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					     Request for Information (RFI)

  Electronic Health Record System

                    ISSUE DATE: July 12, 2010

        RESPONSE DUE DATE: July 30, 2010, 5:00 p.m. CST

       Contact – Grant Savage –

                Region: State of Missouri

Released by the Missouri HIT Assistance Center

Table of Contents
OBJECTIVE ................................................................................................................................. 2
INSTRUCTIONS .......................................................................................................................... 2
VENDOR BACKGROUND AND INFORMATION ................................................................ 4
REFERENCES .............................................................................................................................. 6
SYSTEM TECHNICAL ARCHITECTURE ............................................................................. 7
INTEROPERABILITY & HEALTH INFORMATION EXCHANGE .................................. 8
SYSTEM FEATURES AND FUNCTIONALITY ................................................................... 10
PATIENT CENTERED MEDICAL HOME............................................................................ 22
IMPLEMENTATION AND SUPPORT ................................................................................... 23
ATTACHMENTS ....................................................................................................................... 27

The Missouri Health Information Technology Assistance Center (RFI requestor), is conducting a review
Electronic Health Record (EHR) technologies for healthcare providers. As advocates for primary care
providers, the Assistance Center is distributing this Request for Information (RFI) to solicit responses
from EHR vendors, since the Assistance Center will rely on EHR vendors to provide a variety of services.
The scope of this RFI is limited to activities associated with the purchase, selection and installation of a
comprehensive EHR application for small, medium, and large primary care practices and clinics.

To accomplish this goal, the Missouri HIT Assistance Center recognizes the need to provide its clients
with selection guidelines for assessing the value and functionality of EHR options. To assist with this
project, the Assistance Center has developed this comprehensive RFI to solicit responses from vendors
and to help evaluate the suitability of EHR vendors for Missouri’s primary care providers. Additionally
the Assistance Center will conduct selected web demonstrations to confirm vendor functionality and
evaluate the usability of EHR technologies.

Inquiries - We encourage inquiries and welcome the opportunity to answer questions from potential
vendor applicants. Questions submitted in writing will be posted to the Assistance Center website.
Please direct your written questions to: Any oral
communication shall be considered unofficial and non-binding with regard to this RFI.

Scope of Responses - Interested vendors must submit their responses to all sections of this RFI and
include all requested information. Vendors who wish to send additional materials are welcome to do so,
but these materials may not be considered in the evaluation process. All materials must be converted to
ONE PDF file and submitted via email to the Assistance Center (see RFI schedule below).

Confidentiality - Due to the competitive nature of this RFI, to the extent permitted by law, all vendor
responses will be confidential.

Evaluation of Vendor Responses – The Assistance Center has established a working group to review the
documentation received in response to this RFI. During this review process, additional information may
be required of the vendors and some vendors will be invited to present and demonstrate their EHR

RFI Schedule

Date                       Activity
July 12, 2010              Release of RFI

July 30, 2010              Submission of the full RFI response in single PDF file to email by 5:00 PM CST

August, 2010               Notifications of Vendor demonstrations

August, 2010               Notification of review results

RFI Administrative Conditions
Vendor applicants should note the following:
The issuance of this RFI does not imply an offer to do business with any RFI recipient. The right to accept
any complete response, or portion thereof, or to accept none of the responses even if all the stated
requirements are met is reserved by the requestor. Only the execution of a written contract will obligate
the RFI requestor in accordance with the terms and conditions contained in such contract.

Submitted information packages that do not respond to all items in this RFI may be excluded from
further consideration and alternative information packages will not be considered.

RFI requestors reserve the right to disqualify any vendor from review in the event the vendor submits
the RFI response after the submission deadline.

RFI requestors reserve the right to amend or cancel this RFI at any time prior to the review of vendors,
without any liability to the RFI originators if, in its sole determination, such RFI originator believes that
its best interest is served by so doing.

RFI requestors will not be responsible for any costs incurred by an organization in preparing, delivering
or presenting responses to this RFI. Once submitted, vendor responses will be the property of RFI
requestors and will not be returned.

All responses to this RFI should be clear and concise. Responses of excessive length or containing
excessive advertisement are discouraged and may not be reviewed.

By submitting an information package, the vendor represents that they have read and understand the
RFI and are capable of fulfilling all requirements.

Vendor Background and Information
1. Vendor Company
       Company legal name:
       Public/Privately held:
       State of incorporation:

2. Vendor Primary Contact
           Name:
           Title:
           Office/Location Address:
           Phone Number:
           E-Mail address:
           Organization’s Internet Home Page:

3. Identify the location of the following:
           Corporate Headquarters:
           Field Support Offices:
           Application Support Personnel:
           Programming/Technical Support Personnel:
           Billing Services Personnel:

4. What percent of revenue did your company expend for research and development on your
   proposed products during the last three fiscal years? What is budgeted for the current and next
   three fiscal years?

