Electronic Health Record-Q and A Rev 1.pdf

Electronic Health Record

Q & A

General Clarifica�ons

1) Could you provide the details of exis�ng EHR systems/COSTs products? NASA currently u�lizes athenaFlow as the core EHR and is in the process of upgrading from v22 to v24 to support the �meline to transi�on to the new EHR (athenaFlow sunsets versions roughly every three years). Numerous other programs are u�lized to provide func�onality to the broader EHR. The provided language combined with figures and diagrams within Atachment A: NASA EHR Replacement PWS should provide addi�onal insight.

2) Could you also share the pain areas and challenges in exis�ng EHR systems/COSTs?

The current EHR is func�onal but presents some challenges for NASA. It lacks Mul�- Factor Authen�ca�on required by the government, requires mul�ple third-party modules to meet the government’s needs, and given that the system is twenty years old, it lacks some of the func�onality of modern EHR systems. These factors contribute to a system that requires significant effort to maintain.

3) What are the specific areas of need, or shortcomings, that lead JSC to iden�fy its exis�ng EHR systems needs to be replaced? NASA began exploring an EHR so�ware replacement when the current vendor indicated that the exis�ng applica�on may fully sunset in the future.

4) Could you confirm if NASA has a preferred EHR vendor or an incumbent provider currently in place? And Who is the incumbent managing the current EHR system? NASA does not have a preferred EHR vendor. The current EHR so�ware system is managed by NASA and NASA’s IT support contractor with minimal assistance from the vendor.

5) Are there any mandatory cer�fica�ons or regulatory compliance requirements (e.g., FedRAMP, HIPAA, NIST 800-53)? Mandatory cer�fica�ons are listed in Atachment A:

NASA EHR Replacement PWS.

6) This effort has PoP of Base +4 Op�on Periods, is it NASA’s intent to migrate this data repository to the cloud? If yes, what is the planned �meline? NASA does not have a �meline for moving the EHR into the cloud.

7) The PWS states, “The deployment of a COTS EHR so�ware solu�on at Johnson Space Center, with an effec�ve go-live date no later than 7/7/2026, using an on-premises implementa�on.” Please describe any par�cular advantages gained by NASA by maintaining an on-premises implementa�on versus a cloud implementa�on. NASA JSC atempted a complete cloud migra�on of JSC Clinic applica�ons, which included the Electronic Health Record applica�on, approximately three years ago. It was determined that integrated performance and recurring cost of running clinic applica�ons in the cloud was inferior to the legacy on-premises implementa�on.

Challenges not directly involving the EHR applica�on must be addressed before another atempt to migrate the Clinic-to-the-cloud is atempted. There is currently no projected �meline to address these challenges.

8) What has driven your replacement of your current vendor, other than specified procurement regula�ons? NASA began exploring an EHR so�ware replacement when the current vendor indicated that the exis�ng applica�on may fully sunset in the future.

9) What specific procurement rules are driving your decision to change your Electronic Health Record? Procurement rules are not driving the decision to change to a new EHR. NASA began exploring an EHR so�ware replacement when the current vendor indicated that the exis�ng applica�on may fully sunset in the future.

Technical Requirements

10) Can you provide clarifica�on on the minimum hardware and infrastructure requirements outlined in PWS Sec�on 2.2? The hardware listed in 2.2 is the Virtual Environment that contains the current EMR and other servers.

11) Regarding HL7 bidirec�onal data exchange, are there specific security protocols NASA expects beyond the standard HL7 FHIR and WSDL integra�on? In general, we require protec�on of Data-At-Rest (DAR) and Data-In-Transit (DIT). SSL/TLS is required for all connec�ons to ensure data is encrypted in transit.

12) Are there any addi�onal legacy systems or third-party applica�ons that must be integrated with the proposed EHR solu�on apart from PACS and ImmTrac2?

Informa�on on legacy systems and third-party integra�on is provided in the language, figures and diagrams within Atachment A: NASA EHR Replacement PWS.

13) What are the data migra�on expecta�ons from the exis�ng EHR system? Will NASA provide historical data, or is data extrac�on part of the vendor’s responsibility? Data migra�on is expected to be part of installa�on and implementa�on jointly performed by the vendor and the NASA IT staff.

14) Should the proposed EHR support mul�-tenancy, or will it be a dedicated single-tenant environment? Dedicated single tenant.

15) The Technical Specifica�ons require compliance with ONC HIT cer�fica�on. Would NASA consider a solu�on for a COTS EHR product that is in the process of being cer�fied? Products shall be ONC HIT cer�fied in the categories iden�fied within Atachment A: NASA EHR Replacement PWS at the �me of proposal submission.

16) Will there be an opportunity to conduct a technical assessment of the current EHR infrastructure before migra�on begins to beter understand requirements for the system/workflow and data migra�ons? This will be done during the implementa�on phase of the project.

17) Can you please describe how you order medica�ons from each satellite loca�on?

