Soldiers Homes EMR RFR.docx

Request for Responses for the

Soldiers’ Homes

Electronic Medical Record (EMR) System

Issued by:

Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) Massachusetts Department of Veterans’ Services Soldiers’ Home in Chelsea & Soldiers’ Home in Holyoke

June 23, 2020

Document Number: 21EHSKAEMRSYSTEM

COMMBUYS Bid Number: BD-20-1039-EHS01-EHS01-49184

RFR: For a Third-Generation Pharmacy On-Line Processing System (POPS) 50 Released: MONTH 2008

Table of Contents

Introduction/Background Objective The objective of this RFR is to procure a comprehensive electronic medical records (EMR) system for the Soldiers’ Homes that will accomplish the following: 1) improve clinical care and patient access, 2) develop an interoperable, cloud-based, secure, flexible infrastructure, 3) enhance billing and fiscal management, and 4) facilitate an effective and efficient rollout supported by comprehensive change management and training (“the Project”). The Chelsea Soldiers’ Home and the Holyoke Soldiers’ Home have partnered for this procurement of a single EMR system because they share many common needs and goals and serve a common type of clients. The most critical objective of the new EMR System is to provide a single client record across all clinical settings, and to share the information across both Soldiers’ Homes as appropriate. The envisioned EMR System will be a shared EMR system that also allows each Soldiers’ Home to operate as an independent entity. While the Chelsea Soldiers’ Home will be the contracting entity for this procurement, the envisioned EMR System must meet the requirements for both Soldiers’ Homes, as detailed in this RFR.

The envisioned EMR System will be a full replacement of the electronic records systems at the Soldiers’ Homes as well as a replacement for the largely paper-based medical records system.

The EMR System will be interoperable, cloud-based, have flexible capabilities to expand scope of services, will align with best practices in security standards, and will comply with Executive Office of Technology Services & Security (EOTSS) architecture requirements and the Secretariat Application Reference Manual (SARM), version 3.3 as detailed in Appendix A within Attachment G of this RFR. The functional needs for Bidders’ proposed EMR systems include information and order management for sub-acute, skilled nursing and LTC, outpatient clinic, dormitory and other on-site direct services, including e-prescribing capabilities to meet Centers for Medicare and Medicaid Services (CMS) current and future standards.

The Soldiers’ Homes are seeking (1) an interoperable, cloud-based solution for all user components of the complete system solution; and (2) maintenance and support services for the ongoing operation of the system, as further described in this RFR. It is anticipated that an initial implementation contract resulting from this RFR will be for five (5) years, with the option to renew for an additional ten (10) years in any increments as determined by the Soldiers’ Homes or the Commonwealth.

General Information Overview For more than one hundred years, Veterans’ Homes across the country have worked to provide care to veterans who are unable to care for themselves. After World War I, these homes were consolidated under a nationwide organization that would later become the federal Veterans Administration (VA). Although the VA runs 153 hospitals, 800 community-based outpatient clinics, 126 nursing home care units, and 35 domiciliary programs nationwide, states work in tandem with the VA to provide services to veterans through the State Veterans Home Program, established in 1888 to assist veterans of the Civil War.

Massachusetts faces growing demand for long-term care services tailored to the needs of veterans. Nationally, the veteran population includes 18.8 million men and women who have served in active duty. According to U.S. Census data from 2015, there were at least 327,990 veterans in the state of Massachusetts, or about 6.1 percent of Massachusetts adults. Massachusetts is home to two State Veterans Homes, known as Soldiers’ Homes: one in Chelsea, established in 1882 (prior to the creation of the State Veterans Home Program) and one in Holyoke, which opened in 1952 (collectively referred to herein as “the Soldiers’ Homes”).

The Soldiers’ Homes are sitting within the Department of Veterans’ Services under the Executive Office of Health and Human Services (EOHHS). EOHHS is largest secretariat in Massachusetts, and is responsible for the Medicaid program, child welfare, public health, disabilities, veterans' affairs, and elder affairs. In total, EOHHS oversees 16 state agencies. These agencies include the Department of Veterans’ Services, which is the focus of this Project. Massachusetts is a national leader in the provision of services to veterans. This deep commitment to providing broad access to services to veterans means that there is a wide array of programs available, many of which are supported by state funds.

The Soldiers’ Homes offer a different mix of services, but at their core they serve veterans in need of skilled nursing (SNF) and/or long-term care (LTC) or, through their domiciliary programs, those needing long-term, affordable housing. To be eligible to be served by the Soldiers’ Homes, individuals must be veterans who have been honorably discharged (DD-214 paperwork), served 180 days of regular active duty service, or 90 days of active duty service, one (1) day of which is during "wartime", enroll in U.S. Department of Veteran’s Affairs health benefits, and be a Massachusetts resident.

