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  • 1. Building Systems That Grow: The RFP Process By Diane Gaddis CEO & President November 2007 Copyright 2007 1
  • 2.
    • CHCA is a 501(c)(3) Health Center Controlled Network for section 330 safety-net health care centers and systems throughout Florida.
    • CHCA facilitates the selection, implementation and support of services and technologies that allow its members to expand access to health care while improving quality outcomes.
    • CHCA members leverage resources across the network to enhance patient care while maintaining independent management structures
    • Members choose from a range of technology and services to enhance their health center operations, including health information technology (HIT) and the sharing of information across operational specialties.
    2
  • 3. CHCA Network Aggregate 2006 Results
    • Total sites: 77
    • Providers across the network:
      • 159 physicians, 60 mid-levels
    • Users: 311,489
    • Encounters: 1,268,669
    • Served 52% of Florida’s Rural Areas
    3 2006 Service Area With EHR Project
  • 4. CHCA Professional Services
    • Project management
    • Training
    • Report Writing
    • Technical Assistance
    • Workflow/Process Consultation
    • Go-Live Choreography
    • Day-to-day application support
    4
  • 5. 5 “ Take one of these as often as you can afford to.”
  • 6. EHR Vendor Selection Due Diligence
    • Early 2003: Began market scan and research
    • Mid 2003: Started Workflow Analysis Process
    • Early 2004: Sent our RFI package to six vendors
    • Spring 2004: Two full day presentations by top two contenders for over 30 providers; began contract negotiations with both vendors
    • Summer 2004: Two full day hands-on demonstrations by vendors with select providers
    • Fall 2004: Announced primary vendor choice; continued negotiations with both vendors
    • Nov 2004: Primary vendor eliminated; continued negotiations with other
    • Dec 2004: Contract signed with GE for their Centricity EHR Product
    • Sep 2005: First Go-Live
    6
  • 7. Selection Process Overview
    • Process Analysis
    • Request for Information
    • Self-Education
    • Dog n’ Pony Show
    • Request for Proposal
    • Scoring Assessment
    • In-depth / Situational Vendor Presentations
    • Site Visits
    • Vendor Selection
    • Contract Negotiations
    7
  • 8. Selection Committee
    • Physicians, ARNPs, PAs, CNMs, etc
    • Nursing
    • Finance
    • Operations
    • Medical Records
    • And More Providers!
    8
  • 9. Request for Information
    • Tool for self-education
    • Items to request –
      • Corporate information
      • General client information
      • Target markets
      • Support / Implementation methodologies
      • Features / Competitive Advantages
    9
  • 10. Mini-Demos / Education
    • Vendors perform mini-demos
    • Schedule “Lunch and Learn” sessions
    • Deliver via Webex type services
    • Education component – not final selection
    • Seek out peers, technical assistance
    10
  • 11. KLAS, TEPR, etc
    • Investigate their methods
      • Statistically sound?
      • Interactive competition?
      • How are customers found?
      • Judges relationships to vendors?
      • Vendors members / sponsors of ranking organization?
      • Is organization a stakeholder?
    11
  • 12. Narrowing the Field
    • Thoroughly read the RFIs
    • The more eyes the better
    • Compare and contrast
    • Look past the gloss
    • Evaluate the quality of responses
    • Listen to colleagues
    • Reflect upon mini-demo sessions
    12
  • 13. Dog n’ Pony Show
    • Top two choices invited
    • One day for each
    • Primary attendees – providers, nursing
    • Use patient visit scenarios
    • Control the demo
    13
  • 14. Using Patient Visit Scenarios
    • At least 6 sample visit scenarios
    • Cover the spectrum of service types
    • Provide 3-4 days prior to demo
    • Establish moderator / interaction
    • Use a Scorecard
    14
  • 15. The Demo Scorecard
    • Limit scope
    • Cover scenarios and only key areas
    • All providers participate in scoring
    • Weight each area or item
    • Allow free text comments
    15
  • 16. Request for Proposal
    • Only top 2 vendors
    • Must be very controlled
      • Give single point of contact
      • Dictate format for responses
      • Adhere to deadline
    • Document vendor questions and replies
      • To share or not to share with all?
    16
  • 17.
    • Provide short- and long-term projections
    • Technical infrastructure
    • Current in-house staffing and support plans
    • Leadership
    • Contracting entity
    Request for Proposal, cont’d 17
  • 18. Crafting the RFI / RFP Package
    • Vendor Information:
      • Request references that will provide satisfactory as well as dissatisfied responses
      • Commitment to CHC market?
      • Are references or show sites paid?
      • Project management samples
    18
  • 19. Crafting the RFP Package
    • Functional Requirements:
    • Very Important RFP Component!
