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DriftCare Physicians Group

Request for Proposal

Patient Record Electronic Capture Project (PRE-Cap) Document Management System

Tuesday, February 8, 2011

MMI 408 Medical Technology Acquisition and Assessment Group 3 – Document Management Scenario Lisa Beckman Matt Bednar Bill Michaels Jeremy Music Mary McConville

PRE-cap Document Management System RFP 2/8/2011 2


Table of Contents

1 Statement of Problem and Project ...................................................................................................... 3

2 Administrative Information ................................................................................................................ 5 3 Technical Requirements...................................................................................................................... 7

4 Cost Requirements............................................................................................................................. 12 5 Referenced Documents...................................................................................................................... 13

6 Required Deliverables ....................................................................................................................... 13 7 Proposal Format................................................................................................................................ 14

8 Submission and Decision Schedules ................................................................................................ 16 Appendix A DriftCare Locations & Document Types ............................................................................ 18

Appendix B DriftCare IS Specifications ................................................................................................. 20 Appendix C DriftCare Physicians Group PRE-cap RFP...................................................................... 21



1 Statement of Problem and Project

Introduction:

The purpose of this document from the DriftCare Patient Records Electronic Capture Project (PRE-Cap) is to solicit proposals for a document management system that will capture, index, retrieve, and archive outside/paper documentation or content to integrate with our current EMR system.

Based on a preliminary review of available options, we have chosen your organization to receive this Request For Proposal (RFP).

Background:

DriftCare Physicians Group is a practice consisting of 150 physicians in 20 specialties serving the Minnesota/Wisconsin/Iowa Tri-state region. The practice has one main ambulatory care center, operates 3 community clinics, and has seven offices in the rural areas of the region where physicians practice. We also provide Hospitalists and Intensivists for St. Alfonso Hospital, a 150-bed community hospital operated by the IoWinn Community Healthcare system.

DriftCare successfully implemented the NewCo EMR application suite in 2006 that included CPOE, clinical documentation, clinical decision support, and medical alerts. This web-based system is centrally hosted at the main office and is available to all the DriftCare clinics and offices. Remote access to the system for physicians is made possible through a secure web exchange using https and 128-bit encryption.

With a goal to improve our efficiency and progress toward a truly paperless system, we recognize the need to enhance our current EMR system to incorporate content from all sources into one unified electronic system accessible throughout our enterprise.

Problem:

Our EMR does not include a document management application to incorporate paper documents, faxes, or outside email into the EMR and does not interface with outside electronic medical record systems. Consequently, despite a fairly successful implementation of our EMR in 2006, the majority of patient visits still require a paper chart in conjunction with the electronic medical record. DriftCare believes that this has impeded the full adoption of our EMR system and has limited the financial benefits that were expected from its implementation, considering a significant amount of our operating budget is still required to manage and store paper records. Furthermore, this hybrid system is inefficient, frustrating to our staff and patients, causes delays in care, adds to errors, and is non-compliant with TJC and Meaningful Use mandates.

A study performed by an outside consultant in 2010 showed:

• We currently house over 300,000 paper records • Approximately 2,500 sq. feet devoted to storage (equivalent to 20 exam rooms) • Approximately 17% of staff time is spent on paper management



• Approximately 50% of paper records are copied and multiple copies are stored in multiple clinics and office settings

• Approximate cost/year to maintain paper records: Staff salaries and benefits for management of paper records = $480, 000 Supplies = $20,000 Storage = $50,000 (~$20/ sq. ft.)

Project Objectives:

Our primary objectives in implementing this supplement to our EMR include:

• Provide a complete medical record to clinicians instantly at point of care • Provide clerical staff (including billing and outside covered entities) with a unified medical

record

• Reduce operating costs by eliminating costs associated with maintaining and storing paper records

• Improve efficiency by providing clinicians with unified electronic medical record at point of care

• Improve staff satisfaction and compliance with EMR by providing a solution that is “meaningful, pleasurable, convenient, usable, reliable, and functional”.

This system must:

• Create a unified 100% electronic medical record by providing:

¯ Capture and indexing of all current paper patient records, both legacy and from outside sources, into an electronic record archive.

¯ Capture and indexing of additional paper documents that need to be added to a patient’s EMR. (E.g. insurance cards, referrals, Advanced Directives, HIPAA compliance statements, Signed Consents)

¯ Electronic upload of records into the electronic archive.

• Integrate seamlessly with existing EMR system to provide efficiency and decrease need for additional training of staff



2 Administrative Information

Response to this RFP will be used to further evaluate potential suppliers of the desired software product and eliminate those companies that do not meet our requirements. All vendors will be evaluated utilizing the same criteria and given a score for each category, so it is imperative that you complete this RFP as instructed.

DriftCare expects a narrative response containing the elements outlined in Section 7 of this document: Proposal Format and completion of the RFP Submission Information Workbook which contains multiple worksheets. For convenience, relevant points in this RFP are cross-referenced with corresponding Worksheet sections.

Our practice is robust and busy. Our goal is to provide excellent care to our patients and also remain the employer of choice for our staff, at the forefront of Best Practices in technology as well as patient care. We are only interested in companies that can provide us with a software solution that supports these standards. As such, the following requirements are mandatory:

The product must have the features and functions to fulfill the requirements described in section 3 Technical Requirements

Vendor’s Corporate Mission must be in line with our goal to improve patient safety and improve patient care (see Worksheet 1.1)

A Corporate Vision that demonstrate forward thinking (see Worksheet 1.1) Proven excellence in customer service and technical support (see Worksheet 1.2) Proven reliability (see Worksheet 1.3) Proven longevity and financial stability (see Worksheet 1.4) Reasonable pricing for licensing and annual maintenance cost (see Worksheet 1.5)



Evaluation Categories will be ranked as follows:

CATEGORY CRITERIA SCORE

FINANCIALS 10

REFERENCES 10

EASE OF USE 40

COMPATIBILITY/INTEROPERABILITY 40

VENDOR & PRODUCTS

TOTAL: 100

IMPLEMENTATION PLAN AND METHODOLOGY

20

TRAINING 20

SERVICES

TECHNICAL SUPPORT 20

40 PRICING

TOTAL: 100

GRAND TOTAL 200

RFP Questions and Clarifications

It is DriftCare’s intention to provide all prospective Vendors with any information needed to clarify all aspects of this RFP needed to facilitate a thorough, timely, and accurate response. Please direct all questions or requests for clarification via email to DriftCare Practice Administrator: [email protected] by 5PM CST, February 28, 2011.

