HT0012-RFI-_0008_-_Medical_Electronic_DoD_Integrated_Core_System_(MEDICS).pdf

REQUEST FOR INFORMATION

Title: Medical Electronic DoD Integrated Core System (MEDICS)

RFI#: HT0012-RFI-0008

Release DATE: 8 February 2013

The Department of Defense (DoD) is seeking information in anticipation of a future requirement. The DoD invites all interested parties to submit a written response to this

Request for Information (RFI). This RFI is issued for the sole purpose of conducting market research in accordance with the Federal Acquisition Regulation (FAR) Part 10.

1. Background

The DoD is seeking to deliver to the warfighter an electronic health record (EHR) with the most capability in the shortest period of time for the least cost, through the acquisition of an EHR system (EHRS). The DoD is seeking to acquire an open, modular EHRS utilizing standards-based / non-proprietary interfaces. The scope of this anticipated effort is to replace DoD legacy electronic health records systems (e.g., Armed Forces Health

Longitudinal Technology Application (AHLTA), Composite Health Care System

(CHCS), and Inpatient System Essentris®) with a Generation 3 or better EHRS for clinical and business applications. When fully implemented, the EHRS will provide a single authoritative source of health information for DoD beneficiaries; help improve the health of our population; improve patient safety and quality of care provided; help control health care costs; and contribute to the medical readiness for our military. The EHRS will impact DoD’s direct care population of more than 3 million beneficiaries, and 70,000 clinicians who practice in 56 hospitals, 364 medical clinics, and 282 dental clinics. The

EHRS will maintain, and support enhancements to, ongoing data exchange between DoD and the Department of Veterans Affairs (VA), and all external partners.

The Government is interested in capabilities and approaches to an EHRS, specifically regarding the implementation of an EHRS core of a Best of Suite (BoS) application, which would be followed by the addition of Best of Breed (BoB) applications until full capability is deployed. The DoD would like analyses, alternatives, timelines, and recommendations as to this approach. For the purposes of this RFI, the DoD has defined the EHRS core as containing, at a minimum, the following components:

System Management: Includes support for security (while balancing the need for legitimate access), identity management, disaster recovery, and business continuity

Interoperability: Ability to communicate and interact with other systems

Data Model: Permanent data store that guarantees that information is stored for the legally required time and can be retrieved rapidly and flexibly

Clinical Workflow: Support for the processes involved in clinical care as well as the information needed

Clinical Documentation, Document Management, and Data Capture: Capture all clinically relevant information at the point of care

Clinical Display / Dashboard (part of clinical applications): Present data in a meaningful manner that contributes to the clinician’s ability to use the data effectively

Clinical Decision Support (CDS): Ability to incorporate rules and decisions

Order Management (including Computerized Physician Order Entry or CPOE):

Support a variety of mechanisms for entry and management of all types of clinician orders

The Government is interested in an assessment of this definition of the core in light of best practices and any variances from the interested party’s core.

The operational and technical environment that the DoD’s legacy EHRs operate in is described as follows. The DoD has a tiered healthcare delivery network composed of academic medical centers, community hospitals, and stand-alone health and dental clinics, that are supported by the full range of administrative, logistics, and transportation services. It is a global enterprise that must also operate in an austere and expeditionary environment (e.g., combat zones and areas experiencing natural disasters). The work force is composed of military, government civilian, contractor support, and volunteers.

The patient population is highly mobile and may present at any of the DoD’s healthcare fixed and expeditionary facilities around the globe. Patients are typically Service members and their dependents, although there are special cases that do not fall into these categories. Care is delivered in two (2) ways: (1) the direct care system provides healthcare to DoD beneficiaries in DoD facilities; and (2) the purchased care system provides healthcare to DoD beneficiaries in contractor facilities. Approximately 60% of healthcare is delivered in the purchased care network. DoD requires the capture of this data from the private sector made available to the EHRS using Health Information

Exchange (HIE) standards and best practices.

The technical environment supporting the EHRS is currently composed of 101 host sites operating the CHCS order entry system (e.g., Laboratory, Radiology, Pharmacy, Patient

Administration, Managed Care, Records Management, etc.), a centralized instantiation of the AHLTA clinical note system, with a hospital-based inpatient system. According to

Gartner’s Generation definitions, this combination of healthcare systems is considered a

Generation 2 EHRS. The military services use a DISA provided single logical network on which the EHRS will operate. The DoD desires a regional data storage architecture with virtualization sites placed closer to the direct care facilities. An n-tier architecture is envisioned with a data layer, a Service Oriented Architecture (SOA) / Enterprise Service

Bus (ESB) services layer, an application layer, and a user experience (UX) layer for the graphical user interface (GUI). The DoD desires open and standardized application program interfaces (APIs) to the EHRS core and applications, and open access to the data and data model. The DoD desires a common and configurable UX that can also be used with the VA EHRS. The DoD healthcare data must be interoperable with the VA, and vice versa, supporting the care delivery to shared or transferring patients. The VA data can be normalized and standardized using the 3M Healthcare Data Dictionary (HDD) and other appropriate standards.

