank 1 Proposals submitted by Small

Disadvantaged Businesses. Priority Rank 2 Proposals submitted from a joint

venture with a Small Disadvantaged Business as a joint venture partner.

Priority Rank 3 Proposals submitted with

subcontracting commitments to Small Disadvantaged Businesses.

Priority Rank 4 Proposals submitted by Socially

Disadvantaged Businesses.

Each DB Participation Submittal will be rated for its approach to enhancing the utilization of Small Disadvantaged Businesses and/or Socially Disadvantaged Businesses. Each approach will be evaluated, with Priority Rank 1 receiving the highest score and the succeeding options receiving scores in accordance with the above-listed priority ranking. To the extent that there are multiple DB Participation submittals that offer subcontracting commitments to Small Disadvantaged Businesses, the proposal offering the highest total percentage commitment shall receive the highest score in the Priority Rank 3 category and the other proposal(s) in that category shall be scored in proportion to the highest total percentage commitment offered.

To qualify as a Small Disadvantaged Business or a Socially Disadvantaged Business, the Small Disadvantaged Business or Socially Disadvantaged Business cannot enter into subcontract arrangements for more than 40% of the total estimated dollar amount of the contract. If a Small Disadvantaged Business or a Socially Disadvantaged Business subcontracts more than 40% of the total estimated dollar amount of the contract to other contractors, the Disadvantaged Business Participation scoring shall be proportionally lower for that proposal.

D. Enterprise Zone Small Business Participation In accordance with the priority ranks listed below, bonus points in addition to the total points for this RFP, will be given for the Enterprise Zone Small Business Participation criterion. The maximum bonus points for this criterion is 3% of the total points for this RFP. The following options will be considered as part of the final criteria for selection:

Priority Rank 1 Proposals submitted by an Enterprise

Zone Small Business will receive three percent bonus for this criterion.

Priority Rank 2 Proposals submitted by a joint

venture with an Enterprise Zone Small Business as a joint venture

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partner will receive two percent bonus for this criterion.

Priority Rank 3 Proposals submitted with a

subcontracting commitment to an Enterprise Zone Small Business will receive the one percent bonus for this criterion.

Priority Rank 4 Proposals with no Enterprise Zone

Small Business Utilization shall receive no points under this criterion.

To the extent that an Offeror is an Enterprise Zone Small Business, the Offeror cannot enter into contract or subcontract arrangements for more than 40% of the total estimated dollar amount of the contract in order to qualify as an Enterprise Zone Small Business for purposes of this RFP.

E. Domestic Workforce Utilization: Any points received for the Domestic Workforce Utilization criterion are bonus points in addition to the total points for this RFP. The maximum bonus points for this criterion is 3% of the total points for this RFP. To the extent permitted by the laws and treaties of the United States, each proposal will be scored for its commitment to use domestic workforce in the fulfillment of the contract. Maximum consideration will be given to those Offerors who will perform the contracted direct labor exclusively within the geographical boundaries of the United States or within the geographical boundaries of a country that is a party to the World Trade Organization Government Procurement Agreement. Those who propose to perform a portion of the direct labor outside of the United States and not within the geographical boundaries of a party to the World Trade Organization Government Procurement Agreement will receive a correspondingly smaller score for this criterion. Offerors who seek consideration for this criterion must submit in hardcopy the signed Domestic Workforce Utilization Certification Form in the same sealed envelope with the Technical Submittal. The certification will be included as a contractual obligation when the contract is executed.

III-5. Offeror Responsibility. To be responsible, an Offeror must submit a responsive proposal and possess the capability to fully perform the contract requirements in all respects and the integrity and reliability to assure good faith performance of the contract. In order for an Offeror to be considered responsible for this RFP and therefore eligible for selection for best and final offers or selection for contract negotiations:

A. The total score for the technical submittal of the Offeror’s proposal must be greater than or equal to 70% of the available technical points;

and

B. The Offeror’s financial information must demonstrate that the Offeror possesses the financial capability to assure good faith performance of the contract. The Issuing

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Office will review the Offeror’s previous three financial statements, any additional information received from the Offeror, and any other publicly-available financial information concerning the Offeror, and assess each Offeror’s financial capacity based on calculating and analyzing various financial ratios, and comparison with industry standards and trends.

An Offeror which fails to demonstrate sufficient financial capability to assure good faith performance of the contract as specified herein may be considered by the Issuing Office, in its sole discretion, for Best and Final Offers or contract negotiation contingent upon such Offeror providing contract performance security for the first contract year cost proposed by the Offeror in a form acceptable to the Issuing Office. Based on the financial condition of the Offeror, the Issuing Office may require a certified or bank (cashier’s) check, letter of credit, or a performance bond conditioned upon the faithful performance of the contract by the Offeror. The required performance security must be issued or executed by a bank or surety company authorized to do business in the Commonwealth. The cost of the required performance security will be the sole responsibility of the Offeror and cannot increase the Offeror’s cost proposal or the contract cost to the Commonwealth. Further, the Issuing Office will award a contract only to an Offeror determined to be responsible in accordance with the most current version of Commonwealth Management Directive 215.9, Contractor Responsibility Program.

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PART IV

WORK STATEMENT

WORK STATEMENT/REQUIREMENTS

RFP # 6100019963 INTERNET BASED ELECTRONIC MEDICAL RECORDS (EMR) SYSTEMS SERVICES FOR THE DEPARTMENT OF MILITARY AND VETERANS

AFFAIRS HEADQUARTERS AND SIX (6) STATE VETERANS’ HOMES

Table of Contents

IV-1. Objectives ...................................................................................................................... 27 IV-1.1. General ................................................................................................................. 27 IV-1.2. Specific ................................................................................................................. 27

IV-2. Nature and Scope of the Project .................................................................................... 29 IV-3. Requirements ................................................................................................................. 31

IV-3.1. Functional Requirements ...................................................................................... 31 IV-3.1.1. Activities .......................................................................................................... 31 IV-3.1.2 Admissions/Pre-Admissions ............................................................................... 32 IV-3.1.3. Application Security.......................................................................................... 35 IV-3.1.4. Billing/Revenue ................................................................................................ 38 IV-3.1.5. Clinical Applications ......................................................................................... 42 IV-3.1.6. Clinical Reports ................................................................................................ 49 IV-3.1.7. Dietary ............................................................................................................ 51 IV-3.1.8. Health/Risk Management ................................................................................. 53 IV-3.1.9. Pharmacy ........................................................................................................ 55 IV-3.1.10. Point of Care .................................................................................................. 59 IV-3.1.11. Therapy ......................................................................................................... 60

IV-3.2. Technical Requirements ....................................................................................... 61 IV-3.2.1. General ........................................................................................................... 61 IV-3.2.2. Compliance ...................................................................................................... 61 IV-3.2.3. Customization/Technology Requirements.......................................................... 62 IV-3.2.4. Training ........................................................................................................... 62 IV-3.3.5 Hosting ............................................................................................................. 62

IV-4.1 Create Project Plan ................................................................................................ 65 IV-4.2 Confirm Requirements .......................................................................................... 66 IV-4.3 Plan and Manage Change ...................................................................................... 66 IV-4.4 Perform and Document Analysis & Design .......................................................... 66 IV-4.5 Plan and Execute Data Migration .......................................................................... 67 IV-4.6 Create User Acceptance Test Plan ........................................................................ 67 IV-4.7 Execute User Acceptance Test and Report Test Results ....................................... 67 IV-4.8 Information Security Assessment .......................................................................... 67 IV-4.9 Deploy Integrated Solution ................................................................................... 67 IV-4.10 Develop and Execute a Training Plan ................................................................. 68

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IV-4.11 Provide Maintenance and Support ...................................................................... 68 IV-4.12 Develop and Execute a Transfer Plan ................................................................. 68

IV-5. Reports and Project Control ......................................................................................... 68 IV-5.1 Project Meetings .................................................................................................... 68 IV-5.2 Status Reports ........................................................................................................ 69 IV-5.3. Problem Identification Reports ........................................................................... 69 IV-5.4. Final Report .......................................................................................................... 69

IV-6. Contract Requirements—Disadvantaged Business Participation and Enterprise Zone Small Business Participation................................................................................................... 69

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PART IV

STATEMENT OF WORK IV-1. Objectives IV-1.1. General The Department of Military and Veterans Affairs (DMVA) operates six Veterans Homes located throughout the Commonwealth, with the potential of adding remote facilities in the future. The Homes currently utilize various software packages for maintaining electronic health care records. The agency goal is to merge PrimeCare/QS1, Gerri Menu, ULTRACare and Solace functionality to the greatest extent possible, while having an interface with Resource Systems' CareTracker. The use of one electronic medical record (EMR) application will provide a complete overview of the resident that would include census, reimbursement, diagnosis, allergies, personal contacts, medical assessments, ADT (Admission, Discharge, Transfer) information, RAM (Resident Account Management), care plans, progress notes, medication management information, physician orders, eMAR/eTAR information (Medication/Treatment Administration Records), drug interactions and patient education, prescription/medicine ordering, dietary, and therapeutic information. The accuracy of documentation would improve by eliminating duplicate data entry by utilizing one application. This would improve the level of care in the Homes by allowing more staff hours for hands-on care. IV-1.2. Specific The Department of Military and Veterans Affairs expects to accomplish the following through this procurement:

1. Implementation and ongoing, hosted operations of a secure, internet-based Electronic

Medical Record (EMR) with 24x7 availability as specified in the requirements Section (IV-3) of this document.

2. Minimum Mandatory Requirements a. The selected offeror must have 3 years experience in hosting solutions of a

similar size and complexity.

b. Solution must be hosted in a certified Tier 3 facility. 3. The new EMR System will address the following areas:

a. Activities – Documentation of all scheduled activities the facility provides for residents and the resident’s participation.

b. Admission/Discharge/Transfer (ADT) – maintain resident information and census activity for all areas including retaining pre-registration/admission information from the first contact with the resident.

c. Pre Admission – Enter prospect information that can be transferred upon the prospect’s admission.

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d. Dietary – analyzes meals, recipes, resident intake, and assists the dietician in developing menus, assessing resident needs, printing tray cards, food labels, menu changes, production reports, and nutritional analysis.

e. ePrescribing – A bi-directional interface that allows for streamline medication ordering and reordering to the resident’s pharmacy/pharmacist to review and dispense.

f. Electronic medication management – allow for maintaining of medication orders, chart order administration and vitals at point of care (eMAR/eTAR), checks for adverse drug interactions and allows for computerized medication ordering and reordering.

g. Drug interaction and patient education – Allows the provider to check for drug – drug, drug-allergy, drug-disease, drug-food alerts, therapeutic duplication and ingredient duplication before they are prescribed. Automatically checks prescriptions and posts alerts for known interactions. Provides written medication information for resident and their family.

h. Accounts receivable and billing – allows for the displaying/documentation of a resident account, room and board(R&B)/ancillaries, cash receipts, adjustments, transaction process, print bills, estate billing, and insurance processing.

i. Resident funds (resident trust) – A resident’s money account that is used by the facility for the resident’s use/needs only. Allows for deposits, withdrawals, and adjustments; calculate interest; print resident fund statements; and display and/or print several resident fund reports.

j. Care plans – Each resident has a general plan of care, and the foundation is determined by the policy of the health care facility. However, generally the care plan covers all treatments, medications and therapies ordered for the patient. Goals are also stated for resident care.

k. Physician orders – documents date and time of treatments and medications ordered by treating physicians. These are to be signed by the physician ordering, even if telephones order or phone/verbal order given to a nurse.

l. Resident assessment (MDS 3.0) – electronic data collection and availability of data for creation of the plan of care and goal setting. It may be limited to an overall plan of care, or may allow for discipline-specific plans of care (e.g., therapy plans of care and nursing plans of care)

m. User-defined assessments - ability to create and maintain complete and comprehensive assessment forms that a user can customize to a facility’s specific needs.

