EI RFI 2024 Vendor questions Amendment 3.pdf

36C10X25Q0015 – VHA National Enterprise Imaging Systems RFI

Question Response

In the RFI, is the 80 petabytes to be migrated (historical volume) compressed or uncompressed?

Uncompressed

Will the Government confirm the Cover Page, Table of Contents, Lists of Figures/Attachments, and Attachments are outside of the 10-page limit?

Reference: II. RFI RESPONSE INSTRUCTIONS RFI Pg. 3

This is correct, the listed pages are not included in the 10-page RFI specified page limit.

What product is each Specialty Area currently using for workflow and data management?

Reference: III. REQUIREMENT DESCRIPTION RFI Pg. 6

1. Radiology and Nuclear medicine:

a. Various commercial radiology

PACS systems.

2. Cardiology: Cath, Echo, EKG and Holter

Monitor.

a. GE, Philips Siemens

3. Pathology:

a. Philips Telepathology

(currently in limited pilot)

4. Point of Care ultrasound:

a. GE

b. Fuji

c. Various pocket devices that do not archive.

5. Dental Imaging:

a. MiPACS

6. Ophthalmology and Diabetic Retinopathy

Screening (DRS):

a. Site level Zeiss PACS for

Main departmental use a

b. VistA Imaging Tele Reader for diabetic retinopathy screening programs.

7. Scope - Surgery- Video

a. Provation

8. Clinical Video

a. Somnoware for sleep

b. Handheld video or still cameras with local storage for all others

9. Radiation Oncology treatment planning, imaging in DICOM, DICOM RT, and proprietary formats

a. Varian and Siemens

Is the intent to continue using the current systems or should the current system be replaced?

Reference: III. REQUIREMENT DESCRIPTION RFI Pg. 4;7

VHA is currently conducting market research for a potential Enterprise Imaging system. The industry should respond with all system options.

Does each Specialty Area communicate in

DICOM?

If not, what format is each Specialty Area using for storage or communications, and will the Government provide a spreadsheet that inventories the specific product being used by each Specialty Area?

Reference: III. REQUIREMENT DESCRIPTION RFI Pg. 4

VHA expects all devices to archive in DICOM format. The industry should respond with innovative options for taking the few remaining proprietary format specialties to DICOM. Special attention should be given to Radiation Oncology, Radiation Therapy, and Radiation Treatment Planning. Solutions should also be proposed for non DICOM Tele Pathology, Photography and Video

Does VHA intend to continue using the current workflow management systems in each specialty area or are we to replace this system? Or, for those which remain in place, will you be requiring the interface to the enterprise archive?

Reference: III. REQUIREMENT DESCRIPTION RFI Pg. 4-6

VHA is requesting a fully integrated system that provides highly capable workflow management and work list tools. It must appear to the end user as a single system regardless of the tools used behind the user interface.

What is the vision for creating a unified worklist for all “Area’s” or should we assume each “Area” would operate independently while using a common archive?

Reference: III. REQUIREMENT DESCRIPTION Pg. 6

Answered above.

Will more than one contract vehicle be used since the requirements appear to dictate both on premise and SaaS elements/environment?

Reference: Contractor Business Questions:

RFI Pg. 11

VHA seeks a highly capable and fault tolerant system that that continues to function at a local level in the event of a cloud outage. The industry is to demonstrate how this goal can be achieved.

For Digital Pathology, please confirm if VHA is looking for pricing to include the front-end of the solution (meaning the scanner to digitize the sample), in addition to the IMS (Image Management System) and the on-prem and cloud-based storage.

Yes/confirmed.

1. Data Migration Details

• Are all 80 petabytes of data currently active, or does a portion of it consist of archival data?

o Answer: All 80 PB are active

• What percentage of non-DICOM images will need to be converted or reformatted?

o Answer: Approximately 5 percent of the 80pb are non DICOM. Options should be presented to convert these to DICOM.

• Are there any known data quality issues or inconsistencies within the current repositories?

o Answer: This is not currently known, VHA expects integrity checks and data normalization as part of any potential project.

2. Query Types

• What are the most common types of queries expected (e.g., metadata search, image retrieval, analytics)?

o Answer: DICOM connections of all types in and outbound, some native file format storage using VNA protocols, business intelligence data synchronization with the VA data warehouse.

• With over 90,000 concurrent users, what is the expected query per second (QPS) load during peak usage times?

o Answer: This is a metric we expect from the vendor, they are the system experts. It is expected that a high percentage of the 90,000 users will be actively connected to the system at any given time.