5. List the number of employees (full time equivalents) in your organization by category:

Category                                   # Employees       Average Number Years with Company
Total Employees
Total Employees in US
Executives and Managers
Research and Development
Usability Professionals
Technical Writers
Application Support
Technical Support
Customer Service
Those with clinical background:
         Physicians
         RNs
         Other Clinicians

6. Has your company acquired or merged with any other organizations in the past three years? If so,
   please list each organization and the purpose behind such activity.

7. Please provide your most recently completed fiscal year’s financial statements and annual report.

8. How long has your company been in the business of developing and marketing your products?

9. Please describe your alliances and partnerships.

10. Is your product delivered, hosted (if applicable) and supported by the responding company, or a
    partner, such as a Value Added Reseller, third party Support Center, etc.? Please provide detailed
    information about the partner(s) and the services provided.

11. Describe your compliance plans with the basic criteria listed below.

 Ref ID     Category/Criteria                                 Description and comments
          1 Basic Requirements
 a          Describe plans to achieve HHS/ONC meaningful
            use certification
 b           Describe plans to continue to upgrade system
             to meet meaningful use requirements in 2013
             and 2015

 c         List any CCHIT certifications by the most current
           CCHIT year certified

 d         List any KLAS awards, or AAFP survey rankings
           for the EHR

 e         List adherence to the following EHR standards:
           ICD9/10, LOINC, CPT, SNOMED, and nationally
           available medication terminology
 f         Ability to generate as well as accept HL7
           Continuity of Care Documents (CCD) as
           structured data (not images)
 g         Compliance with meaningful use criteria
 h         Compliance with HIPAA Privacy and Security
           Rules and other regulatory requirements (Joint
           Commission, CMS, and State and Local laws)
 i         Compliance with fair data sharing practices set
           forth in the Nationwide Privacy and Security
 j         Role-based access controls and audit logs
 k         Ability to flag or otherwise identify sensitive
           diagnosis by ICD-9, CPT-4 or other codes
 l         Ability to configure security features (such as
           password policy, lockouts, timeouts, etc.)
 m         Describe your complete solution for covering
           the following system functions: EHR, Practice
           Management, Billing, Clinical Decision Support,
           Patient Portal, ePrescribing, and Laboratory
           NOTE: Partnering with a vendor offering any of
           this functionality which may not be part of the
           core EHR is permissible


1. What is the total number of client installations using your proposed system? Please attach list of
   installed clients in Missouri and at least 3 deinstalled clients, including practice size and contact
   information. Include at least 1 FQHC and 1 practice using your Behavioral Health functionality. If
   available, include 3 clients who achieved NCQA PCMH recognition and the PCMH Level achieved.

                           US         Missouri          2009            2010 (so far)    2010 (queue)
Total Installations

2-3 docs
4-5 docs
6-10 docs
Total Deinstallations

2. Provide specific examples of tangible benefits (Return on Investment) that can be documented by
   other users/clients of your proposed system. Include at least 3 case studies.

3. Do you provide integrated billing outsourcing services? If so, describe your fee structure, services
   and note if provided by company or partner.

System Technical Architecture
Please describe the general architecture of your proposed product(s)

                                     Yes         No            Addtl. Cost Notes
Client /Server Locally Hosted
Client/Server Remotely Hosted
Internet Based
Browser Based
Ability to operate in Connected
and Disconnected modes
Mobile Device access (iPhone,
BlackBerry, iPad)
Single Database for EHR, PMS, eRx,
Multiple Modules aggregated from
various vendors (list vendors)

1. When was your EHR/PMS system developed? Indicate year and whether the system was internally
   developed or acquired from another source.

2. Does your product provide APIs for third party development and integration? If yes, please describe
   and attach specifications.

3. Describe in detail any anticipated future application enhancements or hardware or operating system

4. Please provide a copy of your Quality Assurance Guidelines for testing new software releases.

Interoperability & Health Information Exchange
Review the questions below and describe in detail the interoperability capabilities of your product.