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n. Incidents – form is to be completed any time a medical incident takes place, no matter the severity.

o. Interdisciplinary progress notes – documents progress of each therapeutic department in chronological order, rather than a separate progress note maintained by each department. This may include notes made by more than one department, such as speech, physical and occupational therapies.

p. eCharting including eMAR and eTAR – allows for electronic medication administration records (eMAR) and treatment administration records (eTAR) to be accomplished with a streamlined, automated method to document care.

q. Wounds – allows for the staff to assess the status of a resident's wounds, as well as the conditions or factors impacting development and/or healing, current treatment, recent laboratory findings, probable causes, and a response or action plan.

r. Vitals - Allows for documentation (record, change, delete, and review) and reports of a resident's vitals including weight, height, blood pressure, etc.

s. Intake/Output – Allows for documentation (record, change, delete, and review) and reports of a resident's Intake/Output.

t. Consolidated Reporting – Allows for the consolidation of data across several facilities and combine that data into one report. The information could be occupancy, age, RUGS, statistics, accounts receivable, census, case mix, etc.

u. Health/Risk Management – Allow for documentation of vaccine administered for staff and residents

v. Therapy – allows for a complete management/documentation of a resident’s therapy from assessment to billing.

2. Capable of utilizing wireless point of service handheld devices and bar coding/scanning technology.

IV-2. Nature and Scope of the Project Pennsylvania provides care for its veterans and their spouses in six state run residential care facilities throughout the Commonwealth, with the potential of adding remote facilities in the future. The level of care provided includes personal care, skilled nursing care, domiciliary care, and dementia care. Documentation requirements for the system of long term care facilities follow state Department of Health (DOH), Department of Public Welfare (DPW), and federal Centers for Medicare/Medicaid Services (CMS) guidelines for skilled nursing facilities and personal care homes. State Veterans Homes also meet U.S. Department of Veterans Affairs requirements for skilled nursing and domiciliary care. The electronic medical record will support the following in approximate numbers:

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1. The Delaware Valley Veterans Home located in Philadelphia can provide for 171 residents.

Number of domiciliary and personal care residents 41 Number of skilled nursing residents 130 Number of employees 209 Number of doctors 1 Number of nurses 129 Average number of monthly claims 45 Average number of physician prescriptions monthly 4200 Average number of meals served monthly 15300 Average number of activities scheduled monthly 250

2. Gino J. Merli Veterans Center located in Scranton can provide for 200 residents.


3. Hollidaysburg Veterans Home located in Hollidaysburg is the largest of the state's

veteran’s homes and can provide for 514 residents.


4. Pennsylvania Soldiers' and Sailors' Home located in Erie can provide for 207

residents.

Number of domiciliary and personal care residents 100 Number of skilled nursing residents 107 Number of employees 211 Number of doctors 1

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Number of nurses 140 Average number of monthly claims 168 Average number of physician prescriptions monthly 3954 Average number of meals served monthly 16740 Average number of activities scheduled monthly 190

5. Southeastern Veterans Center located in Spring City can currently provide for 192

residents. Future plans will support 304 residents, 56 domiciliary/personnel care and 248 skilled nursing residents.


6. Southwestern Veterans Center in Pittsburgh can provide for 236 residents.

Number of domiciliary and personal care residents 32 Number of skilled nursing residents 204 Number of employees 257 Number of doctors 2 Number of nurses 187 Average number of monthly claims 249 Average number of physician prescriptions monthly Average number of meals served monthly 21150 Average number of activities scheduled monthly 257

IV-3. Requirements IV-3.1. Functional Requirements IV-3.1.1. Activities

There is a requirement for the EMR solution to include functionality for Activities. This functionality must address the needs of the DMVA long term care facilities by complying with the F248 regulations that govern activities in long-term care facilities. The current Activities process is accomplished utilizing MDI Achieve ULTRACare through their care plan goals, birthday lists, religious list, Military Affairs Activities Assistants' quarterly, annual notes, MDS 3.0 and 802 reports and through Resource System’s CareTracker. We require the use of an electronic based therapeutic activities assessment (Admission, Annual and Significant Change Assessments) as the basis/reference of generating many

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of the following reports for the Activities department. The assessments are done at admission, quarterly, annually and any other significant change. Much of the information needed for activity reports is present on these assessments. For example: religious affiliation, level of mobility, activity interests, preferred activity setting, preferred time to participate in scheduled activities, average time involved in activities, diet, registered voter, interested in voting, aggressive or assaultive list of residents, birthday, and branch of service. The new EMR system must have the ability to flag staff for Residents who have increased falls or behavior problems as we care plan many Residents who exhibit problems in these areas. Activities Reports For a list of current Activities reports generated from ULTRACare and CareTracker, see APPENDIX G – Activities Reports. We require the list of reports in APPENDIX G - Activities Reports to be generated by the new EMR system for Activities. The new EMR system must allow users to run Activity Reports based on data entered into the system and allow users to select what data is generated in a particular report. The ability to generate reports must be user friendly and easy to obtain, without having to go thru several screens or programs. Users require options to define needs, such as to print by resident or unit. Each report must be previewed on the screen allowing the choice to print. All data entered into the system for a particular resident as part of an activity assessment needs to be included in the resident form for that particular assessment whether it is an admission, quarterly, annual or a significant assessment.

IV-3.1.2 Admissions/Pre-Admissions There is a requirement for the EMR system to include functionality for Pre-Admissions and Admissions. This must address the needs of the DMVA long term care facilities by allowing data to flow from Pre-Admissions to Admissions and all information is accessible from the resident’s EMR. The current Pre-Admissions and Admissions process is accomplished through MDI Achieve ULTRACare and through the use of Microsoft Excel sheets to maintain resident numbers. DMVA has specified a set of requirements in this section of the RFP. The Pre-Admissions module must give the ability to transfer key information to a new admission record upon move in. This is one of the first and most important features in setting up a reliable, accurate resident database. The Admissions/Resident Information area is considered the “central library” of all resident information that will be shared to the MDS Assessment, Clinical, AR/Billing, and Health Risk Management modules. These functions are essential and required in the new EMR system. It is typically used by more staff than any other module because of its comprehensive database of information related to these areas which include the current and historical details:

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• Admission History • Leave of Absence Details • Billing Controls • Medical Information • CCRC Related Details • Military Service History • Contact Persons • Room Rate Details • Diagnosis History • Room/Location History • Financial Resource Details • Special Service Details • Incident Details • Status Tracking History • Insurance Details • Tabular Display of Details

The key features of the current Admission and Pre-Admissions modules that are required are:

• Security access can be customized for each user to properly control and audit their activity • Easy on-line, immediate access to current and historical resident information • One-touch maintenance of resident data across all modules • Time-saving, flexible reporting provides easy listings, analysis and exporting of data • Information gathered during the pre-admission process can be automatically transferred to the resident’s admission information • Each new resident admission automatically notifies billing and clinical users of the census change, establishes a schedule for assessments due by type, provides information to open a resident trust fund account, and provides key information to begin the assessment and clinical care plan. • Assisted Living and Medicare Screening assessments • Room/locations assigned to residents automatically enable room rosters and an available room lookup • Digital imaging including resident pictures, documents, and other items • Integration with Microsoft Office • User definable codes tables used for resident information tracking • Easy data entry to maintain a database of resident information including their address (current and date-sensitive seasonal), phone numbers, email addresses, demographics, census history, billing and payment history, etc. • Veteran-specific demographics • VA forms 10-10EZ and EZR, VA 10-10SH, VA-10-5588 including auto-remit • Veteran Service Organization tracking and reporting

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• Multiple, detailed contacts information for each resident including their relationship, address (current and date-sensitive seasonal), phone numbers, email address, etc. • Maintain schedules for resident doctor appointments, activities, and other events • Keep residents and their families updated on community events via mail merge features • Use existing Microsoft Word forms to create on-the-fly customized documents • Create and send email notes and letters directly from the contact information screens • Unlimited on-line notes for handy resident specific information documenting • Admission agreement packet created by DMVA must populate key fields in admissions just as it currently does

The additional requirements are categorized below as Pre-Admission Resident Files, Pre-Admissions Reports, Admission/Resident File, Admission Data Reports, and Special Reports. Pre-Admissions Resident Files The EMR system must have the ability to input all resident information into the pre-admission software and transfer this information to the resident’s permanent admission file/record on the actual day of admission. It is anticipated this transfer will occur by entering the resident’s medical record number in the system on the day of admission. Resident numbers are assigned several days before arrival. Our current system does not support reassigning a resident number due to unscheduled admissions. As a result, the Admissions staff must manually maintain a Microsoft Excel spreadsheet of resident numbers outside of the system. The new system is required to allow the seamless flow of data from Pre-Admissions to Admissions. The new system should allow for the deletion of the resident pre-admission number if the admission was not necessary. It should provide the ability to print admission forms from the pre-admission data. The system should also allow an authorized user to manually input a medical record number for use as the admission number. Pre-Admissions Reports There is a requirement to run pre-admissions reports to show only the data selected for the particular report (i.e. inquiry number, prospective resident’s name, and application date). The reports must be able to be exported to Microsoft Excel. Admissions/Resident Files The admissions/resident file should be displayed in a manner similar to that of a person using an actual paper chart. It should flow from screen to screen without having to close one area to access another. User roles should control access to view and edit the data. Admissions Data Reports

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Admissions data reports should present accurate data within a reasonable amount of time. The reports will allow ad hoc reporting for any scenario due to the facility not knowing what report will be needed at any given time. There are many different reports needed for the various organizations that perform audits and state inspections of each facility. At present these reports are not easy to produce and require a great amount of time to generate as information is not easily found. Admissions marketing reports are required to show trends that may include number of admissions and where admissions applications came from. At a minimum, the following Admissions Data Reports are required: • Report that will show current admission date. • Number of residents that received Flu Vaccine ~ Pneumonia Vaccine

(Contraindicated, Religious Beliefs, Resident Refused, Allergies, Illness/Medical condition, Vaccine unavailable, Had previously/not due, Family refused, POA refused, MD refused, No consent, Admitted after Flu Season).

• Numbers of residents with illness related to: Flu-like Symptoms, Confirmed Flu, Pneumococcal.

• Number of residents expired related to: Flu-like Symptoms, Confirmed Flu, Pneumococcal.

• Number of outbreaks determined by MD: Flu-like Symptoms, Confirmed Flu, Pneumococcal.

