INFECTION CONTROL SYSTEM (ICS)

Vendor Selection

Memorial Regional South Abington Hospital (MRSA)

Juan Estrada, MD Jyothi Golkanda Ellen Nixon, RN Michael Nowak, PhD

Table of Contents
1. 2. 3. 4. 5. 6. 7. 8. POLITICAL ENVIRONMENT .............................................................................................. 2 CHANGE MANAGEMENT PLAN ....................................................................................... 2 VENDOR ANALYSIS ............................................................................................................ 3 EVALUATION CRITERIA METHODOLOGY.................................................................... 4 BUDGET ESTIMATES .......................................................................................................... 5 CONSTITUENCY ROLES ..................................................................................................... 6 VENDOR SIZE INFLUENCE ................................................................................................ 7 ACCEPTANCE TESTING ..................................................................................................... 8 ACCEPTANCE CRITERIA ....................................................................................................... 8 COMPLETION CRITERIA ....................................................................................................... 8 FINAL ACCEPTANCE.............................................................................................................. 9 9. VENDOR SELECTION .......................................................................................................... 9

APPENDIX A: STAKEHOLDER MANAGEMENT .................................................................. 10 APPENDIX B: EVALUATION CRITERIA MATRIX .............................................................. 12 APPENDIX C: SCORE COST EVALUATION METHOD ........................................................ 13 APPENDIX D: EVALUATION CRITERIA FACTOR GUIDELINES ...................................... 14 APPENDIX E: NARRATIVE CONSENSUS STATEMENT ..................................................... 15 APPENDIX F: MRSA VENDOR SPREADSHEET .................................................................... 16 REFERENCES ............................................................................................................................. 17

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1. POLITICAL ENVIRONMENT
In accordance with the Deficit Reduction Act of 20051, the Centers for Medicare and Medicaid Services (CMS), effective October 1, 2008, halted reimbursement to United States hospitals for several hospital-acquired complications or comorbidities. The policy was directed towards, but not limited to, certain surgical infections, hospital-acquired urinary tract infections and hospitalacquired bloodstream infections. Memorial Regional South Abington Hospital (referred to as MRSA), a 300-bed facility, is one of Pennsylvanias largest and most comprehensive hospitals. Without a doubt, these reimbursement changes will have an impact upon the financial health of our organization. An internal analysis revealed surgical site infections at MRSA have been on the rise over the past 5 years. The current medical record system utilized by the surgical department is a paper based system. This system does not have the capacity to communicate, alert or provide any essential information to key members of the infection control committee nor forestall the occurrence or propagation of Healthcare Associated Infections (HAI). The department chief and its members deem the current processes to be effective and well managed. Realistically, modifications to current clinical workflows, utilizing newer technology, would enhance real time team member involvement, proactively prevent HAI and hopefully avoid Medicare penalties.

2. CHANGE MANAGEMENT PLAN

The Change Management Plan from the National Institutes of Health (2001) states, The greatest risk to the successful implementation of an enterprise-wide system is the failure to take into consideration major aspects of Organizational Change Management. The authors go on to state
1

(109th Congress, 2005)

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poor communication, inadequate training or insufficient workforce planning can all contribute to a lack of acceptance for business changes and poor performance at the end-user level. During any large selection process and implementation, such as an ICS, the project team can expect resistance and a reluctance to accept change. The ICS Project Team (Team) first identified the key stakeholders at MRSA and established their current and target project awareness. Additionally, each stakeholders degree of project support and organizational influence was defined. A stakeholder management plan was developed to build greater support among the most influential stakeholders (APPENDIX A). Effective strategic communication is the key to successfully select and implement large-scale organizational initiatives. To ensure effective communication among key players throughout this project, the Team developed a formal Communication Plan: Identification of key stakeholders Discern which information is most valuable to key stakeholders. Establish the optimal communications method and format to disseminate information Establish regular meeting agendas, schedules, location and participants

