08_21_2023_DSH_EHR_QA_set1.xlsx
XLSX spreadsheet 134 KB Posted
- Attached to
- Continuum-EHR 2023-00466
- Solicitation number
- 0000027279
- Issued by
- San Luis Obispo County, Berkeley City, California
About this file
This document is a Q&A set related to a state and local contract opportunity solicitation #2023-00466 by the California Department of State Hospitals (DSH) for an electronic health record (EHR) solution, referred to as Continuum-EHR. DSH is seeking a HIPAA-compliant commercial off-the-shelf (COTS) EHR solution that will include patient registration, pharmacy operations, billing systems, and the delivery of services in primary medical, psychiatric, and nursing care across six DSH facilities. The solicitation has a Phase 1 response due date of July 21, 2023, and a Phase 2 response due date of September 20, 2023. DSH plans to award the contract and begin implementation within 12 months of the execution date, with the first hospital implementation at the DSH-Coalinga facility.
The current payer mix across the DSH facilities ranges from 5-35% Medicare, 0% Medi-Cal, and 0.1-2% private insurance, with the remaining 64-94% of patients being uninsured. DSH currently uses several different picture archiving and communication system (PACS) solutions and laboratory information management systems (LIMS) across the facilities, and is seeking a solution that can integrate with or replace these systems. The solicitation outlines detailed functional and non-functional requirements for the EHR solution, as well as requirements for implementation, training, and support.
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Q&A set1_08_21_2023 DSH Continuum-HER, solicitation #2023-00466 Question and Answer set #1, 08/21/2023
| # | Document ID # | ||
| (Solicitation Section, Exhibit, or Attachment number) | Page # | Solicitation Reference | Bidder's Submitted Question |
and Proposed Changes State's Response
| 1 | General Question | N/A | General Question | Where can I find the State's master terms and conditions? | Solicitation document 2.0 Solicitation Requirements, section 1.1.1 includes links to the State's General Provisions-Information Technology-Cloud Computing - Software as a Service (SaaS), General Provisions, State Model Cloud Computing Services Special Provisions (SaaS), and other requirements of the solicitation and Statement of Work. |
| 2 | Document 1.0 SOLICITATION OVERVIEW | 34 | 4.9 Bidders' Library | The solicitation says the Bidders may be granted a second User ID and password if requested and requests shall be made to the Procurement Officer. Should a second Attachment 2: Intent to Bid and Attachment 3: Confidentiality Statement form be submitted? | A second Attachment 3 does not need to be submitted. The Confidentially statement covers all persons employed by the company. Attachment 3 in part states, “As an authorized representative or corporate officer of the company name below, I have the authority to bind the company contractually, and I agree that all persons employed by this company will adhere to the following policy:”. |
Attachment 2: Intent to Bid Form will be revised in Addendum 1 to include a second table for Bidder's requesting a second User ID and Password.
3 General Question N/A General Question Regarding the scope of the Pharmacy Modernization initiative and the role the Continuum-EHR will play in medication management: Can CA DSH further define what functions will be mutually exclusive between the Pharmacy Modernization system and the EHR?
a. In reviewing the RFP and notes from the Bidder Conference, we perceive some overlap between the Pharmacy Modernization and EHR systems regarding medication prescribing, dispensing, and external pharmacy services. Any clarification and delineation of these functions between the two systems would be greatly appreciated. The Pharmacy Modernization project upgrades pharmacy management / dispensing systems such as the automated dispensing cabinets, medication repackaging machines, and pharmacy inventory management software. These systems will interface patient drug information and cost data with the EHR to enhance treatment information and improve billing efficiency.
The Pharmacy Modernization project upgrades pharmacy management / dispensing systems such as the automated dispensing cabinets, medication repackaging machines, and pharmacy inventory management software. These systems will interface patient drug information and cost data with the EHR to enhance treatment information and improve billing efficiency.
The Pharmacy Modernization project will not upgrade the current pharmacy computer system PHO. This homegrown DSH product is used to validate physician orders and maintain patient medication profiles. PHO also interfaces with medication repackaging machines or the automated dispensing cabinets.
The Continuum EHR solution will replace PHO while interfacing with the pharmacy management / dispensing systems. Therefore, the Continuum EHR solution will need to provide comprehensive pharmacy services as listed in pharmacy functional requirements (Exhibit F).
Additional information about PHO can be found in SOW, Section 2.1 DESCRIPTION OF CURRENT AND PROPOSED NEW ENVIRONEMENT CURRENT ENVIRONMENT, Sub-section 2.1.1. CURRENT ENVIRONMENT.