• Number of residents admitted to hospitals due to flu • Number of residents admitted to hospitals due to confirmed flu • Number of residents admitted to hospital due to pneumococcal disease • Number of residents admitted to hospital due to complications of flu • Number of residents admitted to hospital due to complications of pneumococcal

Special Reports The following special reports are required to give a true picture of our facility as well as our residents: • List of residents adjudicated incompetent through courts. • List of residents that have a fiduciary, or rep payee. • List of admissions for yearly or monthly. • List of transferred/discharged resident yearly, monthly, or quarterly. • List of Residents on Hospice. • List of names of residents 55 and under. • List of names and room numbers for residents that communicate with non-oral

communication devices, sign language, speak another dominant language than English.

• Lists of all residents with MH, MR, physical disabilities, dementia, mobility needs and any complex need.

• List of allergies for each resident - vital. • List of residents with specific diagnoses.

IV-3.1.3. Application Security

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The application security for the new EMR system must allow the DMVA to assign access using the established approved module matrix table below. Currently there is a Security Access Officer at the DMVA headquarters that assigns level of access using a standard form. This process must continue in the new system. The DMVA reserves the option to modify or update this matrix at any time. The employees’ assigned duty position establishes appropriate module access for only their assigned facility. The system must allow for DMVA headquarters staff, and certain few others, the ability to access information for all six facilities, with the potential of adding remote facilities in the future. The Offeror must provide system security access training to Security Access Officers and any other designated employees showing how to establish appropriate security and assign proper access to the system for the employees.

MODULE A Description Executive Level Number of

Users Includes Commandant

Business Manager Director of Nursing PC Administrator Commandant’s Secretary Executive Support

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Why Operation and Management, Executive Decisions for Health Care Operations

MODULE B Description Resident Care Plan Level Number of

Users Includes Medical Director

Physicians Medical Records Staff Pharmacy Staff Social Services Dietary Services Director Clinical Dietician Dietary Clerk Assistant Director of Nursing Registered Nurse Assessment Coordinator Nurse Instructor RN Supervisor Nursing Clerical Infection Control Coordinator

342

Why Treatment of Residents, coordination of treatment, diagnosis coding, medical inspections, investigations, quality review and compliance, medical file

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maintenance

MODULE C Description Financial Level Number of

Users Includes Accounting

Revenue Purchasing

79

Why For Oversight of Reimbursement, payment and financial services

MODULE D Description Direct Resident Care Level Number of

Users Includes Activities Aide

Physical Therapy Aide Registered Nurse Licensed Practical Nurse Certified Nurse Aide Adaptive Equipment Tech Dental Food Service Supervisor Physical Therapist Occupational Therapy Speech Therapy Ther. Rec. Svc. Supervisor Ther. Rec. Svc. Worker

1043

Why Treatment of Residents

MODULE E Description No Access Number of

Users

Includes

315

Why No need to access software due to transfer or separation

MODULE Q Description Quality Assurance Risk Assessment Number of

Users

Includes Quality Assurance Risk Assessment Coordinators Medical Records Directors

15

Why Overall Quality Assurance for facility to include the capability to change/delete data or information per DMVA’s Policy

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Presently, software monthly and quarterly updates are performed by the DMVA Bureau of Information Technology. Once updates are completed, the security access officer runs a software ID program updates process, which grants user access to the new programs. This is currently done in the security module of the existing system. This entails running updates when required, and providing access to software using the established standard access form. Users gain access to software by filling out the established form and taking the required Security level 1 and 2 training per Commonwealth and DMVA regulations. A link is provided on the DMVA Intranet site to allow access using terminal server to the current EMR application once the user is granted access by the security access officer. The security access officer requires only one report, currently referred to as the ULTRACare Users Management report. This report displays the facility, username, CWOPA ID, Staff ID number, and assigned access code. The EMR system must be able to generate the exact same information in a report.

IV-3.1.4. Billing/Revenue The new EMR system must provide revenue, accounts receivable, and billing capability. It must address the revenue and billing needs of the DMVA long term care facilities and be integrated with other EMR modules in such a way that it appears to be one system. The current revenue and billing software used in all six Veteran’s homes, with the potential of adding remote facilities in the future, is the MDI Achieve ULTRACare software A/R Billing Module. This module captures information used for residents’ billing and account information. It also captures information entered in the Admissions module and has an interface to SolAce Electronic Medical Claims, which is used to process various insurances, Medicare and Medicaid bills from the ULTRACare system. Each facility has its own representative, Revenue Officer, Clerk, Revenue Technician (facility reimbursements technicians) that use the software, for a total of 79 financial users. The receivable and billing module provides the following functionality which all are required. When you are ready to perform billing processing, you will find that all the data you need should have already been entered in the Admissions/Resident Information area. This is because the resident’s census and rate information is maintained as it changes from time to time. Ancillary charges can be entered or imported from outside ULTRACare throughout the month. An exhaustive library of reports is available for complete analysis of accounting and billing activity.

• All billing is census driven and date of service sensitive • RUGs scores calculated by the clinical MDS are imported to the billing system for accurate third party billing and follow through to the billing claim • A resident can be in multiple statuses at one time, even for multiple payers • Billing for many payer types is supported including Medicare A and B, Medicaid, HMOs, special contracts, managed care, etc. • Automatic pro-rating of room charges if a resident discharges

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• Detailed billing, payment, and adjustment transaction history viewable at any time • Ancillary charge importing from outside sources such as point of sale, telephone charges, medical supplies, and therapy providers • Retroactive billing featuring a clear accounting trail of transactions • Exception reporting of billed vs. census days • Easy on line notes for you to maintain charge-specific documentation • Plain-paper style private statements which can include your color logo • Extensive billing and accounting analysis reporting • Bank Draft Batch Processing for auto-payment of private charges • Positive Pay export file for resident funds quality control • Assisted Living Rent Rosters • Medicare Therapy Cap reporting • Collections processes to manage AR • Complete Resident Trust Fund accounting - multiple accounts for each resident (separate from the resident’s AR account) including statements, reports, and 1099s. • Easy cash receipts entry with the ability to print receipts • DMERC billing and claims processing • GL journal entries easily created at month end for posting to 3rd party accounting systems

The additional requirements are categorized below into Billing, Enhanced Veterans Reimbursement (EVR), Reports, Forms, and miscellaneous requirements. Billing There is currently an interface between ULTRACare and SolAce to process billing for various insurance providers, Medicare, and Medicaid. Users of ULTRACare can print encounters before transmitting to SolAce. SolAce users can also print reports before transmitting to the payer. Currently ULTRAcare does permit the deletion of entire batches. An example batch is billing for one month, ten encounters in one batch. We do not want to delete any batch after posting the batch to the residents account because it interferes with other transactions in the account. We do want to know why an adjustment was made and not just delete a batch. However, there must be an ability to delete before posting, and the process is as follows:

1. Creating the encounter 2. Printing and Reviewing the encounter within that batch 3. Posting or finalizing the batch

The current A/R module in ULTRACare has the following billing options:

• display resident account • room and board (R&B)/ancillaries • cash receipts • adjustments • transaction process

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• print bills • state billing and process insurance

Insurance carrier information is important for the billing process and should be included in the new EMR system. This includes the billing sequence or priority for billing of each insurance or payer. Billing features, specific to the DMVA facilities, are required to be in the new EMR system. They are electronic payment posting of Medicaid remittance Advices, 10-5588 VA billing, and Resident Assessment Calculation. The electronic payment posting of Medicaid remittance Advices will provide a more efficient process for posting payments (Medicaid payments). For 10-5588 VA billing, we are required by the VA to provide daily census information to the VA in support of the monthly VA billing. In addition, the current software program provides a detailed report (census days, daily rate and monthly billing amount) listing each eligible veteran resident and the related billing amount for each resident. The total of this report ties into the amount we bill the VA per the 10-5588. The new EMR system will be required to generate a completed 10-5588 form to avoid re-typing the same information onto the VA form 10-5588. It must also be able to differentiate the amount that we bill Medicaid versus the amount that we bill VA as residents may have both coverage’s. The current system posts the VA per diem amounts to the resident ledger. The new EMR system is required to include a resident assessment calculation. The calculation of resident maintenance fees is unique to some State Veterans. The capability to perform this calculation and report who receives Aid & Attendance will need to be performed. The report provides the information when a resident was assessed, the amount of the previous fee, the new fee, and the date of the assessment. Enhanced Veterans Reimbursement (EVR) On January 1, 2009, the DMVA Bureau of Veterans’ Homes implemented an Enhanced Veterans Reimbursement (EVR) Program in each of its six veterans’ homes, with the potential of adding remote facilities in the future. Enrollment in EVR allows the generation of additional federal funds with minimal state expenditures. Currently these calculations are performed in our ULTRACare system. The new EMR system must be able to execute the EVR calculations. DMVA will provide the current calculations and regulations. Reports We require the ability to run ad hoc reports with multiple filtering capabilities. The EMR Revenue/Billing must have the ability to export all reports into Microsoft Office. We require various reports for EVR, VA, and Assessments. We require the following additional reports:

• Residents who are receiving aid and attendance • Residents who receive certain pensions

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• Residents who receive Social Security (and like benefits) • Residents who received Social Security benefits on a monthly basis • Residents who receive VA pensions (including Aid & Attendance) • Residents who receive outside private pension • Total income for residents • A/R Aging Reports by separate payer source • A/R Aging Reports by multiple payer sources • A/R Aging Reports for the status of maintenance fee balances • A/R Aging Reports provides the details related to Insurance (Medicare, Medicaid)

accounts receivable status on resident account balances due • On demand Assessment Report to provide a listing of residents with their most

current assessment date, most current assessment amount, and personal needs allowance amount

• Ability to track medical supplies and equipment for each individual resident utilizing the bar code

Forms The new EMR system must be able to generate the Face Sheet that accompanies the resident to the hospital. All insurances, including Medicare and Medicaid and secondary insurances must appear on the Face Sheet in priority order. The DMVA also requires the ability to manipulate forms so that changes and additions to the forms can be updated as needed. Miscellaneous Requirements The following Billing/Revenue miscellaneous requirements must be addressed in the new EMR system:

• Ability to calculate the prorated fees for residents admitted and discharged at various times during the month (current software provides only a full month)

• Ability to print monthly statement and estate billing notices monthly or quarterly • Ability to send balance due letters with options to customize the report to meet

our need for an explanation (i.e. “Please make payments by the 1st of the Month” or “This statement does not include your estate billing”)

• Ability for pertinent documents that impact various departments’ needs to be included as a drop down tab in the resident’s information (i.e. scanned in copy of insurance card, accompany Face Sheet, etc.)

• Ability to interface with CareTracker to track physician visits for utilizing regulations for billing and compliance.

