Business Case.pdf

Oregon Health Authority/ALERT IIS Replacement Project Business Case

Business Case for

ALERT IIS Replacement Project

Oregon Health Authority, Public Health, Oregon Immunization

Program

Date: December 2024 Version: 2.0

Authorizing Signatures

The person signing this section is attesting to reviewing and approving the business case as proposed.

This table to be completed by the submitting agency

Executive Sponsor Collette Young

Signature Date

Agency Chief Information Officer (CIO) or Agency Technology Manager Debbie Estabrook

Business Analyst or Business Case Author Katie McCarthy

1/30/25

01.30.2025

2/5/2025

Table of Contents

Authorizing Signatures

Table of Contents

Executive Summary

Opportunity Statement Cost Estimate (± 100%) Schedule Expectation Business Goals Resource Groups Needed High-Level Milestones

Overview and Background

Measurable Business Benefits

Assumptions & Constraints

Alternatives

Conclusions

Appendixes and References

Executive Summary The Oregon Health Authority (OHA) Oregon Immunization Program (OIP) use the ALERT

Immunization Information System (IIS), a database that records all immunization doses administered by participating providers in Oregon, as a powerful tool for managing immunization records and supporting healthier communities. The ALERT IIS Replacement

Project will ensure continued administration of immunization records and promote modernization of OIP’s processes and applications. This project aligns with the national

Data Modernization Initiative (DMI) and with the Oregon Health Authority’s strategic goal to eliminate health inequities in Oregon by 2030. This project must be executed before

12/31/2027, prior to the end of the existing vendor contract with Gainwell Technologies.

Opportunity Statement

OIP has the opportunity to identify and migrate to a new ALERT IIS. This allows OIP to modernize IIS functionality and integrate some functionality from other current IT solutions used by the program. More specifically the school immunization system (IRIS) used by local public health authorities (LPHA) to manage the annual school exclusion process in Oregon and functionality in

OIP’s Partner Organization Systems Tracking (POST) system. This will enable

OIP to modernize their processes and offerings to better serve Oregonians.

Cost Estimate (± 100%)

SOURCE BUDGET AMOUNT

Modernization $130,000

90/10 CMS Match Funding source being explored

Federal CDC CoAg OIP Project Team

Salaries

CARES COVID $100,000

ALERT IIS Donations $975,000

General Funds Funding source being explored

$10,000,000

*Note:

- Total estimated budget for project and five years of Maintenance and Operations (M&O) is $10,000,000. This estimate was based on transition costs provided by the CDC and comparing current annual M&O costs between Oregon and other states. The identified budget items listed do not currently meet this need. Funding currently used for M&O of the current IIS system may be leveraged upon implementation of the new system.

- The Federal CDC CoAg and current state funds are being used for M&O of current system.

Schedule Expectation

To ensure maintained functionality and allow for adequate testing, the project team aims to implement this solution prior to the end of the current contract with Gainwell Technologies, inc.

Business Goals

1. Expand role-based access to vaccine records for individuals, families, schools, etc., thereby allowing communities the ability to see themselves and use data for public health assessment and interventions.

2. Ensure interoperability within OHA and with external partners, including other IIS jurisdictions.

3. Work towards better equity in establishing accessible processes and applications.

4. Ensure current functionality is maintained throughout the project.

5. Actively engage community throughout the project to ensure requirements are identified and needs are met.

6. Ensure IIS is modernized and maintained with an equity lens.

Resource Groups Needed

1. OHA Immunization Program

2. OIS Project Management

3. OIS Vendor Management

4. OIS Office of Contracts & Procurement

5. DAS Oversight and Security

6. DAS Procurement Services

7. Office of Equity and Inclusion

8. Community Based Organizations

9. OHA Tribal Affairs

10. External Resource Groups: Tribes, LPHA, Schools, Clinics, etc.

High-Level Milestones

1. Confirm approach to proceed based on alternatives researched within this Business Case

2. Finalize project planning

3. Execute project plan

4. Confirm success criteria and requirements have been met and close project

Overview and Background

The Oregon Immunization Program (OIP) works to reduce the incidence of vaccine-preventable disease in Oregon. OIP staff members seek to identify and promote evidence-based public health best practices to both the public and health care professionals throughout the state. In addition to education, the Oregon Immunization Program provides technical assistance and quality improvement for both public and private practices. OIP’s objectives:

• We work to strengthen public health capacity to improve health outcomes by developing and maintaining public and private partnerships that improve community health.