4 General Question N/A General Question Please confirm your estimated payer / insurer mix. For example: 90% Medi-Cal, 5% Medicare, 5% Commercial, etc. Atascadero: 11% Medicare, 0% Medi-Cal, .1% Private Insurance, 88% Uninsured Coalinga: 5% Medicare, 0% Medi-Cal, .1% Private Insurance, 94% Uninsured Metropolitan: 20% Medicare, 0% Medi-Cal, 2% Private Insurance, 78% Uninsured Napa: 35% Medicare, 0% Medi-Cal, 2% Private Insurance, 64% Uninsured Patton: 14% Medicare, 0% Medi-Cal, .3% Private Insurance, 86% Uninsured
| 5 | General Question | N/A | General Question | Will the Department please consider providing a second opportunity for vendors to suggest modifications to the RFP after the Department releases its response to vendor questions? Depending on the Department’s response, it may be necessary to ask that changes be made, however, vendors will not be able to do so without understanding the Department’s responses to clarification questions. | Yes, See Addendum 1, Document 0. COMPLETE SOL PACKAGE, Table 4.4-1 Key Action Dates, for the due date to submit questions to the Changes made in Addendum 1. |
| 6 | General Question | N/A | General Question | For any embedded solution and third-party components (i.e. encoder/groupers, SureScripts, drug database content, patient education), how would the Department like us to handle pass-thru provisions for these? | The Prime Contractor (awardee) is responsible for the adequacy and performance of all aspects of the solution and for meeting all contractual requirements independent of sourcing. Refer to document 1.1 Statement of Work, section 2.2. Contractor Responsibilities. |
| 7 | Exhibit B1: Cost Workbook | N/A | Cost Worksheet – Tab 7 | Within the Cost Worksheet – Tab 7, will DSH please confirm that unanticipated task budget will not be added to the one-time costs or the ongoing costs for scoring/evaluation purposes? | Unanticipated task (UAT) budget is ten percent (10%) of the One-Time Services cost. This total will be included in the awarded Agreement. The cost worksheet is pre-calculated to include the UAT and shall not to be modified by the bidder. |
| 8 | General Question | N/A | General Question | What is the total number of full-time equivalent employees for the Department of State Hospitals? | As of June 1, 2023, there are 12,808 full-time equivalent employees for the Department of State Hospitals. |
| 9 | General Question | N/A | General Question | Will the department give the approximate highest number of concurrent users working in the planned Continuum-EHR at any given time? | See SOW Section 6.4.9. HARDWARE AND SOFTWARE NEEDS which states, Software licenses are necessary to maximize the efficiency of operations. Users are estimated at eleven thousand (11,000) named users total for all six (6) locations and up to five thousand (5,000) concurrently signed-on users during peak usage periods, and two thousand (2,000) concurrent active users. The system must handle these volumes without performance degradation. |
| 10 | General Question | N/A | General Question | Will the department please provide the total number of providers? (Providers in this instance is defined as any medical professional with prescription or ordering privileges - e.g. physicians, nurse practitioners, and/or physician assistants) | The current total number of medical professionals with prescription or ordering privileges (e.g., physicians, nurse practitioners, and/or physician assistants) is 512. |
| 11 | General Question | N/A | General Question | Can the department confirm the total number of beds within the five listed facilities? | As of 05/01/2023 the total number of beds within the five listed facilities is 6,082. |
12 General Question N/A General Question Can the department please confirm the total number of yearly admissions across all five facilities? The total number of admissions for Fiscal Year 2018/2019 across all five facilities was 4,434.
13 General Question N/A General Question Can the department provide an approximate total of behavioral health licensed professionals who use the DSM-5 content? The approximate total of behavioral health licensed professionals who use the DSM-5 content in DSH is 1,250.
14 General Question N/A General Question Does DSH have centralized billing? If so, approximately how many billers are on staff? No, DSH does not have centralized billing. At each Hospital the Health Information Management Department (HIMD) is responsible for the hospital's billing/coding along with the Patient Cost Recovery Department at Headquarters (PCRS). There are 35 people total. The breakdown of staff is as follows:
DSH-Atascadero:5 DSH-Coalinga: 3 DSH-Metropolitan: 5 DSH-Napa:6 DSH-Patton:6 Patient Cost Recovery Section:10 15 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| Does DSH need a full PACS (picture archiving communication system) system included in the vendor proposals? Typically, clients leverage their current PACS system and the radiology information management system interfaces to the PACS? | DSH currently uses several different PACS solutions throughout our facilities. We are currently in the process of moving all hospitals to one standardized PACS solution, GE ZFP PACs (GE Centricity Universal Viewer Zero Footprint) DSH is interested in either integrating with that PACS solution or implementing a vendor provided PACS per SOW section 2.1.2, document 0. section 2.3, and Exhibit G.,NFR-344. |
16 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| Does DSH want the vendors to include full laboratory information management solution if the vendor has one to offer? If so, can DSH provide an approximate yearly total of general laboratory procedures processed across the five facilities? Can DSH give an estimate of the number of anatomic pathology and the number of microbiology procedures annually? | DSH is requiring bidders to include full laboratory information management solution (LIMS). See document 0.COMPLETE_SOL_PACKAGE, Solicitation Overview, Section 2.3. Proposed New System and FR-558 for additional information. |
The number of labs processed at each facility in 2019:
DSH-Atascadero: 178,236 DSH-Coalinga: 159,088 DSH- Metropolitan: 145,000 DSH-Napa: 55,638 DST-Patton: 92,210 17 Document 1.0 SOLICITATION OVERVIEW 31 4.4 Key Action Dates Regarding Attachment 29, will June 13th also be the date the vendors will hear back regarding the modification submittal? Yes, It is the State's intent to release responses to bidder questions and responses to request for changes at the same time. See Document 1, Section 3.1.1(4) General Information which states, "Bidders submit questions and requests for changes regarding the entire scope of the solicitation during this phase using...The State will issue responses to questions and potential Addenda to the solicitation."
See Response to question #5.
Note: On 07/21/2023, the State released a revised Key Action Dates (KADs) for DSH Continuum-EHR Solicitation #2023-00466. The revised KADs will be incorporated in the Addendum 1.
