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1Lincoln-Lancaster County Health Department (LLCHD); Lincoln, Nebraska

Local Public Health Practice Electronic Health Record System

Request for Proposal
INTRODUCTION

We are a City and County-funded Public Health Department located at 3140 “N” Street in Lincoln, Nebraska. The electronic health record software we seek is needed to support clinic, home, and community-based services provided by about 0.60 FTEs of physician services, 28.00 FTEs of public health nursing services, 10.25 FTEs of outreach workers, interpreter, support staff, and other ancillary personnel services, and 8.25 FTEs of service from other professionals, such as, resource specialists, lab technicians, and outreach staff. Concurrent usage is estimated at 35-40.


1 PURPOSE STATEMENT

1.1 To use information technology to support client/patient service activities in a local public health practice by creating an electronic health record (EHR), reducing reliance on paper records, and increasing the capacity to evaluate the effectiveness of services provided based on health outcomes.

1.2 To manage the scheduling, billing and other back office support activities for all direct client/patient services.

1.3 To work with a vendor who is leading the healthcare industry by creating state-of-the-art business practices while employing leading edge technologies.


2 GOALS AND OBJECTIVES

2.1 Off-the-shelf information technology package that utilizes industry standard technology to integrate and automate documentation that supports an EHR.

2.2 Comprehensive, easy-to-use query, reporting, and outcome analysis capabilities that can be tailored by service/program.

2.3 Stable and reliable system that meets current needs, may be easily used to improve operations, and is flexible enough to accommodate future growth and organizational change.

2.4 Minimize the number of automated and manual systems necessary for efficient work, streamline processes, and reduce/eliminate redundant data entry.

2.6 Interoperability using HL7 messaging standards 2.3 or higher, to support the ability to import and export data to/from other agencies/entities.

2.7 Comply with confidentiality and security requirements and administrative simplification standards (HIPAA).

2.8 Planned and orderly migration path to successfully implement the new system.

2.9 CCHIT certified software with a commitment to maintaining the certification.
3 SCOPE OF PROJECT

3.1 Information support for programs and staff who deliver direct client/patient service.

3.2 High level, complex programmability, yet functional and easy for the end-user to access and use at the point-of-service.

3.3 Client/patient information and client/patient management that is easy to navigate through and supports and integrates multiple services and program areas.

3.4 Interoperability: the ability to interface with and exchange data between systems in ways that meet or exceed state and national standards.

3.4.1 Especially important will be the exchange of data with the State of Nebraska’s immunization registry, the importing of data from the State’s Vital Statistics application, and interfacing with the City-supported central registry and the Department’s Dentrix application.

3.5 Supports the development and implementation of client/patient survey tools and critical pathways that tie outcomes to specific care plan goals and interventions.

3.6 Capable of documenting from the field, at a minimum through uploading and downloading, more desirable would be web-based field access.

3.7 Support data entry in a variety of formats, including, for example: point-of-service, batch, and remote access to database in a secure environment.

3.8 Leverages existing network infrastructure in ways that help streamline delivery of services to the public.

3.8.1 Example: an application capable of supporting federally qualified community health center (FQHC) activities and reporting; or one that has a proven track record of interoperability with an FQHC would be considered a significant value-added feature.

3.8.2 Positive track record with local physician practices and/or similar agencies, such as county or state departments of health, would be considered other significant value-added features.


4 GLOBAL REQUIREMENTS

4.1 Support users in a point-of-service environment.

4.2 Capture client/patient enrollment and registration data once, as a precursor to detailed programmatic record-keeping and data analysis and reporting.

4.3 Populate appropriate fields so that data are presented appropriately and the need for duplicate data entry is eliminated.

4.3.1 Example: in the client/patient registration process, data elements (such as, Social Security Number (SSN), gender, date of birth, race, etc) are entered only once and carried forward to all appropriate fields.

4.4 Screens for data entry and retrieval compliment work and business processes.

4.4.1 Example: nurse, as well as, physician can see the client/patient information that either has entered.

4.4.2 Example: once entered, vital signs (VS) or other pertinent data are available for viewing in multiple areas of the record while the service is being provided (VS area, physician notes, etc) and are available to multiple users at the same time.

4.5 Track and support workflow control.



4.5.1 Example: both internal and external referrals to and from department programs and workstations are time/date-stamped for data analysis.

4.6 Scan a variety of types of documents into the system and associate them with the appropriate client/patient EHRs.

4.7 Customer-defined database search capability.

4.8 Query data and create reports.

4.9 Technical environment that facilitates an Internet-ready application and lends itself to wireless connectivity working with an industrial-strength database and topology.

4.10 Software that has been developed from the ground up using the most current technology and utilizing industry-standard languages and database solutions.

