J A_-JA0015_-_Essentris_FBO.pdf

CP/CD Tracking #JA0015

Justification and Approval for Other Than Full and Open Competition

1. Agency/Contracting Activity:

DHA Contract Operations Division (COD) 7700 Arlington Blvd.

Falls Church, VA 22042 Contracting Officer: Robert LeBlanc; (703) 681-1790

2. Nature and or Description of Action being approved:

This is a Justification and Approval (JA) pursuant to Federal Acquisition Regulation (FAR)

6.301 as codified under 10 U.S.C. 2304(c). The intent of this action is to award a sole source firm-fixed price (Labor, Equipment and cost-type for ODCs CLINs) contract for Clinical Information System (CIS) Support. This effort will be funded using O&M and Procurement funds.

3. Description of Supplies/Services: The services to be provided are operational support and sustainment for currently existing Military Treatment Facilities (MTFs) with CIS products.

Services include software and hardware sustainment, technical and customer support, proactive automated system monitoring and alerting, repair service, replacement parts, software updates, configuration assistance, information technology and procurement of equipment. This task order will also provide a range of customer support services at both the MTF and program office level.

The estimated total value, including all options, is $137,365,916.12. The Period of Performance for this effort will be one (1) twelve-month base period with four (4) twelve-month option periods. The CMID number for this action is 21731.

4. Statutory Authority Cited: 6.302-1(a)(2)(iii)(A)(iii) For DoD, NASA, and the Coast Guard, services may be deemed to be available only from the original source in the case of follow-on contracts for the continued provision of highly specialized services when it is likely that award to any other source would result in substantial duplication of cost to the Government that is not expected to be recovered through competition.

5. Reason for Authority Cited: Pursuant to FAR 6.302-1(b)(2), the existence of limited rights in data, patent rights, copyrights, or secret processes; the control of basic raw material; or similar circumstances, make the supplies and services available from only one source in this instance.

This action requires the use of the authority cited because the proposed contractor, CliniComp International, is the only contractor that can provide proprietary services and equipment for the Essentris system, due to the fact that CliniComp has not licensed the resale right to maintain the Essentris software to any other contractors. Essentris, a Commercial of the Shelf (COTS) product, is a mission-critical comprehensive clinical documentation system used in the Services' treatment facilities since 1988. The system is currently deployed in Air Force, Navy and Army

CIS sites. As a deployed application, Essentris has been deployed to and is in sustainment mode at 57 Tri-Service sites.

Under the terms of its standard commercial license, the developer of Essentris, CliniComp, retained the data rights to the Clinical Information Systems (CIS) source code. Access to the source code is necessary to accomplish the maintenance services and Department of Defense Information Assurance Certification and Accreditation Process (DIACAP) services covered by the contract. In addition, CliniComp's source code is cutting edge and proprietary; therefore it is unlikely that any other vendor would be able to understand and maintain the system.

Consequently, during the period covered by this contract, only CliniComp International can provide full-service support and equipment for CIS. Thus, the Contractor is uniquely qualified for fulfilling the contract requirements.

Essentris has been implemented and accepted across the Military Health System (MHS) enterprise for a significant amount of time, approximately 23 years, and as such there would be substantial duplication of costs associated with removing the current system in order to adopt a new system, as well as the sunk costs already invested in the current system. To date, the current Inpatient Documentation Solution Deployment and Sustainment contract (Contract # GS-35F- 0475L, Order # W81XWH-09-F-0282) is valued at a total of $71,184,867, inclusive of all options and modifications, the Requirements Contract (HT0011-13-D-0002) is valued at $5,000,000.00 per year . Prior to these new deployments, the total value of the CIS Maintenance contract (Contract # GS-35F-0475L, Order # W81XWH-09-F-0135) is valued at a total of $78,192,686. This entire amount would be considered a waste of Government resources.

Additionally, because Essentris has been in effect since 1988, multi-millions of dollars have been invested in maintaining the system and training users from then until the present. However, many of these precise costs cannot even be quantified because the clinics have since disbanded and/or historical records have been lost.

It would certainly be more expensive to procure and successfully implement a different system with a new contractor. The estimated cost of procuring a new CIS system is predicted to be 30% higher than the current total contract value. Thus, it is assumed that the total contract value of a new system, with a contract structured after the current Deployment Performance Work Statement (PWS), would meet or exceed the staggering figure of $226,459,981.00.

In the meantime, however, CliniComp’s maintenance services would still need to be purchased in order to maintain Essentris during the out-going transition. These services include labor, ODC’s, and equipment for maintaining hardware and software components. Additionally, as a deployed automated information system, Essentris requires periodic information assurance evaluations. For instance, 12 months of sustainment support from CliniComp for all 57 sites is estimated to cost $26,496,397.54 in FY15. As the delay between cancelling Essentris and acquiring and deploying a new system increases, cost would undoubtedly increase.

