Diane Gaddis

Building Systems That Grow: The RFP Process

By Diane GaddisCEO & President

November 2007

Copyright 2007

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CHCA is a 501(c)(3) Health Center Controlled Network for section 330 safety-net health care centers and systems throughout Florida.

CHCA facilitates the selection, implementation and support of services and technologies that allow its members to expand access to health care while improving quality outcomes.

CHCA members leverage resources across the network to enhance patient care while maintaining independent management structures

Members choose from a range of technology and services to enhance their health center operations, including health information technology (HIT) and the sharing of information across operational specialties.

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CHCA Network Aggregate 2006 Results

Total sites: 77

Providers across the network:

159 physicians, 60 mid-levels

Users: 311,489

Encounters: 1,268,669

Served 52% of Florida’s Rural Areas

2006 Service Area

With EHR Project

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CHCA Professional Services

Project management

Training

Report Writing

Technical Assistance

Workflow/Process Consultation

Go-Live Choreography

Day-to-day application support

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“Take one of these as often as you can

afford to.” 5

EHR Vendor Selection Due Diligence Early 2003: Began market scan and research

Mid 2003: Started Workflow Analysis Process

Early 2004: Sent our RFI package to six vendors

Spring 2004: Two full day presentations by top two contenders for over 30 providers; began contract negotiations with both vendors

Summer 2004: Two full day hands-on demonstrations by vendors with select providers

Fall 2004: Announced primary vendor choice; continued negotiations with both vendors

Nov 2004: Primary vendor eliminated; continued negotiations with other

Dec 2004: Contract signed with GE for their Centricity EHR Product

Sep 2005: First Go-Live

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Selection Process Overview

Process Analysis

Request for Information

Self-Education Dog n’ Pony

Show Request for

Proposal

Scoring Assessment

In-depth / Situational Vendor Presentations

Site Visits Vendor Selection Contract

Negotiations

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Selection Committee

Physicians, ARNPs, PAs, CNMs, etc Nursing Finance Operations Medical Records And More Providers!

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Request for Information

Tool for self-education Items to request –

Corporate information General client information Target markets Support / Implementation

methodologies Features / Competitive Advantages

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Mini-Demos / Education

Vendors perform mini-demos Schedule “Lunch and Learn” sessions Deliver via Webex type services Education component – not final

selection Seek out peers, technical assistance

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KLAS, TEPR, etc

Investigate their methods Statistically sound? Interactive competition? How are customers found? Judges relationships to vendors? Vendors members / sponsors of ranking

organization? Is organization a stakeholder?

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Narrowing the Field

Thoroughly read the RFIs The more eyes the better Compare and contrast Look past the gloss Evaluate the quality of responses Listen to colleagues Reflect upon mini-demo sessions

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Dog n’ Pony Show

Top two choices invited One day for each Primary attendees – providers,

nursing Use patient visit scenarios Control the demo

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Using Patient Visit Scenarios

At least 6 sample visit scenarios Cover the spectrum of service

types Provide 3-4 days prior to demo Establish moderator / interaction Use a Scorecard

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The Demo Scorecard

Limit scope Cover scenarios and only key areas All providers participate in scoring Weight each area or item Allow free text comments

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Request for Proposal

Only top 2 vendors Must be very controlled

Give single point of contact Dictate format for responses Adhere to deadline

Document vendor questions and replies To share or not to share with all?

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Provide short- and long-term projections

Technical infrastructure Current in-house staffing and

support plans Leadership Contracting entity

Request for Proposal, cont’d

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Crafting the RFI / RFP Package

Vendor Information: Request references that will provide

satisfactory as well as dissatisfied responses

Commitment to CHC market? Are references or show sites paid? Project management samples

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Crafting the RFP Package

Functional Requirements: Very Important RFP Component! Expand with details Designating “required” vs “optional”

requirements Attaches to the contract Use HRSA guidelines as starting point Clinicians must provide input

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ftp://ftp.hrsa.gov/healthit/ehrguidelines.doc

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The RFP Scorecard

Tie back to functional requirements User friendly, allow for comments Committee to weight each area Limit areas – High priority focus Grade RFP response thoroughness and

quality

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Investment / Recurring

Costs What is included in the license fee?

