Section 3.4 Select

Soliciting Bids for EHR and HIE – RFI, RFB, RFP

This document describes the steps to take and provides tools to help your local public health (LPH) department acquire electronic health records (EHR), health information exchange (HIE) services, and other health information technology (HIT) applications.

Time needed: 12 – 16 hoursSuggested other tools: 2.3 Visioning, Goal Setting and Strategic Planning for EHR and HIE

How to Use Review the information in this tool and apply the recommended steps and template, in the order suggested, as you look for a vendor for your EHR, HIE services or other HIT.

Preparation for Vendor SelectionVendor selection for any major HIT purchase, including EHR and participation in an HIE organization (HIO), should not be started until your organization thoroughly understands the nature of EHR and HIE, establishes goals for what these technologies should accomplish, assesses its readiness for the new HIT, and analyzes workflows and processes in order to specify and prioritize requirements. Once these steps are accomplished, you are ready to solicit and analyze bids and perform due diligence in order to select the vendor with whom you will negotiate a contract.

Soliciting BidsThe formality of your solicitation of a bid for products and services varies depending upon what you are acquiring, and whether there are any relevant governmental regulations. In general, there are three approaches:

Request for information (RFI). This may be as informal as a call to a vendor to send you a price quote for a specific product or service, or it may be a written request stating briefly who you are and what you are looking for. In the past, the RFI was a formal request for specifications on various products in which you are interested. Because of the widespread availability of this information on the Web, RFIs are no longer are used for this purpose.

Request for bid (RFB). This is a written request for product information or information on services that the vendor can provide based upon your key requirements. Your resource for preparing the RFB should be a Requirements Analysis and Prioritization for EHR and HIE (see Section 2.10). However, you do not want to reveal your priorities to the vendor. You will want to supply the vendor with information on the nature of your organization, size, volume of clients, which HIOs you may connect with, and any other information you think the vendor needs to be able to supply you with a realistic price quote.

Request for proposal (RFP). This is a formal, detailed document that describes all of your requirements and requests formal, structured proposals from vendors. Many government-sponsored organizations are required to issue RFPs, and in some cases you must issue the RFP to all potential vendors in the marketplace. You will probably find that there are only a small number of vendors serving the LPH department EHR marketplace, and most of them are small.

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

Few of these vendors are inclined to respond to a formal RFP. Be sure to seek guidance on the form of the solicitation and number of vendors you must include.

Request for BidUse the following template to describe the products and services you are seeking. Send these to between four and six vendors who you have identified as potentially having the product you seek.Date:Re: Request for Bid for Insert Description of ProductDue Date for Response: Designate a date by which you would like a bid returned.To: Obtain name of regional sales manager and address in your area.From: Include the name, address, phone number, and email address of the individual in your organization who will be responsible for all communications with vendors.Additional Instructions for Responding to this RFB:Include directions concerning limitations on contacting organization, number of copies of responses to be supplied via paper and/or preference for electronic submission, instructions for vendors to request additional information, etc.

A. Background and Information1. Overview of Organization – briefly describe:

Number of clients per year: Number of staff:

2. Special characteristics of organization 3. Overview of Current IT Environment

Extent networked – locally/to other sites: Wireless capability: Internet Service Provider: Web site URL:

4. List of software applications currently in place

B. Vendor Information1. Vendor primary contact

Name: Title: Office/location address: Email address: Organization’s Internet home page:

2. Identify the location of the following if different from above: Corporate headquarters: Field support offices:

3. Briefly describe your company in terms of number of staff, proportion of staff devoted to sales and marketing vs. implementation vs. research and development, how long the company has been in business, and alliances and partnerships (e.g., do you partner with another vendor to supply knowledge databases, report writing tools, HIE, etc.).

C. Product Information1. Describe the major version history for the product being sought through this RFB, including the release proposed for this organization and any other planned new releases.

2. How are enhancement and new release priorities determined? How are clients supported during these releases? How much system downtime is required during these upgrades?

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

3. In how many organizations similar in size to our organization did you install the system you are proposing during the last fiscal year?

D. References1. Provide references for at least three organizations similar to. 2. Supply information about (and invitation for if applicable) the next user group meeting you are

holding.

E. Product RequirementsFor each of our requirements specified below, identify whether it is available in your product and a brief description or other notes to help us understand how your product fulfills the requirement.

Requirements for _____________ Available?(Y/N)

Description/Notes

1. Insert your list of requirements from Section 2.10 Requirements Analysis and Prioritization for EHR and HIE in this first column.

2.3.4.

Technical Requirements1.2.

Operational Requirements1.

Transitional Requirements1.2.3.

F. Price Proposal Provide—in a separate response—a pricing proposal for the software, implementation, interfaces, and hardware as described in our profile. In the pricing proposal, specify how your products are priced. If you do not supply certain capabilities or technologies, acknowledge these and specify any recommendations.Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

RFB Response AnalysisOnce you send requests to vendors, allow four to six weeks to receive responses. During this time

ensure that only one person serves as the communication point with vendors so that all vendors are treated the same. Vendors have many ways of attempting to ingratiate themselves within your organization to cultivate internal sales people.

Once all bids are received, review all but the sealed price proposals thoroughly, using your EHR steering committee and/or representative team of staff members. Have the CFO or other designated staff member

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

review the price proposals to determine if any vendor appears completely out of line. However, do not bias the rest of the reviewers with pricing information. All HIT prices are negotiable. Higher-priced products may have functionality that will provide a higher return on investment; or a product may have functionality that you would have bought as a separate product, making the single product lower in price than the two combined.

