POST - MDH OCMP-22-18251 ELECTRONIC HEALTH RECORDS EHR RFP .pdf

STATE OF MARYLAND

MARYLAND DEPARTMENT OF HEALTH (MDH)

REQUEST FOR PROPOSALS (RFP)

ELECTRONIC HEALTH RECORDS (EHR)

SOFTWARE AS A SERVICE (SAAS)

RFP NUMBER: OCMP-22-18251

EMMA#BPM030665

ISSUE DATE: JULY 12, 2022

NOTICE

A Prospective Offeror that has received this document from a source other than eMarylandMarketplace

(eMMA) https://procurement.maryland.gov should register on eMMA. See Section 4.2.

MINORITY BUSINESS ENTERPRISES ARE ENCOURAGED TO

RESPOND TO THIS SOLICITATION.

Electronic Health Records (EHR) Software as a Service (SaaS)

Solicitation #: OCMP-22-18251 RFP Document

RFP for Maryland Department of Health Page ii of 146

VENDOR FEEDBACK FORM

To help us improve the quality of State solicitations, and to make our procurement process more responsive and business friendly, please provide comments and suggestions regarding this solicitation.

Please return your comments with your response. If you have chosen not to respond to this solicitation, please email completed form to the attention of the Procurement Officer (see Key Information Summary

Sheet below for contact information).

Title: Electronic Health Records (EHR) Software as a Service (SaaS)

Solicitation No: OCMP-22-18251

1. If you have chosen not to respond to this solicitation, please indicate the reason(s) below:

Other commitments preclude our participation at this time

The subject of the solicitation is not something we ordinarily provide

We are inexperienced in the work/commodities required

Specifications are unclear, too restrictive, etc. (Explain in REMARKS section)

The scope of work is beyond our present capacity

Doing business with the State is simply too complicated. (Explain in REMARKS section)

We cannot be competitive. (Explain in REMARKS section)

Time allotted for completion of the Proposal is insufficient

Start-up time is insufficient

Bonding/Insurance requirements are restrictive (Explain in REMARKS section)

Proposal requirements (other than specifications) are unreasonable or too risky (Explain in

REMARKS section)

MBE or VSBE requirements (Explain in REMARKS section)

Prior State of Maryland contract experience was unprofitable or otherwise unsatisfactory.

(Explain in REMARKS section)

Payment schedule too slow

Other: __________________________________________________________________

2. If you have submitted a response to this solicitation, but wish to offer suggestions or express concerns, please use the REMARKS section below. (Attach additional pages as needed.)

REMARKS:

Vendor Name: ________________________________ Date: _______________________

Contact Person: _________________________________ Phone (____) _____ - _________________

Address: ______________________________________________________________________

E-mail Address: ________________________________________________________________

RFP for Maryland Department of Health Page iii of 146

STATE OF MARYLAND

MARYLAND DEPARTMENT OF HEALTH (MDH)

KEY INFORMATION SUMMARY SHEET

Request for Proposals IT - Electronic Health Records (EHR) Software as a Service (SaaS)

Solicitation Number: OCMP-22-18251

RFP Issue Date: July 12, 2022

RFP Issuing Office: Maryland Department of Health (MDH or the "Department")

Procurement Officer: Jim Beauchamp

Office of Contract Management and Procurement 201 W. Preston Street

Baltimore, MD 21201 e-mail:

Office Phone:

Procurement Officer:

e-mail:

Office Phone:

mdh.solicitationquestions@maryland.gov

410-767-0974

Sherida Studwood

Office of Contract Management and Procurement

201 W. Preston Street

Baltimore, MD 21201 mdh.solicitationquestions@maryland.gov

443-681-8833

Proposals are to be sent to: Offeror must submit proposals via eMMA @ https://procurement.maryland.gov/.

Please note that in order to receive a contract award, a vendor must be registered on eMMA. Registration is free. Go to emma.maryland.gov, click on “New Vendor? Register Now” to begin the process, and then follow the prompts.

Pre-Proposal Conference: July 29, 2022, 11:00 am EST Local Time via Web conference

See Attachment A for instructions.

Questions Due Date and Time September 2, 2022, 2:00 pm EST Local Time

Proposal Due (Closing) Date and Time:

September 9, 2022, 2:00 pm EST Local Time

Offerors are reminded that a completed Feedback Form is requested if a no-bid decision is made (see page iv).

MBE Subcontracting Goal: 0%

VSBE Subcontracting Goal: 0%

Contract Type: Firm Fixed Price with Labor Hours Contract

The Contract that results from this RFP shall be a combination of a

Firm Fixed Price contract as described in COMAR 21.06.03.02.A (1) and Labor Hour Contract as described in COMAR 21.06.03.05.A (1).

Contract Duration: Five (5) year base period with Two (2) – One (1) Year option periods mailto:mdh.solicitationquestions@maryland.gov mailto:mdh.solicitationquestions@maryland.gov https://procurement.maryland.gov/ https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage

RFP for Maryland Department of Health Page iv of 146

Primary Place of

Performance:

Proposed by Offeror

SBR Designation: No

Federal Funding: No

RFP for Maryland Department of Health Page v of 146

TABLE OF CONTENTS – RFP

1 Minimum Qualifications

1.1 Offeror Minimum Qualifications

2 Contractor Requirements: Scope of Work

2.1 Summary Statement

2.2 Background, Purpose and Goals

2.3 Contractor Responsibilities and Tasks

2.4 Contractor-Supplied Hardware, Software, and Materials

2.5 Functional/Business Requirements

2.6 Training

2.7 Required Project Policies, Guidelines and Methodologies

2.8 Deliverables

2.9 Service Level Agreement (SLA)

2.10 EHR On-Demand Future Activities

3 Contractor Requirements: General

3.1 Contract Initiation Requirements

3.2 End of Contract Transition

3.3 Invoicing

3.4 Liquidated Damages

3.5 Disaster Recovery and Data

3.6 Insurance Requirements

3.7 Security Requirements

3.8 Problem Escalation Procedure

3.9 SOC 2 Type 2 Audit Report

3.10 Experience and Personnel

3.11 Substitution of Personnel

3.12 Minority Business Enterprise (MBE) Reports

3.13 Veteran Small Business Enterprise (VSBE) Reports

3.14 Work Orders

3.15 Additional Clauses

4 Procurement Instructions

4.10 Pre-Proposal Conference

4.11 eMaryland Marketplace Advantage (eMMA)

RFP for Maryland Department of Health Page vi of 146

4.12 Questions

4.13 Procurement Method

4.14 Proposal Due (Closing) Date and Time

4.15 Multiple or Alternate Proposals

4.16 Economy of Preparation

4.17 Public Information Act Notice

4.18 Award Basis

4.19 Oral Presentation

4.20 Duration of Proposal

4.21 Revisions to the RFP

4.22 Cancellations

4.23 Incurred Expenses

4.24 Protest/Disputes

4.25 Offeror Responsibilities

4.26 Acceptance of Terms and Conditions

4.27 Proposal Affidavit

4.28 Contract Affidavit

4.29 Compliance with Laws/Arrearages

4.30 Verification of Registration and Tax Payment

4.31 False Statements

4.32 Payments by Electronic Funds Transfer

4.33 Prompt Payment Policy

4.34 Electronic Procurements Authorized

4.35 MBE Participation Goal

4.36 VSBE Goal

4.37 Living Wage Requirements

4.38 Federal Funding Acknowledgement

4.39 Conflict of Interest Affidavit and Disclosure

4.40 Non-Disclosure Agreement

4.41 HIPAA - Business Associate Agreement

4.42 Nonvisual Access

4.43 Mercury and Products That Contain Mercury

4.44 Location of the Performance of Services Disclosure

4.45 Department of Human Services (DHS) Hiring Agreement

4.46 Small Business Reserve (SBR) Procurement

RFP for Maryland Department of Health Page vii of 146

4.47 Maryland Healthy Working Families Act Requirements

5 Proposal Format

5.10 Two Part Submission

5.11 Proposal Delivery and Packaging

5.12 Volume I - Technical Proposal

5.13 Volume II – Financial Proposal

6 Evaluation and Selection Process

6.1 Evaluation Committee

6.2 Technical Proposal Evaluation Criteria

6.3 Financial Proposal Evaluation Criteria

6.4 Reciprocal Preference

6.5 Selection Procedures

6.6 Documents Required upon Notice of Recommendation for Contract Award

7 RFP ATTACHMENTS AND APPENDICES

Attachment A. Pre-Proposal Conference Response Form

Attachment B. Financial Proposal Instructions & Form

Attachment C. Proposal Affidavit

Attachment D. Minority Business Enterprise (MBE) Forms

Attachment E. Veteran-Owned Small Business Enterprise (VSBE) Forms

Attachment F. Maryland Living Wage Affidavit of Agreement for Service Contracts

Attachment G. Federal Funds Attachments

Attachment H. Conflict of Interest Affidavit and Disclosure

Attachment I. Non-Disclosure Agreement (Contractor)

Attachment J. HIPAA Business Associate Agreement

Attachment K. Mercury Affidavit

Attachment L. Location of the Performance of Services Disclosure

Attachment M. Contract

Attachment N. Contract Affidavit

Attachment O. DHS Hiring Agreement

RFP for Maryland Department of Health Page viii of 146

Appendix 1. – Abbreviations and Definitions

Appendix 2. – Offeror Information Sheet

Appendix 3. – Non-Disclosure Agreement (Offeror)

Appendix 4. – Electronic Health Records SaaS – Functional Requirements

Appendix 5. - Labor Categories

Appendix 6. - Labor Classification Personnel Resume Summary

RFP for Maryland Department of Health Page 1 of 146

1 Minimum Qualifications

1.1 Offeror Minimum Qualifications

There are no Offeror Minimum Qualifications for this procurement.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

RFP for Maryland Department of Health Page 2 of 146

2 Contractor Requirements: Scope of Work

2.1 Summary Statement

2.1.1 The Maryland Department of Health (MDH or the "Department") is issuing this Request for

Proposals (RFP) in order to procure a multi-tenant, subscription-based Software as a Service

(SaaS) solution for Electronic Health Records (EHR) and revenue-cycle management for eleven

(11) healthcare facilities operated by MDH. This system is referred to as the new or modern EHR system.

2.1.2 The new EHR system will replace the legacy Hospital Management Information System (HMIS) used for census and billing, as well as a legacy pharmacy system and other clinical systems. The new EHR system will support the Admission/Discharge/Transfer (ADT), billing, collections, pharmacy, laboratory, order entry, clinical documentation, behavioral health, and Long-Term

Care (LTC) functions of the facilities. The new EHR system shall be a cloud based hosted solution running in its own instance in a single database.

2.1.3 An Offeror, either directly or through its subcontractor(s), must be able to provide all goods and services and meet all the requirements requested in this solicitation. The successful Offeror (the

Contractor) shall remain responsible for Contract performance regardless of subcontractor participation in the work.

