1. General Description of the Vendor
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
QUESTIONS VENDOR'S RESPONSE
Headquarters location (city and state).
Year established.
Company ownership (public, private, etc.).
Vendor's parent company (if any).
Personnel (in FTEs) in health care information systems for for (year)
current and two prior years. for (year)
for (year)
Number of Implementation Support Personnel
Number of Technical/Customer Support Personnel
Number of new clients in behavioral health information for (year)
systems for the past three years. for (year)
for (year)
Number of years providing proposed system.
Percent of parent corporation revenues represented by your %
division or company.
Percent of revenue allocated to research and development
%
(R&D)
Fiscal year gross revenue for current and two prior years (in $ for (year)
$1,000). $ for (year)
$ for (year)
Percentage of gross revenue realized from the proposed % for (year)
system for current and two prior years. % for (year)
% for (year)
Fiscal year net income for current and two prior years (in $ for (year)
$1,000). $ for (year)
$ for (year)
Percentage of net income realized from the proposed % for (year)
system for current and two prior years. % for (year)
% for (year)
Santa Clara Valley Health & Hospital System
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2. Description of Subcontractor
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
QUESTIONS SUBCONTRACTOR'S RESPONSE
Name of subcontractor.
Subcontractor's headquarters location (city and state).
Year established.
Company ownership (public, private, etc.).
Subcontractor's parent company (if any).
Personnel (in FTEs) in health care information systems for (year) for (year) for (year)
for current and two prior years.
Number of years providing proposed
system(s)/service(s).
Fiscal year gross revenue for current and two prior $ for (year)
years (in $1,000). $ for (year)
$ for (year)
Percentage of gross revenue realized from the % for (year)
proposed system for current and two prior years. % for (year)
% for (year)
Fiscal year net income for current year and two prior $ for (year)
years (in $1,000). $ for (year)
$ for (year)
Percentage of net income realized from the proposed % for (year)
system for current and two prior years. % for (year)
% for (year)
Primary systems and services offered (name of
product(s) and function(s) and date developed).
Specific tasks to be assigned to subcontractor.
Sites where subcontractor has previously performed
these tasks for primary vendor.
Santa Clara Valley Health & Hospital System
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3. Product Information
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
PRODUCT DESCRIPTION VENDOR RESPONSE
Product name or applications family*
Product status (e.g., Fully Operational , Planned, in Testing,
Beta)
How is the product included in the bid (included, not included,
included as an option)?
Product sold with perpetual license (yes/no)
Year product first introduced
Number of major new versions/releases to date
Number and date of current version/release
Projected date of next major version/release
Number of fully operational (i.e., Live) sites (all releases)
Number of fully operational sites (current release)
Subset of fully operational sites that are county providers of
Mental Health and/or Alcohol & Drug Services
Other names under which the product(s) (or previous versions)
have been sold
* Indicate the name(s) of the overall product line(s). Complete one form for each product.