• Ability to track sick visits to augmentation under Medicare Part B • Ability to have Medicare Fees automatically posted so that they do not have to be

individually entered by procedure code • Maintain an A/R collection log for each resident to include date of contact,

method of communication (telephone call; personal to person discussion; collection letters), and the ability to enter summary information relating to the contact such as “resident indicated payment will be made in 2 weeks”

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IV-3.1.5. Clinical Applications

There is a requirement for our new EMR system to include Clinical Applications functionality. It must address the needs of the DMVA long term care facilities and be integrated with other EMR modules in such a way that it appears to be one system. The Clinical Applications module is critical to our EMR solution. The Clinical Applications module software currently used in all six Veteran’s homes, with the potential of adding remote facilities in the future, is the MDI Achieve ULTRACare software. It is an advanced care plan and medical records system that integrates with the Admissions module to access resident information from a centrally shared file, similarly, information entered in the Clinical Applications module is used in the Accounts/Receivable Billing module. Our current Clinical Applications Module features the following options: Care Plan, Resident, Physician Orders, Assess, and Setup. The Clinical Application module can be broken down into the following areas to show the current features - Assessments, Resident Care Plan, Resident Clinical and Electronic Medical Records, and Physicians, Medications, and Treatment Orders. All of these area and functionality are required in the new EMR for Clinical Applications. Assessments Features The MDS 3.0 assessment is the key component of the Assessment section of the Clinical Application module. ULTRACare provides for the entry of all required MDS forms and maintains a complete on line history. Each assessment is evaluated and automatically produces the Care Area Assessment Trigger and Summary. Case mix, RUGs, and full detailed reporting is supported to provide staff with all the resources they need to properly manage the assessment and submission schedule.

• Comprehensive MDS related reporting • CMS 672 and 802 forms and analysis reports • Facility QI profiles • Export of MDS answer detail to Microsoft Excel • Nursing Time Requirements • Assessments due by date and type • MDS Query to search for selected answers by resident • ADL Status and Condition statistics • Swing Bed MDS • Consistent, “by the rules” logic throughout for reliable use • Interfaces with Resource Care Tracker®

Resident Care Plan Features

• Complete resident plan of care maintenance and reporting • Library of problems, goals and approaches that can be user modified • Easy reporting of resident’s problems as documented in care planning • Tracking of care plan schedule and physicians orders review • User definable Care Plan problems that are automatically assigned per CAA trigger

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Resident Clinical and Electronic Medical Records Features

• Assisted Living Support Plans and user definable library • Incident Tracking supported by user definable codes used for type and location of incident • Detailed Incident analysis by date, time, location, etc. • Chart labels and wrist band printing • Discipline Responsibility reports by Care Plan approach • Flow Sheets (Standing Orders) • Nurse Assistant Flow Sheet • Progress Notes and label printing • 24 hour shift notes • Weight variance reporting • Focus Assessments for current and historical tracking of

AIMS Examination Bowel and Bladder Training Elopement Risk Fall Risk Mental Status Mini Mental Pain Restraints Sentinel Event (JCAHO) Skin Integrity Risk Smoking Risk Wander Risk Wounds

• Diagnostic Tests tracking • Vital Statistics tracking including

Weight schedules Interface with Resource Care Tracker Interface with Nurse Rosie Import and export statistical data

• Record resident intake and output • Print a resident’s chart or forms information from multiple records areas • Maintain resident schedules for appointments, activities, events, etc. and report on “missed” items and schedule conflicts

Physicians, Medication, and Treatment Orders Features

• Record, update, and print orders • eMAR and eTAR signatures by shift, med cart, and physician • Exception reports

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The additional requirements for Clinical Applications are categorized below into eMAR and eTAR, Orders, Documentation, Weights, Vitals, Wounds, Scheduling, MDS and Care Plans, Assessments, Medical Information, and Incidents and Accidents. eMAR and eTAR The new EMR system must integrate with the pharmacy software. It must have the ability for MAR and TAR to be computerized for LPN/RN entry purposes, easy look up, and report generation for other pharmacy, QA, and Nursing staff. Other necessary requirements for the eMAR/eTAR are:

• Ability to look up medication side effects and other pertinent data such as maximum acceptable dose, contraindications (replacing the nurse desk drug reference), send notification reference updates, send alerts such as withdraws from market, and notification of interacting medications

• Using alerts, reminders of missed medications or missed residents • Alerts for allergies

Orders The EMR software must have a section for Orders. In addition to what is currently in our software which includes Physician orders, treatment records, medication records, and diagnosis, we require the following:

• Orders by physicians, must be electronic (paperless) using a Computerized Physician Order Entry (CPOE) system

• Electronic orders accessible using mobile devices (physicians want wireless bedside devices)

• Electronic orders to interface with the Pharmacy • Decision support to interoperate with Pharmacy to advise and notify physician of

any concerns about medication regimen • Improved documentation of resident preferences about life-sustaining care, detail

of resuscitation, and treatment-limiting orders. Must be able to update DOH Pa Orders for Life Sustaining Treatment (POLST orders) forms as they change

• On admission orders, the physician will be given options regarding resident preferences (CPR, DNR, hospital transfer only, IV fluids, enteral feeding, etc)

• Notification to designated staff of pertinent labs to be monitored for medications and listing of therapeutic drug levels

• Alerts to advice nurses and pharmacists when a new order is written including new restraint orders, new therapy orders, new orders for adaptive equipment or assistive devices and enablers

• Reminder or alert for the Social Worker or Physician to complete an advance directive documentation form for life sustaining treatment preferences

• Reminder or alert for verbal orders (electronic signatures required on verbal and phone orders)

• Ability for a Physician or designee to write an order for resident’s capability • Ability to bring back suspended orders on admission to hospital with readmission • Ability to generate report on monthly orders which need electronic signature (sign

off on monthly orders)

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• Ability for nurses to compare EMARs and ETARs, CNA treatments and devices to new monthly orders

• Be able to coordinate diet and supplement changes with main charting system and online pharmacy

Documentation Documentation in the new EMR system is extremely important for Physicians, Nursing and the Interdisciplinary Team. The system must have specific areas for documentation. We have categorized our documentation requirements into Physician, and Nursing and Interdisciplinary:

Physician Requirements for Documentation: • Medical Directors require the display of the MAR list (ability to view drug

regimen) and integrate and display labs and all medical imaging systems (MXI, PACS)

• Electronic transfer of information to consulting physicians, hospitals (including advance directives, labs, X ray results)

• Physician History and Physical templates • Templates for Physician Encounters incorporating billing codes and capabilities • Electronic Physician Discharge Summary

Nursing and Interdisciplinary Requirements for Documentation: • Ability to enter progress notes and monthly summary • Generate progress note reports for various disciplines, notes specific to residents,

shift notes, unit progress specific notes, and compliance notes • Ability to input vitals, dialysis information, input/output, and Accu-Check • Ability to import data from XRAY and LAB into the chart. The XRAY and LAB

data should imported in its native format • Ability to scan documents directly into the system (record acquisition system) • Electronic templates that meet current clinical guidelines to assist in nursing

documentation (i.e. resident with a recent head injury) • Automated reminders for documentation in order to improve regulatory

compliance • An interdisciplinary Discharge Program/Planning flow sheet which also provides

medication profile for discharge • A separate "restorative program" section of the system to track and measure

residents participation and progress with the restorative nursing program • Ability to see a resident's previous documentation notes when documenting. This

will increase the nurse’s ability to assess a change in resident condition and provide a detailed report to the physician

• As progress notes are amended, the original progress note must be linked to the amended note

• If focus codes are used for progress notes, the system must have the ability to re-classify/change focus code if entered incorrectly so notes can be sorted for reports appropriately

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• The system must facilitate communication between shifts. As an example, the SBAR note (Situation, Background, Assessment, Recommendation) in an EMR pulls information together in one place to provide reports on residents and events

• Ability to view resident lab schedule, refusals, and pending labs • The ability to place an electronic signature on documents • Reports must be interoperable (i.e. flu vaccine information from communicable

disease module being automatically entered into the MDS or DOH report form) • Ability to track and trend blood sugar levels for residents • Identifying residents by information (room number and floor) in addition to name

associated with documentation to prevent documentation on wrong resident

Assessments The new EMR system should allow our staff to have all the tools needed to create a comprehensive resident assessment. We are requiring the new EMR to allow for the following Focus Assessments: Hydration Risk, Elopement Risk, Fall Tracking, Discharge Summary, Flight Risk, Depression Scale, Cornell Depression, Geriatric Depression, Mental Status Tracking, Mini Mental Exam, Monthly Summary, Pain Tracking, Restraint Tracking, Sentinel Tracking, Side Rail, Skin Tracking, Smoking Risk Tracking, Wander Risk Tracking, Admissions, and Abnormal Involuntary Movement (AIM).

In addition the following is required for Assessments:

• Additional input text boxes in all Focus Assessment areas in order to add additional comments

• Provide assessments built in for Nursing and other disciplines such as Dietary, Social Services, Activities, etc. which are required on Admission, Quarterly, hospital return, significant change in condition, and annually which have our input user-defined

• Provide templates for all assessments, i.e., Nursing, Social Services, Dietary and Activities which will enhance more comprehensive and consistency. The Assessments, whether initial, annual or quarterly, should be in the same system section as the Progress Notes done by all disciplines

• Automatically lock assessments after a specified time period to prevent changes • On Pain Assessments, ability to document resident pain by where the actual sites

are on the body • Ability to track restraint use along with enablers • System requires all fields be completed before allowing user to exit. System

checks for incomplete assessments before locking • Have the ability to run reports indicating scores, due dates and completion dates

of assessments (Falls, AIMS, Pain, Mini Mental, etc.) • Follow DOH regulation time frames for completing assessments • Have the ability to create more than one assessment in a calendar day • A prompt for nurses to enter physical assessment data for new admissions, re-

admissions, and anyone on 24 hour report or with new problems • Ability to generate report about residents at risk for pressure wound development

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• The ability to view any/all residents at risk for wandering, that includes photos for easy identification

Weights and Vitals The "Weights and Vitals" functionality of the new EMR system must allow staff to display all vitals and weights taken for the resident for a user-defined time period. Users must be able to view a list of the most recent vitals and weights taken for a resident. In addition the following is required for Weights and Vitals,:

• Have system automatically update what weights are due based on Physician orders, and be able to print or display a resident weight list when needed (daily, weekly, monthly). For example, when weekly weights are ordered for a resident, that information would automatically update that residents' weight schedule.

• Ability to change current weight schedule report and what information is included in the report. For example, column where current weight is listed, the date of the weight should be reflected on the report.

• Separate weight entry from other vitals to reduce errors. • Ability to identify a wheelchair was used and weight of the wheelchair. • Ability to identify type of scale used. • Ability to view weight and vitals while entering notes. • Ability to have vitals timed-stamped if vitals are captured bedside.

Wounds The "Wounds" functionality must allow staff the ability to assess the status of a resident's wounds, as well as the conditions or factors impacting development and/or healing, current treatment and recent laboratory findings. In addition the following is required for Wounds:

• Ability to track (trends and statistics) wound progress for each individual resident and see progress reports

• Ability to run wound tracking reports based on wound types and stages, non-acquired and acquired wounds, age of wound, infected sites, etc

• Have the information from previous wound tracking “roll forward” when tracking new wounds

• Wound tracking modules should include suggestions for Medicare B covered dressings by wound stage, they should include pull down menus for pressure relieving devices, and dietary supplements, as well as a link to care plans – or the ability to input directly into care plans from drop down menus in the wound care module, the wound care module could populate care plans, and have the ability to print reports that include eligibility for med b to cover dressings.