 Ref ID  Category/Criteria                                      Description and Comments
      2a Functional Interoperability and Health
         Information Exchange
 a         Describe your existing or future EHR systems
           integration with RHIOs and HIE
 b         Describe how your system will exchange and
           receive Continuity of Care Documents and other
           codified data between your EHR and other
 c       Will you commit to interoperability with the
         Missouri statewide health information exchange
         when implemented? Describe costs to providers,
         if any.
 d       Does your infrastructure monitor transmission of
         critical data to relevant agencies to ensure timely
         transmission including alerts and escalation if
         transmission fails?
 Ref ID  Category/Criteria                                      Description and Comments
      2b Privacy and Security Best Practices
 a       How do you capture and exchange patient
         consent (at the practice/patient level)?
 b         Does the system comply with HIPAA Privacy and
           Security Rules?
 c         Does the system comply with the Fair Data
           Sharing Practices set forth in the Nationwide
           Privacy and Security Framework?
 d         Does the system comply with all state and federal
           laws and other requirements, including but not
           limited to privacy and security, CMS regulations,
           Joint Commission requirements, etc.?
 e         Describe how privacy and security (including the
           HIPAA Privacy and Security Rules) is integrated
           into your training curriculum.
 f         How often are your training materials updated to
           reflect changes or updates in privacy and security
 g         Does the system support role-based, access
 h         Does the system support templates or profiles for
           assigning security attributes to each role?

i   Does the system support the creation of a
    hierarchy of user rights based on practice size?
j   Describe the extent that the software encrypts
    patient/practice data.
k   Describe how practice data is securely backed up
    and how is it securely restored.
l   Describe how encounters and patient charts are
m   Describe the audit functions in the EHR in terms
    of security.
n   What functionality exists in the system to protect
    sensitive patient information?
o   Does the system log all activity including ID, time,
    and function performed?
o   Describe how the database is encrypted to
    protect sensitive patient/practice data.
q   Can the system report summarized, de-identified
    data for public health, research, and other
    purposes as dictated by law?
r   Can the system flag or otherwise identify sensitive
    diagnosis by ICD-9, CPT-4 or other codes?
s   When the system goes live, are all security
    controls configured and/or activated?
t   Does the system automatically prompt users to
    change passwords; how often is it configurable?
u   Does the system automatically prompt to enforce
    specific pre-defined password configurations
    (alpha numeric minimum length etc.)
v   Does the system automatically perform lock-outs
    after a pre-determined number of failed access
w   Does the system have a configurable time out
    feature for inactivity?
x   Does the system enforce no consecutive
y   Is the system installed with network security
    software (anti-virus, anti-spam ware); if so, how is
    the software kept up-to-date?
z   Do you provide security audits, including firewalls
    related to wireless routers

 aa          Describe your business continuity plan for
             practices, including back-up and recovery
             mechanisms, as well as the time required to
             recover and re-install data.
 bb          Describe security around your remote access for
             supporting practices.
 cc          Describe how is data secured on the ASP model
             (including data transmission and storage).
 dd          Describe how data is secured on a locally hosted
             system (including data transmission and storage).
 ee          Does your organization have a Chief Security
             Officer on staff?
 ff          Provide the approximate number of FTEs
             dedicated to privacy and security.
 gg          Describe how your staff is trained and kept up-to-
             date on privacy and security.

System Features and Functionality
1. What are the names/versions of your proposed products/applications? Briefly describe each
   application’s functionality.
2. Please review the list of features for meaningful use and please indicate if your proposed solution
   has them available, not available, or planned (indicate anticipated delivery date).

 Ref ID     Category/Criteria                          Description and Comments
          3 Meaningful Use Clinical/Provider
 a          Ability to support CPOE - requires
            computer-based entry by providers of
            orders (meds, lab, procedure,
            diagnostic imaging, immunization,
 b          Ability to support drug-drug, drug-
            allergy, drug-formulary checks
 c          Ability to support maintenance of up-
            to-date problem list of current and
            active diagnoses based on ICD-9 or
 d          Ability to generate and transmit
            permissible prescriptions electronically
 e          Ability to support maintenance of
            active medication list
 f          Ability to support maintenance of

    medication allergy list
g   Ability to record demographics,
    including preferred language,
    insurance type, date of birth, gender,
    race and ethnicity
h   Ability to record vital signs, including
    height, weight, BP
i   Ability to calculate and display BMI
j   Ability to incorporate lab-test results
    into EHR as structured data
k   Ability to generate lists of patients by
    specific condition to use for quality
    improvement, reduction of disparities,
    and outreach
l   Ability to report ambulatory quality
    measures to CMS or to the states
m   Ability to send reminders to patients
    per patient preference for
    preventive/follow up care
n   Support for implementing five clinical
    decision rules relevant to specialty or
    of high clinical priority, including
    diagnostic test ordering, along with the
    ability to track compliance with those
o   Ability to check insurance eligibility
    electronically from public and private
    payers where possible
p   Ability to submit claims electronically
    to public and private payers
q   Ability to provide patients, upon
    request, with an electronic copy of
    their health information, including lab
    results, problem list, medication lists,
r   Ability to provide summary care record
    for each transition of care and referral
s   Ability to exchange electronically key
    clinical information (e.g., problem list,
    medication list, allergies, test results)
    among providers of care and patient
    authorized entities
t   Ability to perform medication
    reconciliation at relevant encounters
    and for each transition of care

