2021-52 Clarifying Questions Final.pdf

PH: 503-742-5400 WWW.CLACKAMAS.US

REQUEST FOR PROPOSALS #2021-52

Behavioral Health Electronic Record System

RESPONSE TO CLARIFYING QUESTIONS

February 3, 2022

Note that these are questions submitted by interested firms to the above referenced solicitation. The below answers are for clarification purposes only and in no way alter or amend the RFP as published.

*Questions are marked in bold type

RECORDS MANAGEMENT

1. What is the expected timeline for migration of historic data and records? Are all records to be loaded prior to go live or can the conversion be a phased approach?

"Users must have all records migrated upon utilization of new EHR to support continued work. This includes current/open clients as well as the 10-year record retention for previous clients"

What specific data is required to be migrated over into new EHR? How many records? Are there documents to be migrated? What document formats (.pdf, .avi, .jpg, .doc, .rtf etc…) and Total Volume of Documents to be converted/archived? Is there a 3rd Party option or archiving/retention being considered?

Having records loaded by go live would be great, but a phased approach would be considered.

Any records from 1/1/2020 through current, as well as any open/assigned clients regardless of timeline should be migrated to new EHR. All scanned documents are in PDF format in Cerner currently.

All other records will be stored in Cerner Cloud for retention of 10 years.

We are unable to get the total volume of records.

2. The RFP indicates that CCBHD is currently using the Cerner Anasazi EHR system. When was the EHR system implemented? Do you self-host or are you vendor-hosted? Does CCBHD have a preference for a Cloud-based solution for the new EHR system?

Cerner went live in or around 2001. The County’s Cerner system is self-hosted. Going forward, a cloud based solution preferred. No demos have been seen at this time.

SYSTEM

3. Approximately how many documents are in the legacy system?

We are not able to get this information at this time.

4. Contact Types: Contact Type is referenced in multiple requirements throughout Section 3.3.2.

a. Please define Contact Type.

b. Please provide relevant examples of the Contact Types that must be created in the new system; and that should appear in the drop down?

c. Please provide a use case example of how a Contact Type must reference a scheduled visit in the new EHR system.

We use face to face (in person), Virtual (Zoom), Phone, Email, Text, U.S. Post, Fax contact types. These are also known as encounter types, may or may not be related to an appointment.

A phone visit, for example may be a scheduled phone call, or an unscheduled follow up call. We need the encounter to be able to be schedulable with attached documentations, or stand-alone contact for documentation only.

5. Attachments: Users must be able to relate an attachment to a contact type. Please provide a use case example describing how you want users to relate an attachment to a contact type.

We need the capability to scan/upload documents related to an encounter/contact type as it relates to the charting. We also need the capability to have stand-alone media (like insurance prior authorizations) not associated with a specific encounter.

6. Scheduling: Schedules may be triggered by appointments but also self-generated to complete tasks to follow ups. Please explain what “schedules may be triggered by appointments” means. What functionality are you expecting in the new system?

Task Management: The new system may have a task type that mirrors contact type as a measure of productivity and a tool for efficiency. Please provide a use case example and/or explain the functionality you are expecting in the new system.

CCBHD wants a schedule tool that allows for scheduling of appointments as well as blocked time for other tasks (for example, project work, care coordination, or phone calls) without an appointment attached. Would like, if possible, for this blocked time to be trackable for productivity tracking.

7. Printing: The system will be able to easily interact with electronic faxing, both sending and receiving.

Our EHR is a modern, web-based system in which faxes and direct messages can be sent directly from the system by the user. Please explain your expectations specific to receiving faxes and the new EHR system.

We need to be able to receive faxes electronically to be loaded (if applicable) to the client’s medical record. For example, referrals.

8. Automation: Regarding the resources that a user may reference or add to the new EHR system, are these educational resources? Please provide examples.

We do not currently have this capability, but are interested in exploring the capability.

9. The questions below are specific to Section 3.3.2 System Requirements.

Could you provide a brief explanation of the types of ‘forms’ being used by CCBHD? An estimate of how many, are they standardized, and/or are these custom forms developed by CCBHD? What types of common mental health assessment tools are currently being implemented by CCBHD?

Each program uses a unique assessment, document type, progress notes and treatment plans that were developed by CCBHD. There is a desire to standardized forms across several programs, though some forms are program specific. We use some forms and reports to meet regulatory requirements.