Scheduling In addition the following schedules and alerts are required for Scheduling:

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• Physician’s reorders, (14, 30, 60, and 90 day) • Annual physical • Annual eye • Annual dental • Podiatrist • Lab work • Pacemaker checks • Weights • Recurring Vitals (ie daily, monthly, weekly, etc.) • Inside and outside medical appointments and testing

MDS and Care Plans The new EMR system must provide MDS and Care Plan capabilities. The MDS assessment is the key component of the Assessment section of the Clinical Application module. It provides for entry of all required MDS forms and maintains a complete on-line history. Each assessment is evaluated and produces the Care Area Assessment Trigger Legend, summary, and guidelines. Case mix, RUGs, and full detailed reporting are currently provided to support staff with all the resources they need to properly manage the assessment and submission schedule. MDS processes must be setup to function according to Federal MDS requirements and the requirement for electronic submission of MDSs. Currently the MDS files are submitted to the national database using the CMS website using AT&T Global Network Client and ULTRACare. MDS files are also submitted to the VA using the VA website. In addition the following is required for MDS and Care Plans: Care Plans

• Make care plan development user friendly (currently the system requires jumping back-and-forth between screens, date fields are ambiguous)

• Care Plan library with NANDA (North American Nursing Diagnosis Association) approved care plans

• Provide alerts for proper care planning (i.e. documented antibiotic initiated, triggers a care plan, documented indwelling urinary catheter triggers a care plan, etc)

• Include a free text description field in order to individualize the care plan based upon the resident’s specific needs

• Include the option for building our own model care plans • Indication when and by whom for Care Plans change. • Initial Care Plan problem statement and goals should be locked and not allow

edits to the original • Ability to update care plans while working on MDS and CAA assessment.

MDS

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• Create the assessment questions to reflect the actual MDS (Resident Assessment Instrument Manual) questions and information needed

• Have the ability to run reports indicating ADL (Activities of Daily Living) scores and ADL changes

• Therapy to input minutes and days to automatically populate the MDS • Ability to move from one resident to another within MDS • Built-in up-to-date RAI manual • For Roster Matrix (802) and Resident Census (672), we require that an automatic

update does not override the manual update, and vice versa Medical Information In the new EMR system, Medical Information functionality is required for recording the resident’s current medical status, advanced directives, professional service codes, specific dietary needs, doctor information, and any other medical records information for the resident. In addition the following is required for Medical Information:

• Navigating to see the assessment and the residents members fund account should be on the same screen

• User defined Resident Face Sheet (ex. to include more space for additional diagnoses)

• The ability to enter the physician diagnosis on Face Sheet, in addition to the ICD-9-CM code definition

• Any information entered/edited/deleted in system should be able to be tracked to who made the entry/edit/delete

• The ability to run a report listing all disclosures (for HIPAA) for a specified timeframe

• The ability to differentiate between levels of care in the system (admission and discharge dates between levels of care)

Incidents and Accidents In addition the following is required for Incidents and Accidents:

• Print the name of the physician associated with the report, whether current or previous

• Ability to perform Quality Assurance (QA) study of incidents • Generate graphs and charts based on incident report trends • Ability to generate reports of incidents resulting in hospital visits • Signature lines on report required for DOH review • Ability to add injury types as check boxes to the reports • Ability to track incident reports based on staff names

IV-3.1.6. Clinical Reports

Clinical reports are required in our new EMR system. The reports will be used by all our Veterans Homes for various reasons. These reasons include generating forms which become part of the clinical record, providing necessary/required documentation for

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regulatory agencies (Department of Health, Department of Public Welfare, Veterans Administration), and providing our administration with reports to monitor compliance and quality issues. The system should also provide the Homes the ability to track trends, generate lists based on user-defined criteria, and monitor individual compliance and quality issues. For a list of current clinical reports we generate from ULTRACare, see APPENDIX H– Clinical Reports. The new EMR system must allow users to run Clinical Reports based on data entered into the system and allow users to select what data is generated in a particular report. Data which is entered into system need to have a tracking system available so that audit trails can be performed to track additions/modifications/deletions. (The act of tracking entries is located under Clinical Applications, but doesn’t mention audit trail-Not sure if you want to put both places or just add ability to run audit trails there). Certain data needs to have ranges identified to eliminate/reduce wrong entries. Examples include: • Allergy Reports - A list of allergies for a particular resident as well as a list of

residents who are allergic to a particular substance. • Incident reports - Ability to provide unlimited text entry for incident description and

follow-up. Allow reporting by incident category on a daily, weekly or monthly basis. Supervisors must be able to enter into incident reports after the fact to enter in follow up care.

The ability to generate reports must be user friendly and easy to obtain, without having to go through several screens or programs. They need to have options that allow users to define needs, such as to print by resident or unit. Each report needs to be previewed on the screen allowing the choice to print. All data entered into the system for a particular resident as part of an assessment needs to be included into the resident form for that particular assessment. Reports need to have demographic data carry over throughout the system and correctly populate fields on reports. The new EMR system must provide the Homes the flexibility to have user defined reports. These include user defined assessments by clinical disciplines for Admissions, Annuals, Significant Changes, and Return from Acute Care. The new EMR system must have the ability to change these forms as needs and regulations change. Homes also need to have regulatory specific forms integrated into the system and ability to have forms updated as regulations change. An example of this is the Vet’s LOCA form (a DPW specific form). The following existing reports from the current system do not meet the needs of the Veterans Homes but are required in the new EMR system: • Consolidated Quality Measures Report are manually built for each home and should

allow flexible date ranges • Weekly/monthly/quarterly Wounds/Pressure ulcer reports are necessary to track

progress. We need ability to generate reports for pressure ulcers, weights and blood sugars.

• We need CMS 672 and 802 Reports for survey and tracking that accurately reflect the data, can be updated and keep the parameters necessary to run the reports

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IV-3.1.7. Dietary The new EMR system is required to include a dietary functionality or an interface to one. It must address the dietary needs of the DMVA long term care facilities and be seamlessly integrated with other EMR modules in such a way that it appears to be one, integrated system. The current dietary software used in the Veteran’s homes is GeriMenu. We do not use the GeriMenu Nutrition Analysis, Inventory, and Recipe Functions (Module 2 in GeriMenu) and it is not a requirement for any of our facilities at this time. As for Weight Tracking, Calorie Count, and Selective Menu functions of GeriMenu, we are not currently utilizing these features; however, we require them to be available if a facility wishes to access them in the future. The system will need to include the ability to have diet information that can be printed for educational purposes. Our dietary needs can be divided into two categories: Food Service and Clinical Nutrition. Food Service For each resident, the system must have the ability to enter diet and diet changes in one main charting system that would automatically update the resident’s meal ticket. The system will automatically substitute foods, when necessary. It must be able to record system user name next to food items that are entered or modified and log the user name and date next to all diet changes/meal ticket changes that have occurred for tracking and accountability purposes. For each facility, the system must be able to create an unlimited list of diets and diet combinations (diabetic, 1800 calorie, etc). It must also have the ability to input as many menus and menu extensions each facility desires, and print resident specific menus for resident selection. The system is required to print dietary menus for resident by name, allowing residents to select choices, much like hospital menu choices. Reports are a major part of our dietary program, which all facilities use. The system must have the ability to produce reports which include:

• Resident Diet List • Birthday List • Snack Check-off Sheet • Allergy List • Adaptive Equipment List • Thickened Liquid List

The system must have the ability to produce production sheets for each meal to include specific food items and quantity needed for food preparation. Typically, a production tally is printed prior to printing meal tickets. This tally presents the number of servings of each item (roast beef, chicken, etc), specific to a tray line. The system also prints according to category (special forks/plate/cups, etc).

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The system is required to place a variety of items on meal tickets. Items such as food allergies, adaptive equipment, feeding instructions/level of need, and menu items which include meal/beverage/and dessert provided at each mealtime. It must also be able to print meal tickets in a particular order and to designate a specific seat/place for resident to eat meals. The system must have the ability to input snacks for residents for a minimum of three (3) snack times per day and have corresponding labels printed for these snacks. In addition, it is required to have a snack check-off sheet printed for record keeping of consumption of snacks. Clinical Nutrition The system must provide the ability to have facility specific nutrition assessment forms (and associated data) installed in program. It must also accommodate facility specific nutrition care plan templates. Currently, we do not have the ability to put templates in our system but we can input information line-by-line in terms of problem, goal, or intervention. We must be able to have the date printed next to problems, goals, and interventions when initiated and when discontinued. The new EMR system must calculate calorie counts/food studies. Nursing should be able to input what the resident ate and the system should calculate that information and notify the dietitian when it has been completed, for charting purposes. The new EMR system should log when the care plan has been reviewed and updated. An example of a deficiency in the current system, is when entering the care plan, the user must move problem by problem to get to a specific problem. There are no dates currently associated to the problems/interventions. The new EMR system must capture and maintain nutrition progress notes. These notes should be saved allowing users to return to the note to add or correct the information within a designated period of time. The current system does not allow this and requires a user to enter additional notes. The new EMR system must allow a user to write a note or input data into a nutrition assessment while simultaneously accessing data from the electronic chart (labs, food intake records, medications, consults, ADL’s, wounds, and weights that are needed to complete nutrition progress note or nutrition assessment. The current system forces the user to log out of the note, go to the information, then go back to the note, for which the information that was entered is lost. There is a weight tracking requirement for the system. We require the ability to:

• Enter resident weight and track significant weight changes • Track and trend residents weights with one, three and six month changes by

percent or amount lost or gained • Modify weight reports per each facility requirements • Change current weight schedule lists and what information is contained in them. • Have weight schedules automatically updated based on physician orders and

facility policy written into the software

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• Calculate BMI and create a BMI report • Generate reports for a greater period than the past 30 days. Our current software

solution does not allow reporting of significant weight changes by date, rather it looks back between a 30 days period forcing us to choose the closest day to the 30 day period. We need a better way to report weights, including a good report to track weights and plot them for an entire during the year.

IV-3.1.8. Health/Risk Management

The definition of Health/Risk Management is the ability to monitor and track infections, immunizations, illnesses, and other modalities to reduce potential negative outcomes. Health Risk Management is a process to help reduce or minimize risk to the facility. A process to help identify, monitor and analyze potential hazards and negative outcomes in the work place, preventing accidents or serious injuries and health risks to both resident and staff. In addition to what is currently in the present software used for Health/Risk Management, we are requesting the addition information as listed below. From the ULTRACare system, all six of our facilities, with the potential of adding remote facilities in the future, utilize the Quality Measures data. Health/Risk Management requirements are categorized in the following: Test, Infection Control, Quality Assurance, and Employee Health from the ULTRACare system, all six of our facilities, with the potential of adding remote facilities in the future, utilize the Quality Measures data. Health/Risk Management requirements are categorized in the following: Test, Infection Control, Quality Assurance, and Employee Health. Test The Test category of the Health/Risk Management module must have the following:

• Ability to track immunizations and PPD's for residents and staff including, but not limited to, Tetanus, Flu, and Pneumonia

• Ability to enter or add the body site where an injection was administered • Ability to produce staff alerts for tests due and tests past due, and print survey

forms either individually by location or alphabetically and immunization records for residents and staff (could be used for resident transfers)

• Ability to view resident lab schedule, refusals, and pending labs • Ability for resident labs to be accessed electronically using each specific

resident's electronic chart/record • Ability to have lab results imported and broken down by test and coded by

LOINC • Ability to track all lab results and diagnostic test results for sharps injuries and

CXRs, pertaining to infectious diseases and the ability to run reports according to lab results by pathogen (MRSA, C-Diff, etc)

• Ability to export Flu and Pneumonia vaccination information for Medicare Part B billing purposes

• Ability to produce Flu and Pneumonia vaccinations reports for the PA Department of Health (DOH). This includes totals and the ability to sort into categories by utilizing a checkbox, for items such as resident refused, and allergy. Reports must also have the ability to be based on the calendar year.

