Quotation System Proposal Template

Document Sample
Quotation System Proposal Template Powered By Docstoc
					             REQUEST FOR PROPOSAL NO. ACMCNM09-2


              SPECIFICATIONS, TERMS & CONDITIONS

 FOR AMBULATORY ELECTRONIC MEDICAL RECORD SYSTEM


                        RESPONSE DUE
                        42B




                           BEFORE
                         4:00P.M. PST
                              ON
                      SEPTEMBER 21, 2009

                              AT

           ALAMEDA COUNTY MEDICAL CENTER
        HEALTHCARE CONTRACTING DEPARTMENT
       43B




ATTN: NANCY McADOO, DIRECTOR OF CONTRACTING SERVICES
          1411 E. 31ST STREET, B WING – 4TH FLOOR
                     OAKLAND, CA 94602
                               ALAMEDA COUNTY MEDICAL CENTER
                                      RFP NO. ACMCNM09-2
                              SPECIFICATIONS, TERMS & CONDITIONS
                                              FOR
                         AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM

                                                          TABLE OF CONTENTS
                                                                                                                                            Page
STATEMENT OF WORK
    Intent/Scope............................................................................................................................. 2
    Specific Requirements ............................................................................................................        2-33
                      ACMC Clinical Applications
                      Financial Applications
                      Features and Functionality
                                 1. Functional Requirements/Features
                                 2. Security/Compliance
                                 3. Clinical Data Repository
                                 4. Technical (Hardware and Operating System Software Questions)

INSTRUCTIONS TO VENDORS
     Acronym and Term Glossary ................................................................................................             34
     ACMC Contacts......................................................................................................................    34
     Calendar of Events..................................................................................................................   34
     Submittal of Proposals ............................................................................................................    35-36
     Response Format.....................................................................................................................   36
     Response Content/Submittals.................................................................................................           36-37
     Evaluation Criteria/Selection Committee ..............................................................................                 38

TERM AND CONDITIONS
    Term/Termination/Renewal………………………………………………..………….                                                                                       39
    Award………….……………………………….…………………………………..….                                                                                                39
    Pricing………………………………………………………………………………….                                                                                                 40
    Method of Ordering……………………………………………..................................                                                                   41
    Invoicing………………………………………………………………………............                                                                                        41-42
    Other Agencies………………………………………………………………………...                                                                                            42
    Funding Out Clause…………………………………………………………………….                                                                                           42
    ACMC Provisions………………………………………………………………………                                                                                              42-48
    Account Manager/Support Staff…………………………………………………..……                                                                                    49
    General Requirements……………………………………………………………….…                                                                                          49-50

           Exhibit A – Bid Acknowledgement
           Exhibit B – Bid Form
           Exhibit C – Insurance Requirements for Professional Services Contracts
           Exhibit D-1 & Exhibit D-2 – Current and Former References
           Exhibit E – Request for Preference for Local Products and Vendors
           Exhibit F – Exceptions, Clarifications, Amendments
           Exhibit G – Sample Proposal Evaluation Form
           Exhibit H – ACMC Sites and Addresses
           Exhibit I – Substitute IRS Form W-9
           Exhibit J – Business Associate Agreement



                                                                             Page 1 of 67
STATEMENT OF WORK


    INTENT/SCOPE

    It is the intent of these specifications, terms and conditions to describe the Alameda County
    Medical Center’s (ACMC) requirements for an Ambulatory Electronic Health Record System.


    SPECIFIC REQUIREMENTS

    Alameda County Medical Center consists of six campuses: an acute hospital, inpatient
    psychiatric hospital, a Neuro-respiratory unit, Rehabilitation unit, a Skilled Nursing Facility and
    three free-standing outpatient clinics. The staffed bed count for each inpatient facility is as
    follows:
    Acute (including Med-Surg, OB, ICU etc.): 131.13; Psychiatric Facility: 63.5 and the three
    other units combined: 122.27

    ACMC currently utilizes a Siemens platform consisting of Invision, Signature, Lawson, PACS.
    Also used are Wellsoft ED and McKesson clinical Documentation.


     ACMC Clinical Applications
    0B




    The primary clinical applications are owned by Siemens Corporation and are contracted back
    to ACMC. The current contract goes through 2017. These applications are run remotely on
    Siemens hardware located in Malvern, PA. Data is moved back and forth over a high speed
    ATM communications network. The Siemens applications include Patient Accounting,
    Radiology, In-Patient Pharmacy, Decision Support, Novious Lab, PACS digital imaging,
    Signature Out-Patient registration and scheduling, Physician Order Entry, LCR (lifetime
    clinical record), Patient Management which includes Admissions, Discharges, Transfers and
    Order Entry and SOAR (Medical Records Imaging Documentation, One-Staff (nurse
    scheduling, GRASP (nurse acuity), RefTrack, Credentialing, SoftMed (Medical Records),
    Dictaphone (dictation and transcription), MUSE (EKG system), ORMIS (OR Scheduling)
    and Wellsoft (ED system).

    IS provides Ad Hoc reporting from some of the above databases.


     Financial Applications:
    1B




    The primary financial applications are owned by Lawson Corporation. These applications
    are hosted remotely by Siemens and include Materials Management, General Ledger,
    Payroll, HR, and Accounts Payable. Also purchased from Lawson was their suite of tools /
    budgeting, Grant Accounting and Process Control.

                                               Page 2 of 67
Siemens currently provides report writing support using SQL to address special report needs.

Features and Functionality

The functional requirement checklist section provides a list of general and/or specific
features or functions required by our organization. Each function has five columns in which
to respond. The criteria for each column are explained below:

Met Fully - The function is available and completely operational.

Custom-Developed - The function will be custom-developed during installation.

Under Development - The function is planned for a future release.

Not Available - The function is not available in the current software, future software
releases, and will not be custom-developed.

For those features marked Custom-Developed or Under Development, provide a time frame
for development or an availability date for the schedule release of the function.

Any comments for each requirement should be entered directly beneath the requirement.




                                          Page 3 of 67
                                                                                                                                         Not Available
                                                                                                                           Development
                                                                                                               Developed
                                                                                                   Met Fully


                                                                                                                Custom



                                                                                                                              Under
                                   Functional Requirements/Features
                                 28B




1.        General
         2B




1.1 Is your solution CCHIT certified to the most current standard? CCHIT (Certification
Commission for Healthcare Information Technology)
1.2 Does your system support both a total paperless function and a hybrid function, where the
      contents of the electronic record can be printed for inclusion in the paper chart?
1.3 Does your system link with a variety of digital and analog dictation systems? Specify the
       systems.

1.4 Does your system stamp all entries by date and time?

1.5 Does your system include automatic translation of codes to data? For example:

             ICD-9-CM, ICD-10-CM

             CPT 4

             NDC

1.6 Does your system include support and updates for the above vocabularies?

1.7 Does your system support local, regional, and national vocabularies, updates and
       enhancements?
1.8 Does your system include the integration of third party coding programs? Specify the
       programs.
1.9 Does your system include extensive error checking of all user input data, including, but not
       limited to:
             ICD-9 (Check diagnosis against gender, age, other as necessary)
             CPT procedure checking against diagnosis
1.10 Does your system do extensive date checking for validity as well as ensuring a valid
       chronological order of events (DX before treatment, scheduling after birth, etc.).
1.11 Does your system include an integrated standard nomenclature of clinical terms.
1.12 Does your system have the ability to print Multimodal data entry?
2.        Demographics
         3B




2.1 Has your system established, bi-directional HL7 interfaces for transmission of patient
       demographic data for registration and scheduling?
2.2 Does your system have the capability to import/create, review, update, and delete patient
       demographic information as well as other non-clinical information from the patient
       record?
2..3 Does your system have required fields in registration?
2..4 Does your system capture race and Ethnicity?
2..5 Does your system have panel assignments?
2..6 Does your system have Bureau of Primary care Required Data?




                                                                  Page 4 of 67
                                                                                                                                       Not Available
                                                                                                                         Development
                                                                                                             Developed
                                                                                                 Met Fully


                                                                                                              Custom



                                                                                                                            Under
                                     Functional Requirements/Features
                                   28B




3.        Medical History
         4B




3.1 Does your system support rapid capture of patient history and physical exam data?
             With Templates?
             Free form text?
3.2 Does your system allow the carry over of any patient history whether it is present/past
       illness, family history, social history, and “normal physical” (i.e. appendectomy scar)
       from one encounter to another?
3.3 Does your system for each new patient captures and stores risk factors. For example:

             Tobacco use and history including number of years and packs per day (PPD)?
             Alcohol use, history?

             Drug use, history?
             Occupational environment?

             Sexual history?
3.4 For each new patient, does your system capture and store the following social history
        elements:

             Marital status?

             Occupation?

             Religious preference?

             Socioeconomic status?

             Native language?

             Translator needed (Y/N)?
3.5 Does your system document the below hospitalization data.

             Admission and Discharge dates?
             Chief complaint?

             Admitting diagnosis / other diagnoses?

             Procedures performed?

             Discharge summary?

             Discharge disposition?
3.6 Does your system document all existing allergies, such as:

             Drug?

             Food?
             Drug-drug?

             Drug-food?



                                                                 Page 5 of 67
                                                                                                                                         Not Available
                                                                                                                           Development
                                                                                                               Developed
                                                                                                   Met Fully


                                                                                                                Custom



                                                                                                                              Under
                                    Functional Requirements/Features
                                  28B




3.7 Does your system capture history of received immunizations?
3.8 Does your system have the capability of linking or grouping records of other family
members on file?
3.9 Does your system have the capability to capture and store genograms?
3.10 Does your system collect and store family history, including, but not limited to:

             History of chronic diseases, including date of diagnosis?

             Disease status?

             Family member functional status?
             If deceased, date and cause of death?
4.        Current Health Data, Encounters, Health Risk Appraisal
         5B




4.1 Does your system obtain test results by using vendor established HL7 interfaces?
4.2 Does your system have the capability to import/create, review, and amend information
       about the patient’s condition obtained from laboratory, radiology/imaging, or other
       equipment or technology-related tests and/or procedures?
4.3 Does your system have the capability to capture and monitor patient health risk factors in a
       standard format?
4.4 Does your system displays encounter data using a problem-oriented format?
4.5 Does your systems support the capture, graphic display and plotting of growth chart
       information, as well as other forms requiring graphic representation?
4.6 Does your system have the capability of reproducing and displaying a variety of end user
       patient and treatment forms?
4.7 does your system have the capability to update other portions of the record with captured
       vital signs data. At minimum, the system collects:

             Height?

             Weight?
             Pulse?

             Temperature?

             Respiratory rate?

             Blood pressure (including multiples)?

             Different position blood pressure?
4.8 Does your system incorporate one or more accepted measure of functional level?
4.9 Does your system support at least one standard health status measure?
4.10 Does your system store automatic measurements of health status such as body mass index?
4.11 Does your system have the capability to import/create, review, update, and amend health
       data (objective and subjective) regarding the patient’s current health status, including
       (as applicable):



                                                                    Page 6 of 67
                                                                                                                                        Not Available
                                                                                                                          Development
                                                                                                              Developed
                                                                                                  Met Fully


                                                                                                               Custom



                                                                                                                             Under
                                Functional Requirements/Features
                              28B




       Chief complaint?

       Onset of symptoms?

       Injury mechanism?
       Physical examination findings?

       Psychological and social assessment findings?
4.12 Does your system provide a flexible mechanism for retrieval of encounter information that
        can be organized in variety of views? For example:
       By name (last, first; first, last; etc.)?
       By date of birth?
       Chronological by encounter date?
       By diagnosis, problem, problem type?
       By chart number?
       By family group / linkage?
4.13 Does your system provide a flexible, user modifiable, search mechanism for retrieval of
        information captured during encounter documentation?
4.14 Does your system provide a mechanism to capture, review, or amend history of current
        illness?

4.15 Does your system ensure dynamic documentation during the encounter complying with all
        standard coding rules?

4.16 Does your system capture the following referral information:

       Type of referral?
       Date?

       Reason?

       Provider?
4.17 Does your system track consultations and referrals?
4.18 Does your system have the capability of printing consultations and referral forms matched
        to the patient’s insurance information?
4.19 Does your system support the electronic submission of consultations and referral forms on-
        line?
4.20 Does your system have an integrated letter writing capabilities with mail merge
        functionality?
4.21 Does your system provide patients with a web portal to access and update allowed areas of
        their own record?
4.22 Does your system provide a proxy option for patients accessing a record via the web
        portal?
4.23 Does your system have BMI calculator?


                                                              Page 7 of 67
                                                                                                                                        Not Available
                                                                                                                          Development
                                                                                                              Developed
                                                                                                  Met Fully


                                                                                                               Custom



                                                                                                                             Under
                               Functional Requirements/Features
                             28B




5.      Encounter – Progress Notes
       6B




5.1 Does your system record progress notes utilizing a combination of system default,
       providing customizable and provider-defined templates?
5.2 Does your system have the capability to automatically update other sections of the record
       with data entered in the progress note?
5.3 Does your system require that the progress note be electronically signed at the end of the
       encounter prior to being allowed to continue?
5.4 does your system allow physicians to save progress notes as “Update pending” to complete
       electronic signature at a later time?
5.5 Does your encounter - progress note template include a space for entering performed and
       planned procedures? Does It also include:

           Performed/planned Laboratory procedures?

           Diagnosis?

           Goals (provider’s and patients) and follow-up plans?

           Medications prescribed?

           Patient education materials?

           Consultation/referrals?

           Patient condition or status?
5.6 Does your system include a progress note template that is problem oriented and can, at the
       user’s option be linked to either a diagnosis or problem number?
5.7 Does your system have the capability of retrieving encounters by a variety of user-defined
       parameters?
5.7.5 Does the system automatically generate charge(s) for professional fee based on procedures
or daily visit that are documented by the clinician?
5.8 Does the system enable standard phrases to be defined/contained in tables and used as pull
       down menus to reduce the key entry effort?
5.9 Does the system automatically capture the electronic signature and title of the person
       entering data and date/time stamps each transaction?
5.10 Does the system enable progress notes to be sorted for viewing in chronological or reverse
        chronological order by encounter date in relation to the active care plan?
5.11 Does the system apply security controls to progress notes to ensure that data cannot be
        deleted or altered except within the current session and by an authorized user?
5.12 Does the system include a medical terminology dictionary within the progress notes data
        entry module?
5.13 Does the system support the capability to automatically collect the data elements defined
        by the associated clinical practice guideline or order?




