Attachment_2_-_IDIQ_SOO_-_Appendix_A_-_Amendment_1_0001.xlsx
XLSX spreadsheet 36 KB Posted
- Attached to
- RFP for Indian Health Service HIT Modernization Federal contract opportunity
- Solicitation number
- 140D0421R0050
About this file
This document includes an attachment and solicitation related to the Indian Health Service Health Information Technology modernization effort. The attachment provides an overview of clinical and business processes supported at IHS, Tribal, and Urban Indian healthcare facilities for illustration purposes. The solicitation is Request for Proposals number 140D0421R0050 issued by the Department of the Interior on behalf of the Department of Health and Human Services Indian Health Service. It seeks an Electronic Health Records provider or integrator to establish a single-award Indefinite Delivery, Indefinite Quantity contract to modernize IHS's Health Information Technology. Responses are due by September 1, 2022 at 5:00pm ET. The award will be conducted using FAR 15.3 procedures and supplemented with additional information. The purpose is to solicit proposals to support the clinical and business processes described in the attachment at IHS, Tribal, and Urban Indian facilities.
View the file
Other files for this federal contract opportunity
Show all 35
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Appendix A-Business Processes
| APPENDIX A - CLINICAL AND BUSINESS PROCESSES / Amendment 1 |
| This is a broad, but not necessarily comprehensive, sampling of clinical and administrative business processes that occur at IHS, Tribal, and Urban Indian healthcare facilities. They are provided to illustrate the breadth of processes that will need to be supported by the modernized HIT solutions. Not all processes occur at all facilities; some facilities may have HIT-dependent processes not included in this table. |
Some descriptions include references to system functions; these are not intended as functional requirements but as illustrations of how solutions may support the business process. Vendors may offer alternative approaches to support the described process.
Business Process Description Timing*
Practice and Revenue Cycle Management
| Practice and revenue cycle management processes in IHS mirror those of the private sector, so it is expected that any commercial solution will natively support these processes and be able to demonstrate them if requested prior to award, except where indicated. Several notable differences from typical private sector practice include: (a) IHS does not charge patients directly for services (some Tribal/Urban sites may have sliding scale fees or charge co-pays for non-beneficiaries); (b) reimbursement for many services, particularly by Medicare and Medicaid, is based on an all-inclusive rate rather than itemized billing (see https://www.ihs.gov/businessoffice/reimbursement-rates/); (c) front/back office operations in IHS support multi-disciplinary practices including dental and behavioral health; (d) outpatient pharmacy billing processes are within scope; as are (e) Purchased/Referred Care processes that are analogous to those employed by self-insured organizations, and are based on eligibility criteria that differ from eligibility for direct services (https://www.ihs.gov/PRC/). | ||
| Patient Registration | Processes for verifying identity, contact information, address, tribal affiliation, third party insurance coverage, and multiple other data points for all new and returning patients. Includes gender identity and preferred names/pronouns. | 1 |
| Scheduling | Processes supporting scheduling patient appointments at preferred facility for all services, e.g. primary care, optometry, behavioral health, dental, etc. Notifications of upcoming appointments or changes in availability, outreach for missed appointments. Integration with patient portal. Ability for providers/support staff to access/manage schedule. | 1 |
| Health Information Management | Providing and enforcing overall medical records and documentation policy, maintaining paper and electronic records, document scanning and incorporation, release of information, HIPAA compliance. | 1 |
| Document sending, receiving, reviewing, sharing, storing | Processes for scanning paper and importing electronic documents; associating with correct patient record; notification to, review, and acknowledgement by providers/care teams. Processes for sharing documents electronically, via secure email, portals, other, with referral network, patients, others as authorized by patient. | 1 |
| Informed Consent | Documentation of informed consent provided by patients, parents, or other proxies for medications, treatments and procedures. Electronic signature capture as appropriate. | 1 |
