Request for Information

West Virginia Health Information Network Health Information Exchange Request for Information

Version 1.0
Prepared by Prepared for Version Released Document Status Christopher R. Clark and Jack L. Shaffer, Jr. WVHIN Technology Committee June 24, 2008 Final

SUMMARY: On behalf of the West Virginia Health Information Network (WVHIN), responses are sought regarding the implementation of an interoperable health information exchange framework throughout the state of West Virginia. This Request for Information (RFI) addresses the goal of interconnecting clinicians and other data sources by seeking solutions for how interoperability of health information technologies and health information exchange can be achieved in the state of West Virginia. Use cases and requirements are presented below in this RFI to inform respondents of the type of data exchange a proposed framework should be able to achieve. The purpose of this Request for Information is to identify solutions and provide WVHIN with estimated pricing, requirements, and ideas that best fit the state of West Virginia. Responses to this RFI will be carefully reviewed and a more detailed Request for Proposals will be prepared based on the feedback received. The RFP will be sent to selected, qualified respondents. As part of the qualifying process, respondents may be asked to provide a demonstration of their proposed solutions based on the criteria listed in this RFI. DATES: Responses must be submitted to WVHIN on or before 5:00 P.M. ET Friday, August 1, 2008.

SCHEDULE OF EVENTS: Respondents are expected to fully participate in the Schedule of Events. EVENT
WVHIN releases RFI

DATE
June 24 July 7 July 14 July 25 August 1

Time period to submit questions to WVHIN Responses provided to questions via email RFI responses due

ADDRESSES: Electronic responses are required and should be addressed to WVHINRFI@hcawv.org. Include WVHIN HIE RFI Responses in the subject line. Non-electronic responses will not be accepted.

WVHIN RFI

FOR FURTHER INFORMATION: Questions from potential responders will be accepted via email at WVHINRFI@hcawv.org. Responses will be provided on or before July 25th. Additionally, a public, online Frequently Asked Question (FAQ) page will be provided by e-mail. BACKGROUND: The West Virginia Health Information Network (WVHIN) was established in 2006 by the Legislature at the request of the Governor to promote the design, implementation, operation and maintenance of a fully interoperable statewide network to facilitate public and private use of health care information in the state while ensuring the privacy and security of patient health care information. It is a public-private partnership for the benefit of all of the citizens of West Virginia. The network is envisioned to support and facilitate the following types of electronic transactions, activities and systems: Secure electronic access to the results of laboratory, X-ray, or other diagnostic examinations and medical record information transfer to medical providers with the patient's consent Disease management and disease surveillance and reporting Health alert systems and other applications related to homeland security Registries for vital statistics, cancer, case management, immunizations and other public health registries Educational offerings for health care providers including links to evidence-based medical practice and patient educational materials Physician order entry, prescription drug tracking, drug and allergy interaction alerts, and secure electronic consultations between providers and patients; Single-source insurance credentialing system for health care providers; Electronic health care claims submission and processing; and any other electronic transactions or activities as determined by the legislature.

USE CASE DESCRIPTIONS:

Responses should address a phased plan that includes the following high priority use cases. Responses need to address both the ability to meet proposed use case functionality and requested information pertinent to each use case. A. Clinical Messaging/Results Delivery The WVHIN plans to deliver clinical documents from hospitals, labs and/or other providers via standardized messages to the ordering physician and other physicians of record for the

WVHIN RFI

patient. Beginning phases should include results delivery directly to ordering physicians and expand to include two way communications between providers in both inpatient and outpatient settings. This use case is initially defined to provide the following types of results: Laboratory ordering and results from laboratory service providers Radiology ordering and reports from radiology service providers Admissions notifications and discharge summaries from hospitals and other ADT encounter data Encounter information and physician notes from outpatient facilities o Patient discharge summaries. o Diagnoses, results and physician notes required to facilitate referrals, consults and transfers in care including: To or from acute care hospitals Skilled nursing facility Rehabilitation facility Home health services Between primary care and specialty services Between physical and behavioral health services Order entry functionality for outpatient labs, radiology, and other services Electronic forms-based communication for public health reporting, prior authorizations, etc.

