Attachment_2_-_IDIQ_SOO_-_Appendix_D.pdf

RFP No. 140D0421R0050

Appendix D, Definitions Physical schema

The physical schema consists of the ISO/IEC 9075-1:2016-compliant data definition language that is used to create the physical database for the EHR and includes definitions of all tables (entities), all primary keys, all candidate keys, all attribute domains, all views and all referential integrity constraints. The physical schema includes the security credentials required to carry out Create, Read, Update, and Delete operations on the EHR database via SQL INSERT, SELECT, UPDATE and DELETE statements. For example, if the vendor’s EHR is deployed on the open source PostgreSQL database, then the physical schema would include the SQL:1600-compliant code necessary to create a new instance of the EHR on a PostgreSQL RDBMS, and the access credentials required to transfer data in one instance of the EHR database to a newly-created database.

The physical schema allows the IHS to create a mirror-image of the OLTP database that the EHR is deployed on, create queries against the OLTP database that the EHR is deployed on, and create ETL code for populating clinical data warehouses such as the OMOP CDM from the OLTP database that the EHR is deployed on.

Reference URL: https://www.iso.org/standard/63555.html

Unified Medical Language System

The Unified Medical Language System (UMLS) is a product of the National Library of Medicine of the National Institutes of Health, was first released in 1986, and has been continuously updated on a semi-annual basis since its 1986 release. The NLM developed the UMLS to facilitate language-agnostic semantic interoperability between EHR systems by serving as a lingua franca for the encoding of biomedical concepts contained in patient medical records to a universal clinical ontology.

The UMLS is a superset of 220 controlled clinical vocabularies, includes all ONC Certification-required controlled clinical vocabularies, and provides a universal coding system that captures more than four million unique clinical concepts. The UMLS eliminates the errors that occur when mapping physician-created information to specific source vocabularies, e.g., ICD-10-CM and/or SNOMED CT. For example, the UMLS is not susceptible to the terminology mapping problem that occurs when attempting to encode Stage IIIA Non-small-cell lung cancer to SNOMED CT or ICD-10-CM: Stage IIIA Non-small-cell lung cancer is encoded directly by the UMLS and by the NCI Thesaurus, but is NOT encoded by SNOMED CT nor is it encoded by ICD-10-CM. That means that it is impossible to do accurate retrospective analytics on Stage IIIA Non-small-cell lung cancer using only SNOMED CT or ICD-10-CM claims data.

Reference URL: https://www.nlm.nih.gov/research/umls/index.html

IHS Facilities are direct-care provider facilities owned and operated by IHS.

Tribal Facilities are composed of Title I Tribal facilities and Title V Tribal 638 facilities.

Federally recognized Tribes or Tribal organizations that contract or contracts with the Indian Health Service (IHS) to plan, conduct and administer one or more individual programs, functions, services or activities under Public Law (P.L.) 93-638, or portions thereof, including construction program that the IHS would otherwise provide for Indian Nations because of their status as Indian Nations. P.L. 93-638 is https://www.iso.org/standard/63555.html https://www.nlm.nih.gov/research/umls/index.html

RFP No. 140D0421R0050 the Indian Self Determination and Education Assistance Act (ISDEAA). Tribes and Tribal Organizations have the option to either (1) administer programs and services the IHS would otherwise provide (referred to as Title I Self-Determination Contracting) or (2) assume control over health care programs and services that the IHS would otherwise provide (referred to as Title V Self-Governance Compacting or the TSGP). These options are not exclusive; Tribes may choose to combine them based on their individual needs and circumstances. Reference: “Title I”, IHS (https://www.ihs.gov/odsct/title1/)

• Title I Tribal Facilities. These are tribal owned and operated, but contracted by IHS.

• Title V Tribal 638 Facilities. These were IHS facilities/programs transferred to tribes under the “Indian Self Determination and Education Assistance Act” (ISDEAA).

Urban Facilities. These are 3rd party healthcare provider facilities in urban areas. Under the Urban Indian Health Program (UIHP) has 41 non-profit 501(c)(3) programs. They are funded through grants and contracts from IHS under Title V of Indian Health Care Improvement Act, PL 94-437. Approximately 45% of UIHP providers receive Medicaid reimbursement as “Federally Qualified Health Centers (FQHC)” and others receive fees-for-service under Medicaid for allowable services. Reference: “Office of Urban Indian Health Program” (https://www.ihs.gov/urban/)

All-Inclusive Rates. On an annual basis the Indian Health Service calculates and publishes calendar year reimbursement rates which are often referred to as the All-Inclusive Rates (AIR or the "OMB rate"). The AIR is published in the Federal Register annually, and is applicable to reimbursement methodologies primarily under the Medicare and Medicaid programs. However, the All-Inclusive Rates are utilized in reimbursement methodologies for services reimbursed under the VA-IHS Reimbursement Agreement and the Federal Medical Care Recovery Act (FMCRA).

Reference:

https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA- Center/info/understand-the-reimbursement-process https://www.federalregister.gov/documents/2020/12/31/2020-28950/reimbursement-rates-for-calendar-year-2021

Purchased and Referred Care (PRC). The Purchased/Referred Care (PRC) Program at IHS is for medical/dental care provided away from an IHS or tribal health care facility. PRC is not an entitlement program and an IHS medical referral does not imply the care will be paid. If IHS is requested to pay, then a patient must meet the American Indian/Alaska Native tribal affiliation, residency requirements, notification requirements, medical priority, and use of alternate resources (including IHS facility).

Reference: https://www.ihs.gov/forpatients/prc/ https://www.ihs.gov/prc/ https://www.ihs.gov/odsct/title1/ https://www.ihs.gov/urban/ https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-Center/info/understand-the-reimbursement-process https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-Center/info/understand-the-reimbursement-process https://www.federalregister.gov/documents/2020/12/31/2020-28950/reimbursement-rates-for-calendar-year-2021 https://www.federalregister.gov/documents/2020/12/31/2020-28950/reimbursement-rates-for-calendar-year-2021 https://www.ihs.gov/forpatients/prc/ https://www.ihs.gov/prc/

Appendix D, Definitions