Fillable Printable Simple Request For Proposal Template
Fillable Printable Simple Request For Proposal Template
Simple Request For Proposal Template
Request for Proposal
(RFP) Template for Health
Information Technology
Template
Provided By:
The National Learning Consortium (NLC)
Developed By:
Health Information Technology Research Center (HITRC)
Wisconsin Health Information Technology Extension Center (WHITEC)
Stratis Health
Wide River Technology Extension Center (Wide River TEC)
ThematerialinthisdocumentwasdevelopedbyRegionalExtensionCenterstaintheperformanceoftechnical
supportandEHRimplementaon.Theinformaoninthisdocumentisnotintendedtoserveaslegaladvicenor
shoulditsubstuteforlegalcounsel.Usersareencouragedtoseekaddionaldetailedtechnicalguidanceto
supplement the informaon contained within. The REC sta developed these materials based on the technology and
law that were in place at the me this document was developed. Therefore, advances in technology and/or changes
to the law subsequent to that date may not have been incorporated into this material.
ThematerialinthisdocumentwasdevelopedbyRegionalExtensionCenterstaintheperformanceoftechnical
supportandEHRimplementaon.Theinformaoninthisdocumentisnotintendedtoserveaslegaladvicenor
shoulditsubstuteforlegalcounsel.Usersareencouragedtoseekaddionaldetailedtechnicalguidanceto
supplement the informaon contained within. The REC sta developed these materials based on the technology and
law that were in place at the me this document was developed. Therefore, advances in technology and/or changes
to the law subsequent to that date may not have been incorporated into this material.
March 31, 2012 • Version 1.0
1
ThematerialinthisdocumentwasdevelopedbyRegionalExtensionCenterstaintheperformanceoftechnical
supportandEHRimplementaon.Theinformaoninthisdocumentisnotintendedtoserveaslegaladvicenor
shoulditsubstuteforlegalcounsel.Usersareencouragedtoseekaddionaldetailedtechnicalguidanceto
supplement the informaon contained within. The REC sta developed these materials based on the technology and
law that were in place at the me this document was developed. Therefore, advances in technology and/or changes
to the law subsequent to that date may not have been incorporated into this material.
NATIONAL LEARNING CONSORTIUM
The National Learning Consortium (NLC) is a virtual and evolving body of knowledge and tools designed
to support healthcare providers and health IT professionalsworking towards the implementation, adoption
and meaningful use of certified EHR systems.
The NLC represents the collective EHR implementation experiences and knowledge gained directly from
the field of ONC’s outreach programs (REC, Beacon, State HIE) and through the Health Information
Technology Research Center (HITRC) Communities of Practice (CoPs).
The following resource is an example of a tool used in the field today that is recommended by “boots-on-
the-ground” professionals for use by others who have made the commitment to implement or upgrade to
certified EHR systems.
DESCRIPTION
This RFP template is intended to aid providers and health IT implementers throughout the EHR vendor
selection process. This template can be used to structure requests for vendors to send proposals on the
specific health IT that needs to be acquired.
INSTRUCTIONS
1.Carefully review the template to see if it contains information needed from the vendors. Add, change,
and delete information as needed. Update items that are noted <INSERT X> with the appropriate
information and remove the <INSERT> prompt.
2.Delete notes that are intended as instructions only.
3.Complete the Cover Page and General Conditions prior to sending to vendors, and complete
information for the Vendor Profile before sending (if known).
March 31, 2012 • Version 1.02
TABLEOF CONTENTS
1Complete Aspects of the Template........................................................................................................4
1.1Providing Information.....................................................................................................................4
1.2Time to respond.............................................................................................................................4
2Sample RFP..........................................................................................................................................5
3Specialty Specific Requirements.........................................................................................................30
March 31, 2012 • Version 1.03
1Complete Aspects of the Template
1.1PROVIDING INFORMATION
Provide accurate information about the organization so the vendor can target the appropriate products
and prepare an accurate price quote. This includes demographic, practice and ITinformation.