18 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| Does DSH want embedded Video/Telepsychiatry functions within the EHR? How does DSH intend to utilize Telepsychiatry? | Currently DSH utilizes Cisco Webex DX80s and regular webcams along with desktop or laptop computers as the hardware. Software utilized is MS Teams, Cisco Webex and Zoom for legal hearings. DSH is open to integration as long the vendor can incorporate current hardware and software capabilities. | |
| 19 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| How many DSH providers currently use telepsychiatry functionality? Does DSH have an approximate number of telepsychiatry visits it expects monthly (and/or annually)? Does DSH have an approximate number of providers who would be using telepsychiatry within the new Continuum EHR platform? | DSH currently employs 19 Telepsychiatrists across its various locations. Conservative estimates put the number of televisits at approximately 515 per month. The EHR platform would be utilized by the telepsychiatrists at the hub and coordinators in addition to various staff who are responsible for facilitating telepresence equipment at the patient's location. That would increase the total number of users of the system at approximately 4,300 staff. | |
| 20 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| Does DSH want the vendors to include a radiology management solution if the vendor has one to offer? If so, can DSH estimate the number of radiology procedures annually across the 5 facilities that are done in-house? | DSH does not currently have a standardized Radiology Information Solution (RIS) Solution. DSH is requiring bidders to include a full RIS. See SOW Section 2.1.2. PROPOSED NEW SOLUTION; document 0.COMPLETE_SOL_PACKAGE, section 2.3. Proposed New System and NFR-344 for additional information. | |
| 21 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
Table 1.1-1: Scope of Services
| Software | 16 | Diagram |
| Does DSH want the vendors to include a full RIS (radiology information system) to accommodate for scheduling, documenting, order entry, worklist management, image and result distribution, and analysis? Or is DSH only looking for an interface to a current RIS system? | See response to question #20. | |
| 22 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
| 1.3.5 BIDDER RESPONSIBILITIES FOR COTS DEMONSTRATIONS | 62 | Is CDSH willing to extend the Bidder(s) 4 hours of actual demonstration time for the BIDDER COTS Demonstration? The vendor feel it will be necessary to meet all 3 scenarios along with the functional demonstrations per each role. Would DSH be willing to make this a 6-hour timeframe? | The State has reviewed this request and will extend the BIDDER COTS Demonstrations from 4 hours to 6 hours. The State will make the change in Addendum 1. | |||
| 23 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 82 | “Some tasks not requiring the Contractor's on-site presence may be performed offsite if pre-approved in writing by the State”. Some events Bidder intends to conduct at least partially virtually. Is there an ability to have a full list of pre-approved virtual events agreed upon prior to the project beginning? | The specific tasks that do not require the Contractor's on-site presence is not known at this time and will depend on the circumstances and may be discussed further during phase 3. | ||
| 24 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 88 | In Matrix of Responsibilities, what is the difference between the two Workflow line items, one under configuration, one under Customization? | DSH recognizes that there may be some components of the bidder's proposed solution that require configuration (e.g., DSH specific forms, workflows, pharmacy formulary, order-sets) while others may require customization. The intent of the Matrix is to outline the state's and bidder's responsibilities. | ||
| 25 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 92 | In the Matrix of Responsibilities table, under training, what does "End user and DSH trainer" entail? There are two additional training of users sections, so looking for clarification as to how this differs. | DSH trainers are DSH facility staff who have been trained on the solution alongside DSH Super Users and AST to help instruct co-workers, provide side-by-side support, and drive system adoption. (See SOW table 2.8.7.3-1: for number of staff). End Users are DSH staff End user refers to the DSH users who will be using the EHR system. See SOW section 2.8.6 KNOWLEDGE TRANSFER and section 2.8.7 TRAINING for more information. | ||
| 26 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
| Table 4.1.1-2 Contractor Project Deliverables | 152 | DSH has the first hospital implementation set for 1 year (12 months) after execution date. Will the State be willing to discuss this timeline based on similar implementations in the state/public sector market to ensure for a successful implementation especially for the first hospital? | Per SOW section 4.1.1 Project Deliverables, "All dates are subject to change with written approval from DSH." | |||
| 27 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 156 &157 | Section 2.8.9 for Final System Acceptance is indicated in both D.5 and D.5.5, there are two different timeframes for due dates for the same deliverable. Seeking clarification as to the differences or which is accurate. | SOW section 2.8.9 Final System Acceptance is in reference to implementation at all DSH locations. D.5 and D.5.5 in SOW table 4.1.1-2: Contract Project Deliverables, are in reference to implementation at 1st Hospital site(DSH-Coalinga) and DSH-Sacramento. | ||
| 28 | Document 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 193 | Attachment 4 Certification of Compliance with California Mandates | Will the State provide additional documentation or clarification around the requirements regarding the Unfair Practices Act and Unlawful Practices? | Each of the bulleted items listed in Attachment 4 are hyperlinks to government codes. |
• Business and Professions Code 17000 or http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=17000.&lawCode=BPC
• Government Code 12960-12976 or http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12960.&lawCode=GOV 29 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2
Proof of Concept Scenario 1: Emergency Enhanced Treatment Program ETP
| Evaluation Workbook Phase 2, POC 1: Emergency ETP Referral | 245 | Will the State please clarify if preference is to keep raw psychological data on paper, in a separate location, or scanned within electronic health record and viewable by only Psychology? | |
| On Page 64, Proof of Concept Scenario 1: Emergency Enhanced Treatment Program ETP Referral states, “Due to ethical and legal concerns, raw psychological test data and test items should not be part of the patient’s medical record.” However, within Evaluation Workbook Phase 2, POC 1: Emergency ETP Referral, the item states, “However, the violence risk test items and raw data are not viewable as part of the patient medical record to anyone but Psychology.” | Market research indicates some EHR solutions have the capability to enter raw psychological test data directly into a test instrument in an EHR system and into the patient record. However, those features do not conform to APA ethical guidelines regarding Test Security and Interpretation by Non-Qualified Providers. DSH is requiring bidders to provide a solution that allows Psychologists to fill out and submit a Violence Risk Assessment Summary. See FR-326 for more information. | ||
| 30 | 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 |
| Proof of Concept Scenario 1: Emergency Enhanced Treatment Program ETP | 245 | Can the State please clarify what requirements are included in ETP Certification? | When certifying a patient for the ETP the FNAT Supervisor completes an ETP Certification form in BHAM. This form includes an indicator as to whether or not the patient has been approved by the FNAP to receive treatment on the ETP for 90 days. Additionally, a brief narrative description of the reasons for certification is included. See FR-435 and DSH-9219 ETP Certification in the Bidder's Library for more information. | |
| 31 | 1.0 Solicitation Overview_05_04_2023 | |||
| 2.3 PROPOSED NEW SYSTEM | 12 | Can the State please list all medical services delivered in the referenced medical clinics that are intended to use the Electronic Health Record (EHR) system and corresponding specialties (e.g. podiatry)? Can the state please detail the services provided by its PCPs? | Psychiatry, primary care (general practitioner, physician/surgeon, nurse practitioner, physician assistant, medical residents), podiatry, dentistry, dermatology, ophthalmology/optometry, endocrinology, infectious disease, orthopedics, neurology, endovascular, obstetrics/gynecology (OB/GYN), nephrology, pain medicine, ear/nose/throat (ENT), anesthesiology (ECT), audiology. |
Some of these specialty care services are referred to contracted external providers, and contract specialists may provide service within the facility.