• We assist the Oregon Health Authority in achieving the triple aim: better health, better care, and lower costs, through partnerships, leadership, and innovation.

• We seek to listen to and collaborate with partners and interested parties across diverse communities.

• Promoting health and preventing the leading causes of death, disease, and injury in

Oregon.

These objectives directly support OHA goals to strengthen public health capacity to improve health outcomes, improve quality of life, and increase years of healthy life.

Thanks to vaccinations, many of the infectious diseases that gripped past generations such as polio, measles, rubella, diphtheria, and tetanus are rarely seen anymore, but outbreaks can still occur. Vaccinating our families according to the Centers for Disease

Control and Prevention (CDC) recommended immunization schedules protects our loved ones and our entire community.

OIP’s ALERT Immunization Information System (IIS) is a confidential, population-based, computerized database that records all immunization doses administered by participating providers in Oregon. Approximately 90% of all Oregon immunizing providers participate in

ALERT IIS. This system is a powerful tool for managing immunization records and supporting healthier communities. ALERT IIS is used for clinical decision making and public health interventions. We have learned in the COVID-19 pandemic that to fight systemic bias we must ensure individuals have access to their own immunization data and that more partners are interested in accessing these data to assist the people they serve.

A new platform for ALERT IIS will be more robust and include lessons learned from the pandemic to better address emerging events by including consumer access modules and

Race, Ethnicity, Language, and Disability (REALD) and Sexual Orientation and Gender

Identity (SOGI) data elements. The addition of role-based access will allow communities the ability to easily see their data and use data for public health interventions.

Immunizing providers access ALERT IIS for clinical decision making and can also use built-in functionality to generate a variety of reports on their patient population. They can run reminder recall reports and notices of patients who are current or past due on immunizations. Additionally, ALERT IIS provides schools and childcare centers with on-line access to students’ immunization records and simplifies the enrollment process for parents to comply with Oregon statutes.

ALERT IIS also plays an increasingly important role in supporting the federal Vaccines for

Children (VFC) and adult Vaccine Access Programs. These programs help provide vaccines to eligible individuals throughout their lifetime. This helps ensure that immunization providers have the data at the point of care for all patients to have a better chance of getting their recommended vaccinations on schedule. Vaccines available through these programs are those recommended by the Advisory Committee on Immunization Practices

(ACIP).

Immunization Quality Improvement for Providers (IQIP) is another critical CDC program that supports immunization providers and state immunization programs. The IQIP program is an evidence-based continuous quality improvement process that uses ALERT

IIS data for improving immunization rates and practices at the provider level. IQIP serves to assist and support health care providers by identifying opportunities to improve vaccine https://www.alertiis.org/ uptake and to help motivate providers to try new vaccination service delivery strategies and incorporate changes into their current practices.

ALERT IIS also plays a critical role in responding to large outbreaks of vaccine-preventable disease, such as the COVID-19 pandemic. In addition to use by medical providers, ALERT IIS also provided vaccination information to a wide variety of interested parties to help meet their needs and pandemic vaccination data to and from ALERT IIS and was one of the biggest drivers of system growth in the last 2 years. Some of the specific ways ALERT

IIS was used in COVID-19 response efforts include:

• Medical providers used ALERT IIS to order government-supplied vaccine and to report vaccination information to ALERT IIS.

• The CDC used ALERT IIS data to assess overall vaccination coverage in Oregon.

• Public health entities used ALERT IIS provider-level pandemic vaccine inventory to assess and inform pandemic vaccine distribution.