To help meet the demand and the increasing acuity of the veteran population, the state is currently building a replacement to the main hospital facility in the Chelsea Soldiers’ Home with the creation of a Community Living Center (CLC). The CLC will feature private individual rooms and support a higher acuity of services than the current physical structure allows. The Holyoke Soldiers’ Home had previously upgraded its clinical environment with renovation of the hospital wards into semi-private rooms.

The Soldiers’ Homes are soliciting competitive responses for a comprehensive Electronic Medical Record (EMR) System that will address the core clinical and administrative functions for both Soldiers’ Homes. The EMR System will support the management of client eligibility determination, admission, clinical care, regulatory documentation, revenue management, utilization, and reimbursement for provided services. The envisioned EMR System shall be able to serve both Soldiers’ Homes and connect with the network of community providers providing continuum of care to the Soldiers’ Homes’ clients.

A Request for Information (RFI) was released in early July 2019 and the responses helped the project implementation team in drafting a set of comprehensive requirements that reflect the functionality needed to support each Soldiers’ Home’s complex environment. To further inform the RFR process, the project implementation team completed a comprehensive review of current Soldiers’ Homes’ systems and workflows. The review included interviews, listening sessions with both staff and external partners, facility tours, data analysis, and research.

Introduction: General Soldiers’ Homes’ Environment Overview The Soldiers’ Homes are funded via Massachusetts State Operating Budget, VA per-diem billing, Medicare/private insurance billing, and by payment of daily care charges by the veterans. On a daily basis, the Soldiers’ Homes submit a census report to the VA, and the billing rate varies by the type of bed and the service-connected disability status of the veteran who is in the bed. The Soldiers’ Homes collectively have more than 800[footnoteRef:2] beds for the following service offerings: Skilled Nursing Facility (SNF); Long-term Care (LTC), including Dementia/ Alzheimer-friendly LTC; Hospice; and Domiciliary services. The Domiciliary services accounts for approximately 335 of the 800 beds. Outpatient services are also provided by the Holyoke Soldiers’ Homes. [2: All general Soldiers’ Homes’ environment figures and estimates in this Section 1.3 and Section 1.4 are current as of April 2020 and are subject to change.]

SNF and LTC services provide assistance with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping).

The Soldiers’ Home in Chelsea is in the construction phases of building a new Long-Term Care/Skilled Nursing Facility/Sub-Acute Care. Ultimately, the CLC will replace its current location in the Quigley Building. The Soldiers’ Home in Chelsea intends to implement a new EMR before transitioning from the Quigley Building to the new CLC building, which currently has a target date of 2022. The new facility will slightly reduce the number of beds, but be able to support an increased acuity level, including sub-acute care and improved Alzheimer’s/Dementia services. The envisioned EMR is seen as a critical element to serving patients in the new facility.

The Soldiers’ Homes also provide Domiciliary services. It is designed for veterans needing independent living services. The Soldiers’ Homes provide social services, a sober living environment, three hot meals, recreational activities and community events for the residents. Each year, roughly 5% of domiciliary residents in Chelsea and Holyoke move to LTC services, some move back and forth throughout the year for services. The average stay for Chelsea’s beds is 7 years. Holyoke has a much smaller Domiciliary services capacity than Chelsea.

In addition to the LTC and Domiciliary services, the Soldiers’ Homes partner with a number of outside organizations to strengthen their on-site service offerings. These vendors and services vary by location. These partners provide everything from x-ray and ultrasound services to hospice care, physical therapy, pharmacy services, and recently planned addition of telemedicine. Holyoke Soldiers’ Home hosts an outpatient department that receives more than 5,000 visits per year and a dental facility that receives more than 3,000 visits per year. While some of these visits are from residents of the Domiciliary or LTC programs, the majority of those receiving outpatient and dental services come from surrounding communities. Please see the chart below for an outline of the mix of on-site service offerings:

On-Site Vendor Services Y indicates there is a vendor contracted to provide services on-site. Chelsea and Holyoke maintain independent contracts with each service vendor.

Ophthalmology

Y

Urology

Y

To fully support the needs to the residents, the Soldiers’ Homes also partner with off-site community organizations for emergency services and specialty services (VA hospitals, Accountable Care Organizations (ACOs), major, private teaching hospitals and other area emergency rooms). Please see the chart below for the service mix:

Off-Site Community Partner Services X indicates a relationship with off-site services. Chelsea and Holyoke maintain independent relationships with each service provider.