3. VENDOR ANALYSIS
The Team formed an ICS Project Evaluation Board (Board), comprised of representatives across the MRSA organization. This Board was divided into two sub- groups: an ICS Technical Assessment Evaluation Committee, comprised of expert clinical users (CMO, CNO, and infection control committee) and operational managers (CIO, COO), responsible for evaluating the relative technical merits; and an ICS Business Assessment Evaluation Committee, responsible for evaluating the contractual terms, conditions, past business conduct, etc. By process of elimination, two Vendors remained in final evaluation process: Premier Safety Advisor and Vecna Medical QC Pathfinder. These two private companies produced over $1 MRSA Vendor Selection Page 3

billion and $350 million in revenue respectively, plus over $100 million in annual net profit. Both companies demonstrate sound corporate structures, retaining executives and management teams with long term health care industry experience. Premier, a much larger company, has a greater amount of successful contracts and implementations at multiple facilities (Premier: 30.000 current users, Vecna: 5000 current users). The two companies do not differ significantly regarding the stability of their ICS implementations. Both have had fully operational systems at multiple facilities for greater than 5 years. Each company has continued to update their software annually or bi-annually (Premiers current version 6, Vecnas current version is 5).

4. EVALUATION CRITERIA METHODOLOGY

The MRSA RFP was designed to select the Vendor solution providing superlative fulfillment of the ICS requirements. A weighted set of criteria (APPENDIX B), determined by relative importance, was utilized by the two evaluation committees. The criteria examine the technical approach, project management plan, quality of data, system application support and maintenance, corporate quality/experience and ease of use. The application of a ratings scale (APPENDIX B) followed, measuring the strengths/weaknesses of each Vendors solution. Evaluators, assigned by their area of their expertise, were required to assess and rate each proposal against the appropriate scorecard (APPENDIX B & APPENDIX D). Subsequent deliberation over criteria scores for each ICS solution culminated in a consensus elimination of all but two preferred Vendors: Premier and Vecna. Formal Board presentations were delivered by each, including responses to questions and specific issues raised by the Board regarding their individual proposal.

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Additional merits sought by the Board were: Future option of independent software operation and customization, with ability to add new sub-systems. Sound financial health, ensuring delivery of the solution as proposed and viable future support of their product. Cultural fit whereby the MRSA-Vendor relationship fosters confidence and trust.

After the formal presentations, the Board reconvened to discuss and review the presentations, any outstanding issues, and the strengths and weaknesses of Premier and Vecna. A narrative consensus report (APPENDIX E), summarizing the selected Vendor process, was filed reporting: Strengths and weaknesses of each proposal derived from individual evaluations and discussions; Documentation of reference checks; Summaries and/or graphs of Vendor evaluation/scores and the consensus by factor for each proposal; Committee members evaluations; and Signatures or initials by all Board members, indicating concurrence with the consensus report contents.

5. BUDGET ESTIMATES
Any budget estimate should incorporate costs for the hospital, vendor, maintenance, training and support.
Budget Limits Hospital Hardware & Installation Software & Training Annual Maintenance Total years 2 - 5 Total Cost $100,000 $230,000 $300,000 $120,000 $750,000 Vendor 1 $72,000 $225,000 $275,000 $100,00 $672,000 Vendor 2 $83,000 $211,000 $283,00 $112,00 $689,000 Vendor 3 $68,000 $248,000 $310,00 $125,00 $751,000 Vendor 4 $107,000 $212,000 $275,000 $118,000 $712,00

MRSA will incur costs for upgrades to existing hardware, software, equipment and the hospital. The vendor costs contain one-time fees for installation, hardware, software, equipment and MRSA Vendor Selection Page 5

training. Finally, the budget estimate should also include the annual cost for maintenance and support for years 2 through 5. While the budget estimates of each vendor will be considered based on the merits their proposal, the total cost of the project shall not exceed $1,000,000.

6. CONSTITUENCY ROLES
1. Senior Administration: Managing Board Members, Chief Executive Officer (CEO), Chief Medical Information Officer (CMIO), Chief Nursing Office (CNO) , and Chief Medical Officer (CMO) This group creates the vision, support, goals and budgetary parameters for the ICS project. Managing Board Members garner public support for MRSAs infection control efforts while the CEO, CMIO, CNO and CMO assure alignment of all staff with the ICS project recommendations. Additionally, the CMIO, CNO and CMO serve as liaisons for the dissemination of information and conveyance of concerns between both the administration and the professional and clinical staffs. 2. Clinical experts: Chief surgeon, Chief surgical nurse, Critical Care Nurses, Intensivist, Infection Control Committee Members-Infection Control Officer (ICO) and Infection Control Nurse (ICN), Pharmacists This group provides the clinical expertise in evaluating the proposed ICS submissions. Their focus is alignment with recommended regulatory and clinical guidelines for infection control, patient safety issues and development and revision of policies, procedures and workflows. Comprised of curmudgeons and champions, this group will take advantage of their influence among their staff and peers to promote the new ICS and its successful implementation. 3. Information Technology (IT) Department: IT Manager, IT Technical Champions, IT Training Staff This group provided the technological expertise to assess the alignment of the ICS solutions with the RFP requirements and MRSAs current infrastructure and legacy systems. This group must