1.2TIME TO RESPOND
Give vendors 4-6 weeks to respond so that they have adequate time to prepare an appropriate response.
March 31, 2012 • Version 1.04
2Sample RFP
Name of Practice
Request for Proposal:
Electronic Health Record ("EHR") and
Integrated Practice Management System
INSERT Date>
<INSERT Practice Logo/Brand>
<INSERT Practice Name>
<INSERT Practice Address>
<INSERT City, State Zip Code>
<INSERT Point of Contact: >
<INSERT Phone: (xxx) xxx-xxxx>
<INSERT Fax: (xxx) xxx-xxxx>
<INSERT Email: [email protected]>
March 31, 2012 • Version 1.05
<INSERT Practice Name>
Request for Proposal
To Whom It May Concern:
About <INSERTPractice Name>
<INSERT History, organization, operations, staffing, patient population, special goals, etc.>
To meet the deadline for the initial approval, all responses to this RFP must be received electronically
by 5:00 PM (EDT) on INSERT Date>. All vendors intending to submit a response are requested to
submit a letter of intent along with any questions they may have by INSERT Date>. All questions
from all vendors will be consolidated and answered in writing by 5:00 PM (EDT) on INSERT Date >.
Vendors will review the information posted and communicate any requested changes or updates in
writing. Questions and completed responses should be sent to:
<INSERT Point of contact>
<INSERT Role>
Terms and Instructions:
Timeline
Process Deadline
Issue RFP INSERT Date>
Intent to Respond Due
Written Questions Due
Responses Posted
RFP Responses Due
Vendor of Choice Selected
Letter of Intent to Respond
<INSERT Organization Name> asks that all vendors email a letter of intent declaring their intention to
respond to this RFP by the given deadline. The e-mail should be sent to <INSERT Email Address> and
received no later than INSERT Date>. Please include the words "RFP: Intent to Respond" in the
subject line.
March 31, 2012 • Version 1.06
Inquiries
We encourage inquiries regarding this RFP and welcome the opportunity to answer questions from
potential applicants. Please direct your questions to <INSERT Email Address>. Please include the words
"RFP: Inquiry" in the subject line.
Deadline for Response
Interested vendors must submit an electronic copy of their proposed solution to <INSERT Email Address>
by <INSERT Date and Time>. Submissions will be confirmed by reply email. Late proposals will not be
evaluated.
Submission Process and Requirements
Responses shall be submitted in PDF format and sent using electronic mail. Send your response to:
<INSERT Email Address> by the date and time specified above. Receipt will be acknowledged via email.
Please include the words "RFP: Vendor Response" in the subject line.
Vendors should organize their proposals as defined below to ensure consistency and to facilitate the
evaluation of all responses. All the sections listed below must be included in the proposal, in the order
presented, with the Section Number listed. The responses shall be submitted in the following format:
Section 1 – Executive Summary (provide a concise summary of the products and services proposed)
Section 2 – Vendor Profile (provide answers using the template and instructions below)
Section 3 – Specifications (provide answers using the template and instructions below)
Section 4 – Implementation Plan (provide a high level implementation plan with estimated timeline)
Section 5 – Hardware and Configuration Specifications (provide a list of hardware requirements and
configuration options [client/server, SaaS, etc.])
Section 6 – Cost Estimate (provide answers using the template and instructions below)
General Conditions
<INSERT Organization Name> is not obligated to any course of action as the result of this RFP. Issuance
of this RFP does not constitute a commitment by <INSERT Organization Name> to award any contract.
The <INSERT Organization Name> is not responsible for any costs incurred by any vendor or their
partners in the RFP response preparation or presentation.
Information submitted in response to this RFPwill become the property of <INSERT Organization Name>.
All responses will be kept private from other vendors.
<INSERT Organization Name > reserves the right to modify this RFP at any time and reserves the right to
reject any and all responses to this RFP, in whole or in part, at any time.
March 31, 2012 • Version 1.07
Vendor Profile
Using the template below, please provide the requested information on your organization. Your response
to a specific item may be attached to this section as an additional page if necessary.