The current staffing for Chelsea and Holyoke includes approximately 400 primary users for the envisioned EMR System.

In the sections below, there is a detailed overview of current services provided at the Soldiers’ Homes that are involved in this Project to help potential bidders understand the system environment.

Current Veterans Services Overview Today, the Soldiers’ Homes are primarily focused on two major services: Long Term Care and Domiciliary services. While there are a number of outside providers bringing additional services to the population there, the primary tasks of staff and management are to support these core components.

Long Term Care (LTC) - Long Term Care services have traditionally been provided in institutional settings, for people who need assistance with six “activities of daily living” (ADLs): eating, bathing, dressing, toileting, transferring, and continence. Most people who need LTC services are over 65, and that cohort is increasing rapidly among the general population, and will remain a large component of the veteran population even accounting for the overall reduction in the population of veterans.

Domiciliary - Traditionally, the Domiciliary services is designed to function largely as a stepping stone to independence: veterans often come from homelessness, many needing a sober-living environment, and the domiciliary is set up as a place where they can stay to get back on their feet. They are provided three meals per day, a room, and a variety of services, and, ideally, are using their time at the Soldiers’ Homes to take advantage of the services available to them and work toward moving back into the community.

Additional on-site services at Chelsea - The Soldiers’ Home at Chelsea has partnered with a number of outside organizations to strengthen its service offerings. In addition to LTC and domiciliary residences the Recreation Department at the Chelsea Soldiers’ Home brings exercise programs, various outings, bingo, and other activities to the veterans. Other services that come to the Chelsea Soldiers’ Home include Alcoholics Anonymous, food addiction groups, the Massachusetts Rehab Commission which provides job search services and Resounding Joy, a music therapy program. Numerous medical partnerships are further utilized, including Mobile Medical Diagnostic Services, Arete for rehabilitative support, Health Drive, US Labs, Care Dimensions, and Cambridge Health. These partners provide everything from x-ray and ultrasound services to hospice care (Chelsea Jewish Hospice and Care Dimensions), physical therapy and emergency services.

Additional on-site services at Holyoke - In addition to LTC beds and the domiciliary, Holyoke offers specialized units within the facility: a 21 bed “comfort care” hospice unit and a 51-bed Dementia/Alzheimer’s unit. The Holyoke Soldiers’ Home is also host to an outpatient department that receives more than 5,000 visits per year and an independent dental facility that receives more than 3,000 visits per year. While some of these visits are from residents of the domiciliary or LTC programs, the majority of those receiving outpatient and dental services come from surrounding communities. In addition, there are services provided for veterans residing at the Home, including a Veterans Assistance Center that is staffed regularly during business hours. Other programs available to residents of the Holyoke Soldiers’ Home include: the Veteran History Project, which aims to capture the stories and experiences of veterans to share with future generations; Honor Flight, which helps provide veterans with transportation to the memorials for the conflicts in which they served; and the Vet 2 Vet Program, a collaboration of a number of entities, including Holyoke Community College, Soldier On, and the VA. There are a number of programs and services that, while not physically located at the Holyoke Soldiers’ Home, regularly send staff to provide services that would otherwise be unavailable at the home. For example, at the Chelsea Soldiers’ Home, services specifically for veterans include benefits assistance from VA representatives and Veteran Service Officers (VSOs) on a weekly basis, as well as weekly meetings with Disabled American Veterans (DAV), and bi-weekly visits from Volunteers of America, which focus on employment, resume writing, interviewing, and housing.

Definitions The following terms and acronyms are used throughout the RFR and shall have the meaning stated in this section, unless the context clearly indicates otherwise.

American National Standards Institute (ANSI): A private, non-profit organization that administers and coordinates U.S. standardization and conformity systems. This standards body is responsible for developing and publishing X12N ANSI transactions that will be used by the departments.

Bidder: An entity that submits a Response to this RFR.

Calendar Day: Any day of the week regardless of whether work is performed, including weekends and holidays.

Centers for Medicare and Medicaid Services (CMS): The agency within the U.S. Department of Health and Human Services that is responsible for oversight of the federal Medicare and the state Medicaid programs.

Change Order or Change Request: A written amendment to the SOW, directing the Bidder to change the contract price, Requirements, or project schedule. Such changes must be within the scope of the SOW and this RFR.

COMMBUYS: The Commonwealth of Massachusetts' sole online procurement record site.

Commonwealth Data: All data used or owned by the Soldiers’ Homes or the Commonwealth to which the Bidder gains access through a contract resulting from this RFR.