Santa Clara Valley Health & Hospital System
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4. Applications Bid
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
CORRESPONDING VENDOR NAME OF
REQUIRED APPLICATION
APPLICATION/MODULE
PATIENT/CLIENT MANAGEMENT
Preadmission
Registration
Admission, Discharge, Transfer Medical Records
Index
Census Reporting
Medical Records
Eligibility
PATIENT ACCOUNTING
Grants Management
Financial Analysis / Entitlement / PFI
Patient Accounting / Billing / Remittance
Clinic Patient Accounting
Payer Contract Management
Cost Accounting
MANAGED CARE OPERATIONS
Member enrollment / eligibility
Service Authorizations / Benefits / Referrals
Claims Processing / Adjudication
Contract Management / Negotiation Support
Provider Relations
Call Logs / Client Contacts
Santa Clara Valley Health & Hospital System
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4. Applications Bid
CORRESPONDING VENDOR NAME OF
REQUIRED APPLICATION
APPLICATION/MODULE
CLINICAL OPERATIONS
Behavioral Health Assessment
Multidisciplinary Documentation
Behavioral Health Treatment Plans and Notes
Order Entry
Results Reporting
Electronic Medical Record
Clinical Decision Support
Inpatient/Outpatient & Resource Scheduling
Controlled Substance/Pharmacy
Quality Assurance – Followup
Ambulatory Clinical Support
Clinician Access
Outcome Measurement/Reporting
GENERAL SYSTEM FUNCTIONS
Security mechanisms and services
Interface engine
Screen Builder
Intranet / Extranet / Internet Enabled
Santa Clara Valley Health & Hospital System
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5. Applications Not Bid
Hospital Santa Clara Valley Health & Hospital System
Vendor
Product
Date
STATUS
VENDOR FULLY OPERATIONAL NOT FULLY OPERATIONAL
APPLICATION NAME YEAR NUMBER OF NUMBER OF STATUS (CHECK ONE ()) ANTICIPATED
INTRODUCED IMPLEMENTATIONS RELEASES PLANNED IN TESTING RELEASE DATE
Santa Clara Valley Health & Hospital System
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6. System Architectural Design
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
INCLUDED NOTES
AVAILABLE
FEATURES IN BID (e.g., list products where feature
(Y/N)
(Y/N) is available)
Able to supports HIPAA security services and
mechanisms
Customizable online help screens
Dedicated training environment
Dedicated testing environment
User modifiable profile/parameter application control to
implement SCVHHS business rules. That is, no custom
coding required to implement clinical and financial rules.
Bar code readers
Bar code generation
Hand held terminals/input devices
Wireless technology
Voice recognition
Palm pilot integration or Windows CE-based computing
Microsoft Word integration (e.g., to compose progress
notes)
User ability to add new data elements to the application
data dictionary and screens
User ability to modify screens and screen flow
Open relational DBMS standard, please specify
ODBC compliant with ODBC driver included
Interface engine architecture
Microsoft Excel and Access native data export building
CCOW clinical context compliant
HL7 data messaging compliant
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
7. Hardware Upgrade Path
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
TRANSACTION VOLUME GROWTH FROM CURRENT VOLUMES
0 - 125 PERCENT 125 - 150 PERCENT 150 - 200 PERCENT 200 - 250 PERCENT
Specify CPU or number of
CPUs Required to (Proposed
Accommodate Transaction Processor)
Volume Growth
Specify Disk Upgrade
(megabytes) to Accommodate (Proposed Disk
Volume Growth Storage)
CONCURRENT USER GROWTH FROM CURRENT VOLUMES
0 – 125 PERCENT 125 - 150 PERCENT 150 - 200 PERCENT 200 - 250 PERCENT
Specify CPU or number of
CPUs Required to (Proposed
Accommodate Concurrent Processor)
User Growth
Specify Applicable
Communications Equipment (Proposed
(e.g., ports, modems, Communications
controllers) Required to Equipment)
Accommodate Device Growth
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
8. Systems Software
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
FROM WHOM DOES THE
LEVEL OF NEED ()
SYSTEMS SOFTWARE PRODUCT NAME RELEASE CUSTOMER PURCHASE
MANDATORY OPTIONAL THE SOFTWARE?
Operating System
Application Programming
Language
Network Software
Communications
Software
Report Writer
Screen Builder
Database Management
System
Other (Specify)
Other (Specify)
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
9. Interface Experience
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
SITE WITH THE
HL-7 BEST EXAMPLE OF
YOUR APPLICATION OTHER VENDOR'S DIRECTION1 MODE2 METHOD3 COMPLIANT THIS INTERFACE/
APPLICATION (yes/no/partial) SIMILAR TO
SCVHHS?
1. 1 = ONE-WAY INTERFACE 2 = TWO-WAY INTERFACE
2. R = ONLINE REALTIME B = ONLINE BATCH T = TAPE/DISKETTE O = OTHER (DESCRIBE) N = NONE
3. P = POINT-TO-POINT IE = INTERFACE ENGINE
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
10. Implementation Support Proposed*
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
SUPPORT FEATURES SUPPORT FEATURES DESCRIPTION
SOFTWARE IMPLEMENTATION SUPPORT
1. Location of implementation team (city, state).
2. Does the vendor have different implementation support
packages? If so, what are they and how do they differ from one
another? Which package is being proposed here?