Formulary subscription / updates? Drug interaction subscription /

updates? Database licensing? Patient education materials?

Perform five year investment / cost analysis

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License Fees

Must understand licensing Per Physician Per Provider Per Named User Per Concurrent User

Thoroughly understand vendor definitions Thoroughly understand how they audit

license compliance

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Support Structure

Hours of operations Methods of support User community

Local Regional National

Special Interest Groups

After hours support access / costs

Service Level Agreements (SLAs)

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Corporate Comparisons

Positioned as a buyer Acquisitions build benefit to

customers or dilute resources? Positioned for a buy

Future less known – new buyer impact?

History of reorganizations? History of management changes?

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Contract Comparisons

To Vendors: “Put your money where your mouth is” Get it in writing Comparison tracking What’s not included

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If they won’t put in writing what they verbalize, walk away

Negotiate - Both Vendors

A lot of work! Saves time later. Negotiator must be armed with

knowledge Conduct with integrity Document, document, document Thoroughly reread every version of

contract sent Involve attorney before signing

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Dog n’ Pony #2?

Don’t be afraid to require Use to clarify functional differences Limit participants Use that scorecard Document key differences Have vendor append functional

requirements document

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Resource Ideas Certification Commission for Healthcare Information

Technology www.cchit.org/work/products.htm

AAFP’s Center for Health Information Technology www.centerforhit.org

BPHC Functional Requirements Sample ftp://ftp.hrsa.gov/healthit/ehrguidelines.doc

Health Information Management Systems Society (HIMSS) www.himss.org

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Baby Step Versus Big Bang

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Baby Step Versus Big Bang

Big Bang Cons:

Takes 2+ years to build

More functionality at Go-Live may impact productivity levels for a longer period of time

Large staffing infrastructure needed to support at Day one

Larger investment required up-front

Longer time frame to recoup investment dollars

Big Bang Pros:

A more complete, comprehensive system is deployed to providers

More time available for configuration and testing

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Baby Step Versus Big Bang

Baby Step Cons:

Patience required as all functionality not available initially

Baby Step Pros:

Return on Investment comes more quickly

Growing champions is easier

Implementation and support can be built slowly

Productivity levels return more quickly

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CHCA Network: EHR Today

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Current Implementation Reach

Over 68 providers

Three multi-site CHC organizations

Serving six counties

CHCA Network: EHR Today- 11/1/2007

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Total Providers Utilizing EHR Visit Documentation Features

0

10

20

30

40

50

60

70

Q4 '05 Q1 '06 Q2 '06 Q3 '06 Q4 '06 Q1 '07 Q2 '07 Q3 '07

Agg

rega

te N

umbe

r of

Pro

vide

rs

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Selected Vendor Strengths Strong history and commitment in the healthcare

arena

Real-time and interactive clinical guidelines

Oracle platform

Works well in Citrix environment

User Friendly interface

NCQA certification for its diabetes reporting capabilities

Strong user forum

CHCA Network: EHR Today

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Selected Vendor Strengths, cont’d CCHIT (Certification Commission for

Healthcare Information Technology) Certified:

Formed in July 2004, the Certification Commission is a recognized certification body for electronic health records and their networks, and a private, nonprofit initiative.

Rigorous criteria and processes to receive certification

HRSA continues to encourage adoption of products that have received this certification

CHCA Network: EHR Today

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Lessons Learned & Other Advice In the RFI / RFP Process:

You don’t know what you don’t know Be prepared to dedicate a substantial

amount of time Once the contract is signed, the

majority of your leverage is gone.

CHCA Network: EHR Today

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“It’s not about the hardware and the

software; it’s about the people

and the process.”

#1 Point to Remember:

For More Information, Contact:Diane Gaddis, CEO & Presidentdiane@chcalliance.org

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