3. Average Size of Scanned

• Do we have an approximate size for the scanned images and documents across the following specialties?

i. Radiology: 11,000,000

ii. Cardiology: 415,000

iii. Pathology: 950,000

iv. Point of Care Ultrasound: 300,000

v. Dental Imaging: -1,650,000

vi. Ophthalmology: 1,500,000

vii. Scope - Surgery- Video: 500,000

viii. Clinical Video: 275,000

ix. Radiation Oncology: 15,000

x. Dermatology - Wound Care: 100,000 o Answer: File sizes estimates are the responsibility of the contractor and their migration partner.

4. Handling Duplicates and Inconsistencies

• Will the Solution provider be responsible for identifying and resolving duplicates or inconsistencies during the data migration process?

o Yes, the vendor will be responsible and must provide a solution for resolving duplicates and inconsistencies.

1. Does VHA intend for the VHA NEIS solution to replace existing Picture Archiving Communication Systems (PACS) across the 18 VISNs with 1 unified/standardized PACS solution or does VHA want each VISN’s existing PACS to be integrated into the NEIS? This is a large cost consideration and industry can better assist VHA’s market research with more accurate budgetary estimates by knowing if VHA wants NEIS to replace or incorporate existing PACS already deployed across the VISNs.

Answer: VHA is currently conducting market research for a potential Enterprise Imaging system. The industry should respond with all system options.

2. Does VHA intend for the VHA NEIS solution to replace existing solutions currently deployed for each one of the defined specialty areas or does VHA want to keep the existing solutions for each specialty area and have them integrated into the NEIS?

system. The industry should respond with all system options. Vendors should present best of breed solutions for each specialty.

3. Can VHA provide additional information to define the required end-to-end workflows for each defined specialty areas?

Answer: VHA welcomes industry input on this topic and would like the industry to present examples of end-to-end workflows for those specialties that have historically not consistently embraced end to end workflows. POCUS, Photography and Video are examples.

1. Does VHA prefer the Prime Contractor to be a System Integrator (such as Booz, GDIT, etc.)

or a classic Medical Device/PACS Manufacturer (such as GE, Fuji, Philips, etc.)? No Medical Manufacturer can provide capabilities across all clinical subspecialties (“ologies”) called for by VHA; therefore, it would be beneficial for the Manufacturers to team with Systems Integrators to deliver on VHA requirements.

Answer: VHA would like to see a complete solution presented.

2. Does VHA intend for the VHA NEIS solution to replace existing Commercial PACS in all VISNs or to integrate/incorporate each VISN’s existing PACS into their the NEIS system? This is a large cost driver of the overall NEIS. Industry can better assist VHA’s market research with more accurate cost projections by knowing if VHA desires to “replace or incorporate” existing PACS.

system. The industry should respond with all system options.

3. Does VHA intend for the VHA NEIS solution to replace existing solutions used for each one of the ologies or to integrate/incorporate the existing solutions into the the NEIS system?

This is a large cost driver of the overall NEIS. Industry can better assist VHA’s market research with more accurate cost projections by knowing if VHA desires to “replace or incorporate” existing PACS.

Answer: VHA is currently conducting market research for a potential Enterprise Imaging system. The industry should respond with all system options. Vendors should present best of breed solutions for each specialty.

4. Please confirm if the VA intends to award VHA NEIS as a single or multiple contract award. If a single award is preferred, does the VA prefer the single Prime Contractor awardee to offer more than 1 provider/vendor for PACS and the other ologies to provide the VISNs a choice.

Or is a single vendor for PACS and each ology the preferred approach?

Answer: VHA is interested in a complete integrated best of breed system, the manner this is delivered is up to the respondent.

1. How many VHA facilities will need a local image cache?

Answer: It is expected that each VAMC (not CBOC) will have some level of local storage and contingency applications.

2. Is there an estimate on the storage capacity requirements for each facility?

Answer: Assume each facility will have capacity for 1 year of storage.

3. What is the storage capacity requirement at the largest facility?

Answer: Top 10 monthly site storage provided below, add 5 percent for non DICOM objects.

Site DICOM Images Storage Estimate TB/month

NORTH-FLORIDA.VA.GOV 5692398 24.24

ORLANDO VAMC 5479893 23.34

MINNEAPOLIS VA HCS 5167850 22.02

CLEVELAND.VA.GOV 5110639 21.77

SAN-ANTONIO.VA.GOV 4912759 20.92

HOUSTON.VA.GOV 4602852 19.60

TAMPA.VA.GOV 4602689 19.60

SAN-DIEGO.VA.GOV 4478147 19.08

DALLAS.VA.GOV 4475898 19.08

RICHMOND.VA.GOV 4412388 18.79

4. What is the storage connectivity protocol for both the current and future EHRs? VistA Tier 2 uses CIFS, does the new EHR, Cerner, also require CIFS or is another storage protocol (ie NFS) required?

Answer: VHA is not wed to existing storage types and protocols. We would like to the industry respond with a best of breed solution.

5. Is Object/S3 required?

Answer: VHA is interested in what the industry has to say on this. We are interested in a storage system that can be easily ported to a new vendor without migrating imaging data as has been done in the past.