It can be helpful to use a comparison tool as illustrated below to score each product:

0 = product does not address the requirement and there is no indication that it will in the future1 = product does not incorporate the requirement today but appears likely to in the near future 2 = product is marginal and lacking in some but not all aspects of the requirement3 = product is satisfactory in terms of the requirement 4 = product fully meets or even exceeds requirement

Vendor Bids: A B C D EFunctional Requirements PriorityList these from your requirements specification/RFB sent to vendors

Technical Requirements

Operational Requirements

Transitional Requirements

Copyright © 2014, Margret\A Consulting, LLC. Use with permission of author

Making the First CutBased on the analysis of the bids, you should be able to narrow the field of vendors to two or three. Note: your review group should still not review prices. Unless there is one vendor that the CFO has deemed completely out-of-line with all others, prices should not be a factor at this time.

Communicating with VendorsOnce you have narrowed the field, you may want to contact the rejected vendors. Many organizations prefer to make some contact to avoid distracting calls from vendors who want to know whether they can conduct product demonstrations, etc. From this point forward, do not communicate further with these vendors. You do not need to elaborate or explain your decision.

Conduct Due DiligenceDue diligence refers to further evaluation of a select few vendors. Ideally after each form of due diligence is concluded by the review group, one or more vendors can be rejected to further shorten the list. It can be helpful to use a version of the tool above for each form of due diligence. Due diligence may include:

Product demonstrations Arrange for either a Web-based or in-person demonstration that is tailored to your specific requirements. You should be able to ask questions, be shown alternative pathways, and discuss different options.

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

Site visits. Although site visits mean that travel costs must be incurred, consider using site visits if it is becoming difficult to differentiate between products. Because most sites will not “expose their dirty laundry” during a site visit, many facilities find that focusing on reference checks yields as much information and more people can be contacted.

Reference checks should be performed for all vendor products you consider close to being finalists. Reference checks should focus on questions you have that have not been addressed in other forms of due diligence, or for which you are getting conflicting information. Reference checks can also be great resources for tips on implementation. The vendor should supply you with a complete list of references. If the list is limited, this may be telling in itself. You may need to work your own personal network to find additional references. It is advisable to use a tool to structure your reference check interviews so you don’t forget any key points. Note that the tool below includes a few similar questions asked in slightly different ways. This strategy enables you to “break the ice” at the start of the conversation and then re-ask questions at the end after rapport has been established—usually yielding more complete answers.

Reference Check Guide

Site: _______________________________ Host: ___________________ Product: ______________

Person(s) contacted at reference site: _________________________________________________

Caller(s) from your organization: ____________________________________ Date: ____________

Establish similarity with your organization and learn about implementation:Verify which of the following reference criteria are met by this call:

Similar client volume Similar number of staff Similar in type of services

Same base systems as Other similar source systems Same version of product applicable

Establish basic understanding of the organization’s level of implementation and adoption:1. Is the application fully deployed – all components for all users? If not, why not?

2. What other products from this vendor and others do you have installed?

3. Did you have to upgrade any other aspects of your existing IT in order to use the product, such as your network, input devices, and other applications?

4. What do you like most about the product you acquired from this vendor?

Determine how successful the implementation was:5. How long did the vendor take to begin implementation after the contract was signed?

6. How long did the vendor take to fully implement once the implementation began?

7. Describe the staff you needed from your organization to support the implementation. How many people? What skills? What were their primary roles? How much did you customize the application?

8. How long did users take to learn how to use the system with full competency?

9. What training methods did you use to successfully get users into a productive mode quickly?

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

10. If you had to do the implementation over again, what would you do differently?

11. What does your organization like least about the product, and what have you had the most problems with? How did the vendor respond to your concerns?

Learn about ongoing maintenance and use:12. What kind of staff/contractor(s) do you have on an ongoing basis to maintain and enhance the use

of the application?

13. Does the vendor supply regular upgrades? Is the vendor responsive to requests for changes?

14. When you have had to contact the vendor for support, how long did it take for a response that resolved the issue?

15. What savings have you achieved with the implementation of the product, and how did you go about achieving them?

16. Is there an enhancement to the product that the vendor has been promising but has not delivered that we could include as a contractual condition for us that might also benefit you?

17. Is there anything else that you would like to tell us about your experience with the product? Any lessons learned or good advice?

Follow up on any specific questions from demos or site visits:

Copyright © 2014, Margret\A Consulting, LLC. Use with permission of author

Select Finalist with Whom to Negotiate ContractFollowing thorough due diligence you may well find that one vendor stands out. But, if you identify more than one comparable vendor, consider the following:

Which vendor has the best track record of successful adoption? In the end, you must get users to use the product. This may mean a slightly higher price, a bit more time to implement, or lowering some expectations in certain other areas.

Which vendor “feels right” to you? You are essentially going into a long term relationship with this vendor and you don’t want to be in an adversarial relationship. Listen to your gut.

Evaluate the pricing of finalist vendors. Do not look just as higher costs; also look at lower costs because these could be flags that a vendor is not supporting the highest-performing or newest hardware. Highlight any price issues for discussion during your contract negotiations.

Contract NegotiationMany organizations in the health fields are either unaware that HIT contracts are negotiable; or find the process foreign and distasteful. However, all HIT contracts are negotiable—and must be negotiated. Furthermore, terms are negotiable, as well as costs. Many vendors overlook necessary components to their contract, such as confidentiality provisions.

Consider hiring an HIT contract negotiation specialist if you are not comfortable negotiating a contract. Also, any major contract should be reviewed by your attorney. For those unfamiliar with contract negotiation, refer to other HIT, EHR, and HIE toolkits from Stratis Health for comprehensive guidance on contract negotiation, available at http://www.stratishealth.org/expertise/healthit/index.html.

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1

Copyright © 2014 Stratis Health. Updated 03-12-14

Section 3 Select—Solicting Bids for EHR and HIE – RFI, RFB, RFP- 1