DRAFT Echocardiogram Technologist PWS.pdf

CORPORAL MICHAEL J. CESCENZ VETERAN AFFAIRS MEDICAL CENTER

Performance Work Statement (PWS)

Echocardiogram Technologist

1. GENERAL:

Services Provided: The contractor shall provide 2 Certified Registered Echocardiogram Technologists to perform onsite Professional and Allied Healthcare Staffing Services under SINS 050 to eligible beneficiaries of the Department of Veterans Affarirs, Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) during the contract period. Contractor shall be able to provide a Certified Registered Echocardiogram Technologist up to 40 hours per week during the contract period. The estimated quantities are based on 40 hours per week, 80 hours per pay period, through 13 pay periods (6 months) at the contractor’s hourly rate. The quantities are not guaranteed and due to the unpredictable nature of the workload could vary significantly from the quantities ordered.

1.1. Place of Performance – Services shall be provided onsite, Corporal Michael J. Crescenz

Veterans Affairs Medical Center, 3900 Woodland Avenue Philadelphia, PA 19104.

1.2. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority.

1.3. Policy/Handbooks:

1.3.1. - VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.3.2. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.3.3. - VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards -http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.3.4. - VHA Handbook 1100.19 Credentialing and Privileging -http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.3.5. VHA Handbook 1907.01 Health Information Management and Health Records:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.3.6. - Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.3.7. "Patient Medical Records-VA" (24VA19). 24VA19 http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm.

1.4. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.4.1. ACLS: Advanced Cardiac Life Support

1.4.2. AOD: Admitting Officer of the Day

1.4.3. BLS: Basic Life Support

1.4.4. CCNE: Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.4.5. CDC: Centers for Disease Control and Prevention

1.4.6. CDR: Contract Discrepancy Report

1.4.7. CEU: Certified Education Unit

1.4.8. CME: Continuing Medical Education

1.4.9. CMS: Centers for Medicare and Medicaid Services

1.4.10. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.4.11. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.4.12. Contractor – A person or company that undertakes a contract to provide materials or labor to perform a service or do a job.

1.4.13. COS: Chief of Staff

1.4.14. CPARS: Contractor Performance Assessment Reporting System

1.4.15. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.4.16. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.4.17. DEA: Drug Enforcement Agency

1.4.18. ED: Emergency Department

1.4.19. FSMB: Federation of State Medical Boards

1.4.20. Full Time Equivalent (FTE): VA’s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.4.21. HHS: Department of Health and Human Services

1.4.22. HIPAA: Health Insurance Portability and Accountability Act

1.4.23. HR: Human Resources

1.4.24. ISO: Information Security Officer

1.4.25. Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.4.26. MOD: Medical Officer of the Day

1.4.27. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.4.28. Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.4.29. NP: Nurse Practitioner

1.4.30. NPPES: National Plan and Provider Enumeration System

1.4.31. POP: Period of Performance

1.4.32. PWS: Performance Work Statement

1.4.33. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for 8independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure.

Clinical privileges must be facility-specific and provider-specific.

1.4.34. QA/QI: Quality Assurance/Quality Improvement

1.4.35. QM/PI: Quality Management/Performance Improvement

1.4.36. QASP: Quality Assurance Surveillance Plan

1.4.37. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.4.38. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in Michigan and Indiana.

1.4.39. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

1.4.40. VetPro: a federal web-based credentialing program for healthcare providers.

1.4.41. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different

VA medical Center, for purposes of this contract, this term shall mean the VA/VAMC – Corporal Michael J. Crescenz Veterans Affairs Medical Center.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. Echocardiogram Technologist – Contracted Technologist personnel shall show competent certification of acute Echocardiogram Radiologic workload of full or part time (greater than 20 hrs. per week) for at least eight months within the last two years. Technologists shall show competent certification from a program accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT) and complies with all state and Federal regulations.

2.1.2. Echocardiogram Technologist - The Contractor shall provide a certified/registered Echocardiogram technologist as offered by the American Registry of Radiologic Technologists (ARRT)(T). A contractor providing onsite Echocardiogram services shall provide services that meet or exceed the Commission on Accreditation of Allied Education Programs Guidelines.