4.11 Software that is readily available to adapt to agency-specific requirements and includes industry-standard baseline reporting.

4.12 Supports the development of custom reports using popular reporting tools.

4.13 Other tools and utilities used to manage and support the system are inherent within the product.

4.14 Vendor supports customers with superior telephone support program, on-line help/support ticket systems and has demonstrated strong user-community relationships that include clients in the product direction loop.

4.15 Does not use proprietary languages and/or database solutions that have been developed for, or are limited to, a vendor-specific application(s).

4.15.1 Does not include any application system that has been refaced to have a current technology appearance.

4.16 Desired product will be certified by the Certification Commission for Health Information Technology (CCHIT).

4.16.1 Vendor will have a stated commitment to maintaining certification for the software product.

4.17 Desired product will be HL7 compliant with version 2.3 or higher.

4.17.1 Desired interoperability or interfaces include:

4.17.1.1 State immunization registry

4.17.1.2 State vital statistics system

4.17.1.3 Department central registry (DB2)

4.17.1.4 Dentrix software

4.18 Supports orderly migration of data from pre-existing systems.

4.18.1 Immunization data includes more than 20 years of records (813,500+) in DB2

4.18.2 Encounter data from SQL and Access data bases (26,200+ encounters)

4.18.3 Central registry data (327,250+ records) in DB2

4.19 Product has a proven track record for handling data in a secure, reliable environment that maintains compliance with all current State, Federal, and industry regulatory requirements and code.
5 CORE COMPONENTS

5.1 Appointment scheduling

5.2 Central registry

5.3 Client/patient surveys/questionnaires

5.4 Critical pathways that document client/patient outcomes and associate these with the appropriate critical pathway/care plan goals/actions

5.5 Daily cash handling and billing, including, for both medical and dental services, the ability to:

5.5.1 Generate and print HIPAA standard transactions

5.5.2 Print standard claims using the CMS 150 format, currently-approved by NUCC

5.5.3 Print patient statements

5.6 Health history and other assessments

5.7 Immunizations

5.8 Information & Referral Center/nurse triage telephone line

5.9 Interoperability (Vital Statistics, Central Registry, Immunization Registry, Laboratories, etc)

5.10 Laboratory orders and results data management

5.11 Medication tracking (Prescription Assistance Program)

5.12 Progress notes: multi-factored progress note entry and build feature allowing template point-and-click, free form text, insertion of other documents (such as, MS Word files), voice recognition interface and any codified point-of-care nomenclatures or vocabularies used in a variety of settings and by a variety of disciplines:

5.12.1 Office practice/clinic setting by doctor, dentist, nurse, case manager, lab tech, mental health, etc

5.12.2 Home and community-based settings by nurse, case manager, social work, etc


6 FUNCTIONAL REQUIREMENTS

Although not a comprehensive list of the functional requirements, the following are examples of needed data elements.

6.1 Record, retrieve, analyze, and report on demographics and other pertinent data, such as, date of birth, Social Security Number (SSN), gender, and race/ethnicity, etc

6.2 Client/patient

6.2.1 Add new client/patient record

6.2.2 Automatically assign a unique identifier to a new client/patient

6.2.3 Link all parts of EHR associated with a unique individual

6.2.4 Search database for specific client/patient

6.2.5 Add or correct information for an established client/patient

6.2.5 De-duplicate with ease

6.2.6 Flag a client/patient record with varying levels of confidentiality

6.2.7 Group/ungroup clients/patients into/out of family units

6.2.8 Display family unit, including emergency contact information

6.2.9 Associate client/patient with multiple services and programs

6.2.10 Display historical summary of events, programs, and services by client/patient

6.3 Address/location & telephone numbers

6.3.1 Search/add/update records by address

6.3.2 Collect address/location in various formats

6.3.2.1 Exact address

6.3.2.2 Parsed format

6.3.2.3 Use City database for edit table

6.3.2.4 Collect inexact address in usable format for GIS mapping

6.3.2.5 Track client/patient address and telephone history

6.3.3 Link all records associated with a specific address

6.3.4 Associate location with multiple events

6.3.5 Associate address with multiple persons

6.3.6 Export/use location data for GIS mapping

6.3.7 All addresses auto-populate the city, state, and county fields when user enters zip code

6.3.8 Separate field for area code for all telephone numbers

6.3.8.1 Default area code with value “402" may be accepted or over-ridden at data entry

6.4 Appointment scheduler

6.4.1 Schedule appointments by clinic, an individual provider, or other staff person, program, or event

6.4.1.1 Share schedules between workstations

6.4.1.2 Track client/patient location and services provided to the client/patient while they are at the Department (queuing system)

