NTP NextGen PACS Q_A.pdf

NTP NextGen PACS Vendor Questions and Government Responses

Request for Proposal 36C10B22F0022

Number Vendor Question Government Response

If 50 Million reports are to be migrated, are they expected to be warehoused both in the PACS and the Voice Recognition system solution, or just the PACS?

The reports shall be warehoused just in PACS.

To confirm, is the Contractor required to include pricing for any cloud-hosting hardware (e.g., servers, storage) costs or does the Contractor only provide the VA with the hardware requirements (e.g., number of servers, storage required)?

VA will host the system in VAEC, and offerors will need to list the cloud resource requirements via AWS or Azure pricing calculator to include at a minimum the following information: server/storage family, description/function of device, vCPU, memory and storage.

To confirm, is the Contractor required to include pricing for any cloud-hosting hardware (e.g., servers, storage) costs or does the Contractor only provide the VA with the hardware requirements (e.g., number of servers, storage required)?

VA will host the system in VAEC, and offerors will need to list the cloud resource requirements via AWS or Azure pricing calculator to include at a minimum the following information: server/storage family, description/function of device, vCPU, memory and storage.

Is the Contractor required to include pricing for the services required to setup, configure, and provision the server environment?

VAEC will initially setup, configure and provision the cloud resources. Contractor will be responsible for deploying the PACS applications on the provided systems and configuring the systems for use.

Is the Contractor required to include pricing for the services required to setup, configure, and provision the server environment?

VAEC will initially setup, configure and provision the cloud resources.

Will the contractor be expected to use the VA ITSM/ITOM tools or should the contractor utilize their own? E.g. ServiceNow for incident, change and problem management.

Contractor will be responsible for providing a change management and work order system that is accessible to the VA, but it does not need to be the VA ITSM/ITOM tools.

In an effort to provide the most cost effective solution for the VA - will the VA commit to a minimal number of studies per year for Phase I?

VA will not commit to a minimal number of studies per year for Phase 1. The system shall be designed to initially accommodate 2 million annual studies per year.

Can the VA confirm that one Image is the equivalent of one Study?

1 study is equivalent to 1 study instance UID for a newly acquired study that is interpreted by NTP

Can the VA confirm how many images are in an Exam? If the answer is multiple images can the VA provide the number of images or an average?

Images per study can range from 1 to 3000+ depending on the modality. Approximate NTP workload over the past 30 days is as follows: 50,000 DX, 35,000 CT, 10,000 MR, 5,000 US and 100 NM.

Note NTP will be adding MG exams in FY23 estimated 5,000 to 10,000 per year initially.

If the contractor utilizes a cloud based ITSM, must that system be hosted in a FedRAMP environment? If so, what level?

No, it is not necessary for a cloud based ITSM (Offeror's work order/change management system) to be hosted in a FedRAMP environment.

What are the projected YOY % growth rates for the number of studies to be conducted?

The system shall be designed to initially accommodate 2 million annual studies per year and be scalable to handle additional growth up to 9 million annual exams.

On the last sentence in paragraph 4 of Section 4.0 did the VA intend to say up to 1 million annual exams per VISN for a period of 12 months instead of ”up to 800,000”? If not, please clarify.

Please see revised PWS, Section 3.0.

Would the VA please document and describe the determining performance threshold that would initiate a request for additional NTP image ingest clusters at additional locations?

Offerors shall determine if their architecture requires the use of regional image ingest clusters in order to optimize transfer time from local/VISN PACS to the NextGen PACS.

Would the VA please describe an example of NTP custom workflow tools?

NTP custom workflow tools include any tools required to meet the PWS and specifications. Examples include but are not limited to: Radiologist/Support request tool, pre-read QC worklist, Q/R tool for priors, business rule tool for automated Q/R of current cases targeted for NTP interpretation, etc.

How many users will need access to the level 1 help desk? Will it only be the 100 radiology technical personnel?