General
NameClick here to enter text.
Address (Headquarters)Click here to enter text.
Address ContinuedClick here to enter text.
Main Telephone NumberClick here to enter text.
WebsiteClick here to enter text.
Publicly Traded or Privately HeldClick here to enter text.
Parent Company (if applicable)
NameClick here to enter text.
AddressClick here to enter text.
Address ContinuedClick here to enter text.
Telephone NumberClick here to enter text.
Main Contact
NameClick here to enter text.
TitleClick here to enter text.
AddressClick here to enter text.
Address ContinuedClick here to enter text.
Telephone NumberClick here to enter text.
Fax NumberClick here to enter text.
Email AddressClick here to enter text.
Market Data
Number of years as EHR vendorClick here to enter text.
Number of live sitesClick here to enter text.
Breakdown of sites by provider # (1-5, 6-9, >10)Click here to enter text.
Number of new EHR installations over the last 3 years?Click here to enter text.
What is the percentage of vendor-provided installs vs. outsourced
to 3rd party companies?
Click here to enter text.
Breakdown of sites by specialtyClick here to enter text.
Size of existing user baseClick here to enter text.
Does the product have a <INSERT State> presence?
If so, # of install sites by specialty and size; list of <INSERT
State> reference sites.
Click here to enter text.
What is the current implementation timeframe when using only
vendor-supplied resources?
Click here to enter text.
Number and percentage of practices in <INSERT Year> that did
not get installed four (4) months after signing contract?
Click here to enter text.
How many organizations have de-installed any vendor systems
over the past two (2) years? Please specify which systems and
why?
Click here to enter text.
What is your EHR customer retention for the years <INSERT Year
1>, <INSERT Year 2>, and <INSERT Year 3>?
Click here to enter text.
Total FTEs Last YearClick here to enter text.
March 31, 2012 • Version 1.08
Total FTEs This YearClick here to enter text.
Explain how your company is planning to meet the increase in
demand for your EHR product (including implementation, training,
and support) over the next five (5) years.
Click here to enter text.
Product Information
Product name and version#Click here to enter text.
When is your next version release?Click here to enter text.
Single Database for scheduling, billing, and EHR?Click here to enter text.
Is it a Client Server, ASP or Hosted model?Click here to enter text.
Does product include a patient portal?Click here to enter text.
Was the product (or any of its significant functionality) acquired
from another company?
If yes, please answer the following:
What was the original company’s name that developed
the product or functionality?
What was the original product’s name?
What version did you purchase?
Click here to enter text.
Does the product include a patient portal and/or does it allow
integration with 3rd party patient portals (e.g., Google Health,
Microsoft HealthVault, iHealth, etc)?
Click here to enter text.
Is the product comprehensive or modular?Click here to enter text.
Modular
List all modules available, their current version, and
provide additional documents with all technical
specifications, requirements, and dependencies for
each module to operate fully with the "core" product.
Click here to enter text.
Which modules are necessary in order to meet
meaningful use criteria?
Click here to enter text.
Are additional or multiple modules required to meet
post-2011 meaningful use guidelines?
Click here to enter text.
Comprehensive
Does the product meet meaningful use guidelines?
Click here to enter text.
Will the product continue to meet meaningful use
guidelines through 2015 without significant changes?
Click here to enter text.
Will there ever be a charge to copy, move, or retrieve patient data
from the product should a customer decide to change vendors or
a provider leave the customer?
Click here to enter text.
List all ways that a practitioner could import a patient’s data into
the product:
CD/DVD
Flash Drive
PDF Format
Paper Copies
Clinical Exchange Document
Click here to enter text.
Reporting Capabilities
Does the product allow custom reports to be created?
Click here to enter text.
Ad hoc reporting by users an option?
Click here to enter text.
Provide a list of standard reports (no customization) which the
customer may run at Go Live to meet meaningful use and/or
HIPAA requirements.
Click here to enter text.