NASA currently u�lizes Dr. First for prescribing. Many prescrip�ons are filled in NASA’s local or satellite pharmacies, but NASA also provides the op�on to send prescrip�ons electronically to retail pharmacies in the local area. Several satellite pharmacies locally dispensed from clinic stock (e.g. sample dispensing).

a. Are they are using a specific pharmacy? The default is the onsite pharmacy (JSC Pharmacy), but prescribers have the ability to prescribe to external pharmacies through Dr. First (including controlled substances).

b. What program that pharmacy uses to process their orders? Frameworks LTC

c. Is it a direct connec�on? It is not a direct connec�on.

18) Does the EHR need to integrate into JSC’s current preferred pharmacy system or is the intent to replace it under a newly implemented EHR system? The current verbiage is slightly vague surrounding the capabili�es needed (under the pharmacy sec�on). Integra�on into the JSC pharmacy system is not required.

19) The RFQ PWS document (Atachment A page 7) describes the exis�ng NASA infrastructure suppor�ng the current electronic health record so�ware that includes a SAN with both SSD and �ered “slow” spindle storage. The replacement Electronic Health Record will require storage to migrate exis�ng data for the new on-premises centralized data repository.

a. Please clarify that this procurement will use the exis�ng infrastructure iden�fied in the PWS. Use of the current infrastructure, or the current infrastructure with minimal addi�ons and/or upgrades is preferred.

b. Please clarify how NASA will procure updated on premises infrastructure separate from this RFQ to support data migra�on and data backup for the new so�ware. Any updates required will go through the normal NASA procurement process for IT infrastructure.

Security and Compliance

20) Does NASA require FedRAMP cer�fica�on for cloud-hosted components, even if the primary system is on-premises? NASA is not seeking a hybrid solu�on with cloud-hosted components.

21) What authen�ca�on methods are mandatory for compliance (e.g., PIV, CAC, MFA, SAML, OAuth, OpenID)? Requirements for authen�ca�on methods are listed in Atachment A: NASA EHR Replacement PWS.

22) Are there any addi�onal data encryp�on standards that must be followed beyond the standard FIPS 140-2 encryp�on? No.

23) Will NASA require specific cer�fica�ons or clearances for personnel working on the project, such as FedRAMP or addi�onal security clearances? Any on-site visits will be covered using guest access. Aside from standard HIPAA and Privacy Act requirements regarding medical data, no addi�onal security clearances or cer�fica�ons are required.

24) Is the assump�on correct that because this is on premise and not cloud hosted that the FedRAMP does not apply? FedRAMP does not apply.

25) Will this solu�on go through an Authority to Operate (ATO) review and approval?

What is the planned �meline to achieve ATO? ATO will be required, which includes comple�on of security control ques�ons from the vendor. The ATO process will begin a�er the contract awarded and prior to the established go-live date.

Implementa�on & Support

26) Could you provide further details on the expected virtual assist implementa�on outlined in PWS sec�ons 2.2, 3.0, and sec�on 7 Figure 5? The general concept and basic responsibili�es of the virtual assist implementa�on are explained in the listed PWS sec�ons. Specific details of how NASA’s IT support contractor and the selected EHR vendor will interact to jointly implement the so�ware will be addressed post award when the NASA and EHR vendor teams are able to openly communicate.

27) Will NASA provide any internal IT resources to assist with the implementa�on?

NASA’s IT support contractor will substan�ally assist with implementa�on as described in the PWS, including sec�ons 2.2, 3.0, and sec�on 7 figure 5.

28) What level of training and knowledge transfer is expected for NASA’s staff? The expecta�on is that the selected vendor will provide full training for the different clinical staff disciplines that interact with the EHR as well as maintenance, updates, and other sustaining ac�vi�es that will be performed by NASA’s IT support contractor over the period of performance of the contract.

29) Is it the intent of NASA to leverage their current investments, such as G5 and PowerPla�orm, to gain efficiencies during the Contract’s total performance period?

Will NASA consider this approach in order to automate workflows, processes and provide mobile access? NASA is recep�ve to any proposed implementa�on provided those proposals demonstrate the case that they will support exis�ng clinic needs and workflows while being technically sound, cost effec�ve, and opera�onally reasonable.

Demonstra�on and Evalua�on

30) Will NASA provide test data for the demonstra�on of features listed in Atachment B Demo Script.xlxs? NASA will not provide any specific test data for the demonstra�on;

vendors should prepare their own as needed to address the proposed system’s capability to meet the elements iden�fied in Atachment B: Demo Script.

31) Will NASA provide specific test cases, or scenarios for the demonstra�on, or should vendors prepare their own? NASA will not provide any specific test cases or scenarios for the demonstra�on; vendors should prepare their own as needed to address the proposed system’s capability to meet the elements iden�fied in Atachment B: Demo Script.

32) Will the government consider addi�onal evalua�on criteria, such as system scalability, cybersecurity risk assessment, or ease of customiza�on? refer to Atachment D - Evaluation Instructions and Criteria.

Pricing and Contractual Terms

33) Can you confirm whether pricing should be structured per-user, per-provider, or per-license /subscrip�on basis? NASA does not have a preference for pricing structure.

Pricing informa�on should be clearly explained, effec�vely ar�cula�ng what is included in pricing, and account for the EHR user counts, types, and defini�ons included in sec�on 3.0 of Atachment A: NASA EHR Replacement PWS. Vendors should provide their best pricing.