We also require the capability to add new forms as needed. Below includes the current number of forms:

• 59 Assessment type forms - not typical assessment forms, but the format required in our current system to run reports

• 28 Documents/attachment types (created both for internal and external to CCBHD)

• 32 Progress Notes

• 2 Treatment Plan

There may be some forms which are currently not in the current EHR, which will need to be created.

The total number of forms is not yet known. A phased approach to getting new forms created is likely.

Likewise, there may need to be edits to forms already existing in the current EHR.

Some examples of common assessment tools include (but not limited to): Columbia Suicide Severity Rating Scale, Safeside framework, PHQ-9 and MDQ (mood disorder questionnaire) HAM-D and GAD-7.

Some examples assessments to meet regulatory requirements include (but are not limited to):

Psychiatric Assessment, Mental Health Assessment, care coordination assessments

10. Forms: Users must see status of progress or completion of forms separate from sign off. Please explain what is meant by “separate from sign off.”

We need for the form to be open to amendments and changes while also capturing the signature with date/time at each edit. We will need forms that either flow from visit to visit pulling the information forward, OR left open outside of the encounter in order to document continued steps.

11. Forms: Users may be able to relate notes, contacts and forms via reference so that within any view you can see that a form was collected during a particular contact and supported by any relevant notes. Please provide an example of a use case.

We are looking for the capability to differentiate different program encounters, as well as filter/sort by program.

DATA/REPORTING

12. Could you clarify: Will the system be used to facilitate client outcomes management?

Yes

13. What database is currently being used for the legacy system?

The exiting data from Cerner will be eventually moved to Cerner cloud. Currently, Cerner holds the data, as well as Marauder.

14. Does Clackamas County have any additional state or local reporting requirements?

Yes. Specific requirements to be define. Reporting currently being done manually with MS Office products.

15. Do you report clinical quality measures such as Merit-Based Incentive Payment System (MIPS), Certified Community Behavioral Health Clinic (CCBHC), National Outcomes Measurement System (NOMS), and/or Healthcare Effectiveness Data and Information Set (HEDIS) reporting now, or possibly plan to in the future?

No, we do not report clinical quality measures. However, some quality measures for internal review would be helpful, but not required.

Which specific measures should be included in the project scope and pricing? N/A

16. Do your project team resources possess SQL knowledge? Are they able to write reports utilizing Microsoft SSRS, Crystal Reports, or Power BI? Do they have .NET development expertise?

Some staff on site has basic SQL knowledge. We will need to continue to explore other options.

17. Please clarify, does CCBHD have its own enterprise data warehouse, or are you requesting bidders to include a data warehouse in their proposed project scope and pricing?

Hosted data warehouse.

a. If you have an existing data warehouse, will the data warehouse be a data source for the new EHR system? N/A

18. Can you explain what is meant by Support for Clinical Data Repository? Is there a need for a separate repository that the system maintains and is required to export data too? If so what is the name of the system or database that is being used?

This is something we would be interested in exploring with the vendor. No database currently being used.

19. What is meant by “Supports varied data formats”?

This is a reference to common file types

20. Are there provisions with the current vendor to provide services to extract the data from the legacy system or is the new vendor responsible for developing processes to extract the data?

New vendor is responsible for developing process to extract data.

BILLING/CODING

21. Could you further define CCBHD’s expectation for using the software for billing and/or integration into currently implemented billing software?

Some claims are currently generated electronically from Cerner. Some claims are generated on paper forms. We would like to move all claims to the EHR electronic filing system. This includes claims to insurance as well as invoices to clients.

We also require denials management with the ability to resubmit claims with added documentation and noting options for tracking.

We would also like to integrate coding functions that run seamlessly into billing like charge capture and sliding scale.

22. How many claims do you produce per month?

We are processing about 150-200 claims per month. Current state is fairly low, but we have expectations that the billing is able to expand with the county.

23. How many billable NPI's do you have? (i.e., billable NPI, not rendering)

We have two billable NPIs

24. What is the number of non-Medicaid claims per month?

We are unable to answer this question.

25. When mentioning invoicing on page 18, can you please expand on that you’re referring to here (i.e., sending invoices to clients for payment, paying contracted providers for services, making payments to vendors on client’s behalf, other, etc.)?

We want to capability to bill insurance and invoice clients for service.

26. Do you provide any services that require E&M coding? If yes, how many users perform these types of services?

We bill with E&M as well as HCPCS. We would like a charge capture function with the ability to add codes and update pricing on fee for service.

We will also need the ability to add a sliding scale for come coded services.

The total number of providers is still to be determined as we are hiring more at this time.