                                                               Page 8 of 67
                                                                                                                                        Not Available
                                                                                                                          Development
                                                                                                              Developed
                                                                                                  Met Fully


                                                                                                               Custom



                                                                                                                             Under
                                         Functional Requirements/Features
                                       28B




5.14 Does your system provide checklists and drop down listings for the creation of progress
        notes with automatic generation of sentences?
5.15 Does your system allow dentists to record completed and planned work by tooth?
5.16 Does your system allows patient search by name, inmate #, MR #, DOB, SSN, etc?

5.17   Can your system calculate prenatal client’s EDD (estimated due date) and trimester of
                pregnancy based on entry of LMP (last menstrual period)?
5.18 Does your system have documentation for supervision (MLPs and residents) templates
        exam with free test option?
5.19 Does your system have downloadable images?
5.20 Does your system adaptable to multiple subspecialties?
6.          Problem Lists
           7B




6.1 Does your system provide a problem status for each shown problem?
6.2 Does the system organize applicable patient data into comprehensive problem summary
       lists?
6.3 Does the system provide problem descriptions based on standard vocabularies?
6.4 Does the system separate resolved and unresolved problems?
6.5 Does the system allow clinicians to identify and record new patient problems as well as the
       current status of existing problems?
6.6 Does the system expand the problem summary list on demand?
6.7 Does the system enable the monitoring of health risk factors?
6.8 Does the system update the active problem list from relevant data in the progress note?
6.9 Does the system record the patient’s current health status collected in a standard format?
6.10 When capturing problem information, does the system capture:

               Diagnosis / problem date(s)?

               Severity of illness?
6.11 For each problem, does the system have the capability to create, review, or amend
        information regarding a change on the status of a problem to include, but not be
        limited to, the date the change was first noticed or diagnosed?
6.12 Does the system archive problems complete with status history?
6.13 Does the system continually update the diagnosis/problem lists with the capture of each
       new piece of patient data in any module?
6.14 Does the system automatically link problems with order and results?
6.15 Does the system automatically update the problem summary lists using approved rules-
       based guidelines?
6.16 Does the system have the capability of allowing the display of past interventions,
       hospitalizations, diagnostic procedures, and therapies for review at the option of the
       provider?




                                                                   Page 9 of 67
                                                                                                                                              Not Available
                                                                                                                                Development
                                                                                                                    Developed
                                                                                                        Met Fully


                                                                                                                     Custom



                                                                                                                                   Under
                                    Functional Requirements/Features
                                  28B




6.17 Dopes the system meet RBRVS/E&M documentation and coding guidelines?
6.18 Does the system automatically update the problem summary lists upon detecting changes
       made to multi-disciplinary guidelines?
6.19 Does your system allow providers to modify problem list?
7.        Clinical Practice Guidelines (CPG)
         8B




7.1 Does the system include standard Clinical Practice Guidelines (CPG) from the National
       Guideline Clearinghouse, a public resource for evidence-based clinical practice
       guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality
       (formerly the Agency for Health Care Policy and Research)?
7.2 Does the system have the capability of allowing initial authoring and revising of clinical
       practice guidelines?
7.3 Does the system allow linkages from the CPG to other system modules?
7.4 Does the CPG module import/create the facility for rapid documentation of the patient’s
       progress along the CPG’s phases?
7.5 Is the format utilized by the guideline for documenting, intuitive, easy to use, and user
         customizable?
7.6 Does the CPG module utilize pull down menus and check boxes to speed up data entry?
7.7 Optionally, can the CPG module be populated by data entered elsewhere in the system?
7.8 Does the system allow reporting and analysis of any / all components included in the CPG

             The performance measures that will be used to monitor the attainment of objectives?

             The quantitative and qualitative data to be collected?

             Performance metrics?

             Collection means and origin of data to be evaluated?
7.9 The system allows the provider or other authorized user to override any or all parts of the
       guideline.
8.        Care Plan
         9B




8.1 Does the system have the capability to import/create, review, and amend information about
       the desired single or multi-disciplinary long / short term goals and objectives that will
       be accompanied by the care plan?
8.2 Does the system have the capability to import/create, review, and amend information about
       the proposed set of single or multi-disciplinary care plan options that are based upon
       expected outcomes?
8.3 Does the system have the capability to import/create, review, and amend information
       about:
             The provider’s explanation and the patient’s or patient representative’s understanding
              of the recommended and/or alternative care plan options?

             The medical orders, which authorize the execution of the selected, care plan?
             The collection of specimens (body fluids, tissue, etc.) from the patient to be used for
              diagnostic or treatment purposes?



                                                                       Page 10 of 67
                                                                                                                                                      Not Available
                                                                                                                                        Development
                                                                                                                            Developed
                                                                                                                Met Fully


                                                                                                                             Custom



                                                                                                                                           Under
                                           Functional Requirements/Features
                                         28B




                    The actions taken to safeguard the patient to avert the occurrence of morbidity, trauma,
                     infection, or condition deterioration?
9.         Prevention
         10B




9.1 Does the system have the capability to display prevention prompts on the summary
       display?
9.2 Does the system provide an “at a glance” summary view of the patient’s health
       maintenance record?
9.3 Does the system allow interactive prevention status documentation. At minimum:

                    Date addressed?
                    Result?

                    Reasons for not performed?

                    Where performed?
9.4 Does the system include user-modifiable health maintenance templates?
9.5 Does the system include a patient tracking and reminder capability (patient follow-up)?
9.6 Does the system allow the graphing of pertinent data into flow sheets for
       presentation/display?
9.7 Does the system include the incorporation of immunization protocols:

                    Universal child?
                    Universal adult?

                    Specific foreign travel?
 10.             Patient Education
               11B




10 1 Does the system have the capability to create, review, update, or delete patient education
       materials?
10.2 Does the system have the capability of providing printed patient education materials in
       culturally appropriate languages on demand or automatically at the end of the
       encounter?
10.3 Does the system include the capability to develop patient instructions for a broad range of
       treatments and services delivered by providers. Examples:
                    Care of wound?

                    Exercise regimen?

                    Diet guidelines?

                    Administration and care of medications?
10.4 Does the system allow patient instructions to be selected from a pull down list?
10.5 Does the system import patient education material from other systems/external web sites.
                    Stores full content from external source?
                    Stores URL link to web site only?



                                                                           Page 11 of 67
                                                                                                                                        Not Available
                                                                                                                          Development
                                                                                                              Developed
                                                                                                  Met Fully


                                                                                                               Custom



                                                                                                                             Under
                                    Functional Requirements/Features
                                  28B




             Stores full URL link with article ID?
10.6 Does the system allow user modifications to instructions to suit individual patient needs
       without altering the original content?
10.7 Does the system enable the linkage of patient instructions to care plans/care maps/
       practice guidelines/orders, enabling automatic printing?
10.8 Does the system allow patient instructions to be printed on demand independent of care
       plans/care maps/guidelines/orders?
10.9 Does the system provide a web portal for patients to review targeted content?
10.10 Does the system include the facility to create a directory of information for patient
        support groups and to include any applicable support group information in the
        instructions?
10.11 Does your system make Krames material available for patients?
 11.      Alerts
        12B




11.1 Does the system include user customizable alert screens / messages, enabling capture of
       alert details, including, but not being limited to:

             Text describing the alert?

             Date and time of the alert?
11.2 Does the system print an alert on demand?
11.3 Does the system have the capability of forwarding the alert to a specific provider(s) or
       other authorized users via secure electronic mail or by other means of secure electronic
       communications?
11.4 Does the system alert overdue orders?
11.5 Does the system e-mail reminders to patients?
 12.      Orders
        13B




12.1 Does the system include an on-line electronic order entry module that has an established,
       bi-directional HL7 interface?
12.2 Does the system route orders based on payer/insurance plan?
12.3 Does the system have the capability to print orders?
12.4 Does the system have the capability to fax orders?
12.5 Does the system have the capability to require that all orders be digitally signed at the
       completion of each order?
12.6 Does the system support a counter signature process?
12.7 Does the system provide fields to document authorizing providers?
12.8 Does the system accept orders from multiple locations?
12.9 Does the system link orders with diagnosis and/or problem lists?
12.10 Does the system have the capability to assign and display an order number for active,
        hold, and pending orders?




                                                                Page 12 of 67
                                                                                                                                           Not Available
                                                                                                                             Development
                                                                                                                 Developed
                                                                                                     Met Fully


                                                                                                                  Custom



                                                                                                                                Under
                                    Functional Requirements/Features
                                  28B




12.11 During the order entry process, does the system have the capability to require the user to
        acknowledge an error and/or alert message prior to being allowed to continue with the
        data entry function?
12.12 Does the system allow the user to accept, override, or cancel an order?
12.13 Does the system require the user to enter a justification for overriding, changing, or
        canceling an order prior to be allowed to continue?
12.14 Does the system include the visual indication of orders in need of review?
12.15 Does the system detect and display duplicate orders issuing visual and auditory warnings,
        and allows the user to override the warning after entering a justification for the
        override?
12.16 Does the system include the capability to:

             Define order sets for each provider or service department?

             Contain all information specific to one order in one display screen?
             Include a pull-down list of all order departments to enable multiple orders?

             Include a user-configurable / customizable pull-down list of tests and services from
              which to place one or more orders?


12.17 Does the system have the capability of displaying the most commonly used orders to
        assist in order placement?
12.18 Does the system display all order sets including components, by any of the following:

             By procedure?

             By provider?

             By diagnosis?

             By date?
12.19 does the system have the capability to specify/display exploding orders?
12.20 Does the system have the capability to enable selected orders to be recurring orders?
12.21 Does the system include an order inquiry mechanism to allow providers to inquire on the
        details of an order?
12.22 Is the order inquiry function accessible within the order entry flow before the session is
         terminated?
12.23 Can an order, at the user’s option, display all the detail data associated with the order,
       including demographics, order parameters, electronic signatures, and order status?
12.24 Can the system recommend alternative orders?
12.25 Can the system display order summaries on demand to allow the clinician to
       review/correct all orders prior to transmitting/printing the orders for processing by the
       receiving entity?
 13.      Results
        14B




13.1 Does the system accept results via an established bi-directional HL7 interface?


                                                                    Page 13 of 67
                                                                                                                                         Not Available
                                                                                                                           Development
                                                                                                               Developed
                                                                                                   Met Fully


                                                                                                                Custom



                                                                                                                              Under
                                   Functional Requirements/Features
                                 28B




13.2 Does the system include an intuitive, user customizable results entry screen linked to
       orders?
13.3 Does the system display results in a customizable, intuitive, and flexible format?
13.3.5 Does the system allow authorized users to copy selected results into a note?
13.4 When displaying results, does the system, at a minimum, display the patient name, date
       and time of order, date and time results were last updated, as well as any alerts
       identifying changes/amendments to the test or procedure, and test name?
13.5 Are returned results grouped by encounter?
13.6 Does the system support order panels that generate multiple orders with a single selection?
13.7 Does the system use visual cues to highlight abnormal results?
13.8 Is the system able to receive and display results of diagnostic testing and flag
        abnormalities? (Lab, Rad, EKG)
13.9 Does your system generate letters/reports for CMR?
 14.      Medications
        15B




14.1 Does the medication module include access to the National Drug Classification (NDC)
       database?
14.2 Does the system store common prescriptions for quick entry?
14.3 Does the system support multiple drug formularies and prescribing guidelines relevant to
       the patient’s insurance coverage?
14.4 Does the vendor maintain and regularly updates drug formularies from insurance
       companies
14.5 Does the system recognize and recommend age and weight appropriate dosages?
14.6 Does the system have the ability to update the progress note with prescription
       information?
14.7 Does the system allow the provider the ability to document the effectiveness or
       ineffectiveness of a medication?
14.8 Does the system store refill and repeat prescription information?
14.9 Does the system allow storage of prescription data for retrieval by any or the following:

             Drug name?

             Drug code number (NDC)?
             Amount prescribed?

             Schedule?
14.10 Does the system provide the following drug/prescription order information:

             Drug contraindication?

             Active problem interactions?
             Check that appropriate studies are obtained?




                                                                Page 14 of 67
                                                                                                                                        Not Available
                                                                                                                          Development
                                                                                                              Developed
                                                                                                  Met Fully


                                                                                                               Custom



                                                                                                                             Under
                                 Functional Requirements/Features
                               28B




14.11 Does the system provide extensive drug interaction information:
          Drug-drug?
          Drug-allergy?
          Drug-food?
          Drug-symptom?
14.12 Does the system provide extensive drug interaction information not just for specific
        drugs, but for drug classifications as well?
14.13 Does the system allow the provider the ability to prioritize / rank the importance of the
        interactions and/or warnings?
14.14 Does your system do Medication Reconciliation?
14.15 Does your system do Electronic prescribing?
14.16 What other systems does your system work with for e-prescribing?


 16. Decision Support
     16B




16.1 Does the system include access to medical research and literature databases such as
       MEDLINE, JAMA, GRATEFUL MED, and others?
16.2 Does the system utilize health data from all sections of the chart to provide decision
       support to providers?
16.3 Does the system trigger alerts to providers when individual documented data indicates that
       critical interventions may be required?
16.4 Does the system automatically triggers an alert upon documentation of a diagnoses or
       event required to be reportable to outside agencies including the Centers for Disease
       Control and Prevention (CDC) and State health and mental hygiene departments?
16.5 Does the system automatically trigger and alert upon documentation of patient health data
       for a member of an existing medical registry or disease management program?
16.6 Are the system’s alert/reminder functions driven by appropriate multi-disciplinary
        clinical guidelines?
16.7 Does the system allow customized studies to be performed utilizing individual and group
       health data from the electronic record?
16.8 Does the system incorporate preventive medicine questionnaires to be completed by
       clinicians and if applicable, patients, during the encounter?
 17. Disease Management/ Clinical Registries
     17B




17.1 Does the system support disease management registries by:
          Allowing patient tracking and follow-up based on user defined diagnoses?
          Integrating all patient information within the system?
          Providing a longitudinal view of the patient medical history?
          Providing intuitive access to patient treatments and outcomes?