• Ability to add diagnostic test codes

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Infection Control The Infection Control category of Health/Risk Management must have the following:

• A link to PA DOH for reporting infections as required by Act 52 • The ability to support Infection Control reporting, investigating, treatment and is

able to provide tracking reports and trending and analysis (example MRSA) • Ability to run reports based on resident name, location, and pathogen for

cohorting purposes • Ability to associate lab results with sharps injuries and infections • Ability to compute Attack Rates • Ability to compute monthly, quarterly, or annual reports of the total number of

infection types and based on infection types, providing a “red flag” for preset criteria indicating a suspected outbreak or problem area. (ex. Catheter related UTIs or Wound infections)

• Ability to have a check box for catheters and organism types, keep check box for “present on admission” and have the ability to run reports based on these criteria as well as the ability to add additional organism types and catheter types

• Provide reference for isolation types (Respiratory, Contact, etc) and necessary precautions for specific infections

Employee Health The Employee Health category of the Health/Risk Management must have the following:

• Ability to incorporate current employee files including: Physician physicals for employees Incorporate or interface with current workmen’s compensation codes,

forms, and incident reporting Employee emergency contact list and allergies or other pertinent medical

history (strictly voluntary) for workplace emergencies Quality Assurance The Quality Assurance (QA) category of the Health/Risk Management must have the following:

• Quality Indicators (QI) are compiled from MDS data and available in reports based on user specified date ranges

• Ability to compare QI and Quality Measure (QM) reports from previous based on user specified date ranges

• Ability to enter QA projects (ex. resident care areas) into the system and automatically generate data for the project. Subsequently print QI reports and graphs on specific QA/QI projects

• Quality indicators/measures are calculated and immediately displayed on the screen for report or print

• Ability to compare and update our quality indicators/measures to State and National percentages

• Ability to compile incident statistics on injury type and include statistics for location and times

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• Ability to preset “red flag” area to provide warning before actually reaching the red flag % which should also include the resident affecting the area

IV-3.1.9. Pharmacy

The new EMR system must include an integrated electronic prescribing (e-prescribing) functionality or an interface to one. It must address the pharmacy needs of the DMVA long term care facilities and be integrated with other EMR modules in such a way that it appears to be one system. The current prescribing software used in five of the six Veteran’s homes, with the potential of adding remote facilities in the future, is the PrimeCare pharmacy management system. The Pharmacists also uses MDI Achieve ULTRACare software to obtain information about residents so medication can be appropriately dispensed and administered. In addition to the current prescribing software functions, our Pharmacists have specified the following requirements, categorized into Essential records, Prescriptions, Reports and Miscellaneous Requirements. Essential Records From our Pharmacists’ perspective, the EMR system must include and maintain essential records for Patient, Drug, Prescriber, and Sig Codes. The patient record contains general information such as the resident’s full name, social security number, date-of-birth, gender, physician, price code, resident status (active, discharged), nursing unit, allergies, and diagnosis. Facility information associated with the patient such as facility name, facility code, room number and medical record number will be maintained. Patient allergies are to be associated with the drug record. The system must allow selection of drug class and/or individual drugs. If an allergic agent is chosen for a resident, a real-time alert must be generated and displayed on the screen. Patient allergies must also contain food and diagnostic agents. The basis for patient medical conditions should come from a customizable International Statistical Classification of Diseases and Related Health Problems (ICD9) list. The system should allow for patient or patient group messages to be tied to a resident for generating alerts when the resident is selected. Payment and insurance information must be tied to the resident patient record and associated with the prescriptions during prescription order entry. The system should allow for multiple payment/price codes associated with their patient record. Drug records within the system are to be reconciled with the national drug database. The system must allow drugs to be quickly added (via internet) by simply entering NDC code or drug description. This information must support prescription order entry, allergies interface, drug monograph, inventory management, and drug interactions.

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Prescriber records are to include the Physician’s full Name, Drug Enforcement and State License number, office address and phone number, email address, fax number, electronic prescriber ID, and interface to prescriber statistics. The system must maintain records on Sig Codes and abbreviations. Record information will include pre-built direction codes to be used in the order entry of prescriptions. This information should be used to calculate quantity of the medication to be sent, dependant on the date and the next date of the resident’s unit scheduled “cycle-fill” (QTY/DAY, QTY/DOSE). Prescriptions The solution must offer a comprehensive and efficient order entry and prescription profile software program. CPOE, eMAR’s will be integrated with the prescription entry and electronic filing capability. The integration of essential records will be used to create individual prescriptions. Order entry must be intuitive, expedient, and include current screening software for drug-drug interactions, therapeutic duplication, drug-disease contraindications, drug allergies, geriatric precautions, drug-food precautions, and adult minimum/maximum dose checking. The system must allow documentation of clinical interventions. This process should also support the labeling/packaging and quality assurance checks (bar code verification & drug images). Labeling of each prescription must be compliant with State and Federal regulatory requirements. The system must have a cycle-fill (prescription batch) management and production capability. This is described as each Nursing unit having a separate control file or print out that controls a particular unit’s residents and pharmacy cycle-fill list production (the number of days per each cycle-fill, date of past/next cycle-fill, fields from drug record, and patient record to include and exclude from the cycle-fill). In order to accomplish our current cycle-fill dispensing requirements, the solution must address the following:

• Prescription / Quantity Report - identify the prescriptions to be included in the selected fill list by type of drug. The system should update each prescription quantity to the specified days supply as listed in the fill list control file for that unit (i.e.30 day cycle fill).

• Fill List Creation - the system gathers a “batch” of prescriptions to be prepared and delivered for a specified unit.

• Update Discontinued Orders - show prescriptions to be removed from the fill list as they have been discontinued during the period of time between the day the list was created and the day it is to be delivered. A technician reviews the list and physically removes prescriptions from the batch prior to delivery.

• Update Supplemental Orders - add to the fill list the prescriptions that have been ordered between the fill list creation and delivery date. A technician prints the labels of these prescriptions and prepares them to be added to the batch cycle-fill.

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• Original Pick List and Delivery Pick List Reports - to list all the prescriptions by patient within a specified unit to be in a cycle-fill. The original list shows prescriptions on the day of its creation, the delivery pick list shows the prescriptions plus the PRN, tabs/caps that should be in the med-cart on the day of delivery of the fill-list. These lists are critical, to the quality double checks that occur during and at the delivery of each cycle-fill.

Reports The new EMR system must include flexible and customizable reports. There are many different type reports needed in an institutional pharmacy. The ability to develop customized reports is essential in many administrative and clinical areas. These reports must have the ability to be exported into spreadsheets and other database management software for further data manipulation. The reports must be generated by altering the select and sort criteria to create specific custom reports. DMVA’s current software has many “canned” reports. The following table lists reports (canned and customized) that are currently used and must be part of the solution. Canned Reports Description

Consultant Pharmacist Report

Reports potential drug therapy adverse consequences by applying customized criteria based on the CMS Federal Guidelines and Guidance to Surveyors Section F329

Psychotropic Reports

Psych drug history and utilization lists to reports potential drug therapy adverse consequences by applying customized criteria based on the CMS Federal Guidelines and Guidance to Surveyors Section F329

Nursing Home Department Report

Lists residents and their non-drug orders such as diets, labs, nursing treatments, vital signs, restorative care orders, oxygen orders, and misc. opening orders

Narcotic Audit / Utilization Report

Audit reports that show utilization This is necessary for in-house audits, inventory control, and DEA compliance reports

Delivery Sheets/Report

Lists meds that will be delivered to specific units on given “batch” deliveries, so as to document delivery and receipt of all pharmaceuticals sent and received

Management Report

Daily/monthly audit reports to shows counts on all prescriptions processed in any selected time frame (daily, monthly etc)

Drug Utilization Report

Can be customized based on drug category. List residents prescribed specifically selected drug or drug category

Inventory Report Forecasting, and Electronic drug ordering. Patient – Allergy Report

List residents and their allergies

Customized Reports

Description

Aid and Attendance Resident List and Drug Utilization

Shows all “Aid & Attendance” category of residents (identified by “price-code” in their patient record) and their drug utilization for a given time period. This report is essential to our participation and

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Report re-imbursement of Pharmacy benefit expenditures for this Veteran category

Behavior Mgmt Team Report

Lists residents and their psychoactive and pain medication orders. This list shows the residents and their active orders for Psycho-active (antipsychotics, anxiolytics, sedative-hypnotics, antidepressants, anti-convulsants, cognitive enhancer meds) and pain meds (both narcotic and non-narcotics) so to facilitate the Behavior Management Team review of residents that present dementia associated behaviors.

Beers Drug Utilization List

Shows where Beers Meds are ordered. Used to facilitate specific clinical review. *Beers Meds* are a specific list of Drugs and Drug/Disease combinations that are listed in the State/Federal Regulations under section F329.

CMS Suggested Geriatric Daily Dose Threshold list and utilization Report

The criteria for this list are again taken from section F329, Guidance For State Surveyors

Pass W/Medication Orders

Utilization list to show where these orders (based on a Pass-Med Price code) occur and to illustrate non-adherence to Drug Regimen

Un-used Prescription Report

Used to show orders that has not been refilled, based on last refill date, so as to illustrate unnecessary medication orders

Laxative Utilization list

In light of CMS Quality indicator of “3 or more Laxatives”, this report list where this occurs.

Anti-coagulant Agent Utilization Report

Shows this specific drug category’s usage, so as to ensure appropriate monitoring

Immunization Report

Influenza and/or Pneumonia vaccination reports

PPD utilization Tuberculin testing utilization list Drug Regimen Review

Pharmacist’s notes and recommendations list that shows the notes and recommendations made by the pharmacist to the attending staff

Miscellaneous Requirements In support of our paperless environment, our pharmacists require a document imaging and tracking capability allowing external documents to be associated with the resident’s electronic record. Documents can be entered into this system using fax, scanner, eMAR, and or ePrescribing methods. The documents will be managed and organized using a folder structure accessible to multiple, authorized users. The system must allow retrieval and easy lookup of any documents such as prescriptions and order history. Our pharmacists require automated medication dispensing systems. The robotic system counts, dispenses, and packages medications. We want to leverage technology and interfaces currently available to completely automate single dose, 30-day blister card filling, sealing and patient labeling without any user interaction. We require the utilization of bar-code systems to ensure every prescription is filled with the correct drug

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and strength and labelled correctly. This will enable electronic scanning of medication and treatment administration. Additionally, this will provide supply scanning for charges and inventory management. The new EMR system must support an inventory management, forecasting, reporting and procurement system. Inventory values in the drug records should track usage, and provide ability to maintain perpetual inventory monitoring. The system will have the ability to interface with McKesson to formulate electronic drug reorders, as well as the ability to automatically receive orders.