• Local and State public health entities used ALERT IIS data to identify vulnerable and traditionally underserved populations and direct program outreach to address health inequities.

• Local and State public health entities, medical providers, Coordinated Care

Organizations, insurance companies, and others used COVID-19 data to help assess and manage vaccination efforts for people under their care.

• ALERT IIS data is used to populate vaccine availability to the public through the

CDC’s vaccines.gov website.

• Oregon’s My Electronic Vaccine Card site used ALERT IIS data to provide consumer access to COVID-19 vaccination status.

ALERT IIS supports many partners and programs by collecting immunization data and generating individual immunization forecasts and aggregate reports, which identify opportunities to improve the health of Oregonians. There are approximately 13,241 active

ALERT IIS users among the following interested parties who rely on a highly functioning

IIS to perform necessary services and comply with immunization-related statues, rule, and regulations:

• Immunization providers – These providers access individual vaccine histories, forecasts, and report immunizations to the IIS, most of which is via electronic data exchange between the IIS and provider Electronic Health Record systems. They also access various IIS reports that provide immunization summary information for the provider. Approximate Total Providers: 3,924 o Immunization providers include local health departments, private providers, pharmacies, health plans, electronic health record (EHR) vendors, and other non-traditional partners. Approximate Total Other Providers: 3,354, of which

1,136 also provided vaccine for the COVID-19 Pandemic Response.

• Vaccines for Children Program (VFC) and Vaccine Access Program (VAP) – The OIP manages the VFC and VAP programs in Oregon which provide vaccines to vulnerable populations including all people under age 19, on Oregon Health Plan

(OHP), uninsured adults, and others. The IIS is used to order and manage federally supplied vaccine to participating providers. State law requires these providers to use the IIS for all vaccine inventory management. OIP provides education to providers using IIS data to improve immunization rates and ensure compliance with federal regulations.

• Oregon Immunization Program – The IIS is used by OIP to manage about 50 million vaccine orders annually that are shipped directly to providers. These users rely on the IIS for the most complete information of vaccinations given and provider vaccine inventory and usage to perform various program purposes, including direct management of the IIS.

• State Children’s Health Insurance Program (SCHIP)- This program uses IIS data to reimburse OIP for the value of vaccine administered to their enrolled members.

• Oregon Schools and Childcare Facilities – These sites use the IIS to verify that children attending the facility comply with relevant Oregon statutes and rules about immunization status. Approximate Total Oregon Schools 1,855 and Approximate

Total Childcare Facilities 1,826

• Local Health Departments – In addition to providing direct immunizations, local health departments use IIS data for other public health purposes, including investigations of vaccine-preventable disease outbreaks, assessing and communicating county population-based immunization rates and managing the annual school immunization exclusion process for their jurisdiction.

• Oregon Tribes and the Urban Indian Health Program - Tribes have the responsibility to ensure the health and well-being of their communities. In addition to providing direct technical assistance and training to tribal clinics, ALERT IIS partners with

Tribes by sharing data with Tribes/Tribal Health Directors to inform policy decisions for immunization purposes.

• Acute and Communicable Disease program – This Oregon Public Health Division program uses IIS data in overall health monitoring and surveillance, and in response to vaccine-preventable disease outbreaks.

• Health Security and Preparedness – Working closely with the state Immunization and Acute and Communicable Disease programs, as well as local health departments and other groups, this program also uses IIS data in response to vaccine-preventable disease outbreaks and pandemics.

• Oregon WIC program – This program uses IIS data to inform WIC participants of their children’s current immunization status, including any recommended immunizations.

• Oregon ODHS OR-Kids program – This program uses IIS data to inform parents and the courts of the immunization status of children in foster care, including any recommended immunizations.

• Coordinated Care Organizations – Working with the OHA Health Analytics program, these organizations use IIS data to monitor their overall progress in meeting immunization-related benchmarks.

Oregonians benefit from IIS provided immunization histories and forecasts as they work with their medical providers to meet their health needs. They can also request a copy of their complete immunization history from the IIS.