Contractor or Selected Bidder or Vendor: Bidder who is selected and executes a contract or agreement with the Soldiers’ Homes under this RFR.

Deliverable: Any work product that the Selected Bidder delivers for the purposes of fulfilling its contractual obligations.

Disaster: A malfunctioning of a critical component without which the system is unavailable to provide the function and features required by this RFR.

Disaster Recovery: The procedures required to ensure continued business operations through adequate alternative facilities, equipment, back-up files, and documentation in the event that a Disaster is declared.

Domiciliary services: The Domiciliary services are designed to function largely as a stepping stone to independence: veterans often come from homelessness, many needing a sober-living environment, and the domiciliary is set up as a place where they can stay to get back on their feet.

Downtime: Any period of time where the Soldiers’ Homes users cannot access any portion of the EMR System.

Electronic Medical Record (EMR) System or EMR System: The system of records and interconnected functionality that is an electronic version of a patient’s medical history that is the subject of this RFR. The system is maintained by providers over time and may include all of the key administrative clinical data relevant to that person’s care, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The system automates access to information and has the potential to streamline clinical workflow. The system also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

Executive Office of Health and Human Services or EOHHS: A secretariat-level executive agency under the Governor of Massachusetts. EOHHS oversees 16 constituent agencies, in addition to the Chelsea and Holyoke Soldiers’ Homes and the MassHealth program.

EOHHS IT: EOHHS’ Information Technology Unit that provides a range of centralized IT services for EOHHS and the Soldiers’ Homes.

Executive Office of Technology and Security Services or EOTSS: Formerly the Massachusetts Office of Information Technology, EOTSS provides a range of centralized IT services; oversees IT policies, standards and architecture; and promotes cross-agency collaboration and adoption of shared services.

e-Prescribing (Electronic prescribing): The transmission of prescription or prescription-related information through electronic media.

Event: In claim adjudication, the occurrence of a Drug Utilization Review (DUR), coordination of benefit, policy, or other MassHealth-defined condition that conflicts with information derived from the submitted transaction or from clinical practice.

Full-Time Equivalent (FTE): An individual who works forty hours per week or individuals who work in aggregate forty hours per week.

Key Personnel: Personnel directly responsible for management of the contract; or those personnel whose professional/technical skills are determined to be essential to the successful implementation of the contract.

MassHealth: The medical assistance or benefit program administered by EOHHS pursuant to M.G.L. c.118E and Title XIX of the Social Security Act (42 USC 1396) and other applicable laws and waivers to furnish and pay for medical services for eligible individuals. MassHealth pays for health care for certain low- and medium-income people living in Massachusetts, including a program for individuals who are HIV positive. MassHealth also manages the Insurance Partnership for small businesses, the Children's Medical Security Plan, Healthy Start, and the Special Kids/Special Care Pilot Program, cosponsored with the Department of Social Services.

Massachusetts Management Accounting and Reporting System (MMARS): The system used by the Massachusetts Office of the Comptroller through which payments to Contractors, certain members, and providers are made.

Meaningful Use: Meaningful Use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

Patient/Client: The individual receiving services or care.

Project Managers: Individuals from the Soldiers’ Homes and Selected Bidder identified and designated as Project Managers who shall perform project management on behalf of the Soldiers’ Homes and Selected Bidder under the contract.

Provider: A provider that furnishes medical services.

Request for Responses or RFR or Bid: This RFR (21EHSKAEMRSYSTEM) procurement specification and referenced documents. All solicitations (e.g., RFRs, Requests for Quotes (RFQs), etc.) are referred to as Bids in the COMMBUYS system.

Requirements: The technical and functional requirements for the Soldiers’ Homes’ EMR System incorporated into Section 2 of this RFR.

Response: Any information submitted by the Bidder in response to the Requirements outlined in this RFR, including any clarifying information provided by the Bidder if requested by Soldiers’ Home. The terms Proposal and Quote are used interchangeably with Response.

Security: Refers to the processes, methodologies, and means which are designed and implemented to protect information systems and information - including print, electronic, or any other form of confidential, private and sensitive information or data - from unauthorized access, use, misuse, disclosure, destruction, modification or disruption, which includes but is not limited to the ability to authenticate and authorize users to provide secure access to the system in a traceable (auditable) manner.

Services: The activities engaged in by Bidder for the purpose of fulfilling its obligations under the terms of this RFR, which may or may not result in the creation of a Deliverable.

Soldiers’ Homes: Refers collectively to Chelsea Soldiers’ Home and Holyoke Soldiers’ Home, who both sponsor this procurement.

