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Vendor Selection Process

In this document we describe the rationale and process that underpins our Electronic Health Record (EHR) vendor selection process. Our aim was for complete transparency and fairness to the vendors and the Providers while offering the Providers the best value for their investments in EHRs. In addition, the Ponce School of Medicines process is an open one for Vendors, so that Vendors may opt to apply or reapply as time goes on. Vendors appearing on our list are those chosen as participating vendors and the list is not exclusionary. A. Background We understand that EHR vendor selection is one of the most important services the Regional Extension Center (REC) can perform in support of the Providers. Most Providers have neither the technical skills nor the time to sort through the myriad of EHR offerings and vendors to select the one best suited to their needs. A mistake in the selection of a vendor by a Provider can be both costly and disruptive, potentially leading to failed implementations. It is essential therefore; that the REC invests the resources to screen the EHR vendors to select those best able to meet the diverse needs of the Providers. The REC is in a position to apply more sophisticated technical and financial analyses as well as to capitalize on its experience in order to select a manageably small group of EHR vendors from which the Providers can choose. In addition, since the PSM REC plans to be actively engaged in supporting both the implementation of the EHRs and the maintenance of them, it is important to establish standards that participating vendors must meet in order to qualify as a participating vendor. In addition to the profile of the vendors and the technical attributes of their EHR system offerings, there are external issues that are brought to bear on the selection process. Chief among these is the need for a vendors EHR system to be ONC certified. That is, it must comply with a series of national standards that pertain to a wide range of technical and functional capabilities. Secondly, we required participating vendors to agree to a standard set of terms and conditions that the REC drafted in order to qualify. These terms and conditions are one of the ways the REC assures the Providers that the vendor contracts will be fair to them and protect their interests as well as those of the vendor. In the subsequent sections we describe the details of our EHR vendor selection process. B. Principles Applied to Vendor Selection Several over-arching principles will be applied to the vendor selection process. The most important of these are as follows: 1. Transparency the process of vendor selection was done and continues to be done in the open using clearly defined selection criteria. Evaluations of the vendors and their EHRs will be documented and auditable.

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2. Fairness Every vendor offering a responsible, compliant EHR product is treated fairly with selection solely dependent upon the quality of their offering and the value they offer the Providers. 3. Inclusiveness vendor selection is ultimately accomplished by a representative panel of stakeholders, including providers, consumers, technical consultants, and Ponce School of Medicine staff. 4. Value vendors must offer an attractive value proposition to the Providers and be best able to help the Providers achieve Meaningful Use standards as they begin to be applied in 2011 and beyond. 5. Protection vendors must agree to a standard set of terms and conditions prepared by the REC for inclusion in each vendors standard contract. These assure the Providers that the contract will protect the interests of the Providers as well as those of the vendor. Although we plan to offer a short-list of participating vendors as options to the Providers making their final selections, every vendor will have an equal chance of qualifying through the process and of reapplying later if they so choose. C. Vendor Selection Criteria The vendor selection criteria consist of three discrete sets of judgments applied at different stages of the process to arrive at a final status. These criteria are listed below by the stage in the process at which they are applied. Stage 1: Initial Screening 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Full Response to RFI ONC certified or close (modular certification allowed if full EHR certification is expected) Product covers an array of specialties In use among Providers elsewhere Spanish Language capabilities SureScripts Certified HIPAA Privacy compliance Practice Management Functionality (CPT4, ICD 9-10) Technical Interface capability Manpower for Implementation Local staff resources At least one MD on staff or available as a consultant User Ratings or references

Stage 2: Detailed Assessments 1. Usability 2. Demonstrations 3. Customizability 2

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4. Role-based security 5. ONC Stage 1 Certification Stage 3: Final Agreements 1. Agreement with PSM REC Standard Terms and Conditions 2. Willingness to partner with the REC on promotion, implementation, and support 3. Willingness to offer favored pricing to Providers

D. Vendor Selection Process We carried out and continue to carry out an efficient, fair, and transparent Vendor Selection process that is also inclusive. The key selection entity on the initial round was a panel comprised of representatives of key stakeholder groups. These groups included Providers, the Ponce School of Medicine, the Health Information Exchange, and consumers. The process we followed is depicted in Figure 1: Vendor Selection Process which is below.
First Screen
Issue RFI Receive & Log RFIs

Pass/ Fail
Pass

Fail

Generate & Issue Rejection Letter

Develop Vendor Selection Criteria

Selection Criteria

Rejection Letter

Assemble Panel

Pass

Pass/ Fail
Fail

Schedule & Conduct Demos

Pass

Pass/ Fail
Fail

Panel Review

Final Screen
Generate & Issue Rejection Letter Negotiate for Standard Contracts

Second Screen
Rejection Letter

Standard Contracts

Figure 1: Vendor Selection Process. The process is designed to be efficient, fair, and transparent.

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The process begins with the launch of an RFI, which was published in local business newspapers and sent via email to many of the CCHIT certified vendors identified on the CCHIT website. The vendors were invited to submit full particulars on their companies and on their solutions. A copy of the RFI announcement is available at the end of this document. The RFI for the initial vendor solicitations was issued in May 2010. Since that time, the RFI and RFQ have been distributed to requestors on demand. After the receipt of the vendor responses, each response is logged and screened by a panel of 3 MAXIMUS technical staff. Those with insufficient response information or without bona fide product in the EHR field were screened out at this initial stage. In stage 2 the panel is brought into the process after being briefed on the assessment criteria and the full process. The result of this effort initially was to reduce the candidate vendors to a core group that offered the best value and best product to enable the Providers to achieve Meaningful Use standards as quickly as possible. For the vendors downselected after this stage, we scheduled and conducted webinar-based demonstrations for the panel members. This enabled the members of the panel to be certain about their selection and validate the written offerings and representations of each vendor. The webinars also afforded the panel members an additional opportunity to ask questions and seek clarification from the vendors on any outstanding questions or items. The final steps in the vendor selection process are: (1) to negotiate standard terms and conditions to be included in each standard vendor contract with the Providers, (2) to sign binding agreements with each of the vendors defining their working relationship with the REC, and (3) to negotiate standard pricing so that the providers have a clear idea of what the product will cost and what services are provided as part of the implementation effort. A major focus of the vendor selection process was to select vendors with both product and support services for implementation and on-going operation. The EHR product is only as good as its implementation is successful and as its support services can assist each Provider in achieving Meaningful Use. E. Summary The main purpose of the vendor selection process is to select a qualified group of EHR system vendors from which the Provider practices can select their own vendor with confidence. The process is designed to be fair, efficient, and transparent. The vendors selected are those that offer the best value for Providers and the best opportunity for each of the Providers to achieve Meaningful Use in the operation of their EHR systems. Each vendor must have products that are either ONC certified or soon to become fully ONC certified so that the Providers remain eligible for Medicaid or Medicare Incentive Program payments offered by the Centers for Medicare and Medicaid Services (CMS).

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Appendix RFI Announcemen