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have a full understanding of the selected ICS in order to perform their integration and implementation responsibilities as delineated in the RFP. 4. Risk Management/Compliance department:. Legal counsel, Risk Management Officers This group provided expertise regarding governmental regulations, Federal privacy/security mandates (HIPAA, CMS and Joint Commission), contracts and service level agreements (SLA). 5. Finance and Accounting/Billing department: Representatives from these departments provided expertise comparing the Vendor cost estimates with MRSAs ICS Project budgetary guidelines.

7. VENDOR SIZE INFLUENCE

The hospital is under significant pressure to reduce HAIs. New CMS regulations will reduce and/or eliminate reimbursement for treatment under these conditions. Insurance companies are also considering these types of restrictions. Due to these factors, the software installation and testing must follow a tight schedule, with heightened focus on installation time lines and customer service. Any delays in installation can have negative impact on MRSAs bottom line. The above requirements are driven by Vendor organizational size. Two major EMR vendors, Cerner and Epic, do not currently have a suitable ICS in their portfolio and were thus eliminated. MRSAs RFP requirements necessitated a search for a best of the breed solution from an established midsized company with a proven ICS solution record, specializing in niche solutions. Annual company sales should exceed $5,000,000, eliminating startup companies. Customer service is an important aspect of the software installation. The Vendor should assure adequate staffing to meet installation benchmarks and provide timely customer support. The Vendor must have a well-established customer service operation with adequate staff to ensure timely issue resolutions as MRSA will not be the only facility employing caller support. A

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smaller company may not have the required staffing to meet all the requirements. The ICS will need to interface with Admission, Discharge and Transfer (ADT) systems as well as legacy lab, pharmacy, radiology and pathology systems. The Vendor will need to have a broad background with experience in all these systems.

8. ACCEPTANCE TESTING
At the end of every milestone, the deliverables will be reviewed and validated to check if the deliverable meets the requirements. MRSA will either approve or reject it and the vendor will have to make necessary updates as soon as possible until the deliverable is approved. A successful vendors system must satisfy the following acceptance criteria: Acceptance Criteria The system must be able to automatically detect a HAI based on the data in the patient records and alert the clinicians for improved response to HAI. Based on the data from the patient chart the system must detect the patients risk factors such as morbidity, invasive devices, surgical procedures etc. to acquire a HAI. Identify potential adverse events by analyzing specific combinations of events and underlining relations between symptoms, treatments, drugs, reactions, and biological parameters. Alert the appropriate clinicians when such potential events are detected. Successfully identify all cases of HAI and related adverse events. A predictive modeling system based on risk factors identified through evidence based medicine and retrospective analysis made by HAI experts to detect the potential for a patient to develop HAI and alert clinicians. Provide a user interface to communicate between hospital wards and infection control committee. Provide clinical quality reports per NQF specification for quality improvement initiatives. Electronic transmission of HAI data to public health agencies Plug and play interface to add additional reports and update the fields and display in the dashboards.

Completion Criteria Prior to acceptance testing vendor will furnish MRSA with documentation of the deliverable items, the expected performance and agreed upon acceptance criteria. MRSA Vendor Selection Page 8

Deliverables for every milestone will be reviewed, upon completion and at project end.. For milestone deliverables MRSA has 10 days to complete acceptance testing and accept or reject the deliverable in writing. If the deliverable is rejected, MRSA will specify in writing the reasons for the rejection and the Vendor must make necessary updates to confirm to the requirements of the contract.