                                                                    Page 15 of 67
                                                                                                                                         Not Available
                                                                                                                           Development
                                                                                                               Developed
                                                                                                   Met Fully


                                                                                                                Custom



                                                                                                                              Under
                               Functional Requirements/Features
                             28B




17.2 Does the system automatically identify all high-risk patients and notify clinical staff for
       preventive care?
17.3 Does the system utilize user authored and/or third party developed clinical guidelines for
       disease and registry management?
17.4 Does the system track / provide reminders and validates care process?
17.5 Does the system generate follow-up letters to physicians, consultants, external sources,
       and patients based on a variety of parameters such as date, time since last event, etc.
       for the purpose of collecting health data and functional status for the purpose of
       updating the patient’s record?
17.6 Does the system link Disease Management functions to all other sections of the EMR?
17.7 Does your system integrate with “Ii2i Tracks”?
 18. Technical
     18B




18.1 Does the system auto-populate user defined data fields with patient demographics at the
       time of order or request?
18.2 Is the system scalable to thousands of concurrent users working with a single database
         server/repository?
18.3 Does the system incorporate a consistent user interface for data entry independent of the
       platform?
18.4 Does the system support a variety of input modalities such as voice recognition, touch
       screen, mouse, keyboard, etc.?
18.5 Is the system CCOW enabled for single sign on functionality?
18.6 Does the system support remote system monitoring technology?
18.7 Does the system support an industry standard locking mechanism to prevent unauthorized
       updates?
18.8 Does the system support and implements system redundancy / fault tolerance?
18.9 Does the system log all transactions processing and archiving?
18.10 Does the system provide physician specific screens such as pre-formatted order sets,
        discharge notes, encounter forms, and Patient consents?
18.11 Does the system support remote access to patient records and discharge records with
        ability to retrieve data and sign/cosign orders?
18.12 Can the system contact a physician by email/alpha-numeric pager/fax/phone/PDA when
      a consult is complete?


18.13 Does the system provide the ability to authenticate records or add signatures to portions
      of records where such a requirement for specified physicians (Attending/Residents),
      consultation, or on-call?


18.14 Does the system provide notification of user defined alert values/messages via
      alphanumeric pager, email/fax/phone/PDA?




                                                                Page 16 of 67
                                                                                                                                          Not Available
                                                                                                                            Development
                                                                                                                Developed
                                                                                                    Met Fully


                                                                                                                 Custom



                                                                                                                               Under
                                  Functional Requirements/Features
                                28B




18.15 Admitting Does the system have the ability to display a list of patients associated with
      physician accessing system, to include Associations of, Attending, Consulting,
      Referring, Resident, other care givers?


18.16 Does your system allow scanned documents to be integrated?

      19. Clinical IT Data Dictionary
         19B




19.1 Is the system structured to support skeleton-to-robust HER?
19.2 Does the system provide attributes for each data element; supports all data types?
19.3 Does the system allow for new user created fields. Describe the number and the extent
       available?
19.4 Does the system support static/dynamic data element relationship?

      20. Implementation and Support
         20B




  20.1 Does the implementation effort begin with the development of a comprehensive
29B




         implementation plan developed jointly with the end user?
  20.2 Does the implementation include a staff-training phase?
30B




  20.3 Does the system package include support and maintenance of application software and
31B




         application system upgrades?




                                                                                                    Narrative

                  Functional Requirements/Features
                32B




               21. Miscellaneous Requirements
1.      Describe how your solution helps with medication reconciliation requirements specified by
        the Joint Commission for Accreditation of Healthcare Organizations.


2.      Describe how you address consistency in medical terminology and content.


3.      Describe how you identify the sources of medical or compliance content included with
        your application (i.e.: drug database, formulary database, medical necessity rules etc).
        How often is each updated and how do updates occur?


4. Describe how your application can be altered to support the way individual physicians
       prefer to work and interact with the system.




                                                                   Page 17 of 67
                                                                                                     Narrative
         Functional Requirements/Features
       32B




5.    Describe the alternatives available to physicians for data input. If dictation is supported,
      what third party products are required.


6.    Describe the system functionality associated with teaching and residency programs.


7.    Describe how your system is customized for physician preferences. Does this require
      vendor support and dollars to accomplish?


8.    Describe the reporting capabilities of your application.


9.    Describe how does your ambulatory EMR lend itself to improving the work flow for
      support staff as well as the physicians.


10.   Describe how the system supports work teams, call coverage, and transition of providers
      from one location to another.


11.   Describe what support is available for validating formulary compliance with patient
      prescription coverage.


12.   Describe the clinical decision support capabilities available in the system for both
      prescribed medications and diagnostic orders.


13.   . Describe how your software automatically manages the medication list as medications
      are added, changed, or discontinued
14.   Describe how does your solution support best practices in health maintenance.


15.   Describe how your application supports chronic care management.


16.   Describe how the system manages encounters for patients presenting with multiple
      medical conditions. Please explain, outlining physician workflow, billing, and staff
      workflow implications.


17.   Describe the system workflow for encounters where patients present for a specific
      reason for encounter and then introduce a second or third condition midway through the
      encounter.


18.   Describe the process by which documentation templates or forms are delivered both
      initially and over time.




                                                                 Page 18 of 67
                                                                                                Narrative
           Functional Requirements/Features
         32B




  19.   Describe how our organization can customize documentation templates. Is vendor
        assistance required? If so, at what cost?


  20.   Describe how your software automatically updates the current problem list as new
        diagnoses are added to the record.

  21.   Describe how your application supports the process for checking medical necessity for
        diagnostic orders.

  22.   Describe how you support orders for a single patient that must be routed to multiple
        ancillary providers.

  23.   Describe how you manage Advanced Beneficiary Notices (ABN) for medical necessity
        requirements.




                                         SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                  APPLICATION FUNCTIONAL                                     Response             Comments
                      SPECIFICATIONS                                           Key              Cross Reference

        Do all applications comply with HIPAA
2083.   regulations including interfaces (both inbound and
        outbound) and transactions code sets?
2084.   Will software upgrades be HIPAA compliant?
        Are software upgrades driven by HIPAA rules
2085.
        included in annual Maintenance fees?
        Is the Health information encrypted when
2086.   transmitted using internet technologies and the
        identities of the sender and receiver authenticated?
        Does the system provide support of open system
2088.   standards such as LDAP authentication and
        authorization control?
2089.   Do idle screens have timeout capabilities?



                                                               Page 19 of 67
                                  SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                         Response     Comments
                    SPECIFICATIONS                               Key      Cross Reference

        Are you forced to change passwords and if so how
2090.
        often?
        Can access be restricted by day of week and times
2091.
        within day?
2092.   Can access be restricted by workstation?
        Does the system keep track of all unsuccessfully
        logons and locks out users after “x” number of
2093.
        unsuccessful attempts a defined by the system
        administrator?
        Does the system have the ability to administer and
        display security ownership via employee name,
2094.
        location, social security number, and assigned
        functionality?
        Describe any system alerts, if any, that are created
2095.
        when security violations are identified?
        Does the system provide multiple Security level
2096.
        access based on user sign on?
        Does the system capture audit trials of all system
2097.   access including what, by whom, when, from
        where?
        Does the system support electronic signatures for
2098.
        authentication of orders and data entry?
        Does the system alert users to the fact that all
2099.   access is being recorded for confidentiality
        purposes?
        Does the system have the ability to specify facility
2100.   access rights by users allowing some users access
        to all facilities and others access to one facility?
        Can security be established at the
2101.
        function/screen/data element level?
        Are menus provided that display functions
2102.   authorized for users as well as user assigned
        specific functions?



                                                    Page 20 of 67
                                 SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                       Response     Comments
                    SPECIFICATIONS                             Key      Cross Reference

        Can the user restrict/control access to sensitive
2103.
        data, based on log in access level?
        Is encryption provided where appropriate when
2104.
        communicating outside of the trusted network?
        Does the system have the ability to set up
2105.   different security for maintaining tables,
        dictionaries, and screens?
        Can the users have access to inpatients by current
2106.
        medical services?
        Does the system have the ability to establish and
2107.   define security privileges based on “roles” for
        users?
        Does the system provide audit/exception reporting
2108.
        of unassigned accesses or updates?
        Any access to any part of the system by nonusers,
2109.   e.g. visitors in patient room or patient can be
        prevented?
        Does the system provide multiple levels of
2110.
        security from network level to screen level?
        Can any module be accessed from any
2111.
        workstation given the proper security rights?
        Does the system have the capability of being
2112.   accessed remotely for trouble-shooting,
        monitoring, and prevention?
        Is the security module capable of accepting and
2113.
        maintaining unlimited users?
        Does the system allow users to choose and change
2114.
        their own password?
        Does the system require password field to be a set
2115.   number of alphanumeric characters and is case
        sensitive?
        Can you reactivate a deactivated user if they
2116.
        return to institution?



                                                  Page 21 of 67
                                  SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                        Response     Comments
                    SPECIFICATIONS                              Key      Cross Reference

        Does the system generate error logs on a
2117.
        consistent basis?
        Is the system able to interface with all ACMC
2118.
        legacy systems.?
        Does the system support the use of additional user
        authentication devices such as smart cards and
2119.   biometric identifiers, in combination to the user
        manually entering his/her username and
        password?
        Are usernames unique and represent only one
2120.
        user?
        Can usernames be comprised of alphabetic or
2121.
        numeric characters?
        Is there sufficient field length for usernames that
2122.   permits organization to utilize a naming
        convention that ensures uniqueness?
        Is there a limitation on maximum password
2123.
        length?
        Can the security administrator specify a minimum
2124.   password length that can be enforced at the
        system level?
        Can the security administrator specify a minimum
2125.
        password length enforced at the user level?
        Does the system allow privileged users the ability
2126.
        to reset passwords for other users?
        Does your system permit the organization to
        determine at the system level if users’ passwords
2127.   are pre-expired and the users are forced to change
        their passwords upon initial log in or when the
        password has been reset?
        Can the organization determine at the user level if
        the user’s password is pre-expired and the user is
2128.
        forced to change his password upon initial log in
        or when the password has been reset?



                                                   Page 22 of 67
                                SECURITY / COMPLIANCE

    Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
  21B




                             Release, N = Not Available

               APPLICATION FUNCTIONAL                      Response     Comments
                   SPECIFICATIONS                            Key      Cross Reference

      Does the system allow the organization to
2129. determine at the system level the lifetime in days
      of user’s passwords?
      Is the organization allowed to determine at the
2130. user level the lifetime in days of a user’s
      password?
      Is there a history database that prevents reuse of
2131.
      passwords?
      Are users deleted, which prevents the reuse of
2132.
      usernames?
      Is there a message displayed upon denial of access
2133.
      due to invalid username or password?
      Can user accounts be automatically disabled after
2134. a predetermined, system-defined number of
      consecutive invalid attempts?
2135. Can user accounts be disabled real-time?
      Does the system provide a system-defined period
2136. of time after which an unused user account is
      disabled?
      Does the system have the ability to accommodate
2137.
      a third party, single sign-on solution vendor?
2145. Are there audit trails by address of PC used?
      Are the audit trails with the reason for
2146.
      unsuccessful attempts?
2147. Are there audit trails by username?
2148. Are there audit trails date/time of system access?
      Does the system log the number of unsuccessful
2149.
      log in attempts?
      Does the system have the functionality that allows
2153. a user to end an application quickly and change to
      another user?




                                                Page 23 of 67
                                  SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                         Response     Comments
                    SPECIFICATIONS                               Key      Cross Reference

        Does the system have position-level security logic
        to set permissions to access an application (or task
2154.   within an application, or a task group) based on a
        user’s position? It is defined for every user of the
        system?
        Can a user be assigned to a position through a
        maintenance tool? Can this be restricted to users
        with appropriate privileges? A user’s position
        should be designed to include all the tasks that
        might be needed to perform his/her job. Can
        multiple users be associated with a single position,
        which aids in the maintenance of your security
        profiles? Can positions be created as reference
        data? Employee position assignments within the
2155.   system may or may not be similar to employee
        titles within an organization.
        Possible positions include:
        Staff Physician               RN
        Nurse Assistant               Pharmacist
        Pharmacy Tech                 Radiologist
        Attending                     House staff
        Physician assistant           ARNP
        Can each clinical application enforce logic to
2156.   determine the user’s right to access the patient’s
        chart?
        Can a site choose to determine specific encounters
        or encounter types that require additional security
2157.
        logic? For example, psychiatric visits, child abuse
        cases, etc.




                                                    Page 24 of 67
                                  SECURITY / COMPLIANCE

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 21B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                        Response     Comments
                    SPECIFICATIONS                              Key      Cross Reference

        Can the system compare the confidentiality level
        of person associated with the username at the time
        he/she is entered into the system, and the
2158.   confidentiality level of the patient and/or the
        encounter set at the time of registration, to
        determine if the user can view information
        regarding the patient or a specific encounter?
        Can security be restricted to an organization that
2159.   may be a physician’s office, hospital, nursing
        station, clinic, etc?
        Is each patient encounter associated with an
2160.
        organization?
        To determine if a user is able to view a patient’s
        encounter, can the system check to see if the user
2161.
        is associated with that organization with which the
        encounter is associated?
        If no association is located, can the system not
2162.   display any information regarding that encounter,
        including display of the encounter’s existence?
        Does the system support electronic signature for
2170.
        authentication of ordered and data entry?




                                                   Page 25 of 67
                                   CLINICAL DATA REPOSITORY
                                 44B




                                       CLINICAL DATA REPOSITORY

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 22B




                            Release, N = Not Available

                APPLICATION FUNCTIONAL                               Response     Comments
                    SPECIFICATIONS                                     Key      Cross Reference


        Does the system provide a Clinical Data Repository that
2176.   supports three-tiered client-server architecture?
        Does the system allow for data to be used by internal
        decision support tools or knowledge system utilizing a
2177.   variety of alert mechanism such as email, beeper, reports,
        etc?