Important partners who invest and support the technology enhancements supporting the immunization programs are:

• Center for Disease Control and Prevention

• Gainwell Technologies is the ALERT IIS Vendor

What functions are provided by IIS?

After going through a Request for Proposal, OIP transitioned to a vendor supported ALERT

IIS, contracting with Gainwell Technologies in February 2009 with initial system implementation in November 2011. This new immunization information system enabled

OIP to have a significant growth of client and immunization records. From 2011 through

2022:

• Client records increased from 4,469,451 to 7,774,867, an average annual increase of 7.3%.

• Immunization records increased from 33,396,699 to 96,797,509, an average increase of 15.9%.

There has been a dramatic increase in electronic data exchange transactions, due to adding a real-time, bi-directional, web-services interface in April 2012. In response to increasing national interoperability standards, and responding to the COVID-19 pandemic, we expect this growth to continue. The bi-directional interface allows providers to request immunization histories and forecasts from the IIS and submit immunization information to the IIS through provider Electronic Health Record (EHR) systems. There are multiple federal policies, incentives, and mandates driving providers towards implementing real-time data exchange within IIS. For instance, providers must continue to comply with OAR

333.0472 and OAR 333.049. The IIS also aligns with the performance goals for the

National Center for Immunization and Respiratory Diseases (NCIRD).

http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws/Documents/Law333-047Vac.pdf http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws/Documents/Law333-049registry.pdf http://www.cdc.gov/ncird/index.html http://www.cdc.gov/ncird/index.html

The chart below demonstrates the growth of electronic data exchange events (jobs) of reporting immunizations and requesting immunization histories from 2011 through 2023:

OIP and Gainwell Technologies work closely together to ensure ALERT IIS is operational, easy to use, and effective for Immunization programs to provide Oregonians the necessary Immunization services to live a longer and healthier life. OIP and Gainwell

Technologies have standard procedures to ensure any enhancements in ALERT IIS do not negatively affect any interested parties or users. The ALERT IIS Change Control Team

(CCT) is an OIP workgroup that oversees changes to ALERT IIS and is made up of OIP managers, a CCT project manager, and subject matter experts. CCT prioritizes Gainwell

Technologies O&M work, collaborates with Gainwell Technologies on designing functionality and documentation that meets ALERT IIS requirements, performs User

Acceptance Testing, and approves system releases.

ALERT IIS users access the system throughout the day and night, every day of the week, retrieving patient records, forecasts, and reporting immunizations. It is critical to have

ALERT IIS operational and functional 24 hours a day seven days a week. The current

ALERT IIS system consists of separate production and non-production environments hosted in an Amazon Web Services (AWS) virtual private cloud, in the AWS West 2

Region, while the IIS vendor, Gainwell Technologies, provides support for the system. The production environment consists of two regions: production and training. The non-production environment consists of four regions: development (DEV), test, user-acceptance testing (UAT), and staging (STG).

The IIS Disaster Recovery environment is hosted in the AWS East 1 Region. The AWS

Backup utility performs daily snapshots for the server instance and all data volumes which are immediately replicated to the DR region.

ALERT IIS Architecture

General Flow of Vaccination Information Between IIS and End Users

The following shows the IIS Architecture for the Production environment. The Non-

Production environment is similar but generally has half the memory and virtual cores of the Production environment. ALERT IIS will be adding a second RDS DB Instance to the

Production environment to support additional IIS reporting capabilities under the current

Gainwell Technologies contract.

Since execution, the Gainwell Technologies contract has had 23 amendments, extending the life of the contract until December 31, 2027, and the NTE of $17,014,274.94. The most recent extension was approved only due to pandemic exemptions. Procurement authority has informed OIP that no more extensions will be approved.

Scope and Future State

The vision of the ALERT IIS Replacement Project is to modernize OIP’s IIS platform and services to better serve their customers and partners. The scope of the project entails the following:

In Scope: Procurement of, testing of, implementation of a system, including complete data migration.

