36C77618C0011-001.pdf

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For

Other Than Full and Open Competition (>$150K)

Point of Care Clinical Decision Support Resource

Acquisition Plan Action ID: VA701-18-AP-0070

1. Contracting Activity:

Department of Veterans Affairs, Veterans Health Administration (VHA), Program Contracting Activity Central (PCAC), 6150 Oak Tree Blvd, Suite 300, Independence, OH 44131. Office of Health Informatics (OHI), VA Library Network Office, offer this Justification for Other Than Full and Open Competition. Purchase Request Number is 776-18-4-8152-0067.

2. Nature and/or Description of the Action Being Processed:

This request is for a subscription to UpToDate for the VHA Library Network Office. The proposed action is for a new standalone, firm-fixed price contract (for a base plus four (4) option year period of performance) following the procedures in Federal Acquisition Regulation (FAR) Parts 6 and 12.

3. Description of Supplies/Services Required to Meet the Agency’s Needs:

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) requires an existing, commercial off-the-shelf (COTS), web-based, electronic subscription to UpToDate, an evidence-based, point-of-care (POC), clinical decision support database resource (product) from Wolters Kluwer, that will be used throughout the VHA healthcare system by multiple simultaneous users, via one interface and one search platform. The UpToDate POC COTS product is a comprehensive database covering a wide range of medical specialties including, but not limited to:

Adult Emergency Medicine Adult Primary Care and Internal Medicine Allergy and Immunology Anesthesiology Cardiovascular Medicine Dermatology Endocrinology and Diabetes Family Medicine and General Practice Gastroenterology and Hepatology General Surgery

Geriatrics Hematology Hospice and Palliative Care Hospital Medicine Infectious Diseases Nephrology and Hypertension Neurology Obstetrics, Gynecology and Women’s Health Oncology Pulmonary, Critical Care and Sleep Medicine

UpToDate provides Continuing Medical Education (CME), Maintenance of Certification (MOC), and MOC Part II CME credits through at least 22 accreditation providers.

The requested period of performance for this contract is as follows: One (1) year from date of award; 9/30/2018-9/29/2019, plus four (4) one (1) year option periods to be exercised at the discretion of the Government; Option Year One (1) of Four (4): 9/30/2019-9/29/2020; Option Year Two (2) of Four (4): 9/30/2020-9/29/2021; Option Year Three (3) of Four (4): 9/30/2021-9/29/2022;

Option Year Four (4) of Four (4): 9/30/2022-9/29/2023.

The estimated total value of the acquisition is $29,436,000.00, for the five (5) year life of the contract.

4. Statutory Authority Permitting Other than Full and Open Competition:

(X) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements per FAR 6.302-1;

( ) (2) Unusual and Compelling Urgency per FAR 6.302-2;

( ) (3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services per FAR 6.302-3;

( ) (4) International Agreement per FAR 6.302-4 ( ) (5) Authorized or Required by Statute FAR 6.302-5;

( ) (6) National Security per FAR 6.302-6;

( ) (7) Public Interest per FAR 6.302-7;

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority):

UpToDate is the only COTS product that comprehensively contributes to the requirements of the VA’s teaching mission. The VHA Office of Academic Affairs’ teaching mission states: “VA's teaching mission contributes to high quality health care of veterans in the following ways: (1) by creating a climate of clinical inquiry between trainees and teachers, (2) by enhancing quality of care through the application of medical advances, (3) through the provision of excellent clinical care by supervised trainees, and (4) through the recruitment of highly qualified health care professionals into the VA healthcare system.”

UpToDate’s COTS product differs from other information services products in the following ways:

The organization and arrangement of UpToDate’s content is appropriate for a large-scale teaching hospital’s usage and relevant to VA’s medical education curriculum programs;

UpToDate’s content is appropriate to use in the development of the VA’s educational curriculum, not particularly focused for the experienced practicing physicians’ use;

UpToDate’s content is presented with/in a scholarly based approach. UpToDate’s content is developed and presented with expansive evidence-based information and not in a “recipe book” or “short answer” format;

UpToDate’s resource provides an evidence-based, comprehensive, integrated differential diagnosis and treatment database that provides information in a narrative format rather than outline or bulleted information, which is typically brief and without discussion or rationale for the management of disease;

UpToDate’s content provides insight to an understanding of the clinical application of the diagnosis and treatment of specialty areas in medicine;

UpToDate’s content is in a narrative format suitable for the education of health sciences students, residents, and fellows on medical/clinical topics;

UpToDate’s content provides an overall academic based approach to sources of clinical information;

UpToDate’s content includes theory based and clinical insight information; and

UpToDate provides a mechanism to create more and advanced understanding of diagnostic and treatment topics. It allows for VA physicians with academic appointments and teaching functions to enhance their instruction methods in educating their medical students, residents, and advanced specialty care fellows.