Moreover, there would be significant schedule delays before the new system is fully implemented. First, to procure a new system, Defense Health Clinical Systems (DHCS) and the Contracting Office would need to prepare, distribute, and analyze results of a Request for Information and Market Research from interested and capable Contractors. The total contract value of a new solicitation for deployment and implementation of all 57 sites is likely to exceed the $100M threshold requiring senior reviews. The acquisition plan would need to be thoroughly vetted and approved by high-level leadership. This review and signature process alone could delay the acquisition by several months. Resources would then need to be invested into preparing a Request for Proposals, holding an evaluation panel, and selecting a new contractor.

This acquisition process could take a minimum of 6 to 12 months, if not longer, due to the complexity of the PWS, as well as, the large contract value.

Second, once the alternate system is awarded, the new Contractor would be required to support the continuation of DHCS-owned, Contractor-managed system/network Certification and Accreditation (C&A) in compliance with MHS Information Assurance (IA), DHCS, DISA, DoD, and Military Service requirements. The Contractor shall develop and maintain the system security documentation necessary to support the Department of Defense Information Assurance Certification and Accreditation Process (DIACAP) as outlined in DoD Instruction 8510.01. The DIACAP review and approval process typically takes a minimum of 12 months due to extensive regulations concerning network infrastructure, which would extend the contract’s period of performance and thus increase costs. Since CliniComp already has a DIACAP-approved system, this schedule delay would not be a factor in sustaining the current Essentris product. There are no other Vendors who can provide Essentris Software, and procuring alternative systems would be cost prohibitive and cause extensive delays (estimated at a minimum of one year) in establishing the current level of DIACAP security and productivity. CliniComp is uniquely positioned and organized to provide uninterrupted maintenance and support services for the 57 Army MTFs in accordance with the material requirements of the Sustainment solicitation as a result of many years of experience.

Furthermore, acquiring an alternate CIS system would not fit with the DHCS Program Office’s mission statement to integrate into AHLTA all related software and hardware that comprise the MHS Electronic Health Record (EHR) system. DHCS seeks to eliminate organizational redundancies, streamline operations, and enhance the delivery of much needed information technology solutions to all Military Health System (MHS) beneficiaries. Essentris currently touches AHLTA, which in turn touches all other EHR applications. The integration effort would be delayed, and costs would be incurred in order to successfully remove all integration features via Essentris and instead integrate a new system.

The government does plan to replace Essentris with a modernized EHR. Defense Health Management Systems (DHMS) is working a request for proposal to all sources and will select a replacement modernized EHR by 2015. Deployment of this new EHR is planned to take until 2022 when Essentris will be replaced.

Due to all of the above stated reasons, the Government would be burdened with an unreasonable amount of cost and schedule risks. To mitigate these risks, the Government should sustain the current Essentris system rather than procure a new CIS system at this time.

6. Efforts to Obtain Competition: Due to the proprietary nature of CliniComp’s commercial software, the need to negotiate special license rights allowing other contractors access to the applicable source code, and the potential increased costs of those rights, no efforts were made to obtain competition for maintenance services for this automated information system.

7. Actions to Increase Competition: None

8. Market Research: Market research was conducted which revealed that CliniComp International is the only contractor that can provide proprietary services and equipment for the Essentris system, due to the fact that CliniComp has not licensed the right to maintain the Essentris software to any other contractors. The proposed contractor for this action, CliniComp, has certified that: (a) CliniComp has not granted any third party maintenance and support contractor any license or right to use or access the proprietary Essentris source code for any purpose or use, including, without limitation, for engineering development of software updates, changes necessary to correct software problems, produce software enhancements or implement critical IA security software changes; (b) CliniComp does not permit any third party access to the dedicated DoD maintenance and support enclave at CliniComp’s headquarters nor has it granted others the right to use any of the Government Furnished Equipment (GFE) located in the enclave, which is required to be maintained to comply with requirements for the Essentris Approval to Operate certificate pursuant to DIACAP; (c) does not make available to any third party CliniComp’s proprietary maintenance and software needed for the continuous monitoring and maintenance of the Essentris Systems; and (d) CliniComp has not licensed or granted to any third party any other right to provide maintenance and support services for the proprietary Essentris software or data acquisition systems.

Procuring alternative systems would be cost prohibitive and cause extensive delays (estimated at a minimum of one year) in establishing the current level of DIACAP security and productivity.

CliniComp has not licensed the right to maintain the CIS software to any other companies.

Consequently, given the current market conditions, based on the current contractor’s fulfilling the Government’s need, with regards to price, efficiency, past-performance and experience, the price for the services CliniComp provides is fair and reasonable.

9. Other Facts: None

10. Interested Sources: To date, no other sources have expressed written interest in the proposed acquisition.

11. Methods to overcome barriers: None