- New Features/Functionality o Engagement of community, partners, and interested parties to ensure

Organizational Change Management and equity o Integrates school law assessment and reporting functionality o Includes some functionality from the partner tracking tool, POST o Interoperable with OIP Learning Management System for managing user training o Leverages modern technology and process, including:

▪ HL7 and FHIR capable

▪ consumer access module

▪ user interface

▪ WCAG accessibility for any/all modules

▪ modularity

▪ Race, Ethnicity, Language, Disability (REALD) and Sexual Orientation and Gender Identity (SOGI) data elements

▪ Full complement of reporting that schools and childcares are required to complete

- Existing Features/Functionality o maintains the functionality of our current system(s) at minimum o meets all current confidentiality and security rules and laws in Oregon o Interoperable with OIP systems POST for managing organization enrollment with OIP programs o is secure, with interoperability with partner systems including, but not limited to:

▪ CDC

▪ Other State or Jurisdiction Immunization Systems

▪ Other State of Oregon Public Health Systems

▪ Health Information Exchange (HIE)

▪ Insurers

▪ Student Information Systems

Out of Scope:

- System will not host or store other public health data elements including, but not limited to:

o TB test results, BMI, Lead, Infant Hearing Screening o Other therapeutics

- System will not host or store site visit reports and related tracking

- System will not contain all functionally from the partner tracking tool POST, only some functionality will be integrated to the system through this project

- System will not offer appointment scheduling

- System will not offer public-facing vaccine availability (“Get Vaccinated Oregon”

(GVO)) functionality

- System will not include a Learning Management System

The future state achieved through this project will impact internal and external partners, and the people of Oregon. The resulting system will continue to provide the current functionality that immunization providers rely on, as well as offer modern features including an accessible platform and a secure consumer access portal where individuals can request their own immunization record.

Internally, there will be changes to process requiring training and change management.

Externally, to our partners, some will have training requirements to use the new system and others using electronic health record systems will need to verify with their vendors that new connections can be prioritized and completed. With this, there may be additional costs with these vendors to configure new end points or update their processes. OIP will work with partners including community partners to better understand all impacts throughout the project to best ensure a smooth implementation.

Measurable Business Benefits

As ALERT IIS is a mission critical public health technology system, it is imperative that either it remain supported and updated or that a new version of this system be available.

There are many measurable benefits associated with this project, as listed below. The measurements will be further elaborated as we proceed into the planning phase of this project.

Table 1 – Benefit and Measurement

Benefit Measurement

Faster data sharing with national, federal, and state partners

Decrease the amount of time it takes to send data to partners

More complete data sharing with national, federal, and state partners

Increased amount of data shared with partners

Availability of REALD and SOGI data

Increased ability to gather and provide data beyond the national standard, satisfying the Oregon specific standards

Better accessibility and availability of the IIS system Increased access for all user types

Reduce manual workload by automating workflow and eliminating duplicate data entry and manual processes

Reduced amount of data entry and validation processes

Reduce technical support needed Reduced amount of service desk calls

Allow Oregonians to access vaccination records Deployment and use of end-user portal

Improved adherence to CDC/IIS functional standards Increased percentage of CDC/IIS dashboard measures met

Improved efficiency in assessing compliance with the State of Oregon School and Child care Law Requirements

Reduced manual workload and processing time for LPHAs, School, and child care facilities

Improved security, adaptability, and sustainability related to IT Standards

Increased compliance with security standards.

Strategic alignment: Maintain operations of mission-critical system, as required by statute and policy

No significant loss of system availability during transition.

Assumptions & Constraints

Constraints:

- Compliance with CDC’s IIS functional standards are required for federal funding.

- Some state functional standards fall outside of the federal standards.

- Expiration of current Gainwell Technologies contract on December 31, 2027.

- Current resource constraints are resulting in delays in procurement timelines.

Currently, RFPs can take up to and beyond 20 months to process.

- New contract and/or system implementation must abide by guidelines for compliance, security, and standardization with other state, federal, and partner systems.

- Compliance with Oregon Statute, Rules, and Policies.

