Attachment_2_-_IDIQ_SOO_-_Appendix_B.xlsx
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- RFP for Indian Health Service HIT Modernization Federal contract opportunity
- Solicitation number
- 140D0421R0050
About this file
This request for proposals solicits an electronic health records provider or integrator to establish an indefinite delivery, indefinite quantity contract supporting the Indian Health Service's health information technology modernization efforts. The single award contract will provide products and services to replace the Resource and Patient Management System with a modernized electronic health record, transition imaging and document management from VistA Imaging, and support over 100 existing interfaces including those with reference laboratories, pharmacy systems, public health agencies, the Veterans Affairs mail order pharmacy, and revenue cycle management and financial systems. Questions are due by August 11th, 2022 and phase one proposals are due by September 1st, 2022. The Department of the Interior is issuing this RFP on behalf of the Department of Health and Human Services and the Indian Health Service.
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Appendix B - Interfaces
| Appendix B - Clinical Data Flow and Interfaces Context |
| This appendix provides a list of current-state IHS Health IT interfaces/connections between the Resource and Patient Management System (RPMS) and external systems. The purpose is to advise offerors of the types of connections that need to be in place, at a minimum, in order to support existing operations. |
Most of these interfaces are typical in other healthcare settings. A subset, called out below, are more specific to the IHS.
This list may be updated as additional interfaces and connections are identified.
Category Name Description IHS Context
Interfaces common to typical Health IT solutions and implementations
Imaging / Picture Archiving and Communications System (PACS) / teleradiology Interfaces that transmit imaging orders from the EHR to a Modality Worklist, store DICOM images, provide DICOM images to PACS workstations, transmit them to remote teleradiology services, receive and incorporate diagnostic reports into the EHR. The IHS currently uses VistA Imaging (VI) for DICOM storage, VistA RAD as the PACS workstation. These will be retired as modernization progresses, and will need replacement. Some sites use other PACS solutions.
The majority of sites utilize remote radiology reading services; reports are incorporated into the EHR, and clinicians may view radiographs, etc. in the EHR.
| Clinical Documenation | Document scanning | Scan or otherwise incorporate non-DICOM documents, e.g., PDF, XML, JPG, etc. and associate them with patients and encounters for simplified access/review by staff. | The current document scanning solution in IHS is VistA Imaging (VI). VI stores both DICOM and non-DICOM images and documents, which are viewable within the RPMS EHR. VistA Imaging will retire along with RPMS, and an alternative document management system will be required. |
| Medical Devices | Medical devices and laboratory equipment | Transmits orders and results to and from various medical devices and laboratory equipment. Laboratory equipment is typically interfaced through a middleware system but may be directly interfaced as well. Medical devices may be directly interfaced or interfaced via some type of broker. | The middleware currently used by IHS between RPMS and laboratory devices is Data Innovations. Offerors should propose interfaces and middleware that are most appropriate for and reliable with their solutions. |
| Laboratory | Reference Lab Interfaces | Bi-directional interfaces with regional reference laboratories to place orders electronically and receive results into the EHR. | Virtually all sites have relationships with regional reference laboratories and utilize the RPMS reference laboratory interface component to send orders and retrieve results via HL7 messaging. Configurable result notifications are sent to providers or surrogates, particularly of critical abnormal results; providers view results in the EHR, acknowledge notification, and annotate if desired. The current reference lab interface supports a wide range of specimens and tests including cytology and microbiology. |
| Pharmacy Point of Sale | Interface supporting real-time submission of outpatient pharmacy claims, including eligibility, formulary, timeliness of refills, etc. | IHS uses the Pharmacy Point of Sale component of RPMS; the intermediary is Change Healthcare. | |
| Pharmacy Robotics/Automation | Interface supporting transmission of reviewed prescription orders to robotic systems in outpatient pharmacies for automated dispensing and labeling. | The most commonly used pharmacy robotics solution at IHS sites is ScriptPro; Parata and GSL are others. | |
| Pharmacy Dispensing Cabinets | Interfaces to pharmacy dispensing cabinets that will receive orders and support dispensing of medications when pharmacy staff are not present. | The RPMS Pharmacy-Automated Dispensing Interface System provides an Admission/Discharge/Transfer (ADT) interface to Omnicell and Pyxis dispensing equipment. These devices are used in both inpatient and ambulatory settings where pharmacy coverage is not full time. |
Medication Refill Requests Interface permitting patients to phone in medication refill requests through an Interactive Voice Response (IVR) system. The Pharmacy Auto Refill system allows RPMS to interact with a commercial automated telephone system to refill prescriptions. Most IHS facilities use AudioCare.