| 32 | Attach22_FitGap_05_4_2023 | |||||
| Functional Tab | FR-556 | The EHR Solution must provide transparent functionality to access, annotate, and view images from external image servers (with full DICOM support), including image PACS Solutions. Does DSH need a full PACS replacement? | DSH currently uses several different PACS solutions throughout our facilities. We are currently underway in a process to move all hospitals to one standardized PACS solution, GE ZFP PACs (GE Centricity Universal Viewer Zero Footprint) DSH is interested in either integrating with that PACS solution or implementing a vendor provided PACS. See NFR-344 for additional information. | |||
| 33 | Attach22_FitGap_05_4_2023 | |||||
| Functional Tab | FR-521 | Can the State please provide clarification on what “backup medications” are? | Patients who refuse their regular dose of oral anti-psychotic medications and who have a court order for involuntary medications may be prescribed a secondary "backup" injectable medication. | |||
| 34 | Attach22_FitGap_05_4_2023 | |||||
| Functional Tab | FR-522 | Can the State please provide clarification on what “backup medications” are? | See Response to question #33. | |||
| 35 | Attach22_FitGap_05_4_2023 | |||||
| Functional Tab | FR-542 | Can the State please provide additional details on the MVR workflows that are currently defined and implemented? | Examples of a medication variance is noted in FR-541. In general, a medication variance is any incident or event that deviates from or neglect in the stages of medication prescribing, dispensing, administration, documentation, and storage. In the current state, the medication variance report (MVR) workflow is triggered when a medication variance is discovered by staff. The incident is reported using a DSH-developed system wherein users document the context and related circumstances to the medication variance. This report is then reviewed in stages by supervisors who in turn adds their analysis in the report. This workflow and is not part the patient's medical record. | |||
| 36 | Attach22_FitGap_05_4_2023 | FR 567 | The Phase 2 Evaluation Workbook confirms that the Patients’ Rights Office is an external entity. Can the State please confirm if it intends to extend access to the Electronic Health Record (EHR) system to the Patients’ Rights Office? If so, can the State please share details on the level of access (e.g. read only, restricted access to information and system tools) it intends to extend to the Patients’ Rights Office and additional information on specific workflows the EHR system should support? | The California Office of Patients' Rights (COPR) is a contracted Business Associate, meaning they may have access to confidential patient information without an ROI/Authorization from the patient, so long as it is for purposes of their scope of work under the contract. As such DSH intends to extend read only access to the Electronic Health Record to COPR team members working at DSH facilities. Please see NFR 043, 044, 046, 064 066, 069 076, 179, 207, 251, and 279 which all address role-based security. |
Please note that he State has removed FR-567 in Addendum 1.
37 Attach22_FitGap_05_4_2023
| Functional RQMTS Tab | FR-261 | Can the State please provide details regarding the Enhanced Observation workflow, including any information the State would expect within the future Electronic Health Record (EHR) system? | DSH staff provide enhanced observation based upon a provider order to patients who are at an increased risk for Danger to Self (DTS), Danger to Others (DTO), Danger from Others (DFO), or for urgent/emergent medical conditions when less restrictive measures have failed or cannot reasonably and safely be utilized given the severity of the circumstances. Enhanced observation includes 1:1’s, 2:1’s, Line of Sight (LOS), and q15 minute checks. Patients on LOS, 1:1, or 2:1 are under direct and continuous observation at all times. Staff observing patients ordered enhanced observation are required to document the patient behavior every 15 minutes. Additional FRs that reference Enhanced Observation include FR- 077, 082, 083, 084, 085, and 251. | ||
| 38 | Attach22_FitGap_05_4_2023 | FR-410 | “The Solution must trigger a task for the Vocational Services staff to send a notification to the referring clinician with the patient's new scheduled job hours once the patient's job schedule is recorded in the MP Scheduler.” |
| Can the State please describe where and how vocational staffing time is managed today? Can the State please clarify what is meant by MP Scheduler? | Vocational staffing time is currently managed differently at each hospital. There is currently no statewide application. Most hospitals use an excel spreadsheet or something similar to track patient job hours. The MP Scheduler refers to EHR scheduling functions or Primary or Principal Patient Scheduler. | ||
| 39 | Attach22_FitGap_05_4_2023 | FR-413A through | |
| FR-413F | “The Solution must provide the functionality to a forensic evaluator to sort the tasks by: |
A. Patient” Can the State please provide additional details pertaining to the tasks it expects Forensic Evaluators to complete in the Electronic Health Record (EHR) system? Forensic Evaluators are expected to complete Forensic Evaluations on assigned patients by assigned due dates.
Forensic Evaluator conduct assessments and evaluations. Based upon these assessments and evaluations a report is completed and filed in the patients medical record. Reports may include: Court Report (on legally defined intervals), Sex Offender Assessments, Violence Risk Assessments. See FR-413A-F for additional information.