| Coding | Assignment, review and validation of codes and terminologies, i.e., ICD, CPT, HCPCS, SNOMED CT, others as appropriate, to hospital and clinic encounter documentation, for billing/revenue cycle, quality reporting, and statistical/analytics purposes. Iterative updates of any changes and updates to the endorsed terminology and messaging standards. | 1 |
| Revenue Cycle - Billing/AR | Creating and submitting claims for reimbursement, posting payments, correcting and resubmitting rejected claims, and working aged claims. Many claims are reimbursed according to the Office of Management and Budget (OMB) All-Inclusive Rates (AIR). | 1 |
| Purchased/Referred Care | All processes relating to external referrals for care, including verifying eligibility for services, prioritization of referrals, identifying primary payers, scheduling, sending and retrieving referral documentation, and completing approved payment to consultant. Comparable to processes employed by self-insured organizations to prioritize and pay for referred care services. | 2 |
| Pharmacy Point of Sale Billing | Process for verifying coverage for prescription orders with third-party pharmacy benefit payers, consulting with providers regarding formulary issues as necessary, and charging/receiving payments from payers. Monitoring, reviewing, processing rejections. Payer denials may be overridden if clinically indicated; patients are typically not charged directly. | 1 |
Direct Patient Care Processes
| The patient care processes described herein mirror those of the private sector, so it is expected that any commercial solution will natively support these processes and be able to demonstrate them if requested prior to award except where indicated. Notable differences from typical private sector practice include the fact that IHS offers multi-disciplinary services in an integrated care model, often including behavioral health, dental, eye care, and others. The traditional healer role is somewhat analogous to that of clergy in other settings, with limited but configurable access to the EHR for receipt of referrals and documenting services. | ||
| Primary Ambulatory Care | Ambulatory care services provided by licensed providers (MD, DO, NP, PA, OD, other) in multiple specialties (family medicine, internal medicine, pediatrics, OB/GYN, psychology/psychiatry, podiatry, general/orthopedic/podiatric surgery, cardiology, nephrology, endocrinology, others). | 1 |
| Screening/Primary Prevention | Processes relating to identifying individuals and reminding providers about those appropriate for screening/primary prevention, administering or referring for said screening, following up and notifying of results, determining and tracking next steps. | 1 |
| Immunization | Processes related to determining immunizations that are due (all ages) based on local data and that derived from State or other immunization information systems (IIS), administering and documenting immunizations and patient/family education. De-duplication of immunizations for a given patient derived from various data sources and information exchanges. Bi-directional exchange with appropriate State(s) IIS and/or IHS central IIS in accordance with reporting requirements. | 1 |
| Child Health | Ambulatory services for individuals newborn through age 18, including birth, nutrition, growth and development, anticipatory guidance for parents/caregivers, patient education, oral health, and immunization (see also Immunization). | 1 |
| Prenatal Care | All activities associated with providing and documenting care for female patients throughout their pregnancies and in postpartum visits. Includes longitudinal views of pregnancy progress, milestones, screening. | 1 |
| Ambulatory Documentation | Creation of organized, accessible, and policy-compliant documentation of ambulatory services, including minor office procedures. Support for configurable templates, free text, and dictation/voice recognition. | 1 |
| Group Note Documentation | Support for documentation of services provided in group settings, including both group documentation and notes specific to individual patients. Examples include behavioral health group therapy, diabetes education, nutrition, prenatal, vaccine clinics, etc. | 1 |
| Clinical Decision Support | Automated, patient- and context-specific information to assist with clinical decision-making, including such things as differential diagnosis, test, medication or treatment selection. Includes protocol driven reminders for screening, follow up due, etc. | 1 |
| Medication Management (Provider) | Reviewing current and past medication treatment regimens, reconciling medication lists derived from various sources including HIE, assessing and selecting new treatments, ordering and renewing prescriptions, reviewing and addressing order checks/warnings/decision support, monitoring results of treatment. Processes utilized by all licensed prescribing providers including dentists, and other team members as appropriate (e.g. reconciliation). Includes electronic prescribing as well as electronic prescribing of controlled substances (EPCS) to the internal facility pharmacy or to community pharmacies of the patient's choice, in accordance with state requirements as appropriate. | 1 |
