NTP NextGen PACS Vendor Questions and Government Responses Final.pdf

NTP NextGen PACS Vendor Questions and Government Responses

Request for Proposal 36C10B22F0022

# Document Reference Point Section Vendor Question Government Response

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The Contractor shall import approximately 50M+ reports from the existing NTP PACS via bulk export and will begin HL7 and image ingest during system configuration/testing.

Reports will be normalized to the standard accession number format and will be unambiguously associated to the matching images where available. The Contractor shall provide an HL7 Report Migration Plan.

5.2.3.5 (P32) 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.

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The Contractor shall work with VA to provide inputs for establishing cloud capacity, accounts, and privileges. This includes monitoring and tracking the creation, update, and deletion of application user (e.g., developer, systems administrator) accounts, and ensuring cloud capacity requirements are satisfied.

5.2.3.2 (P31)

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.

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Offerors shall provide a complete compute and storage breakdown for cloud-based components and on-premises hardware.

Written Technical Approach.

(P118)

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.

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The Contractor shall support setup, configuration, and provisioning of the solution in the VAEC environment.

5.2.3.1 (P31) 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.

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The central PACS servers, associated application servers and Vendor Neutral Archive (VNA) shall be hosted in VAEC via Amazon Web Services (AWS) or Microsoft Azure.

VA shall be responsible for providing the VAEC resources, while the Contractor shall be responsible for all application and OS management and provision of all software and licenses beyond the OS.

1.0

BACKGROU

ND (p22)

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.

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5.3.2 Monitor

Performance and Reporting

(P3)

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.

1001AH

Option

Period One;

Ongoing support to Next Gen

Pacs (P12)

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.

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10001AH

Period One;

Ongoing support to Next Gen

PACS (P12)

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

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Period One;

1002 (P13)

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.

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1.0

Background/ 4 (P22)

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.

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3.0 Scope 0f

Work/1 (P26)

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.

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"If Optional Task 1 is exercised, the system shall be scaled to accommodate VISN PACS deployments with an estimate average annual volume of 1 million studies per VISN."

Last sentence in paragraph 4 of Section

3.0 (P26)

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.

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"The Contractor shall provide regional image ingest clusters for NTP where necessary to optimize image transfer speeds to the VNA.

5.2.1.5 (P29)

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.

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5.2.4.2 (P32) 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.

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5.3.1.3 (P33) 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.

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5.3.1.3 (P33) 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.

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5.3.1.3 (P33) Will the Level 1 help desk need to be provide in phase 1?

No. Help desk is required after activation

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5.3.1.3 (P33) 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.

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5.3.1.1 (P34)

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.

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If necessary for optimal local Radiologist viewing performance, the Contractor shall provide on premises VISN-based image caches with a minimum of 2 years’ worth of image data that shall be expanded to up to 5 years if required to provide LAN level viewing performance for simultaneous review of current and prior exams.

This applies for VISNs that utilize the NextGen PACS as their VISN-centric replacement PACS.

5.4.5 (P36) 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.

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5.4.1 Phase

Two

Expansion of Nextgen PACS to VISNs/2

(P36)

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.

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Where required as part of the VISN PACS architecture, the Contractor shall be responsible for providing all on-premises server/storage hardware.

The Contractor shall provide on-site installation of on-prem components and remote installation/configuration of all cloud-based based components. Ongoing support costs will cover all PACS hardware and software updates and upgrades with full service and support 24x7x365.

The system shall include a VA site license for all applications and there will be no separate license

5.4.6 (P37)

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.

costs associated with study volume increases.

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Information System Hosting, Operation, Maintenance or Use/2 (P43)

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.

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6.2.1 Position/Tas

k risk designation

(P43)

Plese 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.

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The NextGen PACS is a mission critical application that is required to be online 24x7x365. The system shall be designed and deployed with appropriate redundancy and fault tolerance to eliminate single points of failure.

The target uptime threshold for the overall system must be 99.99%.

The Contractor’s design and technical support infrastructure must meet or exceed that level of performance. System shall be designed for 99.99% uptime as measured by 24x7 availability.

Downtime will be defined as failure of one or more components that measurably impacts VA’s ability to receive or interpret studies or transmit reports to the originating EMR.

Contractor shall provide NTP and VISNs with a monthly uptime report with adjusted billing of the ongoing service/support cost per the discount rate below. Note that scheduled downtime such as work to complete software upgrades and maintenance is excluded from the downtime calculation, though it is expected that fail-over and/or test servers will be used to perform these activities with little or no impact to the clinical operations.

(P46)

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.

A1.1 VA

Internet and

Intranet Standards/ 3

(P50)

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.

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4. PRICE

EVALUATIO

N

APPROACH.