Please complete the attached spreadsheet and submit via email to the address listed below. Any supplemental information should be submitted as (3) hard copies and one electronic copy to the address below. Hard copies should be enclosed in a binder.



3 Technical Requirements

System Architecture. Based on the vendor’s understanding of the DriftCare requirements please provide a complete technical configuration (e.g., dedicated hardware, networking requirements, third party tools, etc.). These recommendations should include:

1. Production environment 2. Non-production environments 3. Database configurations 4. Scalability and capacity planning 5. Identification of all communication and networking requirements (firewall, VPN, DMZ, etc) 6. Identification of location and types of storage to be used for the system and database (SAN,

NAS, local disk, etc) 7. Disaster recovery

Third-party Software. Please list all third party software that must be by DriftCare in order for vendor’s document management system to function (see Worksheet 3.1). Interface Requirements. Please complete the table below identifying vendor system’s capability of meeting the integration requirements that have been identified by DriftCare for the document management system. For any functionality identified as “future release”, provide the latest release date to which vendor will be willing to commit to.

Functionality Yes No Future Release

NewCo EMR Integration • Vendor document management solution allows DriftCare

EMR to act as the MPI and assign patient identification codes to the document management system

• Vendor document management solution has API or SOAP methods that allow NewCo EMR system to display if the selected patient has any documents stored in the vendor document management system

• Vendor document management solution has API or SOAP methods that allow NewCo EMR system to list documents stored in the vendor document management system

• Vendor document management solution has API or SOAP methods that allow NewCo EMR system to view all documents stored in the vendor document management system

• Vendor document management solution has API or SOAP methods that allow authorized users to upload patient documents to the vendor document management system from within the NewCo EMR system

• Vendor document management solution support tagging documents for content and/or document type using coding defined within the NewCo EMR system.

• Vendor document management solution is capable of integrating with NewCo EMR so that the printout of a patient record can be done within NewCo EMR and contain all selected data from both the vendor solution and NewCo EMR




• Vendor document management solution is capable of integrating with NewCo EMR so that the electronic creation of a patient record file can be done within NewCo EMR and contain all selected data from both the vendor solution and NewCo EMR:

o As a .pdf o As a CCD o As a custom .xml

Electronic File Uploads • Vendor document management solution can receive

electronic files from other systems via SFTP

• Vendor document management solution can receive electronic files from other systems via secure email (If yes, list supported email solutions)

• Vendor document management solution can receive electronic files from other systems via fax

• Electronic files received by system can be automatically associated with patients and associated to document and content type defined within the NewCo EMR system provided they are formatted correctly

• Electronic files received by system that are not formatted for automatic upload are stored in a queue for manual processing

• The following electronic file formats are supported: o .txt o .rtf o .pdf o .xml o .tif o .jpeg o .bmp o .msg

Functional Requirements. Please complete the table below identifying vendor system’s capability of meeting the functional requirements that have been identified by DriftCare for the document management system.


Document Management • Vendor document management solution supports the use of

scanners from multiple vendors that are easily available through commercial outlets.

• Vendor document management solution supports the use of high capacity scanners.

• Vendor document management solution can employ OCR technology to identify key terms and identification information from the document being scanned.

• Vendor document management solution can be programmed to automatically scan large batches of documents with minimal user interaction.




• Vendor document management solution allows authorized users to print documents stored in the system.

• Vendor document management solution allows authorized users to fax documents stored in the system.

• Vendor document management solution provides faxing functionality so that only fax numbers defined within the vendor system can be faxed to. Included within the fax information is the name of the fax machine owner and an indicator that the fax number has been verified.

• Vendor document management solution allows authorized users to electronically transfer documents stored in the system through an encrypted technology such as SFTP.

• Vendor document management solution provides electronic file transfer functionality so that only receiving systems defined within the vendor system can receive electronic files. Included within the recipient information is the IP address of the receiving system, the system owner and an indicator that the receiving server information has been verified.

System Management • Vendor document management solution provides tools and

applications required to maintain the system including:

o Measuring system performance o Monitoring system interfaces o Managing user permissions o Alerting support staff on technical issues o Updating application code o Managing print, fax, scanner, and electronic file

transfers

• Vendor document management solution includes a minimum of 3 non-production environments (certification, training, build & upgrade testing)

• Vendor requires a solution where vendor will provide all system technical support.

• Vendor requires a solution where vendor will provide all system application support.

• Vendor offers a solution where vendor will provide all system technical support.

• Vendor offers a solution where vendor will provide all system application support.

• Vendor requires a solution where system is hosted by vendor in a cloud, RHO, or ASP model.

• Vendor offers a solution where system is hosted by vendor in a cloud, RHO, or ASP model.

• Vendor requires a solution whereby the system is hosted by the client at the client’s designated data center.



Security Requirements. Please complete the table below identifying vendor system’s capability of meeting the security requirements that have been identified by DriftCare for the document management system.


Authentication and Authorization • Vendor document management solution allows Active

Directory authentication of users

• Vendor document management solution allows Active Directory to define authorization levels for position based security, rights, and privileges

• Vendor document management solution allows single signon access when opening a patient’s document from within the NewCo EMR

• Vendor document management solution allows limiting access for a patient’s files to specific users.

• Vendor document management solution allows limiting access to specific document types within a patient’s file to specific users.

Document Access • Vendor document management solution provides

encryption and other technologies to ensure that patient files can only be viewed through specific supported methods (e.g. integrated EMR viewer, vendor software UI, etc)

• Vendor document management solution provides encryption and other technologies to ensure that patient files can only be uploaded through specific supported methods (e.g. integrated EMR viewer, vendor software UI, etc)

• Vendor document management solution can control who is allowed to print records stored within the system.

• Vendor document management solution can control who is allowed to fax records stored within the system.