        Does the system provide for the following Reporting
        Capabilities?
2178.     a) Standard Reports
2179.     b) Graphical Reports
2180.     c) Histograms
2181.     d) Ad-hoc Reporting Capabilities
2182.     e) Report Exporting formats such as:
2183.           1) FTP
2184.           2) E-Mail
           f) File Formats such as Txt, .XLS, .MDB,
2185.
           and DBF
2186.      g) Printing Options such as:
2187.           1) Excel
2188.           2) PDF
2189.           3) Word
2190.      h) Drill down capabilities
2191.       i) Filtering
2192.       j) Sorting options.
2193.       k) Statistical Modeling
2194.       l) Web-enabled Reporting
2195.      m) Meta-Data



                                                          Page 26 of 67
                              CLINICAL DATA REPOSITORY

   Response Key: A = Available/Installed, C = Can be Custom Developed, F = Future
 22B




                            Release, N = Not Available

               APPLICATION FUNCTIONAL                      Response     Comments
                   SPECIFICATIONS                            Key      Cross Reference


        Does the system provide Benchmarking
2196.   Capability (Ability to import from other sources
        e.g. AHCA)?
        Does the system provide the ability to chart
2197.
        and/or graph clinical information?
        Does the system provide the ability to hyperlink
2198.   to JHS as well a Departmental Policies and
        Procedure Manuals?

        Does the system provide for the following
        Interfacing Capabilities:
2199.        a) Access to Legacy Systems
            b) Database Connectivity: ADO,
2200.
               ODBC,
2201.        c) Interface Protocols: XML, HL7

        Does the system have an interface engine? If so,
2202.
        what product or vendor?




                                                  Page 27 of 67
                                              TECHNICAL
                                            45B




  HARDWARE AND OPERATING SYSTEM SOFTWARE QUESTIONS
23B




                                                    GENERAL:
                                                  36B




In a non-hosted environment, provide the following information:

1. Use TABLE 1 “PROPOSED HARDWARE CONFIGURATION” to itemize the proposed hardware.
You may attach a separate configuration, provided it contains all information requested in TABLE 1.
Provide UPS requirements. Attach the hardware schematic and footprint.

2. Describe other hardware platforms that may also support the proposed system and indicate reasons for
your primary solution.

Using the configuration proposed in the response to question 1:

3. How many devices (PCs, terminals and printers) can be added to the proposed configuration before
additional hardware is required?

4. How many devices can be added before degradation of the system becomes obvious to the user?

5. Describe how the proposed hardware will be improved and expanded to accommodate growth.

6. What is the maximum number of devices and users the system can accommodate simultaneously
without any system degradation?

7. Specify the disk storage requirements for five years of online data retention.

8. Describe the delivery and installation of hardware and operating system software and note the
responsible parties.

9. Describe the process required to relocate a terminal or PC after installation. What application
modifications will need to be made?

10. Describe the method and procedures for maintaining and troubleshooting proposed hardware and note
the responsible parties.

11. Use TABLE 2 “SYSTEM SOFTWARE” to identify all operating system, database management and
utilities software.

12. Is the source code available for purchase? If purchased, will the source code be delivered with the
application software? What Language(s) is the proposed system written in? Will any changes to the source
code made by JMH void any warranties or guarantees?

13. List any software, which may not be installed on the same CPU as the proposed application software.
Include packages, languages, and utilities.



                                                        Page 28 of 67
14. Discuss the architecture of the proposed system as it relates to growth, stability and performance
balancing. If it is necessary to distribute applications between or among CPU’s, describe how this is
accomplished. Are any proprietary modifications of the proposed system necessary in order to
accommodate growth?

15. What types of power protection are recommended for this system? Why? Describe the impact on the
application in the event of a power failure or power surge.

16. Define response time as it relates to the proposed system. Estimate the following times in a typical
operating environment.

      What is the average response time for a database inquiry?
      What is the average response time for a database update?
      What is the average response time for a retrieval of portions of the patient record?
      What is the average response time for a retrieval of the entire patient record?
      What is the average time to log in to the system?

17. Identify situations where stated response times would not be met.

18. Identify any applications that will degrade the proposed system, and therefore, must be run at off peak
hours.

19. Describe how your software is stored and maintained on the proposed system and how you manage
your change control.

20. Describe the steps involved in implementing a new release of your product.

21. Describe any system management tools you provide to help the client monitor and control the technical
aspects o your system.



Communications:

23. Identify the network management software (if any), which will support the proposed system.

24. Identify the type and bandwidth of communication lines required to support the proposed system as
configured for our environment as described in the overview.

25. Identify any communication software or protocols, available from the hardware vendor, which may not
be utilized in conjunction with the propose system.



  INTERFACES:
37B




26. Identify all communication protocols the proposed system interfaces will support, e.g., asynchronous,
SNA, LU 6.2, LAT, TCP/IP, IPX, etc.

27. Describe how transmission and data integrity errors are detected and handled by the interfaces.


                                                       Page 29 of 67
28. Describe the recovery mechanisms that are available for re-transmission of any interface transactions.

29. Do the proposed interfaces include store and forward capabilities?

30. When a receiving system interface is down for an extended period of time, or there is a power failure or
power surge, what system limits exist for the amount of queued interface data.



  STORAGE AND BACKUP:
38B




31. What type of storage technology is recommended for use in the proposed configuration?

32. Can the proposed system use a shared storage system like a Storage Area Network? If so, what
manufacturers and configurations are approved for use?

33. Can the proposed system use a shared data backup device? If so, what manufacturers and
configurations are approved for use?

34. Describe the recommended backup strategy. Identify the software utilized to perform system backups.
Estimate the amount of time and identify the storage media necessary to perform and store daily, weekly
and monthly backups. Identify any proprietary modifications, to the proposed system, associated with this
procedure.

35. Does the recommended backup procedure require the application system to be down? If not, how does
the backup procedure affect system performance?

36. Does the backup procedure lock records, files or applications?

RECOVERY/RESTORE:

37. Describe the recommended recovery and restore procedure utilizing daily, weekly and monthly
backups. Identify the software utilized to perform system recovery and restore. Does the restore procedure
allow for the selective recovery of transactions, individual files and disks? Identify any proprietary
modifications associated with this procedure.




                                                    Page 30 of 67
 TABLE 1 “PROPOSED HARDWARE CONFIGURATION”


 VENDOR NAME ______________________________________________

                      MODEL
HARDWARE ITEM                  MANUFACTURER          FUNCTION   QUANTITY
                        #
CPU(s)
Storage System
Backup System
Tape Drives
Printers
Personal Computers
Terminals
Scanners
Communication
Equipment
Network Electronics
Other, List Below




                                     Page 31 of 67
                       TABLE 2 “SYSTEM SOFTWARE”


VENDOR NAME ___________________________________________

       SOFTWARE              VERSION                PUBLISHER




                                    Page 32 of 67
                     TABLE 3 “ENVIRONMENTAL CONSIDERATIONS”


VENDOR NAME __________________________________________


       ENVIRONMENTAL              VENDOR SOLUTION       RECOMMEND
       CONSIDERATION                                      SOURCE
Heating
Ventilation
Cooling

Humidification/Dehumidification
Electrical Requirements
UPS
Cabling
Fire Prevention
Noise Suppression
Flooring

Other, List Below:




                                        Page 33 of 67
INSTRUCTIONS TO VENDORS


    ACRONYM AND TERM GLOSSARY

     ACMC                   Alameda County Medical Center
     OSHPD                  Office of Statewide Health Planning & Development
     RFP                    Request for Proposal

    ACMC CONTACTS

    All questions regarding these specifications, terms and conditions are to be submitted in
    writing, via email before 4:00pm PST on September 8, 2009 to:

    Nancy McAdoo
    Director, Contracting Services
    Email: nmcadoo@acmedctr.org
           0H




    CALENDAR OF EVENTS

                 Event                             Date
          Request Issued                     August 24, 2009
          Written Questions Due              September 8, 2009
          Addendum Issued                    September 14, 2009
          Response Due                       September 21, 2009
          Evaluation Period                  September 22 – October 31, 2009
          Contract Start Date                TBD

    Note: Award and start dates are approximate.

    The Addendum to this RFP will be posted on the ACMC website ( www.acmedctr.org), under
                                                                         1H




    Doing Business with us on the date specified above. It is the responsibility of each bidder to be
    familiar with all of the specifications, terms and conditions and the site condition. By the
    submission of a bid, the bidder certifies that if awarded a contract they will make no claim
    against ACMC based upon ignorance of conditions or misunderstanding of the specifications.




                                               Page 34 of 67
SUBMITTAL OF PROPOSALS

    A.   Returned responses must be received at the Healthcare Contracting Department of the
         Alameda County Medical Center BEFORE 4:00 p.m. on the due date specified above.

    B.   Vendors are to submit one (1) original plus three (3) hard copies of their proposal. The
         original proposal is to be clearly marked and is to be either loose leaf or in a 3-ring
         binder, not bound. In addition, electronic copies in MS Word format must be provided
         on individual compact disks (CDs).

    C.   Proposals are to be addressed as follows:

                RFP No. ACMCNM09-2
                Alameda County Medical Center
                Healthcare Contracting Department
                Attention: Nancy McAdoo
                Director, Contracting Services
                1411 E. 31st Street, B Wing – 4th Floor
                Oakland, CA 94602

    D.   Vendor’s name and return address must also appear on the envelope.

    E.   Responses will be received only at the address shown above, and prior to the time
         indicated. Any response received at or after said time and/or date or at a place other
         than the stated address cannot be considered and will be returned to the vendor
         unopened.

    F.   No telegraphic or facsimile proposals will be considered.

    G.   All responses, whether delivered by an employee of the vendor, U.S. Postal Service,
         courier or package delivery service, must be received and time stamped. Vendor must
         email or fax date/time stamp to ACMC, Healthcare Contracting at (510) 535-7542 for
         U.S. Postal Service, courier or package delivery services. Otherwise, the ACMC
         Purchasing Department's timestamp shall be considered the official timepiece for the
         purpose of establishing the actual receipt of proposals.

    H.   Vendor agrees and acknowledges all RFI specifications, terms and conditions and
         indicates ability to perform by submission of a reply.

    I.   Submitted responses shall be valid for a minimum period of six (6) months.

    J.   All costs required for the preparation and submission of a bid shall be borne by the
         Vendor.


                                             Page 35 of 67
K.        Only one response will be accepted from any one person, partnership, corporation, or
          other entity; however, several alternatives may be included in one response.

L.        It is the responsibility of the vendors to identify information in their responses that
          they consider to be confidential under the California Public Records Act. To the
          extent that ACMC agrees with that designation, such information will be held in
          confidence whenever possible. All other information will be considered public.

M.        ACMC has the right to decline any response.


RESPONSE FORMAT

A.        Proposals are to be straightforward, clear, concise and specific to the information
          requested.

B.        In order for requests to be considered complete Vendors must provide all information
          requested.


RESPONSE CONTENT/SUBMITTALS

A.        Vendor responses must be signed in ink as set forth in this subsection. Include
          evidence that the person or persons signing the Proposal are authorized to execute the
          Proposal on behalf of the Vendor

B.        Vendors shall follow the requirements set forth below. Any material deviation from
          these requirements may be cause for rejection of the Proposal, as determined in
          ACMC’s discretion. All items listed below are required to be submitted in each RFI
          response. The content and sequence of each proposal shall be as follows:

     1.      Title Page: Show RFI number and title, your company name and address, name of
             the contact person, telephone number and proposal date.

     2.      Table of Contents: Bid responses shall include a table of contents listing the
             individual sections of the quotation/proposal and their corresponding page
             numbers. Tabs should separate each of the individual sections.

     3.    Cover Letter: Bid responses shall include a cover letter describing the Vendor and
           include all of the following:

           a.)   The official name of the Vendor

           b.) The Vendors organizational structure (e.g. corporation, partnership, limited
               liability company, etc.);


                                              Page 36 of 67
          c.)   The jurisdiction in which the Vendor is organized and the date of such
                organization;

          d.) The address of the Vendor’s headquarters and of any local office of the Vendor
              involved in the bid proposal/quotation;

          e.)   The Vendor’s Federal Tax Identification Number;

          f.)   The name, address, telephone, fax numbers and e-mail address of the person(s)
                who will serve as the contact(s) with ACMC, with authorization to make
                representations on behalf of and to bind the Vendor;

          g.) A representation that the Vendor is in good standing in the State of California
              and has all necessary licenses, permits, certifications, approvals and
              authorizations necessary in order to perform all of the Vendor’s obligations in
              connection with this RFI.

          h.) An acceptance of all conditions and requirements contained in this RFI.


4.    Letter of Transmittal: Responses shall include a description of approach to service in
      one or two pages stating the understanding of the work to be done and a positive
      commitment to perform the work as specified.

5.   Executive Summary: A brief synopsis of the highlights of the proposal and overall
      benefits of the proposal to ACMC. This synopsis should not exceed three pages in
      length and should be easily understood.

6.   Vendor’s Qualifications and Experience

     A description of the capabilities of the Vendor that pertain to this RFP. This
     description should not exceed five pages and should include a detailed summary of the
     Vendor’s experience relative to RFP requirements described herein, including
     references. Vendors with less than three years of relevant experience may be
     disqualified.

7.    Financial Statements

      Responses are to include any or all of the following information upon request prior to
      award:

      -     Audited financial statements for the past three (3) years; or
      -     Company’s most recent Form 10-K; or
           Unaudited financial statements for the past three (3) years; or
           Company’s most recent Dun & Bradstreet Supplier Evaluation Report; or
           Federal income tax returns for the past three (3) years.


                                          Page 37 of 67
EVALUATION CRITERIA/SELECTION COMMITTEE

If you are a current vendor of ACMC you may skip to section “EVALUATION
CRITERIA/SELECTION COMMITTEE”

All Proposals will be evaluated by the ACMC Selection Committee. The ACMC Selection
Committee will be composed of departmental staff and other parties with expertise or
experience in Ambulatory Care. The Selection Committee will select a Vendor in
accordance with the specific & general requirements and evaluation criteria set forth in this
RFI. The evaluation of the Proposals shall be within the sole judgment and discretion of the
ACMC Selection Committee.

The ACMC Selection Committee will evaluate each Proposal meeting the qualification
requirements set forth in this RFI. Vendors should bear in mind that any Proposal that is
unrealistic in terms of the technical or schedule commitments, or unrealistically high or low
in cost, will be deemed reflective of an inherent lack of technical competence or indicative of
a failure to comprehend the complexity and risk of ACMC’s requirements as set forth in this
RFI.
The basic information that each section should contain is specified below, these
specifications should be considered as minimum requirements. Much of the material needed
to present a comprehensive proposal can be placed into one of the sections listed. However,
if relevant information needs to be presented to further support the bidder's case, other
appropriate sections may be added.

