Attachment A NASA EHR Replacement PWS.pdf

Attachment A Performance Work Statement

Attachment A Performance Work Statement

For

Johnson Space Center (JSC) Electronic Health Record

(EHR) Replacement

PERFORMANCE WORK STATEMENT

JSC EHR REPLACEMENT

TABLE OF CONTENTS

Table of Contents

1.0 Introduction

1.1 Purpose

1.2 Overview

2.0 Background

2.1 Relevant Constituents

2.1.1 Flight Medicine

2.1.2 Lifetime Surveillance of Astronaut Health

2.1.3 Occupational Health

2.1.4 Behavioral Health

2.1.5 Employee Assistance

2.1.6 Neutral Buoyancy Lab (NBL)

2.1.7 Star City/Moscow (Russia)

2.1.8 Test Subject Screening (TSS)

2.1.9 White Sands Test Facility (WSTF)

2.2 Current Electronic Health Record

2.3 Unique Attributes

2.4 Unique Services

2.5 EHR Usage for Astronauts

2.6 Additional background information

3.0 Scope of Work

3.1 Technical Requirements

3.1.1 Data Management and Integration

3.1.2 Software Features and Capabilities

3.1.3 Customization and User Interface

3.1.4 Operational Support and Maintenance

3.1.5 Patient and Medical Data Handling

3.1.6 Access Controls

3.1.7 Clinical Documentation and Data Handling

3.1.8 Training

3.1.9 Integration

3.2 Schedule Requirements

3.2.1 Reserved

3.2.2 Project Initiation

3.2.3 Master Project Plan

3.2.4 Launch Functional System

4.0 Reserved

5.0 Travel

6.0 Reserved

7.0 Interface Table and Diagrams

8.0 Acronyms

9.0 Standards, Regulations & Compliance References

List of Figures Figure 1 – NASA JSC EHR System to System Interface Table Figure 2 – NASA JSC EHR Edge Location End-Points Diagram Figure 3 – NASA JSC EHR System Interfaces Diagram Figure 4 – NASA JSC EHR Device Interfaces Diagram Figure 5 – EHR Software Implementation Roles and Responsibilities Figure 6 – EHR Detailed Interface Diagrams

1.0 Introduction

1.1 Purpose

This document outlines the functional and technical requirements for the NASA JSC Electronic Health Record (EHR) Replacement Project. This document provides an understanding of the project scope, for successfully implementing the NASA JSC EHR.

1.2 Overview

The Human Health & Performance Directorate (HH&PD) at NASA is responsible for ensuring the health and productivity of humans during all phases of spaceflight. This includes providing flight and ground-based healthcare, occupational health, research, test subject screening, and support functions. The goal is to achieve NASA's mission objectives.

HH&PD collects, processes, stores, uses, and disseminates human subject health-related information to fulfill these functions. They use various data management products and services, including an EHR system, to support operational decision-making.

The purpose of the JSC Clinic is to recognize, evaluate, control, and mitigate illness and disease associated with the flight and institutional work environments and to ensure the health, productivity, and wellness of the JSC team members.

NASA intends to replace the current commercial-off-the-shelf (COTS) EHR system at JSC with a new COTS EHR solution. This Performance Work Statement (PWS) aims to identify and select a successful contractor to deliver an EHR solution that best matches the criteria and conditions specified.

The current EHR is installed on-premises at Johnson Space Center in Houston, Texas.

Backup facilities are in White Sands, New Mexico. This configuration is stable, well-understood, expandable, secure, and highly functional. Locations of care not physically located at Johnson Space Center utilize the NASA VPN to access the EHR. Geographically, the EHR software will only be installed at NASA JSC.

2.0 Background

2.1 Relevant Constituents

The primary stakeholders and customer end-user personnel using NASA JSC EHR products and services are core constituents supporting NASA HH&PD's medical care operations.

They come from the following functional areas:

2.1.1 Flight Medicine

The Flight Medicine Clinic at JSC is responsible for capturing complete documentation of patient clinical encounters for Active Astronauts, Dependents, Aircraft Operations Division (AOD) personnel, Flight Directors, International Astronauts, and Retired Astronauts. EHR documentation in the Flight Medicine Clinic contains, but is not limited to: annual physical exams, periodic visits (sick visits, immunizations, etc.), flight medical clearance notifications, workman’s compensation documentation, consultant reports, lab reports, PACS imaging reports, audiology exams, dental exams, internal correspondence (release of information, request for records, and clinic survey letters), private medical conference notes, patient debrief letters, and flight-related exams (including PACS imaging reports). Within the Flight Medicine location of care, there are 3 subordinate locations to allow separate management of International Partner (IP) charts: Japanese Aerospace Exploration Agency (JAXA), European Space Agency (ESA), and Canadian Space Agency (CSA.)

2.1.2 Lifetime Surveillance of Astronaut Health

The Lifetime Surveillance of Astronaut Health (LSAH) program is a proactive health screening and monitoring program managed by epidemiologists and designed for active and retired astronauts. The program aims to detect and prevent occupational-related injuries or diseases that may affect astronauts. It examines acute and chronic health issues among astronauts and identifies the risks associated with their occupational exposures, beginning with their active service and continuing for their lifetime.

2.1.3 Occupational Health

The Occupational Medicine Clinic (OMC) at JSC is responsible for capturing complete documentation of patient clinical encounters for NASA Civil Servants, Contractors, and JSC visitors. EHR documentation in the Occupational Medicine Clinic contains but is not limited to annual physical exams, periodic visits (sick visits, immunizations, etc.), workman’s compensation documentation, provider written opinion letters, lab reports, PACS imaging reports and diagnostic tests (PFTs, audiometry reports, and vision screenings).

