Sources Sought Notice – Request for Information — IHS HIT Modernization
Notice Type: Sources Sought Notice
Posted Date:
Office Address:
Subject: Request for Information -- IHS HIT Modernization
Classification Code: D - Information technology services, including telecommunications services
Solicitation Number:
Contact:
Description:
IHS HIT Modernization RFI Department of
This Request for Information (RFI) is part of a special IHS exploratory market research effort called 'Reengineering of American Indian's & Alaska Native's Health IT Systems' or 'RAINH' to assess industry innovations and capabilities that might best address IHS' emerging enterprise healthcare delivery and modernization needs. This is not a Request for Proposal (RFP) and shall not be considered an Invitation for Bid (IB), or a Request for Task Execution Plan (RTEP). Additionally, there is no obligation on the part of IHS to acquire any products or services described in this
Responders must also understand that a solicitation is not being issued at this time, and this notice shall not be construed as a commitment by IHS to issue a solicitation, nor does it restrict IHS to a particular acquisition approach. Any information provided by industry to IHS as a result of this
I. Introduction
The
In execution of its mission, IHS develops and maintains a comprehensive integrated government-off-the-shelf (GOTS) health information system-of-systems which supports a broad range of clinical and business functions at IHS Federal, Tribal and Urban (I/T/U) hospitals and clinics across
Business functions supported by the RPMS include, but are not limited to: practice management, such as patient registration, scheduling, billing and accounts receivable, release of information; ancillary clinical applications, such as inpatient and outpatient pharmacy, e-prescribing of controlled substances (EPCS), laboratory, radiology, image archiving, consults and referrals, terminology, telemedicine/telehealth, women's care, dentistry, prenatal care, optometry, community care / purchase referred care (PRC); emergency department (ED); and point of care clinical applications for behavioral health, oral health, inpatient and ambulatory care; iCare, diabetes management; and reporting systems such as Clinical Reporting System (CRS), Uniform Data System (UDS), National Patient Information Reporting System (NIPRS) and others found online at the IHS website. Additional key capabilities include electronic medication administration record (eMAR) with bar code assisted technology (BCMA) for inpatient settings, EDs, and/or
The RPMS is certified as a Complete Electronic Health Record (EHR) for inpatient and ambulatory settings according to the 2014 version certification criteria published by the
Though not an exhaustive list, additional system capabilities important to IHS are real-time query, immunization forecasting, Vaccine For Children's (VFC) program inventory tracking, well child, 2D barcoding for immunization administration and Vaccine Information Sheets, transport mechanism used to transport immunization data files, and automated data reporting and receipt of immunization history to and from the states; procedure tracking capabilities, such as Woman's Health (Pap and Mammogram), colon health, bone health, and hepatitis screening; disease specific modules that aid in the tracking and follow up of specific conditions such as diabetes; population health management for outpatients and inpatients - ability to follow by specific conditions, labs, communities, sex, age, referrals, and/or transfers; employee health tracking; security that allows for tracking of who, how, and when a patient's record is accessed (e.g., audit); availability and use of SNOMED Clinical Terms(R) for problem list documentation and search features; interface terminology with extensive unconditional and conditional maps SNOMED and ICD-10 for both problems and visit diagnoses, an inpatient admission, discharge, and tracking application (ADT); prenatal management, problem list, and tracking features; and case management functions (see http://www.ihs.gov/RPMS/ for additional capability sets).
IHS's PRC Program (see https://www.ihs.gov/prc/ for additional information) is similar in many ways to other public health entity's purchased care / community care models; however, it is not an entitlement program. Typical medical and dental care provided at an IHS or tribal health care facility is called 'Direct Care'. Each visit to a non-IHS health care provider or 'Indirect Care' and the associated medical bill is considered distinct and must be examined individually to determine PRC eligibility. For example, a patient must meet residency, notification, medical priority of care and use of alternate resources requirements of 42 CFR 136.23, 136.24 and 136.61 in order to be eligible for PRC. In addition, there are referral and authorization processes around which IHS is contemplating further automating as part of this
The IHS Health Information Technology (HIT) landscape further expands across the circa 567 sovereign nations to include multiple non-RPMS independently deployed commercial-off-the-shelf (COTS) EHRs such as
To that end, IHS' RAINH objective is an effort to modernize, augment or replace RPMS legacy healthcare systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure. RAINH will address the current state of IHS, where multiple healthcare legacy systems and disparate data stores, developed over four+ decades, are in need of re-platforming, consolidation and modernization to ensure and enable sustainability, flexibility, intra/interoperability, patient data federation, population health, and clinical quality measures, toward improved continuity of care.