34) Can you confirm whether on-site support during go-live is required, or if remote support is acceptable? On-site support during go live is required as iden�fied in sec�on 3.1.4.1.1 of Atachment A: NASA EHR Replacement PWS.

Ques�ons for Procurement

35) Is there an an�cipated budget range for this procurement? This procurement is being competed under FAR part 13.

36) Will there be an opportunity for oral discussions or revisions a�er the ini�al proposal submission? There will be no opportunity for oral discussions or revisions a�er the ini�al quote submission.

37) Are there restric�ons on subcontrac�ng for implementa�on and post-go-live support? There are no restric�ons on a subcontrac�ng plan for implementa�on and post-go-live support.

38) Can the real �me virtual demonstra�on (Atachment B) be conducted via any preferred pla�orms (e.g., Zoom, Microso� Teams)? No, real �me virtual demonstra�ons shall be conducted using Microso� Teams.

39) Can you provide addi�onal details on evalua�on criteria weigh�ng for Technical, Past Performance, and Price? For any ques�ons regarding evalua�on criteria please see Atachment D – Evalua�on Instruc�ons and Criteria

40) Is there flexibility in contract structure (e.g., milestone-based payments vs. fixed-price deliverables)? Please refer to the RFQ.

41) How should pricing be managed for op�onal future enchancements or feature customiza�ons beyond the base requirements? Please refer to the RFQ.

42) Background: Many companies are structured with mul�ple divisions or mul�ple legal en��es that individually perform Prime Contracts but fall under a broader corporate umbrella. Recognizing such corporate structures exist across the industry, the procurement rules and numerous GAO decisions have made clear that procuring agencies may evaluate and credit an offeror with the past performance and corporate experience of sister subsidiary companies where the offeror’s proposal demonstrates that the resources of the sister subsidiary (e.g., workforce, management, facili�es, or other resources) will be meaningfully contributed to contract performance. See GM–Bulltrack, B- 414591.6 (Comp. Gen. Oct. 30, 2018) (holding that an agency may properly atribute the experience or past performance of a sister subsidiary), and Iyabak Construc�on, LLC, B-409196 (Comp. Gen. Feb.6, 2014) (holding that the agency failed to ar�culate a ra�onal basis for solicita�on’s refusal to consider experience and past performance of sister subsidiaries).

a. Ques�on: Would the Government please clarify that the Offeror may cite the prime contract past performance and corporate experience of a sister subsidiary company so long as the Offeror demonstrates how the resources of the sister subsidiary will meaningfully contribute to the performance of the opportunity? Refer to the RFQ Atachment D – Evalua�on Instruc�on and Criteria.

b. Will the government allow offerors to reference relevant past performance from teammates and subcontractors? Refer to the RFQ Atachment D – Evalua�on Instruc�on and Criteria.

43) The Solicita�on reads: “The contractor shall ensure a func�onal system is ready for use and system go-live is completed no later than 7/7/2026” will this date be adjusted based on any delays, including the scheduled award date? Refer to the RFQ.

44) Is NASA looking for a contractor to provide solu�ons tailored to the outlined func�ons, or is the requirement specifically for a contractor that already has a ready-made product? Please see Atachment A – NASA EHR PWS.

45) Is working with a third-party contractor something you’d consider for this requirement? Refer to the RFQ and Atachment D – Evalua�on Instruc�on and Criteria.

46) Can you please confirm if the es�mated budget for this RFQ is $34M for the One (1) base year with four (4) one (1) year op�ons or 34M for the One (1) base year. Please see Atachment D – Evalua�on instruc�ons and Criteria Part 2.0. EVALUATION

CRITERIA.

47) Will JSC allow Offerors to propose a modern, cloud-hosted solu�on that meets your stringent security requirements? No.

48) Is NASA opposed to moving to a more cost-effec�ve and efficient proven cloud solu�on? Yes.

49) If NASA is firm on an on-premise solu�on would NASA consider moving to a cloud solu�on in the op�on years? No.

50) Is lowest cost part of the target evalua�on criteria? Please see atachment D- Evalua�on Instruc�ons and Criteria.

51) Is NASA agreeable to an open source EHR solu�on? No.

52) Is it important to NASA that the solu�on be able to integrate with medical records from other federal agencies such as Veterans Administra�on? No.

53) Is there an expecta�on of ATO? Please see ques�on 25.

54) Is there an expecta�on of in-person at JSC and if so, how big would the team be that we would interface with? Please see Atachment A - NASA EHR PWS.

55) Who (which organiza�ons, contractors) should the contractor's team be prepared to engage with both onsite and virtually? To be provided a�er contract award.

56) Given NASA's goals of data access for end users and interoperability, are you open to approaches that leverage the FHIR standard? NASA is open to approaches that leverage the FHIR standard.

57) Is NASA open to transi�oning to an opensource EMR? No.

58) Is NASA open to using FHIR as the standard for interoperability? Please see Atachment A – NASA EHR PWS.

59) What are some of the challenges faced by the current EMR? Please see ques�on 2.