2.1.4 The State does not wish to procure a software application still under development. The SaaS solution shall have been fully operational within the last five (5) years and preferably have been in full and complete successful production for at least one (1) year in a behavioral healthcare provider organization with no less than 2,500 employees.

2.1.5 It is the State’s intention to obtain goods and services, as specified in this RFP, from a Contract between the selected Offeror and the State.

2.1.6 The Department intends to make a single award as a result of this RFP. See RFP Section 4.18

Award Basis for more Contract award information.

2.1.7 A Contract award does not ensure a Contractor will receive all or any State business under the

Contract.

2.2 Background, Purpose and Goals

2.2.1 MDH Healthcare System

Maryland’s healthcare delivery system consists of public and private hospitals, nursing homes, outpatient clinics, home healthcare services, hospices, providers, and health educators, among others. As a public health department, the goal is to improve the health status of every Maryland resident and to promote access to quality healthcare. MDH is responsible for assisting the mission of regulating healthcare providers, facilities, organizations, and manage direct services to patients, where appropriate.

MDH has four (4) major Departments:

1. Behavioral Health Administration (BHA)

2. Developmental Disabilities Administration (DDA)

3. Public Health Services Administration (PHS)

4. MDH Healthcare System (See Section 2.2.2)

In addition, the Department has twenty (20) boards that license and regulate healthcare professionals, various commissions that issue grants and research, and make recommendations on issues that affect

RFP for Maryland Department of Health Page 3 of 146

Maryland’s healthcare delivery system. MDH depends on a staff of more than 6,500 and a budget of more than $14 billion to provide health-related services to Maryland communities.

A. The Behavioral Health Administration (BHA) promotes recovery, resiliency, health, and wellness for individuals who have emotional, substance use, addictive and/or psychiatric disorders. Most admissions (98%) involve patients involved in the criminal justice system (sometimes referred to as forensic patients). Among the BHA functions are:

1. The Clinical Services Division - ensures that an effective comprehensive system of behavioral health services and support are available and accessible to adults throughout their lifespan in response to the needs of individuals with mental health conditions, substance-related disorders, and the co-occurring of the conditions and disorders. The Clinical Services Division evaluates the network of services that the BHA funds and is responsible for Statewide planning, development, administration and monitoring the comprehensive system of behavior health services of the BHA. The mission of the Clinical Services Division is implemented through the offices of Adult and Specialized Behavioral Health Services, and Quality Assurance, and the

State Opioid Treatment Authority.

2. The Children’s Services Division - develops a system of care for young people and their families ranging from early childhood through adulthood. The system of care is designed to meet the needs of individuals within this age range who have mental health conditions, substance-related disorders, and those who have both.

a. The Office of Court-Ordered Evaluations and Placements (OCEP) oversees services provided for individuals with mental disorders and developmental/intellectual disabilities who are court-involved. OCEP includes the divisions listed below:

i. Centralized Admissions Office (CAO) - Serves as the single point of contact for submission of all court orders that commit defendants to MDH for evaluation or treatment of a mental health or substance use disorder

ii. Adult Pretrial Services - responsible for coordinating mental-competency evaluations ordered by the adult criminal courts of Maryland.

iii. Juvenile Pretrial Services - responsible for providing pre-adjudication evaluations for competency to proceed in Juvenile court. Unlike the adult criminal system, Juvenile

Pretrial Services does not evaluate for criminal responsibility. Juvenile Pretrial Services oversees competency attainment services and the ongoing re-evaluations of juveniles who have been found incompetent to proceed but attainable.

iv. Justice Services-Addictions - charged with monitoring and conducting court ordered evaluations and placing defendants into treatment under court orders.

v. Community Forensic Aftercare Program (CFAP) - responsible for monitoring individuals on signed orders of conditional release in both District and Circuit court in every county in the State of Maryland.

B. MDH oversees the operation of two (2) developmental disability State residential centers, the Holly

Center in Salisbury, and the Potomac Center in Hagerstown. Both State Residential Centers are responsible for the provision of needed services to people who have intellectual disabilities admitted to the facility while working to integrate these people into less restrictive settings in the community.

1. The Court Involved Residence Program (CIRP) is located within the Potomac Center campus provides evaluation and assessment services, as well as active treatment to people with intellectual disabilities and court involvement within a secure and safe environment. In addition, direct case consultation and assistance is provided to both criminal justice and human

RFP for Maryland Department of Health Page 4 of 146 services staff regarding people with intellectual disabilities involved with the criminal justice system.

C. The Public Health Services Administration (PHS) oversees nine (9) major units (or bureaus) and twenty-four (24) local health departments that provide surveillance, prevention, treatment, and regulatory oversight services to all Marylanders. PHS operates two (2) Chronic Care Facilities (CCF), Deer’s Head Center and Western Maryland Center. These facilities provide comprehensive healthcare and rehabilitation services for the clinically complex patient and resident.

1. The Western Maryland Center’s Specialty Hospital Medical Care Unit is a unique program that bridges the gap between hospital and home. Citizens of Maryland with multi-system and specialized healthcare needs are managed by a dedicated, interdisciplinary team of healthcare professionals that assist the patient in reaching their highest level of independence possible. Patients admitted to the hospital unit, who are ventilator dependent, require frequent intervention, rehabilitation, Peritoneal Dialysis, Total Parenteral Nutrition, or special isolation.

Any number of diagnosis and co-morbidities are accepted into the Specialty Hospital including but not limited to: Brain Injury Rancho I – II emerging and requiring ventilator management, Spinal Cord Injury, Multiple Trauma, Multiple systems failure, post Coronary Artery Bypass

Graft or other open heart surgeries requiring extensive re-stabilization and rehabilitation, Stage

III-IV wound management and wound vac, hyperalimentation, and infectious disease management and isolation including negative pressure isolation.