The RAINH objective is researching both the architectural approaches and levels-of-effort required to deliver an end-to-end suite of next generation, federated, inpatient / outpatient solutions with modularized software components that would extend and accommodate an EHR-agnostic and device-agnostic design architecture that facilitates access to, provenance of, and sharing of common patient data no matter where that data resides. The implementation and hosting models would likely encompass a combination of on-premises, cloud-based, and other low comm innovations. Given the diversity of the types and sizes of healthcare facilities across IHS (ref source: https://www.ihs.gov/findhealthcare/ ), their varying degrees of connectivity/bandwidth, a 'one-size-fits-all' COTS EHR approach is likely neither functionally nor economically feasible. This
II. Questions
1. At the core of IHS' mission are people, partnerships, quality, resources; how would your solution(s) best support a Relationship-based Care model (patient centeredness, collegiality, and self-care). 2. How would your solution(s) best address key areas of
Project Management/Program Management &
4. Please briefly describe your approach to project and program management in light of the IHS HIT ecosystem Would it be any different than your standard approach to commercial or other government engagements 5. Briefly describe your approach to integrated solution development (e.g., techniques, methodologies, DevOps, performance measures, automated regression testing, continuous integration and deployment (CI/CD)) 6. Given that the IHS environment encompasses multiple geographic and sovereign political boundaries, briefly describe your organization's experience and proposed approach to integration, implementation, and enterprise architecture (EA) across those boundaries.
Practice Management
7. How would your solution(s) support practice management capabilities such as revenue generation, purchased referred care/community care processes and policies, financial reconciliation, collection procedures and policies that comply with federal law 8. How would your solution(s) support a purchased referred care / community care (PRC/CC) paradigm that facilitates electronic patient data exchange both in and out of IHS Ref sources: https://www.ihs.gov/prc/ 9. How would your solution(s) contemplate implementing an enterprise EDR across IHS as part of an overarching HIT solution 10. Describe your proposed HIT solution(s) to provide behavioral health care across an IHS continuum 11. Describe how your solution(s) might help eliminate suicide rates across AI/AN communities 12. How would your solution(s) best compliment an iCare-style care coordination and management paradigm 13. How would your HIT solution(s) address employee health in addition to IHS patient care
Clinical Decision Support & Quality Measures
14. How would your solution(s) best support Improvement Science, Quality Improvement, Data Analytics, and Quality Initiatives (e.g. Federal policies) such as the Quality Payment Program - MACRA. To that end, please describe how it addresses Advancing Care Information (ACI) Clinical Quality Measures (eCQM), Appropriate Use Criteria (AUC), and other related initiatives Ref sources: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Proposed-rule-fact-sheet.pdf and https://www.youtube.com/watch v=p0mBO9S7GL8 (slides 1 and 2) 15. How would your proposed HIT solution(s) support condition-specific/scenario-specific information to providers at the point of care (versus cognitive overload of information/data) 16. AI/AN have different needs, issues, and stressors than the general US population; these issues vary between Indian Nations. Supporting solutions need to be robust in their ability to respond to these changing needs. To that end, please describe from an epidemiological perspective, the ability your solution(s) has/have to incorporate changes to EHRs based on advice from epidemiological evidence (e.g., decision support, added data fields, data monitoring). 17. Does your HIT solution(s) incorporate Natural Language Processing as a decision support tool (e.g., ability to aggregate and filter information based on groups of problems/conditions, which is helpful in filtered displays of information, as well as triggering decision support tools for multiple chronic conditions which are very common even amongst relatively young patients) 18. Does your HIT solution(s) provide alerts when patient data indicates intervention is recommended Can one access medical literature, clinical guidelines, etc., at the point of care Ref source: https://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool 19. Please describe whether or not your solution(s) can accommodate the notion of a "visit wrapper" - i.e., the ability to display data entered during visit and relevant to visit (e.g., surgical history) with an option to "authenticate" where the system should be able to store metadata for each data element (e.g., "signed" if entered by user, "reviewed" if entered elsewhere, "authenticated" if required such as standing orders). 20. How would your solution(s) allow for storage of coded structured data for reuse in decision support, coding tools, etc. (e.g., elements of history and physical (H&P) would be set up as structured data with LOINC/SNOMED) 21. How would your solution(s) provide or support an 'adaptive computation and machine learning' enterprise interface terminology capability that includes: a) support of a standard code set; b) mappings of interface terminology to standard codes sets to support data capture, HIE, revenue cycle, and quality measures; c) capture/migration of IHS specific codes sets to a new interface terminology solution; and d) process for extension of the terminology 22. Does your HIT solution(s) support use of flowsheets 23. How would your HIT solution(s) and processes best support Usability 24. Does your HIT solution(s) allow one to multi-task (e.g., create tasks, order labs, etc.) while charting 25. Please list your solution(s) current ONCHIT certification status. What are your plans for future certification and where do you think the market is trending 26. Describe plans to continue to upgrade system to meet regulatory standards to include Meaningful Use (MU) and Quality Payment Program requirements.