Can this report information be exported to CD/DVD in CSV or Click here to enter text.
March 31, 2012 • Version 1.09
comma text delimited format?
ONC-ATCB Certification
Is the product ONC-ATCB certified?
Click here to enter text.
Version and Year of Certification
Click here to enter text.
Certified as Comprehensive or Modular?
Click here to enter text.
Meaningful Use
Are the modules necessary to meet each of the menu set
objectives included in the attached pricing, or are they sold
separately at an additional cost?
Click here to enter text.
Do you have a guarantee the product will meet the current
standards and future standards?
Click here to enter text.
Additional Information
Timeframe to receive demonstration of product
Click here to enter text.
Is a demo copy available prior to purchasing?
Click here to enter text.
Onsite implementation or remote?
Click here to enter text.
Training sites
Click here to enter text.
Training options (train-the-trainer, # hours all staff)
Click here to enter text.
Has your company acquired, been acquired, merged with other
organizations, or had any "change in control" events within the
last five (5) years? (If yes, please provide details.)
Click here to enter text.
Is your company planning to acquire, be acquired, merge with
other organizations, or have any "change in control" events within
the next five (5) years? (If yes, please provide details.)
Click here to enter text.
Does your company use resellers to distribute your product(s)?
If yes, please answer the following:
What is your reseller structure?
Who are your resellers who are authorized to sell within
[STATE]?
If no, please answer the following:
What is your distribution and sales structure?
Click here to enter text.
Please provide information on any outstanding lawsuits or
judgments within the last five (5) years. Please indicate any
cases that you cannot respond to as they were settled with a non-
disclosure clause.
Click here to enter text.
March 31, 2012 • Version 1.010
Security and Security Features
Describe how the product meets all HIPAA, HITECH, and other
security requirements.
Click here to enter text.
Does the product provide different levels of security based on
User Role, Site, and/or Enterprise settings?
Click here to enter text.
Does the product provide different levels of security based on type
of patient (Employee vs. VIP)?
Click here to enter text.
Describe the audit process within the product.
Click here to enter text.
List the security reports the product provides at Go-Live to meet
all auditing and HIPAA reporting needs.
Click here to enter text.
Describe any remote tools you offer the provider to access patient
data (e.g. iPhone) and how these devices/data may be secured if
the provider loses their device or a breach is suspected.
Click here to enter text.
Describe the product's ability to terminate user
connections/sessions by an administrator (remotely) if a breach is
suspected.
Click here to enter text.
Describe the product's ability to lockout users (for upgrades,
security breaches, employee terminations, etc).
Click here to enter text.
Describe the product's ability to create new security rights/roles
based on new workflows or enhancements (e.g., customer-
developed content such as Psych notes or departmental
flowsheets).
Click here to enter text.
Data Protection
Describe how the patient’s data is secured at all times and in all
modules of the product (e.g., strong password protection or other
user authentication, data encrypted at rest, data encrypted in
motion).
Click here to enter text.
Describe how the patient’s data is secured when accessed via
handheld devices (e.g., secured through SSL web sites, iPhone
apps, etc).
Click here to enter text.
Licensing
How is the product licensed?
Click here to enter text.
Are licenses purchased per user?
Click here to enter text.
Define ‘user’ if it relates to the licensing model (i.e., FTE MD, all
clinical staff, etc).
Click here to enter text.
How does the system licensing account for residents,
part time clinicians, and midlevel providers?
Click here to enter text.
Can user licenses be reassigned when a workforce
member leaves?
Click here to enter text.
If licensing is determined per workstation, do handheld devices
count towards this licensing?
Click here to enter text.
Is system access based on individual licensing, concurrent, or
both?
Click here to enter text.
What does each license actually provide?
Click here to enter text.
For modular systems, does each module require a unique
license?
Click here to enter text.
In concurrent licensing systems, when are licenses released by
the system (i.e., when the workstation is idle, locked, or only when
user logs off)?
Click here to enter text.
March 31, 2012 • Version 1.011