2. MDH is also responsible for overseeing the delivery of the public behavioral health system

(PBHS). Maryland currently provides or funds PBHS in two ways, directly through its State psychiatric hospital system and by funding its managed fee-for-service system, using both State and federal funds. All community behavioral health treatment services are administered through a

Behavioral Health Administrative Services Organization, in partnership between the Behavioral

Health Administration (BHA) and the State’s Medicaid Program.

2.2.2 Maryland Department of Health (MDH) Healthcare System

MDH operates the following eleven (11) facilities listed below. The number of users of the system are approximately 3,100 and subject to change due to changes in staffing levels. In total, MDH operates five (5) psychiatric hospitals, two (2) developmental disability facilities, two (2) long-term care hospitals and two (2) Regional Institute for Children and Adolescent (RICA) facilities. The total average daily census across all facilities is approximately 1,180. The smallest facility population is approximately 32 and the largest is approximately 377.

NOTE: Please note that the numbers listed under each facility are subject to change throughout the solicitation and implementation of the EHR system.

A. Clifton T. Perkins Center – Jessup

The Perkins Center is a maximum-security psychiatric hospital located in Jessup. Some patients stay for short periods, while others may stay for 20 years or more. Perkins has 289 beds. There are 58 clinical providers (doctors, nurse practitioners, licensed social workers, psychiatrists, etc.) at Perkins. With nurses and additional staff, the total number of users is estimated at

394. Perkins has its own pharmacy and will require access to a pharmacy module. Perkins uses an external laboratory, Quest, and will require an orders/results interface.

RFP for Maryland Department of Health Page 5 of 146

B. Springfield Hospital Center - Sykesville

Springfield Hospital has a campus setting with many buildings and is located in

Sykesville. Springfield has 239 beds. There are 24 psychiatrists, 7 somatic physicians, 2 physician assistants, 23 psychologists, 25 social workers, 17 occupational therapists, 1 physical therapist, 163 registered nurses, 88 LPNs, 3 addiction specialists, 3 registered dietitians and 11 medical records staff with an estimate of 575 users that will use the new system. McKeldin

Assisted Living Unit (ALU) will be opening soon on Springfield Hospital Center Campus.

C. Spring Grove Hospital Center - Catonsville

Spring Grove has a campus setting with many buildings and is located in Catonsville. The facility has several different types of units with different dispensing requirements (unit dosing, 30 days, etc.). Spring Grove is the largest MDH facility, with 397 beds. There are 600 clinical providers that will be users of the system including 450 nurses. Spring Grove uses the Assurance and

Improvement in Medications Safety (AIMS) pharmacy module for dispensing medications. They use

Quest as an external lab. They use TechCare for external radiology.

D. Thomas B. Finan Center – Cumberland

The Thomas B. Finan Center is located in Cumberland. Finan has 66 beds and 22 ALU beds. There is a total of 156 users who will access the system. Finan uses the Western Maryland Hospital Center as an external laboratory. The facility utilizes a system developed in-house (called DPOE, for Direct

Physician Order Entry) to allow physicians to enter orders and staff to create/modify/print MARs and other medication forms. This system utilizes Access and is used as a front and back end to the existing pharmacy module used by the other pharmacies. The Assurance and Improvement in

Medications Safety (AIMS) pharmacy module is used for dispensing medications.

E. Eastern Shore Hospital Center - Cambridge

The Eastern Shore Hospital is located in Cambridge and has 84 beds, but this number is subject to change throughout the implementation of the EHR system. The facility uses the E-Chart system for patient census data and pharmacy management system. It does not use the AIMS pharmacy module. There are 6 psychiatrists, 1.5 somatic physicians, 1 forensic psychiatrist, 4 psychologists, 6 social works, 83.35 nursing FTEs, 11 rehabilitation staff and 6 medical records staff, for a total of

319 users who will all access the system.

F. Deer’s Head Hospital Center - Salisbury

The Deer’s Head Hospital Center is a chronic care facility located in Salisbury and has 80 licensed beds in the chronic care unit, 66 licensed long-term care beds, and services 60 dialysis and 16 PT/OT outpatients each day. There are 38 clinical providers, and a total of 150 clinical and direct care staff that will be using the system. Deer’s Head is using the OptimusEHR system from vendor Yardi.

Deer’s Head uses an internal laboratory system (SchuyLab) and two external labs: the State of

Maryland and Peninsula Regional Medical Center (Epic). They are running the DIAPro dialysis system from Gaia Software, use an external pharmacy (Allied), an external imaging service

(Mobilez at Peninsula Regional Medical Center) and the OnDemand dietary system. Reporting is sent to the Center for Medicaid Services (CMS) for SNF, LTCH and quality measures.

RFP for Maryland Department of Health Page 6 of 146

G. Western Maryland Hospital Center - Hagerstown

The Western Maryland Hospital Center is a chronic care facility located in Hagerstown and serve 46 beds. The facility provides three types of services: chronic care, traumatic brain injury and long-term care (for ventilator dependent patients). They are also using the Yardi OptimusEHR system. There are 151 clinical employees that would access the new system. They are using an external pharmacy (Allied) and are running Orchard Software for their internal laboratory.

