Building Systems That Grow: The RFP Process
By Diane GaddisCEO & President
November 2007
Copyright 2007
1
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.
2
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
3
CHCA Professional Services
Project management
Training
Report Writing
Technical Assistance
Workflow/Process Consultation
Go-Live Choreography
Day-to-day application support
4
“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
6
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
7
Selection Committee
Physicians, ARNPs, PAs, CNMs, etc Nursing Finance Operations Medical Records And More Providers!
8
Request for Information
Tool for self-education Items to request –
Corporate information General client information Target markets Support / Implementation
methodologies Features / Competitive Advantages
9
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
10
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?
11
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
12
Dog n’ Pony Show
Top two choices invited One day for each Primary attendees – providers,
nursing Use patient visit scenarios Control the demo
13
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
14
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
15
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?
16
Provide short- and long-term projections
Technical infrastructure Current in-house staffing and
support plans Leadership Contracting entity
Request for Proposal, cont’d
17
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
18
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
19
ftp://ftp.hrsa.gov/healthit/ehrguidelines.doc
20
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
21
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
22
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
23
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)
24
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?
25
Contract Comparisons
To Vendors: “Put your money where your mouth is” Get it in writing Comparison tracking What’s not included
26
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
27
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
28
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
29
Baby Step Versus Big Bang
30
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
31
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
32
CHCA Network: EHR Today
33
Current Implementation Reach
Over 68 providers
Three multi-site CHC organizations
Serving six counties
CHCA Network: EHR Today- 11/1/2007
34
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
35
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
36
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
37
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
38
“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 & [email protected]
39