2.1.3. Credentialing and Privileging –Credentialing is to be done in accordance with the provisions of VHA Handbook 1100.19 (referenced in section 1.4.5). The Contractor is responsible to ensure that proposed contracting personnel possesses the requisite credentials. No services shall be provided by any contract personnel prior to obtaining approval by the CMCVAMC Medical Executive Board and Medical Center Director.

2.1.3.1. If a contract technologist is not credentialed or has credentials suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4. Technical Proficiency - Contract Technologist(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read, and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all technologists shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contract personnel as required by the VA.

Training Frequency (once a year, etc.)

Annual Hours

VA Privacy and Information Security Awareness Training/Rules of Behavior

Prior to rendering services and annually thereafter

Approximately 3 hours

Privacy and Health Insurance Portability and Accountability Act of 1996 (HIPAA) Focused Training

Prior to rendering services and annually thereafter

Approximately 1 hour

All other training as deemed necessary and required by

CMCVAMC

As Necessary

2.1.6. Standard Personnel Testing (Purified Protein Derivative (PPD), etc.): Contractor shall provide proof of the following tests for Technologists within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer (CO).

Tests shall be current within the past year.

2.1.6.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contract technologists. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.6.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all contract Technologists for measles, mumps, rubella, or a rubella titer of 1.8 or greater.

If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR.

2.1.6.3. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contract technologists; provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The CMCVAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998;

26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control.

Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.6.4. COVID-19: Contractor shall provide proof that that all contract technologists are fully vaccinated against COVID-19, subject to the exceptions that may be required by law.

Contractor shall adhere to Executive Order 1403.

2.1.7. Conflict of Interest: The Contractor and all contract technologists are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.8. Citizenship related Requirements:

2.1.8.1. The Contractor certifies that the Contractor shall comply with all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to CMCVAMC patient referrals.

2.1.8.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract, or subcontract with an illegal alien; foreign national non-immigrant who is in violation of their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.8.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services CMCVAMC patient referrals; or other place where the Contractor provides services to veterans who have been referred by CMCVAMC; and shall form the basis for termination of this contract for breach.

2.1.8.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.8.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.9. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.9.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract technologist(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.9.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by CMCVAMC Chief of Staff (COS) or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the CMCVAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all contract technicians shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Inherent Government Functions: Contractor and Contract technologists shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.6. No Employee status: The Contractor shall be responsible for protecting Contract technologists furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.6.1. Workers’ compensation

2.6.2. Professional liability insurance

2.6.3. Health examinations

2.6.4. Income tax withholding, and

2.6.5. Social security payments.

2.7. Tort Liability: The Federal Tort Claims Act does not cover Contractors or technologists. When a

Contractor or contract technologist has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor or contract technologist(s) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.8. Key Personnel:

2.8.1. The VA Full Time Equivalency (FTE) for the services required is 1.0 FTE. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.8.2. A Registered Echocardiogram Technologist must be available within six (6) hours of initial contact from CMCVAMC personnel.

2.8.3. The number of registered/certified Echocardiogram Technologists located within the CMCVAMC, daily (be on site) is 1 as defined in paragraph Hours of Operation in this section.

2.8.4. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor personnel due to sick leave, personal leave, vacations and additional coverage as required.

2.8.5. Personnel Substitutions: During the first ninety (90) calendar days of performance, the

Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.8.5.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.5.2. For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.8.5.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contract technologist she/he may request, without cause, immediate replacement of said Contract technologist(s). The CO and COR shall deal with issues raised concerning Contract technologist(s) conduct. The final arbiter on questions of acceptability is the CO.

2.8.5.4. Contingency Plan: Because continuity of care is an essential part of CMCVAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contract technologist(s) leaves Contractor employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION/SCHEDULING:

3.1. Registered Echocardiogram Technologist coverage: The Contractor will provide Echocardiogram Technologist(s) services 8 hours per day and 7 days per week and includes Federal Holidays.

3.2. The Contractor will be required to provide on call and call back services to the CMCVAMC on the following Federal Holidays:

New Year’s Day January 1

Martin Luther King ‘s Birthday Third Monday in January President’s Day Third Monday in February

Memorial Day Last Monday in May

Juneteenth June 19

Independence Day July 4

Labor Day First Monday in September

Columbus Day Second Monday in October

Veterans Day November 11

Thanksgiving Day Fourth Thursday in November

Christmas Day December 25

3.2.1. Care will be rendered within six (6) hours of notification of call back from the

CMCVAMC personnel.