    • Expand with details
    • Designating “required” vs “optional” requirements
    • Attaches to the contract
    • Use HRSA guidelines as starting point
    • Clinicians must provide input
    19
  • 20. ftp://ftp.hrsa.gov/healthit/ehrguidelines.doc 20
  • 21. The RFP Scorecard
    • Tie back to functional requirements
    • User friendly, allow for comments
    • Committee to weight each area
    • Limit areas – High priority focus
    • Grade RFP response thoroughness and quality
    21
  • 22. Investment / Recurring Costs
    • What is included in the license fee?
      • Formulary subscription / updates?
      • Drug interaction subscription / updates?
      • Database licensing?
      • Patient education materials?
    • Perform five year investment / cost analysis
    22
  • 23. License Fees
    • Must understand licensing
      • Per Physician
      • Per Provider
      • Per Named User
      • Per Concurrent User
    • Thoroughly understand vendor definitions
    • Thoroughly understand how they audit license compliance
    23
  • 24. Support Structure
    • Hours of operations
    • Methods of support
    • User community
      • Local
      • Regional
      • National
    • Special Interest Groups
    • After hours support access / costs
    • Service Level Agreements (SLAs)
    24
  • 25. Corporate Comparisons
    • Positioned as a buyer
      • Acquisitions build benefit to customers or dilute resources?
    • Positioned for a buy
      • Future less known – new buyer impact?
    • History of reorganizations?
    • History of management changes?
    25
  • 26. Contract Comparisons
    • To Vendors: “Put your money where your mouth is”
    • Get it in writing
    • Comparison tracking
    • What’s not included
    26 If they won’t put in writing what they verbalize, walk away
  • 27. Negotiate - Both Vendors
    • A lot of work! Saves time later.
    • Negotiator must be armed with knowledge
    • Conduct with integrity
    • Document, document, document
    • Thoroughly reread every version of contract sent
    • Involve attorney before signing
    27
  • 28. Dog n’ Pony #2?
    • Don’t be afraid to require
    • Use to clarify functional differences
    • Limit participants
    • Use that scorecard
    • Document key differences
    • Have vendor append functional requirements document
    28
  • 29. Resource Ideas
    • Certification Commission for Healthcare Information Technology
    • www.cchit.org/work/products.htm
    • AAFP’s Center for Health Information Technology
    • www.centerforhit.org
    • BPHC Functional Requirements Sample
    • ftp://ftp.hrsa.gov/healthit/ehrguidelines.doc
    • Health Information Management Systems Society (HIMSS)
    • www.himss.org
    29
  • 30. Baby Step Versus Big Bang 30
  • 31. Baby Step Versus Big Bang
    • Big Bang Cons :
    • Takes 2+ years to build
    • More functionality at Go-Live may impact productivity levels for a longer period of time
    • Large staffing infrastructure needed to support at Day one
    • Larger investment required up-front
    • Longer time frame to recoup investment dollars
    • Big Bang Pros :
    • A more complete, comprehensive system is deployed to providers
    • More time available for configuration and testing
    31
  • 32. Baby Step Versus Big Bang
    • Baby Step Cons :
    • Patience required as all functionality not available initially
    • Baby Step Pros :
    • Return on Investment comes more quickly
    • Growing champions is easier
    • Implementation and support can be built slowly
    • Productivity levels return more quickly
    32
  • 33. CHCA Network: EHR Today 33
  • 34.
    • Over 68 providers
    • Three multi-site CHC organizations
    • Serving six counties
    CHCA Network: EHR Today- 11/1/2007 Current Implementation Reach 34
  • 35. 35
  • 36.
    • Strong history and commitment in the healthcare arena
    • Real-time and interactive clinical guidelines
    • Oracle platform
    • Works well in Citrix environment
    • User Friendly interface
    • NCQA certification for its diabetes reporting capabilities
    • Strong user forum
    CHCA Network: EHR Today Selected Vendor Strengths 36
  • 37.
    • CCHIT (Certification Commission for Healthcare Information Technology) Certified:
      • Formed in July 2004, the Certification Commission is a recognized certification body for electronic health records and their networks, and a private, nonprofit initiative.
      • Rigorous criteria and processes to receive certification
      • HRSA continues to encourage adoption of products that have received this certification
    CHCA Network: EHR Today Selected Vendor Strengths, cont’d 37
  • 38.
    • Lessons Learned & Other Advice In the RFI / RFP Process:
    • You don’t know what you don’t know
    • Be prepared to dedicate a substantial amount of time
    • Once the contract is signed, the majority of your leverage is gone.
    CHCA Network: EHR Today 38
  • 39. #1 Point to Remember: “ It’s not about the hardware and the software; it’s about the people and the process.” For More Information, Contact: Diane Gaddis, CEO & President [email_address] 39