2.1.4 Behavioral Health

The Behavioral Health Department at JSC is responsible for capturing complete documentation of patient clinical encounters for Active Astronauts, Dependents, AOD personnel, Flight Directors, International Astronauts and Retired Astronauts (case by case basis), OMC Civil Servants and contractors. JSC provides primarily supportive, therapy, counseling and family support services, office-based evaluation of routine mental health conditions in healthy (employed) populations, and some use of screening inventories (PHQ9, etc.) and neurocognitive testing including formal testing tools. The Behavioral Health Program (BHP) leverages the EHR’s storage and infrastructure, but due to the very sensitive nature of BHP data, the charts are stored separately from other EHR data, and access is strictly controlled. JSC segregates behavioral health / employee assistance program records from routine medical records to avoid any possibility of unapproved identification of behavioral health engagement by employees, even if details of the encounters are secured.

Currently this is done through the use of separate charts per patient, fully independent of each other, however NASA is open to considering the utilization of a single patient chart with appropriate access control and compartmentalization. To satisfy NASA requirements, a Notification of Contact form is filled out and stored in the EHR, but this form only contains basic demographic information about the clinical encounter.

2.1.5 Employee Assistance

NASA’s Employee Assistance Program (EAP) requires a stable electronic health record system that allows clinicians to document clinically relevant data at the point of care. The EAP implementation will mirror the implementation for BHP—the two groups have very similar requirements.

2.1.6 Neutral Buoyancy Lab (NBL)

The Neutral Buoyancy Lab at JSC’s Sonny Carter Training Facility captures complete documentation of patient clinical encounters for Aerospace Physiology Specialists and Flight Surgeon/Diving Medical Officers. EHR documentation in the NBL location of care contains, but is not limited to, medical screenings, dive physicals, and periodic visits (sick visits, immunizations, etc.).

2.1.7 Star City/Moscow (Russia)

The Star City Clinic in Russia is responsible for capturing complete documentation of patient clinical encounters to provide medical support to Astronauts, Dependents, and NASA employees in Russia. EHR documentation in the Star City and Moscow locations of care contains, but is not limited to, medical screenings and periodic visits (sick visits, immunizations, etc.).

2.1.8 Test Subject Screening (TSS)

The Test Subject Screening Department at JSC is responsible for capturing complete documentation of patient clinical encounters for the Test Subject Screening participants.

EHR documentation in the Test Subject Screening location of care provides encounters that conduct tests for ground-based research or microgravity studies. It contains but is not limited to annual physical exams.

2.1.9 White Sands Test Facility (WSTF)

JSC’s White Sands Test Facility in New Mexico captures complete documentation of patient clinical encounters for individuals who work on projects within NASA’s core capability.

EHR documentation in the WSTF location of care contains but is not limited to, medical screenings, annual physical exams, periodic visits (sick visits, immunizations, etc.), audiology exams, vision exams, and management of occupational work injuries and/or illnesses.

2.2 Current Electronic Health Record

The NASA JSC EHR system offers comprehensive medical and occupational health care delivery according to federal, agency, program, and organizational requirements, regulations, policies, and standards. The system holds approximately 30,000 records for employees dating to the beginning of the U.S. Space Program in the early 1960s. It consists of a variety of file types and data sets and including scanned images such as pdf files. The current system uses approximately 400 forms (150 encounter forms and 250 independent forms.) There are approximately 25,000 URLs/hyperlinks (many of which point to pdf documents and PACS images/studies.) The EHR size, excluding PACS files, is approximately 5 TB.

The NASA JSC EHR generally consists of:

• Intuitive user interfaces for data capture and review.

• A secure, centralized data repository for data storage.

• Computerized physician order entry (CPOE), and clinical decision support capabilities for facilitating clinical workflows and automation.

• An open data architecture for standards-based interoperability and data exchange with other internal HH&PD IT and external service provider systems.

The current implementation is on-premises and meets all performance and security requirements.

JSC possesses a large data center utilized by multiple NASA organizations. The cost for this facility (power, generator backup, cooling, hardware racks, etc.) is not borne by the organizations that utilize it. The on-premises implementation of EHR software will be housed in this facility with backup files at White Sands Test Facility. Current hardware specifications are listed below.

The current on-premises implementation utilizes a virtualized server environment consisting of six physical Supermicro SYS-2029U-TR servers.

• Each Server includes 768 GB RAM and 2 Intel Xeon Gold 6226 CPUs running at 2.70 GHz each.

• Each CPU includes 16 cores for a total of 32 cores per each Supermicro box.

• Each of the 6 machines runs Windows Server Datacenter and uses VMWare at a minimum version level of 6.7.0.

A storage area network (SAN) providing tiered storage consisting of approximately 15 TB available Solid-State-Drive (SSD) “fast” storage and approximately 45 TB of “slow” spindle storage is available to these machines. Of note, this environment supports operations of approximately 70 virtual machines not associated with the EHR.

Active Directory Federation Services (ADFS), Broadcom SiteMinder and EntraID are available for Enterprise SSO Integration.