Statement of Work or SOW: A contract resulting from this procurement governing the implementation of an EMR System for the Soldiers’ Homes. A model SOW is attached hereto as Attachment F.

Task: A material activity engaged in by a Vendor for the purpose of fulfilling its obligations to the Soldiers’ Homes under the terms of this RFR, which may or may not result in the creation of a Deliverable.

Overview of Scope of Work Current Technical Environment Overview – By Location Currently, the Chelsea and Holyoke Soldiers’ Homes use separate legacy systems to record demographics, admissions, Minimum Data Set (MDS), and billing, which will be replaced by the single EMR System. In addition, the current technology infrastructure includes a portfolio of ancillary systems, comprised of more than 25 products providing the functionality outlined below. However, the primary means of documentation still relies on paper patient records and paper-based physician orders.

The envisioned EMR System shall be able to serve both Soldiers’ Homes and connect with the network of community providers providing continuum of care to the Soldiers’ Homes’ clients, including VA, as illustrated below:

The Soldiers’ Homes seek a fully functional EMR System able to collect all standard inputs and outputs associated with the patient demographics, vitals, diagnostics, treatment, and discharge. The Soldiers’ Homes will primarily focus on Bidders’ quality of user experience and ability to integrate with other business operational and management systems, as further described below.

Soldiers’ Home Chelsea Chelsea currently uses a legacy system hosted at the Massachusetts Information Technology Center (MITC) in Chelsea, MA. The current legacy system has been in Chelsea for approximately 15 years, but has never been used as a true EMR system. The system is used to manage patient admission, dietary care plans, billing (no current Medicare A/D or private insurance), and the onsite bank. Patient information is stored in paper charts, and by and large, the care plans, medical records, and reporting are maintained outside of the legacy system, primarily on paper.

Over the course of the 15 years, there have been attempts to make the system more closely encompass the full clinical workflow at the Chelsea Soldiers’ Home. The current system installation does not meet Chelsea’s requirements and this procurement aims to replace the current installation of the existing EMR system in Chelsea, and integrate with disparate systems, both financial and clinical. Chelsea currently lacks a unified technical infrastructure to link its EMR with numerous clinical-related systems such as imaging, glucometers, and patient bracelet tracking. In addition to the EMR System linking with the clinical-related systems, the EMS System should also connect with state finance and accounting software, such as MMARs and state banking services. Other ancillary systems will remain in place and need to be integrated where possible with the new EMR System.

Soldiers’ Home Holyoke Holyoke’s Soldiers’ Home is also characterized by a mix of paper and electronic records across several systems. Holyoke currently uses a legacy system hosted onsite. The system is used to manage the admission process, census tracking, billing, and MDS reporting. The care plans, dietary care plans, and complete medical records are managed outside of the legacy system.

Similar to Chelsea, the Holyoke system offers limited functionality and is based on a legacy user interface model. The legacy system offers a minimum of utility and the clinical team is currently dependent on paper files and handwritten orders. Holyoke will similarly benefit from an improved EMR System supporting integration with clinical and financial systems.

Functional Requirements - Attachment A In consideration of the legacy systems as described above, the detailed functional requirements needed by the Soldiers’ Homes are set forth in Attachment A. These requirements must be addressed in the Response. Attachment A is not a specification listing, but rather a business need/requirement listing. The Bidder will be asked to indicate their ability to meet the requirement and a comments field will be available to clarify that response, if required or necessary, to explain how the proposed solution meets the specific business or technical need. Additional instructions can be found in the “IntroKey” worksheet contained in Attachment A.

These requirements were gathered after an extensive review of current processes. Following the review, the Soldiers’ Homes worked collaboratively over several months to establish a common set of business requirements that are now incorporated into this RFR. Each Soldiers’ Home has its own specific functional requirements that are included in these requirements, but collectively all the requirements in this RFR, further outlined in Attachments A and B, must be met by the envisioned EMR. During the development of the Statement of Work, each Soldiers’ Home will select the components appropriate for its specific needs.

The Bidder’s responsibilities are to assess the business issues presented, respond to the specific requirements, and clearly indicate whether their application satisfies each requirement listed.

Specific instructions for the format of the responses are provided in Attachment A in the “IntroKey” tab. The Bidder will use this spreadsheet with multiple tabs, found in Attachment A, to respond to each requirement.

Section Overview for Attachment A - Functional Requirements The functional requirements are separated into a table of contents, information key (IntroKey), and six requirements sections that are organized into logical functional areas:

· Section A: Global Features

· Section B: Care Management

· Section C: Billing

· Section D: Fiscal and Inventory Management

· Section E: Other Business Requirements, and

· Section F: Ancillary Services.