27. Do your users complete 270/271 eligibility checking?

We are not currently doing 270/271 and are not checking eligibility.

b. If you use a clearinghouse, which one? N/A

c. Is it done directly with State Medicaid or via Medicaid MCO entities? N/A

d. How many total sources / interfaces will be required? N/A

28. Do you bill Medicaid and Medicare directly, or does this go through a clearinghouse? If you use a clearinghouse, which one?

We bill directly.

ACCESS/PROVDERS

29. Question: The RFP indicates that CCBHD has 85 employees. How many users (staff, other agency users, contracted providers, etc.) does CCBHD anticipate using the new EHR system? Should pricing be based on 85 named system users?

Initially all 85 will be assumed to have access with the need to grow.

30. Please provide a breakdown, by role, of who these staff are?

We would like to create role base access with defined capabilities and views for each role.

Direct service: look at org chart for total # 62

Admin (Program Support/Billing/HIM): 7

Quality/Compliance: 5

Management: 11

Plus room to grow.

31. Is access via I-Pad required or is Laptop acceptable?

Laptops and IPads both required.

32. Should vendors include a mobile/disconnected solution in the proposed project scope and pricing that staff could use when providing services in the community? For example, providing your users with the ability to document a service note in the field, without internet access, on a mobile device such a smartphone or tablet.

If yes, how many named users will need access to the new EHR system in a disconnected state?

Approximately 20 with room to grow.

33. Question: Is there a need to e-Prescribe medications? If so, what is the number of prescribers?

Yes, there is a need to e-prescribe. There is one prescriber.

34. Question: Please provide the total number of prescribers that need electronic prescribing capabilities. Of these, how many will need to prescribe controlled substances?

There is one prescriber that will need to prescribe controlled substances.

35. Question: How many non-prescribers (i.e., users that prep medications and/or need to have access to order/prescription information)?

Currently not doing this, but would love the capability. Number of users unknown.

36. Question: How many psychiatrists do you have (if applicable)?

None

37. How many primary care doctors do you have (if applicable)?

Not applicable, we are only a Behavioral Health provider, we do not do primary care services

38. How many Healthcare providers do you have at the facility ( MDs, NP, MA )

About 62

39. Does CCBHD’s staff include clinicians and/or providers who provide direct services? Does CCBHD manage contracted, community-based providers who provide resident/client services? Will the contracted providers need access to the new EHR system?

Yes, CCBHD’s staff includes clinicians and/or providers who provide direct services. Also, CCBHD contracts with community based providers who provide resident/client services.

COMMUNIY CONNECT/INTERFACE

40. Do you expect ‘clients’ to be able to access and engage with the system within a client portal?

Yes, we would like to discuss this capability.

41. Do County residents/clients need to be able to create accounts and view/update their information in the new EHR system? We have a patient/client portal to improve access to services and communication that we can include in your project scope and pricing.

Yes, if we move forward with client portal.

42. Do you require a Patient Portal? Please describe your primary vision/objectives for using a Patient Portal?

We do not have a current vision. This is something we would like to discuss.

43. Do you use any Labs? Do you need to share information with labs? If yes, which lab vendors do you work with (i.e., Quest, Lab Corp)?

Yes. We do not have a specific lab that we use, but rather we refer patients to their PCP office, a local hospital outpatient lab or in rare occasions, an online lab.

44. Does CCBHD have a direct interface to any lab providers that will need to be established in the new EHR system? If yes, which lab provider(s)?

No, we do not have a direct interface to any lab providers. It could be helpful to have a direct interface with lap providers. Something we want to discuss further.

45. Do you need to connect to a Health Information Exchange (HIE)? If so, can you provide a list of specific HIEs?

Collective Medicine, Connect Oregon

46. Does CCBHD currently connect to a Health Information Exchange (HIE)? If yes, which HIE?

Yes, Collective Medicine

47. Is there a need to exchange data with community providers/partners (i.e., hospitals, non-profits/private providers)?

Please provide a list of pharmacies, labs, health information exchanges, clearinghouse, or other solution partners that Clackamas County will interchange data with?

Genoa, Collective Medicine, Connect Oregon, PHTECH

We need to continue to discuss this option further.

a. If so, how many community partners/providers will you need to communicate with?

b. If so, will any community partners/providers need to have access to this EHR?

c. If so, do you pay any community partners/providers for services they provide?

48. Can CCBHD provide a list of external systems the new EHR system will need to integrate with, and whether the interface will need to be bi-directional for each system?

We need to discuss this further. Please see answered above.

