Approve agreement with Netsmart Technologies, Inc. in the amount of $1,950,000 for the period of July 1, 2023 through June 30, 2026 for the provision of computer technical support and maintenance for Avatar Management Information System (the County’s Electronic Health Record “EHR”). (No general fund impact) (Sullivan)

Approve agreement with Netsmart Technologies, Inc. in the amount of $1,950,000 for the period of July 1, 2023 through June 30, 2026 for the provision of computer technical support and maintenance for Avatar Management Information System (the County’s Electronic Health Record “EHR”).

Avatar was chosen, in part, due to its ability to meet the State and Federal reporting requirements for Medi-Cal Specialty Mental Health Services and Drug Medi-Cal Services as well as the ability to provide technical and physical security as required by the national standards Health Insurance Portability and Accountability Act (HIPAA) of 1996. Avatar can track eligibility, billing, payment application, appointment scheduling, medical records maintenance, and critical data items.
This Agreement with Netsmart will provide the County with the necessary licenses to continue utilizing Avatar as the County’s Electronic Health Records (EHR) system. It will also allow Netsmart to continue to provide technical support and maintenance that will enable HHSA to fully utilize its database, including remote hosting. More specifically, this effort will allow HHSA to continue the transmittal of required information to the State Department of Healthcare Services in a timely manner, the completion of State and Federal billing and reporting requirements, and the effective tracking of the clinical services that HHSA provides to consumers.

In addition to the support and maintenance services, this Agreement also includes the following:
1. An annual fee for Electronic Signature Pads.
This allows staff to work more efficiently with consumers in the field as well as the office, to gain signature consent for treatment and services, release of information, etc.

2. Order Connect e-Prescribing Module
The Order Connect suite is an e-Prescribing and medication management product. The full version of this product has the ability to exchange web-based pharmaceutical information with defined allied healthcare partners. This will allow the medical prescribers on HHSA staff to increase efficiency and accuracy, ensuring prescriptions are sent to the appropriate pharmacy, decrease, if not eliminate lost prescriptions, thus speeding up the provision of our consumers medication support.

3. Enlighten Analytics
A powerful management tool that helps clients understand their organization's strengths and opportunities for improvement compared to similar organizations regionally and nationally. Transforms data into actionable information an organization can use. Encompasses hundreds of behavioral health and human services metrics in the clinical, operational, financial and organizational climate realms of performance.

4. Document Capture [Point of Service (POS) Scanning and Batch Imaging]
Allows for the scanning, importing and archiving of cards, images and forms from a paper to electronic format.  Point of Service provides staff the ability to quickly and easily scan, capture and organize low volume scanned images.  Batch Imaging provides staff the ability to scan large volumes of documents without presorting/separating by patient or document type in advance.  The document batch can then be manually organized / separated by patient, document type, or episode using an ImageNow eForm.

5. MyAvatar Hosting (Simplify System Management and Maintenance)
Netsmart Plexus™ Cloud offers a secure hosting environment for Netsmart CareRecords™ (EHR solutions), as well as all your other enterprise applications used throughout an organization. Clients are hosted in fully redundant TIER 3 class data centers with SSAE16-certified operations. Plexus Cloud is a cost-efficient service that ensures information systems are accessible yet secure, allowing organizations to focus on their core mission: providing the highest quality care possible to populations they serve.

6. ICD-10 Upgrade Subscription
This latest version of the DSM manual includes significant changes to the way that a diagnosis is recorded including the removal of all Axes designations.  As a result of these changes, Netsmart Technologies, Inc. has made changes to the existing myAvatar platform to support these transitions.

7. Meaningful Use Certification Module
Meaningful Use is comprised of four software components; Health Information Exchange (Connect/Care Quality), OrderConnect; and Care Guidance/Clinical Quality Metrics.  A description for each component is provided below:
a. Health Information Exchange:

i. CareConnect enables the sharing of clinical information between and among providers involved in the care of a consumer and with other entities such as Regional Health Information Organizations (RHIOs). CareConnect works with the Netsmart enterprise system to provide a secure way to exchange clinical and administrative information. It is the vehicle for Clinical Information Exchange.
ii. Carequality builds on data exchange relationships and agreements you already have in place, and expands their reach.  We do this by connecting what we call Implementers, who might be HIEs, EHR vendors, payers, clearinghouses, or other types of organizations.  Carequality Implementers provide access to data from many different sources.  When you get a cell phone, you sign up for service with a network provider and then can make calls to anyone, regardless of their provider.  Carequality brings that concept to health IT.  Once you have connectivity services from one of our Implementers, you can exchange records with any other participant regardless of their Implementer.

b. OrderConnect is Netsmart’s Surescripts Certified Secure Web-based electronic prescribing, order tracking management system. OrderConnect helps providers improve quality of care, reduce medication errors and meet criteria to receive Medi-Cal and Medicare funds for Meaningful Use of an Electronic Health Record (EHR). It is fully integrated with Netsmart’s enterprise solutions.
c. Care Guidance is a module that provides reports and monitoring metrics for Meaningful Use Measures and Clinical Quality Measures. Dashboards and alerts support clinician awareness and help organizations to improve care and outcomes. Beyond regulated reporting, Netsmart’s Care Guidance for Meaningful Use Stage 2 includes the ability to benchmark an organization’s performance on all required Clinical Quality Metrics as data becomes available in 2015. As Centers for Medicare & Medicaid Services (CMS) potentially changes the Meaningful Use menu requirements year to year, Care Guidance subscription covers these changes.

8. KPI Dashboards
Tracking key performance indicators (KPIs) is an essential step to becoming a truly data-driven organization. KPI Dashboards provide at-a-glance metrics to clinical, financial and operational decision-makers to determine if your organization is moving in the right direction to achieve organizational goals. The solution organizes and presents information to the user in a way that is easy to read and share with others.
This dashboard solution provides snapshot views for clinical, financial and operational data of select KPIs, as well as the ability to create user-defined views and filter aggregated data by program, service type, caseload and more. Flexibility and ease of use mean performance measures can be shared regularly with staff members who can affect these key metrics through performance and outcomes. As a result, your organization can make steady, measurable progress toward well-defined goals.

9. Managed Services Organization (MSO)
A uniquely adaptable system which serves the specialized needs of states, counties, Managed Care Organizations, specialty networks, and providers attempting to carefully monitor both at-risk and non-risk contracts.  This application is an add-on feature to Avatar. This will assist with providing contract monitoring and authorization monitoring from within Avatar.

Performance Measures included in this Agreement are as follows:
Performance Measures are not associated with this Agreement.

County Counsel has approved this Agreement as to form.
Department of General Services, Procurement Division

On May 10, 2023, the Yolo County Procurement Manager approved a sole/single source procurement for these services.

Procurement reviewed HHSA’s request and determined that it was in the best interest of the County to renew the agreement, based on satisfactory service/reasonable prices and to avoid the interruption of County business. Without a sole source approval and renewal of the agreement with the vendor, the County would lose their EHR system and loss of revenue. Factors considered, included but were not limited to:

1) Avatar is our only EHR for BH services, to which we have 100% dedicated resources, and expanding access to providers; 2) satisfactory vendor performance-vendor is the sole creator and maintainer of the Avatar system; 3) vendor works closely with HHSA staff and ensures our annual committed funds are reasonable and appropriate and ensures annual increases are not outrageous; and 4) loss of revenue-unable to document services provided and thus be unable to claim reimbursement for Medi-Cal services from the state.