• Vendor document management solution can control who is allowed to electronically transfer records stored within the system.

Auditing • Vendor document management solution can produce audit

reports of all personnel who uploaded documents to a patient’s file from within the NewCo EMR application. The report will show the specific file uploaded.

• Vendor document management solution can produce audit reports of all personnel who uploaded documents to a patient’s file from within the vendor’s UI or through any other vendor supported access method.

• Vendor document management solution can produce audit reports of all personnel who viewed a patient’s documents from within the NewCo EMR application.

• Vendor document management solution can produce audit reports of all personnel who viewed a patient’s documents from within the vendor’s UI or through any other vendor




supported access method. • Vendor document management solution can produce audit

reports of all personnel who printed documents from a patient’s file from within the vendor’s UI or through any other approved access method. Report must show the specific file(s) printed and the target printer.

• Vendor document management solution can produce audit reports of all personnel who printed documents from a patient’s file from within the NewCo EMR. Report must show the specific file(s) printed and the target printer.

• Vendor document management solution can produce audit reports of all personnel who faxed documents from a patient’s file from within the vendors UI or through any other approved access method. Report must show the specific file(s) faxed the target fax number, and the fax recipient.

• Vendor document management solution can produce audit reports of all personnel who faxed documents from a patient’s file from within the NewCo EMR. Report must show the specific file(s) faxed, the target fax number, and the fax recipient.

• Vendor document management solution can produce audit reports of all personnel who electronically transferred documents from a patient’s file from within the vendors UI or through any other approved access method. Report must show the specific file(s) transferred, the IP address to which the file was transferred to, and the recipient.

• Vendor document management solution can produce audit reports of all personnel who electronically transferred documents from a patient’s file from within the NewCo EMR. Report must show the specific file(s) transferred, the IP address to which the file was transferred to, and the recipient.

• Vendor document management solution can be set up to automatically alert system administrators when suspected security breaches have occurred.

Performance Requirements. Based on the vendor’s understanding of the DriftCare requirements, please describe the service levels to which the vendor is prepared to commit to along with descriptions of the tools and utilities used to measure these metrics with respect to:

1. System availability. DriftCare defines system availability as the ratio of expected system uptime versus the sum of expected uptime and unplanned downtime, where downtime is defined as the inability of all users to be able to access the system OR the inability of all users to perform all functions defined within the scope of the application agreement.

2. Planned maintenance. Describe the frequency and duration which vendor will require system to be unavailable or have reduced or limited functionality for planned maintenance activities.

3. System performance: a. Average time to search for a document from within the EMR b. Average time to display a requested document from within the EMR



c. Average time to load the screen or window to scan in a new document from within the EMR

d. Average time to scan a new paper document. e. Average time to upload an electronic document.

4. Testing of high availability. Describe how and frequency to which vendor will test high availability solution (server clustering, load balancing, etc) to ensure availability SLAs can be met.

5. System upgrades. Describe the vendor strategy and timeframes for providing and implementing: a. Major code upgrades b. Corrections and enhancements outside of the major version release cycle

Disaster Recovery. Based on the vendor’s understanding of the DriftCare requirements, please describe how vendor’s system will provide

1. Off-site storage of database and server backups 2. Security of database and server backups stored off-site 3. Recovery point objective (RPO) requirement of 8 hours 4. Recovery time objective (RTO) requirement of 24 hours 5. Semi-annual testing of vendor’s DR solution

Implementation Timeline. Please provide a high level timeline of the tasks and durations that will be required to implement the vendor solution (see Worksheet 3.2). The timeline should include the following tasks at a minimum:

1. Detailed scope assessment and project plan development 2. System installation and configuration 3. System build 4. Testing (build acceptance, integration, parallel, and load testing)

4 Cost Requirements

Pricing Please do not include pricing information within the narrative proposal response. To assist with analysis of the costs, enter the information on Worksheet 4.1 Pricing Structure and Worksheet 4.2 Hardware Pricing. Be specific and inclusive when estimating costs associated with this project. Cost Justification DriftCare expects the costs of the document management system to be offset by a significant reduction in overhead allocations for office space devoted to storage of medical records and increased operating efficiencies. Please address the cost justification for achieving these objectives and provide insight on other cost/benefit scenarios provided by the solution proposed. Alternatives Propose any other alternatives to eliminating paper charts within DriftCare Physician Group practice. Estimate approximate costs of alternatives or options discussed in the narrative (see Worksheet 4.3).



5 Referenced Documents

Standards DriftCare has achieved success by adopting appropriate standards and exercising oversight in assuring that they are used. Address the respondent’s level of experience with the following standards. 1. Healthcare Document Management Systems –HITSP Healthcare Information and Technology

Standards Panel http://wiki.hitsp.org/docs/SC112/SC112-1.html

2. Federal Meaningful Use Rule– 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule Federal Register / Vol. 75, No. 144 / Wednesday, July 28, 2010 / Rules and Regulations http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

3. .HIMSS Management Engineering and Process Improvement

http://www.himss.org/ASP/topics_managementProcess.asp Key DriftCare Reference Material Refer to the Appendices for pertinent facts about the DriftCare practice. Appendix A includes information about locations and document types. Appendix B details the IS infrastructure at DriftCare. Appendix C is the master contract that DriftCare uses for major system purchases.

6 Required Deliverables

The following is a list of deliverables that will be required from the software vendor in coordination with the project team. Each deliverable will have an expected delivery date and/or completion date, specific acceptance criteria and an individual or group that will approve it. There must be a process that defines the method in which a deliverable expected date or acceptance criteria must be modified. The change or modification must be approved by the project team.

Documentation 4. Business Case Document – The Business Case document will provide a clear statement of

purpose for the project, the intended use of the software and the objectives that must be met. If will also outline the measurable financial and clinic targets that must be met during and after project implementation.

5. Project Definition – The Project Definition will outline and define the scope of the project and management of the project, in detail. This document should also contain staffing requirements and competencies of the staff that will be involved during implementation.

6. Functional Requirements – The Functional Requirements document will define the overall functionality of the system. The document should also contain any additional functionality that is more advanced over other products or vendors.

7. Technical Requirements – The Technical Requirements document will define the overall technical requirements of the system, as stated above in section 2.