B. Clinical Results Retrieval The WVHIN plans to allow providers to search for patients and retrieve clinical documents from across multiple participating sources. Through use of appropriate patient and provider identification, the WHIN would assist providers, in both ambulatory and inpatient settings, in obtaining needed patient information. This is considered technology whereby a physician can search for results on patients for which they did not place the orders. This use case is initially defined to provide access to the following types of results: Lab reports from laboratory service providers Radiology reports from radiology service providers Discharge summaries from hospitalizations and ED visits Treatment encounter data admission dates, discharge dates, and other ADT information Encounter information and physician notes from outpatient facilities Allergies Immunization data from the state Prescription drug histories from the following potential sources: Payers/PBMs, Pharmacies, Hospitals/providers, RxHub/SureScripts/other clearing houses

Responses should also address:

WVHIN RFI

Use Cases for Consideration in Future Phases E-prescribing enhancements WVHIN supported enhancements to eprescribing technology allowing physicians to electronically write and communicate drug prescriptions, track and monitor patient medications and receive drug related decision support at the point of care. Emergency Department Communications WVHIN functionality focused on the improved clinical information availability and communication between regional emergency departments. Administrative Communications WVHIN functionality focused on the standardized transfer of claims related data between payers and providers. Includes e-billing, eligibility monitoring, insurance benefits and deductible determination. State Public Health Integration Functionality allowing for both outgoing and incoming messages between the WVHIN and state public health agencies and systems (e.g. immunization registries, disease surveillance, syndromic surveillance) Quality Performance Functionality allowing the use of longitudinal data, advanced tools, quality indicators and data from multiple sources to enhance chronic disease management, preventive care, and pay for performance efforts. Emergency Responder Timely electronic access to critical health information related to assessment, stabilization and treatment of the victims of emergency incidents. Personal Health Record Functionality allowing patients to access clinical and billing data via web portals as well as the ability to securely request medication refills and communicate with physicians. Reporting Functionality to allow the reporting of quality measures and ad hoc reporting of clinical information. Research Functionality that allows de-identified data to be used for academic research and clinical trials.

WVHIN RFI

Please address the following questions as they relate to the proposed development of a health information exchange solution. General 1. Please provide a key point of contact to coordinate any follow-up or questions that the team may have regarding your response. 2. Please provide an executive summary containing an overview of previous experience with health information exchange technology, all major points detailed in the RFI and an explanation of how the proposed solutions strategy addresses the key principles described. 3. Please describe and/or provide a visual representation of how your system will meet the various workflows described in the use case and how each component of your proposed solution is utilized throughout the workflow. Additionally please respond to the questions posed for each use case. Also, please describe the differences in workflow between the state vs. regional/entity processes. 4. Please describe your strategy for historical data loading, including services offered and recommendations. 5. Please indicate your willingness to agree to the terms and conditions specified on form WV-96 attached. 6. Please supply a copy of your standard contract language for purchase and ongoing maintenance and support. 7. Please indicate the quantity of training materials for physicians using the system and the media that these materials are available. 8. Please discuss the nature of your solution from an intellectual property perspective. Do you retain all rights to all source code and enhancements? Please discuss how your source code is maintained and secured. 9. Please indicate your experience working effectively with other vendors as a team to provide innovative community and state solutions. Questions related to Use Case A 9. Describe how the proposed solution would preserve, augment or replace existing lab ordering and result posting functionality in physicians offices. 10. The delivery of information to physicians will depend upon the technology they have available. Some options that have been considered include: a. Messaging to a secure e-mail results inbox;

WVHIN RFI

b. Messaging to an existing electronic Medical Record (EMR) clinical application; or c. Electronic or paper facsimile (fax) or dedicated printer. Describe how the proposed solution would support each of these options. Describe the feasibility/practicality of each option. 11. Please describe whether your solution has limited EMR-like functions (e.g. electronic inbox with physician work flow tools) and elaborate on its functionality. 12. Please describe whether your solution allows for the secure forwarding of clinical messages between providers. Questions related to Use Case B 13. Patient authorizations / identification a. Describe how the solution would verify and manage authorizations for information, patient release of information etc. 14. Patient search functionality a. Describe technologies utilized to confirm patient identification. How is certainty presented to the provider? Describe search logic. b. Describe the process and sources utilized to produce the most reliable complete and cost efficient patient history. c. Describe how validity of information is determined d. Describe how information / encounters would be updated by multiple providers across the exchange 15. Please describe the Record Location Service (RLS) functionality of your product. 16. Please describe the Master Patient Index (MPI) functionality of your product. General Technical Requirements 17. Please provide and describe a technical architecture including major design principles and elements i.e. Federated/Centralized/Software as a Service (SaaS, etc. 18. Please clearly describe the hardware, software, operating systems, and database requirements that your proposed solution requires from data user, data provider, and system administrator perspectives. Include in your response any product names included in your proposed solution including vendor, version, current release and a description of how each product or component fits into the overall architecture. 19. Define how your solution interfaces to existing source systems. List which data types your solution can handle and which data standard formats you would support. Include how information can be captured as well as disseminated from your solution.

