Electronic Health Records Modernization Services

The Vendor is required to provide electronic health records modernization system must be highly adaptable to evolving regulatory, clinical, and tribal governance requirements.
- Integrated clinical architecture
1. Medical/primary care:
• Dynamic templates with GPRA/UDS clinical decision support (pop-up alerts for missing measures).
• Native e-prescribing (EPCS) with integrated PDMP/maps checking.
• Bi-directional lab and imaging interfaces (hl7).
2. Dental services:
• Full odontogram and PERIO-charting integrated with the primary medical record.
• Native support for ADA coding and specialized dental billing workflows.
3. Community health (CHR) and outreach:
• Mobile-ready design: full functionality on tablets for home visits.
• Screening: integrated tools for social determinants of health with automated referral triggers to community partners.
4. Referral management:
• Closed-loop tracking for internal/external referrals with PRC (purchased/referred care) fund tracking/billing/coding.
• Automated status updates for patients via the portal.
- Data migration
• Full extraction: extraction of all rpms data, including clinical, dental, and billing records.
• Structured conversion: migration of discrete data elements including problem lists, medications (with history), allergies, labs, and immunizations.
• Image and document migration: integration of all scanned documents and vista imaging assets into the new patient record.
• Historical continuity: strategy for maintaining access to longitudinal records for GPRA and population health trending.
• Validation and QA: a formal process for data reconciliation, including a "test migration" and tribal sign-off period.
• Downtime strategy: a plan to minimize clinical disruption during the "big bang" or phased cutover.
• Rpms expertise: provide a summary of previous rpms migrations, including references for those specific projects.
- Interoperability
• Standards compliance: full support for hl7, FHIR, and CCDA formats.
• State and local exchange: native integration with UPHIE and automated reporting to MCIR (immunizations) and maps
• Diagnostic interfaces: bi-directional hl7 interfaces for commercial labs and local hospital imaging systems.
• Federal and public health reporting: automated generation of UDS and GPRA reports.
- Revenue cycle and billing
• Comprehensive third-party billing: support for Medicare, Medicaid, and private insurance with automated coordination of benefits (cob) for primary, secondary, and tertiary payers.
• Tribal-specific logic: mandatory support for the service all-inclusive rate (AIR), encounter-based billing, and the payer of last resort rule.
• Purchased/referred care (PRC): integrated PRC module to manage authorizations, track commitment of funds, and monitor medical priority levels.
• Claims management: integrated claims scrubbing to identify errors prior to submission and full support for 837 (claims) and 835 (remittance) transactions.
• Unified billing: consolidation of medical, dental, and behavioral health billing into a single platform.
• Financial reporting: advanced reporting suite including A/R aging by payer, net collection ratios, and automated UDS/GPRA financial data extraction.