(P115)

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.

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5.

VETERANS

INVOLVEME

NT

EVALUATIO

N

APPROACH.

(P115)

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.

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Section 6.

SMALL

BUSINESS

PARTICIPAT

ION

COMMITME

NT

EVALUATIO

N

APPROACH.

(P115)

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.

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2.c (P117) 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)

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2.c (P117) 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.

Attachment 1 - Principle Requirements

Item D (P1) Does the VA require a minimum 10Mb/s network connection from the PACS viewer for WAN enabled streaming to perform as required?

Yes.

Attachment 1 - Principle Requirements

Item E (P1)

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 will be provided and in what format?

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

34 Attachment 3

Item 5a and 5b Post

Technical Demonstrati on (2 week

Gov exercising)

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

PWS –

Section 4.0

Last sentence in paragraph 4 of Section 4.0 states “Optional Task #2 shall be for ongoing VISN service/support post activation shall be exercised for up to 800,000 annual exams per VISN for a period of 12 months.” In Section 3.0, paragraph 1, it states that “If Optional Task 1 is exercised, the system shall be scaled to accommodate VISN PACS deployments with an estimated average annual volume of 1 million

PWS –

Section 4.0

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.

studies per VISN.”

Question:

36 PWS, 5.2.1.5

The Contractor shall provide regional image ingest clusters for NTP where necessary to optimize image transfer speeds to the VNA.

PWS, 5.2.1.5

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.

37 PWS, 5.2.4.2 PWS, 5.2.4.2

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.

38 PWS 5.3.1.1

The system shall include a VA-wide site license for all applications and there will be no separate license costs associated with study volume increases.”

PWS 5.3.1.1

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.

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“This evaluation will be conducted in two steps.

Step One: Technical Factor 1 – Principal Requirements will be evaluated in this step.

1. TECHNICAL FACTOR 1

EVALUATION

APPROACH. The evaluation process will consider the following:

Technical Factor 1 shall be evaluated on a Pass/Fail basis. Accordingly, the proposed solution will be evaluated to determine if all responses are marked “Yes” in each Offeror’s response to Attachment 1 - Principal Requirements.

Should an Offeror mark “No” for any response, or leave any response blank, that Offeror will be rated as “Fail”; the evaluation will not proceed to Step Two;

and the Offeror will be eliminated from further consideration.

Step Two: Technical Factor 2 – Written Technical Approach and Technical Demonstration, Past Performance, Price, Veterans Involvement, and Small Business Participation Commitment will be evaluated in this step.“

P. 112 C.

EVALUATIO

N

APPROACH

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.

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The Offeror’s proposal shall be submitted electronically by the date and time indicated in the solicitation to Contract Specialist, Heera Polanco, heera.polanco@va.gov and Contracting Officer, Kathryn Pantages, kathryn.pantages@va.gov . Proposals submitted by

P. 116 D.

PROPOSAL

SUBMISSIO

N, 1.

INTRODUCT

ION

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.

any other method will not be evaluated. File sizes shall not exceed 100MB

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P. 117 C.

Content

Requirement s

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

Please Iist 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.

Attachment 1 - Principle Requirements and PWS Attachment 1

– Principle

Requirement s, item E) and PWS

Attachment 1, Spec 43)

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.

Attachment 1 - Principle Requirements and PWS

– Principle

Requirement s, item B) and PWS

Attachment 1, Spec 2

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.

PWS

Attachment 1

Spec 67

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.

PWS

Attachment 1

Spec 57

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.

PWS

Attachment 1

Spec 57 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.

PWS

Attachment 1

Spec 57 Is the VR application expected to be Zero-footprint or Citrix based?

Not required for VR application.

Spec 123-

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.

49 Attachment 2 Technical Eval 44

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.

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5.2.1.7

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 crosswalk 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.

5.2.1.10, ICDs

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.

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5.2.3.3

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- 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/Know ledgeService/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/Know ledgeService/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.

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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.

Section 5.0 Deliverables, Table 1, Item

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.

36C10B22R0

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.

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Section 3.0, Scope of Work and

5.2.1.4

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

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The Contractor will provide training for new and updated software modules as released

5.4.8

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 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.

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.

Section 6.1.2, subsection 1

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.

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5.2.1.11

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.

PWS

Attachment 1 Specifications

Item 2

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.

PWS

Attachment 1 Specifications

Item 3 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

PWS

Attachment 1 Specifications

Item 7 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 known as Joint Legacy Viewer

PWS

Attachment 1 Specifications

Item 15 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.

PWS

Attachment 1 Specifications

Item 18

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

PWS

Attachment 1 Specifications

Item 20 Will the VA provide a separate VM in the VAEC for ATNA logging?