NASA maintains an information technology support staff that manages the network and provides tier-one and some tier-two support. Support provided by NASA IT staff includes making changes and customizations to the current system to address evolving spaceflight medicine practices and the development of custom forms and workflows for utilization within the EHR software system. NASA IT staff is very familiar with exporting data and have the capability and knowledge to utilize standard SQL APIs. Due to NASA security policies, the selected EHR contractor will not be given direct access to NASA IT systems. NASA IT support personnel will implement the selected EHR software with the EHR software contractor providing virtual assistance during the EHR replacement project. NASA IT support staff includes system and business analysts, infrastructure specialists, IT architects, system engineers, and service desk personnel. This team is well versed in supporting the current implementation and NASA expects to utilize its internal IT support staff to continue to provide support to the new EHR software system at the same level as the current system. A table is provided (section 7, Figure 5) that clarifies expected roles and responsibilities for NASA IT personnel and EHR contractor personnel.

The current Electronic Health Record (EHR) system relies on over 50 connections, that include formats and protocols such as HL7, TXT, PDF, XML, CSV, JPG, GIF, TIFF, PNG, MDF, HTML, PST, SQL, API, DICOM, MLLP, SMTP, WCF, SOAP, FILE, FTP, WCF-

Custom, Windows SharePoint Services, WCF-SQL, WCF-WSHTTP, WCF-Basic HTTP, TCP/IP, and SMB. Many connections rely on BizTalk interfaces between the EHR and downstream systems. NASA maintains a direct, NASA procured, license for Biztalk that can be utilized with another EHR if necessary. Given BizTalk’s projected end of life in the next four to six years, NASA prefers to utilize a different interface engine, whether native to the proposed software or an additional commercial product, so long as existing connections are replicated or functionally replaced. It is NASA’s preference that the contractor provides any required commercial interface engine license as part of their proposed solution. Detailed interface documents are attached to this packet as supporting documents.

2.3 Unique Attributes

• NASA requires the ability to manage multiple unique and separate charts per patient.

• NASA does not bill.

• NASA collects insurance information but does not file claims.

• NASA does not use practice management software but may be interested in utilizing some features and functionality.

• NASA does not allow self-scheduling.

• NASA interfaces with internal SharePoint and a file server outside the EHR but on our local network.

• NASA actively uses both ICD-9 and ICD-10 codes. NASA does not participate in state or federal quality reporting.

• NASA requires the use of federally approved forms for employee exams and reporting of workplace injuries.

• NASA has a heavy reliance on custom reporting for tracking specific data entered into the EHR. This includes qualifications such as flight, dive, and other certifications and the associated recurring requirements to maintain these certifications. A wide variety of real time data is queried for many daily, weekly, monthly, and annual data calls. Reports are both pre-build and created on-the-fly to support program needs.

• NASA requires system functionality, including scheduled downtimes or other unavailability to be managed 24x7 worldwide.

• NASA relies heavily on a specialized pharmacy that uses a custom formulary, maintains a limited inventory, and compounds medications.

2.4 Unique Services

• Extensive vision and auditory testing, including hearing conservation.

• Behavioral health services as well as an Employee Assistance Program.

• Support for reacclimating astronauts physically, psychologically, and operationally when they return from microgravity.

• Unique workflows to obtain data from astronauts inflight to support medical monitoring by physicians on the ground.

• Annual OSHA and occupational health exams and certifications specific to NASA operations.

• Occupational health workplace injury, exposures, surveillance, tracking, and reporting.

While JSC provides unique services and gathers unique data there are many similarities to standardized clinical care, workflows, and documentation. The key difference is a heavy reliance on the creation and use of custom forms and workflows to capture unique data.

Data is gathered through a combination of in-person visits, private medical conferences where the provider inputs a visit note, and API downlinks from medical devices integrated with the

EHR.

Using physical re-acclimatization astronauts as an example, EHR use and documentation would look similar to a typical strengthening and reconditioning program for a debilitated patient.

Protocols use normal physical therapy processes, devices, and regimens and data captured in the EHR is standard. Duration, intensity, specific exercises performed, and additional custom data collected will be specialized to meet the unique demands of returning from a microgravity environment.

2.5 EHR Usage for Astronauts

• The EHR manages data throughout an astronaut's career, from initial application until death.

• Requirement to collect discrete and granular data that will be used for approved research programs.

2.6 Additional background information

• The current EHR configuration uses Athena Flow with bolt on software to handle labs, PACS, device integration, and connections to other supporting systems.

• The Certified Health IT Product Listing (CHPL) maintained by the Office of the National Coordinator for Health Information Technology (ONC HIT) reflects that Athena Flow is certified in 43 of 54 ONC HIT criteria, including ONC HIT 170.315(b)(10).

• EHR records are stored on premises at JSC with backups at White Sands Test Facility.

• International sites and subordinate locations access the current on-prem EHR via remote access that is usually achieved through a connection to a terminal server.

(Remote access is defined as EHR access occurring at a non-JSC Clinic location.)

• The EHR client runs within the bounds of the terminal server. In rare instances, select personnel may have an EHR client installed on a local workstation that they carry on their person. In all cases network connections to the terminal server and EHR server route over data pathways that are VPN secured at the network or application level, or both.

• NASA is responsible for ensuring compliance with foreign requirements for international partner astronaut information housed in the EHR system.

• Generally, JSC uses OSHA standard reporting for occupational medicine issues.

Other reports are local custom reports (such as compliance with annual astronaut physicals, flight and dive qualifications, etc.) Most of these qualification reports have custom interval, frequency and content requirements and are used to track clearance and certification currency.

• Primary encounter information is stored using the current EHR software. JSC maintains parallel file systems for file storage such as consult reports. Imagery is maintained in a separate PACS system.