| PDMP Queries | Integration of State Prescription Drug Monitoring Program queries into clinical workflows of clinicians and other authorized staff including nurses, dentists, pharmacists, and documentation of findings/results. | 1 |
| PDMP Reporting | Controlled substance prescription reporting to States in accordance with regulatory requirements. | 1 |
| Outpatient Pharmacy Services | All processes relating to outpatient pharmacy operations. Receiving, processing, filling, dispensing, refilling/renewing medication prescription orders created in the EHR for patients. Receiving and processing of medication prescription orders from external providers via e-prescribing (including EPCS). Hard-copy, telephone, and faxed prescriptions are typically accepted as well. IHS pharmacists are core members of patient care teams and utilize their access to the entire record to support patient counseling and consultation with medical providers as needed. Pharmacy inventory management. Use of pharmacy robotic devices is common in IHS facilities. | 1 |
| Pharmacist-Managed Clinics | Pharmacist-managed clinics serving patients with chronic conditions in ambulatory settings, for such things as anticoagulation, cardiovascular conditions (lipids, hypertension, etc.), Hepatitis C, HIV, etc. | 1 |
| Infusion Therapy | Processes related to receiving, fulfilling, and documenting IV medication orders associated with short or long term IV infusion therapy in an outpatient/ambulatory setting. Includes bar code scanning or equivalent to support "six rights" - right patient, right drug, right dose, right route, right time, right documentation. | 1 |
| Patient Education | Processes supporting provision of appropriate condition-specific educational counseling and materials to patients and documentation of their understanding. | 1 |
| Team-Based Care | Processes facilitating multidisciplinary teams to individually and collectively contribute to holistic patient care. Support for Patient-Centered Medical Home model best practices. | 1 |
| Care Planning and Management | All processes relating to documentation and communication of care plans within care teams, regular reassessment and updating of care planning as appropriate. Includes healthcare team members that provide community based care. | 1 |
| Behavioral Health | Evaluation and treatment services related to behavioral health and serious mental illness in an integrated care setting. Compliance with privacy regulations concerning substance abuse treatment, including 42 CFR Part 2. See also Residential Treatment Center processes below. | 1 |
| Consult Management | Creation, ordering and tracking of consultations requested by providers or members of the healthcare team for a within-system service. Creation of consultant notes as appropriate. Notification to the referring provider of status of consult, results, and follow-up needed. See Purchased/Referred care for external referral processes. | 1 |
| Urgent Care | Provision of ambulatory care services on an urgent (unscheduled) basis, in hospital or clinic settings. | 1 |
| Emergency Department | All services offered in a licensed Emergency Department setting from presentation, triage, care to disposition / discharge / transfer /admission. Some facilities in IHS with Emergency Departments do not have inpatient services. | 1 |
| Imaging Services | All processes relating to obtaining, securely storing and digitally transmiting electronic images and clinically-relevant reports obtaining and storing radiographic, ultrasound, magnetic resonance, dental, and other DICOM-compliant clinical images; facilitates healthcare team members and provider access to images and their interpretive reports. Ability to store non-DICOM images as well, e.g. wound care tracking. Most facilities use external radiology reading services, sending digital images and receiving reports into the patient record, with ordering provider notification and acknowledgement. | 1 |
| Laboratory Services | Receiving and accessioning lab orders, resulting tests locally and/or transmitting orders to and receiving results from reference labs, reporting results to ordering providers. Includes microbiology, cytology, and surgical pathology result reporting. Includes support for documentation/resulting of point-of-care testing administered by nursing or other staff in clinic, ED, in the field, etc. Laboratory services vary greatly among I/T/U facilities, including various accreditations (COLA, CLIA, CAP, TJC), CLIA-waived labs, and sites offering point-of-care tests only. Virtually all have relationships with reference laboratories. | 1 |