- OIP currently have limited duration staff who will not be available for the duration of the project.

- Should the project receive funding from CMS, then the project must adhere to the

CMS oversight requirements

Assumptions:

- Financial resources will be identified to cover the costs for this project.

- OHA and Public Health Department (PHD) executive leadership is available for direction and support when and as needed for the project.

- Required technical resources will be available when and as needed and dedicated to this project.

- Required business resources staff will be available when and as needed and dedicated to the project.

- PHD resources for technical accessibly review and community engagement will be dedicated to this project.

- A technical solution will meet accessibility standards.

- Integrating some of the functionality and data from IRIS and POST will require

Oregon specific development.

- IT governance, solicitation, and contracting processes will have few issues and will not impede making the project deadline.

- OIP will be able to implement a solution that offers an accessible platform, available for viewing in all languages used in Oregon. Current list includes 13 languages –

Spanish, Vietnamese, Russian, Somali, Korean, Arabic, Chinese (Simplified), Chines

(Traditional), Marshallese, Hmong, Chuukese, Portuguese, and English

- OIP will not include functionality outside of official project scope.

Alternatives

In determining the best way to proceed, the following alternatives were identified and evaluated based on the assumptions and constraints listed above. Alternatives were identified and evaluated through in-depth market research and collaboration with our partners at the CDC and the American Immunization Registry Association (AIRA). OIP held calls with other states who recently went through similar transitions to understand their approaches and findings and participated in public webinar demonstrations of new IIS products coming to market.

You will find details outlined below.

1. Do Nothing

Allowing the contract with Gainwell Technologies to expire on December 31, 2027, would leave OIP without support on the existing IIS system, which would need to be shut down.

No modernization would be possible and vaccination tracking would revert to only medical providers and manual processes. This would also prevent the integration of IRIS, requiring the use of multiple applications for data storage and reporting. This would heavily impact the interested parties associated with school law functionality as the processes and technology in place are inefficient and manual.

Benefits: Proceeding without replacing the contract or solution would eliminate the need for upfront and continuing costs as well as strain on currently overburdened staff.

Risk/Costs:

- ALERT IIS would be terminated, removing access to the best consolidated immunization record for Oregonians. This would have a catastrophic effect by eliminating a mission-critical system, including putting OHA in violation of state statutes and rules, require Oregon to stop participating in federal programs including VFC and other CDC systems, and removing a key system for addressing disease outbreak and response.

- School Law Functionality, having not been addressed due to the intention to add related efforts to the scope of this project would further delay this work. This would amplify existing frustration associated with existing inefficient and manual processes for reporting and tracking.

- Without continued support or maintenance of the ALERT IIS system there would be no opportunity to modernize or to integrate with IRIS. This would require continued manual processes internally and externally.

- OIP and LPHAs would no longer have access to population data for immunizations to help drive effective interventions which could result in decrease in immunization rates and increase in vaccine preventable diseases.

Process: N/a

Timeline: N/a

2. Extend Use of Current IIS

Extend Use of Current IIS Platform with Gainwell Technologies Support

OIP has been contracted with Gainwell Technologies since 2009 and through amendments have been able to continue to extend that contract. This alternative looked at continuing to contract with Gainwell Technologies for the existing ALERT IIS. However, it has been determined that Procurement authority will not allow continued contracting with Gainwell

Technologies at this time. Therefore, this alternative is not viable.

3. Internal IIS Support/Build

A. Migrate the Current IIS Platform, Support to Internal Resources

The technology used for this platform is legacy and non-conforming to current Solution

Design & Development (SDD) or support Microsoft based standards or the national DMI.

Therefore, migrating the current IIS platform support to internal OIS resources is not viable.

B. Leverage Internal OIS Resources to Develop a New IIS

This alternative involves internal resources and expertise to build a custom system or transition to internal support of the existing current IIS.

Leveraging staff time and effort from the Office of Information Services (OIS), OIP could develop a new IIS system internally. However, upon researching this option it was determined that due to the lack of resources and expertise this option is not viable.