3.3. VA Business Hours: 7:30 am – 4:00 pm EST are normal business hours.

3.4. Work Schedule: Work schedule is 7:30am -4:00 pm Monday through Friday, normal business hours.

3.5. Cancellations:

3.5.1. Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide contract technologist(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1. Contract Technologist(s) shall be responsible for signing in and out when in called back.

Time sheets will be used by the COR to confirm hours/day call back services were provided against the contract invoices.

4.2. Standards of Echocardiogram Technologist: The contract technologist(s) care shall cover the range of acute services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized TJC, VA and national standards as established by:

4.2.1. VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

4.2.2. Commission on Accreditation of Allied Education Programs Guidelines.

http://www.caahep.org/

4.2.3. The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

4.2.4. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5. The requirements contained in this PWS.

4.3. MEDICAL RECORDS

4.3.1. Authorities: Contract technologists providing healthcare services to CMAVAMC patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164

(HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a Business Associate Agreement (BAA) for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the CMCVAMC are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19).

Contractor generated CMCVAMC Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the CMCVAMC.

Records identified for review, audit, or evaluation by CMCVAMC representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his/her expense. Contractor shall deliver all final patient records, correspondence, and notes to the CMCVAMC within twenty-one (21) calendar days after the contract expiration date.

4.3.3. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the CMCVAMC authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records: http://www.va.gov/vaforms/va/pdf/VA3288.pdf, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The CMCVAMC’s Release of Information Section shall provide the Contractor with assistance in completing forms.

Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information:

http://www.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Corporal Michael J. Crescenz VAMC, 3900 Woodland Avenue, Philadelphia PA 19104.

4.4. Echocardiogram Technologist

4.4.1. DIRECT PATIENT CARE: 95% of the time involved in direct patient care.

4.4.2. Scope of Care: The incumbent works in the Cardiology section of the Medicine Service.

The incumbent technician has intimate knowledge of thoracic anatomy and physiology as related to cardiovascular function and has demonstrated abilities to operate echocardiography equipment for use in studies of the heart. A medical instrument technician at this level performs routine ECHO (cardiac ultrasounds) without the direct supervision of a cardiologist. The person incumbent to this role understands when physicians need to be consulted immediately. The MIT Echo technician utilizes advanced knowledge of anatomy and physiology, including an understanding of cardiac anatomy and physiology of the heart and great vessels as it relates to cardiac disease diagnosis to interpret study requests and to recognize the need for additional tests and intervention.

4.4.2.1. Duties

1. Functions:

This position is that of a medical instrument technician in the Echocardiography Laboratory of the Cardiology Section of Medicine Service. The services performed by the Medical Instrument Technician Echocardiography include the performance of routine and emergency cardiac echo procedures on inpatient and outpatients and demonstrates the following knowledge, skills and abilities:

Ability to produce diagnostic quality images and Doppler frequency shift recordings using M-mode, two-dimensional, three dimensional, pulsed and continuous wave Doppler spectral display, and color flow Doppler imaging.

The technician will demonstrate knowledge of normal echocardiographic findings and deviations produced by a wide variety of disease states.

The incumbent must demonstrate the ability to perform complex procedures such as cardiac studies of the four chambers of the heart and valves using sector scanning techniques to detect stenotic and incompetent valves, chamber enlargement, pericardial effusion/tamponade, pressure gradients across stenotic valves, valve prolapse, septal defects, etc.

The technician will demonstrate proficiency in performing contrast and bubble echo studies, stress echo studies and assist with performing transesophageal echo studies.

The incumbent will display clinical expertise in adapting transducer positioning, instrument controls and examination techniques to fit the individual patient circumstance/need against the problem to be evaluated and document/ report abnormal findings.

The incumbent in this position will be able to manage an outpatient clinic profile along with providing services to address inpatient echocardiogram requests.

The technique is extremely operator dependent, and the examination process is complex. The cardiac technician must use independent judgment in applying knowledge of clinical cardiology and ultrasound, and Doppler principles.

The technician must use problem-solving skills to optimize the evaluation and adjust the exam to ensure that it is comprehensive and accurate.

The technician records and interprets the result of the exam and presents pertinent information and findings to the interpreting physician, Failure to integrate such data may lead to inaccurate exam and erroneous clinical interpretation.