Bidders responding to this RFR must support the functionality needed by both Soldiers’ Homes and therefore must review and provide answers for each of the six sections (A-F) of requirements.

Further description and explanation of the six requirements sections are outlined below.

Table of Contents The first spreadsheet or tab in the Excel Workbook in Attachment A (the functional requirements) is the Table of Contents (TOC). Table 3 contains the TOC taken from Attachment A, Sections A-F.

IntroKey The second spreadsheet or tab in the Excel Workbook in Attachment A is the “IntroKey”. The information key or “IntroKey” contains information to help the Bidder when responding to the requirements and defines the options available for the vendor responses.

Section A – Global Features The requirements listed in Section A are general global features required for the new system. The requirements include specific software features and cover functionality such as custom forms, tasks, notifications etc. Both Soldiers’ Homes require a system that can support care management, eligibility determination and admissions, clinical assessment and needs determination, wait list management and prioritization, outside provider network management, records management, service coordination, and community support. The functionality outlined in Section A supports these business needs.

Section B - Care Management Care management is a vital piece of the services provided by the Soldiers’ Homes. The functionality in Section B covers direct provision of services, maintaining EMR, pre-admissions/pre-screenings, inpatient care, outpatient care, ambulatory care, staffing, order-entry, laboratory, intake/discharge, episodes of care, referrals, e-prescribing and medication management, scheduling, and all other needs related to care management, as well as addressing all former Meaningful Use requirements for both Inpatient and Ambulatory Care. The functionality outlined in Section B supports these business needs and a full outline of the sub-sections can be found in the requirement’s Table of Contents also included in Table 3 above. The Soldiers’ Homes seek to procure an EMR that will follow the best of CMS standards and recommendations for the length of the contract. These standards include the current and updated versions of CMS standards for Certified EHR Technology and for interoperability.

Please reference the below links for more detail:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2019ProgramRequirementsMedicaid Bidder must identify functionality that supports CMS standards and recommendations. Bidder must describe how their proposed system supports these standards, including existing certification, in the Bidder Comment/Description field in Attachments A and B. This information may also be summarized in the bidder’s narrative response.

Section C – Billing The functionality outlined in this section includes, but is not limited to, general billing, service entry/charge capture, bill submission/HIPAA transactions, reporting, payment/adjustment/denial, consumer/individual fund and resident trust management, and budgeting. For a full list of the sub-sections covered in Section C please see the requirement’s Table of Contents, also included in Table 3 above.

Section D – Fiscal and Inventory Management Section D describes functionality needs for revenue management such as tracking and managing financial information, including Accounts Payable, General Ledger, Fixed Assets, Bank Reconciliation, Capital Projects, F9 Reporting and Inventory management.

Section E – Other Business Requirements Section E represents other business functionality needed by both Soldiers’ Homes. The functionality outlined in this section would support and augment the functionality outlined in both Sections A and B. These shared requirements include, but are not limited to, client/patient portal(s), incident management, and appeals/grievance/reconsiderations. The Section E requirements support these business needs and a full outline of the sub-sections can be found in the requirement’s Table of Contents, also included in Table 3 above.

Section F – Ancillary Services The Soldiers’ Homes have partnered with a number of outside organizations to strengthen their service offerings. Section F contains requirements related to connectivity with these vendors.

Technical Requirements - Attachment B The development and structure of the Technical Requirements were similar to the process described for the Functional Requirements described in Section 2.2 above.

In consideration of the legacy systems as described above, the detailed technical requirements needed by the Soldiers’ Homes are located in Attachment B. The functionality outlined in this section includes, but is not limited to, security, system administration access, account creation, access control, hosting, integration, etc. These requirements must be addressed in the Response.

Section Overview for Attachment B The requirements in Attachment B are separated into a table of contents (TOC), information key (IntroKey), and two requirements sections:

· Section A: Technical Requirements

· Section B: Performance Standards Section A – Technical Requirements This section of the document describes the technical requirements needed to satisfy the core business and operational processes for a new EMR System. The Bidder shall propose a solution that will address the requirements laid out within. The current EMR system is configured on outdated software architecture and does not meet the objectives of specified in Attachments A and B.

Several of the listed requirements are based on processes currently in place. Bidders are encouraged to describe and suggest their own solutions or approaches if they provide an equivalent or more efficient way of satisfying the outlined business needs.

Bidders should review the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) Chief Technology Office’s Secretariat Application Reference Manual (SARM) – attached within Attachment G of this RFR. The SARM was created to provide guidance on standards, technology and tools to be used for EOHHS IT projects.