Responses to this proposal must be complete. Responses that do not address each of the
items listed below will be considered incomplete, be rated a fail in the Evaluation Criteria
and will receive no further consideration.

  Completeness of Response……………………………………Pass/Fail
52B




A.    Cost - An evaluation will be made of (a) reasonableness (i.e., does the proposed pricing
      accurately reflect the Vendor’s effort to meet requirements and objectives?); (b) realism
      (i.e., is the proposed cost appropriate to the nature of the products and services to be
      provided?); and (c) affordability (i.e., the ability of ACMC to finance the services.
      Consideration of price in terms of overall affordability may be controlling in
      circumstances where two or more proposals are otherwise adjudged to be equal, or
      when a superior proposal is at a price that ACMC cannot afford.
B.    Implementation Plan and Schedule - An evaluation will be made of the likelihood
       that the Vendor’s implementation plan and schedule will meet ACMC’s schedule
       which is to have an Ambulatory Electronic Health Record installed and running by
       December of 2011.



                                          Page 38 of 67
TERMS AND CONDITIONS

    TERM / TERMINATION / RENEWAL

    A.   The term of a contract will be five years.

    B.   A contract will be subject to termination by either party, without cause, upon sixty (60)
         days advance written notice of intention to terminate.

    C.   ACMC may terminate a contract at any time without written notice upon a material
         breach of contract and substandard or unsatisfactory performance by the Vendor. In
         particular, any violation of Specific Requirements will be considered a material breach.

    D.   By mutual agreement, a contract may be extended for additional terms at agreed prices
         with terms and conditions remaining the same.

    E.   ACMC is soliciting a lump sum price for this project. The price quoted shall be the
         total cost ACMC will pay for this project including tax and all other charges.

    F.   The total lump sum shall be divided and costs advised for each of the following
         phases:
          Design Development Phase
          Specifications and Installation Documents Phase
          Product Installation
          Travel and related costs.

    G.   All prices quoted shall be in dollars and "whole cent," no cent fractions shall be used.
         There are no exceptions.


    AWARD

    A.   The committee will recommend award to the vendor who, in its opinion, has submitted
         the proposal that best serves the overall interests of ACMC and attains the highest
         overall point score. Award may not necessarily be made to the Vendor with the lowest
         price.

    B.   ACMC reserves the right to reject any or all responses that materially differ from any
         terms contained herein or from any Exhibits attached hereto and to waive informalities
         and minor irregularities in responses received.

    C.   The Alameda County Medical Center, Board of Trustees approval is required to award a
         final contract.



                                             Page 39 of 67
PRICING

    A.    Prices quoted are to be firm for the first twelve months of the contract.

    B.    Price escalation for the second and third years of the contract shall not exceed the
          percentage increase stated by the bidder on the Bid Form, Exhibit B. Request for price
          adjustments must be submitted by the Contractor, in writing, sixty (60) days prior to the
          annual anniversary date of the contract.

    C.    All pricing as quoted will remain firm for the term of the contract.

    D.    Unless otherwise stated, the Contractor agrees that, in the event of a price decline, the
          benefit of such lower price shall be extended to ACMC.

    E.    All prices are to be F.O.B. destination. Any freight/delivery charges are to be included.

    F.    Any price increases or decreases for subsequent contract terms may be negotiated
          between Contractor and ACMC only after completion of the initial term.

    G.    The ACMC is soliciting a lump sum price for this project. The price quoted shall be
          the total cost ACMC will pay for this project including tax and all other charges.

    H.    The total lump sum shall be divided and costs advised for each of the following
          phases:
           Pre-Design Phase
           Schematic Design Phase
           Design Development Phase
           Specifications and Installation Documents Phase
           Product Installation

    I.    All prices quoted shall be in dollars and "whole cent," no cent fractions shall be used.
          There are no exceptions.

    J.    ACMC has the right to decline to award this contract if it is determined that proposed
          pricing is not competitively priced with similar sized counties or non-county agencies
          within the State of California.

    K.    A lump sum fixed price quote is required for this contract and will be the maximum
          price ACMC will pay. Minor adjustments to the scope of work (plus or minus 10%t)
          will be included in the quoted price.

    L.    Contractor shall include a quote of time and materials and schedule of fees for additional
          work outside the scope of work threshold. (include T&M format on Exhibit B, Bid
          Form)


                                               Page 40 of 67
    M.      Price quotes shall include any and all payment incentives available to the ACMC.


METHOD OF ORDERING

    A.      Written purchase orders (PO’s) shall be issued upon approval of written itemized
            quotations received from the contractor (use for furniture design/install RFPs).

    B.      Individual order price quotations shall be provided upon request per project and shall
            include, but not be limited to, an identifying (quotation) number, date, requestor name
            and phone number, ship to location, itemization of products and/or services with
            complete description (including model numbers, fabric and finish grade, description,
            color, etc.) and price per item and a summary of total cost for product, services, and tax.

    C.      A written purchase order (PO) and executed Standard Agreement contract which
            includes the Terms and Conditions of this RFP and the successful Contractors proposal
            shall be issued upon Board approval.

    D.      PO’s and Standard Agreements shall be faxed, transmitted electronically or mailed and
            shall be the only authorization to the contractor to place an order.

    E.      Purchase orders and payments for products and services shall be issued only in the
            name of the Contractor who is awarded a contract.

    F.      Contractor shall adapt to changes to the method of ordering procedures as required by
            ACMC during the term of the contract.

    G.      Change orders shall be agreed upon by Contractor and ACMC and issued as needed in
            writing by ACMC.


INVOICING

    A.      Contractor shall invoice requesting department, unless otherwise advised, upon
            satisfactory receipt of product and performance of services.

    B.      Payment will be made within thirty (30) days following receipt of invoice and upon
            complete satisfactory receipt of product and performance of services.

    C.      ACMC shall notify contractor of any adjustments required to invoice.

    D.      Invoices shall contain ACMC purchase order number, invoice number, remit to address
            and itemized products and/or services description and price as quoted and shall be
            accompanied by acceptable proof of delivery.




                                                Page 41 of 67
    E.     Invoices shall be issued and payments made only to the Contractor who is awarded a
           contract.

    F.     Payments shall be issued to and invoices must be received from the same Contractor
           name specified on the purchase orders.

    G.     ACMC will pay Contractor monthly or as agreed upon, not to exceed the total lump sum
           price quoted in the bid response.


OTHER AGENCIES

    Other tax supported agencies within the State of California who have not contracted for their
    own requirements may desire to participate in this contract. The Contractor will be requested to
    service these agencies and will be given the opportunity to accept or reject the additional
    requirements. If the Contractor elects to supply other agencies, orders will be placed directly by
    the agency and payments made directly by the agency.


FUNDING OUT CLAUSE

    ACMC may, at its sole option, terminate this agreement at the end of any ACMC Fiscal Year,
    for reason of non-appropriation of funds. In such event, ACMC will give Contractor at least
    thirty (30) days written notice that such function will not be funded for the next fiscal period.
    In such event, ACMC will return any associated equipment to the Contractor in good working
    order, reasonable wear and tear expected.


ACMC PROVISIONS

    A.     Preference for Local Products and Vendors: A 5% preference shall be granted to
           Alameda County Products or vendors on all sealed bids on contracts except with respect
           to those contracts which state law requires be granted to the lowest responsible bidder.
           An Alameda County vendor is a firm or dealer with fixed offices or distribution points
           located in and having a street address within the County and which holds a valid
           business license issued by the County for a city within the County. Alameda County
           products are those which are grown, mined, fabricated, manufactured, processed or
           produced within the County.

    B.     Hold Harmless: The vendor agrees to defend, indemnify and hold harmless ACMC, its
           officers, employees, agents and servants, for any and all liability caused by the
           negligence or wrongful act of the vendor arising out of the performance of this contract,
           or any act or omission of vendor, its agents, employees and servants, or for product
           liability or breach of warranty by vendor, either expressed or implied, and to pay all
           claims, damages, judgments, legal costs, adjuster fees and attorney fees related thereto.

                                                Page 42 of 67
C.   Insurance: Please refer to Exhibit C for the insurance requirements applicable to this
     request.

D.   Drug-Free Workplace: It is the policy of ACMC to maintain a drug-free workplace.
     The unlawful manufacture, distribution, dispensation, possession and/or use of
     controlled substances in the workplace are prohibited. Controlled substances are those
     defined in 21 USC Section 812 and include, but are not limited to, such substances as
     marijuana, heroin, cocaine and amphetamines. The workplace is presumed to include all
     ACMC facilities and premises where ACMC employees may visit in the execution of
     their job duties such as homes, schools, hospitals, etc. All ACMC employees are
     required to comply with this policy as an essential condition of employment.
     Individuals who are not considered ACMC employees, but who perform work at ACMC
     worksites for ACMC’s benefit, are required to comply with this policy. Such
     individuals who unlawfully manufacture, distribute, dispense, possess or use controlled
     substances in the ACMC workplace may be barred from further work for and in
     ACMC’s facilities as well as from future consideration.

E.   Immigration Naturalization Service Requirements: In compliance with the Immigration
     Reform and Control Act of 1986, Contractor shall require all persons in its employ to
     provide the necessary documentation to establish identity and employment eligibility.
     The Owner requires that all personnel employed be eligible for employment in the
     United States and have substantiated their eligibility with the Contractor.

F.   Equal Employment Opportunity Practices Provisions: Contractor assures that he/she/it
     will comply with Title VII of the Civil Rights Act of 1964 and that no person shall, on
     the grounds of race, creed, color, disability, sex, sexual orientation, national origin, age,
     religion, Vietnam era Veteran’s status, political affiliation, or any other non-merit factor,
     be excluded from participation in, be denied the benefits of, or be otherwise subjected to
     discrimination under this contract.

            1. Contractor shall, in all solicitations or advertisements for applicants for
               employment placed as a result of this contract, state that it is an “Equal
               Opportunity Employer” or that all qualified applicants will receive
               consideration for employment without regard to their race, creed, color,
               disability, sex, sexual orientation, national origin, age, religion, Vietnam era
               Veteran’s status, political affiliation, or any other non-merit factor.

            2. Contractor shall, if requested to so do by ACMC, certify that it has not, in the
               performance of this contract, discriminated against applicants or employees
               because of their race, creed, color, disability, sex, sexual orientation, national
               origin, age, religion, Vietnam era Veteran’s status, political affiliation, or any
               other non-merit factor.

            3. If requested to do so by ACMC, Contractor shall provide ACMC with access
                to copies of all of its records pertaining or relating to its employment


                                          Page 43 of 67
               practices, except to the extent such records or portions of such records are
               confidential or privileged under state or federal law.

            4. Contractor shall recruit vigorously and encourage minority- and women-
               owned businesses to bid its subcontracts.

            5. Nothing contained in this contract shall be construed in any manner so as to
               require or permit any act that is prohibited by law.

            6. Contractor shall include the provisions set forth in paragraphs numbered 1
               through 5 (above) in each of its subcontracts.

G.   Independent Contractor Status: Contractor hereby agrees that it is engaged as an
     independent contractor and not as an agent or employee of ACMC; that it has and
     retains the right to exercise control and supervision of the work and full control over
     the employment, direction, compensation and discharge of all persons assisting in the
     work; that it will be solely responsible for wages, including withholding of income
     taxes, social security taxes and preparation and filing of IRS Form 1099 for each
     individual furnished to ACMC under this contract, workers' compensation premiums,
     compliance with OSHA and all employment-related regulations relating to its
     employees; and that it will be responsible for its own acts and those of its
     subordinates, employees and agents during the term of this contract. Contractor
     agrees that as an independent contractor it is solely responsible for all Federal, State
     and local taxes. Contractor further agrees that its officers and employees do not
     become employees of ACMC, nor are they entitled to any ACMC employee benefits
     as a result of the execution of this contract.

H.   Conflict of Interest: The Parties hereto and their respective employees or agents shall
     have no interest, and shall not acquire any interest, direct or indirect, which will
     conflict in any manner or degree with the performance of services required under this
     agreement. Contractor, and any and all agents or employees of Contractor agree to
     complete and submit, on an annual basis or upon request, conflict of interest
     disclosure forms, in a form and format required by ACMC, to the Clerk of the Board
     of Trustees.

     No Contractor nor any member of Contractor’s family shall serve on any ACMC
     board, committee, or hold any such position which either by rule, practice or action
     nominates, recommends, supervises Contractor’s operations, or authorizes funding to
     Contractor.

I.   Confidentiality: Confidential information is defined as all information disclosed to
     Contractor which relates to ACMC’s past, present and future activities, as well as
     activities under this agreement. Contractor will hold all such information in trust and
     confidence. Upon cancellation or expiration of this Contract, Contractor will return to
     ACMC all written or descriptive materials that contain any such confidential
     information.


                                        Page 44 of 67
J.   Use of ACMC Property: Contractor shall not use ACMC premises, property (including
     equipment, instruments or supplies) or personnel for any purpose other than in the
     performance of its obligations under this contract.

K.   Alameda County Medical Center: The responsibilities, functions, objectives and terms
     of agreement, including financial arrangements and charges of each such outside
     resource, shall be delineated in writing and signed by an authorized representative of
     ACMC and the person or the agency providing the service. The agreement shall specify
     that ACMC retains professional and administrative responsibility for the services
     rendered. The outside resource, when acting as a consultant, shall appraise the
     administrator of recommendations, plans for implementation and continuing assessment
     through dated and signed reports which shall be retained by the administrator for follow-
     up action and evaluation of performance.

     Tuberculosis: Contractor shall provide ACMC yearly with acceptable proof of Mantoux
     skin test for tuberculosis or chest x-ray (14 x 17) for all personnel providing on-site
     services at ACMC. Initial proof shall be provided prior to the provision of service.
     Acceptable proof shall be a statement signed by a physician of a negative Mantoux test
     or a signed negative chest x-ray. Contractor or any employees of Contractor who
     convert from a negative Mantoux test to a positive test must provide a signed
     physician’s statement indicating they are free from the presence of infectious disease.
     Contractor shall provide proof of such immunization within 10 days of the annual
     date of commencement of this agreement to the Office of Employee Health.