8. Test Plan – The Test Plan will outline the testing requirements and expected outcomes. The plan will provide detailed documentation of testing for all components, including technical capacity and accuracy of data. The document will also include regression, unit and system testing specifications.



9. Test Signoff – This document will be presented to the Board, Committee, and management leaders for approval. Test plan and results will need to be included in this document.

Software 1. System Implementation – The System Implementation will include the installation and

operability onto the hardware provided. PC’s and any mobile devices. This will include both the test and live environment.

2. Test Data Load – The Test Data Load will require vendor to load test data into the test environment and the system must pass a capacity and data usability test designed by the vendor. Test scripts and results should be documented and presented.

3. Creation of Security Groups – Vendor will define and physically create security groups and roles within the system. This will include creation of the user ID and initial passwords.

4. Report and Document Definition and Creation – This deliverable will require the vendor to define and create custom reports and documents that will be needed to successfully utilize the system. These reports and documents must be listed and outlined in the vendor’s proposal.

5. System Installation – The vendor will need to install and/or migrate software and any related setup data, i.e. lookup tables, user accounts, reports, alerts, etc in the live environment. Vendor will need to supply at least one onsite support specialist during the day of implementation.

Training 1. Training Plan – Vendor will need to create and facilitate a complete training of physicians, end

users and management. Training will include both documents and live training on site. DriftCare will supply training lab.

Hardware & Equipment 1. Hardware Setup – Vendor will define and provide hardware requirements for implementing the

system. DriftCare will purchase and acquire required hardware, including servers, PC’s and tablets.

Warranty for System 1. Warranty – Vendor will supply written documentation of details of warranty. Some of the

details should include times of phone support, any additional cost for after-hours support, etc. 2. Issue Follow-Up – Vendor will document and provide timelines for resolving any issues or

problems encountered during test, go-live and predetermined timeframe post go-live. Development & Test Tools

1. Physician and End User Testing – Vendor will provide test scripts for functional testing for both physician and end users. An advantage would be if vendor has testing tools to automatically load test data and compare actual results with expected results.

7 Proposal Format

Below is a listing of format requirements for each of the proposal areas. Each section has specific requirements that need to be included in the narrative component of the proposal. The narrative is supported by a Proposal Submission Workbook which presents full pricing details as well as key data for ease of comparison during evaluation. Both components must be submitted. If there are any questions regarding the proposal format requirements, please email [email protected]

Narrative Component Sections – Please address in the order presented here.

1. Technical Proposal – The technical proposal should be outline technical requirements, including server(s), workstations, tablets, peripheral devices and software. The document should



be in an electronic format, listing in detail the requirements for each of the areas listed above. The document should be submitted in a version of Microsoft Word or Excel.

2. Management Proposal – The project management proposal shall delineate how these various areas will be addressed:

Implementation, the specific detailed implementation plan Key personnel, your project manager and team and methods of contacts Schedule, the detailed timeline of the project implementation Project reporting and communication, your ideas for best practice of

organizational interface between your firm and DriftCare Change management structure. How necessary and proposed changes to the

project requirements and/or timeline will be dealt with Your needs for physical space, technical assets, assistance by our staff, and

management and clinician availability 3. Statement of Work – Please provide a statement of work that as best as possible describes your

plans, timelines, methods, and designated staff to complete the project.

4. Supplemental Information

a. Financial Report of Respondent – Please include financial reports for your organization for the previous 3 years. At minimum they should include, PL statements and balance statements.

b. Respondent’s Technical Credentials – Please include any licensure information for your firm and staff. Include professional society memberships and honors or censures for your firm and staff. List continuing education credits of staff and participation and training in other vendors systems and the certification provided.

c. Resumes of Key Personnel – Resumes of key individuals must be included in the submission, including, but not limited to, project manager, network analysts, programmer, nurses, and any other key clinical staff that will be utilized on the project.

d. Site Visits – Please provide us with the opportunity to visit your headquarters and arrange visits with two (2) recent clients so we may assess your performance as it pertains to our needs.

<Vendor Name> Proposal Submission Workbook

The template for the Proposal Submission Workbook is included with the invitation to bid package.



8 Submission and Decision Schedules

IMPORTANT DUE DATES AND ADDRESSES:

Items to be Returned:

Address: Date To Be Received By:

*No later than 11:59 PM CST

Vendor Questions or Clarification Requests

[email protected] March 16, 2011

Completed Response to RFP

[email protected] March 30, 2011

Any Supplemental Information

DriftCare Physicians Group Attn: Mary McConville 1234 Ioway Mannington, WI 54321

March 30, 2011

Timeline for Vendor Selection:

RFP responses due March 30, 2011 *no later than 11:59PM

Vendor list narrowed down to 4 for remote demonstrations

April 15, 2011

Remote demonstrations April 18-21, 2011

Vendor list narrowed down to 2 for on-site demonstrations

April 22, 2011

On-site demonstrations April 25-29, 2011

Final “preferred” supplier identified May 2, 2011

Timeline for Finalization and Implementation:

Due diligence and contract negotiations

May 3-6, 2011

System Installation/implementation July 1, 2011

Testing Period July 5 to July 15, 2011



Timeline for Finalization and Implementation:

Commencement of patient data uploads July 17, 2011

Training of HIM staff, clinicians, support personnel July 17 to August 18, 2011

Expected date of system steady state operation September 30, 2011



Appendix A DriftCare Locations & Document Types

Office Name Type Location Specialties Physician FTEs

Other staff

Chart Homes

DriftCare Physicians Group - Family Practice

Main ambulatory care center LaCrosse, WI

Primary Care - OB Gyn - Peds - Surgeons - Cardiology - Endocrinology 45 160 225000

St. Alphonso Hospital Hospital-based LaCrosse, WI Hospitalists / Intensivists 12 24 0