49. Do you utilize a human resource management system? If yes, would you be interested in a one way interface that can pass demographic and credentials for auto staff setup in the new EHR system? This could be included in project scope and pricing, or detailed below the line as optional.

Not likely an interface, but we need to capability to add providers manually at least. This is something we would be willing to discuss.

50. Do you use Microsoft Outlook for staff calendars?

Yes

a. If yes, should a one way interface from the EHR to Outlook, for appointment blocking free of PHI, be included in the project scope and pricing or detailed below the line as optional?

No

COUNTY SERVICES

51. Does the County provide any direct care services (I.e., county run psychiatric hospitals, outpatient clinics, residential facilities)?

a. If yes, are these services in scope for this project / part of this EHR procurement process?

Yes, the County provides direct care service including outpatient mental health, mobile crisis, forensic and care coordination. These services are in scope for this project.

52. Please provide details on the facilities, programs, and services being provided by CCBHD and that the new EHR system will support?

# Facilities: 4

PSB (Public Services Building) - administration, care coordination, quality management

MHC (Clackamas MHC) - MCRT/BHU, Crisis, A/A, ICP, PRSB

Brooks - BHU

Jail - Discharge services

# Programs: 10 (ICC, Choice, Wrap, MCRT/BHU, Crisis, A/A, ICP, PSRB, QM, Jail Discharge)

Types of services performed: direct mental health services, care coordination, forensic, billing, health information management, and quality management

53. Do you provide any Residential or Inpatient program services? If yes, should associated functionality such as a bed board, white board, and automated per diem billing be included in the proposed project scope and pricing?

Answer: No

54. Do you provide telehealth services? If so, how many telehealth providers do you have?

Do you require a Telehealth solution? Can Clackamas County provide the number of Telehealth users that will need access to the system?

What is the estimated # of telehealth hours provided per month?

We are currently providing telehealth services, and will continue to do so. We are using the Zoom platform. We would consider an integrated platform as long as it meets the needs of services, including the ability to have group/coordinated visits.

There would be approximate 62 users, with the need to grow.

55. Question: Do any users currently use voice dictation technology? If so, what vendor do you currently use? If so, how many users use this technology?

No

56. Question: Can you define more concisely how High-definition session recording will be used? Is this a reference to audio or video recording?

Unsure at this time.

VENDOR EXPECTATIONS

57. Do you have an anticipated go-live date, or a desired implementation timeframe from contract signing to go-live such as 9 months or 12 months?

By 6 months

58. "Vendor must agree to and sign the county BAA" Can the County provide a copy of the BAA?

Yes

59. In the CBH IT, Privacy and Security Requirements Section, are all bullets in this “Must” or are there also “May” items as they are not differentiated as in the other sections

These are musts to comply with privacy regulations and accountability tracking.

60. Section 5, 5.1.4: To ensure that vendors can fully respond to your RFP, is there any flexibility in the 30 pages limit? Can vendors provide relevant examples in an addendum that will not count towards the maximum 30 pages limit?

We believe that 30 pages should be enough to encompass a proposal to make a determination of the product.

61. The numbering on page 16 begins with 5.1, 5.2 then the next number is 5.5 on page18, are there missing requirements or what is the correct numbering?

There are no additional or missing requirements, this was a numbering error.

DEMONSTRATIONS

62. Can you please provide the anticipated timeframe for vendor demonstrations?

The schedule included in the RFP does not indicate a timeline for CCBHD to evaluate and short-list vendors or to conduct software demonstrations. Will you be short-listing vendors and requesting EHR system demonstrations?

a. If yes, do you have an associated timeline? Short-listed vendors should anticipate being notified when? And, demonstrations will occur when?

CCBHD has not seen any demos. Per Section 4.3, Clackamas County will score the proposals and the 3 top scoring vendors will be invited to provide a demonstration. The timeline for the short list is not yet defined. We estimate sometime in March.

BUDGET

63. What are the current operating expenses for CCBHD? More specifically, the Clinical and Information Technology budgets?

CCBHD Operating budget is approximately $30 million annually.

64. What is the budget for this EHR project – both one-time year one costs and annual recurring costs?

We understand that you may not want to disclose your actual budget but we request that you consider disclosing a budget or a budget range for the initial purchase and the annual costs. This will help us, and other vendors, tailor an approach to address your functional and implementation requirements.

We have a $1.2 million budget for the next 5 years.

65. Please confirm that vendors should provide pricing based on a 5 year Contract Term.

Yes, this should include initial purchase and support for the next 5 years

End of Clarifying Questions #1