Final Acceptance Acceptance testing will be performed on-site on MRSA platform. The final delivered product must be fully implemented in MRSAs live production environment no later than 4/27/2013. MRSA has sixty-days to accept or reject the Contract in writing. In the case of rejection, MRSA will specify, in writing, the reasons for rejection. The Vendor must update the product to conform to the Contract requirements as soon as possible at no additional cost to MRSA and continue to do so until MRSA accepts the product or terminates the Contract. MRSA has 12 months following the final acceptance and delivery to verify product conformance and performance with the Contract requirements and the system design specifications provided by the Vendor. In the event MRSA finds any defect, deficiency or nonconformance to the requirements or design specifications, the Vendor must correct the defect at no charge or agree to a mutually acceptable plan for correction within 30 days of the receipt of the written notification from MRSA.

9. VENDOR SELECTION
Reviewing the 6 Vendor responses received and the requirements of MRSA, Premier and Vecna were selected as the top two vendors. Premier SafetySurveillor has a very good customer base. In addition to providing an ICS per MRSAs requirement, Premier also has a hospital engagement network (HEN) which serves as a mobile classroom with clinical improvement advisors (CIAs) providing:

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Training and education programs including onsite hospital visits Technical support to achieve quality measurement goals Online database of safety tools and resources National and regional best practice sharing forums Data benchmarking and tracking to measure quality improvement goals HEN identifies the solutions already proven to reduce healthcare-acquired conditions and readmissions, and spreads the best practices and resources to other hospitals and healthcare providers.

Vecna QC PathFinder has a web-based application that automates surveillance for infection and offers fast and effective interventions. Vecna offers real-time infection surveillance using data from ADT, Laboratory, Pharmacy, and Surgery. QC PathFinder supports the detection of HAI, reportable communicable diseases, adverse drug events, ventilator-associated pneumonia, and other threats to patient safety. It automatically collates relevant information such as provider details and location history. This information is then processed by the applications analysis and graphing tools to identify trends and clusters; create C, G, and P charts; and generate visual data summaries. In addition, users can customize an at-a-glance dashboard to view key data points, analyses, and up-to-the-minute alerts. On the weighted scoring scale (APPENDIX B), based on importance, performance and value, Premier SafetySurveillor outscored Vecna QC PathFinder and, therefore, was awarded MRSAs contract.
Comment [E1]: Define

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APPENDIX A: STAKEHOLDER MANAGEMENT

Stakeholder Chief of surgery Chief Information Officer Chief Surgical Nurse

Awareness (H/M/L) High High

Support (H/M/L) Low High

Influence (H/M/L) High Moderate

Plan Regular meetings, data and result driven communication Recent addition to the team, will need to engage staff frequently to have their buy in Recent arguments with surgeons. Will need physician champions to engage rest of department

High

Moderate

Moderate

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APPENDIX B: EVALUATION CRITERIA MATRIX2

Criteria 1. General Quality & Adequacy of Response a. Completeness and thoroughness b. Grasp of problem c. Responsiveness to terms and conditions 2. Technical ApproachQuality of Package Provided a. Approach to program analysis b. Services to be renderedquantity and quality 3. Organization, Personnel, and Experience a. Qualifications of personnel b. Experience with program analysis & model presentations c. Past experience with government organization, applicable programs 4. Timetable a. Ability to meet schedules 5. Cost (see APPENDIX_____) 6. Total

Weight

Total pts. 150

Vecna QC PathFinder 30 50 35 115

Premier SafetySurveillor 35 65 40 140

40 70 40 300 100 150

80 120 200 200

90 140 230

80 80 40

70 70 20 160

80 80 40 200 90 230 890

100 250

100 250

80 200 775

(State of Wisconsin)

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APPENDIX C: SCORE COST EVALUATION METHOD3

1. Cost will be divided by the total points to arrive at a cost per point per proposal and ranked accordingly. Cost is one of the evaluation categories listed above and will be a percentage of the total RFP evaluation. After the final grading of the proposal requirements, cost will be prorated with the lowest cost proposal given the highest score for that category. The formula would be as follows: X Lowest Bid (constant) Other Proposer's Bid (varies)

2.

Cost Score = Maximum cost evaluation points given (250)

3.

Calculation of points awarded to subsequent proposals will use the lowest dollar bid amount as a constant numerator and the dollar amount of the firm being scored as the denominator. (This result will always be less than one.) The result then is multiplied by the number of points given to the cost section of the RFP. Total the final score.