Electronic Prescribing Interfaces and capabilities for transmitting electronic prescriptions to the pharmacy of the patient's choice. IHS supports multiple electronic prescribing capabilities. Most prescriptions are handled between the RPMS EHR and Outpatient Pharmacy system, and filled at the in-house pharmacy. Others are transmitted to the VA Consolidated Mail Outpatient Pharmacy (CMOP) for mailing to patients (see below). IHS also supports ePrescribing through the SureScripts network. Prescriptions and related messages originate in RPMS and are transmitted through a central hub to SureScripts. RPMS is certified for multiple SureScripts message types. Incoming prescriptions from community pharmacies are currently not supported.
EPCS Authentication Interfaces supporting multi-factor authentication of prescribers using electronic prescribing of controlled substances (EPCS) in accordance with DEA requirements. EPCS is supported at RPMS sites whether the prescription is destined for the in-house outpatient pharmacy (processed within the RPMS suite) or will be transmitted externally to a community pharmacy via the SureScripts network. The required multi-factor authentication utilizes the federal Personal Identity Verification (PIV) card for government employees but also supports the use of tokens supplied by IdenTrust or ORC Widepoint.
The EPCS capability in RPMS creates an export file of controlled substance prescriptions for submission to state PDMP.
Prescription Drug Monitoring Program (PDMP) Interfaces for reporting to State PDMP in accordance with regulations. The RPMS Controlled Drug Export System is used to identify prescriptions for controlled drugs and other specified drugs dispensed at IHS and tribal health care facilities, and create an export file for transmission to state PDMP. Data is extracted from the local RPMS Outpatient Pharmacy application. Queries to the state PDMP by clinicians/nurses/pharmacists are presently done manually.
| State Immunization Information System (IIS) | Interfaces to State IIS to ensure updating of patient immunization records with current information. | RPMS supports a bi-directional interface capability that can retrieve and/or send patient immunization information to State IIS. At present, each site establishes and maintains its own IIS connection(s). | |
| Transmission to Public Health Agencies | Interfaces to Public Health Agencies for a variety of mandated reporting purposes. | RPMS supports data transmission for Syndromic Surveillance, Reportable Laboratory Tests and Values/Results, Electronic Case Reporting, Antimicrobial Use and Resistance report, and others. | |
| Terminology Services | Interfaces to terminology service systems to ensure currency and updating of standard terminologies used in the EHR, ancillary and billing systems. | At present, the only terminology-related interface supported by RPMS is a connection to an instance of the Apelon open source terminology services solution managed by IHS, which delivers SNOMED CT and associated ICD-10-CM mappings via an interface to RPMS. Other terminologies and standard file updates (e.g. ICD-10, CPT, DSM-5, LOINC, UCUM, CVX, drug files and wholesale pricing) are delivered to RPMS instances as software patches. | |
| QRDA Extraction & eCQM Submission | Features and interfaces necessary for extracting QRDA Category 1 files from RPMS and calculating specific electronic Clinical Quality Measure (eCQM) results in QRDA Category 3 format. | Presently in IHS, an RPMS module extracts QRDA-1 files from RPMS and exports them to a separate (EHR-agnostic) "eCQM Engine". This engine creates the QRDA-3 files necessary for provider measure reporting and returns them to the RPMS site. QRDA-1 and QRDA-3 files are submitted to CMS in accordance with requirements using manual processes. | |
| Inventory Management | Inventory Management System | Track and manage supplies of drugs, supplies, and durable medical equipment, provide data to billing system. | Current use of inventory management in IHS is limited; utilization is principally for pharmaceuticals. |
| Patient Portal | Secure access for patients and approved proxies to personal health data in accordance with "view/download/transmit" (V/D/T) requirements. | The current IHS Personal Health Record (PHR) is an internally-developed web portal that provides patients with certified V/D/T capabilities. The data is derived from C-CDA exports from participating RPMS sites. Features also include Direct secure email communication with care teams, medication refill requests, and more. | |
| Direct Secure Email | Secure e-mail communication among providers and between patients and care teams using the Direct protocol. | IHS manages a Health Information Service Provider (HISP) that is certified to DirectTrust requirements. Patients have access to Direct on the Personal Health Record portal. Providers and care teams use a 3rd party email client to access Direct and communicate securely with patients and private sector providers and organizations. | |