40 Attach22_FitGap_05_4_2023 FR-422 The Solution must trigger a task for the FNAT Supervisor to review and accept/reject the ETP referral upon submission of a ETP Referral Form.
| Can the State please provide additional detail regarding how both internal and external referrals are managed today? | DSH only accepts internal referrals to the ETP. These referrals are currently managed by the Forensic Needs Assessment Team (FNAT) Supervisor in the Behavioral Health Assistance Module (BHAM). ETP Referrals may be submitted from any of the 5 DSH Hospitals. The FNAT Supervisor reviews referrals and determines if the patient is appropriate for placement on the ETP. If the patient is appropriate and there is an open bed, the FNAT Supervisor will accept the referral. If the patient is not appropriate for the ETP, the FNAT Supervisor will reject the referral. | ||||
| 41 | Attach22_FitGap_05_4_2023 | FR-425 | Can the State please describe how emergency referrals are managed today? | Emergency ETP Referrals are currently managed in DSH legacy application (BHAM). They are managed the same way routine referrals are managed, with an expedited time frame. | |
| 42 | Attach22_FitGap_05_4_2023 | FR-637, | |||
| FR-638 | Can the State please provide additional detail specifics to the referenced unique identifier that will be assigned to a claim or a bill? What is the unique identifier? How will the unique identifier be used? Is the unique identifier assigned to every claim/bill or a subset of claims/bills as determined by the State? Does the State wish to assign a different unique identifier to each claim/bill or will a single or set of unique identifiers determined by the State be assigned to specific claims/bills based on qualifying criteria? | The State uses a unique identifier number on each claim sent out to Medicare. The State's billing system assigns a specific unique identifier number to each claim generated. This number is used to look up claims when reviewing claims for errors. Unique identifiers are not used for bills or statements sent to patients and only used for claims sent to Medicare or any other insurance carrier. Each claim created, to be sent out to Medicare or any other insurance, has a different unique identifier number. | |||
| 43 | Attach22_FitGap_05_4_2023, Nonfunctional requirements tab | NFR-266, Line 314 | There is an internal note from Prakash Pattnaik at DSH-S that says, "NFR-276 will be deleted." (NFR-266 is regarding MS Outlook notifications.) NFR-276 is a requirement about patching. Is Prakash Pattnaik's note mistakenly on NFR-266 and referring to 276, or is there a typo and it should say 266? Could you please clarify if NFR-276 and/or NFR-266 requirements will be deleted? | The internal note was inadvertently not removed during solicitation development. Please disregard the comment. The comment will be removed in Addendum 1. | |
| 44 | Attachment 31: Bidder COTS Demonstration | NFR-015 | Can the State please describe how and in what systems external radiologists are reading images today? | DSH currently uses several different PACS solutions throughout our facilities. DSH is currently underway in a process to move all hospitals to one standardized PACS solution, GE ZFP PACs (GE Centricity Universal Viewer Zero Footprint). Films are read off-site. | |
| 45 | Attachment 31: Bidder COTS Demonstration | FR-556 | Can the state please clarify if clinicians and PCPs have access to view radiology images currently? If so, in what PACS system? | DSH currently uses several different PACS solutions throughout our facilities. We are currently underway in a process to move all hospitals to one standardized PACS solution, GE ZFP PACs (GE Centricity Universal Viewer Zero Footprint). | |
| 46 | Attachment 31: Bidder COTS Demonstration | ||||
| PHASE 1 - DEMO SCENARIO 1 - MANAGING INTAKE | FR-252 | “Did the system allow lab staff to document lab results in the system?” |
| Can the State please describe which lab system(s) are in use today and how lab results are received? Can the state please confirm if the current LIMS assets will be retained or if it is the State’s intention to replace them as part of this procurement? | DSH is pursuing a single laboratory contract for all facilities. Current third-party laboratories are Quest and Foundation Labs. Laboratory information systems currently being used are Orchard Harvest, MetroLab, and Velocity by LabSoft. Additionally, each facility may send laboratory specimens to local external hospitals for analysis in certain circumstances (i.e., after hours, weekends/holidays, stat). DSH is requiring bidders to include full laboratory information management solution. See Solicitation Overview, Section 2.3. Proposed New System and FR-558 for additional information. | |||
| 47 | Phase 1 Evaluation Workbook, Ph1-Func.Demo Pt 3-Record Mgmt. | NFR-017 | “Did the system allow the demonstrator to show an example of removing 3rd party information on documents given to patients?” |
Can the State please clarify what 3rd party information may need to be removed (e.g. conservator, social worker, vendor, entity)? Would the State please consider providing an example of a scenario? Addresses, names of victims, family members, DOB of others, are examples of third-party information that may be redacted.
An example would be that a patient has requested a copy of a document included in their chart be provided to them. The document requested includes detailed information about the victim of the patient's instant offense which must be redacted prior to providing a printed copy of the document to the patient.
48 Evaluation Workbook Phase 2 - POC Scenario 1: Emergency Enhanced Treatment Program Referral “The Office of Patients' Rights (an external entity) is notified that the patient has been referred to ETP.”