     Rubella and Rubeola Immunity: Prior to assignment, the Contractor shall provide
     acceptable proof of rubella and rubeola immunity and other immunities as may be
     required by law for all individuals who will be providing on-site services at ACMC.
     Acceptable proof of immunity (positive titer and/or vaccination) shall be a signed
     statement from an official health provider or a signed health certificate such as for
     marriage or international travel. Contractor shall provide proof of such immunization
     within 10 days of the annual date of commencement of this agreement to the Office of
     Employee Health.

     Administrative Responsibilities: Consistent with Title 22, California Administrative
     Code, Section 70713, ACMC retains professional and administrative responsibility
     for services rendered under this Agreement. ACMC’s retention of these
     responsibilities shall not alter or modify, in any way the hold harmless,
     indemnification, insurance or independent contractor provisions set forth herein.

L.   Access To Records: Until the expiration of five (5) years after the furnishing of any
     services, Contractor shall make available, upon written request, to ACMC or to the
     Federal/State/County government, or any of their duly authorized representatives, this
     Agreement, and such books, documents and records of Contractor that are necessary
     to certify the nature and extent of the reasonable cost of services to ACMC. If
     Contractor enters into an ACMC approved agreement with any related organization to
     provide services with a value or cost of $10,000 or more over a twelve (12) month

                                        Page 45 of 67
     period, such agreement shall contain a clause to the effect that until the expiration of
     five years after the furnishing of services pursuant to such subcontract, the related
     organization shall make available, upon written request, to ACMC or to the
     Federal/State/County government, or any of their duly authorized representatives, the
     subcontract, and books, documents and records of such organization that are
     necessary to verify the nature and extent of the services and costs. This paragraph
     shall be of no force and effect when and if it is not required by law, or if modified by
     law, such modification will supersede this clause. ACMC shall have access to
     Contractor's financial records for purposes of audit. Such records shall be complete
     and available for audit ninety (90) days after final payment hereunder and shall be
     retained and available for audit purposes for five (5) years after final payment
     hereunder.

     ACMC shall have the right to conduct an audit/compliance review of Contractor, and
     Contractor shall cooperate fully and promptly with such audit. ACMC may conduct
     periodic audits of billing and collection services performed by Contractor under this
     agreement. Contractor shall comply within ten (10) business days with any
     reasonable request of ACMC for records pertaining to billing, collections, and clinical
     care.

M.   Conformity with Law Standards and Safety:

     1.    Contractor shall observe and comply with all applicable laws, ordinances, codes
           and regulations of governmental agencies, including federal, state, municipal, and
           local governing bodies, having jurisdiction over the scope of services or any part
           hereof, including the Joint Commission on Accreditation of Healthcare
           Organizations standards for compliance and accreditation, State Department of
           Health requirements, as set forth in California Code of Regulations, Title 22, and
           all provisions of the Occupational Safety and Health Act of 1979 and all
           amendments thereto, and all applicable federal, state, municipal, and local safety
           regulations. All services performed by Contractor must be in accordance with
           these laws, ordinances, codes and regulations. Contractor shall indemnify and
           hold ACMC harmless from any and all liability, fines, penalties and
           consequences from any noncompliance or violations of such laws, ordinances,
           codes and regulations.

     2.    ACMC is committed to monitoring performance and continually improving the
           quality of care delivered. Contractor and any of its subcontractors and
           employees, shall cooperate with and, as necessary, actively participate in the
           ACMC performance improvement process. This shall include participation on
           performance improvement teams and/or committees, cooperation with sentinel
           event investigations, participation and/or cooperation in disease and case
           management programs. Contractor will additionally participate in preparation
           for surveys and/or audit by accrediting or regulatory agencies and any plan(s)
           of correction, which may follow.



                                        Page 46 of 67
      3.    Accidents: If a death, serious personal injury or substantial property damage
            occurs in connection with the performance of this Agreement, Contractor shall
            immediately notify ACMC and the ACMC Risk Manager’s Office, and the
            ACMC Contracting Officer, by telephone. Contractor shall promptly submit to
            ACMC, the ACMC Risk Manager and the ACMC Contracting Officer a written
            report, in such form as may be required by ACMC of all accidents that occur in
            connection with this Agreement. This report must include the following
            information: (1) name and address of the injured or deceased person(s); (2) name
            and address of Contractor’s subcontractor, if any; (3) name and address of
            Contractor’s liability insurance carrier; and (4) a detailed description of accident
            and whether any of ACMC’s equipment, tools, material, or staff were involved.
 4.         Contractor, its employees and subcontractors will report potential identified
            compliance issues to ACMC’s contract manager or Compliance Officer when
            identified.

N.    Travel Expenses: Contractor shall not be allowed or paid travel expenses unless set
      forth in this Agreement.

O.    Work Products and Inventions: ACMC shall have a royalty-free, exclusive, and
      irrevocable license to reproduce, publish and use all original computer programs,
      writings, sound recordings, pictorial reproductions, drawings and other works of similar
      natures produced in the course of or under this Agreement; and Contractor shall not
      publish any such material without prior written consent of ACMC.

P.    Assignment of Contract: Nothing contained in this Agreement shall be construed to
      permit assignment or transfer by Contractor of any rights or delegation of any duties
      under this Agreement and such assignment, transfer or delegation of duties is expressly
      prohibited and void unless otherwise approved in writing by ACMC.

Q.    Subcontracting: None of the work to be performed by Contractor shall be
      subcontracted without the prior written consent of ACMC. Contractor shall be as
      fully responsible to ACMC for the acts and omissions of any subcontractors, and of
      persons either directly or indirectly employed by them, as Contractor is for the acts
      and omissions of persons directly employed by Contractor.

R.    Lobbying: Contractor shall not use any funds provided under this agreement to pay
      the salary or expenses of any person or entity who, while on the job, is engaging in
      activities designed to influence legislation or appropriations pending before the
      Congress of the United States, California State Legislature or the Alameda County
      Hospital Authority Board of Trustees.

S.    Improper Conduct: Notwithstanding any other provision of this agreement, Contractor
      agrees that they, or any member of their staff, if charged with a felony or otherwise
      engages in improper conduct which results in a negative impact upon ACMC, or its
      officers or employees, Contractor will remove itself or the effected member of their
      staff from ACMC premises until such matter is fully resolved to the satisfaction of
      ACMC. Prior to removal, Contractor may meet with representatives of ACMC to

                                         Page 47 of 67
     discuss ACMC’s concern(s) regarding said charge(s) and/or conduct and Contractor
     will be provided an opportunity to respond.

T.   Workplace Efficiency and Dispute Resolution: ACMC has the exclusive right to make
     all determinations necessary toward maintaining efficiency of its operations and
     exercising complete control and discretion over its operation and performance of its
     work. In the event that Contractor disputes or otherwise disagrees with any decision
     made by ACMC in this regard, Contractor shall immediately communicate the precise
     nature of its dispute, including the provision of any documentation and other material
     related to that dispute.

U.   Compliance: Subcontractor shall not be currently excluded from the provision of
     services to programs or patients of Medicare, Medicaid or other federally or state
     funded programs.

     Contractor agrees to participate in ACMC’s Compliance Program trainings when
     offered or in the alternative provide a written copy of its own Compliance Program to
     ACMC’s contract monitor within sixty days after the execution of this contract.

V.   Employment: Employment of individuals who have entered into an employment
     agreement with ACMC, terms and conditions of employment are governed by the
     employment agreement. To the extent that their employment agreement does not
     otherwise conflict, their employment shall also be governed by the provisions of the
     Human Resources Policy and Procedure Manual.

W.   Absence of Sanctions: Contractor represents that neither Contractor nor any of its
     employees, owners, or agents have been sanctioned by or excluded from participation
     in any federal or state health care program, including Medicare and Medicaid.
     Contractor agrees that if it or any such individual associated with it should be
     sanctioned by or excluded from participation in any federal or state health care
     program, including Medicare and Medicaid, it will immediately notify ACMC of such
     event and ACMC shall have the right to immediately terminate the agreement without
     penalty or cost.




                                       Page 48 of 67
ACCOUNT MANAGER/SUPPORT STAFF

A.   Contractor shall provide a dedicated competent account manager who shall be
     responsible for the ACMC account. The account manager shall receive all orders from
     ACMC and shall be the primary contact for all issues regarding this contract.

B.   Contractor shall provide adequate, competent support staff who shall be able to service
     this account during normal working hours, Monday through Friday. Such
     representatives shall be knowledgeable about the contract, products offered and able to
     identify and resolve quickly any issues including but not limited to order and invoicing
     problems.

C.   Account manager shall be familiar with ACMC requirements and standards and work
     with ACMC to ensure that established standards are adhered to.

D.   Account manager shall keep the ACMC informed of requests from departments as
     required.


GENERAL REQUIREMENTS

A.   The successful contractor shall be regularly and continuously engaged in the business of
     providing services as described for at least five (5) years.

B.   The successful Contractor shall possess all permits, licenses and professional credentials
     necessary to supply product and perform services as specified under this contract.

C.   Proper conduct is expected of Contractor’s personnel when on ACMC premises. This
     includes adhering to no-smoking ordinances, the drug-free work place policy, not using
     alcoholic beverages and treating employees courteously.

D.   ACMC has the right to request removal of any Contractor employee who does not
     properly conduct himself/herself or perform quality work.

E.   Contractor personnel shall be easily identifiable as non-ACMC employees (i.e. work
     uniforms, badges, etc.).

F.   Contractor shall be responsible for any and all damage to ACMC facilities or equipment
     as a result of an act or omission arising out of the performance under this contract.

G.   All work shall be performed in a professional manner according to generally accepted
     industry standards and manufacturers instructions.

H.   Contractor shall not assign or transfer this agreement, any interest therein or claim
     thereunder without the prior written approval of ACMC.


                                         Page 49 of 67
I.   Time is of the essence in each and all the provisions of this agreement.

J.   No alteration or variation of the terms of this agreement shall be valid unless made in
     writing and signed by the parties hereto.

K.   Governing law shall be written for "California”.

L.   The assertions made in your proposal shall be considered part of the contract.




                                        Page 50 of 67
                              ALAMEDA COUNTY MEDICAL CENTER EXHIBIT A – BID ACKNOWLEDGEMENT

                                                                      RFP No. ACMCNM09-2
                                                                    24B




                                                                               for
                                                       For Ambulatory Electronic Health Record System


The Alameda County Medical Center (ACMC) is soliciting bids from qualified vendors to furnish its requirements per the specifications, terms and conditions
contained in the above referenced RFP number. This Bid Acknowledgement must be completed, signed by a responsible officer or employee, dated and submitted
with the bid response. Obligations assumed by such signature must be fulfilled.
1. Preparation of bids: (a) All prices and notations must be printed in ink or typewritten. No erasures permitted. Errors may be crossed out and corrections
     printed in ink or typewritten adjacent and must be initialed in ink by person signing bid. (b) Quote price as specified in RFP. No alterations or changes or
     any kind shall be permitted to Exhibit B, Bid Form. Responses that do not comply shall be subject to rejection in total.
2. Failure to bid: If you are not submitting a bid but want to remain on the mailing list and receive future bids, complete, sign and return this Bid
     Acknowledgement and state the reason you are not bidding.
3. Taxes and freight charges: (a) Unless otherwise required and specified in the RFP, the prices quoted herein do not include Sales, Use or other taxes.
     (b) No charge for delivery, drayage, express, parcel post packing, cartage, insurance, license fees, permits, costs of bonds, or for any other purpose,
     except taxes legally payable by ACMC, will be paid by ACMC unless expressly included and itemized in the bid. (c) Amount paid for transportation of
     property to ACMC is exempt from Federal Transportation Tax. An exemption certificate is not required where the shipping papers show the consignee
     as ACMC, as such papers may be accepted by the carrier as proof of the exempt character of the shipment. (d) Articles sold to ACMC are exempt from
     certain Federal excise taxes. ACMC will furnish an exemption certificate.
4. Award: (a) Unless otherwise specified by the bidder or the RFP gives notice of an all-or-none award, ACMC may accept any item or group of items
     of any bid. (b) Bids are subject to acceptance at any time within thirty (30) days of opening, unless otherwise specified in the RFP. (c) A valid,
     written purchase order mailed, or otherwise furnished, to the successful bidder within the time for acceptance specified results in a binding contract
     without further action by either party. The contract shall be interpreted, construed and given effect in all respects according to the laws of the State of
     California.
5. Patent indemnity: Vendors who do business with ACMC shall hold ACMC, its officers, agents and employees, harmless from liability of an nature or
     kind, including cost and expenses, for infringement or use of any patent, copyright or other proprietary right, secret process, patented or unpatented
     invention, article or appliance furnished or used in connection with the contract or purchase order.
6. Samples: Samples of items, when required, shall be furnished free of expense to ACMC and if not destroyed by test may upon request (made when the
     sample is furnished), be returned at the bidder’s expense.
7. Rights and remedies of County for default: (a) In the event any item furnished by vendor in the performance of the contract or purchase order
     should fail to conform to the specifications therefore or to the sample submitted by vendor with its bid, ACMC may reject the same, and it shall
     thereupon become the duty of vendor to reclaim and remove the same forthwith, without expense to ACMC, and immediately to replace all such
     rejected items with others conforming to such specifications or samples; provided that should vendor fail, neglect or refuse so to do ACMC shall
     thereupon have the right purchase in the open market, in lieu thereof, a corresponding quantity of any such items and to deduct from any moneys due or
     that may there after come due to vendor the difference between the prices named in the contract or purchase order and the actual cost thereof to ACMC.
     In the event that vendor fails to make prompt delivery as specified for any item, the same conditions as to the rights of ACMC to purchase in the open
     market and to reimbursement set forth above shall apply, except when delivery is delayed by fire, strike, freight embargo, or Act of God or the
     government. (b)Cost of inspection or deliveries or offers for delivery, which do not meet specifications, will be borne by the vendor. (c) The rights
     and remedies of ACMC provided above shall not be exclusive and are in addition to any other rights and remedies provided by law or under the
     contract.
8. Discounts: (a) Terms of less than ten (10) days for cash discount will considered as net. (b) In connection with any discount offered, time will be
     computed from date of complete, satisfactory delivery of the supplies, equipment or services specified in the RFP, or from date correct invoices are
     received by ACMC at the billing address specified, if the latter date is later than the date of delivery. Payment is deemed to be made, for the purpose
     of earning the discount, on the date of mailing ACMC warrant check.
9. California Government Code Section 4552: In submitting a bid to a public purchasing body, the bidder offers and agrees that if the bid is accepted, it
     will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C.
     Sec. 15) or under the Cartwright Act (Chapter 2, commencing with Section 16700, of Part 2 of Division 7 of the Business and Professions Code),
     arising from purchases of goods, materials, or services by the bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made
     and become effective at the time the purchasing body tenders final payment to the bidder.
10. No guarantee or warranty: ACMC makes no guarantee or warranty as to the condition, completeness or safety of any material or equipment that may
     be traded in on this order.