H. Holly Center - Salisbury

The Holly Center is a developmental disability center located in Salisbury. Holly has 100 licensed beds. There are 148 staff positions (including 92 direct care assistants, 24 RNs, seven LPNs, five

PT/OT/ST, two social workers, one RD, one psychiatrist, one podiatrist, and one psychologist, seven contract professionals, and a nurse agency contract), who will all access the system. There is no existing EHR system, although they are using an Access database for census, in addition to

HMIS. They use an external pharmacy (Allied) and an external lab at Peninsula Regional Medical

Center, which runs on the Epic EHR System.

I. Potomac Center - Hagerstown

The Potomac Center is a developmental disability center located in Salisbury. Potomac has 47 licensed beds and 95 clinical providers, all those who hold a license: doctor, RN, LPN, CNA, LCSW, Psychiatrist, Psychologist. They have no EHR in use at this time. They are using an external pharmacy (Pharmacare), external laboratories (LabCorp and a local hospital using Meditech Lab).

J. CIRP (Court Involved Residence Program) Potomac Center Campus - Hagerstown

The Court Involved Residence Program (CIRP) – Hagerstown Program provides evaluation and assessment services, as well as active treatment to people with intellectual disabilities and court involvement within a secure and safe environment. The CIRP unit is located on the grounds of the

Potomac Center campus. The management and operations of the unit are under the Potomac Center leadership. The CIRP has 28 beds and 75 clinical providers. The estimated total number of users for

Potomac/ CIRP is 224.

K. RICA – Baltimore

The Regional Institute for Children and Adolescents - Baltimore is a mental health residential treatment facility located in the city of Baltimore. The facility is operating with a capacity of 45 beds. There are 28 clinical providers, excluding nurses. There are 22 licensed nurses/state employees, 17 unlicensed nursing staff/state employees, and 31 unlicensed nursing staff/contractual employees. Total number of users is estimated to be 174. They have no EHR in use at this time. They are using an external pharmacy (Allied), and two external laboratories (Friends &

LabCorp).

L. JLG RICA – Rockville

The John L. Gildner Regional Institute for Children and Adolescents is a residential, clinical, and educational facility serving children and adolescents with severe emotional disabilities, located in

Rockville. The facility is operated in conjunction with the Montgomery County Public School

RFP for Maryland Department of Health Page 7 of 146 district to provide an academic, behavioral, day and residential treatment program in a highly structured, therapeutically integrated milieu. The facility has 32 beds for residents and there are 75-day treatment children for which there are medical records. There are 41 clinical providers (five of whom are receiving their license & will require co-signature). In addition, there are 30 CAMHAs who access the medical record. Total number of users is estimated to be 147. They have no EHR in use at this time. They are using an external pharmacy (Allied), and an external laboratory (Quest).

2.2.3 Overview of Current Systems

A. The existing Hospital Management Information System (HMIS) was purchased and implemented in 1987. HMIS originally included only census and billing functions. All MDH facilities use HMIS for census functions, as well as entering diagnoses and patient incidents

(e.g., restraints, seclusion). In 1999 a pharmacy module was added. An admit-discharge-transfer (ADT) interface passes patient information from the census module to the pharmacy module.

B. The current system is an electronic health record system used at the two chronic care facilities (Deer’s Head and Western Maryland), in addition to HMIS. It supports census, charting, pharmacy, and Minimum Data Set (MDS) collection and submission for long term care. The system allows clinicians to chart by selecting icons from touch screens. The system also supports an Electronic Medication Administration Record (eMAR) function.

C. The e-Chart and e-Staff systems are used at the Eastern Shore Hospital Center for census (in addition to HMIS), medication ordering, clinical documentation, patient incident reporting, employee profiles, credentialing, and infection control.

D. DIAPro is used at Deer’s Head for clinical documentation for dialysis patients.

E. SchuyLab is a laboratory system used at Deer’s Head for accessioning and processing specimens and reporting results via instrument interfaces.

2.2.4 Challenges of the Current Systems

A. Application Gaps

1. Nearly all functionality required for Promoting Interoperability (Meaningful Use) attestation is unavailable to MDH facilities with paper patient records.

2. None of the electronic health record systems in use are certified for Promoting Interoperability

Promoting Interoperability (Meaningful Use).

3. Failure to attest to Promoting Interoperability (Meaningful Use) has resulted in reduced reimbursement from CMS.

4. Facilities using the current EHR, and E-Chart/E-Staff systems are the only facilities that have made progress toward the HIMSS electronic health record model.

5. Heavy reliance on paper and manual processes in workflows create an environment with many opportunities for delay and error.

B. Access to Information

1. Paper records cannot be accessed remotely. On-call physicians must travel to the facility when called.

2. Medical record audits must be performed manually with paper records.

3. Quality reporting must be performed by manually pulling records and counting.

RFP for Maryland Department of Health Page 8 of 146

4. There are a limited number of workstations available to physicians, nurses, and other clinicians, and MDH will need to assess the expansion of the local network to accommodate additional workstations, as well as the type of workstation (desktop, laptop, and tablet).

C. Integration

1. The industry standard is “enter once, use many”.

2. Patient information collected at facilities with paper records is re-written on multiple forms.

3. Facilities with Access database applications also require the re-entry of patient information due to a lack of integration among the applications.

4. HMIS is partitioned by facility, so patient information cannot be transferred to another facility when the patient is transferred, requiring large-volume fax transmissions and re-entry of data into HMIS.

5. Some facilities have no fully electronic order entry/results cycle with external pharmacies and labs, requiring physicians hand write orders, nurses transcribe orders onto forms which are then faxed, followed by phone calls from the pharmacies/labs with questions, and then handwritten medication administration records are used – all disconnected processes that requires staff to monitor attentively.