| Nutrition / Dietetics | Processes associated with assessing nutritional needs of patients (inpatient/ambulatory), providing nutrition education in 1:1 or group settings, providing and documenting nutrition consultation, directing hospital dietetics staff in customizing dietary offerings for hospitalized patients. | 1 |
| Physical Therapy and Rehab Services | Physical, occupational, speech and other therapy/rehabilitation services and associated documentation, including wound care. | 1 |
| Optometry/Eye Care | Care provided by opticians, optometrists, ophthalmologists. Diagnosis and treatment of refractive errors, prescribing, fitting and dispensing spectacles and contact lenses. Assessment and treatment of common optometric and ophthalmic conditions including diabetic retinopathy, glaucoma. | 1 |
| Dental/Oral Health | Oral health is a core component of the integrated healthcare services provided by the IHS. While dental staff use the Henry Schein Dentrix product (currently at v8.0.9), appropriate bi-directional interfacing supports sharing of key data ranging from registration to billing, and including clinical factors such as problems, allergies, medications, order entry, coding (e.g. CDT), consult requests and responses. | 2 |
| Traditional Medicine | Referrals to and services provided by traditional healers in the patient's community. | 2 |
Hospital-Based Processes
| The hospital-based processes described herein mirror those of the private sector, so it is expected that any commercial solution will natively support these processes and be able to demonstrate them if requested prior to award. IHS and Tribal hospitals tend to be small, and several are Critical Access Hospitals. Others provide a broader range of services including surgery, labor and delivery, and intensive care. | ||
| Admit / Discharge / Transfer | Processes associated with admission of patients to Emergency Departments or hospital wards, transfers between units, transfer or discharges to other facilities or home, and all related order tracking, bed management, and notifications. | 1 |
| Hospital Medication Administration | Processes relating to the safe administration of medications by any route in the hospital setting (Emergency Department, Observation, Labor and Delivery, Inpatient). Includes bar code scanning or equivalent to support "six rights" - right patient, right drug, right dose, right route, right time, right documentation. | 1 |
| Hospital Pharmacy | Processes related to receiving and fulfilling unit of use and IV medication orders intended for administration directly to patients within facility in hospital and ambulatory settings. Addresses regulatory requirements for sterile and non-sterile medication compounding records. | 1 |
| Labor and Delivery | Processes associated with maternal-fetal monitoring and assessment, documentation of all services relating to pregnancy at the time of labor and delivery including caesarian section. | 1 |
| Blood Bank Services | Activities relating to ordering, matching, delivering, and administering blood and blood products to patients. Includes OB blood type and Rh screening. | 1 |
| Anesthesia | Preoperative, intraoperative, and postoperative documentation and monitoring of patients undergoing anesthesia. Includes obstetrical anesthesia such as epidurals; includes traditional anesthesia record-keeping functions. | 1 |
| Surgery | Managing and scheduling Operating Room availability, supplies/equipment required for operative procedures, and documentation of surgical services performed. | 1 |
| Hospital Nursing and Related Documentation | Documentation of inpatient nursing, respiratory therapy, and other acute care services including flowcharts or equivalents for vital signs and measurements, input/output, patient acuity assessments, observations, shift notes and handoffs. | 1 |
| Hospital Provider Documentation | Documentation of admission history/physical, progress notes, transfer notes, discharge summaries, and medication reconciliation at admission and discharge or transfer. | 1 |
| OB Triage | Services related to systematic maternal and fetal assessment performed when a pregnant woman presents for care, to determine priority for full evaluation. | 1 |
| Day Surgery | Processes related to surgical procedures offered on an ambulatory basis, not preceded by or typically resulting in hospital admission. | 1 |
| Post-partum / Newborn Care | Specialty care provided to mothers and their newborns in the immediate postpartum period. | 1 |
| Residential Treatment Center Processes | ||