WVHIN RFI

20. Discuss your solutions ability to provide a single-sign-on solution integrating to hospital and other health care providers existing web portals as well as linking to existing hospital PACS systems from within the solution. 21. Please discuss your solutions ability to serve as an input mechanism for a clinical data warehouse. 22. Describe in as much detail as possible the hardware requirements for a statewide HIE such as the WVHIN. (See www.hcawv.org and http://www.wvdhhr.org/ohflac/ for numbers of providers) Privacy/Security 23. Please describe how your solution ensures the privacy, confidentiality, and security of patient information from technical and functional perspectives. Include in your response details regarding compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) 24. Please indicate how your solution would assist in creating / obtaining the necessary inter-entity agreements needed to share data of this nature. 25. Describe the level of information available in the solutions audit trail and the process for HIE utilization and reporting of the audit trail. 26. Please describe whether your solution will allow consumers to opt-in or opt-out of having their information shared by the HIE and the ability to segregate and identify certain types of health information that can and cannot be shared and the level of granularity of consent (e.g. at the individual lab result or document, document type, or all or none). 27. Please discuss your solutions ability to conform to current SAMHSA rules regarding the transmission of substance abuse information. Standards 28. Please indicate how your solution ensures compliance with accepted standards in electronic communication including where possible references to the following standards organizations. a. Health Level 7 (HL7) Please list specification(s)/version(s) supported. b. Public Health Information Network (PHIN) c. Healthcare Information Technology Standards Panel (HITSP) c. National Institute of Standards and Technology (NIST) d. International Organization for Standardization (ISO) e. American Society for Testing Materials (ASTM) f. Federal Public Key Information Policy Authority (FIPS)

WVHIN RFI

g. Healthcare Information and Management Systems Society (HIMSS) h. Liberty Alliance i. Request for Comments Series j. American National Standards Institute (ANSI) k. The Open Group (TOG) l. Object Management Group (OMG) Interoperability and Extensibility 29. Define how your solution interfaces to existing source systems (please list vendors and versions see #32). List which data types your solution can handle and which data standard formats you would support. Include how information can be captured as well as disseminated from your solution. Be sure to address how integration will occur for providers that are the least technologically advanced (i.e. paper-based) to the most advanced (i.e.paperless) 30. Please describe any Application Programming Interfaces (APIs), Software Development Kits (SDKs) or other tools available for third-parties to extend the functionality offered by your solution as well as the ability for users or administrators to create and modify forms, menus, rules and reports. 31. The WVHIN expects that providers will have an extremely diverse range of technical capabilities and systems in their organizations. To support sharing of data among these disparate systems, a flexible architecture will be required that can take advantage of these existing systems and provide redundancy. Additionally WVHIN believes that the architecture should communicate via public network services (i.e. the Internet) to avoid the creation of additional infrastructure for the exchange. Service Oriented Architectures (SOA) are useful in unifying business processes while accomplishing these goals. Please describe your solutions approach to interoperability and service oriented architectures. 32. Please list which EMRs, Practice Management Solutions, PHRs, and Laboratory systems that your system currently interfaces. Please indicate approximate costs. Scalability 33. Please describe how the system would be deployable to additional organizations in a scalable manner and the incremental technical, financial, and operational implications associated with system expansion at both data provider (federated) and administrative (central) levels. Describe the ongoing support and maintenance that will be necessary for your solution at both the statewide and regional level. Include the estimated pricing and costs associated with each component. 34. Please describe how the system would be deployable to additional organizations in a scaleable manner and the incremental technical, financial, and operational implications associated with system expansion at both data provider (federated) and

