Boulder County Public Health (BCPH) Electronic Health Record System with Medicaid Billing

Specifications

Client Portal

• Clients can complete registration for programs through the portal and fill out and sign all relevant documents (immunization registration, screening checklists, HIPAA forms, etc.).

• Client portal allows for electronic signatures on documents.

• Client portal should be offered in English & Spanish.

• Clients must have the ability to cancel and reschedule appointments through the portal. This needs to be configurable by program - some programs may not allow scheduling/rescheduling at all or may have different timing requirements.

• Clients have access to their immunization records and vaccine information sheets on the portal.

• The system has the capability to create, maintain, and verify patient treatment decisions in the form of consents and authorizations when required.

• Ability to firewall off the internal notes so that they are not visible in the portal.

• Ability to have secure two-way messaging between clients and BCPH staff.

Notifications

• Clients receive automated appointment notifications via text or email: appointment confirmation after booking, day-before, and day-of appointment reminders.

Notifications of appointments or upcoming appointments are also visible in their client portal.

• Ability to configure our own client and staff notifications/recalls. Examples: six-month reviews, depression screens, upcoming immunization opportunities/immunizations that are due. The system includes a patient tracking and reminder capability (patient follow-up) updatable by the user at the time an event is set or complied with.

• The system has the capability to create, review, update, or delete patient education materials, including vaccine information sheets. The materials must originate from a credible source and be maintained by the vendor as frequently as necessary.

• The system has the capability of providing printed patient education materials in culturally appropriate languages on demand or automatically at the end of the encounter. At minimum, the materials must be provided in English and Spanish as applicable.

• BCPH staff need to be notified to enter their notes within 24 hours of visit.

• Must have a monthly dashboard or report that highlights how many things were done on time/overdue. This would be focused on staff activities.

• EHR should have real-time recommended vaccine logic based on vaccine schedules in CIIS.

• Must have alerts on records for outstanding updates, vaccines that are due, allergies or contraindications. The system identifies drug interaction warnings (prescription, over the counter) at the point of medication ordering. Interactions include drug to drug, drug to allergy, drug to disease, and drug to pregnancy.

• The system offers prompts to support the adherence to care plans, guidelines, and protocols at the point of information capture.

Clinics

• Ability for staff to create mass clinics/group events and mass sign up clients that attend the event. (Sign-ups would need to be optional - some groups may want numbers rather than individual sign-ups)

Referrals

• The system enables the origination, documentation, and tracking of referrals between care providers or healthcare organizations, including clinical and administrative details of the referral.

Integrations

• Must have bi-directional, real-time integration with Colorado Immunization

Information System (CIIS). Data that must transfer includes immunization information, vaccine inventory, inventory reconciliation & ordering, inventory returns, allergies or contraindications, ability to input patient-provided vaccine information from other states and countries.

• System has existing data sharing agreements with other states to allow sharing of immunization information.

• Integrates with Outlook to put appointments on BCPH staff calendars.

• Integrates with CIIS to pull vaccine inventory, process reconciliations, orders, and returns. Note: Two-way communication between the EHR and CIIS is required.

Inventory

• All locations can access all vaccine inventory.

Billing

• Home visits must have the ability to select multiple billing codes.

• Ability to create and update services, billing codes, and costs for services provided.

• Ability to create an itemized receipt for clients.

• Ability to check to see if client is Medicaid eligible.

• Ability to see Medicaid billing errors, correct them, and re-submit the bills (such as a report that links to the record for easy correction, along with a description of why the record was rejected).

• Ability to add other, third-party insurance coverage and generate bills for that.

• System automatically updates Medicaid billing codes when Medicaid updates them.

• Realtime electronic insurance eligibility/verification and real time claim edits.

• Ability to send one bill (via text and/or email) to client if services not paid in full at time of service.

• Ability to accept credit card, check, or cash payments through the system. If credit card or ACH, either provides payment processing within the system itself or allows an API connection to our county payment processing service.

• Payments can be made by clients through the client portal.

• System tracks client payments and unpaid balances.

Client Management

• Workflow, including inactivation or closure of client records, configurable by record type

• Retention schedules are configurable by record type.