Up to 40 NTP Support staff will need access to level 1 help desk. Up to 20 staff per VISN.

Will the VA take the first call to triage the incident then escalate to the contractor provide level 1 desk?

NTP Support triages issues and resolves items within our control. Tier 1 help desk contact will be for issues that NTP Support can't resolve independently.

Will the Level 1 help desk need to be provide in phase 1?

No. Help desk is required after activation

Does the VA have any historical call volumes for level 1 or level 2 help desk with the existing solution?

The existing solution's historical call volume is not an accurate representation and does not relate to any proposed solution.

Does the VA require Perpetual Enterprise Licenses for both the Teleradiology applications and the underlying infrastructure operating systems, system admin tools, databases licenses?

Enterprise licenses will be required for the Teleradiology applications to include the core PACS and all associated applications identified in the requirement (i.e., PACS viewer, worklist, voice recognition, AI, etc.) as well as the system admin tools and databases. Licensing must be included in the cost per study.

VA will provide VAEC hosting resources to include the operating system license on the servers dedicated to the system.

Can the VA provide the anticipated disk storage capacity in Terabytes for 2yrs worth of image data and 5yrs capacity of image data?

Estimates should be based on industry averages and typical PACS deployments.

Is a Change Management Database (CMDB) system required? If so, will the Contractor be required to utilize the VA CMDB system?

Contractor will be responsible for providing a change management & work order system that is accessible to the VA. It is not necessary to utilize the VA CMDB system.

Can the VA provide the network baseline details on quantity of ports available and port speed for uplinks for new infrastructure servers? Also, is there any network compression devices inline between local sites and cloud resources? If so please provide those details.

For regional ingest servers, both 1 Gb and 10 Gb ports are available at data centers. WAN compression via Riverbed is being decommissioned within VA.

What tier of background investigation is required?

All regular VA network accounts required a SAC (Special Assessment Check) and then a NACI.

For a contractor to have elevated privileges and be a system administrator on a VAEC deployed PACS, then a moderate risk/Tier 2 (BI) Background Investigation is required.

Please confirm if all personnel assigned to this contract are required to be US Citizens? If not - are US person's acceptable? Are offshore resources acceptable?

All personnel who require elevated privileges and access to the system will be required to have a background investigation. In order to do a background investigation, the person must be a U.S. citizen or have lived in the U.S. for 3 or more years.

The NTP solution calls for Server/Storage/Application to be deployed on existing VA LAN/WAN networks, Since our solution will be connecting to an existing LAN/WAN network that may impact the VA's ability to receive or interpret studies or transmit reports, please confirm that degraded network performance and/or lan/wan network outages will not be assessed in application monthly uptime reports and therefore not impacting service or support costs.

Uptime calculations will not include VA LAN/WAN network outages.

Does the VA consider IP addresses, system logs, or other "system" data to be privileged information? If yes, should this be treated as VA sensitive data?

VA data must be restricted to only those individuals with appropriate training and clearance in accordance with VA Privacy/Security and Rules of Behavior or equivalent. IP addresses should be treated as sensitive data.

Will the VA be providing a pricing matrix for the Contractors to complete to ensure that all Offerors are being evaluated the same?

All Offerors shall complete Section B.4 Schedule of Supplies/Services which will be evaluated by the Government in accordance with the solicitation. A pricing matrix will not be used.

Can the VA provide what the evaluation credit amount or a range that an Offeror (prime contractor) who is a Service- Disabled Veteran-Owned Small Business (SDVOSB) or a VOSB will receive?

Please refer to VAAR 852.215-70 for SDVOSB/VOSB evaluation credits.

The best pricing for the majority of the hardware and software will come directly from the large business OEMs so in an effort to provide the most aggressive pricing would the VA consider removing or lowering the small business requirement to 10%?

No, the Small Business evaluation criteria will not be changed.