DriftCare Physicians Group - West LaCrosse

Community Clinic LaCrosse, WI

Primary Care - OB Gyn - Peds - Surgeons - Cardiology - Endocronolgy 15 30 21000

DriftCare Physicians Gorup - Onalaska

Community Clinic Onalaska, WI


DriftCare Physicians Group - Winona

Community Clinic Winona, MN


DriftCare Physicians Group - Caledonia

Rural Minnesota 1

Caledonia, MN Primary Care 17 33 5400

DriftCare Physicians Group - Rushford

Rural Minnesota 2 Rushford, MN Primary Care 5 9 2550

DriftCare Physicians Group - Harmony

Rural Minnesota 3 Harmony, MN Primary Care 6 12 2100

DriftCare Physicians Group - Stoddard

Rural Wisconsin 1 Stoddard, WI Primary Care 3 6 2250

DriftCare Physicians Group -Holmen

Rural Wisconsin 2 Holmen, WI Primary Care 8 15 1800

DriftCare Physicians Group - Decorah Rural Iowa 1 Decorah, IA Primary Care 6 12 4800 DriftCare Physicians Group - Waukon Rural Iowa 2 Waukon, IA Primary Care 5 9 5100



Appendix A cont’d

Document Types & Origin

Document Origin Importance to current care

Contains hx of care, immunizations, growth charts, past surgeries Legacy paper record This institution

Allergies, etc. Outside records for new patients Referring institutions Same as above

Outside lab results Outside labs Diagnosis, plan of care, plan of care, may prevent unnecessary redundant tests

Reports/readings of Outside images

Outside clinics or imaging centers

Diagnosis, plan of care, ma prevent unnecessary redundant imaging

Advanced Directive/Living Will

Patient or legal representative

Provides information re. who can speak for patient if necessary, patient’s wishes if incapacitated

Consultation responses Consulted physicians Provides clinical feedback on patients referred for further diagnosis or treatment

Hospital discharge summaries Hospitals Basis for continuity of care with

other institutions Immunization records Patient supplied



Appendix B DriftCare IS Specifications Data Center: DriftCare’s primary data center is located in the basement of its main ambulatory care center. The raised floor area is 150 square feet, with 24 square feet available for additional server cabinets. There is no available space in any existing server cabinet, so any additional hardware to be hosted at the data center will require at least one cabinet.

Both 110V and 220V power is available, with current power sources capable of supporting a maximum of 10KW. Primary power is provided by City Power, with a 4hr battery backup available on a manual bus transfer. Each server rack includes a UPS to ensure that servers remained powered while switching between main and backup power systems.

Data center cooling is sufficient to accommodate a server base up to the limits of the current 10kw available power.

Servers and Storage: The data center hosts the servers required for the NewCo EMR and MedPractice Pro financial applications. Servers for the DriftCare web site, employee intranet site, and FTPS are also hosted out of the data center. All application servers run Microsoft Windows 2003 SE. The NewCo EMR and MedPracticePro use SQLServer 2005 for their database and IIS for web services. Load balancing on the NewCo EMR and MedPractice Pro web servers is accomplished through BigNet hardware load balancers. Driftcare recently migrated to Microsoft Active Directory 2008 and uses AD to manage all security (including assigning roles and permissions, and authentication for the NewCo EMR and MedPractice Pro applications).

All servers connect to a NetApp fibre NAS for storage. The NAS currently has 5TB of free disk space (RAID 10) with the ability to expand to 40TB.

DriftCare uses Symantec Backup Exec, Endpoint Protection, and Net Backup to provide server and data backups and malware and intrusion detection. Backups are stored on the NetApp NAS and replicated to the DR site provided by Steel Hill.

Network: MPLS circuits provided by Dash Telco connect the main data center to the 3 community clinics and 7 remote offices. Ciscom network switches operate on a 1gb backbone with 100mb to the desktops. Employees are able to access the DriftCare network through a web VPN.

IS Department Staff: The Information Systems Department at DriftCare consists of the IS Director, a system administrator, a web analyst, and three desktop support personnel. Staff members hold certifications with Cisco, MSCE, and MCDBA.



Appendix C DriftCare Physicians Group PRE-cap RFP

PROFESSIONAL SERVICES, HARDWARE PURCHASE AND SOFTWARE

LICENSE AGREEMENT

THIS PROFESSIONAL SERVICES, HARDWARE PURCHASE AND SOFTWARE LICENSE AGREEMENT ("Agreement") is made this ^ day of ^, 20^, by and between <SELECTED VENDOR> a corpration located at <location> ("Seller") and DriftCare Physicians Group LLC, a Wisconsin corporation located at LaCross, Wisconsin ("Buyer")

WHEREAS:

Seller is in the business of selling computer equipment and developing and selling software for computer equipment. Seller desires to sell and license, and Buyer desires to acquire, a computer system as more particularly described herein.

NOW THEREFORE:

§1. DEFINITIONS.

The following definitions shall apply whenever used in this Agreement:

§1.1 System.

The term "System" shall mean the computer system comprising the hardware, software and related equipment, and having all the qualities and features, and being capable of performing all of the functions, described in the Specifications.

§1.2 Specifications.

The term "Specifications" shall mean all of the detailed design specifications and agreements set forth in:

(a) Schedule A hereto, which consists of a list of new equipment (hereinafter sometimes referred to as the "Equipment"),

(b) Schedule B hereto, which consists of a description of software products and services (hereinafter sometimes referred to as the "Software"),

(c) Schedule C hereto, which sets forth a list and description of features of the System,

(d) Exhibit A hereto, which sets forth design and power specifications of the System,

(e) Exhibit B hereto, which is a copy of that certain Agreement of Seller and Buyer dated ^, 19^, and

(f) Exhibit C hereto, which is a copy of that certain letter agreement from ^, President of Buyer, to President of Seller, dated ^, 19^.

§1.3 Effective Level of Performance.

The term "Effective Level of Performance" shall mean the result determined by dividing (a) the remainder obtained by subtracting from Operation Use Time the System Failure Time, by (b) Operation Use Time, and expressing the quotient as a percentage.

§1.4 Operation Use Time.



The term "Operation Use Time" shall mean the time, measured in whole minutes, during which the System is scheduled for operation for the purposes intended by Buyer.

§1.5 System Failure Time.

The term "System Failure Time" shall mean the time, measured in whole minutes, during which the System's central processing unit, the Equipment's operating system or firmware, or the Software or any combination thereof, is inoperable, but does not include any such failure which is caused solely by Buyer or Buyer's employees. System Failure Time shall be deemed to include the time between successive periods of System Failure Time where the time between such successive periods is 30 minutes or less.