• QUESTION: Please clarify for the 80 pedabytes of data to be migrated from VistA Imaging to NEIS, what percentage needs to be readily available versus archived (infrequent use).

Answer: VHA suggests the industry to respond with innovative ways for studies to be presented on demand regardless of age or location. We expect responses to include legacy predictive and AI driven storage management.

• QUESTION: The RFI states, “Number of required HL7 interfaces: 1,500.” What are the 1,500 HL7 interfaces? Is there any standardization for these feeds? What are the source and destination, and what message types are included?

Answer: The industry should use the 1500 interface count to price standard interfacing hours to VistA and Oracle electronic medical records. Assume standard HL7 ORM, ORU, and ADT for orders-based systems and MCAR interfaces for VistA consult based systems. Keep in mind that VistA will require multiple interfaces for each. For example, to provide ORM-ORU, ADT, MCAR to a system three VistA interfaces are required. For the purposes of this RFI assume the interfaces are from the various VHA EHR systems to the proposed Enterprise Imaging System. The industry should provide innovative ways to manage the interfaces.

• QUESTION: The original RFI states, “Hybrid cloud-based vendor neutral archive with local image cache at VHA facilities…”; however, “hybrid” was removed in the Amended RFI and that bullet now states, “ cloud-based vendor neutral archive with local image cache at VHA facilities.” Was the deletion of “hybrid” intentional or made in error?

Answer: This is not an error, we decided to remove an architecture suggestion from the RFI to allow the industry more freedom to innovate in the response. The system must work in the cloud, and function at a pre-determined functionality level locally should the cloud become unavailable.

1. Regarding dose tracking requirements. What is the format of the dose data, is the data in a standard format? Is dosage data archived in VistA Imaging? Is there a requirement for migrating historical dose data or is this day 1 forward requirement?

Answer:

▪ 5-year historical dose migration

▪ The system must capture RDSR. In the absence of RDSR, the system must be able to extract the value from a DICOM tag if available. The vendor should list any other methods they can use to capture dose data. For Example, optical character recognition (OCR).

2. Regarding cross-site collaboration, can the Government define cross-site collaboration use case/ requirements?

Answer: Any specialty should be able to be read from any location. For example, a radiologist, cardiologist, pathologist, and others, working on the west coast of the United States must be able to read cases for a facility located on the east coast. This should only require a worklist change to accomplish.

3. Can the Government provide the specific requirements for 3D functionality expected to be included in the EI system?

Answer: VHA declines to name a vendor, we expect advanced visualization and AI for diagnostics and planning to be provided by the system for all listed specialties.

4. Is the vendor expected to replace VA employees at the facility e.g. local PACS Administrators or BioMed personnel? Or is it acceptable to assume that those employees would be trained by vendor to continue their roles using the new EI system?

Answer: Existing employees will be trained and continue in their roles. The industry should consider how to augment local/VISN expertise. How and to what level is left to the vendor.

5. When the requirements speak to the need to have local image storage capabilities and function locally in the event a cloud link is severed, can the Government define what is meant by locally, i.e. is the expectation for a standalone node at each facility or would a regional/ per VISN node be acceptable?

Answer: Local capability at each VA medical center. This does not include community-based outreach centers (CBOC) and smaller sites as they would connect to the parent site.

6. When the requirements speak to the need to have local image storage capabilities and function locally in the event a cloud link is severed, can the Government provide specific requirements on what functionality is required to be accessible locally and specifics on the required amount of image data to be stored (60D, 90D, etc.)?

Answer: One year of studies on-line, we would like the industry to respond on how much functionality of the 10 specialties would remain available.

7. With 24x7x365 support does the Government want staffed help desk support for “off hours” or an “on-call” helpdesk model for issues occurring outside of business hours?

Answer: VHA is requesting a fully managed system. Vendor is expected to train existing VA PACS support personnel to handle day to day user interface and study QC tasks. The vendor may choose to augment local personnel with their own personal. 24x7x365 continuous system monitoring, remote response and helpdesk are required. We are interested in understanding how the industry would structure their support organization.

8. To ensure a balanced evaluation, how is the Government planning to enforce compliance with

VA, NIST and FISMA cybersecurity requirements for systems hosted outside the VA enclave?

Would those systems require ATO accreditation, be responsible for code security scanning (Nessus, BigFix, etc.) and associated information assurance compliance procedures?

Answer: The proposed system, regardless of prem/cloud location must function at the highest levels of VA security policy enforcement. Vendor will be responsible to obtain a system-level Authority to Operate (ATO) and will be responsible for ongoing sustainment efforts to ensure the ATO remains in good standing.

9. Can the Government provide more detailed requirements/ timelines regarding the image migration tasking? E.g. is there a minimum amount of image migration required to transition operations to new EI system if older images are available in a query/ retrieve manner?