The DICOM Conformance Statement is not included in the attachments. Can the VA provide this attachment?

Offeror must provide the DICOM Conformance Statement(s) for their product(s)

The Cloud Resources.xls file is not included in the attachments. Can the VA provide this attachment?

Each Offeror is required to provide this attachment. It is not a Government template. Please list the cloud resource requirements via AWS or Azure pricing calculator to include at a minimum the following information: server/storage family, description/function of device, vCPU, memory and storage.

Does the VA require a minimum 10Mb/s network connection from the PACS viewer for WAN enabled streaming to perform as required?

Yes.

Does the VA currently have a Master Patient Index (MPI) across all of the current systems (VistA, Cerner EMR, existing VHA PACS) already?

If yes, please provide additional details on what data

VA's Master Person Index will be the authoritative source for patient identifiers and the PACS must be able to interface with this system and support multiple patient identifiers due to VistA using SSNs and Cerner using EDIPI. See PWS 6.1.2 will be provided and in what format?

Will the VA provide the same sample cases to all offerors? If yes, when and how will this be provided?

Each Offeror shall provide representative sample cases via a demo PACS system

Does the VA intend that the last sentence in paragraph 4 of Section 4.0 say up to 1 million annual exams per VISN for a period of 12 months instead of ”up to 800,000”? If not, please clarify.

Please see revised section 3.0.

Would the VA please document and describe the determining performance threshold that would initiate a request for additional NTP image ingest clusters at additional locations?

Offer shall determine if their architecture requires the use of regional image ingest clusters in order to optimize transfer time from local/VISN PACS to the NextGen PACS.

Would the VA please describe an example of NTP custom workflow tools?

NTP custom workflow tools include any tools required to meet the PWS and specifications. Examples include but are not limited to: Radiologist/Support request tool, pre-read QC worklist, Q/R tool for priors, business rule tool for automated Q/R of current cases targeted for NTP interpretation, etc.

Does the VA require Perpetual Enterprise Licenses for both the Teleradiology applications and the underlying infrastructure operating systems, system admin tools, databases licenses?

Enterprise licenses will be required for the Teleradiology applications to include the core PACS and all associated applications identified in the requirement (i.e., PACS viewer, worklist, voice recognition, AI, etc.) as well as the system admin tools and databases. Licensing must be included in the cost per study.

VA will provide VAEC hosting resources to include the operating system license on the servers dedicated to the system.

If an Offeror responds “Yes” to the requirements in Attachment 1 and the government concludes the Offeror “failed” based on its review of the full proposal, will Offerors be provided with the reason for failure and provided an opportunity for clarification if failure is due to a potential misunderstanding of facts and circumstances that led to that decision?

The Government will not be reviewing full proposals in Step One other than the Principal Requirements. Any technical deficiencies that are discovered following Step One will be evaluated in accordance with Step Two evaluation approach.

Is the electronic submission to be achieved via email or by some other electronic means (file upload site)?

Proposals shall be emailed in accordance with the solicitation instructions. Please notify the Contract Specialist with any issues.

What specifically is to be included in the Cloud Resources.xls file? This document is not referenced elsewhere in the solicitation.

Please List the cloud resource requirements via AWS or Azure pricing calculator to include at a minimum the following information: server/storage family, description/function of device, vCPU, memory and storage.

In one section (Attachment 1 – Principle Requirements, item E) it is stated the system must provide MPI services. Another section (PWS Attachment 1, Spec 43) requires NextGen PACS to integrate with VA MPI. Are both statements true?

If so, how many domains are required to be integrated to the NextGen MPI?

VA's Master Person Index will be the authoritative source for patient identifiers and the PACS must be able to interface with this system and support multiple patient identifiers due to VistA using SSNs and Cerner using EDIPI.

What is the specific volume the system should be licensed to support for NexGen PACS?