| Medicaid Eligibility Download | Update data on patient Medicaid eligibility from State Medicaid program. | All sites regularly communicate with their respective States on eligibility. Sites occasionally run these updates manually if they determine that information available from automated State connections are not current. | |
| Fiscal Intermediary for Billing & Accounts Receivable | Interfaces with standard (X.12, 835, 837 format) data transmissions to a Fiscal Intermediary and/or to state Medicaid programs, for claims, EOB receipt, adjudication, posting, etc. | RPMS includes integrated billing and accounts receivable packages to allow sites to transmit claims to or receive adjudication information from third party payers (Medicare, Medicaid, VA, private insurance) either directly or via a clearinghouse. Some claims are processed manually. See also UFMS interface description below. |
Interfaces that are not typically present in commercial Health IT solutions but required for IHS
Electronic Dental Record (EDR) Electronic Dental Record (EDR)
| Bi-directional exchange of information between the EDR and the EHR and supporting applications (e.g., registration, scheduling, billing). | IHS facilities use the Henry Schein Dentrix EDR system. Demographic/registration/scheduling data are transmitted from RPMS to Dentrix, and procedure data are transmitted from Dentrix to RPMS. Numerous other features including entering medication orders and problem list updates directly from Dentrix have been requested by the IHS dental community. | ||
| Analytics and Reporting | Fiscal Intermediary for Purchased and Referred Care (PRC) | Data transmission to and from the PRC FI contractor concerning referrals that have been approved and will be paid at least in part by the IHS or tribal facility. | Information about obligations for approved referrals is sent in a flat file to a central data system, and thence to the contracted Fiscal Intermediary for PRC. The FI manages the claim from the consultant, and provides an Explanation of Benefits back to RPMS for accounting of paid claims. See also UFMS interface description below. |
| Unified Financial Management System (UFMS) | Interfaces and data transmissions to the HHS UFMS, for both accounts payable (e.g., PRC), and accounts receivable (e.g., insurance claims). | UFMS is an HHS system that processes and tracks financial and accounting transactions for IHS federal sites. UFMS is included on all transactions with Fiscal Intermediaries and insurance payers, and is the accounting system for federal sites. |
UFMS is specific to federal sites; comparable accounting systems for tribal/urban organizations may also require support.
| Joslin Vision Network (JVN) | Bi-directional communication between originating (sending) and reading/reporting site concerning screening for diabetic retinopathy. | The IHS JVN initiative detects early retinal changes in diabetic patients. Retinal images are taken at originating sites and transmitted through the Joslin Vision Network to the reading center at the Phoenix Indian Medical Center. The findings are transmitted in a report back to the requesting site. |
| National Patient Information Reporting System (NPIRS) | IHS national data analytics and business intelligence solutions. | NPIRS consumes a variety of data streams from RPMS sites, including general workload and encounter data as well as numerous program-specific data such as diabetes, behavioral health, and more. These exports are generated by RPMS and pushed to NPIRS in various formats. In addition, NPIRS publishes standard formats for non-RPMS EHR systems to use in submitting data from tribes and urban Indian organizations that use commercial EHR products. These data are used by IHS for internal analytics and business intelligence, as well as for agency reporting, e.g. Government Performance and Results Act (GPRA). |
| IHS Centralized Interoperability Suite (CIS) | Bi-directional HL7 updates of patient identifiers/demographic data to support enterprise Master Patient Index (eMPI), and C-CDA standard exports of encounter data to support patient portal and health information exchange. | The IHS CIS includes an eMPI which is updated by HL7 feeds of registration data from participating sites, and supplies the eMPI-generated patient identifier to those sites. The CIS receives standard C-CDA documents from participating sites for all new and updated encounters. This data is accessible to patients through the Personal Health Record (PHR) portal, and is parsed into a database called the Four Directions Hub (4DH). Authorized users of the 4DH can thereby view consolidated patient data from the disparate contributing sites. The 4DH has a connection to the eHealth Exchange, supporting health information exchange with VA and other participants on the eHealth Exchange. |
Phamacy Veterans Affairs Consolidated Mail Outpatient Pharmacy (CMOP) Utilizes an interagency agreement with the Department of Veterans Affairs to support mailing of prescriptions to patients. Facilities using RPMS utilize connections with the VA CMOP program (Leavenworth, KS), to transmit prescription orders and have them fulfilled by mail (excepting controlled drugs) to patients. Messages are handled via VA MailMan that is native to RPMS.
Revenue Cycle Management (RCM)
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