u         Ability to submit electronic data to
          immunization registries and actual
          submission where required and
v         Ability to provide electronic syndromic
          surveillance data to public health
          agencies and actual transmission
          according to applicable law and
w         Compliance with HIPAA Privacy and
          Security Rules
x         Compliance with fair data sharing
          practices set forth in the Nationwide
          Privacy and Security Framework
y         Ability to stratify reports by gender,
          insurance type, primary language, race
          and ethnicity
z        Ability to exchange health information
         with external clinical entity (i.e., labs,
         care summary, and medication lists)
aa       Ability to report up-to-date status for
         childhood immunizations
bb       Ability to conduct or update a security
         risk assessment and implement
         security updates as necessary
Ref ID   Category/Criteria                            Description and Comments
       4 2011 Meaningful Use Reporting
         Measures Capability
a        % diabetic patients with a1c under
         control to an outside entity
b        % hypertensive patients with BP under
c        % of patients with LDL under control
d        % of smokers offered smoking
          cessation counseling
e         % of patients with recorded BMI
          % of orders (for medications, lab test,
          procedures, radiology and referrals)
          entered directly by physicians through
g         Use of high-risk medications (Re: Beers
          criteria) by the elderly
h         % of patients over 50 with annual
          colorectal cancer screening

i         % of females over 50 receiving
j         % of patients at high-risk for cardiac
          events on aspirin prophylaxis
k         % of patients who receive flu vaccine
l         % of lab results incorporated into EHR
          in coded format
m         % of all medications entered into EHR
          as generic, when options exist in the
          relevant drug class
n         % of orders for high cost imaging
          services with specific structured
          indications recorded
o         % claims submitted electronically to all
p         % patient encounters with insurance
          eligibility confirmed
q         % of all patients with access to
          personal health information
r         % of all patients with access to patient-
          specific educational resources
s         % of patient encounters for which
          clinical summaries were provided
t         % of patient encounters where
          medication reconciliation was
u        % of patient transitions in care for
         which summary care record is shared
         (i.e., electronic, paper, e-Fax)
Ref ID   Category/Criteria                            Description and comments
       5 General Clinical Functionality
a        Ability to document treatment plans
b        Ability to document detailed patient
         history, including Family, Medical,
         Surgical, and Social
c        Ability to longitudinally trend relevant
         patient information, including
d        Ability to electronically refer patients
         in a standardized manner to ancillary
         care providers (counselors, diabetes
         educators, etc.)

e   Ability to appropriately pseudonymize
    or de-identify patient-level data for
    transmission (pseudonymization
    allows for data to be re-linked if
    requested by an authorized entity)
f   Ability to electronically notify PCP of
    patient admission to the ED via a
    clinical summary document, including
    electronic copies of recent lab work
    and medication history (e.g., new RXs,
    lab tests, problem lists, and radiology
g   Ability for providers to select the
    patient information that will be
    downloaded into the EHR; options
    should include automatic loading of all
    available patient data
h   Ability for the system to generate
    point-of-care reminders when relevant
    patient history or habit is documented
    (nutrition, obesity, alcohol
    consumption, etc.)
i   Ability for the system to notify the
    provider that a patient may qualify for
    a quality measure population,
    including the measure numerator,
    denominator, and exclusion
j   Ability for providers to manually select
    or deselect a patient as part of a panel
    of patients who are relevant or
    qualified for specific quality measures
k   Ability for ordering providers to
    electronically receive radiology result
l   Ability to review access logs within the
m   Ability to review access to patient
    health and financial information
n   Ability to support the documentation
    of a progress note for each encounter
o   Ability to provide access to patient-
    specific education resources
p   Ability for patients to release or not
    release personal health information, as
    required by Missouri state law

q        Ability to record advance directives
r        Ability to support speech; please
         describe where in the EHR it is
         supported, which vendors are
         supported and any additional costs to
         the provider
s        Ability to insert dictation markers in
         clinical notes; describe transcription
t        Ability to document Pregnancy Care
         according to ACOF standards.
u        Describe support for Pediatric care,
         including specific immunization
v        Describe, in detail, support for
         Behavioral Health visits and billing
w        Describe support for E&M and
         procedure coding advice (including
         modifiers) in provider work-flow
Ref ID   Category/Criteria                          Description and comments
       6 Practice Management Capabilities
a        Ability to send electronic claims to
b        Ability to receive and automatically
         process Electronic Remittance Advice
c        Ability to check eligibility with payers
         in real time and batch mode
d        Ability to view payer and
         clearinghouse reports in the system
c        Ability to create Patient Statements at
         the practice and as a clearinghouse
d        Ability to track and send overdue
         patient accounts to collection agency
e        Describe automated tickler/dashboard
         system for tracking claim status
f        Describe ad hoc and standard
         reporting for AR; specify available
g        Ability to manually post payments
h        Ability to view and print individual
         patient accounts and balances
i        Ability to customize and display
         patient specific financial alerts