A1 Security The Bidder may be required to use Commonwealth data and IT resources in connection with its work on the Project.

The Bidder may be required to use Commonwealth personal data under MGL ch. 66A and/or personal information under MGL ch. 93H, or to work on or with information technology systems that contain such data to fulfill part of its specified tasks and shall be expected to comply with the obligations set forth in the Data Management and Confidentiality Agreement (DMCA) attached to the Attachment F, Model Statement of Work, as Exhibit B. For purposes of this work effort, electronic personal data and personal information includes data provided by EOHHS to the Bidder, which may physically reside at a location owned and/or controlled by the Commonwealth or EOHHS or the Bidder.

Care must be taken to safeguard confidential and/or sensitive information that includes Personally Identifiable Information (PII) and Protected Health Information (PHI). Social security numbers, federal tax return information and medical records are some of such confidential or restricted personal information. The Bidder must ensure that confidential data is appropriately protected at all times. Bidders should review the NIST SP800-53 Standards – attached within Attachment F - Model SOW.

The purpose of auditing is to ensure that an application is compliant with the security policy. A security audit is responsible for collecting, analyzing, and reporting event records within the EMR System. Security audit analysis includes real-time review for intrusion detection, and after-the-event review in defense of repudiation claims. In particular all access to PHI data must be captured and recorded. If PHI and/or PII data is added, removed, or changed, the action must be tracked along with who and when the action occurred. Auditing for accessing the application is done by Enterprise Services. However, the application must also keep track of what actions a user performed within the EMR System.

When real data is used in test environment or outside of the protected production demilitarized zone (DMZ), the data should be masked to ensure that data is protected. The standard toolset and approach for Data Masking for EOHHS is the Oracle Data Masking Pack. PII, PHI, and other privacy laws require that certain personal data are to be protected from viewing or other processing by unauthorized parties. Data masking must be applied whenever exporting data from production databases to QA, Systems Test, and/or Development environments or for transmission to outside organizations that do not have approval to access production data. This requirement does not extend to data being loaded into a “production reporting” or “certification” database.

Confidential and sensitive data requires data encryption that covers data at rest (whether on the database or file system or on backups) and in motion / transit (over the network, between network layers). Types of data that require protection include (but is not limited to) PII, Payment Cards Information (PCI), Social Security Information, Income Tax (IRS) data and PHI.

The EMR System is required to protect data at rest and data in motion using appropriate tools and technologies. Oracle Database 11g Enterprise Edition with Oracle Advanced Security option is used in EOHHS to address the following privacy and regulatory compliance issues and requirements for protecting sensitive data on the network, on storage media, and within the database from unauthorized disclosure:

Additional encryption and security tools are also in use for SSL, XML Encryptions, file system encryptions etc.

A2 System Administrator (SA) The System Administration function must include all administrative tasks that will be performed by the System Administrator (SA). The SA must be able to configure features listed under the following requirement categories: user interfaces, reports, alerts, notifications, auditing, user management, dashboards, client and service data management, claims management, imports and exports. The Bidder must describe in detail all SA Functions its solution offers.

A3 Accessibility Bidder’s proposed application must be in compliance with WCAG 2.0 ADA requirements and be Chapter 508 compliant, or obtain a waiver from Executive Office of Technology Services & Security (EOTSS). EOHHS accessibility requirements are specified at: https://www.mass.gov/policy-statement/eohhs-accessibility-policy.

The Bidder is responsible for addressing accessibility problems in any implementation, configuration, or documentation delivered or performed by Bidder, and in any software published by Bidder and delivered under this solicitation.

The Bidder must ensure that accessibility and usability are addressed at every stage of the project. At the commencement of any project under this Solicitation, prior to beginning any significant design or implementation work, Bidder’s project manager shall meet with the Commonwealth’s project managers and appropriate resources to review the Enterprise Accessibility Standards, the AT/IT List, and any accessibility guidance provided by software Bidders, to review their impact on the project. On an ongoing basis, Bidder must incorporate accessibility testing into all test plans, and include users of assistive technology in end user testing.

A4 Software Integrity Controls The Bidder recognizes the serious threat of fraud, misuse, and destruction or theft of data. These threats could be introduced when unauthorized or inappropriate modifications are made to a production system. The Bidder must implement the required controls for the purpose of maintaining software integrity and traceability throughout the software creation life cycle, including during development, testing, and production.

A5 Operations Support The Bidder must provide support for the EOHHS application support team to address the required types of capabilities (Note: it is expected that only a very small number of individuals will be authorized to utilize this help desk).