6.5 Service encounter event

6.5.1 Create a new service encounter record

6.5.2 Automatically assign a unique encounter event identifier

6.5.3 Specify type of service down to the program level

6.5.4 Associate service encounter with site/location(s)/client/patient

6.5.5 Associate a single service encounter with multiple clients/patients

6.5.6 Historical event/encounter information can be reviewed as it relates to a particular client/patient or client/patient group, to a service provided, or to a program area

6.6 Date/time stamp data entry to program area, service, and person entering data

6.7 Care Plan/Case Management/Critical Pathway

6.7.1 Systematically document care plans using Department-established criteria

6.7.2 Link problem/diagnosis to care plan goals/objectives

6.7.3 Document actions, interventions, and outcomes

6.7.4 Link outcomes to problem/diagnosis and care plan goals/objectives
7 DESCRIPTION OF DEPARTMENT CLIENT SERVICES PROGRAMS

7.1 http://www.lincoln.ne.gov/city/health/nurse/index.htm


8 ORGANIZATIONAL CHART

8.1 Attachments A & B


9 PROGRAMS & ACTIVITIES SUPPORTED BY SYSTEM

9.1 Ambulatory Care Clinic, including immunizations, STD/HIV, etc

9.2 Information & Referral Center, including health information and referral tracking, etc

9.3 Laboratory

9.4 Maternal Child Services, at both main clinic and remote sites

9.5 Mass Clinics

9.6 Medicaid Access Coordination, including medical transportation, etc

9.7 Medication tracking and inventory control

9.8 Off-site Service Delivery by multiple programs, including home visitation, etc

9.9 Outreach and Case Management

9.10 Targeted screenings or other activities for groups

9.11 Supports staff efforts for

9.11.1 “One” (0.6 FTE) physician – 24 hours per week of physician-staffed clinics; several physicians provide service on a scheduled rotation

9.11.2 28 FTEs public health nursing services

9.11.3 10.25 FTEs outreach workers, interpreters, support staff, and other ancillary personnel services

9.11.4 8.25 FTEs service from other professionals, such as resource specialists, lab technicians, and outreach staff

9.11.5 Estimated concurrent usage is 35-40
10 ESTIMATE OF ANNUAL SERVICE ACTIVITY

10.1 http://www.lincoln.ne.gov/city/health/annual/2007/CHS_S.pdf


11 TECHNICAL CAPACITY AND INFRASTRUCTURE

11.1 The Lincoln-Lancaster County Health Department (LLCHD) Client Registry application currently operates on a multi-platform environment utilizing an IBM Enterprise Server running the z/OS operating system located at the City Information Services office at 233 South 10th Street; Lincoln, Nebraska.

11.2 The Client Registry application utilizes DB2 as the Database Server Software and CICS Transaction Server Software.

11.3 Community Health Services and Health Promotion staff use approximately 80 of LLCHD’s 220 microcomputers.

11.3.1 The microcomputers connect to the mainframe via a 3270 emulation product.

11.4 Network connects to the IBM mainframe utilizing fiber optic communications.

11.5 Internal network is comprised of a routed/switched Ethernet network with a gigabyte backbone supporting Ethernet.

11.6 LLCHD has a satellite office at 2662 Cornhusker Highway in Lincoln, Nebraska that is connected via a high speed connection to the City Information Services office and back to LLCHD via fiber.


12 SERVERS AT LLCHD

12.1 Novell Server

12.1.1 Compaq Proliant ML530 2.4 ghz

12.1.2 Network file server and network drives

12.1.3 NDS tree/security

12.2 Windows 2000 Server

12.2.1 Compaq Proliant DL380 G3 2.8 ghz

12.2.2 Windows 2000 server

12.2.3 Windows Domain member server

12.2.4 IIS 5.0

12.2.5 SQL Server 2000

12.2.6 Crystal Reports XI

12.2.7 Crystal Enterprise XI

12.2.8 Microsoft.net and Visual Studio.net

12.3 ARCIMS Server

12.3.1 Compaq Proliant DL380 G3 3.2 ghz

12.3.2 Windows Domain member server

12.3.3 IIS 6.0

12.3.4 Windows 2003 server

12.3.5 ARC IMS 9

12.3.6 Smart Array Controller 6402/128

12.4 Dentrix Server

12.4.1 Compaq Proliant DL38065 3.0 ghz

12.4.2 Microsoft SQL Server 2000

12.4.3 Windows Server 2003

14.4.4 Smart Array 20 Modular

14.4.5 Smart Array Controller 6402/128
13 SERVERS AT CITY INFORMATION SERVICES

13.1 http://www.lincoln.ne.gov/city/finance/dp/admin/profile.htm





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