IV-3.1.10. Point of Care Point of Care within our current EMR system is accomplished using CareTracker and ULTRACare, which are both hosted by the DMVA. ULTRACare is accessed from terminal servers and CareTracker is accessed from a link or through the 112 kiosks throughout the six facilities, with the potential of adding remote facilities in the future. It is extremely important that the new EMR Point of Care system is able to exchange data with the Resource Systems CareTracker System currently used by our facilities. The system must be able to provide real-time data transfers (versus a delay). CareTracker information must be synchronized with data in the new EMR system. This will help eliminate paper documentation, manual entry and tracking, duplication of data needed on multiple systems and allow for more accurate, easier communication between departments. Information entered into CareTracker should be visible in the new EMR system, and it must flag certain information recorded and send “alerts” automatically to the key departments – i.e. “resident refused a meal,” which is an alert to be sent to the dietician. Most data is entered by the CNAs using the kiosks. Other staff such as Restorative and Nurses will document using the computer through a web link as special reports are needed by these users. Notes are input using a computer keyboard because kiosks do not provide a keyboard or mouse (everything is touch-based). The data is exchanged through the use of Resource Systems’ Enterprise Interface Services (EIS) Tools. Each facility is updated on an hourly basis. Currently, as seen from the schedule below, a facility is updated every ten minutes unless a manual push is done from ULTRACare to CareTracker.

CareTracker Export Schedule Home Time Export Runs After the Hour SEVC On the hour DVVH 10 minutes after the hour GMVC 20 minutes after the hour PSSH 30 minutes after the hour HVH 40 minutes after the hour

SWVC 50 minutes after the hour

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Current information shared between CareTracker and ULTRACare is: • Resident Demographic information such as name, room, category, wing, etc. • Resident Assessment Schedules which affect the turning on of yellow “lights” in

CareTracker on the dates and shifts called for in the specific schedule program. • Census data gives the ability to dynamically update information showing holds,

leaves, etc. of the residents • Clinical MDS is gathered from the multiple records of information collected by

CareTracker for each section of the MDS for ADL (Section G) and Mood and Behavior (Section E).

Some information does overlap between the two current systems, but it is minimal. For instance, facilities are currently entering vital signs and weights in ULTRACare, but can also be documented in CareTracker. Just as some items overlap, there are some items that are not used in CareTracker. Facilities are not documenting vital signs and weights in CareTracker. The Supplies button is not currently being used. Not all facilities are using the Charting button, but this could have great potential in the future. One of the main reasons we use CareTracker is to replace the bedside chart so the nurse aide can document direct care performed with the residents. At a later time, additional applications were included for Activities. CareTracker is also used for real-time documentation and the ability to give reports and progress of care per shift/per unit.

IV-3.1.11. Therapy Currently all therapy (OT/PT/ST) is performed under a contract with Benchmarking Therapy. Benchmarking Therapy staff writes progress notes, behavioral information, quarterly screens and fall screens, and other pertinent information into the notes section for the nursing staff within ULTRACare. The remainder of the documentation such as evaluations, charting, and reports (those for MDS and given to RNACs, Month End Reports, Units per Visit, Plan of Treatment, Discharge Summary, etc) are captured online in the Rehab Optima therapy software by GiftRap. See the forms identified in APPENDIX I – Rehab Optima Therapy Forms. The Therapy staff manually enters resident information into the Rehab Optima. The information includes patient demographic data. The DMVA requires the new EMR system to include the ability to host resident therapy data and if possible, have the ability to transfer resident demographic data through an interface into the Rehab Optima software. The DMVA requires that the new EMR system have the ability to document therapy to include evaluation, daily encounter, weekly progress, re-evaluation, behavior, fall screens and any other important information required of the nursing staff. Additionally we require the ability to attach PDF or Microsoft Word documents in support of the entered therapy data. These attached documents could include evaluation reports or other documents and may contain numerous pages.

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The new EMR system must be able to capture billing information for therapy services, which is generated from the Rehab Optima software. The MRN information that is currently entered into the Rehab Optima software is obtained from the face sheet in ULTRACare.

IV-3.2. Technical Requirements

IV-3.2.1. General To support continuity of operations during an emergency, including a pandemic, the Commonwealth requires a strategy for maintaining operations for an extended period of time. One part of this strategy is to ensure contractors supplying critical support provide an emergency plan. Included in this plan is a description of how and when the emergency plan will be tested, and if the plan will be tested by a third-party. The new EMR system will include all of the required components being hosted on a secure site. The system must be available for use 24 X 7 and address the technical requirements in the sections that follow.

IV-3.2.2. Compliance a. System must be able to exchange information through the Federal Nationwide

Health Information Network (NwHIN) directly or through the PA eHealth Collaborative or its successor.

b. The new EHR system must be certified or is in the process of being certified by

an Authorized Testing and Certification Body (ATCB) in accordance with 45 CFR 170.

c. System must support all technical standards and code sets defined by ONC and

CMS for health information exchange.

d. Offerors delivering services/systems to agencies under the Governor's jurisdiction are required to comply with the IT standards and policies issued by the Governor's Office of Administration, Office for Information Technology (OA/OIT). The IT standards and policies are outlined in the Information Technology Bulletins.

e. Afford the ability to establish data retention schedules based on the nature of data,

in accordance with state and federal law. f. Comply with Service Level Agreements (SLAs) found in APPENDIX J - SLAs. g. Vendor to provide all necessary or mandated system software upgrades to comply

with on-going changes in state or federal regulations to include, but not limited to HIPAA and ARRA HITECH, i.e., MDS 3.0, ICD 10, HIPAA 5010 and D.0. etc.

i. Version 5010 – the new version of the X12 standards for HIPAA

transactions

http://www.portal.state.pa.us/portal/server.pt/community/policies_and_procedures/416/information_technology_bulletins/210791�

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ii. Version D.0 – the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions

iii. Version 3.0 – a new NCPDP standard for Medicaid pharmacy subrogation

h. Compliance with current and future federal and state laws and regulations related to the security and privacy of health information.

i. The system will include data-element centric and role-based access, audit trail logging and reporting capabilities to meet all requirements identified by state and federal laws and regulations including HIPAA and ARRA/HITECH.

j. Ensure user connection to hosted system and all health information in transit and

at rest is encrypted.

k. Disaster recovery functionality with roll-over capability and redundancy to original site.

IV-3.2.3. Customization/Technology Requirements a. Data migration will be required during implementation from the current

systems to the new electronic medical record (EMR). b. Creation of unique fields is necessary to maintain medical records for

veterans, the required fields can be found in APPENDIX K – Unique Fields. c. Creation of user defined fields will be required to ensure the ability to deal

with future data storage and adhoc reporting requirements.

d. Provide the ability to import forms that are specific to caring for veterans, see list in APPENDIX L – ULTRACare Forms

e. Capable of utilizing wireless point of service handheld devices within each

facility. f. Capable of utilizing bar coding/scanning technology.

IV-3.2.4. Training

a. Provide training plan including approach to ensure proper end user and system administration training during implementation at each veterans home.

b. Provide a proposal for online training modules, train-the-trainer and classroom

end user training for on-going training requirements.

IV-3.3.5 Hosting Hardware/Environmental Architecture

a. The electronic medical record must be available for use 24 hours per day, seven days per week.

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b. The Offeror shall provide an email resource account for technical support to

receive user questions and issues with respect to the Software, including:

a. Clarification of functions and features of the Software; b. Clarification of the Documentation; c. Guidance in the operation of the Software; and d. Error verification, analysis and correction to the extent possible by

telephone.

c. Offeror shall supply or subcontract all Hosting Equipment (hardware and software) required for installation of the materials and custom software on one or more network servers.

d. Offeror shall maintain all Hosting Equipment (hardware and software) and

replace as necessary.

e. Offeror shall house all servers and equipment in an operational environment that meets industry standards including climate control, fire and security hazard detection, electrical needs, and physical security.

f. Offeror shall be solely responsible for all data storage required in a manner compliant with all state and federal regulations as identified in the RFP.

g. Offeror shall allow the Commonwealth or its delegate to review the Offeror’s

hosted system location and security architecture. h. The selected Offeror shall be solely responsible for all data storage required.

i. Offeror staff, directly responsible for day-to-day monitoring and maintenance,

shall use industry standards applicable to the environment and system architecture used.

j. The selected Offeror staff, directly responsible for day-to-day monitoring and

maintenance, shall have industry standard certifications applicable to the environment and system architecture used.

Information Security

a. Offeror shall use industry best practices to protect access to the system with a firewall and firewall rules to prevent access by non-authorized users and block all improper and unauthorized access attempts.

b. Offeror shall limit access to the system and servers and provide access only to

those staff that must have access to provide the proposed services.

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c. The selected Offeror shall provide secure access to all levels of users using the internet.

d. Offeror shall describe the system used to provide secure access to all levels of

users via the Internet.

e. Offeror shall describe the Internet connection bandwidth entering and exiting their facility and server capacity.

f. The Offeror shall use industry best practices to ensure their system is able to

detect and deter unauthorized intrusions into their network and data.

g. Offeror shall be responsible to monitor, prevent and deter unauthorized system access. Any and all known attempts must be posted on the system within the timeframe set out by the agreed upon Service Level Requirements.

h. The Offeror shall ensure industry best practices for virus protection exists on all

servers and network components.

i. Offeror shall completely test and apply patches for all third party software products before release.

j. The selected Offeror shall employ reasonable disaster recovery procedures to

assist in preventing interruption in the use of the system. k. Offeror shall conduct a third party independent security/vulnerability assessment

at its own expense and submit the results of such assessment to the Commonwealth within 2 months of execution of the contract. Assessments completed within 12 months prior to the execution of the contract will be acceptable.

l. The selected Offeror shall comply with Commonwealth directives/resolutions to

remediate the results of the security/vulnerability assessment to align with the standards of the Commonwealth.

m. The selected Offeror shall use industry best practices to update all systems and

third party software security patches to reduce security risk.

n. The selected Offeror shall utilize a secured backup solution to prevent loss of data, back up all data every day and store backup media. Storage of backup media offsite is required. Portable media must be kept in an all-hazards protective storage safe at the worksite and when taken offsite. All back up data and media shall be encrypted.

o. Offeror shall take all necessary measures to protect the data including, but not

limited to, the backup of the servers in accordance with Section IV-3 Backup and

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Recovery of the RFP and generally accepted industry standards and encryption techniques.

p. Offeror shall describe their method to backup data to prevent physical loss. The

method must utilize off-site backup.

q. Offeror shall examine system and error logs on a regular basis to minimize and predict system problems and initiate appropriate action.