3. Number of Entity’s person-hours required for implementation with
the proposed option.
4. Does the vendor utilize a "train-the-trainer" or "train-the-user"
approach for the application software.
5. Aggregate percentage of core trainer training for the application a. % Onsite b. % Offsite
software held onsite and offsite?
6. List offsite training locations for the application software.
7. Indicate the maximum number of people that can be trained in a
vendor-sponsored class for the application software.
8. Regarding technical training that addresses the issues below,
state how and when the training for each is received and whether
the training is conducted on- or offsite.
Classes for system programmers and database managers.
Classes on system utilities such as report writers, screen
builders, database design, and query functions.
Classes in system operations and job processing.
* Use the last page of this form to answer questions fully.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
10. Implementation Support Proposed*
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
SUPPORT FEATURES SUPPORT FEATURES DESCRIPTION
HARDWARE INSTALLATION SUPPORT
1. Whose responsibility is it to transport the hardware, upon delivery at
the Entity, from the loading dock to the Entity's storage or staging
site? The hardware vendor? The software vendor? The shipping
company? The Entity?
2. Does the software or hardware vendor uncrate the hardware?
3. Does the software or hardware vendor install the hardware?
4. Does the software or hardware vendor install the operating system?
5. Number of vendor's person-hours dedicated to hardware training.
* Use the last page of this form to answer questions fully.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
10. Implementation Support Proposed*
To provide more complete responses to any of the questions on Form 10, this page may be utilized. Please number each
question being answered below.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
11. Recommended SCVHHS Staffing Requirements
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
ESTIMATED TIME COMMITMENT REQUIRED ESTIMATED TIME COMMITMENT REQUIRED
STAFF CATEGORY
FOR IMPLEMENTATION ACTIVITIES FOR ONGOING ACTIVITIES
Systems Office Department
Systems Office Manager
Project Manager
Applications
Programmer/Analyst
User Analyst
Systems Programmer
Microcomputer Analyst
Database Administrator
Operations Manager
Security Officer
Job Scheduler
Operator
Data Entry Clerk
Trainer/Documenter
Clerical Staff
Forms Distributor
Interface Specialist
Network Manager
Other (Specify)
User Departments
Administrative Management
System Trainers
Clinical Management
Clinical Staff
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
11. Recommended SCVHHS Staffing Requirements
ESTIMATED TIME COMMITMENT REQUIRED ESTIMATED TIME COMMITMENT REQUIRED
STAFF CATEGORY
FOR IMPLEMENTATION ACTIVITIES FOR ONGOING ACTIVITIES
Report/Results Processing
Other (Specify)
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
12. Implementation Support Description
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
IMPLEMENTATION
PROJECT MANAGEMENT* TRAINING**
SUPPORT***
APPLICATION OFFSITE OFFSITE OFFSITE
TRAINING DAYS ONSITE DAYS DAYS ONSITE DAYS DAYS ONSITE DAYS
OPERATIONS/TECHNICAL TRAINING
HARDWARE TRAINING
* Indicate the time allotted for project management activities.
** Indicate the time allotted for user training, including training for such activities as file building, report generation, and software function.