The technician consults physicians in planning and obtaining appropriate imaging based on patient presentation.

Receives patients, explains procedure, and performs exam.

The technician is able to calibrate the machine settings based on patient presentation and clinical situation.

2. Supervisory Controls:

The individual is responsible to the nurse Manager of Cardiology Services, who provides direction and supervision. The supervisor defines goals, priorities and deadlines of the work. The supervisor helps the employee with unusual situations, which have no clear precedents.

The technician assists with procedures, handles problems and deviations in the work assignment in line with previous training and accepted practice. The technician uses judgment and initiative that includes selecting appropriate instrument adjustment and methods, recognizing conditions that cause erroneous results and troubleshooting equipment. The Echocardiography Technician at this level works autonomously, consulting the supervising clinic physician with more complex issues and questions. The Attending Cardiologists check completed work for accuracy and results achieved and overall adequacy of results produced.

The Echocardiography Technician at this level is responsible for troubleshooting equipment (echo machines) and transmission issues to the cardiology PACS. The incumbent in this position also interacts with Biomedical Engineering in resolving issues and reports all equipment issues to the Cardiology Nurse Manager.

3. Qualifications:

See VA Handbook 5005, Part II , Appendix G-(25)

Citizenship of the United States

There are no specific educational requirements for this occupation.

4. Licensure or Certification:

Basic Life Support (BLS) is required and Advanced Cardiac Life Support (ACLS) is encouraged.

Citizen of the United States English language proficiency with demonstrated ability to communicate verbally and in writing.

Demonstrated ability to establish effective interpersonal relationships with all levels of medical center personnel. Demonstrated leadership ability including self-direction, problem-solving and small project management.

Certification through Cardiovascular Credentialing International for RCS (Registered Cardiac Sonographer and/or certification through ARDMS for Registered Diagnostic Cardiac Sonographer preferred.

5. Customer Service Requirements:

Employee meets the needs of customers and patients while supporting Medicine, Cardiology Section, the VHA missions; consistently communicated and treats customers (patients, their representatives, visitors, and all VA staff) in a courteous, tactful and respectful manner; provides customer with consistent information according to established policies and procedures; and handles conflict and problems in dealing with customers constructively and appropriately.

6. Age Development, and Cultural Needs of Patients Requirement.

The primary age of patients treated and cared for are normally at the geriatric level, i.e.

60 years of age or older, although there may be younger patients between the ages of 18- 60 years of age that require care. The position requires the employee to possess or develop an understanding of the particular needs of these types of patients. Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors must be consistently achieved.

1. Young adult hood (20-40). Persons in general have normal physical functions and lifestyles.

2. Middle age (40-65). Persons may have physical problems and may have changes in lifestyles b/c children have left home.

3. Older adulthood (65-75)

4. Middle Old (75-85)

5. Old (85 and over).

The employee must demonstrate the knowledge of the changes associated with aging and possess the ability to provide care/support based upon age related factors.

7. Computer Security Requirements:

Protects printer and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, Federal regulations, VA statutes and policy, and VHA policy. Protects data from unauthorized release or from loss, alteration, or unauthorized deletion. Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc.

Uses word processing software to execute several office automations functions such as storing and retrieving electronic documents and files; activating printers; inserting and deleting text, formatting letters, reports, and memoranda; and transmitting and receiving e-mail. Uses Veteran Health Information Technology Architecture (VISTA) to access information in the medical Center computer System.

8. Physical Demands:

The tasks of this position generally require sitting, standing, occasional crouching or kneeling. Moderate lifting is required to move equipment throughout the Echo clinic and other Medical Center locations. Considerable manual dexterity and hand-eye coordination are continuously required. This includes continuous observation of a computer screen. Cardiopulmonary resuscitation demands coordination and stamina.

Heavy Lifting (50 LBS and over); Heavy Carrying (50 LBS and over); Straight Pulling (up to 1 hour); Pushing (1 – 2 hours); Reaching above shoulder; Use of fingers; Both hands required; Walking (up to 3 hours); Standing (up to 3 hours); Repeated bending (up to 1 hour); Ability for rapid mental and muscular coordination simultaneously; Near vision correctable at 13” to 16”; Hearing (aid permitted).