• All EHR connections are terrestrial in origin. Data provided by in flight systems is routed through Mission Control and via Private Medical Conferences with providers that input notes directly into the EHR. Connectivity should be designed to ensure on demand availability from users operating at JSC.

• The current EHR system interfaces with multiple different third-party modules (PACS, audiology, pharmacy, etc.) The ability to reduce some of the module interfaces is desired but an interfaced system will meet the needs of the JSC clinic.

• The JSC clinic does not provide dental care. Dental records from outside consultants are received via fax or email and scanned into the EHR.

• JSC pharmacy utilizes both commercial and custom software. Frameworks is utilized for operations and JSC chooses to manually reconcile between the pharmacy systems.

• JSC does not dispense medications that are not commercially available in the US.

Whether standard formulary or compound, JSC only uses FDA approved medications. There are off label uses and non-standard dispensing (for example, JSC may issue an entire year’s supply of medication for an astronaut being sent to the International Space Station for a yearlong mission). JSC also tracks expiration dates not just based on date of dispensing but also based on manufacturer’s expiration date.

• The constituent components in compounded medications are identified by standard FDA naming. JSC only uses FDA approved medications even in compounded medications. Volume could be up to a year supply of the medication at a time, in standard or near standard dosing, though off-label use is possible.

Usually, yearlong supply would only be required for up to six individuals at a time.

• NASA uses e-prescribing in its medical offices in Moscow and Star City, Kazakhstan, however medications prescribed are issued from NASA stock.

NASA does not prescribe to or interface with foreign pharmacies.

• NASA EHR data elements and terminology largely utilize standard EHR structures, but there are some non-standard data/terminology structures that require customization.

3.0 Scope of Work

The scope of the tasks included in this PWS shall include the following:

• The deployment of a COTS EHR software solution at Johnson Space Center, with an effective go-live date no later than 7/7/2026, using an on-premises implementation.

• Due to NASA security policies, the selected EHR contractor will not be given direct access to NASA IT systems. NASA IT support personnel will implement the selected EHR software with the EHR software contractor providing virtual assistance during the EHR replacement project. Software installation and configuration requiring access to NASA IT infrastructure shall be performed by NASA’s existing IT contractor with guidance from the selected EHR software vendor being provided in a virtual assist manner.

• Items and services required as part of this project include a master project plan, product integration and configuration, tailored group and individual training, and implementation support.

• The implementation of a comprehensive EHR solution accessible from secure local and remote, as well as national and international NASA HH&PD care locations to support critical programs, functions, and services. (See Figure 2 – NASA JSC EHR Edge Location End-Points Diagram). EHR access for locations of care not on the NASA/JSC network will utilize NASA VPN to access the EHR.

• The implementation of a comprehensive EHR solution to support NASA HH&PD's staff and patient population sizes includes supporting:

o Current number of patient records in the system is 27,401 (these are not all active patients.)

o 5,200 average annual patient encounters.

o 181 total number of current EHR users consisting of:

• 50 current users that perform e-prescribing:

• 43 Electronic prescribing of controlled substances (EPCS) users.

• 7 E-prescribing users.

131 current EHR users who perform no prescribing.

o Of the 181 total users, 128 are EHR clinicians (clinician = someone that accesses the EHR to do clinical documentation and/or ordering. This includes the front desk/clinic support personnel due to their expanded role at the JSC clinic.)

o The number of EHR users fluctuates to meet agency needs and the user counts above should be considered as average, however there will be no more than 50 users in the EHR at any given time (max of 50 concurrent users.)

• The development and implementation of a comprehensive systems integration solution focused on seamless, standards-based interoperability and real-time data exchange between diverse clinical systems (See Figure 3 – NASA JSC EHR System Interfaces Diagram.) to enable a cohesive and synchronized healthcare environment. This integration includes interfaces for data exchange with core internal ancillary clinical support systems and other internal secondary support systems as they are added. It also includes interfaces for data exchange with other external service provider systems, including diagnostic testing, medical consulting, telehealth services, and other external entity systems located at remote physical locations as they are added.

• Many JSC workflows depend on a multi-featured portal and secure messaging capabilities to communicate with patients, providers, employees, job applicants, and others. Secure messaging and document exchange directly to and from the patient’s chart is necessary from locations worldwide utilizing automatic and manual transmission of messages and documents. NASA strives for user interfaces that ensure accessibility for diverse user demographics and integrated security measures to safeguard patient privacy and comply with relevant healthcare regulations. JSC’s use of secure messaging spans multiple digital platforms and there is a heavy reliance on the capability to send large amounts of text, large files of varying formats, and document hyperlinks.

3.1 Technical Requirements

EHR software solution shall meet the requirements listed below to address the needs of JSC’s unique patients. JSC strives to deliver unparalleled care to its patient population of astronauts, employees, and contractors by meeting individual medical needs and supporting longitudinal research goals.

3.1.1 Data Management and Integration

3.1.1.1 Data Integrity and Migration

3.1.1.1.1 Migration of Data, Forms, and Hyperlinks

The contractor shall guide the JSC IT team in migrating data, forms, and hyperlinks from the existing EHR into the new EHR.