*** Indicate the time allotted to support the implementation other than training or project management.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
13. Ongoing Support Description
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date Ongoing Support Description: Basic
DOES THE VENDOR IS THE COST FOR INDICATE WHETHER
PROVIDE THIS THIS FEATURE THE SUPPORT IS TO BE
SUPPORT FEATURE? INCLUDED IN THE PROVIDED BY THE
SUPPORT FEATURES
(YES/NO) PROPOSED PRIMARY VENDOR OR
SUPPORT COSTS? BY A SUBCONTRACTOR
(YES/NO)
Conformance to Federal Regulations
Conformance to California Regulations
Conformance to Santa Clara County Regulations
Conformance to JCAHO Requirements
Conformance to HIPAA Requirements
Hard Copy and Soft Copy Documentation Updates
Training on System Software Upgrades
Training on New Releases
Customized Workshop/Educational Programs
Operational Audit/System Performance Evaluation
User Group Membership
Hardware Maintenance
Time and Materials
8:00 - 5:00 PCT, Monday through Friday
24 Hours/Day, 7 Days/Week
Software Support
8:00 - 5:00 PCT, Monday through Friday
24 Hours/Day, 7 Days/Week
Remote Support Available
Entity Santa Clara Valley Health & Hospitals System
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
13. Ongoing Support Description
Vendor
Product
Date Ongoing Support Description: Premium
DOES THE VENDOR IS THE COST FOR INDICATE WHETHER
PROVIDE THIS THIS FEATURE THE SUPPORT IS TO BE
SUPPORT FEATURE? INCLUDED IN THE PROVIDED BY THE
SUPPORT FEATURES
(YES/NO) PROPOSED PRIMARY VENDOR OR
SUPPORT COSTS? BY A SUBCONTRACTOR
(YES/NO)
Conformance to Federal Regulations
Conformance to California Regulations
Conformance to Santa Clara County Regulations
Conformance to JCAHO Requirements
Conformance to HIPAA Requirements
Hard Copy and Soft Copy Documentation Updates
Training on System Software Upgrades
Training on New Releases
Customized Workshop/Educational Programs
Operational Audit/System Performance Evaluation
User Group Membership
Hardware Maintenance
Time and Materials
8:00 - 5:00 PCT, Monday through Friday
24 Hours/Day, 7 Days/Week
Software Support
8:00 - 5:00 PCT, Monday through Friday
24 Hours/Day, 7 Days/Week
Remote Support Available
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
14. Software Change Policy
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
SOFTWARE MODIFICATION CATEGORY
(e.g., Version, Release)
MODIFICATION NAME/FEATURE (specify) (specify) (specify) (specify)
1. Are customers charged (in addition to support fees) for this
category of modification (yes/no)?
2. What is the estimated cost for purchase of this modification?
3. How often are modifications issued (e.g., monthly, quarterly,
yearly)?
4. Are modifications vendor-installed or customer-installed? If
the answer varies by level of support purchased, explain.
5. What is the estimated cost of installation for these
modifications?
6. Does vendor provide user education? If so, does education
occur onsite or at vendor location?
7. Will vendor guarantee that these modifications are
compatible with existing customer-specific code? If so, is
there an additional charge to upgrade the custom code?
8. How many of this category of modifications have been
issued within each of the last two calendar years?
9. What is the number and date issued of the most current
modification?
10. Does the customer control the date and time of modification
implementation?
11. Does the vendor provide user documentation for software
modifications?
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
15. Client Base Overview
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
NUMBER OF NUMBER OF SITES NUMBER OF IS MODULE
NUMBER OF
CLIENT BASE DESCRIPTION SIGNED IN IMPLEMENTATION SYSTEM/PRODUCT INCLUDED IN
"LIVE" SITES
CONTRACTS PHASE DEIMPLEMENTATIONS BASE
SYSTEM?
Total Client Base
(Proposed Product)
Base System
[SPECIFY] Module
[SPECIFY] Module
Clients in California
[SPECIFY] Module
Other Module
__________________
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
16. Client References*
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
CLIENT NAME:
Total yearly Mental Health client visits: ____________ Total yearly Alcohol & Drug client visits: ____________
Client Contact (name, title, phone):
APPLICATION HISTORY
APPLICATIONS RELEASE NUMBER DATE INSTALLED
HARDWARE PLATFORM
CPU/Memory/Disk:
Number of Workstations:
Has This Hardware Been Upgraded? Is Upgrade Planned?
