Electronic Health Record (EHR): Systems Baseline Study

by Bongs Lainjo

 

 

 

 

 

 Implementation of Stage one C.M.S Electronic Health Record(E.H.R) incentive program.

 

Enquiries: Goddard Lainjo, MD

41 Dolson Avenue

Middletown, NY 10940

Telephone: 845-341-4655

E_mail: glainjomd@hvc.rr.com

bsuiru@bell.net

 

 

RFP (Request for proposal):  Stage one of CMS Electronic Health Record (EHR) incentive program

 

Goddard Lainjo, MD

41 Dolson Av.

Middletown, NY 10940

E-mail: Glainjomd@hvc.rr.COM

Telephone: 845-342-4655

 

General Objective: To transform the current manual medical record system (MRS) into an electronic health record (EHR) system.

 

Specific Objective: To implement stage one of Center for Medicaid and Medicare Service (CMS) Electronic Health Record incentive plan.

 

Background:

 

In 2007, the Federal Government introduced an incentive plan to encourage physicians to computerize as many of their activities as possible. This initiative among other things was meant to enable doctors provide their services with evidence-based support. There are also other advantages of automating health services. These include: more secure data, easy access, guaranteed reliability, improved efficiency and better quality. While the initial reaction and level of acceptance was relatively low, the current trend does signal a potential uptake, increasing enthusiasm, momentum and motivation. It is in light of this general interest and the need to improve service provision that Dr. Lainjo’s practice has finally decided to implement an electronic medical record system in his office.

 

Office Setting:

 

This is an individual practice occupying a building with a square footage of 3250. The layout is divided into a waiting room, a front reception area, nurses’ office, three examination rooms, EP’s office, infusion room, closets, two general purpose offices and a kitchen.

 

The practice has been operating successfully for over two decades. During this period, all transactions have been done manually. Some exceptions include outsourced billing, occasional electronic prescription (e_Rx, supplied by Allscrpt Healthcare), routine correspondence, client check-in data base.

 

The staff composition includes two medical secretaries, two registered nurses (RN), one receptionist, one professional organizer and one medical assistant. They all report directly to the eligible professional (EP) – Dr Lainjo.

 

Annual Service Statistics:

 

Between 2008 and 2011 for which data are available, the total number of client visits peaked in 2009 with a drop in 2010. This drop is associated to extended vacation time taken by the EP for family reasons. The same observation applies to table two. Over that period of time, the mean number of patient visits was 6027 with a corresponding mean number of new patients equal to 445.  With respect to insurance claims between 2008 and 2011, there was an average of about 3051 claims for medicare and a mean of 3434 for from private insurance plans. Table one and two represent client load and insurance claim cases respectively. The number of cases and claims in both tables are as expected quite consistent.

 

Table 1: Client load by Year

YEAR

REPEAT

NEW

REMARKS

2008

4524

400

 

2009

6684

544

 

2010

6121

420

 

2011

6778

417

 

Source: EP’s Office

 

Table 2: Number of Insurance claims by Year and Type of Insurance Plan

YEAR

MEDICARE

MEDICAID

PRIVATE

OTHER

2008

2333

0

2591

0

2009

3401

0

3877

0

2010

3083

0

3458

0

2011

3385

0

3810

0

Source: EP’s Office

 

Morbidity Data:

In its meaningful use strategy, the CMS has made availability and access to diagnosis-based data sets a very important component of an efficient and functional E.H.R. In this regard, the CMS has developed a set of core impact indicators that will serve as roadmap in its efforts to achieve meaningful results. Many EPs in return have also recognized the importance of these indicators and how can significantly contribute in providing evidence-based reports that can be used in making informed decisions. These reports when reliably produced will also help EPs in strengthening their service provision. 

 

In order for this system to succeed, substantial efforts will be required from both EPs and their respective E.H.R suppliers. Such efforts will make this initiative convincingly sustainable, user-friendly and effective. While EPs are expected to use reports generated through the PQRS, suppliers will assume the key role of developing effective data quality control systems.

 

Dr. Lainjo is a specialist in rheumatology. Table three indicates that between 2008 and 2011, the average number of arthtritis-rheumatoid cases was 1897; with a distant second of 841 cases; followed by 596 cases with bursitis on the average; and 404 cases diagnosed with arthritis-gout. The remaining average number of cases was below 400.

 

On an annual basis, the highest mean number was achieved in 2009 with 671 cases. This was closely followed by 664 cases diagnosed in 2011.

 

In terms of morbidity differentials, about forty percent of cases diagnosed between 2008 and 2011 were patients with arthritis-rheumatoid. The remaining cases ranged from three percent with raynaude syndrome to 18 percent with bursitis.

 

Table 3: Annual distribution of morbidity between 2008 and 2011

ICD9 Code

Description

2008

2009

2010

2011

Mean

714

Arthritis;Rheumatoid

2014

1907

2119

1547

1897

726.5

Busrsitis

458

1019

576

1310

841

715.2

Osteoarthrosis; Low Leg/Knee

300

990

412

684

596

74

Arthritis;Gout

212

502

275

626

404

729

Fibromyalgia

261

393

438

489

395

715.1

Osteoarthritis

158

277

236

331

250

696

Arthritis;psoriatic

128

160

177

187

163

443

Raynauds Syndrome

211

123

157

137

157

 

Average

468

671

549

664

 

 

 

 

 

 

 

 

Source: EP’s Office                                                                                             

 

 

 

Current System:

The automated office system includes desktops (all are desktops procured in 2002 including Windows XP and MS suite) with details presented in table four; a network system with description later; a WiFi system; two HP Laser jet 4500 series; two canon 6500 series. The printers are all black and white and over three years old.