3.1.1.2 Interfacing and System Integration

3.1.1.2.1 Interface Support

The EHR software solution shall have an interface that can support connection to equipment and systems utilizing standard formats and protocols commonly used in the medical field, including HL7, TXT, PDF, XML, CSV, JPG, GIF, TIFF, PNG, MDF, HTML, PST, SQL, API, DICOM, MLLP, SMTP, WCF, SOAP, FILE, FTP, WCF-

Custom, Windows SharePoint Services, WCF-SQL, WCF-WSHTTP, WCF-Basic HTTP, TCP/IP, and SMB, to replicate or functionally replace connections, including but not limited to those connections listed in the provided diagrams.

3.1.1.2.2 Integration with LDAP/AD

The EHR software solution shall integrate with organizational backup services, interface with LDAP/AD services for credential exchanges, and interface with institutional email relay services.

3.1.1.2.3 Lab Interfaces

The EHR software solution shall interface with lab ambulatory care devices.

3.1.1.2.4 Expandable Storage

The EHR software solution shall be expandable to accommodate data storage needs.

3.1.1.2.5 Protocols

The EHR software solution shall utilize LAN Datalink protocols for network infrastructure and adhere to TCP/IP standards.

3.1.1.2.6 Concurrent Users

The EHR software solution shall handle up to 50 concurrent users and have the ability for identified administrators to suspend or log out a user.

3.1.1.2.7 Secured Data Exchanges with External Systems

The EHR software solution shall authenticate external systems prior to release of data or acceptance of incoming data.

3.1.2 Software Features and Capabilities

3.1.2.1 Clinical Support and Decision-Making

3.1.2.1.1 Compliance with Selected ONC HIT Criteria

The EHR software solution shall comply with applicable standards in the Office of the National Coordinator for Health Information Technology (ONC HIT) Certification Program (See Section 9. Standards, Regulations & Compliance References). The proposed solution shall, at a minimum, be ONC HIT compliant in the following areas:

3.1.2.1.1.1 170.315 (a)(1) Computerized Provider Order Entry (CPOE – Medications

3.1.2.1.1.2 170.315 (a)(2) CPOE – Laboratory

3.1.2.1.1.3 170.315 (a)(3) CPOE – Diagnostic Imaging

3.1.2.1.1.4 170.315 (a)(4) CPOE – Drug-Drug, Drug-Allergy Interaction Checks

3.1.2.1.1.5 170.315 (d)(1) Authentication, Access Control, Authorization

3.1.2.1.1.6 170.315 (d)(2) Auditable Events and Tamper-Resistance

3.1.2.1.1.7 170.315 (d)(3) Audit Report(s)

3.1.2.1.1.8 170.315 (d)(12) Encrypt Authentication Credentials

3.1.2.1.1.9 170.315 (d)(13) Multi-Factor Authentication

3.1.2.1.1.10 170.315 (g)(10) Standardized API for Patient and Population

Services

3.1.2.2 Multi-factor Authentication

The EHR software solution shall support authentication using industry standards, including but not limited to Security Assertion Markup Language (SAML) and OpenID Connect (OIDC). Additionally, the capability to integrate with Enterprise Single Sign On (SSO) Systems shall be available.

3.1.2.2.1 In the event of an outage (e.g., Network Outage) where emergency access is required, the system shall support offline type (local to the EHR system) emergency access accounts or methods to ensure continuity of service.

3.1.2.3 Risk Management

The EHR software solution shall meet the requirements from NIST SP 800-37, Risk Management Framework for Information Systems and Organizations standards at the appropriate categorization level of Low-High-Moderate (Confidentiality-Integrity- Availability), with the appropriate privacy overlay. (See Section 9 Standards, Regulations & Compliance References)

3.1.2.4 FIPS Standards

The EHR software solution shall comply with all applicable requirements from Federal Information Processing Standard (FIPS) 140-3 encryption standards and subsequent versions as defined. (See Section 9 Standards, Regulations & Compliance References)

3.1.2.5 Custom Formularies

The EHR software solution shall support custom formularies that allow for tailored medication management.

3.1.2.6 E-prescribing

The EHR software solution shall support electronic prescribing, prescription renewals, reminders, and reporting and alerting.

3.1.2.7 Medication Histories

The EHR software solution shall support the input of comprehensive medication histories ensuring complete records.

3.1.2.8 Prescription Database

The EHR software solution shall sustain a current and searchable database for prescriptions, ensure compatibility with varied prescription formats, and embed prescriptions within the system.

3.1.2.9 Free Text Searching

The EHR software solution will be capable of free text medication name searches and support comprehensive medication reconciliation management.

3.1.2.10 Clinical Recommendations and Alerts

The EHR software solution shall provide real-time recommendations and alerts based upon clinical guidelines and medical support system.

3.1.2.11 Lab Ranges

The EHR software solution shall provide normal and abnormal value ranges for each test and allow for graphical representation of individual test results.

3.1.2.12 Order Transmission

The EHR software solution shall facilitate the transmission of orders to various internal and external systems, utilizing HL7 or printing.

3.1.2.13 Support for CPOE

The EHR software solution shall support customizable Computerized Physician Order Entry (CPOE) order creation, enable providers to sign orders electronically and ensure workflow efficiency and compliance with healthcare protocols.

3.1.2.14 Orders for Specific Processes

The EHR software solution shall enable the generation of orders reflecting specific departmental processes and priorities, possess capabilities for order searching and filtering, and provide access for viewing order status based on user role permissions.

3.1.3 Customization and User Interface

3.1.3.1 Clinician Customizable User Interface

The EHR software solution shall have a customizable user interface that provides views of the patient’s diagnosis, problems, allergies, alerts, and medical history.