| RTC Processes | IHS and Tribal Residential Treatment Centers (RTC) provide extended (weeks to months) treatment services in a residential setting for youth or adults. Examples of processes requiring support by HIT include individual and group encounter documentation, electronic prescribing, electronic medication administration record, treatment planning, case management, DSM-5 coding, interim billing for extended stays, temporary absence without discharge (therapeutic leave/home pass). Interoperability with residents' home healthcare facility is essential to their continuity of care. | 2 |
Community Health
| IHS and Tribal facilities are closely tied to the communities they serve, and the staff and events described below serve critical roles in extending the reach of the care team. Often the community-based providers are employed by a separate organization than the clinic or hospital (e.g. Tribal health program staff and a Federal Service Unit), but they care for the same population and the ability to communicate and have appropriate role-based access to information across organizational lines is essential. | ||
| Community Health Representatives | CHRs are typically tribal employees, non-professional community members who serve to extend the healthcare team into the community. Activities in support of the patient and care team may include such things as transportation to appointments, medication delivery, post-hospitalization checks, etc. CHRs may act upon requests from clinicians or case managers and report back on findings or status. | 3 |
| Community Health Aide Program | Community Health Aides are are non-LIP extenders of the healthcare team, who receive training in specific healthcare domains such as Behavioral Health, dental, and primary care. They offer protocol-driven assessments and care for members of the community, under the remote supervision of licensed providers. | 3 |
| Community-Based Health Services (PHN) | Healthcare services offered by Public Health Nurses (PHN) including 1:1 home visits and group encounters such as immunization clinics. Includes a broad number of activities in the clinic as well as the community, including schools. PHNs operate in IHS much as they do in other sectors, except that they are closely integrated with primary and/or hospital-based care teams. | 2 |
| Other Community-Based Services | Health-related informational/educational events, immunization drives, etc. at schools, chapter houses, rodeos, and other tribal programs. Examples include WIC and Head Start services. | 2 |
| Ambulance / Emergency Medical Services | Emergency Medical Services (EMS), typically operated by tribes in very rural areas. Not presently supported by HIT but solutions to support EMS-Hospital communications and data sharing are of interest. | 3 |
| Population and Public Health |
| The IHS mission is population-focused, and the processes described herein, utilized by all levels of the organization from the provider and care team and above, provide the visibility needed to improve care and outcomes at the population and public health levels. They are central to how IHS, Tribal, and Urban organizations operate. | ||
| Personal Health Record | Support for patients and proxies to enroll to use a Personal Health Record portal, securely access their health information, view/download/transmit this information in accordance with published standards, view and request appointments, submit medication refill requests, communicate with care team. | 1 |
| Population Health | Processes devoted to assessing health status of or targeting screening or other interventions to specific populations or communities, such as empaneled patients, patients in specific registries, etc. Simplified creation and configuration of cohorts for tracking and interventions. | 1 |
| Public Health | Processes concerning providing services, conducting surveillance, and reporting on issues relating to public health such as immunizations, syndromic surveillance, and communicable disease reporting. Supports alerting providers and ensuring rapid response to outbreaks and clusters including communicable disease and suicide. | 1 |
| Secure Messaging/Communication | Processes that enable providers to engage in secure electronic communications with other providers and/or with patients concerning healthcare issues and including personally identifiable and protected health information (PII/PHI). | 1 |
Data Analytics (Facility-Level)
| In addition to analytical capabilities exercised at the IHS Headquarters level through the National Patient Information Reporting System (NPIRS), I/T/U facilities and IHS Area Offices routinely utilize metrics and analytical tools such as those described below, in addition to a wide array of reports and ad hocqueries that may be initiated at virtually any level of the organization. Asking questions of the data allows clinicians, clinical and administrative leadership, and organizations discover opportunities to improve. | ||