| Can the State please confirm if the Office of Patient’s Rights falls under the Department of State Hospitals (DSH) and will therefore have access to the Electronic Health Record system and will be able to receive communication via a secure message center embedded in the EHR system? | The California Office of Patients' Rights (COPR) is a contracted Business Associate, meaning they may have access to confidential patient information without an ROI/Authorization from the patient, so long as it is for purposes of their scope of work under the contract. As such DSH intends to extend read only access to the Electronic Health Record to COPR team members working at DSH facilities. | ||||||
| 49 | Attachment 24: Draft Implementation Plan | 265 | In our past experiences, a detailed project plan developed in Microsoft (MS) Project that includes a go-live for each of the five hospitals, full testing of the Continuum-EHR, and the tasks, duration, dependencies, and resources to fulfill the services in each project phase, will require 14-16 pages. Understanding that Attachment 24 has an overall 20-page limit, can the MS project plan be excluded from the page count or provided as an appendix to our response? | The State has reviewed the request and will make this change in Addendum 1. | |||
| 50 | Document 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 59 | 1.2.1. Attachment 14: Bidder Qualification Form | Can qualifications and references from the Prime Contractor and a Subcontractor partner who have both served as Prime on other client projects be considered in the Bidder Qualification Form and Bidder Client Reference Form? | No, Document 2.0 SOLICITATION REQUIREMENTS, section 1.2.1 states, "The Bidder must have been the prime contractor (Systems Integrator) for each of the referenced projects." |
See Addendum 1 to ATTACHMENT 13: BIDDER QUALIFICATION FORM INSTRUCTIONS, for further clarifications.
| 51 | Document 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 266 | |
| 26 | Attachment 25: Draft Solution Implementation Schedule |
3.1.2 Phase 1 Response Submittal"
| RFP submission requirements ask for one PDF of submissions. Attachment 24 asks for the Implementation Schedule to be created in Microsoft Project. Please confirm if the Microsoft Project source file should be converted to PDF or if we should submit the Microsoft Project MPP file as well? | In accordance with document 1, section 3.1.2 and section 3.2.2, "All Attachments shall be submitted in one pdf document to the State…" | ||
| 52 | Document 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 25 | |
| 27 | 3.1.1 General Information, |
Item 5 Table 3.1.2-1: Phase 1 Attachments For Phase 1 submission, it asks for Attachments 14, 14.1, 15, 23, 25, “and all other Phase 1 attachments as defined in Section 3.1.2 Phase 1 Response Submittal”. In Section 3.1.2, Table 3.1.2-1, Attachment 31 Bidder COTS Demonstration is on the list.
| Can you please confirm if a narrative of what will be demonstrated if invited to Stage 1B should be submitted in the July 21 Phase 1 RFP response submission? | A narrative is not required to be submitted for the COTS demonstration. However, there are several narratives attachments that are required with phase 1 and phase 2 submittals. See Table 3.1.2.-1: Phase 1 Attachments and Table 3.2.2-1: Phase 2 Attachments for a list of the requirements by phase. | |||||
| 53 | Document 0.COMPLETE_SOL_PACKAGE_DSH_EHR_05_04_2023v2 | 180 | 9.0 Escrow Source Code | Given the industry standards, we assume that escrow and ownership does not pertain to pre-existing products and assets so long as the State receives a license to use. Can CA DSH confirm if this is correct? | Correct, the State would not obtain access to the source code unless one of the events listed in Paragraph 5 occurred. However, for software that is pre-existing, the State would not obtain ownership of the source code but would instead have a license to utilize the source code in connection with the service provided, in accordance with section 30 of the Cloud Computing SaaS GPs. | |
| 54 | Exhibit F and G: Functional and Nonfunctional Requirements | FR-556 | We understand the importance of image access, annotation, readability, and transmission. Will CA DSH need new PACS functionality and/or enhancements? | The State has reviewed this question and determined that FR-556 will be removed in Addendum 1. See NFR-344 for additional requirement information. | ||
| 55 | 94 | 2.2 Contractor Responsibilities, Complete Solicitation Package | Are there CA DSH priorities or plans that would occur during the Continuum-EHR procurement timeline? (e.g., system upgrades, network, facility expansion) | While DSH will always be upgrading systems, network, etc. as a matter of course in standard operations, DSH does not have plans to introduce any new systems or facilities that would materially roadblock the Solution implementation. | ||
| 56 | 1.5 Work Location, Complete Solicitation Package | 82 | Many California projects currently use people outside the United States to perform services such as software development, configuration, enhancements, testing, interface development, and maintenance and operations. These activities are performed without requiring access to production data or PII/PHI. Meaningful price reductions can be achieved by allowing this approach. Would CA DSH consider allowing this type of support to be completed outside the United States? | Cloud hosting services outside of the US are prohibited. Allowing access to protected data (PII/PHI) from outside of the US is prohibited. Any level of support or access from adversarial nations is prohibited. Support that does not meet these definitions is allowable. | ||
| 57 | 6.4.9 Hardware and Software Needs, Attachment 1.1 Statement of Work | 104 | Can the State provide a breakdown of 11,000 users across the six (6) locations based on business functions to enable vendors to appropriately plan for software licenses required across CA DSH’s business functions? | DSH-Atascadero = 1782, DSH-Coalinga = 2109, DSH-Metropolitan = 1733, DSH-Napa = 2179, DSH-Patton = 2392, DSH = Sacramento = 781. Approximately 90% of the hospital users will be point of care, 10% will be administrative/supervisory. At DSH-Sacramento, all users will be administrative. SOW section 6.4.9 has been updated to include this detailed information. | ||
| 58 | 2.1.1 Current Environment, Attachment 1.1 Statement of Work | 17 | Can the State provide an architecture diagram and data flow diagram of the current CA DSH environment which includes applications listed in Section 2.1.1, any other legacy systems, and any interfaces between these applications/systems and the State? | See Bidder's Library documents, Continuum-EHR - 2.5.4.1 DataArchitectureAsIS (rev 3-13-18) and EHR Project Preparedness BCM with EHR Solution Overlay. |