CLIENT PROFILE IMPLEMENTATION HISTORY
Multientity Site (Yes/No): Previous System(s) Replaced:
Public provider organization (Yes/No): Other Systems Installed at this Site:
Uses contract providers (Yes/No): Duration of Implementation to
Start End
Operates in California (Yes/No):
Unique Aspects Regarding This Site:
* Complete one form for each client reference.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
16(2). Client References*
INTERFACE HISTORY
ENTITY:
FROM SYSTEM TO SYSTEM APPLICATION(S) NATURE OF INTERFACE () STATUS ()
INTERFACED
Vendor Name Product Name Vendor Name Product Name One-Way Two-Way Batch Online Live Planned
ENTITY:
FROM SYSTEM TO SYSTEM APPLICATION(S) NATURE OF INTERFACE () STATUS ()
INTERFACED
Vendor Name Product Name Vendor Name Product Name One-Way Two-Way Batch Online Live Planned
ENTITY:
FROM SYSTEM TO SYSTEM APPLICATION(S) NATURE OF INTERFACE () STATUS ()
INTERFACED
Vendor Name Product Name Vendor Name Product Name One-Way Two-Way Batch Online Live Planned
* Complete one form for each client reference.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
17. Hardware Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
SUGGESTED TOTAL PURCHASE UNIT ANNUAL TOTAL ANNUAL EXTENDED
ITEM DESCRIPTION UNIT COST
QUANTITY PRICE MAINTENANCE* MAINTENANCE MAINTENANCE**
Total
Discounts
Net Total
* Cost for 24-hour support.
** A one time payment for multiple years (e.g., five years) of hardware support.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
18. Application Software Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
ONE-TIME IMPLEMENTATION EXTENDED
APPLICATION LICENSE TERM* ANNUAL COST TRAINING COST
LICENSE COST COST MAINTENANCE**
Total
Discounts
Net Total
* Indicate number of years of license term, or "P" for perpetual license.
** A one-time payment for multiple years (e.g., five years) of software support.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
19. Other Software Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
LICENSE LICENSE ONE-TIME ANNUAL EXTENDED
ITEM PRODUCT NAME
TERM1 TYPE2 LICENSE COST COSTS MAINTENANCE3
Operating System
Application Programming
Language
Report Writer
Screen Builder
Forms Builder
Data Dictionary
Database Management System
Network Software
Communications Software
Other
(Specify)
Other
(Specify)
Total
Discounts
Net Total
1. Indicate number of years of license term, or "P" for perpetual license.
2. Indicate license type: "S" = Site "U" = Single User License
3. A one-time payment for multiple years (e.g., five years) of software support.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
20. Interface Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
INTERFACE(S) BID
ONE-TIME IMPLEMENTATION
VENDOR TARGET 1 2 3 4 ANNUAL
DIRECTION MODE FORMAT MEDIUM LICENSE COST COST
SYSTEM SYSTEM COST
[SPECIFY] [SPECIFY]
Additional Software, Utilities, Tools, etc. Required (specify):
Total
1. DIRECTION: 1 = ONE-WAY INTERFACE 2 = TWO-WAY INTERFACE
2. MODE: R = ONLINE REALTIME B = ONLINE BATCH
3. FORMAT: FLATFILE X12 HL7 UB92 Other (Specify)
4. MEDIUM: F = FTP T=Tape D=Diskette/CD E= Interface Engine Other (Specify)
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
21. Conversion Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
ASSUMPTIONS
CONVERSION FILE ONE-TIME COST
(e.g., file must be in vendor-specified format)
[SPECIFY]
Total
Discounts
Net Total
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
22. Additional Costs
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
ITEM ONE-TIME COST ANNUAL COST
Additional Application Software Training
System Operations Training
Software Customization
Travel and Living Expenses
File Building Assistance
Software Escrow Fee
Project Manager*
Manuals and Documentation
Other (specify)
Other (specify)
Total
Discounts
Net Total
* Specify time commitment included in basic implementation and what this additional cost includes.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
23. Cost Notes and Assumptions
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
Use this form to specify notes and assumptions to Forms 15 through 20.
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc
24. Cost Summary
Entity Santa Clara Valley Health & Hospitals System
Vendor
Product
Date
COST CATEGORY ONE-TIME COST ANNUAL ONGOING COST
HARDWARE COSTS
SOFTWARE COSTS
Application Costs
Other Software
Implementation
Conversions
SOFTWARE COSTS SUBTOTAL
INTERFACES
Interface Costs
Implementation
INTERFACE COSTS SUBTOTAL
ADDITIONAL COSTS
TOTAL COSTS
Santa Clara Valley Health & Hospital System
f0087f51-c357-48fb-a085-49af2a5179ca.doc