 

The network includes a server – HP Proliant ML 350, MSWindow 2003 RS (OS), Netgear, technology G4, an APA battery backup (Smart UPS 750, with 750 Watts, a system backup – Iomega (Rev 70 GB) used daily of designated tapes. Topology etc {???}

 

The internet set up includes an Intel pro 100 VE network (prided by Time Warner Cable, RCA MODEM and router.

 

The wireless is a ZyAir (Zyxel), secured with model FS116 (Netgear Ethernet switch.

 

Table 4: Computer distribution and set up location

 

Location

Make

Processor

RAM

Use

EP’s Office

HP Compaq

2.80 GHz

2.49GB

Professional

Infusion Center

HP dx Micro Tower

2.2 GHz

.99 GB

Professional

Medical Secretary (MS)

IBM

2.80 GHz

1.24 GB

Secretarial

MS

HP Compaq

3.00 GHz

199 GB

Secretarial

General Office (three)

IBM

2.80 GHz

1.24 GB

General Use

Front Desk

HP dx 2400

2.20 GHz

.99 GB

Check Out

Front Desk

HP dx 7100

3.20 GHz

2.24 GB

Check in

Nurses’ Off.

HP Compaq

2.80 GHz

2.49 GB

Professional

Server

HP Proliant ML 350

3.0 GHz

3.5 GB

Network

 

 

 

 

 

 

 

 

 

 

Source: EP’s Office

 

 

RFP Requirements:

 

The proposals will be evaluated based on two key areas – technical and financial. Billing will be considered as either an integrated or a “stand alone” part of the proposal.

 

Components to be addressed in detail in the technical section will include:

 

  • Compliance with CMS requirements – PQRS, e_Rx, CQM), etc;
  • Billing (Insurance Plans, Quality Control, Security Levels, Backup, Portability, Ownership etc)
  • Training (manual, online, didactic, group, individual etc);
  • Technical Support (in-house, Remote, etc);
  • System Availability (Web based, stand alone etc);
  • Availability of Cloud Computing (security, Backup, etc);
  • Demonstration session (On line, on site etc);
  • Timeline (Details to include task, responsible party, period, location and Assumptions;
  • Copy of CMS accreditation;
  • A copy of Company Prospectus;
  • Provision for OCR services (Include portability, Hardware, Software and license policy;
  • Computer System (Software, Two Options with specs: Desktops and Laptops with 16+ inch screens);
  • Data Management (Portability, Security Levels, Quality Control, Input (screens), output (Reports), etc);
  • Network Specifications (Manual, Server, topology: Network, Token Ring, Star, max nodes (simultaneous users), set up, configuration, S/W,OS,  Manufacturer etc);
  • WiFi (High speed, DSL etc);
  • Voice Recognition System (H/W, S/W, etc);
  • Three or more references;

 

The costs will be detailed, categorized by group of items. No hidden or “fine print” costs will be considered. In cases where figures are likely to change (like hotel, car rentals, per diem etc), ongoing costs will be accepted.

 

Proposal Evaluation Criteria: The methodology that will be used to assess each proposal will be based on the following process:

 

 

 RFP Score Formula:

       Total score=Technical Score + Financial Score

       Technical Criteria weight; [70%], maximum 700 points

       Financial Criteria weight; [30%], maximum 300 points

With this weighted scoring method, the award of the contract will be made to the individual supplier whose offer receives the highest score out of a pre-determined set of weighted technical and financial criteria:

       All the offers of individual suppliers who scored 490 (70% from 700) and more points will be included for financial evaluation. The lowest technically qualified proposal receives 300 points and all the other technically qualified proposals receive points in inverse proportion according to the formula:

        

       P=Y*(L/Z), where, P=points for the financial proposal being evaluated. Y=maximum number of points for the financial proposal. L= price of the lowest price proposal. Z=price of the proposal being evaluated

Summary Table: Table two represents a summary of all items (technical and financial) to be considered. The table serves as a reminder to potential suppliers. A completed copy is required with every proposal. Innovative ideas are encouraged and will be considered seriously. They however will not be included in the evaluation process. The self-described table includes the following columns:

  • Component ( presented earlier);
  • YES (Check if component has been addressed);
  • NO (Check if component has not been addressed);
  • Remarks (Additional and relevant observations ex. When a component has been addressed and service is currently not available)

 

Table two: Proposal Summary Table

 

Component

YES

NO

Remarks

Compliance with CMS requirements

 

 

 

Billing

 

 

 

Training

 

 

 

Technical Support

 

 

 

System Availability

 

 

 

Availability of Cloud Computing

 

 

 

Demonstration Session

 

 

 

Timeline

 

 

 

Copy of CMS accreditation

 

 

 

Copy of Company Prospectus

 

 

 

Provision of OCR

 

 

 

Computer System Specifications

 

 

 

Data Management

 

 

 

Network Specification

 

 

 

WiFi Specification

 

 

 

Voice Recognition System (VRS)

 

 

 

Three References

 

 

 

 

 

 

 

 

 

 

 

Two printed copies of each proposal will be mailed by courier to the following addresses:

 

Goddard Lainjo, MD

(Ref: CBSIP)

41 Dolson Ave

Middletown, NY 10940

 

 

Closing date: March 31, 2012

 

 

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