§1.6 Preliminary Test.

The term "Preliminary Test" shall mean the execution by Seller of diagnostic routines on the System sufficient to determine if the System is fit and ready for use by the Buyer in accordance with the Specifications, as more fully described in §6.(d) hereof.

§1.7 Preliminary Test Date.

The term "Preliminary Test Date" shall mean that date on which the Buyer receives Seller's written certification to the effect that the Preliminary Test has been completed satisfactorily and that the System is fit and ready for use by the Buyer in accordance with the Specifications.

§1.8 Conversion.

"Conversion" shall be the process of transferring the Buyer's applicable diskettes into the System more fully described in §6.5 hereof.

§1.9 System Acceptance Test.

The term "System Acceptance Test" shall mean the acceptance test applicable to the system which is more fully described in §6.5 hereof.

§1.10 System Acceptance Date.

The term "System Acceptance Date" shall mean the date on which the Buyer gives Seller written notice that the System successfully passes the System Acceptance Test.

§1.11 System Documentation.

The term "System Documentation" shall mean the set of documents and manuals and source code which collectively contain a complete description and definition of all System operations and all user guides describing the operation and management of the System.

§2. PURCHASE AND SALE.

Seller agrees to sell, and the Buyer agrees to purchase, the System upon the terms and subject to the conditions set forth in this Agreement.

§3. PURCHASE PRICE.

Buyer shall pay to Seller the following: a purchase price of $^ as the total System purchase price (hereinafter referred to as the "Purchase Price"), which Purchase Price includes payment for the cost of the Equipment, installation, delivery, handling and insurance of the Equipment, a one-time, fully paid license fee for the Software, the training of the Buyer's personnel by Seller, and all applicable sales and use taxes.



§4. PAYMENT.

Buyer shall pay to Seller $^ toward the Purchase Price upon the execution of this Agreement by both parties hereto. Buyer shall pay an additional $^ toward the Purchase Price on the Preliminary Test Date. The balance of the Purchase Price, $^, shall be paid by Buyer to Seller within 30 days of the System Acceptance Date.

§5. CANCELLATION.

Buyer may cancel this Agreement without cause by giving Seller written notice thereof. In the event Buyer cancels this Agreement without cause, Buyer shall pay a cancellation charge to Seller in an amount equal to the cancellation charge incurred by Seller from the manufacturer(s) for cancellation of purchase of the Equipment. Deposits tendered herewith shall be applied to the cancellation charges. Any balance due shall be charged to Buyer.

§6. DELIVERY, INSURANCE AND INSTALLATION OF EQUIPMENT.

(a) Seller shall deliver all of the Equipment at Buyer's offices at 1234 Ioway, LaCrosse, Wisconsin on or before ^, 20^. Seller shall give Buyer notice of the impending delivery of the Equipment at least fifteen days prior to such delivery unless the Buyer consents to a shorter notice period.

(b) Buyer shall not bear the risk of loss or damage to the Equipment until it is delivered to the loading dock at Buyer's designated address of delivery. Thereafter Buyer shall bear the entire risk of loss or damage to the Equipment, provided that damage caused by any manufacturer or Seller shall be borne by Seller.

(c) All costs of transportation, delivery and installation shall be paid by Seller. All costs of assembly of the System shall be paid by Buyer.

(d) Buyer, under the direction of Seller, shall complete the installation and assembly of the System on or before ^, 20^. The installation and assembly of the System will be deemed complete upon the System passing the Preliminary Test. The details of the diagnostic routines which are part of the Preliminary Test will be developed by Seller with consultation and reasonable concurrence of Buyer. All costs associated with the Preliminary Test shall be borne and paid by Seller.

(e) On or before ^, 20^, Buyer, at its expense, but at the direction of Seller, shall have converted all applicable information stores into a format which can be accurately used by the System. It is understood that the System shall be operable according to the Specifications upon the completion of the Conversion.

(f) The System shall be subject to the System Acceptance Test which shall commence on the first business day following the Conversion. The Systems Acceptance Test shall consist of (i) the System's performing in accordance with the Specifications to Buyer's satisfaction over a period of not less than 30 days and (ii) the maintenance by the System of an aggregate Effective Level of Performance of not less than 99% over a period of 30 consecutive days. In the event the System shall not pass the System Acceptance Test during the first 30 consecutive days after the Conversion, Seller shall promptly use its best efforts to determine and correct the causes of the System's failure to pass such test and the System Acceptance Test shall be continued on a day-today basis until such test shall be passed, subject to the provisions of §14(a) hereof.

(g) Before the Preliminary Test, Seller will deliver to Buyer one copy of the System Documentation, which Seller hereby represents and warrants is the only documentation necessary for the effective operation of the System.

§7. TRAINING.

By ^, 19^, Seller, at its expense, shall have provided Buyer at Buyer's offices with sufficient training to permit Buyer to fully operate the System according to the Specifications.

§8. EQUIPMENT MAINTENANCE.



Other than as specifically provided elsewhere in this Agreement, this Agreement shall not be interpreted to require any maintenance by Seller of the Equipment being sold hereunder. Any maintenance obligations not created hereunder shall be governed by separate agreement.

§9. OPERATING SYSTEM AND FIRMWARE.

As updates or revisions are made to either the operating systems or firmware incorporated in the Equipment, such updates and revisions shall be offered to Buyer in accordance with manufacturer price schedules then in force and effect. Seller shall cause the manufacturer of the Equipment to provide Buyer at no additional cost with a fully paid perpetual license to use the operating system and firmware incorporated in the Equipment and a letter from such manufacturer to the effect that such manufacturer shall grant a similar license at no additional cost to any subsequent purchaser of the Equipment.

§10. SOFTWARE LICENSE.

(a) Seller grants to Buyer a perpetual, nonexclusive license to use the Software. For purposes of this Agreement, the licensed Software shall include all related materials, source code, documentation, enhancements and information provided by Seller to Buyer under this Agreement.