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

PWS

Attachment 1 Specifications

Item 21 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.

Attachment 1 Specifications

Item 51

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.

PWS

Attachment 1 Specifications

Item 58 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.

PWS

Attachment 1 Specifications

Item 85

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 NTPs? How many of them are there currently?

NTP PACS Assistants and PACS Administrators are located both at NTP Reading Center and remote via VPN. Plan for 25 PACS Assistants and 10 PACS Administrators.

74 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.

76 RFP B.4.1

1.Information systems that are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA directives developed in accordance with FISMA, HIPAA, NIST, and related VA security and privacy control requirements for Federal information systems. This includes standards for the protection of electronic PHI…. in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 system security categorization (reference VA Handbook 6500, Risk Management Framework for VA Information Systems – Tier 3: VA Information Security Program, and the TIC

What is the security categorization level of the proposed solution according to FIPS 199?

(https://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.1 99.pdf)

Current security categorization is moderate, though it could potentially be reassessed as high during subsequent review.

Table 1 lists “Organization” as NTP or VISN X.

PWS 5.0

Table P27

To confirm, those tasks are not done by NTP or VISN X, but rather will be done by the vendor. Is this correct?

The tasks would be completed by the vendor. The tasks would be broken out for NTP (Phase I) and VISN (Phase 2)

Paraphrase: The Contractor shall design, deploy, and support the NTP PACS to handle initial annual study volumes up to 2 million Radiology exams with full activation to be completed no later than November 30, 2023.

Phase 2/Optional Task 1 shall include expansion of up to 7 VISNs and up to 9 million annual exams total.

PWS 3.0

P26-27

Does each of the VISN PACS contain all the historica studies for the patient or are we also expected to query VistA Imaging for additional historical images?

Query will be to the VISN or facility PACS for VistA sites. For Cerner sites, query will go to the VISN PACS and potentially to the site-based Compass Router. That workflow is a work in progress as we work though deployment/integration issues with Cerner. The number of historical studies available on the existing VISN PACS would vary by VISN. On an ad-hoc basis for specific historical images (not for a mass migration event), query/retrieve functionality to VistA Imaging may be needed for access to historical images that are not available on the VISN PACS.

The system shall provide seamless API integration with VA/DoD Joint Legacy Viewer (JLV), which requires the use of Clinical Context Object Workgroup (CCOW). This shall include a button or other mechanism to launch JLV directly from within the PACS application, have it pass patient context via CCOW to JLV, and then maintain patient context as different studies are viewed within the PACS (i.e. update CCOW context).

PWS

Attachment 1

Item #7

According to HL7 International, CCOW has been retired and is being replaced by HL7 FHIRCast. Are there plans in place to replace CCOW Integration with FHIRCast Integration for the Joint Legacy Viewer?

JLV currently supports CCOW and at such point in time that HL7 FHIRCast is fully validated with JLV, the PACS to JLV interface should be updated

DICOM servers shall be a promiscuous SSCP without a license restriction on the number of Application Entity (AE) Titles.

PWS

Attachment 1

Item #40

The majority of health institutions are moving away from promiscuous DICOM connections due to security vulnerabilities that this methodology creates. This approach seems to contradict other security measures outlined in this RFP. Can you confirm that you desire open promiscuous connectivity for inbound DICOM study transfer?

Confirmed. We will utilize Access Control Lists (ACLs) and firewalls as compensating controls.

Offerors shall submit up to three (3) relevant contracts

D.2.c.iii P119 To demonstrate the strength of our capabilities, can Vendors provide four (4) relevant contracts for Past Performance?

No, in accordance with the solicitation instructions, Offerors shall submit up to three.

Areas of relevance include deployment and ongoing support of multi-site PACS with a similar size, scope, and complexity as the NextGen PACS….

D.2.c.iii P119

To ensure that the VA can achieve its goal of attaining a best-of-breed NextGen PACS, it would be beneficial to broaden the past performance to be more inclusive of the cloud, network, and other components that will deliver the most comprehensive solution. Therefore, would the VA amend the Past Performance proposal instructions to read “Areas of relevance include deployment and ongoing support of multi-site health IT, clinical workflow, AI, PACS, and other components with a similar size, scope, and complexity as the NextGen

PACS."

No, areas of relevance will not be amended.

83 D.2.c.iii P119

Our private / commercial clients have requested that we keep “Awarded price/cost” confidential, and that all requests for contacting to a Contracting Officer or Technical Representative go through our company’s assigned Account Executive.

Could the VA please amend the proposal instructions to waive requirements for D.2.c.iii (b), (c), (g), and (h) for private / commercial clients?

No, this requirement will not be waived as it is needed for the evaluation.