WVHIN RFI

administrative (central) levels. Describe the ongoing support and maintenance that will be necessary for your solution at both the statewide and regional level. Include the estimated pricing and costs associated with each component. Implementation 35. Please attach a sample project plan that includes typical project tasks, milestones, estimated timelines, and required resources (indicate if task is typically staffed with respondent-supplied implementation team, client team, or third party resources). Please reference management procedures and tools used to track implementation timelines, manage and resolve issues, and maintain project documentation. Please indicate implementation services that are typically included and those that can be purchased on a fee basis. 36. Please describe the recommended technical and end user training / education including documentation, approaches, modules offered, and services that would be offered. 37. Please describe how your solution and its implementation facilitate physician adoption. Include how the proposed solution will incorporate and compliment existing provider workflows. Be sure to include details related to ease of use particularly in the area of patient searches 38. Describe your ability and timeline to demonstrate your proposed solution to the project team. 39. Please describe your proposals approach with regards to intellectual property and source code management. 40. Please describe your organizations commitment to and experience with open source solutions and initiatives. 41. Discuss the number of current employees and your companys capacity to install a statewide health information exchange. 42. Please discuss your implementation strategy ASP, web based, federated/central data repository/ hybrid. 43. Please discuss your ability to establish extended test and demonstration systems for the WVHIN and whether you will be available to provide live system access for the RFQ/RFP phase. Patient and Provider Identification

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44. Please describe your proposals approach to provider identification, credentialing and verification. Please include the following scenarios of providers seeking healthcare information: a. Physician previously credentialed by HIN with established patient relationship b. Physician credentialed by HIN, no established relationship c. Physician not credentialed by HIN without established patient relationship 45. Please describe your proposals approach to maintaining accurate patient identification across organizations 46. Describe how your proposed solution integrates with any third party vendor for a) identity management b) record locator services. If your solution provides a tool for a) identity management b) record location services are you required to use that specific tool? Please describe. Maintainability 47. Please describe the level of support and maintenance required for your proposed solution. Include in your description the types of services required to keep the solution operational, hours of operation for support, support contact methods, response times, whether support is outsourced, and any other information that may be valuable to WVHIN. Financial / Total Cost of Ownership 48. Please provide an estimated cost model to purchase/develop, implement, and operate your proposed solution including unit costs based on key variables such as data users, source systems, interfaces, and the pricing scales based on those key variables 49. Please provide any references to cost reductions or return on investment associated with your proposed solution. 50. Please indicate previous experience with sustainable funding models associated with your solution. 51. Describe the anticipated resources and costs required to support the development, implementation, and operations of your proposed solution to supplement the model you provide in question #48. Please differentiate between the data provider, data user, vendor, and system administrator components. 52. In addition to the above, respondents are encouraged to propose alternative pricing approaches that may be advantageous to a statewide HIE and the respondent. For each pricing approach proposed, respondents must clearly state all assumptions underlying your pricing response (i.e., charge basis, charge variances and sensitivities, etc.). Please list any other considerations for purchasing.

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53. Please provide a current version of the companys financials. 54. Please discuss any planned changes in company ownership. 55. Are there any pending legal actions against your company? 56. What are your research and development plans for new software? 57. Please indicate your experience in developing creative funding models to allow time for the HIE to scale up to sustainable levels. Performance, Reliability and Availability 57. Describe the system performance for the proposed solutions. In addition to the items below, list any requirements and other factors that could influence performance of the system. a. Response time for the types of transactions mentioned in the above use cases (average, maximum) b. Capacity (for example, the number of concurrent customers or transactions the system can accommodate) c. Average system response time after user input d. System safeguards that prevent users from severely degrading system performance or hanging the system (e.g., searches that return a large number of records) 58. Address the following questions regarding system availability: a. Describe your applications availability in terms of redundancy or fault tolerance. b. What are the implementation requirements for maximum system availability? c. Does the application allow for a limited mode of operation (e.g. continued operation in event of a disaster)? d. Describe aspects of the system that allow continued usability when certain services or entities are not available (offline), or become unavailable during communication. 59. Please discuss the business continuity / disaster recovery that your company has designed around your HIE solution. National Health Information Network (NHIN) Concerns 60. How would the system conform to the architectures and standards utilized by the NHIN pilots established by the ONC?

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61. Looking to the future how will your solution integrate with other regional HINs in West Virginia and NHIN? 62. How would the WVHIN system conform to the architectures and standards utilized by the NHIN pilots established by the ONC? 63. Please list and describe data standards that your proposed solution currently supports at each phase of the workflow. History / References 64. Please provide a brief summary of your company along with previous health information exchange experience. Include descriptions of any other companies or groups that will be included in your proposed solution. Please include 3 current references. The organizations may be contacted by the team without prior notice.