| Analytics | Using data created during healthcare processes to answer questions, study trends, and evaluate performance. Ability for clinicians, managers and administrators to ask questions of the EHR to better understand individual patients and populations. | 1 |
| Hospital Electronic Clinical Quality Measures | Support for calculating and submitting a broad range of certified eCQMs to allow Hospitals and Critical Access Hospitals to successfully participate in CMS Promoting Interoperability programs. | 1 |
| Provider Electronic Clinical Quality Measures | Support for calculating and submitting a broad range of certified eCQMs to allow ambulatory providers to successfully participate in CMS Promoting Interoperability programs. | 1 |
| Other Quality & Performance Measures | IHS employs numerous metrics and measures to evaluate performance and quality of care. These include Uniform Data Set (HRSA BPHC), IHS Improving Patient Care (aka Patient Centered Medical Home), Partnership to Advance Tribal Health (PATH), and others. See table for reference. | 2 |
| Reporting and Compliance | Processes supporting compiling, validating, and submitting required reports to IHS, state, or federal agencies concerning services provided, outcomes, barriers, etc. Supports Office of Civil Rights reporting. | 2 |
Miscellaneous
| Interoperability & Health Information Exchange | Interoperability, among the organizations using the enterprise EHR, between all Tribal/Urban partners using other certified EHRs, and with external referral networks in private and government sectors (e.g. VA/DoD), is a core Objective of IHS HIT modernization. The IHS has stood up the Four Directions Hub (4DH) to facilitate data sharing among IHS and participating Tribal/Urban sites, and to support external exchange through the eHealth Exchange and potentially other connections. Current technology supporting the 4DH includes InterSystems HealthShare, Patient Index, Unified Care Record, and Health Exchange. | 1 |
| Provider Task Management | Creation and scheduling of ad hoc tasks and reminders by and for providers and other end-users. | 2 |
| Medical Device Integration | Connecting, calibrating, testing, tracking and training staff or patients (as appropriate) in the use of medical devices (bedside and other) connected to and sharing timely and reliable data with the health information system. | 2 |
| Provider Credentialing and Privileging | Communication with credentialing/privileging solutions to support role-based access to EHR system functions. | 1 |
| Telemedicine | Integration with IHS-selected clinical video telehealth platform for patient scheduling, provider review of EHR data and documentation. | 2 |
| Employee Health | Ability to share data with a separate employee medical record as authorized by patient and employee health staff. | 2 |
| Inventory Management | Management of inventory, including configurable auto-ordering, for pharmaceuticals and other supplies used and documented in the provision of care. | 2 |
| Joslin Vision Network (JVN) tele-ophthalmology | Receipt and import of findings, diagnoses, and plan of care recommended by remote consultants reviewing retinal images for diabetic patients. | 2 |
| VA Consolidated Mail Outpatient Pharmacy | Bidirectional communication with the VA CMOP system in support of mailed prescriptions/refills to patients. | 2 |
| Dentrix interface | Bi-directional interface with separate Dentrix Electronic Dental Record system as needed to support Dental/Oral Health processes described above. | 2 |
| Pharmacy-related interfaces | Devices in use at many IHS hospitals and clinics to support pharmacy processes include robotics (e.g. ScriptPro, Parata), dispensing cabinets (e.g. Pyxis, Omnicell), controlled substance cabinets (e.g. Pyxis CII Safe, Omnicell Controlled Substance Managers), radiofrequency ID (e.g. GSL bin management), integrated voice response (IVR) and web-based systems for refill requests. Medication refill requests and related communications through patient portal. | 2 |
| Reference laboratory interfaces | Virtually all sites have relationships with regional reference laboratories, with bi-directional interfaces to send accession information and receive results into the medical record, as noted above under Laboratory Services. Some interfaces may not be operational upon award but expected to be operational before go-live. | 2 |
| Standard Code Book compliance | IHS Standard Code Book (www.ihs.gov/scb) includes numerous IHS-specific code sets that the agency relies upon for a variety of operational tracking and reporting purposes. | 2 |
| Medical Speech Recognition | Capability to automatically convert dictated clinical information from voice to text, text to data, and populate data fields with relevant data. | 1 |
*Timing is interpreted as follows: 1 = Capable/demonstrable upon award; 2 = Capable at first Go-Live; 3 = Timing Negotiable
File details come from the government source that posted it. Updated .