3.1.3.2 Patient Portal with Secure Messaging

The EHR software solution shall feature a patient portal that includes secure messaging and document exchange from any location, enabling both automatic and manual transmission of messages and documents based on user roles.

3.1.3.3 Messaging Management

The EHR software solution portal capabilities shall support messaging from various devices, automated sending of document links for patient completion, and the incorporation of received messages into the patient's chart.

3.1.3.4 Attachment File Formats

The EHR software solution shall allow the attachment of various file formats in patient communications, facilitate secure dialogue between patients and healthcare providers, and ensure any patient communications and completed documents via the portal are captured and stored in the patient chart.

3.1.4 Operational Support and Maintenance

3.1.4.1 Deployment and Maintenance

3.1.4.1.1 On-site Support

The contractor shall provide in-person support for super users and physicians at NASA JSC during go live.

3.1.4.2 Performance Monitoring and Reporting

3.1.4.2.1 Error Logging, Alerts, and Analytics

The EHR software solution shall ensure error logging, provide alerts for system anomalies, and allow performance analytics.

3.1.4.2.2 System Backup and Availability

The EHR software solution shall ensure system availability of 99.9% and permit regular backups of all user and operational data.

3.1.4.2.3 Integrity Checks

The EHR software solution shall support routine integrity checks on software and hardware to safeguard critical system components.

3.1.4.2.4 Report Generation

The EHR software solution shall offer comprehensive and customized report-generation capabilities.

3.1.5 Patient and Medical Data Handling

3.1.5.1 Custom Forms and Fields

The EHR software solution shall allow approved system users to create and utilize custom forms and custom structured data fields.

3.1.5.2 Management of Appointments

The EHR software solution shall allow for the creation and management of appointments based on user role permissions.

3.1.6 Access Controls

3.1.6.1 Role-based Access

The EHR software solution shall provide secure, role-based access control for system, sub-system, and patient data access.

3.1.6.2 Access and Amendment Control

The EHR software solution shall track access and amendments to records to ensure accountability and patient record integrity.

3.1.7 Clinical Documentation and Data Handling

3.1.7.1 Charting Functionality

The EHR software solution shall facilitate detailed clinical documentation, support behavioral health workflows with enhanced, role-based security compartmentalization, and enable comprehensive patient charting with tools for ad hoc notes, diagrams, and specialty forms.

3.1.7.2 Chart Status

The EHR software solution shall allow a chart to be identified as inactive/archived to remove charts from view and deleted from the system per retention guidelines.

3.1.7.3 Chart Sorting

The EHR software solution shall allow charts to be sorted by patient type category from demographics.

3.1.7.4 Demographic/Insurance Editing

The EHR software solution shall allow demographic/insurance information edits without recreating the record.

3.1.7.5 Referral Tracking

The EHR software solution shall support entering, tracking, and reporting on referrals.

3.1.7.6 Problem Lists

The EHR software solution shall enable the creation and modification of problem lists, medications, and allergies, including modifications, searching, and tracking deleted data.

3.1.7.7 Immunization Tracking

The EHR software solution shall support documenting and managing immunization data based on the user's role.

3.1.7.8 Free Text Entry and Search

The EHR software solution shall ensure data entry of at least 2,000 characters for free text fields and observation terms (discrete data fields.)

3.1.7.9 Outcomes and Results

The EHR software solution shall enable tracking and reporting of patient outcomes and lab results.

3.1.7.10 Document Searching

The EHR software solution shall allow the searching of documents by identifiers and free text.

3.1.7.11 Data Import/Export

The EHR software solution shall provide data import and export configuration and management.

3.1.7.12 Notes Management

The EHR software solution shall enable the secure transfer of various note types including telephone notes.

3.1.7.13 Version Control

The EHR software solution shall include version control for data records.

3.1.7.14 Data Retrieval

The EHR software solution shall enable automated data retrieval and importation according to customized workflows.

3.1.7.15 Behavioral Health Compartmentalization

The EHR software solution shall ensure the existence of behavioral health and employee assistance program records and information is completely hidden from anyone without appropriate permissions as discussed in section 2.1.4.

3.1.8 Training

The contractor shall provide training for the EHR software solution in a train-the-trainer format for up to eight super users and IT support staff and in a general format for all clinical users. It is preferred that this training be conducted virtually as practicable.

3.1.9 Integration

3.1.9.1 The EHR software solution shall integrate into JSCs environment.

3.1.9.2 During the configuration, testing, and deployment stages, the contractor shall support NASA personnel in establishing and maintaining test environments, including development, integration, user acceptance testing (UAT), and staging environments.

These environments shall align with production configurations where applicable, include necessary test data management, and comply with all security and access requirements.

After successful implementation, stabilization, and mirroring the test environment with the production environment NASA will assume all responsibility for operating and maintaining these environments.

3.2 Schedule Requirements

3.2.1 Reserved

3.2.2 Project Initiation

Project initiation shall begin immediately after contract award.

3.2.3 Master Project Plan

The EHR contractor shall assist NASA JSC’s IT support contractor in developing a comprehensive project schedule and master project plan. The NASA IT support contractor shall be responsible for delivering and managing this plan. The selected EHR contractor shall provide necessary inputs, collaborate in planning activities, and ensure alignment of its implementation efforts with the overall project schedule.

3.2.4 Launch Functional System

The contractor shall ensure a functional system is ready for use and system go-live is completed no later than 7/7/2026.

4.0 Reserved

5.0 Travel

Travel may be required for in-person training and go-live support. See sections 3.1.4.1.1 and 3.1.8.