9. Work Environment:

The work is performed in the Echo clinic and other patient care areas. Due to the nature of a hospital work, there is the possibility of the technician in a health care setting being exposed to infectious disease from patients, thus it is essential to practice universal precautions at all times.

10. Patient Safety:

The employee will be responsible for promoting a culture of safety and will fully cooperate in efforts to improve patient safety and eradicate potential events including the reporting of events resulting in actual or potential injury to a patient. Employee must demonstrate knowledge of the reporting procedures involving safety issues relating to patients.

11. Reusable Medical Equipment:

Demonstrates knowledge of reusable instruments, equipment, medical devices or supplies in the area assigned including familiarity with standard operating procedures for proper set-up, use and reprocessing of individual items. Demonstrates knowledge of the transmission of disease and illness by acting to correct and maintain standards when improperly cleaned equipment is present. Removes from service, notifies supervisor and infection control and obtains replacement to facilitate patient care.

12. Security Clause:

SUBPART 839.2 – INFORMATION AND INFORMATION TECHNOLOGY SECURITY

REQUIREMENTS

a. Due to the threat of data breach, compromise or loss of information that resides on either VA-owned or contractor-owned systems, and to comply with Federal laws and regulations, VA has developed an Information and Information Technology Security clause to be used when VA sensitive information is accessed, used, stored, generated, transmitted, or exchanged by and between VA and a contractor, subcontractor or a third party in any format (e.g., paper, microfiche, electronic or magnetic portable media).

b. In solicitations and contracts where VA Sensitive Information or Information Technology will be accessed or utilized, the CO shall insert the clause found at

852.273-75 - SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION

TECHNOLOGY RESOURCES (INTERIM- OCTOBER 2008)

The contractor, their personnel, and their subcontractors shall be subject to the Federal laws,regulations, standards, and VA Directives and Handbooks regarding information andinformation system security as delineated in this contract.

13. VA INFORMATION AND INFORMATION SYSTEM SECURITY AND PRIVACY

LANGUAGE FOR INCLUSION IN CONTRACTS, AS APPROPRIATE:

1. GENERAL. This entire section applies to all acquisitions requiring any Information Security and Privacy language. Contractors, contractor personnel, subcontractors and subcontractor personnel will be subject to the same federal laws, regulations, standards, VA directives and handbooks, as VA personnel regarding information and information system security and privacy.

2. VA INFORMATION CUSTODIAL LANGUAGE. This entire section applies to all acquisitions requiring any Information Security and Privacy language.

a. The Government shall receive unlimited rights to data/intellectual property first produced and delivered in the performance of this contract or order (hereinafter “contract”) unless expressly stated otherwise in this contract. This includes all rights to source code and all documentation created in support thereof. The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General. The primary clause used to define computer software license (not data/intellectual property first produced under this contractor or order) is FAR 52.227-19, Commercial Computer Software License.

b. Information made available to the contractor by VA for the performance or administration of this contract will be used only for the purposes specified in the service agreement, SOW, PWS, PD, and/or contract. The contractor shall not use VA information in any other manner without prior written approval from a VA Contracting Officer (CO). The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General.

c. VA information will not be co-mingled with any other data on the contractor’s information systems or media storage systems. The contractor shall ensure compliance with Federal and VA requirements related to data protection, data encryption, physical data segregation, logical data segregation, classification requirements and media sanitization.

d. VA reserves the right to conduct scheduled or unscheduled audits, assessments, or investigations of contractor Information Technology (IT) resources to ensure information security is compliant with Federal and VA requirements. The contractor shall provide all necessary access to records (including electronic and documentary materials related to the contracts and subcontracts) and support (including access to contractor and subcontractor staff associated with the contract) to VA, VA's Office Inspector General (OIG), and/or Government Accountability Office (GAO) staff during periodic control assessments, audits, or investigations.

e. The contractor may only use VA information within the terms of the contract and applicable Federal law, regulations, and VA policies. If new Federal information security laws, regulations or VA policies become applicable after execution of the contract, the parties agree to negotiate contract modification and adjustment necessary to implement the new laws, regulations, and/or policies.

f. The contractor shall not make copies of VA information except as specifically authorized and necessary to perform the terms of the contract. If copies are made for restoration purposes, after the restoration is complete, the copies shall be destroyed in accordance with VA Directive 6500, VA Cybersecurity Program and VA Information Security Knowledge Service.