Integration
27. How would your solution(s) integrate and/or co-exist with IHS deployed systems (e.g., RPMS, Cerner, Epic, VistA Imaging) Or does your solution(s) dictate consolidation and migration around a single EHR instance and system of record If so, please describe the rationale why only one If not, please also describe why multiple EHRs could co-exist as part of IHS' HIT ecosystem 28. Please provide a listing of all supported modules of your proposed HIT solution(s), including modules used for federal reporting; how would you map those to existing IHS needs, and how would it/they integrate with other HIT components if a part of the data flows or work flows 29. What kinds of web-based services, other enterprise shared services, and/or application programming interfaces (APIs) does your solution(s) provide (e.g., open API platform) 30. What kinds of web-based or other services must be present for your solution(s) to function properly and intra-operate across IHS, as well as interoperate with community care partners and public health entities 31. Briefly describe how integration with various biomedical devices would be accomplished in the proposed solution. Will interface support be included in the base package, a one-time fee, and/or an increase in the recurring system charges 32. Briefly describe the third party revenue capabilities of your solution(s). If included, has there been experience in integrating the system into federal accounting systems similar to the Unified Financial Management System (UFMS), and are there capabilities to integrate the system into other disparate accounting systems that may be in use at Tribal and Urban facilities 33. Does your solution accommodate bi-directional interfaces for laboratory (in house testing and external reference lab) as well as radiology orders to and reports from an offsite radiologist (Current interface configurations for lab/rad use HL7 standards.) Does your solution include an auto interface for laboratory test orders and results 34. Describe any ePrescribing capability your HIT solution contains (e.g., any related certification, capability to transmit via existing e-Prescribing mechanisms, 2-factor authentication/multi-factor authentication (MFA), and/or single sign-on capabilities).
Business Configurability
35. How does your solution(s) ensure 508 compliance for IHS users (e.g., 508 compliant vs 508 configurable) 36. How would you define and to what degree would you describe your proposed HIT solution(s) as being 'business configurable' versus 'customizable' to that end, what type of governance model would you propose IHS use with your solution(s) to optimize its business and IT efforts to improve speed to market for new functionality 37. How would your solution(s) afford an ever-changing environment where federal mandates are issued with little lead time requiring changes to be made to business processes and/or IT solutions 38. Does your HIT solution(s) offer the ability to enable/ disable specific components to adapt to the agency's need
General Innovation
39. How would your solution(s) accomplish clinical reconciliation (e.g., problem list, medications, allergies, immunizations, reminders) at the point of care and from disparate systems of record How would you propose annotating a change, discrepancy or correction in a system of record other than your own (i.e., 'write-back', e.g., correction to an erroneous allergy entry in another facility's system of record) 40. Please describe what HIT innovations differentiate your solution(s) from others (e.g., leveraging a microservices architecture (MSA) that supports HIT standards such as FHIR ) 41. In light of public health EHR and HIT trends of late, what approach would you recommend IHS take with regards to its participation in the open source community (e.g., role in OSEHRA) Will the solution(s) you propose participate in the open source community and if so, to what extent 42. How would your HIT solution(s) accommodate a variety of form factors (e.g., device-agnostic capabilities that run on self-service kiosks, mobile devices, tablets) Describe ease of integration with other proprietary COTS products Describe the procurement and tech refresh approach to obtaining form factors such as patient check-in kiosks (e.g., leasing). 43. How would you best approach and describe the concept of 'BYOE' ('bring your own EHR') 44. Given IHS' commitment to expanding and extending telemedicine services both inside and outside the IHS firewall, how would your solution(s) facilitate remote providers offering those services 45. How would you approach the need for robust interface terminology services Specifically address how you would approach mapping terms used for problems and visit diagnoses to SNOMED and ICD-10 that leverages reuse of data, minimizes user input, and accurately captures clinical data 46. In your general opinion, please summarize what near-term/interim state or long-term HIT solution(s) you would recommend to be the best for IHS and why
Transition & Modernization