The principle requirement (Attachment 1 – Principle Requirements, item B) says "in excess two million" which is non-specific, while PWS Attachment 1, Spec 2 states “up to 2 million” which is also non-specific.

Enterprise licenses will be required for the Teleradiology applications to include the core PACS and all associated applications identified in the requirement (i.e., PACS viewer, worklist, voice recognition, AI, etc.) as well as the system admin tools and databases. Licensing must be included in the cost per study.

VA will provide VAEC hosting resources to include the operating system license on the servers dedicated to the system.

Please provide a concise definition of "Cloud-native" to meet the principle requirements. Is this as defined by the CNCF?

https://github.com/cncf/toc/blob /main/DEFINITION.md or another broader definition such as a scalable application designed for cloud, regardless of microservice and containerized infrastructure.

The broad definition of cloud-native application is an application that is designed to run and be hosted in a cloud computing environment and is optimized to operate across the WAN.

Please define the Zero-footprint nature of the requested components. Is the Radiologist Image viewing application to be delivered as a zero footprint (no client) technology, requiring no software download, browser extensions, or plugins?

Please see revised specification 52 and revised Technical Evaluation Question 25 for clarity.

Which functionality can be delivered via Citrix versus zero-footprint? Please define full functionality versus Zero- Footprint functionality.

Please see revised specification 52 for clarity.

Is the VR application expected to be Zero-footprint or Citrix based?

Not required for VR application.

Are all services listed in this RFO required to be delivered by a single vendor or by a multi-vendor environment? Is it expected that the voice recognition system provided is a native function of the provided solution, or an embedded 3rd party? Is it expected that the assignment engine and worklist is provided by the same vendor versus multiple vendors?

Solution can be provided by a single vendor if they have all of the required features/functions, but it is not required to be a single vendor solution.

Please provide additional clarification on what “Auto Next” refers to. Is this functionality a broad descriptor or a vendor specific term?

"Auto Next" is a broad descriptor used within the PACS industry to indicate that the next available study is automatically launched on a Radiologist's worklist without them selecting the study.

Will the NTP office provide Patient ID “cross-walk” tables to match local patient identifiers (such as SSN) to EDIPI or will VistA / Cerner HL7 messages and DICOM tags contain all the data necessary to make the mappings?

VA Master Person Index will provide the range of patient identifiers. As part of deployment planning, NTP will provide a cross-walk of patient ID formats for each site's HL7 messages and for their PACS images.

Note that PID content will change as sites move from VistA to Cerner.

NTP’s Foundations STAT Portal – specifies a bi-directional HL7 interface is required, please provide the current HL7 specification for STAT Portal. Please provide the current interface specification for JLV, Cerner VDI and MPI (is this HL7, HTTPS?) Please provide the Option 1 (Acuo VNA) DICOM Conformance Statement and IHE Integration Statement for the version of VNA that is deployed.

Interface specifications will be provided and developed during deployment. VistA sites utilize HL7 2.3 and 2.4 via the VistA Radiology Package, and Cerner sites utilize HL7 2.3 via Cerner OpenLink. Acou DICOM Conformance Statement is a publicly available document.

Who is the Designated Approval Authority? Is a DHA (Defense Health Agency) ATO equivalent and sufficient?

Please provide an overview of the VA ATO/RMF process with timelines. Is there a VA Program Office that works to obtain the ATO whom the vendor must work through? Is the VHA responsible for obtaining the ATO, or is the vendor?

Who is the Designated Approval Authority? The Designated Approval Authority is the VA’s CIO, who has delegated these duties to several Authorizing Official’s (AO).

Is a DHA (Defense Health Agency) ATO equivalent and sufficient? No, we would still need a VA ATO (Authority To Operate). There are some reciprocity ATO’s but it still needs to be approved on the VA side and be within eMASS, the VA’s Governance, Risk and Compliance (GRC) tool.

Please provide an overview of the VA ATO/RMF process with timelines.

