C01 - Brillians J_A REDACTED.pdf

Brillians Software License Control Number VA-23-00067135

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION

1. Contracting Activity: Department of Veterans Affairs (VA) Office of Procurement, Acquisition, and Logistics

Technology Acquisition Center 23 Christopher Way Eatontown, NJ 07724

2. Description of Action: The proposed action is for a firm-fixed price contract for the procurement of one Brillians software license that will allow access for an unlimited number of users, technical support and end user training to be issued on a sole source basis with SupraVISTA Medical Decision Support Systems (SupraVISTA DSS), LLC, 514 Maon Road, Farnham, Virginia 22460-2301, United States.

3. Description of Supplies or Services: The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Veterans Integrated Service Network (VISN) regional area 16 (VISN 16) has a requirement for the procurement of one Brillians software license for an unlimited number of users, technical support and end user training. Specifically, VISN 16 requires a software license, technical support and end user training for cognitive support software that integrates with VHA’s Veterans Health Information System Technology Architecture (VistA) and Computerized Patient Record System (CPRS) currently in use by VHA. VHA requires the software license for a Windows based desktop application which runs on the VHA’s computer systems and operates without any additional hardware. In addition, VHA requires a license for software that must consist of note writing features, customizable reports, searchable labs, imaging and documentation from all sites for inpatient and outpatient care. The software shall have the capability to provide automated alerts and problem-centric reports at the point of care. Automated alerts and problem-centric reports allow the clinician to access all the information in one location rather than search for each desired element on different tabs of CPRS. These features reduce the risk of clinical errors due to “missed finding” because all the patient care data is easily accessible in one location.

VISN 16 requires a software license and technical support for cognitive support software that has features designed to increase clinicians’ productivity and efficiency, which reduces clinical errors. According to American Medical Association studies, providers spend up to two-thirds of their patient care time on the electronic health record related activities. Most of the clinician’s time is spent on searching and organizing data for clinical decision making. Well-designed cognitive support software identifies and prevents clinical errors before they can harm the patient.

Clinicians are able to provide high-quality care more efficiently with less burn-out, which translates to better continuity of care with staff retention and high morale. The required technical support includes Tier-2 and Tier-3 technical support. The Tier-2 technical support includes the actual or perceived application error(s) in one or more features which the VA staff can reproduce but cannot explain or solve. However, the rest of the application remains fully functional. For Tier-2 technical support needs, the Contractor shall provide support via email within two working days. Tier-3 technical support includes issues which cause the application to become unstable or unusable. The resolution requires highest level of technical skill and often includes the developers. For Tier-3 technical support needs, the Contractor shall provide support via email within two working days. In addition, the Contractor shall assist VA’s staff with software installation and configuration related questions.

VISN 16 also requires end user training for cognitive support software. The end user training shall include providing extensive help and training resources in the form of written documentation with many help documents directly accessible from the conventional Help menu, expanding the library of training videos on YouTube and providing various training resources on the Contractor’s website.

The period of performance shall be one 12-month base period, with two (2) 12-month option periods to be exercised at the Government’s discretion for continue Brillians subscription renewal, inclusive of technical support and training. The total estimated value of the proposed action is , inclusive of all option periods.

4. Statutory Authority: The statutory authority permitting other than full and open competition is 41 U.S.C. 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

5. Rationale Supporting Use of Authority Cited Above: Based on market research, as described in paragraph 8 of this document, it was determined that SupraVISTA DSS is the only source capable of providing a software product that satisfies the VA requirements discussed above. Specifically, SupraVISTA DSS’s Brillians is the only clinical cognitive support software deployed for both inpatient and outpatient care with note writing features, customizable reports, searchable labs, imaging and documentation from all sites for inpatient and outpatient care. As noted in section 8, no other software product can meet this VHA requirement. Brillians was designed from the ground up to meet VA clinicians' needs and works seamlessly with the VA's unique VistA system. Brillians does not create any data, but rather extracts existing data from VistA. This functionality is required in order for VA providers to access healthcare data to maximize the quality of Veterans’ healthcare across the entire VA enterprise. Furthermore, it is the only product that can meet the VA requirement to provide automated alerts and problem-centric reports at the point of care. This not only saves search time for the clinician but also support staff’s time that would be spent developing data visualizations or entering in additional data. Brillians is the only application that offers automated rule-based analysis of clinical data at point of care and works with VHA’s existing IT architecture. It further provides automated alerts and problem-centric reports at point of care.