j        Describe the functionality of the
         scheduling application
k        Ability to support open scheduling and
         wave scheduling
l        Ability to support FQHC operations by
         collecting and reporting (UDS)
         regulatory information and by
         appropriate billing abilities (UB92)
Ref ID   Category/Criteria             Description                               Answers and comments
       7 General System
a        Enterprise-Level System Provide and describe the product's
         Architecture                  overall architecture diagram, including
                                       all integrated components such as
                                       Practice Management (registration,
                                       scheduling, billing), EHR components,
                                       Lab interfaces, ePrescribing, and
                                       Patient Portal
b        Software As A                 If applicable, describe the SaaS/ASP
         Service/ASP Solution          EHR solution, including information
                                       about the hosting environment
c           Locally-Hosted Solution   If applicable, describe the locally-
                                      hosted EHR solution, including the
                                      information found in System Details
Ref ID     Category/Criteria          Description                                Answers and comments
         8 System Details
a          Software Architecture      Describe the system's software
                                      architecture (e.g., J2EE/.NET/open
                                      source) and list all software
                                      programming languages used in the
                                      system; if applicable, describe your SDK
                                      offering for building customized plug-
                                      ins to your system.
b           Hardware Architecture     Provide a list of hardware/software
                                      required to support the system,
                                      including typical configurations
                                      required for various practice sizes
                                      (small 1-4 physicians, medium 5-10
                                      physicians, large 10+ physicians); also
                                      list optional equipment and add-ons
                                      supported such as medical devices,
                                      signature pads, etc.

c   Database Architecture     Describe the production database
                              architecture of your clinical data
                              repository (e.g., MySQL, MS SQL Server,
                              etc.), including the EHR database
                              design methodology, level of
                              normalizations, and the total number
                              of tables used to represent the EHR
d   Data Warehouse            If applicable, describe your data
    Architecture              warehouse solution and its integration
                              with the production EHR database
e   System Configuration -    Describe your system's configurability
    Enterprise, Site, Role,   at each available level, but at least at
    User                      the enterprise, site, role, and user
                              levels; include enabling/disabling
                              specific features, security settings,
                              default templates, configurable
                              templates, user-defined pick lists,
                              restricting access to sections/features,
                              preferences, etc.
f   Development Process       Describe your development
                              methodology (e.g. Agile), including
                              development workflow
g   Testing/Validation        Describe the system's testing and
    Process                   validation process, including whether
                              your testing personnel are an
                              independent team, or are included
                              within development
h   Testing/Validation        Describe the robustness of your living
    Process -Testing          laboratory used to fully test the new
    Environments              features in a simulated clinical
                              environment with full system
i   Privacy & Security        Describe (1) your overall approach to
    Process                   privacy/security in developing, testing,
                              and maintaining the software; (2) how
                              privacy/security is designed into the
                              product offering to ensure secure use
                              of the software; and (3) your
                              company's internal
                              privacy/security/confidentiality policies
                              for maintaining customer account
                              information, hosting clinical data,
                              remote customer system access, etc.

j   Third Party                List and describe all required and
    Applications/Plug-         optional third-party system
    ins/Tools                  components such as MS Office, Adobe,
                               Active X, Citrix, scanners, DICOM
                               viewers, etc. and their licensing
k   Third Party Interfaces     Describe your existing partnerships and
                               integration with lab companies (e.g.,
                               Quest, Labcorp, etc.),
                               Surescripts/RxHub, billing
                               clearinghouses, and other third-party
                               companies requiring interfaces to your
                               system; provide details on how
                               interfaces are typically configured
                               during installations.
l   Third Party Content        Describe how your system integrates
                               with third-party content providers such
                               as UpToDate, MD Consult, medication
                               terminologies (e.g., First DataBank,
                               Medispan, RxNorm, etc.), as well as any
                               others; provide details on how third
                               party content is typically configured
                               during installations
m   Third party reporting      Describe any third party reporting tools
    tools                      that you offer and describe the
                               enhanced functionality above any
                               product capabilities those will provide
n   System Support Details     Describe typical support procedures for
                               installing, upgrading, and maintaining
                               customer systems, including error
                               reporting and communication back to
                               practices; provide a support procedure
                               diagram which illustrates the
                               procedures and systems involved in
                               identifying, reporting, tracking, and
                               following up on system bugs and
                               enhancement requests
o   System Maintenance:        Describe your update and patching
    Upgrading/Patching         procedures, including details about
    Procedures and Policies.   typical upgrade/patch schedule, critical
                               patient safety patch schedule,
                               downtime requirements, etc.