Timelines depend on the system/project completion of the RMF steps. It could take from anywhere from 6 months to a year to get an ATO. The following documents provide an overview of the ATO/RMF process.

NIST Risk Management Framework and SP 800-53 VA Directive 6500 – VA Cybersecurity Program, VA Handbook 6500 - Risk Management Framework for VA Information Systems - VA Information Security Program VA Directive 6517 – Risk Management Framework for Cloud Computing Services, VA Handbook 6517– Risk Management Framework for Cloud Computing Services Link to the Knowledge Service (KS) page as KS is the authoritative source for RMF/eMASS – link (eMASS KS https://dvagov.sharepoint.com/sites/OITOIS/Knowledge Service/Pages/eMASS.aspx )

Is there a VA Program Office that works to obtain the ATO whom the vendor must work through?

OIS (Office of Information Security) and the GRC Committee are responsible for eMASS and the process, but the system must do the work to get the ATO. (GRC Committee KS page -https://dvagov.sharepoint.com/sites/OITOIS/Knowledge Service/Pages/GRC-Committee.aspx )

Is the VHA responsible for obtaining the ATO, or is the vendor?

The vendor is ultimately responsible but the VA is involved as the Information System Owner, ISSO, AO, and can assign a system steward to assist. The vendor can also be a system steward but needs a VA network account and specific eMASS training.

Is it the VA’s intention to supply workstations and diagnostic monitors at the reading centers?

Yes. VA will be responsible for workstations and diagnostic monitors.

In section 5.0 Deliverables, Table 1, Item 4, is there a description or definition of “NTP custom workflow tools”?

NTP customer workflow tools include any tools required to meet the PWS and specifications. Examples include but are not limited to: Radiologist/Support request tool, pre-read QC worklist, Q/R tool for priors, business rule tool for automated Q/R of current cases targeted for NTP interpretation, etc.

Once NTP is in production, is there a provision for the contractor to revisit, reconfigure and test new HL7 interfaces and virtual desktop integration with the new EMR, as Cerner roles out its implementation? This requirement would be necessary to query for priors, etc, as the patient ID transitions from SSN to EDIPI.

Contractor to provide a test PACS that can be used to test new interfaces and application updates. Support for Cerner integration at go live is required and not a future state. Querying from priors will be via the NextGen PACS application and the PACS must query the various PACS where the patient has images, whether it is at a Cerner connected site or VistA based

PACS.

Under the first paragraph of Section 3.0 Scope of Work, the VA states, “The Contractor shall provide VHA with a state-of-the-art enterprise scale PACS to include …voice recognition” capability;

however, in 5.2.1.4, there appears to be a requirement to “interface” with an existing voice recognition system.

Please confirm whether the VA will require the Contractor to provide voice recognition or to interface with an existing voice recognition system

Contractor to provide recognition system

In section 5.4.8, “The Contractor will provide training for new and updated software modules as released”. As this training approach may be aperiodic, would the VA find value in the Contractor providing annual applications training for the reading

Any vendor decision to provide and schedule annual refresher training to align with major application updates is not required but could be proposed if the Offeror feels it adds value.

radiologists in lieu of training following an upgrade? Annual training would be more consistent, reliable and provide greater satisfaction to the VA team of radiologists.

In section 6.1.2, subsection 1, the VA specifies an interface requirement to the VA’s “Master Person Index”. Is this in conjunction with the requirement for the NexGen PACS to also provide MPI functionality?

VA's Master Person Index will be the authoritative source for patient identifiers and the PACS must be able to interface with this system and support multiple patient identifiers due to VistA using SSNs and Cerner using EDIPI.

The VA states in 5.2.1.11, “The Contractor shall support all required transfer syntaxes and SOP classes incorporated into the PACS solution listed in PWS Attachment 3, “DICOM Matrix Update.” Should this reference be “Attachment 4 – DICOM Matrix Update” instead of Attachment 3?