47. What RPMS components would you propose replacing in the course of implementing your solution(s), which one(s) would you modernize or keep and why, and what would that transition roadmap and timeline look like from your perspective 48. What approach would you propose for the transition/migration from existing IHS instantiations to your solution(s) (e.g., data conversion, data migration, run legacy and COTS systems in parallel for x amount of time, data persistence) 49. What (if any) data migration experience from a Mumps or NoSQL type database does your company have as part of your proposed solution(s) Please provide one or more examples. 50. To what extent does your proposed solution(s) rely on paperless processes that reduces the need for printed material 51. What alternatives to written signatures, such as the use of electronic signature pads, does your proposed solution(s) support
Infrastructure
52. How would your solution(s) provide high availability, high performance, scalability, and on-demand elasticity to serve large numbers of patients with millions of health record documents 53. How would your solution(s) provide ideal HIT application performance and high-availability in a low comm and/or decentralized client environment 54. How would your solution(s) provide enterprise microservices, data optimization, data federation, deduplication, aggregation and visualization to providers and administrative users on-demand, in real-time, and in high and low comm situations, even 'no comm' disconnected states 55. Does your proposed solution offer the ability to scale out (i.e., add new instances and load balance across them), and the ability to scale down (i.e., remove instances and remove them from the load balancer) 56. How would you propose innovative ways and/or partnerships to introduce or increase broadband to highly rural communities through which enhanced healthcare can be delivered to AI/AN stakeholders, unemployment rates can be reduced, enriched education can be provided, and commerce can be expanded
Implementation
57. Where would your proposed HIT solution(s) operate (e.g., in-house data center, in a commercial data environment, in IHS, centralized, distributed, public cloud, private cloud) How do you monitor bandwidth utilization for your customers; can you provide examples of reports, including context regarding the size of the engagement (e.g., number of employees, number of patients, minimum bandwidth between sites) 58. How would data ownership be handled under your recommended HIT solution(s) (e.g., in the event IHS were to decide to move to a different solution) 59. How would you operate, control, monitor and support the enterprise solution(s) given the diverse IHS ecosystem; what would a general service level agreement (SLA) look like in our case Would the SLA recognize the sovereign nature of the Federal and Tribal governments that would be a party to those agreements 60. Does your solution(s) allow for a consumption-based hosting model versus firm-fixed hosting fees What services would be available in the event the organization could not appropriate funding at the time of renewal (e.g., Continuing Resolution or Government furlough of non-critical resources) 61. How would your solution(s) handle a diverse user base that resides both inside and outside of the IHS firewall 62. How would you propose innovative ways to provide both configuration and end user training for initial operating capability (IOC) and ongoing support 63. How would clinical staff training be addressed as part of migrating to or adopting your proposed solution(s)
Interoperability & HIE
64. How will you ensure that your solution(s) is/are compliant with national HIE requirements, and describe how you would implement new document formats, handle variations in C32 and C-CDA documents, facilitate 'data liquidity', and deal with exceptions (e.g., improperly formatted exchange records) 65. How would your solution(s) facilitate the correlation of IHS patients with both internal and external partners, as well as discover and handle previously held correlations that were incorrect 66. In addition to compliance, how would your solution(s) extend compatibility and interoperability of the standardized healthcare data framework and exchange standards promulgated by ONCHIT to enable the exchange of health data 67. How would your solution(s) support the 21st Century Cures Act Trusted Exchange Framework and Common Agreement What challenges/opportunities do you foresee and how would you propose IHS accommodate this initiative Ref source: http://docs.house.gov/billsthisweek/20161128/CPRT-114-HPRT-RU00-SAHR34.pdf 68. Describe any active/live HIE solutions you have implemented across industry, the volume of data that has been exchanged, and what partners were involved (e.g., IHS healthcare entities). 69. How would your approach to HIT/HIE solution(s) extend the
Operations, Maintenance (O&M) & Support