p   Enterprise-wide System    Describe your strategy for maintaining
    Versioning                system version control across a
                              distributed network of multiple
                              customer installations, and your
                              process for tracking which upgrades,
                              patches, and system configuration
                              settings have been applied to each
                              customer's server/client machines.
q   Backup/Restore            Describe your system's backup and
    Procedures                restore process, including details for
                              both the application and clinical
r   Off-site Backup/Restore   Describe your off-site backup/restore
    Services: You are         services; if partnering with a third-party
    required to provide an    solution, describe its setup process and
    off-site backup/restore   integration with your system and any
    service                   licensing requirements/fees
s   Failover Plan             Describe typical business continuity
                              plans for hardware or software failures,
                              in both a locally or an ASP hosted
t   Practice                  Describe any services/tools provided
    Management/Clinical       for migrating existing third-party
    Data Migration            practice management/EHR/clinical data
    Services/Tools            to your system
u   Software/Hardware         Describe typical processes for
    Migration                 expanding system architecture (e.g.,
    Procedures/Tools          upgrading hardware for expanded
                              clinical capacity, increasing system
                              performance, replacing broken
                              hardware, etc.)
v   Multilanguage Support     Describe your system's user interface
                              and reporting capability for multiple
                              languages including Spanish, Chinese,
                              Russian, etc., including support for
                              multiple character sets
w   Document Management       Describe your system’s ability to scan
                              documents, to manage scanned
                              documents, and to attach documents
                              to patient chart elements
x   Data Export               Describe your abilities to export data
                              from your product(s) in the event of
                              contract termination, including
                              provider cost and timeline for

Ref ID     Category/Criteria            Description                             Answers and comments
         9 Standards Compliance
a          EHR Data Encoding            For each of the EHR sections below
                                        describe how the content has been
                                        stored, either as 1) Coded = assigned
                                        codes from national/New York state
                                        standards (ICD-9, SNOMED, LOINC,
                                        RxNorm, CVX Immunization, etc.);
                                        Please specify the standard used. 2)
                                        Structured = pick list/pull
                                        down/templates that are vendor/user
                                        specific; 3) Free Text = Narrative
                                        (History/Physical) vs. Brief (Chief
                                        Compliant). Describe how each section
                                        can be used for meaningful use
                                        measurement/quality reporting and
                                        clinical decision support.
b           Diagnosis/Assessment        Coded, Structured, or Free Text?
c           Problem List                Coded, Structured, or Free Text?
d           Medications                 Coded, Structured, or Free Text?
                                        Specify use of third-party medication
                                        terminology vendor (e.g., First
                                        DataBank, Medispan, etc.)
e           Laboratory Orders           Coded, Structured, or Free Text?
f           Laboratory Results          Coded, Structured, or Free Text?
g           Vitals                      Coded, Structured, or Free Text?
h           Immunizations               Coded, Structured, or Free Text?
i           Allergies                   Coded, Structured, or Free Text?
j           Progress Notes              Coded, Structured, or Free Text?
k           Chief Complaints            Coded, Structured, or Free Text?
l           HPI                         Coded, Structured, or Free Text?
m           Billing                     Coded, Structured, or Free Text?
n           Review of Systems           Coded, Structured, or Free Text?
o           Physical Exam               Coded, Structured, or Free Text?
p           History (Medical, Family,   Coded, Structured, or Free Text?
            Social, Surgical)
q           Procedures/Radiology        Coded, Structured, or Free Text?