     THE undersigned acknowledges receipt of above referenced RFP and/or Addenda and offers and agrees to furnish the articles and/or services specified
     on behalf of the vendor indicated below, in accordance with the specifications, terms and conditions of this RFP and Bid Acknowledgement.

             Firm:
             Address:
             State/Zip
             What advertising source(s) made you aware of this RFP?


          By:_______________ ________________________________________________ Date____________ Phone_____________________


          Printed Name Signed Above:_______________________________________________________________________________________


          Title:__________________________________________________________________________________________________________
                                     EXHIBIT B

                      ALAMEDA COUNTY MEDICAL CENTER
                              RFP NO. ACMCNM09-2
                                         For
                    For Ambulatory Electronic Health Record System

                                     BID FORM

        DESCRIPTION                    Cost           Monthly Cost   Annual Cost
Hardware
Additional User Devices
Software
Implementation
Annual Maintenance
Any Additional Cost




Company Name:
                                                                                                  EXHIBIT C (Page 1 of 2)

                                Insurance Requirements for Professional Services Contracts
                              25B




Contractor: You are required to provide evidence of insurance shown for the category selected below. Please provide a copy
of this form to your Insurance Agent(s).

 Contractor: Use Category that applies to your organization
  Independent Contractor contract under $10,000 or Employee Contractor, any contract amount
   – Use Category A
  Independent Contractor (No Employees) over $10,000 - Use Category B
  Independent Contractor w/employees, Corporation, Partnership, LLC, Public Entity, Non-Profit Agency,
   CBO’s – Use Category C


     CATEGORY A MINIMUM REQUIREMENTS                                        CATEGORY B MINIMUM REQUIREMENTS
                                                                          41B




 Automobile Liability(8)                                            Commercial General Liability
       Minimum Limit 15/30/10                                             Minimum Limit $1,000,000 CSL
                                                                          Additional Insured Endorsement

 Professional Liability (3)                                         Professional Liability (3)
         Medical $1,000,000/$3,000,000                                      Medical $1,000,000/$3,000,000
         Other $1,000,000/$1,000,000                                        Other $1,000,000/$1,000,000
         OR                                                                 OR

 Errors and Omissions Insurance(3)                                  Errors and Omissions Insurance(3)
         $1,000,000                                                         $1,000,000

                                                                    Automobile Liability (8)
                                                                          Minimum Limit $1,000,000 CSL


      CATEGORY C MINIMUM REQUIREMENTS                                           MISCELLANEOUS REQUIREMENTS
                                                                                    (May apply to any category)
 Commercial General Liability                                        Fidelity Bond $ _____________
       Minimum Limit $1,000,000 CSL
       Additional Insured Endorsement                                Crime Insurance $ _____________
       Exclude “Exclusion” S2013 & S2005 (5)
                                                                     Other ___________ Limit $ ____________
 Automobile Liability
       Minimum Limit $1,000,000 CSL(8)
       Any Auto or Non-owned or Hired

 Professional Liability (3)
         Medical $1,000,000/$3,000,000
         Other $1,000,000
         OR

 Errors and Omissions Insurance(3)
          $1,000,000/3,000,000
          Contract Limit $ ______________
 Workers’ Compensation
         Statutory or $1,000,000
         Employers’ Liability $100,000 (minimum)

                                    See Attached Additional Requirements and/or Conditions.
                                                                                                         Exhibit C (Page 2 of 2)
                                                                                                       33B




        Additional Requirements and/or Conditions
      34B




1.    All Insurance Certificates showing proof of insurance must include a 30-day notice of Cancellation. Except
      Personal Automobile may show a minimum of 10 days).

2.    Additional Insured Endorsement shall name the County of Alameda, * its Board of Supervisors, officers, agents and
      employees as Additional insureds with respect to services being provided. Additional insured endorsement shall be
      equivalent to ISO form CG 20 09 10 93.

               *Certificates of insurance may indicate: “County of Alameda as Additional Insured”. This is acceptable
               provided that the actual endorsement to the policy is worded correctly. This is also encouraged if you have
               contracts with other County Departments.

3.    Professional Liability(3) or Errors and Omissions Insurance is required when contractor is required to be either licensed
      or certified to practice their trade or profession. *Behavioral Science MD’s minimum limit $1,000,000/$1,000,000 is
      acceptable.

4.    Commercial General Liability coverage shall be equivalent to ISO form CG O1 O1 96.

5.    All Commercial General Liability policies must include Personal Injury coverage.

      Remove “Exclusion” (5) S2013 &S2005. These endorsements exclude coverage for Sexual Harassment, abuse, and
      molestation, and are required to be removed, if attached, from liability policies where the contractor is providing
      services to the County’s clients and/or community.

6.    Commercial/Business Automobile Liability shall be equivalent to ISO form CA 00 01 06 92.

      Independent contractors or employee contractors may provide evidence from their personal automobile insurance
      company. If use of an automobile while servicing the contract is incidental or minimal, the contractor may submit a
      copy of their personal automobile declaration page if they incur problems obtaining a certificate.

7.    Contractors that hire vehicles or have employees or volunteers that use their personal vehicles shall provide non-owned
      automobile liability coverage.

8.    If contractor(8) is providing transportation services e.g. transporting clients or goods, $1,000,000 automobile liability
      and an additional insured endorsement is required. This requirement is automatic is the transportation condition applies.

9.    For Contracts over $25,000 insurance companies shall have a minimum Best Rating of A- VII or subject to approval by
      Risk Management. Risk Management must review all contracts over $25,000.

10.   If contractor is self-insured for any of the required coverages, contractor must submit evidence satisfactory to the
      County of contractor’s financial ability to respond to losses or claims for each self-insured coverage. Governmental
      Agencies may provide a letter of self-insurance.

11.   Professional Liability Deductibles: Risk Management must approve Deductibles over $25,000.

12.   Contractors are responsible for payment of all insurance deductibles.

13.   Contractor’s insurance must be primary to any other insurance available to the County with respect to any claim arising
      out of this contract or agreement.

      Address Certificate of Insurance to:
                                                            Alameda County Medical Center
                                                            Healthcare Contracting Department
                                                            1411 East 31st Street
                                                            Oakland, CA 94602
                                                 EXHIBIT D-1 46B




                                   ALAMEDA COUNTY MEDICAL CENTER
                                    48B




                                           RFP NO. ACMCNM09-2
                                                      For
                                 For Ambulatory Electronic Health Record System


                                                         REFERENCES
                                                       26B




Respondents are to provide a list of three (3) current clients in the area provided below. References shall be provided as required
per the RFP specifications, terms and conditions. References should have similar volume and requirements to those outlined in
these specifications, terms and conditions.

ACMC may contact some or all of the references provided in order to determine the proposer’s performance record on work
similar to that described in this request. ACMC reserves the right to contact references other than those provided in the
response and to use the information gained from them in the evaluation process.

 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:

 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:

 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:




Company Name:
                                      EXHIBIT D-2            47B




                            ALAMEDA COUNTY MEDICAL CENTER
                                    49B




                                  RFP NO. ACMCNM09-2
                                           for
                    FOR AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM


                                                         REFERENCES
                                                       27B




Respondents are to provide a list of three (3) former clients in the area provided below. References shall be provided as required
per the RFP specifications, terms and conditions. References should have similar volume and requirements to those outlined in
these specifications, terms and conditions.

ACMC may contact some or all of the references provided in order to determine the proposer’s performance record on work
similar to that described in this request. ACMC reserves the right to contact references other than those provided in the
response and to use the information gained from them in the evaluation process.


 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:

 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:

 Company Name:
 Address:
 City, State, Zip Code:
 Contact Person:
 Telephone Number:
 Type of Business:
 Dates of Service:




Company Name:
                                                EXHIBIT E

                          ALAMEDA COUNTY MEDICAL CENTER
                                RFP NO. ACMCNM09-2
                                         for
                    AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM

                                   REQUEST FOR PREFERENCE
                                             for
                                 LOCAL PRODUCTS AND VENDORS

                IF YOU WOULD LIKE TO REQUEST THE LOCAL PREFERENCE
                  COMPLETE THIS FORM AND RETURN IT WITH YOUR BID

A five-percent (5%) preference shall be granted to Alameda County products or vendors on all sealed bids on
contracts except with respect to those contracts which State law requires be granted to the lowest responsible
bidder. An Alameda County vendor is a firm or dealer with fixed offices or distribution points located in and
having a street address within the County of Alameda and which holds a valid business license issued by the
County or a city with the County. Alameda County products are those which are grown, mined, fabricated,
manufactured, processed or produced within the County of Alameda.



       Company Name:

       Street Address:

       Telephone Number:

       Business License Number:


The Undersigned declares that the foregoing information is true and correct:



       Print/Type Name:

       Title:

       Signature:

       Date:
                                                    EXHIBIT F

                          ALAMEDA COUNTY MEDICAL CENTER
                                RFP NO. ACMCNM09-2
                                         for
                    AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM

                                   Exceptions, Clarifications, Amendments
List below request for RFP/RFQ clarifications, exceptions and amendments, if any, and submit with your bid response.
ACMC is under no obligations to accept any exceptions and such exceptions may be a basis for bid disqualification.

Item        Reference To:
No.    Page No.    Paragraph                                      Description
                   No.




Contractor:
                                                 EXHIBIT G

                            ALAMEDA COUNTY MEDICAL CENTER
                                    RFP ACMCNM09-2
                                          for
                      AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM



                                       PROPOSAL EVALUATION FORM
Vendor Name:

Evaluated By:

                      Completeness of Response
 A.                                                             Pass/Fail

                                                             Weight    X        = Points
                                                                       Rating *

 B.

 C.

 D.

 E.

 F.

 G.

                                                 Sub-Total

                                Plus 5% Local Preference

                                          Evaluation Total
* 5 = Excellent             2 = Fair
  4 = Above Average         1 = Poor
  3 = Average
                    EXHIBIT H

        ALAMEDA COUNTY MEDICAL CENTER
              RFP NO. ACMCNM09-2
                      FOR
FOR AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM


              ACMC SITES & ADDRESSES
            50B




                        1.HIGHLAND HOSPITAL AND CLINICS
                            1411 East 31st Street
                            Oakland, CA. 94602
                        2.EASTMONT WELLNESS CENTER
                             6955 Foothill Blvd., Suite 200
                             Oakland, CA. 94605
                        3.FAIRMONT HOSPITAL AND CLINICS
                             15400 Foothill Blvd.
                             San Leandro, CA. 94578
                        4.JOHN GEORGE PSYCHIATRIC PAVILION
                             2060 Fairmont Drive
                             San Leandro, CA. 94578
                        5.WINTON WELLNESS CENTER
                            24100 Amador St., Suite 250
                            Hayward, CA. 94544
                        6.NEWARK HEALTH CENTER
                           6066 Civic Terrace Avenue
                           Newark, CA. 94560
                                         EXHIBIT I     51B




                              ALAMEDA COUNTY MEDICAL CENTER
                                    RFP NO. ACMCNM09-2
                                            FOR
                      FOR AMBULATORY ELECTRONIC HEALTH RECORD SYSTEM

                            SUBSTITUTE IRS FORM W-9
          REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION

The purpose of this form is to obtain or verify the accuracy of information regarding the Alameda County Medical
Center’s (ACMC’s) payees. ALL payees must have an accurate Substitute IRS Form W-9 on file in the ACMC General
Accounting Office in order to be paid. If you fail to furnish your correct TIN, you may be subject to a penalty. If you
are a nonresident alien and/or foreign entity, or you do not have a TIN, or for further information, see the Instructions on
the back of this form.
Please print or type. Do not send to IRS. Return to Alameda County Medical Center in the envelope provided.
Name on record with IRS or Social Security Administration:


All DBA(s) or Invoice Name(s) (if different from above name) use attachments if necessary:


Address of Correspondence or 1099 (we will take the remittance address, if different from the invoice):


                                TAXPAYER IDENTIFICATION NUMBER (TIN)
Enter only one TIN and it must be the type of TIN (SSN or EIN) that is appropriate to your type of entity. Only ONE
Number will be ACCEPTED.
SOCIAL SECURITY NUMBER (SSN): _ _ _ - _ _ -_ _ _ _
EMPLOYER ID NUMBER (EIN):                     __-_______

                                         Type of Entity (please check only one)
    Individual                                     Corporation-State of Incorporation:
    Sole Proprietor                                Government or Trust (specify)
    Partnership                             Tax-Exempt Organization under Section 501(c)
    Other (specify)

Check the boxes that apply to Alameda County Medical Center’s payments to you:
    Goods Only                Goods and Services                Rents/Leases
    Legal Services                      Medical & Health Care Services          Rents/Leases Paid to You as the Agent
    Non-Medical/Non-Legal Services – Describe:
Exempt from backup withholding?              YES        NO
Certification – Under penalties of perjury, I certify:
(1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be
    issued to me).
(2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been
    notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report
    all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
(3) I am a U.S. person (including a U.S. resident alien).
The IRS does not require your consent to any provision of this document other than the certifications required to
    avoid backup withholding.
Please sign here (required). Check if this signature applies to Certification:         (1),     (2), and/or   (3).
Signature                                                            Date
         Print Name                                                  Title
         Phone No.                                                   FAX No.
         e-mail address
                                                                        INSTRUCTIONS
                                                                      35B




      Purpose of Form. – To furnish your correct TIN to a payer and (when applicable) to certify (1) that the TIN you are furnishing is correct (or that
      39B




      you are waiting for a TIN), (2) that you are not subject to backup withholding, and (3) to claim exemption from backup withholding if applicable.
      Use this Substitute Form W-9 only if you are a U.S. person (including a resident alien). If you are a nonresident alien and/or foreign entity,
        complete the appropriate Form W-8 and mail to ACMC, (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

How to obtain a TIN. – Individuals should obtain Form SS-5 from their local Social Security Administration. Businesses and all other entities
should obtain Form SS-4 from their local IRS office. If you do not have a TIN, write “Applied For” in the TIN space on the front of this form and
send it to us. Keep a photocopy of the blank form. You will have 60 days to receive your TIN and send the completed photocopy Substitute W-9 to
the address on the front/top of this form. If we do not receive your TIN within 60 days, backup withholding, if applicable, will begin and continue
until you furnish your TIN.