g. If a Veterans Health Administration (VHA) contract is terminated for default or cause with a business associate, the related local Business Associate Agreement (BAA) shall also be terminated and actions taken in accordance with VHA Directive 1605.05, Business Associate Agreements. If there is an executed national BAA associated with the contract, VA will determine what actions are appropriate and notify the contactor.

h. The contractor shall store and transmit VA sensitive information in an encrypted form, using VA-approved encryption tools which are, at a minimum, Federal Information Processing Standards (FIPS) 140-2, Security Requirements for Cryptographic Modules (or its successor) validated and in conformance with VA Information Security Knowledge Service requirements. The contractor shall transmit VA sensitive information using VA approved Transport Layer Security (TLS) configured with FIPS based cipher suites in conformance with National Institute of Standards and Technology (NIST) 800- 52, Guidelines for the Selection, Configuration and Use of Transport Layer Security (TLS) Implementations.

i. The contractor’s firewall and web services security controls, as applicable, shall meet or exceed VA’s minimum requirements.

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor may use and disclose VA information only in two situations: (i) in response to a qualifying order of a court of competent jurisdiction after notification to VA CO (ii) with written approval from the VA CO. The contractor shall refer all requests for, demands for production of or inquiries about, VA information and information systems to the VA CO for response.

k. Notwithstanding the provision above, the contractor shall not release VA records protected by Title 38 U.S.C. § 5705, Confidentiality of medical quality-assurance records and/or Title 38 U.S.C. § 7332, Confidentiality of certain medical records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse or infection with Human Immunodeficiency Virus (HIV). If the contractor is in receipt of a court order or other requests for the above-mentioned information, the contractor shall immediately refer such court order or other requests to the VA CO for response.

l. Information made available to the contractor by VA for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract will be protected and secured in accordance with VA Directive 6500 and Identity and Access Management (IAM) Security processes specified in the VA Information Security Knowledge Service.

m. Any data destruction done on behalf of VA by a contractor shall be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management, VA Handbook 6300.1, Records Management Procedures, and applicable VA Records Control Schedules.

n. The contractor shall provide its plan for destruction of all VA data in its possession according to VA Directive 6500 and NIST 800-88, Guidelines for Media Sanitization prior to termination or completion of this contract. If directed by the COR/CO, the contractor shall return all Federal Records to VA for disposition.

o. Any media, such as paper, magnetic tape, magnetic disks, solid state devices or optical discs that is used to store, process, or access VA information that cannot be destroyed shall be returned to VA.The contractor shall hold the appropriate material until otherwise directed by the Contracting Officer’s Representative (COR) or CO. Items shall be returned securely via VA-approved methods. VA sensitive information must be transmitted utilizing VA-approved encryption tools which are validated under FIPS 140-2 (or its successor) and NIST 800-52. If mailed, the contractor shall send via a trackable method (USPS, UPS, FedEx, etc.) and immediately provide the COR/CO with the tracking information. Self-certification by the contractor that the data destruction requirements above have been met shall be sent to the COR/CO within 30 business days of termination of the contract.

p. All electronic storage media (hard drives, optical disks, CDs, back-up tapes, etc.) used to store, process or access VA information will not be returned to the contractor at the end of lease, loan, or trade-in. Exceptions to this paragraph will only be granted with the written approval of the VA CO.

3. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS. This section applies when any person requires access to information made available to the contractor by VA for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract.

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees and subcontractors only to the extent necessary to perform the services specified in the solicitation or contract. This includes indirect entities, both affiliate of contractor/subcontractor and agent of contractor/subcontractor.

b. Contractors and subcontractors shall sign the VA Information Security Rule of Behavior (ROB) before access is provided to VA information and information systems (see Section 4, Training, below). The ROB contains the minimum user compliance requirements and does not supersede any policies of VA facilities or other agency components which provide higher levels of protection to VA’s information or information systems. Users who require privileged access shall complete the VA elevated privilege access request processes before privileged access is granted.

c. All contractors and subcontractors working with VA information are subject to the same security investigative and clearance requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors shall be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office of Human Resources and Administration/Operations, Security and Preparedness (HRA/OSP) is responsible for these policies and procedures. Contract personnel who require access to classified information or information systems shall have an appropriate security clearance. Verification of a Security Clearance shall be processed through the Special Security Officer located in HRA/OSP.