A6 Integration and Interoperability All modules of the proposed system must be fully integrated, i.e. the data must be centralized and accessible by all service and administrative modules. The system must support interoperability with outside entities such as ACO, and other community health partners.

A7 HIway Service Suite – HIE Service Offerings for EMR\EHR Interoperability Bidders must adhere to required HIE service(s) offerings as identified in Attachment B.

A8 Mobile Device Functionality It is expected that mobile devices will be the primary source of entry for the EMR System. The Bidder’s solution should be able to interface with multiple devices and platforms.

A9 Authentication and Identity Management Mutual SSL authentication, also called certificate based mutual authentication, refers to two parties authenticating each other by verifying the provided digital certificates to ensure the other party's identity. In technology terms, it refers to a client authenticating themselves to a server that hosts a web service and a server authenticating itself to the client by verifying the public key certificate/digital certificate issued by the trusted Certificate Authorities (CAs).

A10 Account Creation and Access Account Creation is the mechanism to obtain secure, role-based access to the system. As part of account creation, the Bidder shall describe in detail its access and identity management processes.

The Bidder must discuss how the Bidder solution would work with EOHHS’ Oracle based Access and Identity Management software (AIMS).

A11 Authorization and Access Control In the EOHHS environment, based on the Separation of Concern (SoC) design principle, the Application Security implementation has been separated from the core application implementation. This separated EOHHS Application Security implementation is AIMS (Access Information Management System), which is an enterprise shared service for Identity and Access Management for EOHHS applications.

A12 System Hosting The Soldiers’ Homes prefer for the Bidder to suggest a hosting solution that optimizes the performance of the Bidder’s proposed solution. Bidders should review Exhibit D: Cloud Procurement Terms in the Attachment F Model SOW for additional requirements that the Bidder would be expected to comply with in connection with its provision of the EMR System.

A13 Data Analytics The Bidder must provide a comprehensive cost modeling, forecasting, self-service analytics and reporting tool that will reduce IT support or intervention for critical and timely client reporting.

Section B – Performance Standards This section is for the Bidder to confirm the systemic quality of the Soldiers’ Homes EMR System. This requirements list is not exhaustive but is intended to capture the most important requirements for Service Level Agreement (SLA) Performance Standards (Table 4 - B1) and other Performance Standards (Table 4 - B2). Bidders must refer to Exhibit D to Attachment F - Model SOW (Cloud Procurement Terms) for additional obligations that the Bidder would be expected to comply with in connection with its provision of the EMR System.

Project Milestones and Deliverables The Soldiers’ Homes have identified the following major milestones for delivery of various components and features outlined in this RFR. Each milestone has a defined scope and will follow its own system development lifecycle. For each milestone, EMR System components will be tested, and released if they pass all types of testing up through and including User Acceptance Testing.

Table 5 Project Milestones and Deliverables

List of Deliverables The Selected Bidder will be responsible for producing, revising and updating the following deliverables at each project milestone in order to accomplish the goals of each milestone:

1. Project Management Plan

2. Project Work Plan

3. Project/Iteration Schedule

4. Quality Assurance and Risk Management Plan

5. System Hosting Plan

6. Business Continuity Plan

7. Data Migration Plan

8. Communication Plan

9. System Testing Plan

10. Environment Plan

11. Security Plan

12. Integration Plan

13. Contingency/Recovery Plan

14. Change Management Procedure Plan and Documents

15. System Design

16. Training Plan and Materials

17. Test Results & Reports

18. Customer Support Services Plan Additional Deliverables The following shall be made available on an agreed upon schedule identified in the project plan:

1. Training Plan and Materials

2. Project Implementation Plan

3. Use Cases Documents

4. User Interface Wireframes

5. System Architecture Document

6. Database Design Document

7. Information Security Risk Assessment

8. User Manuals

9. Operation Manuals

10. Customer Support Services Document Verification and Testing The Selected Bidder must conduct the following verification and tests as appropriate for the system components produced within each milestone:

1. Unit Testing

2. Automated Code Review

3. Integration Testing

4. Regression Testing

5. Functional Testing

6. Performance/Stress Testing

7. Security/Vulnerability Testing

8. Accessibility & Usability Testing

9. Release Dry Run

10. Post Release Validation All deliverables and test results will be reviewed by the Soldiers’ Homes. After review and evaluation of the deliverable, the Soldiers’ Homes’ Project Manager will notify the Selected Bidder’s Project Manager in writing of the acceptance or rejection of the deliverable. Each deliverable will be accepted or rejected within ten (10) business days of its receipt.

System Documentation, Manuals and Training Materials In the course of the EMR development and implementation, the Selected Bidder shall provide a number of documents, manuals, and training materials to…