4. Intergovernmental Agreement with Another State/Jurisdiction

Currently, outside of home-grown systems, there are three main IIS systems used throughout the United States; Envision, Wisconsin Immunization Registry (WIR), Scientific

Technology Corporation (STC). While more are becoming available, should Envision or

STC potentially satisfy OIP’s requirements, OIP may have the opportunity to leverage an

Intergovernmental Agreement (IGA) to leverage another jurisdiction’s contract with one of these providers.

Benefits:

- Leveraging this procurement method may provide cost savings to OIP.

- IGAs typically take much less time than RFPs.

- Potential ability to leverage lessons learned and training performed by other state during implementation.

Risk/Costs:

- It may be possible that jurisdictions that OIP would be interested in contracting through do not have the appropriate contractual mechanisms in place for an IGA to occur.

- Depending on the existing contract, additional customization may require further negotiation, increasing time and cost.

Process:

- Perform research and interviews with jurisdictions where OIP may want to leverage an IGA to determine whether it is possible.

- Negotiate and join contract with vendor.

- Plan and implement new IIS system.

Timeline:

- If working with another governmental body, direct award would take between 3-7 weeks.

5. Request For Proposal (RFP)

A. RFP for Replacement IIS System with Vendor Support

OIP has the option to proceed with posting a Request for Proposal (RFP) for a replacement solution.

- This alternative allows for potential to modernize the platform and OIP’s processes.

- This would also enable OIP and OIS to leverage a vendor’s expertise with integration and data migration.

- Through initial market research, there is an assumed benefit of cost savings as the existing vendor is one of the costliest in the market.

- Establishing a new system would allow the integration of IRIS, some POST functionality, and school law functionality.

Risks/Costs:

- RFPs currently take on average up to 20 months to complete (draft, post, close) due to resource constraints. Should there be a delay in starting this process, the length of time may push implementation beyond the current contract deadline.

- Depending on market availability and needed customizations costs may grow beyond OIP’s estimations.

Process:

- Proceed with initiating project, engaging all necessary parties to draft and post an

RFP.

Timeline:

- Around 20 months to complete an RFP, assuming we begin drafting in April 2023 –

December 2024

- 18 + months for project planning and implementation – June 2026

B. Special Procurement and RFP

To leverage existing funds and contract with Gainwell, OIP could process a Special

Procurement to add scope to the existing contract, extend the timeline and then perform an RFP once the transition to the Gainwell platform has completed.

- This alternative allows for the use of funds that may otherwise be lost or needed to be used less strategically.

- This alternative allows for potential to modernize the platform and OIP’s processes, in a shorter amount of time than simply performing an RFP.

- This would also enable OIP and OIS to leverage a vendor’s expertise with integration and data migration.

- Through initial market research, there is an assumed benefit of cost savings as migrating under an existing contract would lessen the complexity.

- Establishing a new system would allow the integration of some functionality from

IRIS, some POST functionality, and school law.

Risks/Costs:

- Should the RFP result in the award to a vendor other than Gainwell, OIP’s transition costs and timeline would go up.

- RFPs currently take on average up to 20 months to complete (draft, post, close) due to resource constraints. Should there be a delay in starting this process, the length of time may push implementation beyond the current contract deadline.

- Depending on market availability and needed customizations costs may grow beyond OIP’s estimations.

- This would require additional FTE to ensure adequate support, impacting the budget.

Process:

- Proceed with processing a Special Procurement. Execute the updated contract and migrate to Gainwell’s new IIS.

- In parallel, proceed with posting the RFP.

Timeline:

- Processing of the Special Procurement and RFP would likely result in migration to

Gainwell’s new platform within two years and should the RFP be awarded to

Gainwell, a finalization of the project by 2029.

C. RFP for Replacement IIS System with Internal OIS Support

OIP has the option to proceed with posting a Request for Proposal (RFP) for a replacement solution that once implemented would then be maintained and supported by OIS staff.

- This alternative allows for potential to modernize the platform and OIP’s processes.