(State of Wisconsin)

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APPENDIX D: EVALUATION CRITERIA FACTOR GUIDELINES4

Exceptional (1.0) Exceptional understanding of MRSAs goals and objectives One or more major strengths exist. No major weaknesses exist. Strengths significantly outweigh the weaknesses. Expected to cause no disruption in schedule, increase in cost, or degradation in performance. Will require no organizational emphasis and monitoring to overcome difficulties. Very Good (0.8) Very good level of understanding of the goals and objectives of the acquisition. Strengths outbalance weaknesses that exist. Any weaknesses are easily correctable. Expected to cause minimal disruption of schedule, increase in cost or degradation of performance. Will require a low level of organizational emphasis and monitoring to overcome difficulties. Good (0.5) Good level of understanding of the goals and objectives of the acquisition. There may be strengths or weaknesses or both. Weaknesses are not offset by strengths, but the weaknesses do not significantly detract from the Proposers response. Expected to cause minimal to moderate disruption in schedule, increase in cost, or degradation in performance. Will require low to medium level of organizational emphasis and monitoring to overcome difficulties. Marginal (0.2) Marginal level of understanding of the goals and objectives of the acquisition. Weaknesses have been found that outbalance any strengths that exist. Weaknesses will usually be difficult to correct. Expected to cause moderate to high disruption in schedule, increase in cost, or degradation in performance. Will require medium to high organizational emphasis and monitoring to overcome difficulties. Unacceptable (0) Poor understanding of the goals and objectives of the acquisition. No major strengths exist, and one or more major weaknesses exist. Weaknesses clearly surpass any strength. Weaknesses are expected to be very difficult to correct or are not correctable. Extremely high risk to the success of the program. Expected to cause significant, serious disruption in schedule, increase in cost, or degradation in performance. Will require significant or constant, high level of organizational emphasis and monitoring to overcome difficulties.
4

(Decision Lens, 2008)

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APPENDIX E: NARRATIVE CONSENSUS STATEMENT 5.

(Summary Statement only) The resultant award provides for an Infection Control System The Infection Control System RFP was issued to qualified vendors based on their match with our technical and business model, their reputation, references and preliminary budget. The ICS RFP closed on ____ and MRSA received ____ response proposals. Based on the evaluation panel review, discussion, and comparative analysis conducted in the course of this evaluation process and through a consensus, the evaluation panel confidently recommends award to _________________. __________________ proposed a price of

_______, and is the fairest price, technically acceptable proposal. This Evaluation Recommendation has been developed in a fair and unbiased manner. We have personally reviewed each proposal received, have documented the results of our evaluation, and have completed this document in good faith and in the best interest of MRSA.: By signing below the evaluators confirm that they have reviewed both the technical proposal and price/cost proposal discussed herein and that the assessment documented herein reflects consideration of both aspects of the proposal. Printed Name Signature Date Printed Name Signature Date Printed Name Signature Date Printed Name Signature Date

(Consensus Recommendation Report)

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APPENDIX F: MRSA VENDOR SPREADSHEET

MRSA SPREADSHEET.XLS

(TGI, 2013)

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REFERENCES

1. 109th Congress. (2005). Deficit Reduction Act of 2005. Retrieved from www.GovTrack.us: http://www.govtrack.us/congress/bills/109/s1932 2. Consensus Recommendation Report. (n.d.). Retrieved from Tricare: EVALUATION BOARD/PANEL CONSENSUS: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0CEgQFj AE&url=http%3A%2F%2Ftricare.mil%2Ftma%2Fams%2Fdownloads%2FEvaluation_B oardPanel_Consensus_LPTA.doc&ei=kmAhUazTD4OcyQGM0oDwDw&usg=AFQjCNGHP nqpLQkYak_rtGsqh-U_AFT3HA&cad=rja 3. Decision Lens. (2008). Vendor Selection Decisions. Retrieved from http://www.decisionlens.com/docs/WP_Vendor_Selection.pdf 4. State of Wisconsin. (n.d.). SAMPLE REQUEST FOR PROPOSAL (RFP), Appendix C. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=21&ved=0CC8Q FjAAOBQ&url=http%3A%2F%2Fvendornet.state.wi.us%2Fvendornet%2Fdoaforms%2 Frfp.doc&ei=zb4VUa-iDuaYygG48IG4Cg&usg=AFQjCNEN_Om9HPXJMYKtiOvzDgpO6tsoQ&bvm=bv.42080656,d.aWc

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