Brillians is the only CSS software that can provide the necessary functionality and also integrate with VistA and CPRS. This functionality is required in order for providers to access healthcare data to maximize the quality of Veterans’ health care across the entire VA enterprise. The use of any alternative cognitive support software product for this requirement, such as Avicenna, Theradoc, List Runner, Stanson, Rimidi, Watson Health, IBM or Care Align, would require the redevelopment of interfaces to integrate with VistA and CPRS and maintain patients’ medical information. These efforts to redevelop interfaces will require a multi-year development effort and an estimated cost of at least $2M. These estimates of duplicative costs and time are based on previous similar development efforts. These duplicative costs would not be recovered through competition. In addition, the anticipated savings to the VA by utilizing Brillians cognitive support software will be evidenced by reduced clinical errors, increased provider productivity and efficiency, reduced lawsuits and related costs, better continuity of care with staff retention and high morale and greater patient and provider satisfaction.

Additionally, only SupraVISTA DSS can provide the required technical support and training resources services for the Brillians brand due to proprietary constraints.

Specifically, only SupraVISTA DSS can access the proprietary source code necessary to perform these services.

Without Brillians, clinicians will lack the ability to generate the critical problem-centric report and miss important clinical data which would lead to clinical errors that would harm Veterans. Brillians is the only cognitive support software which can meet the requirement to provide clinical relevant data within seconds. Brillians has the ability to automate data, examine and analyze hundreds of data elements in patient’s chart and create a “short list” of items that need clinician’s attention/alerts. Brillians’ problem-centric and system-centric reports aggregate all of the relevant data about a given medical condition or a body system. This allows clinicians to provide high quality of care in a timely fashion while at the same time prevent clinician burn out and help with staff retention.

As such, it was determined that Brillians is the only cognitive support software solution that meets the VA’s requirement.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that can meet the Government’s requirements. There is no competition anticipated for this acquisition. Additionally, the proposed action will be synopsized on Contract Opportunities in accordance with FAR 5.201. Any proposals that are received shall be evaluated.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the market place that would enable future actions to be competed.

8. Market Research: The Government’s technical experts conducted market research in October 2022 by reviewing similar software products to ascertain if other brands could meet the VA’s requirements. Specifically, the Government’s technical experts conducted web-based research on alternative clinical cognitive support software to include products from Avicenna, Theradoc, List Runner, Stanson, Rimidi, Watson Health, IBM and Care Align. While other software solutions from alternative manufacturers exist, they do not meet all of VA’s functional requirements as detailed in Section 3 of this justification. None of the alternative software solutions have the combined capabilities for note writing, customizable reports, searchable labs, automated alerts, problem-centric reports and patient-specific data analysis. Brillians completes the task within seconds, instead of taking many minutes if the same is done manually in CPRS. Additionally, no alternative software solution has the required interfaces in place to integrate with VistA/CPRS and maintain patient medical information related to their personalized care as clinicians move from patient to patient. Therefore, no alternative software solution can avoid the duplication of cost and time as outlined in Section 5 of this justification.

The Government’s technical experts contacted SupraVISTA DSS to determine if there are any authorized resellers and they responded in writing that SupraVISTA DSS does not have any authorized resellers and does not plan to have any in the foreseeable future, as resellers are not equipped to provide appropriate representation or support due to highly technical nature of the products. As such, there are no resellers that can provide Brillians software due to copyright and proprietary reasons.

Based on this analysis, it was determined that SupraVISTA DSS is the sole provider of the Brillians software product and it is only available to be procured open-market.

9. Other Facts: None.