• Intake process needs to be configurable by record type, including intake fields, demographics, and additional forms (including electronic signatures).

• Must have the ability for users to chart their own free-hand/ad-hoc notes.

• Ability for (non-immunization) teams to receive notifications automatically if clients have vaccinations due based on record history.

• The system includes a combination of system default, provider customizable, and provider-defined and reusable templates for data capture.

• System has the ability to make forms read-only and not editable once filled out.

• Configurable scoring for some forms is needed.

• Need to be able to print or send visit notes/care plan/immunization record directly to client through system - text/client portal availability/email.

• Standard comments available for certain record types - usual language related to certain events/appointment types automatically filled in and adjustable to meet needs of that specific visit.

• Voice note dictation for visit notes and/or compatibility with AI notetaker.

• Release of information forms available that allow the client to agree to share certain information across programs.

• The system presents a chronological, filterable, and comprehensive review of patient’s EHR, which may be summarized and printed, subject to privacy and confidentiality requirements.

• The system provides a flexible, user modifiable, search mechanism for retrieval of information captured during encounter documentation.

• The system provides administrative tools for organizations to build care plans, guidelines, and protocols for use during patient care planning and care.

• The system generates and automatically records in the care plan document, patient-specific instructions related to pre- and post-procedural and post-discharge requirements. The instructions must be simple to access and available in English and Spanish.

• Time-tracking for time spent on a given case (including info-only).

• Ability to add a list of upcoming and prior appointments. These could be appointments within one of our programs or with external agencies.

Reporting

• Must have ability to write our own reports, both ad-hoc and custom, either through an on-board reporting tool or (preferred) a SQL database connection.

• Dashboards for managing workload are available within the system.

• Has standard reporting templates out of the box.

• Has a robust data dictionary.

IT Requirements

• Vendor must meet IT & Cybersecurity requirements as outlined in Exhibit C: Data &

Cybersecurity Requirements.

• Must be able to download and own the data.

• Must have an offline mode, so visits can be conducted and recorded in places that do not have internet access

• The system provides privacy and security components that follow national standards such as HIPAA.

• Must integrate with Boulder County's identity management platform, Active

Directory via SAML, so our employees can access the system with their county account, including multi-factor authentication.

• The system will need to generate audit logs of everything done by each employee accessing the system and changes to the system.

• If the system is cloud-based, Boulder County's data must be kept in its own container, separate from the rest of your customers.

• The system will need to be configured so that all data is strongly encrypted in transit and at rest.

• The system integrates with Microsoft Outlook so emails sent out are not marked as impersonating Boulder County.

• Vendor is willing to participate in a security assessment by Rule4.

• Vendor must provide evidence of their security program.

• Must be able to migrate data from an existing software into the new software.

Role Based Security

• Must have the ability to control user rights and access to the different record types.

• Rights can be configured such that other programs can (when appropriate) see client records with other programs but with limited information.

• Ability to edit and read staff notes is configurable by role.

• Ability to define common assessments that can be seen across record types that share them.

Timeline The project will start as soon as the contract is signed, anticipated in January 2027.

The system should be configured with all stakeholders in mind, but implementation will roll out in phases to the following Boulder County Public Health teams:

• Phase One: Immunization Team – Desired March 2027 Go-Live

• Phase Two: Children with Special Needs Team – Desired April or May 2027 Go-Live

• Phase Three: IECMHC & WIC-LC Teams – Desired June 2027 Go-Live

• Phase Four: Genesis & NFP – Desired July 2027 Go-Live

Please provide a schedule that includes the following milestones for each phase above:

1. Detailed Requirements Gathering & Analysis

2. Research & Application Design

3. Development

4. Data Migration (Needed for Phase Four ONLY)

5. Vendor Testing & User Acceptance Testing

6. Production Configuration & Go-Live

7. Transition to Support

Pricing Please provide an all-inclusive price breakdown including:

• Pricing for design, development, testing, training, and implementation, including support, bug fixes, changes, and updates related to the requirements during the initial 1-year period. Include any anticipated travel costs and explanation.

• Pricing for 50 licensed users.

• Pricing for annual support and maintenance for four years post implementation.

• Pricing for elevated tier support post implementation.

• Pricing for configuration changes post implementation.