System Maintenance

a. The Offeror shall describe their method for software and hardware maintenance. Include in this description how access to the applications will be maintained during routine procedures. Examples of maintenance include software and firmware upgrades, patch management, and the use of real-time monitoring software such as Microsoft Operations Manager. The Offeror is expected to maintain system availability during any such system maintenance.

b. For all other maintenance not described above, the Offeror shall provide a two (2) week advance notice for non-routine maintenance to be performed during non-peak hours.

c. From time to time, Emergency Maintenance may be required to bring down the

system. In such situations, if possible, the Offeror shall give advance notice, before the system goes down for maintenance. The Offeror will limit the Emergency Maintenance to those situations which require immediate action of bringing down the system that cannot wait for the next scheduled maintenance period. It is expected that the Offeror will maintain system availability during any such system maintenance.

IV-4.1 Create Project Plan Within 2 weeks after contract award, the selected Offeror will deliver the initial Project Plan to manage the project. Reports and Project Control to be incorporated in the plan are specified in section IV-5. The project plan will cover both Offeror and stakeholder representatives tasks and responsibilities, as well as a work schedule. The vendor will manage and update this plan through the life of the project. At a minimum. the Project Plan will include the following: Project Organization

- Provide a description of the roles and responsibilities of project team members. Include a project team structure.

Work Plan - Provide a detailed work plan containing all the work (phases, activities and tasks), the resources assigned to accomplish the work, and the planned schedule dates for the work to occur. Deliverables for the project should be included in the work plan and highlighted for reporting purposes. The work plan can be delivered in both a gantt chart and a spreadsheet format, displaying all the work and the planned start and finish dates.

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Communications Plan

- Describe the communication management process which must be followed for the entire duration of the project. This will address time frame and frequency for project meetings and reports, what is communicated (Status Reports, Agendas, Minutes), who will communicate and who will receive the information, and the methods to convey the information (electronic, hard copy).

Risk Management Plan

- Describe how risks will be monitored and controlled. Identify the high level project risks, probability of occurrence, impact, and mitigation strategy.

Issues Management Plan

- Describe the issue management process. During the course of the project, the selected Offeror will create and maintain an Issue Log and escalation process. The purpose is to manage issues, corrective actions, and monitor who is responsible for resolving specific issues by target date. Issues will be summarized in the Problem Identification Reports described in section IV-5 of this document.

Deliverable: Project Plan IV-4.2 Confirm Requirements The selected Offeror is responsible for documenting and confirming the requirements for this effort. Initial requirements are included within this RFP. It is expected that that the Offeror will interview the representative Stakeholders to confirm the requirements applicable to customization. The Offeror will determine the number and length of sessions necessary to document the requirements. Once the DMVA approves the requirements, changes in scope will be managed through the change management process. Deliverable: Requirements Document IV-4.3 Plan and Manage Change To coordinate change across the entire project, the selected Offeror will describe the process to manage change. The Offeror will address how to control scope, identify when a change needs to occur, manage approved changes, document the impact, and control and update the scope, cost, budget, and schedule based upon approved changes. Implementation of changes must follow the change process documented in an approved Change Management Plan. Deliverable: Change Management Plan IV-4.4 Perform and Document Analysis & Design The selected Offeror is responsible for analyzing the requirements of section IV-3 and providing a solution. The analysis & design documentation will present sufficient design information to allow the DMVA to understand the solution and ensure it will address their requirements. It is expected the solution will be designed from a set of integrated, off-the-shelf, customized products. The analysis & design documentation will show what functionality is addressed by what software components. The design will address the architecture of the solution, any customization, and how the software components fit together. The design must accommodate unique fields, user defined fields, and the ability to import specific forms required to maintain

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records for Veterans. The documentation will also include the reports required of the DMVA business areas, and how ad hoc reporting will be addressed. Scalability, usability, hardware and software resources required of the system must be included. Deliverable: Analysis & Design Documentation IV-4.5 Plan and Execute Data Migration The selected Offeror is responsible for the planning and the migration of data from the current DMVA systems into the new, integrated solution. It is expected data will be migrated into the Offeror’s test and production environments. The Contractor is responsible for writing all data transformation and load programs required to migrate the extracted legacy data to the new solution. Deliverable: Plan and Execute Data Migration

IV-4.6 Create User Acceptance Test Plan The selected Offeror is responsible for creating a User Acceptance Test Plan for each release. The plan will address the testing necessary to give end users confidence the solution being delivered to them meets their requirements. Testing for each release should be limited to the customization work performed to address specific requirements of section IV-3. It is not expected the DMVA will re-test off-the shelf product capability, but to test any customization or integration work. The approved user acceptance test plan can also be used for regression testing.

Deliverable: User Acceptance Test Plan

IV-4.7 Execute User Acceptance Test and Report Test Results For each release, the selected Offeror is responsible for executing the user acceptance test plan and providing a summary test report. This report will include the results of testing along with any items that may be conditionally accepted until the next release. Approval of the user acceptance test confirm DMVA’s approval of the solution and that it meets the requirements of its users and is ready deployment. Deliverable: User Acceptance Test Report IV-4.8 Information Security Assessment Since the solution will be hosting personal health records on Veterans, the DMVA is requiring an information security assessment. This assessment shall be accomplished by a third party contractor, independent of the selected Offeror. The assessment shall evaluate security management practices, access control, physical security, network security, encryption, business continuity planning, and operations security. Due to this being an externally hosted solution, it is expected some Offeror’s may already have current assessments on file and elect to satisfy this task and deliverable by providing that assessment. Deliverable: Information Security Assessment IV-4.9 Deploy Integrated Solution

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The selected Offeror is responsible for hosting the solution on a secure site, accessible from the internet, external to the Commonwealth. It is expected production releases will be deployed upon approval and conclusion of acceptance testing. The Offeror is responsible for deploying, ready for use releases of the solution to all hosted environments which include test, production, and disaster recovery. All configuration items required for each release shall be maintained by the selected Offeror. Deliverable: Deployed Solution IV-4.10 Develop and Execute a Training Plan The selected Offeror is responsible for developing and executing a Training Plan that includes training materials and training users on the solution. The plan should include online, train-the-trainer, and classroom training. Offerors responding to this RFP are expected to break out training costs separately. The DMVA reserves the right to exercise training as an option as part of the contract. Deliverable: Plan and Execute Training IV-4.11 Provide Maintenance and Support The selected Offeror is responsible for maintenance and operational support of the solution for the life of the contract. The Offeror must support and maintain the test and production systems upon deployment of each release. This task includes all of the activities to appropriately support and maintain the proposed solution. Maintenance and support must provide for weekly routine and unscheduled system maintenance in accordance with the Service Level Agreements (SLAs) included within this RFP. Deliverable: Maintenance and Support IV-4.12 Develop and Execute a Transfer Plan To allow the DMVA to transfer functionality and data at the end of the contract, the selected Offeror must develop and execute a Transfer Plan. The goal for this task is to prepare contracted or Commonwealth staff to maintain and support a solution that may be hosted at the Commonwealth or contracted facility. The plan will include all activities needed prior to the end of the contract in order to successfully transition to another entity. This includes Offeror to new contractor collaboration, participation and knowledge transfer. This Transfer Plan must describe standards and procedures required to extract and export the data from the solution, if the DMVA so desires. Deliverable: Plan and Execute Knowledge Transition IV-5. Reports and Project Control The project team will be led by the selected Offeror’s Project Manager that will report to DMVA. To satisfy DMVA’s ability to sufficiently measure the progress and quality of the project, the Offeror will be responsible for the following items: IV-5.1 Project Meetings

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Project meetings will be conducted weekly in accordance with the approved Project Plan. It is expected that meetings will be scheduled to gather requirements, present project performance, and convey status. All project meetings will be held in person at the DMVA facility or by webex and conference calls. Responsibilities include creating agendas, facilitating meetings, and creating and distributing meeting minutes. IV-5.2 Status Reports A weekly status report will be submitted covering activities, problems and recommendations. This report should be keyed to the Offeror developed work plan, as amended or approved by the Issuing Office. The Offeror will create and distribute progress or status reports to project stakeholders. Status Reports will include updates on deliverable progress. IV-5.3. Problem Identification Reports An “as required” report will be used to describe problems and their impact on the overall project and on each affected task. The report should list possible courses of action with advantages and disadvantages of each, and include recommendations with supporting rationale. The purpose is to manage issues, corrective actions, and monitor who is responsible for resolving specific issues by target date. IV-5.4. Final Report Once the project is complete, the selected Offeror will close out the project by providing a Final Report as evidence of completeness and indicating any approved outstanding issues. Any unapproved outstanding issues must be remedied prior to project closeout. A Final Report will be submitted, by the Offeror, for approval within 7 days after the project completion. IV-6. Contract Requirements—Disadvantaged Business Participation and Enterprise Zone Small Business Participation All contracts containing Disadvantaged Business participation and/or Enterprise Zone Small Business participation must also include a provision requiring the selected contractor to meet and maintain those commitments made to Disadvantaged Businesses and/or Enterprise Zone Small Businesses at the time of proposal submittal or contract negotiation, unless a change in the commitment is approved by the BMWBO. All contracts containing Disadvantaged Business participation and/or Enterprise Zone Small Business participation must include a provision requiring Small Disadvantaged Business subcontractors, Enterprise Zone Small Business subcontractors and Small Disadvantaged Businesses or Enterprise Zone Small Businesses in a joint venture to perform at least 50% of the subcontract or Small Disadvantaged Business/Enterprise Zone Small Business participation functionality of the joint venture. The selected contractor’s commitments to Disadvantaged Businesses and/or Enterprise Zone Small Businesses made at the time of proposal submittal or contract negotiation shall be maintained throughout the term of the contract and through any renewal or extension of the contract. Any proposed change must be submitted to BMWBO, which will make a recommendation to the Contracting Officer regarding a course of action.

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If a contract is assigned to another contractor, the new contractor must maintain the Disadvantaged Business participation and/or Enterprise Zone Small Business participation of the original contract. The selected contractor shall complete the Prime Contractor’s Quarterly Utilization Report (or similar type document containing the same information) and submit it to the contracting officer of the Issuing Office and BMWBO within 10 workdays at the end of each quarter the contract is in force. This information will be used to determine the actual dollar amount paid to Small Disadvantaged Business and/or Enterprise Zone Small Business subcontractors and suppliers, and Small Disadvantaged Business and/or Enterprise Zone Small Business participants involved in joint ventures. Also, this information will serve as a record of fulfillment of the commitment the selected contractor made and for which it received Disadvantaged Business and Enterprise Zone Small Business points. If there was no activity during the quarter then the form must be completed by stating “No activity in this quarter.” NOTE: EQUAL EMPLOYMENT OPPORTUNITY AND CONTRACT COMPLIANCE STATEMENTS REFERRING TO COMPANY EQUAL EMPLOYMENT OPPORTUNITY POLICIES OR PAST CONTRACT COMPLIANCE PRACTICES DO NOT CONSTITUTE PROOF OF DISADVANTAGED BUSINESSES STATUS OR ENTITLE AN OFFEROR TO RECEIVE CREDIT FOR DISADVANTAGED BUSINESSES UTILIZATION.

REQUEST FOR PROPOSALS FOR INTERNET BASED ELECTRONIC MEDICAL

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