- This would also enable OIP and OIS to leverage a vendor’s expertise with integration and data migration.

- Through initial market research, there is an assumed benefit of cost savings as the existing vendor is one of the costliest in the market.

- Establishing a new system would allow the integration of IRIS, some POST functionality, and school law functionality.

Risks/Costs:

- RFPs currently take on average up to 20 months to complete (draft, post, close) due to resource constraints. Should there be a delay in starting this process, the length of time may push implementation beyond the current contract deadline.

- Depending on market availability and needed customizations costs may grow beyond OIP’s estimations.

- This would require an in-depth analysis of OIS and OIP staffing, likely resulting in the need to establish a team to adequately support and maintain this complex of a system.

- State hosting would require 24/7 support, increasing the necessary budget for

M&O.

Process:

- Proceed with initiating project, engaging all necessary parties to draft and post an

RFP.

Timeline:

- Around 20 months to complete an RFP, assuming we begin drafting in April 2023 –

D. RFP for Vendor Support of Current IIS System

While OIP’s contract will end with their supporting vendor, they still have access to their existing

IIS. OIP has the option to proceed in posting an RFP to obtain vendor support of the existing system beyond the end of contract.

- This alternative may allow for potential to modernize the platform and OIP’s processes.

- This would also enable OIP and OIS to leverage a vendor’s expertise with integration and data migration.

- Through initial market research, there is an assumed benefit of cost savings as the existing vendor is one of the costliest in the market.

- This alternative may allow for some maintenance of internal processes, as the platform would remain.

Risks/Costs:

- RFPs currently take on average up to 20 months to complete (draft, post, close) due to resource constraints. Should there be a delay in starting this process, the length of time may push implementation beyond the current contract deadline.

- Depending on market availability and needed customizations costs may grow beyond OIP’s estimations.

- This alternative may allow for potential to modernize but at significant development cost and time.

- Due to the legacy technology and vendor hosting, the RFP may return limited responses.

Process:

- Proceed with initiating project, engaging all necessary parties to draft and post an

RFP.

Timeline:

- Around 20 months to complete an RFP, assuming we begin drafting in April 2023 –

Conclusions

Based on the above analysis, considering the assumptions, constraints, risks, costs, timelines, etc., OIP is recommended to pursue a Special Procurement while posting an RFP to obtain a new Vendor Solution that will be maintained and supported by said vendor.

Start Do Nothing No Extend Use of

Current IIS No

Internal IIS

Support/Build No IGA No RFP

While this alternative has risks associated with procurement timelines and expense, the specialized market for IIS technologies, and the related opportunities and benefits, make this alternative the most feasible and valuable to OIP. This alternative, with the involvement of our community partners, will ensure that the project aligns with the

Oregon Health Authority’s strategic goal to eliminate health inequities in Oregon by 2030.

OIP’s next steps should entail the engagement of DAS’ Office of Contracts and

Procurement (OC&P) to begin drafting the RFP. Failure to proceed will result in delay of the RFP and therefore risk to completing migration prior to the end of the Gainwell Technologies contract.

Appendixes and References

• OAR 333.0472

• OAR 333.049

• Performance goals for the National Center for Immunization and Respiratory

Diseases (NCIRD)

• Public Health Informatics Institute (PHII) Requirements List

• AIRA and CDC reports, standards, tools:

o CDC IIS Data Quality Blueprint o CDC IIS Functional Standards o AIRA Aggregate Analysis Reporting Tool (AART) http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws/Documents/Law333-047Vac.pdf http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/RulesLaws/Documents/Law333-049registry.pdf http://www.cdc.gov/ncird/index.html http://www.cdc.gov/ncird/index.html https://phii.org/what-we-do/iis-hub/iis-operations/requirements-2/ https://www.cdc.gov/vaccines/programs/iis/downloads/Data-Quality-Blueprint-508.pdf https://www.cdc.gov/vaccines/programs/iis/functional-standards/func-stds-v4-1.html https://www.immregistries.org/aggregate-analysis-reporting-tool