73. What is your approach for incorporating IHS-specific change requests (CRs) to make continual enhancements to your solution(s); describe your product roadmap process and how IHS' CRs would be prioritized against other customer's CRs; and what is your 'routine' cycle for issuing product updates and upgrades 74. What level of flexibility is provided to the organization on national, regional or local levels to support the O&M of test environments for the purpose of providing local support, optimization and enhancement of the HIT solution(s) 75. What is your approach to correcting software defects across the HIT continuum 76. Describe the ideal integrated IT service management (ITSM) or Customer Relationship Management (CRM) solution to providing tiered level support to users in the field 77. What type of knowledge management capabilities do you have as part of your ITSM or HIT solution(s) 78. What are your response times to reported issues that require development or even questions/support tickets that do not necessarily require development, rather just general questions 79. What features and functions does your proposed solution(s) provide related to application performance measurement and tuning
Business Intelligence (BI) & Analytics
80. Describe one or more proposed enterprise business intelligence and analytics solution(s) that would accommodate automated extract, transfer and load (ETL) capabilities, automated aggregation of data, visualization of data through dashboards, drill-down capabilities, and configurable views. 81. Would your proposed solution(s) be described as data virtualization or data visualization solution(s) Describe in your opinion the differences between the two and which would be most cost effective for and beneficial to IHS. 82. Via what cloud service models is your BI solution available (e.g., Software-as-a-Service (SaaS), Data-as-a-Service (DaaS), Information-as-a-Service (IaaS), Infrastructure-as-a-Service (IaaS), Platform-as-a-Service (PaaS)) 83. Are your data visualization schemas proprietary or would the government have flexibility to visualize that same data via other means outside of your solution(s) without incurring a cost 84. Does your solution(s) have predictive analytic capabilities that could be used in an IHS healthcare setting If so, what are the challenges you have experienced implementing such a capability 85. Can the HIT solution(s) report summarize, de-identify data for public health, research, and other purposes as dictated by law
Security & Privacy
86. What have you done to ensure that data is encrypted in transit and at rest within your solution(s), and to what federal standards have you used to 'harden' them 87. Is/Are your proposed hosting solution(s) FedRAMP approved with HIPAA BAA, in process of approval, and if so, at what level(s); or would you need government sponsorship 88. Is there a US Federal Government Access Point in place at your hosting facility/facilities If not, are you in the process of implementing one If one is in process, when is it expected to be in place 89. Is your proposed hosting capability exclusive for the US Federal Government (physical or logical) If not, what are the restrictions on the use of your infrastructure 90. Is your proposed data center (DC) and computing services managed and operated by
Risk Management
104. Do your HIT solution(s) licensing model(s) provide for perpetual use if the solution is abandoned by either party 105. Describe the role(s) your HIT solution(s) would play as part of a wider enterprise risk management system. Based on your experience and lessons learned, describe what risk management approach would best fit IHS' HIT landscape.
Investment & Cost
106. What other products would IHS need to acquire in order to implement your solution(s) 107. What options do you have regarding available licensing models, what are your assumptions, and is there any flexibility built-in 108. What additional investments would IHS need to contemplate in order to implement your solution(s) to ensure a smooth and comprehensive roll-out (e.g., training, deprecation, consolidation, data migration, help desk, O&M, 'hidden costs') 109. Would you recommend a data correlation and migration occur between old and new HIT solution(s), or would you recommend running legacy systems in parallel in a view-only mode What are the associated costs, timeframes and challenges that you would anticipate in either case given IHS' environment 110. How would your solution(s) help IHS meet and continue implementing OMB mandates in its day-to-day HIT operations (e.g., Federal Information Technology Acquisition Reform (FITARA)) 111. How would you propose ascertaining IHS' current hardware inventory and infrastructure needs to support your solution(s)
Past Performance
112. How long has your company been in the business of developing and marketing your HIT solution(s) 113. Can you provide past performance references (including measurement metrics), dollar value, magnitude, and description of the scope of similar efforts 114. Please describe your alliances and partnerships pertinent to this
III. Instructions for Submission
In addition,
Qualified vendors from the
Link/URL: https://www.fbo.gov/spg/HHS/IHS/AMB/17-236-SOL-00046/listing.html
Combine Solicitation – 72– ARTWORK – FRAMED AND CANVAS; DECORATIVE WINDOW FILM NURSING HOME – DEPT OF VETERANS AFFAIRS MEDICAL CENTER
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