What is Backup Withholding? – Unless you are exempt (see next section), payments you receive will be subject to 30% withholding (29% after
December 31, 2003) if:
     (1) You do not furnish your TIN, or
     (2) You do not certify your TIN when required, or
     (3) The IRS notifies us that the TIN/name combination you furnished is incorrect, or
     (4) The IRS notifies you that you are subject to backup withholding because you did not report all your interest and dividends on your tax
           return, or
     (5) You do not certify to us that you are not subject to backup withholding under (4) above.
All amounts withheld will be sent to the IRS. Under no circumstances will the withheld amount later be sent directly to you. The total amount
withheld will be reported in Box 4 of your 1099-MISC.
You will not be subject to backup withholding on payments you receive if you give ACMC your correct TIN, make the proper certifications, and
report all your taxable interest and dividends on your tax return.

Who is generally exempt from backup withholding of payments made by Alameda County Medical Center?
    (1) A corporation, except a corporation which provides medical, health care or legal services;
    (2) An organization exempt from tax under Internal Revenue Code Section 501(a);
    (3) A government;
    (4) A real estate investment trust, a common trust fund operated by a bank under section 584(a), and a trust exempt from tax under section 664
         or described in section 4947;
    (5) A financial institution.
For more information on exempt payees, see the Instructions for the Requester of Form W-9.

Penalties for failure to furnish TIN. – You are subject to a penalty of $50 for each failure to furnish your correct TIN/name combination unless
your failure is due to reasonable cause and not to willful neglect. If you make a false statement with no reasonable basis that results in no imposition
of backup withholding, you are subject to a penalty of $500. Willfully falsifying certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.

What TIN/name combination should be reported on the front of this form?
Individual – Provide the SSN of the individual. Individual’s names may never be used in combination with employer’s TIN’s. If you are an
individual, you must generally provide the name shown on your social security card. However, if you have changed your last name (e.g., due to
marriage without informing the Social Security Administration of the name change, please enter your first name and both the last name
shown on your social security card and your new last name.
Two or more Individuals – Choose one name to list first and circle and show his/her SSN (payments will be reported on 1099 for that
name and SSN only. If only one person on a joint account has an SSN, that person’s number must be furnished.
Sole proprietorship – Sole proprietors must show the owner’s name on the first line as the “name on record”. (If the owner is a
married couple, choose one name to list first and circle and show his/her SSN.) On the second line, show the business name as a
“dba” if that is the name on the invoice. Sole proprietors may use either a SSN or EIN (if you have one).

Signing the Certification – You are required to furnish your correct TIN/name combination. The Internal Revenue Service does not
require your consent to any provision of this document other than the certifications required to avoid backup withholding. If two
individuals are listed, only the one who’s SSN is reported may sign the certification.

Privacy Act Notice – Section 6109 requires you to furnish your correct TIN. The IRS uses the numbers for identification purposes
40B




and to help verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file a tax return.
Payers must generally withhold 30% (29% after 12/31/03) of taxable payments to a payee who does not furnish a TIN. Certain
penalties may also apply. If we disclose or use your TIN in violation of Federal law, we may be subject to penalties.
                                           EXHIBIT J
                                ALAMEDA COUNTY MEDICAL CENTER
                                      RFP NO. ACMCNM09-2
                                              FOR
                                ALAMEDA COUNTY MEDICAL CENTER

                                    BUSINESS ASSOCIATE AGREEMENT
This Addendum supplements and is made part of that Service Agreement (“Agreement”), effective ______________, entered
into by and between ________________ hereafter referred to in this agreement as “Business Associate” and Alameda County
Medical Center hereinafter referred to in this agreement as “Covered Entity”.

1.     Definitions.
       a.       “HIPAA” means the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.
       b.       “HIPAA Regulations” means the regulations promulgated under HIPAA by the United States Department
                of Health and Human Services, including, but not limited to, 45 CFR Part 160 and 45 CFR Part 164.
       c.       Any terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms
                have under HIPAA and the HIPAA Regulations.

2.     PERMITTED USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION (PHI)

2.1    Performance of Services. Except as otherwise limited in this Agreement, Business Associate is permitted to use or
       disclose PHI on behalf of, or to provide services to, Covered Entity if such use or disclosure of PHI would not
       violate the HIPPA Regulations if done by the Covered Entity or the minimum necessary policies and procedures
       of the Covered Entity in connection with the performance of the services [listed in Exhibit A of the Agreement]
       provided under Alameda Ambulatory Health Care Services Administrative Services Agreement between ACMC
       and ______________________or such use or disclosure is expressly permitted under Section 2.2 of this
       Agreement.
2.2    Business Activities of the Receiving Party. Unless as otherwise limited in this Agreement, the Business Associate
       is permitted to:
       a. Except as otherwise limited in this Agreement, Business Associate may use PHI for its proper management
           and administration and to fulfill any present or future legal responsibilities of the Business Associate provided
           that such uses are permitted under state and federal confidentiality laws.
       b. Except as otherwise limited in this Agreement, Business Associate may disclose PHI to a third party for the
           purpose of its proper management and administration or to fulfill any present or future legal responsibilities,
           provided that the disclosure is required by law; or the Business Associate obtains reasonable assurances from
           the third party to whom the PHI is disclosed that it will (i) keep confidential and use or further disclose the
           PHI only as required by law or for the purpose for which it was disclosed to the third party; and (ii) the third
           party will notify the Business Associate of any instances of which it is aware in which the confidentiality of
           the information has been breached.
       c. Except as otherwise limited in this Agreement, Business Associate may use PHI to provide data aggregation
           services to Covered Entity as permitted by 42 CFR 164.504(e)(2)(i)(B). Data aggregation services involve the
           combining by the Business Associate of (a) PHI created or received by a Business Associate in its capacity as
           the Business Associate of a Covered Entity with (b) PHI received by the Business Associate in its capacity as
           a Business Associate of another Covered Entity, to permit data analyses that relate to the health care
           operations of the respective Covered Entities.
       d. Business Associate may use PHI to report violations of law to appropriate Federal and State authorities,
           consistent with 42 CFR 164.502(j)(1).
       e. Business Associate may de-identify any and all PHI created or received by Business Associate under this
           Agreement; provided, however, that the de-identification conforms to the requirements of the HIPAA
           Regulations. Such resulting de-identified information would not be subject to the terms of this Agreement.

3.     RESPONSIBILITIES OF THE BUSINESS ASSOCIATE WITH RESPECT TO PROTECTED HEALTH
       INFORMATION
3.1    Responsibilities of the Receiving Party. With regard to its use and /or disclosure of PHI the Business Associate
       hereby agrees to do the following:
      a. Use and/or disclose the PHI only as permitted or required by this Agreement as defined in Section 2 or as
           otherwise required by law.
      b.   Report to Covered Entity any use or disclosure of the PHI in violation of this Agreement as soon as
           reasonably practicable.
      c.   Establish procedures for mitigating, to the greatest extent possible, any deleterious effects from any improper
           use and/or disclosure of PHI that the Business Associate reports to the Covered Entity
      d.   Use appropriate safeguards to prevent any use or disclosure of the PHI other than uses and disclosures
           expressly provided for by this Agreement.
      e.   Ensure that any agent, including a subcontractor, to whom it provides PHI agrees to the same restrictions and
           conditions that apply through this Agreement to Receiving Party.
      f.   Make available all records, books, agreements, policies and procedures relating to the use and/or disclosure of
           PHI to the Secretary of the Department of Health and Human Services (“Secretary”) for purposes of
           determining the Receiving Entity’s compliance with this Agreement.
      g.   Upon prior written request, make available during normal business hours at Receiving Party’s offices all
           records, books, agreements, policies and procedures relating to the use and/or disclosure of PHI to the
           Covered Entity within 30 days for purposes of enabling the Covered Entity to determine the Receiving Party’s
           compliance with the terms of this Agreement.
      h.   Document such disclosures of PHI and any information related to such disclosures as would be required for
           Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance
           with 45 CFR 164.528 and the policies of Covered Entity.
      i.   Provide to Covered Entity information collected in accordance with Section 3.1.h of this Agreement, to
           permit Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in
           accordance with 45 CFR 164.528 and the policies of Covered Entity. Such information shall be provided in a
           time and manner designated by the Covered Entity.
      j.   When requested by Covered Entity, Business Associate agrees to provide access to PHI in a designated record
           set to Covered Entity or to an Individual in order to comply with the requirements under 45 CFR 164.524 and
           the policies of Covered Entity. Such access shall be provided by Business Associate in the time and manner
           designated by Covered Entity.
      k.   When requested by Covered Entity or an Individual, Business Associate agrees to make any amendment(s) to
           PHI in a designated record set that the Covered Entity directs or agrees to pursuant to 45 CFR 164.526 and
           the policies of Covered Entity. Such amendments shall be made by Business Associate in the time and
           manner designated by Covered Entity.
      l.   Subject to Section 6.5 below, return to the Covered Entity or destroy, within 60 days of the termination of the
           Agreement, the PHI in its possession and retain no copies whether in paper, electronic, or any other form of
           media.
      m.   Disclose to its Subcontractors, agents or other third parties, and request from the Covered Entity, only the
           minimum PHI necessary to perform or fulfill a specific function required or permitted hereunder.

4.    RESPONSIBILITIES OF THE COVERED ENTITY WITH RESPECT TO PROTECTED HEALTH
      INFORMATION
      4.1  Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not
           be permissible under the HIPAA Regulations if done by Covered Entity or that is not otherwise expressly
           permitted under Section 2.3 of this Agreement.

5.    INFORMATION OWNERSHIP
5.1   Information Presumed Owned by Covered Entity. The following provisions control the ownership of PHI
      Disclosed under this Agreement. These provisions shall not apply to information which (a) is readily available or
      can be readily ascertained through public sources, (b) a party has previously Received from a source or sources
      legally entitled to Disclose such Information to the party, or (c) can be demonstrated by documentation to have
      been independently developed by the Business Associate without reference to any information provided by the
      Covered Entity.
      a. All information shall be deemed to be the exclusive property of the Covered Entity, unless (a) otherwise
          expressly agreed in writing or (b) the information was previously received by the Covered Entity from
          another party to this Agreement, who did not disclaim ownership in Writing.
      b. A disclosure of PHI shall not transfer legal title to information to the Receiving Party, unless otherwise
          expressly agreed in Writing.
6.    TERMS AND TERMINATION OF THE AGREEMENT
6.1   Term. This Agreement shall become effective on the Effective Date and shall continue in effect until all obligations
      of the Parties have been met, unless terminated as provided in Section 6 of this Agreement.
6.2   Termination by the Disclosing Entity. The Covered Entity may immediately terminate this Agreement and any
      related agreements if the Covered Entity makes the determination that the Business Associate has breached a
      material term of this Agreement. Alternatively, the Covered Entity may choose to: (i) provide the Business
      Associate within 30 days written notice of the existence of an alleged material breach; and (ii) afford the Business
      Associate and opportunity to cure said alleged material breach upon mutually agreeable terms. Failure to cure in
      the manner set forth in this paragraph is grounds for the immediate termination of this Agreement.
6.3   Termination by Receiving Party. If the Business Associate makes the determination that a material condition of
      performance has changed under this Agreement, or that the Covered Entity has breached a material term of this
      Agreement, Business Associate may provide thirty (30) days notice of its intention to terminate this Agreement.
      Business Associate agrees, however, to cooperate with Covered Entity to find a mutually satisfactory resolution to
      the matter prior to terminating.
6.4   Automatic Termination. This Agreement will automatically terminate without any further action of the Parties
      upon the termination or expiration of the Standard Agreement between the Parties.
6.5   Effect of Termination.
      a. Upon termination of the Agreement, for any reason, Business Associate shall return or destroy all PHI
           received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This
           Business Associate shall retain no copies of the PHI.
      b. Notwithstanding the foregoing, in the event that Business Associate determines that returning or destroying
           the PHI is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that
           make return or destruction infeasible. Upon mutual agreement of the parties that return or destruction of PHI
           is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and limit further
           uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long
           as Business Associate maintains such PHI.

7.    Miscellaneous
      a.      Regulatory References. A reference in this Agreement to a section in HIPAA or the HIPAA Regulations
              means the section as in effect or as amended, and for which compliance is required.
      b.      Survival. The respective rights and obligations of Business Associate under Section 5.c of this Agreement
              shall survive the termination of this Agreement.
      c.     Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits
             Covered Entity to comply with applicable law protecting the privacy, security and confidentiality of PHI,
             including, but not limited to, HIPAA and the HIPAA Regulations.
      d.      State Law. Nothing in this Agreement shall be construed to require Business Associate to use or disclose
              PHI without a written authorization from an individual who is a subject of the PHI, or written
              authorization form any other person, where such authorization would be required under state law for such
              use or disclosure.
      e.      Indemnification. Business Associate shall indemnify, hold harmless and defend Covered Entity form and
              against any and all claims, losses, liabilities, costs and other expenses resulting from, or relating to, the
              acts or omissions of Business Associate in connection with the representations, duties and obligations of
              Business Associate under this Agreement.
      f.      Primacy. To the extent that any provisions of this Agreement conflict with the provisions of any other
              agreement or understanding between the parties, this Agreement shall control.
  IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement as of the Effective Date.

                      Contractor                                     Alameda County Medical Center

         Signature of Authorized Representative                  Signature of Authorized Representative
Name:                                                    Name: Wright L. Lassiter, III
Title:                                                   Title: Chief Executive Officer
Date:                                                    Date:

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:121
posted:7/28/2011
language:English
pages:67
Description: Quotation System Proposal Template document sample