6. There is no integration with the Maryland health information exchange, CRISP, so patient history, medication, allergies, problems cannot be obtained electronically.

7. There is no integration with county health department systems.

8. There is no integration with the Department of Public Safety and Correctional Services

(DPSCD) nor with other county jail systems.

2.2.5 Key Functionality of the Current Systems

The existing systems, where deployed, support the following high-level processes and reporting:

1. Census, including Admissions/Discharges/Transfers (ADT)

2. Order entry (and computerized physician order entry at some facilities)

3. Pharmacy

4. Clinician Documentation (including physicians, nurses, therapists, psychologists, and other professionals)

5. Laboratory

6. Dialysis

7. Long Term Care (LTC)

8. Billing

9. Credentialing

2.2.6 Maryland Healthcare System – Current Functionalities

MDH seeks to increase the scope and quality of the reports and analytics that are listed below and referenced in Appendix 4 - Functional and Business Requirements to be generated by the new

EHR system.

1. Admissions: Admissions for the five (5) psychiatric hospitals and the two (2) developmental disability centers, Holly and Potomac, are managed by the Centralized

Admissions Office (CAO), a division within the Office of Court Ordered Evaluations and

Placements (OCEP). The CAO processes approximately 3,500 court orders a year, orders that commit defendants to MDH for evaluation or treatment of a mental health or substance use disorder. The CAO uses Salesforce to manage processes and store documents. When a court order is received, the CAO sends a forensic evaluator to the

RFP for Maryland Department of Health Page 9 of 146 detention center to perform an evaluation. Once the evaluation is completed, the evaluation is uploaded into the Salesforce application for processing. The CAO staff then begins the process of gathering medical records, court documents and demographic information needed for admission, and the patient is placed on the waitlist. The CAO works with the MDH facilities to locate the appropriate setting for placement based on capacity, condition and level of care needed for the patient. Once a location and bed are determined, transportation is scheduled to transport the patient to the facility. OCEP is also notified when patients are preparing for discharge. The Community Forensic

Aftercare Program (CFAP) division is notified and is engaged in discharge planning and aftercare planning for the patient. Once patients are conditionally released, CFAP monitors the patient in the community by receiving monthly reports from providers to ensure adherence to the patient’s aftercare plan.

2. Billing and Revenue Cycle: Census data is stored in the Hospital Information

Management System (HMIS) with the patient’s demographic and medical profile information. The census data is collected and used by the Division of Cost Accounting and Reimbursements (DCAR), program administrations, and hospital administrators. This information is used to invoice third party and private payers for services provided in the facilities and for a variety of administrative and management activities ranging from daily patient accounting to Joint Commission (JC) accreditation.

The DCAR Financial Agent Offices (located at each State facility) forward billing information on a form (BIF – Billing Information Form) to DCAR Central Office for processing. The Central Office staff sets up the appropriate billing in the Client

Billing Profile and uses this information to add retroactive charges, adjustments and payments that need to be made to the automated accounts receivable.

A. DCAR prepares billings for Medicare Part A, Medicare Part B (Ancillary &

Physician), Medicaid, Insurance Companies, Sponsors, Hospital Bank and Social

Security MDH Payee.

Medicare Part A includes billings listing in the table below for:

Table 2-1 Medicare Part A Payment System Types

Payment System Type Facility

Long Term Care Hospital

Prospective Payment System

(LTCH PPS)

Chronic Facilities

Inpatient Psychiatric Facility

Prospective Payment System (IPF

PPS)

Mental Health Facilities

Skilled Nursing Facility Prospective

Payment System (SNF PPS)

Nursing Homes

These billings are prepared using manual hard copy data received from the State facilities. The claims are sent to Novitas via MyAbility, Inc Direct Data Entry for processing. The charges are entered manually into the Accounts Receivable (A/R) as are all payments received.

RFP for Maryland Department of Health Page 10 of 146

B. Medicare Part B includes billings for Ancillary and Physician services. The

Ancillary services billing is prepared using lab slips and logs sent from the facilities. This data is keyed into a menu option in the current system, and it is processed during the monthly ancillary billing. The National Standard Format file created in this process is then processed through an 837 Translator developed in-house. The 837 file is then sent to Highmark Medicare Services for payment.

The payments are entered manually into the A/R. The Physician services billing is prepared using Physician service logs sent from the facilities. This data is then keyed into a menu option in the current system, and it is processed during the monthly physician billing. The National Standard Format file created in this process is then processed through an 837 Translator program written in-house.

The 837 file is then sent directly to Novitas for payment. An 835-remittance file is received from Novitas, and the payments are electronically applied to the A/R.

C. Medicaid includes billings for the Chronic, Behavioral Health, Developmental

Disabilities and Nursing Homes. These billings are prepared using data from the

Client Billing Profile and the Patient Moves data. The Chronic and Mental

Health are billed using a per diem rate, and the Nursing Homes are billed based on Revenue Codes and Patient Moves. The National Standard Format files created by the system are then processed through the 837 Translator program. The 837 file is sent to Maryland Medicaid for processing. An 835-remittance file is received from Maryland Medicaid and then applied electronically to the A/R. Only Nursing Homes are billed based on Revenue

Codes.

D. Insurance claims are prepared on Uniform Billing-04s (UB-04) generated manually and by the system during the monthly billing process. The data used to prepare the bill is generated from the system’s Client Billing Profile and Census data. The UB-04s are submitted to insurance companies via MyAbility for payment. The payments received are applied manually to the A/R.

E. Sponsor Bills are created from data in the Client Billing Profile and the Census

Module. The bills are generated by the system during the monthly billing process, printed on data mailers, separated manually and then mailed. The payments received are then entered manually into the A/R.