See the following solution requirements for additional information:
FR-062
FR-282
FR-537
FR-554
FR-555
FR-558
FR-803
NFR-037
| x | ||||
| 59 | Attachment 1.1 Statement of Work | 17 | 2.1.1 Current Environment, | Can the State provide a close approximation of integrations which currently exist? In addition, can the State also provide the following to enable vendors to account for adequate integration effort: |
• Integration points expected with the Continuum-EHR (e.g., Interface with each reference lab would be a separate integration point)
| Comprehensive list of other third-party vendors and applications the Continuum-EHR will need to integrate with | See response to question #58. | x | ||||
| 60 | Attachment 1.1 Statement of Work | 105 | 6.5 Compatibility and Interface | Can the State provide a close approximation of the transactions per day in the current CA DSH ecosystems for the following type of transactions? | ||
| • | HL7s (ADTs, DFTs, ORU, ORMs, etc.) | |||||
| • | Claims generated | |||||
| • | Claims errored | |||||
| • | Claims processed successfully | We estimate approximately 30,000 such HL7 transactions per day. We estimate 0.05% error out but do not have a reliable breakdown by status beyond that. | ||||
| 61 | Attachment 24: Draft Implementation Plan, Attachment 25: Draft Solution Implementation Schedule | 265-266 | Attachment 25: Draft Solution Implementation Schedule is to be submitted with Phase 1 and Attachment 24: Draft Implementation Plan is to be submitted with Phase 2. Should Attachment 24 build upon what is developed for Attachment 25, or are these intended to be completely independent documents? | Attachment 25: Draft Solution Implementation Schedule and Attachment 24: Draft Implementation Plan are separate documents that will be evaluated and scored based on their individual requirements and scoring criteria (3.0 Eval Workbk phase 1 and phase 2). Attachment 24: Draft Implementation Plan will follow the completion of the POC which is designed to provide the bidder an opportunity to gather additional information about DSH's specific requirements. Attachment 25: Draft Solution Implementation Schedule, can be (in accordance with the requirement) presented from a higher level than Attachment 24. | ||
| 62 | 16 | Table 1.1-1 | How does CA DSH refer to and delineate patients being served in inpatient and outpatient settings? | DSH is an in-patient hospital system. However, DSH does provide treatment at internal hospital clinics in an outpatient manner. For example, physical therapy, electrocardiogram, and dentistry are all services provided within DSH inpatient hospital setting but in an outpatient manner. | ||
| 63 | 16 | Table 1.1-1, item 7 Manage Patient Financials | What is CA DSH's current approach for doing the encounters related to the patient stays and services in inpatient and outpatient settings? | See response to question #62. | ||
| 64 | Attachment 1.1 Statement of Work | 49 | 2.8.2. Requirements Analysis | Has CA DSH already conducted any Business Process Reengineering (BPR) activities to use the new system effectively? | DSH has completed As-Is and initial To-Be Business Process workflows for all clinical and administrative business areas. Also, DSH has reviewed all hospital clinical forms and gained leadership agreement on standardization of DSH EHR form content for the EHR. DSH also created a committee for reviewing and reconciling any newly created hospital forms to ensure standardization ahead of EHR. DSH expects further BPR will occur after a solution is selected. | |
| 65 | Attachment 1.1 Statement of Work | 17 | 2.1.1 Current Environment, | Does CA DSH use any reporting tool for meeting the state and federal reporting requirements? Can CA DSH provide a list of existing reports available via the ADT, BHAM, WaRMSS applications? In addition, can CA DSH also provide the list of anticipated reports within the Continuum EHR? | DSH does not employ a specific reporting tool for meeting state and federal reporting requirements. A list of reports currently in use is located in the Bidder's Library in the folder "Continuum-EHR Forms". | |
| 66 | Document 1.0 SOLICITATION OVERVIEW | 16 | 1.0 Overview | |||
| 3.1.2 Phase 1 Response | The Phase 1, nor Phase 2 submittal does not list a place for bidders to include an Executive Summary? Where would DSH prefer bidders to include this in responses? | An executive summary is not a solicitation requirement. The State prefers Bidders NOT include an Executive Summary with its response to Phase 1 and Phase 2. Bidders must complete and submit Attachment 1 and Attachment 18 in lieu of an executive summary. | ||||
| 67 | Document 1.0 SOLICITATION OVERVIEW | 31 | 1.0 Overview – | |||
| 4.4 Key Action Dates | We respectfully ask that at least a second round of Questions and Request for Changes be added. This is a large, complex solicitation with multitudes of documents, including a Bidders Library that many vendors may have just gotten access to. Additional questions and change request periods will help both bidders as well as ensuring that DSH receives more complete responses from the bidder community. | See response to question #5. | ||||
| 68 | Bidders Library | |||||
| To-Be Clinical | Continuum EHR Funding Timeline | This document opens as, “28.2 Forensics Clinical Involuntary Medication (High Level) To Be Workflow”. Is this correct? | No, DSH does not have a document labeled "Continuum EHR Funding Timeline" in the Bidders' Library. It is unclear what the bidder is referencing. | |||
| 69 | Attachments 05_04-2023 | |||||
| 45 | 2.0 Background | Regarding skilled nursing: When a patient is transferred to a SNF, will they still be involved in all the activities of their treatment pathways (NGRI, IST, etc.) or are these treatments paused until they are released from the SNF? | Under Title 22, Division 5., Chapter 3. Skilled Nursing Facilities Article 3. Each patient is encouraged to participate at the level they can to encourage self-care and resumption of normal activities and promote quality of life. | |||
| 70 | Attachments 05_04-2023 | |||||
| 22 | Attachment 12: RFP Checklist | In both Phase 1 and Phase 2 there doesn’t appear to be a place in the response requests for Bidders to provide additional documentation, attachments or their standard contract agreements to be used in a potential negotiation. | The State is not requesting additional attachments or documents for phase 1 nor phase 2 that are outside of the requirements listed in Document 0. COMPLETE SOL PACKAGE, section 3, Table 3.1.2.1 and Table 3.2.2-1. |
See Section 3.3 SOLICITATION PHASE 3, for the negotiation process. Once the State moves into negotiations, there will be opportunity for limited discussions.