(b) Seller shall provide Buyer with all notifications, updates or corrections of existing problems related to the Software modules installed on Buyer's Equipment. Such notification or Software shall be forwarded to Buyer within 15 days from receipt by Seller. All support services required (including tape copies and analyst time) shall be billed by Seller at the standard rate then in effect or per a software support agreement, if in effect.

(c) Buyer acknowledges that the Software is the property of Seller and that the Software is being made available to Buyer in confidence and solely on the basis of its confidential relationship to Seller. Buyer agrees to use reasonable efforts to prevent Buyer's employees from printing, copying, providing or otherwise making available, in whole or in part, any portion of any original or modified Software or related materials except for installation and use by Buyer and except as may be needed for backup security.

(d) Seller will provide a third party escrow of source code for software systems.

§11. PROGRAMMING AND SUPPORT SERVICE.

Seller agreed to provide consulting and support services as requested by Buyer at Seller's standard fee schedule in effect at that time.

§12. WARRANTIES.

(a) Seller represents and warrants to Buyer that as of the date of delivery:

(i) Seller has good and merchantable title to and the right to sell and/or license the System as the case may be as provided for in this Agreement, free and clear of all security interests, liens and encumbrances.

(ii) The System is designed in accordance with this Agreement.

(iii) The System is comprised of all of the hardware, software and related equipment agreed to herein.

(iv) Buyer shall receive any repair or replacement warranties extended by the manufacturer or supplier to Seller in connection with the System.

(b) Seller further warrants and covenants that for a period of one year following the System Acceptance Date:

(i) The Equipment will perform in accordance with the manufacturer's published specifications therefore.

(ii) The System will be free from defects in workmanship and material.



(iii) The System will have all of the qualities and features, and be capable of performing all of the functions described in the Specifications.

(iv) The System will be of merchantable quality, will be fit for the ordinary purposes for which such goods are used, and will pass without objection in the trade.

(v) The System will operate at an Effective Level of Performance of not less than 99%.

(vi) Seller will comply with all federal and state regulations applicable to patient confidentiality and security (HIPAA)

(c) During the one year following the System Acceptance Date,

Seller will immediately and in no event later than 30 calendar days after notice, provide, at no charge to Buyer, corrections, modifications or additions to the System where Buyer notifies Seller in writing, of any errors, omissions, deficiencies or inconsistencies in the System, provided Buyer provides Seller access to the System via a dial-up modem. Buyer shall assist Seller in identifying these circumstances on which such errors, omissions, deficiencies or inconsistencies are discovered, and, if requested by Seller, shall document their existence.

(d) EXCEPT AS SPECIFICALLY PROVIDED IN THIS AGREEMENT, THERE ARE NO EXPRESS WARRANTIES WHICH EXTEND BEYOND THE DESCRIPTION SET FORTH IN THIS AGREEMENT.

(e) IN NO EVENT SHALL SELLER BE LIABLE TO BUYER FOR LOSS OF PROFITS ARISING OUT OF ANY CLAIMED BREACH BY SELLER OF ITS OBLIGATIONS HEREUNDER.

§13. PATENT AND COPYRIGHT INDEMNITY.

(a) Seller warrants that the use of the System by Buyer pursuant to the terms hereof shall not constitute an infringement of any existing patent, copyright or other right. Seller hereby agrees to defend or settle any suit, proceeding or claim brought against Buyer based on a claim that the use of the System or any part thereof by Buyer constitutes an infringement of any existing patent, copyright or other right. Seller shall pay all damages or costs awarded against or expenses, including attorneys' fees, incurred by Buyer in such suit, proceeding or claim.

(b) In the event the System or any part thereof shall be in Seller's opinion likely to or shall become the subject of a claim for patent, copyright, or other infringement, subject to §13(c) hereof, Seller may, at its option and expense, and without diminishing Seller's obligations under §13(a) hereof, procure for Buyer the right to continue using such affected part of the System or modify such affected part to become noninfringing. Should Seller elect to remove or modify such infringing part of the System, Seller shall forthwith replace such part with a functionally equivalent noninfringing part and/or take other appropriate action to ensure that the System conforms to the Specifications to Buyer's satisfaction, without cost to Buyer.

(c) In the event that Seller shall refuse or shall be unable to supply or shall be prevented from supplying the System or any part thereof to Buyer, or in the event that Buyer's continued use of the System shall be prohibited or enjoined at any time, Seller shall promptly replace all affected parts of the System with functionally equivalent noninfringing parts and/or shall take such other action to ensure that the System conforms to the Specifications to Buyer's satisfaction, without cost to Buyer.

(d) Seller warrants that Buyer shall suffer no interruption of its normal business activities or cycles as a result of any claimed infringement, any litigation referred to in §13(a) hereof or any replacement of items contemplated in §§13(b) or 13(c) hereof.

§14. DEFAULT.

(a) In the event Buyer shall default in any payment due under this Agreement, Seller may discontinue the installation of all further Equipment and Software contracted for hereunder, may demand and shall receive at Buyer's expense, return of



all materials furnished by Seller for which Buyer shall not have tendered payment. Furthermore, Seller may pursue any additional or alternative remedies provided by law.

(b) If Buyer shall become insolvent, or if a petition for relief shall be filed by or against Buyer as bankrupt, insolvent or debtor under any federal or state bankruptcy, insolvency or reorganization laws and Buyer shall be unable, within 60 days after the commencement of any such proceeding to obtain the dismissal thereof, Seller shall be entitled to cancel any order then outstanding at any time during the period allowed for filing claims against Buyer's estate and Seller shall have such further remedies as provided for herein or by law.

(c) If Seller shall fail to meet the delivery, Preliminary Test, or training deadlines, set out respectively in §§6(a), 6(d) or 7 herein, or any agreed-upon extensions thereof, by more than 20 business days for causes not attributable to Buyer, Buyer may, at any time thereafter, at its option, terminate this Agreement by writing notice to Seller with no further obligation or liability on the part of Buyer.

(d) If the System Acceptance Test shall not be completed within 60 business days from completion of the Conversion for causes not attributable to Buyer, Buyer, at any time thereafter, at its option, may terminate this Agreement by written notice to Seller with no further obligation or liability on the part of Buyer.