The VA’s requirement of UpToDate’s COTS product is substantiated by the following:

In Academic Year 2017, 43,565 medical residents, 24,683 medical students, 463 Advanced Fellows, and 849 dental residents and dental students received some or all of their clinical training in VA. Of its 152 VA medical centers and 6 independent outpatient clinics (IOC's), 124 hospitals and 3 IOC's have affiliation agreements with 135 of 141 allopathic Accredited Medical Schools and 35 of 40 osteopathic medical schools for physician education. Many trainees have their health profession degrees and contribute substantially to VA’s ability to deliver cost-effective and high-quality patient care during their advanced clinical training at VA.

https://fas.org/sgp/crs/misc/R43587.pdf.

Another rationale and confirmation that UpToDate is a sole source for this type of information needs can be explained by the following:

According to the VA’s Office of Inspector General (OIG), “Hospitals by their very nature carry an intrinsic risk to patients as personnel contend with unpredictable situations, infection control, large numbers of vulnerable individuals with significant care needs, and changing demands on a daily basis. Given these challenges, it is critically important for [VA medical centers (sic)] hospitals to have effective Information resources services that promote quality patient care and safety, education, and research activities. (https://www.va.gov/oig/pubs/VAOIG-17-02644- 130.pdf). Only UptoDate is adequate of providing effective information resources services that promote quality patient care.

An absolute necessity for the VA is to have “Links to Full Text Journals/Articles” to the VA wide 153 separate Serials Solutions accounts (https://www.va.gov/LIBRARY/Find_Journals_and_Books.asp) that each medical center is provided by the VA Library Network Office (LNO). UpToDate’s COTS product provides this access. This access allows for better use of the 7,000 journal titles the LNO provides VA-wide, and provides valuable interoperability to the clinical information the VA already possesses. EBSCO Dynamed has a deficiency of the necessity which they are not able to meet this requirement.

UpToDate’s COTS product also integrates the National Library of Medicine PubMed’s Linkout functionality. Other vendors provide very limited access and interoperability to the journal subscriptions that the LNO provides. Other vendors have PubMed links (with limited e-journal connections) (https://www.va.gov/Library/Find_a_Database.asp#pubmed), but UpToDate’s COTS product fully implements the VA’s 153 unique journal collections profiles.

http://www.va.gov/oig/pubs/VAOIG-17-02644-http://www.va.gov/oig/pubs/VAOIG-17-02644-http://www.va.gov/oig/pubs/VAOIG-17-02644-http://www.va.gov/LIBRARY/Find_Journals_and_Books.asp) http://www.va.gov/Library/Find_a_Database.asp#pubmed)

UpToDate’s COTS product links directly to the full scope of nearly all of the LNO’s subscribed journal content and subscribed to databases, such as VisualDX, from within UpToDate, which improves efficiency, enhances patient care, and minimizes disruptions to the essential clinical workflow.

One major distinction of UpToDate from other point of care databases is that they are the only point of care database that provides integrated and direct links from the topic search results to VisualDX.

Users are redirected from UpToDate directly into their VisualDX subscription to relevant images.

VisualDX is a commercial, web-based Point-of-Care Dermatology Diagnostic Clinical Decision Support Software Product utilized nationwide throughout the VHA Healthcare System.

The number and breadth of UpToDate’s topic reviews are far greater than any other point of care database. Also, content is the biggest difference: 10,000+ topics (UTD) vs. 3,300+ (DynaMed); 203% difference. UpToDate’s extensive content is essential for well-rounded teaching and education.

UpToDate also is the industry standard with 90% of academic medical centers in the U.S. and more than 36,500 hospitals and institutions worldwide use UpToDate.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable:

A sources sought notice 36E77618Q1934 was posted to Federal Biz opps (FBO) on 02/08/18 looking for vendors to provide a capability statement by 03/09/18 if they felt their company could provide the necessary requirement. There was one (1) response received from EBSCO Information Services which was found not capable by the Library Network Office (LNO) program manager. EBSCO’S POC component does not appear fully capable of meeting the extensive educational/teaching needs of the VA due to its limited content and lack of detailed, in-depth narrative.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

The Government has developed an Independent Government Cost Estimate (IGCE) for this procurement with a base plus four (4) option years with a total of $29,436,000.00. The IGCE is based on Wolters Kluwer’s list price with Government discount.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons

Market Research Was Not Conducted:

In accordance with FAR Part 10, market research has been conducted for this acquisition. The following techniques were used:

A sources sought notice 36E77618Q1934 was posted to Federal Biz opps (FBO) on 02/08/18 looking for vendors to provide a capability statement by 03/09/18 if they felt their company could provide the necessary requirement. There was one (1) response received from EBSCO Information Services which was found uncapable by the Library Network Office (LNO) program manager. EBSCO’S POC component is not fully capable of meeting the extensive educational/teaching needs of the VA due to its limited content and lack of detailed, in-depth narrative.