Document 0. COMPLETE SOL PACKAGE, section 4.6 EVALUATION OF REQUIERED INFORMATION AND REQUIREMENTS states, "A response may be rejected if it is conditional or incomplete, contradicts the requirements, contains any alterations of form, or contains other irregularities of any kind, including alterations to any terms and conditions.
Responses will be rejected if any such defect or irregularity constitutes a material deviation from the Solicitation requirements."
| 71 | Attachments 05_04-2023 | ||
| Attachment 17 | 65 | Since raw psychological test data and items cannot be part of a patient’s medical record, where does DSH anticipate violence risk assessment tests (such as HCR-20) be completed by the FNAT psychologist? |
| Or does DSH just want to ensure that the information is stored so access to the data is restricted to only Psychology and other qualified users/groups and/or limiting the release the data. | See response to question #29. | |||||
| 72 | 3.0 Evaluation Workbook Phase 1 | N/A | Attach 25 Solution Implementation Tab | There is no evaluation criteria description for bidders with specifics on what constitutes an Excellent evaluation and receive 100% of the points on this tab. Was this an oversight by DSH? | Document 3 EVAL Workbk_Phase 1 and Document 3 EVAL Workbk_Phase 2 contain tables, "Table A-Evaluation Criteria" in the worksheet labeled "Evaluation Process". These tables outline the Evaluation criteria, ratings and % Max points available. | |
| 73 | 3.0 Evaluation Workbook Phase 1 | N/A | Multiple Tabs | The evaluation criteria lists 100%, 70%, 50%, 10% and 0% as point levels. Will evaluators only have these 5 percentages to score bidders on, or are they allowed to provide scores that fall between these percentages? | The evaluation team will score narrative responses based on the five (5) set percentages associated with the evaluation criteria and Ratings listed in Table A of Document 3 EVAL Workbk_Phase 1 and Document 3 EVAL Workbk_Phase 2, worksheet "Evaluation Process". | |
| 74 | 3.0 Evaluation Workbook Phase 1 | N/A | Phase 1 Demo -Scenario 2 Tab, line item # 7 | After triage, is the patient then scheduled to a time slot, or is the expectation that a unit is notified and acts at its first available? | Timeframes in which patient will be seen by a provider (Physician Follow-up Appointment) based upon RN triage assessment are as follows: Non-Urgent 24 hours, Urgent 2 hours, Emergent immediately, Routine next available time for this specific scenario triage is "routine" and the provider will see the patient the same day. See FR-396A for additional information. | |
| 75 | 3.0 Evaluation Workbook Phase 1 | |||||
| Phase 1 Demo | N/A | Scenario 2 Change and Condition Tab, item # 1.09 | Is the 7 day follow up dictated by policy or by physician order after care? | The 7 day follow up is dictated by policy. | ||
| 76 | 3.0 Evaluation Workbook Phase 1 | |||||
| Phase 1 Demo | N/A | Scenario 3 Records Management Tab, line # 1.02 | Is this an established portal that Bidder would need to interface with? Or is this an outside partner that has access to a direct secure messaging inbox? |
| Does the State prefer the eventual final To-Be workflow, portal or HIPAA standard secure inbox/HIE workflow? | No, this is not an established portal. DSH is looking for a best solution to share documentation securely within HIPPA compliance with external partners, per NFR-015. | |||
| 77 | 3.0 Evaluation Workbook Phase 1 | |||
| Phase 1 Demo | N/A | Scenario 3 Records Management Tab, line # 1.05 | What is DSH’s current process for redacting third-party documentation on given to patients? | HIMD staff manually reviews sections of records, redact 3rd party information based upon DSH-S Privacy Team, and then release the redacted versions to the patients. |
| 78 | 3.0 Evaluation Workbook Phase 1 | |||
| Phase 1 Demo | N/A | Scenario 3 Records Management Tab, line item # 1.07 | Is DSH referring to access to a patient record by someone who does not have cause? Or is this referring to a report for breach attempts at the system security level? | DSH is referring to any security incident in which unauthorized person(s) gain access to the EHR system and/or its data. |
| 79 | Attachment 22- | |||
| Functional Requests | N/A | FR-030 | Can you please provide examples of tasks referred to in this requirement? | The State has reviewed this question and determined that FR-030 will be removed in Addendum 1. |
| 80 | Attachment 22- | |||
| Functional Requests | N/A | FR-036 | Who is/are the authorized user(s) for this requirement? Med student, dieticians, etc.? | The State has reviewed this question and determined that FR-036 will be removed in Addendum 1. |
| 81 | Attachment 22- | |||
| Functional Requests | N/A | FR-160 | Who are the appropriate users that need to be notified? Anyone who can access the chart? Or based on assignment? | The State has reviewed this request and determined that FR-160 will be updated in Addendum 1 to state that DSH Public Health Department Staff are the appropriate users to be notified. |
| 82 | Attachment 22- | |||
| Functional Requests | N/A | FR-165 | Who are the appropriate users that need to be alerted? | The State has reviewed this question and determined that FR-165 will be removed in Addendum 1. |
| 83 | Attachment 22- | |||
| Functional Requests | N/A | FR-206 | What are the parameters that would trigger an alert to the care plan? |
| Do these alerts also need to go to the care team managing the patient? | The State has reviewed this question and determined that FR-206 will be removed in Addendum 1. | |||
| 84 | Attachment 22- | |||
| Functional Requests | N/A | FR-280 | Can we please get additional information on the refusals that you would like to track (e.g., refusal to go to group, take medication, brush their teeth, etc.)? | Refusals to be tracked would include Medications, Physician Ordered Treatment, Physician ordered diagnostics (i.e., lab draws, radiology), Scheduled medical and dental appointments, Nursing Assessments. See FR- 273A-F. Also see FR274 A-E, FR 275, 276, 277, 278, FR 279A-G, FR 280- 282. |
| 85 | Attachment 22- |
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