Ref ID  Category/Criteria      Description                                  Answers and comments
     10 EHR Architecture
a       Vocabulary             Describe (1) the architecture for
        Services/Master Data   managing clinical vocabularies used to
        Management             record EHR content, including
                               national/commercial vocabulary
                               sources (e.g., ICD9/10, LOINC,
                               SNOMED, Medispan, etc.) as well as
                               internal proprietary system codes; (2)
                               how this content is updated, whether it
                               requires code recompilation/
                               development, or if it exists as an
                               independent system module; and (3) if
                               there are any costs associated, please
                               detail them in the Pricing section
b       Clinical Guideline     Describe (1) how your system
        Knowledgebase          represents the clinical knowledge
                               needed for its business rules, e.g., the
                               computable knowledge needed for
                               triggering alerts for quality measure
                               follow-up, medication interactions,
                               etc.; (2) how this content is updated,
                               whether it requires code
                               recompilation/development, or if it
                               exists as an independent system
                               module; and (3) your use of any
                               national guideline representation
                               standards such as Arden Syntax, GELLO,
c       Decision Support       Describe (1) your decision support
        Architecture/Rules     architecture, its integration with a rules
        Engine                 engine (e.g.. Drools), clinical guideline
                               knowledgebase, vocabulary services,
                               and clinical data repository, or how you
                               combine each of these components in
                               your system; (2) your support for both
                               data and time driven decision support
                               types; and (3) provide examples of
                               existing decision support alerts,
                               reminders, resources, etc.
d       EHR/Public Health      Describe how your system interfaces
        Integration            with public health departments,
                               including immunization registry
                               reporting, disease/syndromic reporting,

 Ref ID  Category/Criteria           Description                                Answers and comments
      11 Quality Measures
 a                                   Can the EMR derive and report HEDIS
                                     measures? If so describe
 b                                   Can the EMR derive and report QUARR
                                     measures? If so describe
 c                                   Is the EMR certified to report quality
                                     measures (for example PQRI)
 d                                   Can the EMR report PQRI measures to
                                     an external entity? If so describe

Patient Centered Medical Home
Review the questions below and describe your product’s ability to support PCMH

 Ref ID   Category/Criteria               Description                         Answers and comments
       12 Medical Home                    Full detail on NCQA reporting       Describe briefly if and how
                                          requirements for PCMH               your product provides
                                          recognition can be found at:        appropriate documentation
                                       to support the following
                                          /D efault.aspx                      NCQA Patient Centered
                                                                              Medical Home standards:
 a         System reporting on patient
           data by condition,
           medication, risk factors
 b         Patient portal to request
           appointment, refills, access
           to portions of records
 c         Patient Tracking and
           Registry Functions (all
 d         Care Management,
           especially preventive
           service/ or other clinician
 e         Electronic Prescribing,
           including writing, and
           decision support with safety
           and cost checks
 f         Test Tracking (all elements)
 g         Referral Tracking
 h         Performance Reporting,
           including performance
           measures, reporting to
           physicians, standard

          measures, external

i         Advanced Electronic
          Communication (all
Ref ID   Category/Criteria                Description                       Answers and comments
      13 PCMH Recognized Practices        Yes/No                            Details
a         Have any of your Missouri
          customers achieved NCQA
          PCMH recognition? If yes,
          please attach list of all
          NCQA PCMHs in Missouri
          who achieved that
          recognition using your
b         Have any of your customers
          achieved NCQA PCMH
          recognition? If yes, please
          attach list of all NCQA
          PCMHs who achieved that
          recognition using your

Implementation and Support
Review the questions below and describe your implementation methodologies and available support for
your product. Please be short and succinct – limit your response to 200 words or less.

Ref ID  Category/Criteria                                     Description
     14 Education and Outreach to Center and Providers
a       How do you plan to assist in identifying and
        referring potential small private physician
        practices, CHCs and hospital out-patient
        departments to the Missouri HIT Assistance
b       How do you plan to demonstrate and explain the
        benefits of your solution and services to potential
        users, including providing demonstrations,
        webinars, etc.?
c         Describe the training resources (including
          clinicians) you have available to explain the
          clinical benefits of your system and services to

d        Describe how you recommend potential partners
         (hardware, network, IT services) to practices
e        Which public events do you participate in with
         the purpose of expanding the awareness of your
         products and services?
f        Which groups do you interact with on how to
         promote your services (state and local health
         services, public health agencies, professional
         organizations, consumer organizations, etc.)
g        What materials and methods do you have so that
         the Assistance Center and providers have access
         at all times to up-to-date information and
         documentation on your system and services
h        What metrics do you keep and will make available
         to the Assistance Center to understand the status
         and trends of outreach, pipeline, live installations
i        Describe the training which you will make
         available to Assistance Center staff and
         contracted implementation partners to educate
         them on your products
j        What process do you have to incorporate user
         feedback into the product roadmap
k        How will you assist the Assistance Center in
         providing educational tools and information
         regarding general EHR adoption strategies and
         meaningful use to providers? (Note: Not specific
         to your product)
Ref ID  Category/Criteria                                       Description
     15 Implementation and Project Management
a       How will you provide access to the Assistance
        Center's staff/partners to a test environment
        capable of being used to fully test the system’s
        features in a simulated clinical environment with
        full system functionality including bi-directional
        links to labs, insurance, etc.