A notice of intent to sole source was posted to FBO on 04/11/2018 with responses due back by 04/25/2018. There was one (1) response received from J.E Federal Enterprises which is an authorized reseller for EBSCO Health point of care DynaMed. The capability statement was sent to the LNO Project Manager to determine if the company was capable or not. The program manager determined that J.E Federal Enterprises is not capable due to missing salient characteristics of the statement of work (SOW). The vendor can only provide alternate resource currently provided by another source. For example, the LNO currently uses VisualDX a commercial, web-based Point-of- Care Dermatology and Diagnostic Clinical Decision Support Software Product utilized nationwide throughout the VHA Healthcare System. Whereas the vendor can only provide their product Isabel.

LNO would have no need to double buy resources already purchased. DynaMed is not capable of meeting the extensive educational/teaching needs of the VA due to its limited content and lack of detailed, in-depth narrative.

A search was conducted on wwww.vetbiz.gov utilizing the NAICS code “519130” yielded one hundred and forty-three (143) verified SDVOSB & VOSB companies. An email was sent out to all one hundred forty-three companies with the link to the sources sought FBO posting. There was one response received from a SDVOSB; Nationwide Pharmaceutical (NWP) which is a reseller of Wolters Kluwer point of care (POC) UpToDate. Using a reseller, the technical and customer service needs would have to be filtered through the reseller first. This is not acceptable for the potential 30 thousand daily users of this product which can directly affect patient care. Also, the reseller has no background in the specs of this product as they will only be passing on the request for service from the VA to the Wolters Kluwer technical support staff. This would cause delays in service and will complicate the communication of service and resolutions of problems the VA will likely have on a regular basis.

Market Research was conducted by meeting with LNO Project Manager who stated that there are only two (2) parent companies that provide Point of Care Subscriptions (POC). These parent companies are EBSCO and Wolters Kluwer. The Department of Veteran Affairs has used both subscriptions in the past, however Wolters Kluwer POC subscription has unique characteristic which have been found to meet the requirements to the VA concerning educational qualities and access to Visual DX that relate to the VA’s teaching mission.

This procurement is not able to be set aside because of subcontractor’s inability to comply with thelimitations in 13 CFR 125.6 as mentioned below. This contract will have a value greater than $250,000.00 and any small businesses will not be able to meet the 50% self-performance or similarly situated requirements.

(a) General. In order to be awarded a full or partial small business set-aside contract with a value greater than $250,000, an 8(a) contract, an SDVO SBC contract, a HUBZone contract, a WOSB or EDWOSB contract pursuant to part 127 of this chapter, a small business concern must agree that:

(1) In the case of a contract for services (except construction), it will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated. Any work that a similarly situated subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded.

http://www.vetbiz.gov/

(2) (i) In the case of a contract for supplies or products (other than from a nonmanufacturer of such supplies), it will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated. Any work that a similarly situated subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded. Cost of materials are excluded and not considered to be subcontracted.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition:

As stated in section 8 of this J&A, a sources sought was posted to FBO with one (1) response received from EBSCO which was found not capable of providing the full requirement. There was one response from a SDVOSB Nationwide Pharmaceutical which is a reseller of Wolters Kluwer UpToDate. Using a reseller, the technical and customer service needs would have to be tunneled through the reseller first. This is not acceptable for the potential 30 thousand daily users of this product. Also, the reseller has no background in the specs of this product as they will only be passing on the request for service from the VA to the Wolters Kluwer technical support staff. This would cause delays in service and will complicate the communication of service and resolutions of problems the VA will likely have on a regular basis. Wolters Kluwers UpToDate is the only product on the marketplace that comprehensively contributes to the requirements of the VA’s teaching mission.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

Wolters Kluwer is the sole source that expressed interest in the Acquisition.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required:

N/A

12. Requirements Certification: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Thomas P.

Digitally signed by Thomas P. Waugh

Waugh 105835 T1o0m5W8a3u5gh Date: 2018.06.08 Date Librarian, Library Ne1tw0:4o8r:k08O-0ff5i'c0e0'

13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Andrea Fink Date

Andrea L. Fink 198348

Digitally signed by Andrea L. Fink 198348 Date: 2018.06.08 11:31:27 -04'00'

Contracting Officer Program Contracting Activity Central (PCAC)

b. Director of Contracting/ Designee I certify the justification meets requirements for other than full and open competition.

Richard C.

Dahmen

Digitally signed by Richard C. Dahmen 199197 Date: 2018.07.23 14:03:32

199197 -04'00'

Richard Dahmen Date Director of Contracting Program Contracting Activity Central (PCAC)

c. VHA SAO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and recommend approval (if over $68 million) or approve ($700K to $68 million) for other than full and open competition.

Terry L. Spitzmiller Acting Executive Director, SAO Central Department of Veterans Affairs

07/25/2018

Date

TERRY L.

SPITZMILLER

394683

Digitally signed by TERRY

L. SPITZMILLER 394683

Date: 2018.07.25 09:37:32 -04'00'