6.0 Reserved

7.0 Interface Table and Diagrams

Figure 1 – NASA JSC EHR System to System Interface Table

Figure 1 shows external systems connected to the current JSC Electronic Health Record server program via networked connections.

# Item Description Clinic Workflow Item Type Interface Type File Format

Export (from EMR) or Import (into

EMR)

1 Benson Audiology system Annual, work related, diagnostic hearing exams Device BizTalk CSV -> HL7 Import

2 DocuTRAK The DocuTrak system integrates with EMR to provide extended document storage (consultant reports, images etc.).

Folders within the CFS01 - BizTalk listens on multiple ports to identify the Orch based on the receive port. Some folders within the Docutrak path will not have orchestrations associated and will be an entirely manual process.

Infrastructure > File Server

File server -Manual Upload to Secure Folder CFS01. N/A Import

3 EasyOne Connect (PFT Exam)

PFT Testing system COTS software used to maintain the clinic's EasyOne Spirometer equipment (used to measure lung capacity) PFT Testing Used to support the EasyOne spirometer equipment.

This is installed on one workstation in Clinic Annual, work related, diagnostic exams System BizTalk XML -> HL7 Import

EMCNS > Dive Suit Qualifications Tracking

Portal site displays clearance status for employee, and test subject clearance exams (4 sharepoint sites) This site provides the ability to track physical exam requests and certification expiration dates that qualify/disqualify personnel for a subset of job types at JSC and other Centers. Job related clearances, employer notificfation of clearance System BizTalk HL7 -> XML Export

EMCNS > Flight Controller Qualifications Tracking

Portal site displays clearance status for employee, and test subject clearance exams (4 sharepoint sites) This site provides the ability to track physical exam requests and certification expiration dates that qualify/disqualify personnel for a subset of job types at JSC and other Centers. Job related clearances, employer notificfation of clearance System BizTalk HL7 -> XML Export

EMCNS > Flight Crew & QNC Qualifications Tracking

Portal site displays clearance status for employee, and test subject clearance exams (4 sharepoint sites) This site provides the ability to track physical exam requests and certification expiration dates that qualify/disqualify personnel for a subset of job types at JSC and other Centers. Job related clearances, employer notificfation of clearance System BizTalk HL7 -> XML Export

EMCNS> Test Subject Qualifications Tracking

Portal site displays clearance status for employee, and test subject clearance exams (4 sharepoint sites) This site provides the ability to track physical exam requests and certification expiration dates for test subjects. Job related clearances, employer notificfation of clearance System BizTalk HL7 -> XML Export

8 ezAccess

COTS product Secure Messaging Patient Portal ezAccess is a secure medical communication system with IT security at the forefront to protect the individuals utilizing the system, the data contained within the system and the system operational environment. Secure messaging, import online patient forms/data System

Direct Connection:

DTS N/A Export/Import

Information Platform for Analytics and Aggregation (IMPALA)

Data analytics and data science platform ezAccess is a secure medical communication system with IT security at the forefront to protect the individuals utilizing the system, the data contained within the system and the system operational environment. N/A System Direct Connection queries data via

SELECT

statements Export

Lifetime Surveillance of Astronaut Health (LSAH) Push of all Astronaut discrete data to LSAH surveilance database

Renal Ultrasound, Eye Ultrasound, MRI, OCT, PFT, PACs (direct), EKG, Demographics System BizTalk HL7 -> XML -> SQL Export

Medical And Research Syndication Site (MARSS) > Fundoscopy

Bidirectional interfaces to Web App for mostly inflight data and file share capability The Medical and Research Syndication Site (MARSS) is a web-based site that functions as a short to medium-term image repository for the VIIP Project.

EMR Orders to MARSS, discrete data and XML files sent to EMR via HL7, Fundoscopy System BizTalk HL7 -> XML -> HL7 Export/Import

Medical And Research Syndication Site (MARSS) > OCT

Bidirectional interfaces to Web App for mostly inflight data and file share capability The Medical and Research Syndication Site (MARSS) is a web-based site that functions as a short to medium-term image repository for the VIIP Project. EMR Orders to MARSS, discrete data and XML files sent to EMR via HL7, OCT System BizTalk HL7 -> XML -> HL7 Export/Import

Medical And Research Syndication Site (MARSS) > PHS

Bidirectional interfaces to Web App for mostly inflight data and file share capability The Medical and Research Syndication Site (MARSS) is a web-based site that functions as a short to medium-term image repository for the VIIP Project.

EMR Orders to MARSS, discrete data and XML files sent to EMR via HL7.

Periodic health status, visual acuity, OCT. System BizTalk HL7 -> XML -> HL7 Export/Import

Medical And Research Syndication Site (MARSS) > Visual Acuity

Bidirectional interfaces to Web App for mostly inflight data and file share capability The Medical and Research Syndication Site (MARSS) is a web-based site that functions as a short to medium-term image repository for the VIIP Project.

EMR Orders to MARSS, discrete data and XML files sent to EMR via HL7, Visual Acuity System BizTalk HL7 -> XML -> HL7 Export/Import

15 Medication Management

Dr. First cloud based product for medication management The Management System Assessments is an audit management application. Dr. First cloud based product for medication management System N/A N/A Export/Import

Figure 2 (continued) – NASA JSC EHR System to System Interface Table

# Item Description Clinic Workflow Item Type Interface Type File Format

Export (from EMR) or Import (into

EMR)

Multilateral Space Medicine Board

(MSMB)

.net site to query EMR for specific values to populate standardized form for international clearance board.