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WV-96 Rev. 10/07

AGREEMENT ADDENDUM

In the event of conflict between this addendum and the agreement, this addendum shall control: 1. 2. 3. 4. DISPUTES - Any references in the agreement to arbitration or to the jurisdiction of any court are hereby deleted. Disputes arising out of the agreement shall be presented to the West Virginia Court of Claims. HOLD HARMLESS - Any clause requiring the Agency to indemnify or hold harmless any party is hereby deleted in its entirety. GOVERNING LAW - The agreement shall be governed by the laws of the State of West Virginia. This provision replaces any references to any other States governing law. TAXES - Provisions in the agreement requiring the Agency to pay taxes are deleted. As a State entity, the Agency is exempt from Federal, State, and local taxes and will not pay taxes for any Vendor including individuals, nor will the Agency file any tax returns or reports on behalf of Vendor or any other party. PAYMENT - Any references to prepayment are deleted. Payment will be in arrears. INTEREST - Should the agreement include a provision for interest on late payments, the Agency agrees to pay the maximum legal rate under West Virginia law. All other references to interest or late charges are deleted. RECOUPMENT - Any language in the agreement waiving the Agency's right to set-off, counterclaim, recoupment, or other defense is hereby deleted. FISCAL YEAR FUNDING - Service performed under the agreement may be continued in succeeding fiscal years for the term of the agreement, contingent upon funds being appropriated by the Legislature or otherwise being available for this service. In the event funds are not appropriated or otherwise available for this service, the agreement shall terminate without penalty on June 30. After that date, the agreement becomes of no effect and is null and void. However, the Agency agrees to use its best efforts to have the amounts contemplated under the agreement included in its budget. Non-appropriation or non-funding shall not be considered an event of default. STATUTE OF LIMITATION - Any clauses limiting the time in which the Agency may bring suit against the Vendor, lessor, individual, or any other party are deleted. SIMILAR SERVICES - Any provisions limiting the Agency's right to obtain similar services or equipment in the event of default or non-funding during the term of the agreement are hereby deleted. ATTORNEY FEES - The Agency recognizes an obligation to pay attorney's fees or costs only when assessed by a court of competent jurisdiction. Any other provision is invalid and considered null and void. ASSIGNMENT - Notwithstanding any clause to the contrary, the Agency reserves the right to assign the agreement to another State of West Virginia agency, board or commission upon thirty (30) days written notice to the Vendor and Vendor shall obtain the written consent of Agency prior to assigning the agreement. LIMITATION OF LIABILITY - The Agency, as a State entity, cannot agree to assume the potential liability of a Vendor. Accordingly, any provision limiting the Vendor's liability for direct damages to a certain dollar amount or to the amount of the agreement is hereby deleted. Limitations on special, incidental or consequential damages are acceptable. In addition, any limitation is null and void to the extent that it precludes any action for injury to persons or for damages to personal property. RIGHT TO TERMINATE - Agency shall have the right to terminate the agreement upon thirty (30) days written notice to Vendor. Agency agrees to pay Vendor for services rendered or goods received prior to the effective date of termination. TERMINATION CHARGES - Any provision requiring the Agency to pay a fixed amount or liquidated damages upon termination of the agreement is hereby deleted. The Agency may only agree to reimburse a Vendor for actual costs incurred or losses sustained during the current fiscal year due to wrongful termination by the Agency prior to the end of any current agreement term. RENEWAL - Any reference to automatic renewal is hereby deleted. The agreement may be renewed only upon mutual written agreement of the parties. INSURANCE - Any provision requiring the Agency to insure equipment or property of any kind and name the Vendor as beneficiary or as an additional insured is hereby deleted. RIGHT TO NOTICE - Any provision for repossession of equipment without notice is hereby deleted. However, the Agency does recognize a right of repossession with notice. ACCELERATION - Any reference to acceleration of payments in the event of default or non-funding is hereby deleted. CONFIDENTIALITY: -Any provision regarding confidentiality of the terms and conditions of the agreement is hereby deleted. State contracts are public records under the West Virginia Freedom of Information Act. AMENDMENTS - All amendments, modifications, alterations or changes to the agreement shall be in writing and signed by both parties. No amendment, modification, alteration or change may be made to this addendum without the express written approval of the Purchasing Division and the Attorney General. VENDOR Company Name: _______________________________________ Signed: _______________________________________________ Title: _________________________________________________ Date: ________________________________________________

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ACCEPTED BY: STATE OF WEST VIRGINIA Spending Unit: _________________________________________ Signed: _______________________________________________ Title: _________________________________________________ Date: _________________________________________________