(e) Buyer at its option may terminate this Agreement at any time, with no further obligation or liabilities on the part of Buyer, if Seller shall breach any material provision or warranty of this Agreement and shall fail to remedy such breach on a basis reasonably acceptable to Buyer within 30 days after the giving of written notice from Buyer reasonably specifying such breach.

(f) Buyer may forthwith terminate this Agreement, with no further obligation or liability on the part of Buyer, upon written notice to Seller if Seller shall become insolvent, or if a petition for relief shall be filed by or against the Seller as bankrupt, insolvent or debtor under any federal or state bankruptcy, insolvency or reorganization laws and the Seller shall be unable, with 60 days after the commencement of any such proceeding to obtain the dismissal thereof.

§15. EFFECT OF TERMINATION PRIOR TO SYSTEM

ACCEPTANCE DATE.

In the event of the termination of this Agreement pursuant to the provisions of §§14(c), 14(d), 14(e) or 14(f) hereof prior to the System Acceptance Date, (a) Seller shall refund to Buyer all amounts previously paid by Buyer to Seller hereunder and (b) Seller shall remove and pay for the removal of the System from Buyer's offices. The remedies of Buyer provided for in this §15 and elsewhere in this Agreement are neither exclusive nor mutually exclusive and Buyer shall be entitled to resort to any such remedy or any other remedy available at law or in equity, or some or all such remedies in any combination, at Buyer's discretion.

§16. PERSONNEL.

Seller will assign a designated employee to be primarily responsible for supervising the installation and testing of the System and the training of Buyer's employees with respect to the System. Buyer shall also have the right of prior approval of all other Seller personnel performing any of Seller's obligations hereunder who will have direct contact with Buyer's personnel or agents. Seller will replace within a reasonable time under the circumstances, any of its employees who may be engaged in performing its obligations under this Agreement whose removal is requested and reasonable cause for such removal is specified in writing by Buyer.

§17. COMPATIBILITY SPECIFICATIONS.

At all times following the System Acceptance Date, Buyer shall be at liberty to install or attach to the System any functionally compatible equipment and Seller shall provide Buyer such relevant compatibility specifications as are in the possession of or available to Seller, in such detail as Buyer may reasonably require. Such compatibility specifications will become a part of the Specifications.



§18. FORCE MAJEURE.

No party shall be liable for delay in performance hereunder due to causes beyond its control including, but not limited to, acts of God, fires, strikes, delinquencies of manufacturers or suppliers or acts of war. However, each party undertakes to minimize any such delay to the extent possible. Notwithstanding the foregoing, it is understood that, absent the specific agreement of Buyer, Buyer's rights pursuant to §§14(c) and 14(d) shall only be delayed for a maximum of 60 days by reason of the provisions of this §18.

§19. COMPLIANCE WITH LAWS.

(a) Buyer shall, at its own expense, use the Software in a careful and proper manner and shall comply with and conform to all laws, ordinances and regulations in any way relating to the possession, use and/or maintenance of the Software.

(b) The Software license is granted solely for Buyer's use in the United States of America. Unless specifically authorized in writing by Seller, Buyer shall not export, or in any way transfer the Software to any destination outside said country in which it was originally licensed. Regardless of any disclosure made by Buyer to Seller of an ultimate destination of the Equipment and/or Software, Buyer shall not export either directly or indirectly, the System without first obtaining a license to reexport from the United States Government, as required, and will comply with United States Government export regulations, as applicable.

§20. SELLER'S NOTIFICATION OF LACK OF

REPRESENTATION.

(a) Buyer acknowledges that Seller is not a representative, agent, commission sales agent, commissionaire, servant or employee of its suppliers for any purpose. Subject to the terms of this Agreement, Buyer acknowledges that it is not relying upon any representations made by Seller's suppliers in entering into this Agreement with Seller (except for any Equipment and/or Software maintenance which any supplier may have agreed to provide). Seller has no right or authority to create any obligation or responsibility on behalf of its suppliers except as may from time to time be provided by written instrument signed by said suppliers.

(b) SUBJECT TO THE TERMS OF THIS AGREEMENT, IN NO EVENT SHALL SELLER'S SUPPLIERS BE LIABLE TO BUYER FOR LOSS OF PROFITS ARISING OUT OF ANY CLAIMED BREACH.

§21. MISCELLANEOUS.

(a) Buyer may sell and lease back the Equipment and Software from a third party for purposes of financing provided that Buyer remains responsible for performance of its obligations under this Agreement.

(b) No waiver of any breach of any provision of this Agreement shall constitute a waiver of any prior or subsequent breach of the same provision or a waiver of any breach of any other provision. No waiver shall be effective unless made in writing and signed by an authorized representative of each party hereto.

(c) This Agreement shall be governed by and construed and enforced according to the laws of the State of Illinois. This Agreement contains the entire, integrated Agreement between the parties, and shall be binding upon both parties and their respective heirs, successors and permitted assigns. Seller will not assign this Agreement without first obtaining the written consent of Buyer.

(d) This Agreement shall become binding and effective as of the date hereof.

(e) Section headings are inserted for convenience only and shall not be used in any way to construe the terms of this Agreement.



(f) If any immaterial provision of this Agreement is held to be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions will not in any way be affected or impaired thereby.

(g) Except as otherwise provided, any notice, request, demand, consent or other communication provided or permitted hereunder will be deemed given on the date it is sent and will be in writing and delivered by personal delivery, by certified mail, or by ordinary mail, postage prepaid, addressed to the party for which it is intended at the party's address as indicated in the heading of this Agreement and until such time as either party has given the other notice of a change of address.

(h) In the event of any conflict or inconsistency between the provisions of this Agreement and the provisions of any exhibit or schedule annexed hereto or any document referred to herein including but not limited to any maintenance agreement for the System, the provisions of this Agreement will prevail and govern the interpretation thereof.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement under seal as of the date first written above.

DRIFTCARE PHYSICIAN GROUP LLC

By:

Its:

VENDOR

By:

Its:

[Attach the Schedules and Exhibits Referred to in the Above

Agreements.]

SOURCE: IdeaBuyer Form 9.17 accessed 2/7/2011 www.ideabuyer.com/resources