F. Hospital Bank Billing is done based on data compiled on the Hospital Bank Rep printout. The data represents information contained in the Client Billing Profile and Patient Moves. The printout is sent to each facility’s Business Office for payment. The payments are entered manually into the A/R.

G. Social Security and Maryland Department of Health (MDH) Payee Billing is generated based on data from the Client Billing Profile and patient moves. The charges are based on rates established by the Financial Agents in the State facilities. The payments consist of the Social Security check for the MDH Payee patients. The Social Security checks are direct deposit, and the check files are sent to DCAR by Banking Services in Annapolis for processing. The Social

Security Unit then uses a system-generated Patient Allowance report to give each patient receiving a check a patient allowance. A transmittal is sent to MDH

General Accounting for allocation of funds to the facilities. Supplemental

Security Income (SSI) is not processed through HMIS.

RFP for Maryland Department of Health Page 11 of 146

H. Retroactive Billings are prepared using Sponsor / Resource system billing options and the Client Billing Profile. Retroactive billing is very common in the

State Hospital billing environment. Financial investigations can take up to six months to complete and the patients stay for extended periods in the facilities, thus causing accounts to be adjusted for retroactive periods.

I. The Accounts Receivable (A/R) consists of invoiced entries and their associated company/plans. The entries are produced by monthly and on demand billings, charge entries, payment/adjustment entries, retroactive billing entries and re-bill entries.

2.2.7 Pharmacy Current Systems

The BHA operates five (5) state psychiatric facilities with in-house pharmacies located throughout the State of Maryland. The new system will replace the legacy pharmacy management system used in these facilities. The new system will support all the functions of the in-house pharmacies.

The CIRP receives medications from one of the State psychiatric facility pharmacies, rather than a commercial pharmacy. The new EHR will track these transactions.

2.2.8 MDH operates five internal pharmacy departments supported. MDH also operates six other inpatient facilities that use the HMIS ADT module for patient census information however; they purchase their prescriptions from outside pharmacies.

Although they are not using the existing pharmacy management system, there will need to be an interface with new EHR and current contracted pharmacies.

Facilities that use external pharmacies are listed below:

1. RICA - Rockville

2. RICA - Baltimore

3. Deer's Head Hospital Center - Salisbury

4. Holly Center - Salisbury

5. Potomac Center - Salisbury

6. Western Maryland Hospital Center - Hagerstown

2.2.9 ORYX Reporting of Current Systems

The current HMIS system is fully compliant with all Joint Commission Performance Management

(ORYX) reporting requirements coordinated through the National Research Institute’s (NRI)

Behavioral Healthcare Performance Management System. These reporting requirements include, but are not limited to, patient episodes for all admissions and discharges and patient events such as injuries, patient seclusions and restraints, medication errors, patient leaves such as absent-without-leave (AWOL) or home visits and readmissions within 30 days of discharge. Additionally, the current system transmits electronic files on monthly patient episode and event data for each facility to

NRI for editing purposes. All identified errors are returned to the facility for correction and retransmission to NRI. All monthly files must pass all fatal errors, as defined by NRI, before the next month is sent to NRI for editing purposes. The ORYX reporting requirements change on at least an annual basis and MDH’s Department of Information Technology makes changes to the HMIS source code to accommodate these changes.

RFP for Maryland Department of Health Page 12 of 146

2.2.10 User Groups of the Current Systems

The current system is used at each MDH facility by staff from admissions, medical records, physicians, nurses, therapists, consulting physicians, pharmacists and pharmacy technicians, lab technicians, administrators, social workers, utilization review, performance improvement, infection control, and others.

Information is currently collected and used by DCAR for billing, as well as NRI for ORYX reporting.

The Maryland State Police (MSP) also queries a database extracted from HMIS (and augmented with data from all other State hospitals) to determine if a gun purchaser has been a psychiatric patient.

2.2.11 State Roles

In addition to the Procurement Officer and Contract Monitor, MDH has the following implementation personnel and will establish the following governance bodies:

Table 2-2 MDH State Roles

STATE ROLE RESPONSIBILITY

A. MDH Facilities Director This role is the empowered leader, manager, and coordinator for all the

MDH hospitals and healthcare facilities. This person will be final arbiter on decisions as to MDH facility requirements (functionality, workflow, reports, etc.) and EHR system configuration; and will be responsible for planning and executing Organizational Change

Management (OCM)

B. MDH EHR Delivery Manager

(Program/Project Manager for

MDH)

The MDH EHR Delivery Manager will be paired and partnered with the

Contractor’s Program / Project

Manager. This person will be responsible for the classic tasks of adhering to schedule, controlling scope, sticking to budget, fulfilling the Contract, addressing risks, and escalating issues.

C. MDH EHR Senior Business

Analyst

Works with senior MDH leadership, the facilities, MDH OIT, and the

Contractor’s team to understand, prioritize, and manage requirements; to design and decide the EHR workflow, configuration, and reports; to contribute to the planning and execution of OCM, RFP for Maryland Department of Health Page 13 of 146 including system training and support.

D. MDH EHR Configuration and

Integration Analyst(s)

Responsible for administering, configuring (including reports), and maintaining the new EHR system. The role will work closely with the

Contractor’s implementation team

Contractor’s technical support.