RFP Attachment 4 will be incorporated into the contract at PWS Attachment 3 in accordance with Section D - Contract Documents, Exhibits, or Attachments.

Do you have a break down by modality or exam description of the current workload being read by the NTP? How about data traffic in peak GB per day or hour?

Do we know which or how many facilities will connect to a VISN PACS and which ones will connect to the facility

PACS?

Approximate NTP workload over the past 30 days is as follows: 50,000 DX, 35,000 CT, 10,000 MR, 5,000 US and 100 NM. That is the volume interpreted by NTP and does not include 2-3 relevant priors per study that are transferred as well. Note NTP will be adding MG exams in FY23 estimated 5,000 to 10,000 per year initially. Most facilities utilize a central VISN-based PACS, but several use facility-based. Inbound study volume for representative weekday and weekend are included on Sheet 2 with 1 min sampling window.

Can caregivers at sites view reports with a status of “preliminary’?

NTP preliminary reports "Sent to NTP but not yet dictated" are visible to requesting providers at VA facilities

Is CCOW currently operational with patient context? What is the product name of the JLC viewer?

CCOW is in use with the VA/DHA Joint Longitudinal Viewer (JLV) formerly knows as Joint Legacy Viewer

How many regional image ingest clusters are deployed?

To be determined based on offeror's architecture and design requirements. NTP currently uses 4 regional clusters plus our core PACS, but that is based on our current, non-cloud based system.

Is it correct to assume that the vendor is not responsible for the hardware or networking in the VAEC? The VA will provide a VM as per vendor specification?

Correct

Will the VA provide a separate VM in the VAEC for ATNA logging?

Offeror should specify all VAEC resource requirements for a complete solution.

Are there any response time requirement for the logging?

These logs will be very large.

There are no response time requirements for logging;

however, near real-time availability is standard.

Can you please provide additional information about Foundations? Whose product is it and what type of reports is providing now? Can you provide more details on the type of access that is being requested and if this in addition to the HL7 workflow messages.

Foundations is provided by Health Level Inc. -www.healthlevel.com. They currently provide the NTP STAT Portal and our analytics system. PACS workflow status messages (exam opened, exam read, etc.) get sent to Foundations along with ORUs.

Is the only request for support of teaching files to deidentify patient information and then, we assume, DICOM store the images to a teaching server?

Teaching files should be deidentified and stored in a separate location/tab/folder within PACS. Files do not need to be stored on a separate server.

Do the current NTP workstations support mammo viewers? Are they using a mammo reporting tool, such as PenRad (mammo reporting is very specific, including the follow-up letters to the patient).

NTP will be deploying a mammography tracking system in early FY23.

Do the current NTPs all use the same VR system? If so, what are they using?

Currently, Powerscribe 360 is used by most; however, each Offeror shall propose the VR system most efficient for the proposed solution.

Is there a standard configuration for the current NTP workstations? If not, is there a minimum number of monitors that are used?

Current non-mammo systems utilize 1-2 worklist monitors with a single, large-format 6 MP diagnostic monitor.

Can you provide an estimated number of radiologists by NTP location? We feel the radiologists will need on-site training.

90+% of NTP Radiologists work remotely via VPN.

Are the NTP Assistants located centrally or at each of the

NTP PACS Assistants and PACS Administrators are located both at NTP Reading Center and remote via

NTPs? How many of them are there currently?

VPN. Plan for 25 PACS Assistants and 10 PACS Administrators.

How many of the VNAs / PACS support IOCM?

Unknown

What is the acceptance plan for the implementation / start of system usage? Will it be a demonstration that the system passes the Testing Plan? How long does the VA have to run / approve the testing plan after the vendor indicates the system is ready for testing?

Test/acceptance will require validation that all specifications are met along with applicable PWS elements. Testing will be an iterative process during design/deployment and once the vendor indicates that the system is ready for final acceptance, NTP will target 30 days to complete testing and provide results.