The MSMB Application provides data entry forms, lists, libraries, calendar and reports that support the Multilateral Space Medicine Board. The MSMB is the ISS Board with the authority and responsibility for final medical certification and periodic re-certification of ISS crew members, after they are medically certified and recommended by the medical organization of their agency. In order to fulfill its mandate, the MSMB reviews complete medical information on astronauts and cosmonauts, including those assigned to long-duration ISS expeditions (main ISS crew), as well as all individuals on ISS-visiting spacecraft (visiting crew).

This Application supports the MSMB board activities. Data query to populate standardized form for international clearance board System BizTalk HL7 -> XML Export

17 NASA AD Launchpad/SSO/EMR etc. Infrastructure X.500/LDAP N/A Export/Import

18 NASA BOX

External File-Sharing Tool - Internal NASA Box Account created first before external sharing can be established securely. Multiple manual workflows Infrastructure

SMB (Manual file upload) N/A Import

19 NASA EXCHANGE SERVER

Do we still use exchange for something? This might be 0376/IMAP protocol N/A Infrastructure SMTP N/A Export/Import

20 Orchard Lab Information System Outbound orders, inbound results System BizTalk HL7 -> HL7 Export/Import

21 PACS > Epihpany

Bidirectional interface for the processing of cardiovascular testing results. Connects EHR to Epiphany Cardioserver by way of Synapse

CV.

System is used to perform diagnostic image analysis of x-rays, sonograms, and other radiological images of the Astronaut Corp.

System also archives images for future reference and comparison.

The vendor is Fujifilm. The full product is called Synapse PACS and is apart of the Fujifilm Medical Synapse PACS suite.

Outbound orders, inbound results including image links

Vendor= Epiphany Healthcare Product/Software = CardioServer ECG Management System Hardware Device is called GE Case Carts Device is located @ JSC Clinic (2 devices) and Astronaut Quarantine building (1 device) Device model # GE MAC VU360 Tests it performs: ECG, Stress Test

System is used to perform diagnostic image analysis of digitally signed ECGs, stress, Holter, PFT, cardiac rehab, and other diagnostic test reports

System BizTalk HL7 -> HL7 Export/Import

22 PACS > Synapse

Bidirectional interface for the processing of DXA Scans, X-Rays, and MRI. Connects EHR to Fuji Synapse System is used to perform diagnostic image analysis of x-rays, sonograms, and other radiological images of the Astronaut Corp.

System also archives images for future reference and comparison.

The vendor is Fujifilm. The full product is called Synapse PACS and is apart of the Fujifilm Medical Synapse PACS suite.

Outbound orders, inbound results including image links

Vendor = Fuji Product/Software = Synapse

Device: Radiology machine Location: JSC Clinic Device maker: Care Stream Model: DRX-1 K5484-7092

Device: DEXA machine #1 Location: JSC Clinic Device maker: Hologic Model: Horizon A model 100183

Device: DEXA machine #2 Location: Building 21 Device maker: Hologic Model: Discovery W model 49368

Imports of reports/data other facilities---but these are received by Medical Records and then manually uploaded.

MRIs, CT scans, MRA, MRV

System is used to perform diagnostic image analysis of x-rays, and other radiological images (Static images) Infrastructure BizTalk HL7 -> XML -> SQL Export/Import

PACS > SynapseCV (ProSolv CV in

AART)

Bidirectional interface for the processing of work orders for cardiovascular ultrasounds. Connects EHR to SynapseCV (Prosolve) System is used to perform diagnostic image analysis of x-rays, sonograms, and other radiological images of the Astronaut Corp.

System also archives images for future reference and comparison.

Radiologist and Ultrasound technicians will have the added feature of access to Phillips Qlab and GE EchoPac in order to create imaging reports. The vendor is Fujifilm. The full product is called Synapse ProSolv Cardiovascular (CV) and is apart of the Fujifilm Medical Systems Synapse PACS suite.

Outbound orders, inbound results including image links

Vendor = Fuji Product/Software = Synapse CV (aka ProSolv) Devices located @ JSC Clinic and at the Astronaut gym Device model # E10 Hardware Device= GE LOGIQ (ultrasound machine)

Imports---but these are received by Medical Records and then Manually uploaded.

Other images that are imported = fundoscopy images & retinal images – ground based and inflight studies Infrastructure BizTalk HL7 -> XML -> HL7 Export/Import

24 SiteMinder A&CL - No Data Present N/A Infrastructure API N/A Export/Import

Figure 2 – NASA JSC EHR Edge Location End-Points Diagram

Figure 2 shows the edge location endpoints where data capture, access, and care activities are performed.

Figure 3 – NASA JSC EHR System Interfaces Diagram

Figure 3 identifies the supporting systems used to provide other ancillary clinical, secondary use, and administrative support functions and their interconnections.

Figure 4 – NASA JSC EHR Device Interfaces Diagram

Figure 4 identifies the supporting devices used to capture and transmit results from clinical tests and their interconnections.

Configuration/Implementation Area

NASA JSC IT Personnel Responsibilities

EHR Contractor Responsibilities

Hardware and Software Install all hardware and software including databases

Provide and explain hardware/software requirements

Hardware and Software Operate and maintain hardware and software post-go-live

Provide support for successful operation post-go-live

Network Configuration Maintain network configurations including firewalls and security protocols

Assist with network configurations as required

Data Migration and Systems Integration - be more demonstrative

Collaborate in planning and executing…