E. MDH OIT Director of

Infrastructure

Role will be on a part-time dedication to the EHR implementation, is responsible for understanding, planning, and fulfilling the requirements for hosting, operating, and securing the new EHR system

F. MDH OET HMIS Team The team will be dedicated to supporting the EHR implementation from both functional and technical perspectives, including collaboration with the Contractor in activities required for data cleansing and conversion; for hospital-by-hospital rollouts

G. Facility Leadership and Staff MDH will obtain participation and provide access to leadership and staff within facilities as reasonably requested by the Contractor. Requests from the Contractor shall be submitted to the MDH EHR Delivery Manager for decision.

H. Program Management Office

(PMO)

MDH will establish a PMO to be led by the MDH EHR Delivery Manager in collaboration with the Contractor’s

Program / Project Manager

I. Change Control Board (CCB) MDH will establish a CCM within the

PMO in order to manage EHR scope consistent with the EHR

Contract. The CCB will include representatives from the

Contractor. The CCB will escalate decisions that it cannot resolve itself to the HER Executive Steering

Committee and the Office of the

Attorney General (OAG), as appropriate

J. Facilities Advisory Board

(FAB)

MDH will establish a FAB within the

PMO to facilitate activity, communications, organizational

RFP for Maryland Department of Health Page 14 of 146 change, and issue resolution with leadership of the facilities. The FAB will include the CEOS and COOs of the facilities along with others as deemed appropriate

K. EHR Executive Steering

Committee (ESC or Steering

Committee)

MDH will establish a Steering

Committee for executive sponsorship, including empowerment of the delivery team, mitigation of risks, and resolution of issues, including issues relating to the provisions and enforcement of the Contract

2.3 Contractor Responsibilities and Tasks

2.3.1 Overview

System implementation will span approximately two years, starting in 2022 and conclude in 2024.

A. The Contractor shall provide implementation that will encompass activities such as deciding how to automate and standardize workflow; configuring the new EHR system; cleaning and converting data; engaging and training the end-user community; deploying to facilities in a multi-stage rollout; and launching the steady-state support services.

B. The Contractor shall deploy in a facility-by-facility manner, rather than in an application-by-application or module-by-module basis. The approach shall entail fully implementing three to four facilities for each of the deployments or “go-lives.” To minimize time-to-value and also to manage risk, facilities that have no EHR in place today will presumably be scheduled for deployment before those that are currently running other systems. See Table 2-3 for facility system implementation order.

C. The Contractor shall clean and convert existing patient data. This process will need to identify and combine duplicate patient records across multiple facilities. The process will include creating digital images of records that are not in a structured digital format (e.g., paper records) and attaching them to the patient’s record.

2.3.2 Controlling Federal and State References

The Contractor shall review, familiarize, and adhere with any pertinent requirements from the following

Federal and State laws, regulations, and waivers:

A. 42 U.S.C., 45 Electronic Code of Federal Regulations (e-CFR), §§ 160.101 through 160.105 –

General Administrative Requirements https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.2.160&rgn=div5

B. 42 U.S.C., 45 e-CFR, §§ 164.102 through 164.534 – Security and Privacy

C. 42 U.S.C, § 1305 – Social Security Act

D. 42 U.S.C., § 1320d-2 – Standards for Information Transactions and Data Elements

E. 42 U.S.C., § 18001 – Immediate Access to Insurance for Uninsured Individuals with a Preexisting

Condition https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.2.160&rgn=div5 https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.2.160&rgn=div5

RFP for Maryland Department of Health Page 15 of 146

F. 42 U.S.C. § 12101-12213 – Americans with Disabilities Act of 1990, Public (P) Law (L) Number

(No) 101-336

G. CMS, The State Medicaid Manual, Publication# 45 https://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927

H. Federal Information Processing Standard (FIPS) Publication (PUB) 140-2 – Security Requirements for Cryptographic Modules (Mentioned in 3.7.5 (B)6 under Security Requirements) https://csrc.nist.gov/publications/detail/fips/140/2/final

I. FIPS PUB 199 – Standards for Security Categorization of Federal Information and Information

Systems https://csrc.nist.gov/publications/detail/fips/199/final

J. FIPS PUB 200 – Minimum Security Requirements for Federal Information and Information

Systems https://csrc.nist.gov/publications/detail/fips/200/final

K. Health Insurance Portability and Accountability Act of 1996 (HIPAA), P.L. No. 104-191

L. National Institute of Standards & Technology (NIST) Special Publication (SP) 800-53 Rev.5 –

Security and Privacy Controls for Information Systems and Organizations https://csrc.nist.gov/publications/detail/sp/800-53/rev-5/final

M. NIST SP 800-63 [series] – Digital Identity Guidelines https://www.nist.gov/itl/applied-cybersecurity/tig/projects/special-publication-800-63

2.3.3 Facility Systems Order of Implementation

Contractor shall integrate into their implementation plan in Table 2-3 The eleven (11) MDH facilities identified in 2.2.2 for implementation of the EHR system shall acquire this service in the order listed below. This is the current preferred order of implementation; however, MDH may modify the order, if necessary.

Table 2-3: Facility System Order of Implementation

ORDER WITH THE

NUMBER 1 BEING THE

FIRST

FACILITY

1 Clifton T. Perkins Center Jessup

2 RICA – Baltimore

3 Spring Grove Hospital Center – Catonsville

4 Eastern Shore Hospital Center – Cambridge

5 Springfield Hospital Center – Sykesville

6 Holly Center – Salisbury

7 JLG RICA – Rockville

8 Potomac Center – Hagerstown https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927 https://csrc.nist.gov/publications/detail/fips/140/2/final https://csrc.nist.gov/publications/detail/fips/199/final https://csrc.nist.gov/publications/detail/fips/200/final https://csrc.nist.gov/publications/detail/sp/800-53/rev-5/final…