b   Can you in real-time or on a daily basis monitor
    the configuration settings and functional status of
    each individual practice installation in order to
    track the status and use of system features? Will
    you have the ability to query the practices directly
    and receive these results centrally using a query

c   How will you send appropriate real-time alerts
    and queries out to providers based on certain
    selection criteria?
d   How will you send appropriate real-time alerts
    and queries out to providers based on certain
    selection criteria? Can this be controlled in a
    centralized fashion for a community of practices
    by a central administrator?
e   How will you share configurations and templates
    between practices?
f   How do you upgrade/patch all or selected
g   How will you generate a quality report card based
    upon clinical performance metrics and be able to
    send it out directly to practices and providers?
h   What is your implementation methodology and
    average length of implementation for each
    practice type and size?
i   What project management tools do you use to
    track the progress of each practice and of the
    pipeline as a whole?
j   Will you assign a project manager to each
    practice and what will be the average caseload?
k   What is your escalation pathway for resolving
    implementation issues or delays?
l   What tool do you have in place to assess the
    computer skills of clinic staff pre go-live, and what
    resources do you have available to assist with
    remedial training?
m   What process will you have in place to assess the
    training process and adequacy of staff skills in
    advance of go-live?
n   How will you ensure you have dedicated training
    resources to meet the needs of the providers in

o        What is your process for documenting both
         current and future state workflows and how does
         it differ based on practice type?
p        How will you ensure that the training for each
         practice is based on its specific workflow?
q        What evaluation will you conduct of providers
         both pre and post go-live to insure a successful
         system install?
r        How will you assess practice and provider's
         comprehensive usage of the EHR?
s        How will you assess the meaningful use of the
t        What mechanism will the providers use to place
         support tickets both pre and post go-live?
u        What is your support ticket tracking tool, and
         what technology is it based upon?
v        Will you assign a support manager to each
w        How will you ensure issues and tickets are
         resolved adequately and within the specifications
         of the Service Level Agreement (SLA)?
Ref ID  Category/Criteria                                     Description
     16 Practice and Workflow Redesign
a       What templates do you have for practices to use
        to map their current workflows?
b        What are the key workflows you will review with
         the practice?
c        What process do you have in place to assist
         practices to redesign their workflows, increase
         efficiencies and maximize the use of the EHR?
d        What process will you have in place to verify
         progress towards meaningful use as defined by
         the ARRA legislation?
Ref ID  Category/Criteria                                     Description
     17 Local Workforce Support
a        Do you have a standard testing plan for use with
         workflows, interfaces, and relevant functionality?
b        How do personnel (from the Assistance Center
         and provider) define and report issues and
         priorities while on site?
c        How does a person on-site test the accuracy of
         the quality and utilization reports?

 d         How do you plan to test for meaningful use
           compliance and data submission?
 e         How do you test new installations?
 f         How do you test a practice after an upgrade?
 g         How does a user define priorities of issues?
 h         How many dedicated technical support personnel
           do you plan to have per 100 practices?
 i         How do you plan to assist providers and or the
           Assistance Center personnel on-site conduct
           interface mappings and testing?
 j         What are the various methods by which problems
           are reported (phone, web, etc.), and how are
           responses sent back to users?
 k         How do you inform users of the functionality
           included in new releases?
 l         How is after hours support handled?
 m         What are your escalation procedures?

Please also include the following with the completed RFI Response:

     1. High-level implementation plan for a one-, five-, and 10-doctor practice with estimated timeline
     2. A copy of your support policies and procedures as applicable to the proposed solution
     3. Pricing for a one-, five-, and 10-doctor practice broken down into five areas:
             a. Licensing (include model)
             b. Training and implementation (define deliverables and include travel expenses)
             c. First year maintenance
             d. Second year maintenance
             e. Add-ons (e.g., e-prescribing, document management, patient portal, mobile
                  applications, practice management, billing services)
             f. Content & third party (e.g. ,MS Word, FDB, CPT, Patient Lit, CDS)
             g. Interfaces (include standard price and hourly rate for customization)
     4. Copies of your standard contract and Business Associate Agreement
     5. Hardware specifications for a one-, five-, and 10-doctor practice (include estimated cost)
     6. List of all currently operational interfaces supported by your product (Laboratory, Radiology,
        Prescriptions, Immunizations, Hospitals, Claim Clearinghouses, Collection Agencies, Payers,
        Practice Management Systems, Financial Systems, In-Office Devices, Commercial PHRs, Check-In
        Kiosks, PQRI, HIE, RHIO/HIO, Other)
     7. Itemized list of all attachments included with the RFI response.

This completes the questionnaire. Thank you for your interest in the Missouri HIT Assistance Center.


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