Answer: VHA declines to answer this question as asked. We would like to see the industry response on how fast they can migrate images, and innovative ways to bring in prior images to the system that have not been migrated. VHA and the industry are familiar with the traditional DICOM migration models. We are interested in how data could be migrated outside of the legacy DICOM model if the vendor had access to the EMR database and the images storage locations.

10. Will the Government consider allowing vendors to propose the use of existing VA infrastructure contracts for cloud services and on-prem storage to leverage existing VA resources such as IaaMs and VAEC? This would reduce net new costs, expedite delivery and mitigate project risk.

Answer: VHA is open to leveraging existing systems where possible. Keep in mind that these systems my have legacy storage management components that may not meet the forward-thinking spirit of this RFI.

11. Can the Government define image life management requirements for all study types in the new

EI system as well as existing VA repositories (VistA Imaging & CAMM)?

Answer: VHA is tasked with keeping these electronic records for up to 70 years, we would like the industry to present options for managing this data in a way the reduces cost but still provides rapid access to images. For example, what is the most economical way to archive deceased patients records but still have them available should family member and research.

12. For images outside a certain date range, is the Government willing to accept lower accessibility storage tiers such as AWS Glacier and workflow-based pre-fetch capabilities to reduce storage costs?

Answer: Refer to question 11 answer

13. Is the VA planning to keep existing Compass Routers as a part of the new EI system or will the vendor be expected to replace all functionality contained within the existing Compass Routers?

Answer: Compass routers (HTM and CI) will remain.

14. Can the VA define system performance metrics in the context of reading workflows? These performance requirements would inform local image cache and infrastructure requirements.

Answer: Other than current and prior imaging needing to be available for immediate access the is nothing more to say. Waiting for a DICOM retrieve is not acceptable.

15. With regard to requirement that “Studies not currently archiving to Oracle Health CAMM 7 or Vista Imaging must be migrated from their systems of origin”, can the VA provide details on those systems including data volume and details? We are aware of several of these systems like MUSE, Zeisss and others but a comprehensive listing would be useful.

Answer: Add Echo and Cath Lab systems to your assumptions. No specific volumes for these systems are available currently. These will be provided as part of any potential RFP.

16. Is there an expectation that the awarded vendor would be provided with a bulk export of all reports for historical exams across all specialties?

Answer: Yes

17. Will the VA consider the utilization of existing enterprise licensing for the VR requirement in this bid to reduce net new costs, specifically Dragon Medical One?

Answer: Yes, where legally allowed.

18. Can the VA describe the relationship of the Enterprise Imaging system with the separate efforts underway specific to Pathology based imaging? Is the EI system intended to replace those contracts or work in conjunction with those efforts?

Answer: The VHA Telepathology Pilot has been very successful as a clinical tool and as a learning exercise for the unique needs and special workflows used pathology. For the purposes of this RFI, assume Pathology will be a full specialty with the overall EI system.

Also assume a DICOM end to end workflow.

19. Can the VA confirm that the scanning and conversion of non-digital pathology records is not a part of this EI effort?

Answer: This is correct in that we will not be migrating slides in mass. The system must be able to scan older slides that have been retrieved from long term storage.

20. Can the VA define the plan for continued expansion of Cerner CAMM? Would the new EI system replace these efforts and if so, is there an established timeline? Continued expansion of CAMM during EI implementation will add additional effort/ cost to the EI project.

Answer: VHA choses not to answer this question.

21. Regarding patient portal, is the preference of this procurement to integrate imaging capabilities with the existing VA patient portals (Cerner Patient Portal, MHV) or to stand up a new patient portal specific to imaging?

Answer: The intent is for a potential patient portal to be presented inside of existing VA patient access portals.

22. Can the VA provide more detail on AI requirements? E.g. is the desire to have an AI compatible platform and AI expansion capabilities or to include specific AI capabilities in the initial EI system deployment? With the rapid evolution of clinical AI capabilities and ongoing establishment of AI governance our suggestion is to build an EI system capable of AI integration/ expansion.

Answer: VHA would like to hear the industries response and ideas on AI. We do suggest it be presented through a platform that provides vetted AI tools to the EI system.

23. Currently both VistA Imaging and Cerner CAMM store non DICOM image-based records including patient documents (Means Test, Advanced Directives, etc.). As part of this solicitation does the VA want that data in a true content management system or simply included in the image repository? Typically, documents stored in a VNA are going to be DICOM wrapped. Content management systems like Hyland OnBase, can make these records more easily accessible outside the imaging realm.

Answer: We leave it up to the industry to demonstrate their ideas and workflows. Keep in mind that there should be a balance struck between documents and directives that have historically been ingested through an EHR and the types of objects that are ingested by an imaging system.