The DoD anticipates that the overall replacement EHRS effort may include, but not be limited to: (1) system and software engineering; (2) system integration; (3) installation, testing, and deployment; (4) lifecycle logistics support to include user training; (5) system and data hosting; (6) operations and maintenance (O&M) support; and (7) business intelligence and research.

2. Purpose of this RFI

The DoD is performing market research to ascertain the interest, capabilities, Rough

Order of Magnitude (ROM) life cycle costs, and available solutions within the healthcare industry to provide the following:

1) An EHRS core, as defined in paragraph 1, or as recommended by the interested party to meet the purposes of the core.

2) A full EHRS system capable of adding, upgrading, and interfacing with BoB products

These are the primary DoD objectives. Other information requested in this RFI is in support of these objectives.

Additional information on anticipated system objectives is provided in Attachment (1).

3. Capability Statement Submission Instructions

Interested parties should submit a tailored capability statement for this requirement not to exceed fifty (50) pages, using 12 point Arial font, which clearly details the party’s capability to perform any aspects of the requirements described in this RFI. An additional twenty five (25) pages of other materials (e.g., graphs, tables, figures) may be submitted.

The Government encourages responses from interested parties who are capable of responding to the entire scope of the RFI, as well as interested parties who may have specific expertise in only limited areas of this RFI.

This RFI shall not be considered an Invitation for Bids, Request for Quotations, or

Request for Proposal (RFP). Furthermore, this RFI is issued solely for informational, market research, and planning purposes and may not result in any future RFP(s). Nor does this RFI commit the Government to contract for any supply or service. The DoD is not seeking proposals at this time, and will not accept unsolicited proposals. Respondents are advised that the Government will not pay for any information or administrative costs incurred in response to this RFI. All costs associated with responding to this RFI will be solely at the responding party’s expense. Proprietary information may be submitted;

however, interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. Proper restrictions shall be marked as such on each page. The Government intends to use contracted staff from

The MITRE Corporation, a Federally Funded Research and Development Center

(FFRDC), to assist in the review of the RFI responses.

Specifically, the Government requests that capability statements include the following sections and address the items noted in the following subparagraphs.

3.1 General

a) Provide the business name and / or team name, a point of contact (POC), address, and

DUNS number.

b) Provide an indication of current certified business and socioeconomic status; this indication should be clearly marked on the first page of the capability statement.

c) Provide a description of the proposed core capability set, and the full EHRS, that meets the objectives provided in this RFI.

d) Provide a description of the company or team’s background, technical expertise, experience, staffing, and other capabilities that demonstrate its capability to provide the anticipated objectives listed in Attachment (1). Specifically:

i. Describe your approach, with a corresponding timeline, to support an initial deployment of two separate and distinct hospital sites using at least the core, and possibly the entire EHRS, and then to all the remaining DoD medical facilities (i.e., hospitals and clinics).

ii. Describe your Agile approach and timeline to configure and deploy the EHRS at multiple sites and in multiple healthcare environments across multiple time zones, scaling up to world-wide deployments. The Government will provide a product owner who will be embedded in each Scrum team. Describe your management approach to using two-week sprints ending in demonstrations.

iii. Describe your approach to scale the development and integration of complex healthcare systems with greater than five (5) million members.

iv. Describe your approach to implement, configure, deploy, and / or develop, an

EHRS using Agile Scrum processes.

3.2 EHRS Solution

a) Describe the functionality within your solution. At a minimum:

i. Describe how your EHR core addresses the DoD’s definition of an EHRS core as described in paragraph 1. The DoD is interested in industry’s feedback on

DoD’s core definition, to include (1) comparing it to how they define their product’s core, (2) describing potential differences and the reasons for those differences, and (3) providing recommendations with regards to the use of the

DoD model and how their product core compares to the DoD model.

ii. Identify specific functions / modules provided in your EHRS and how each function / module is priced. Describe the ability and impacts of turning off specific function(s) which are not essential to the core EHRS, but support the use of interfaced BoB applications. Describe the impacts or benefits of utilizing alternate BoB applications to obtain those functions or capabilities.

b) Describe the Generation level of your product, based on Gartner's 2007 Criteria for the Enterprise CPR, Published: 29 June 2007.

3.3 Test

a) Provide / describe any empirical test evidence that your EHRS performs as expected in the intended user or similar environment. Describe the scalability of your EHRS.

b) Describe your capability to support an Agile testing process that requires early inclusion of users and Government technical specialist operating in a team to manage and report on development / integration / testing activities in two-week sprints. What program(s) have you supported in this capacity and what were the associated products(s) / capability?

3.4 Integration

Describe your approach to integrating your EHRS into the DoD environment as described in paragraph 1.

3.5 Transition

a) Describe your approach to transitioning from a legacy EHRS to a new core and / or

EHRS.

b) Describe your approach to a typical deployment and implementation of the EHRS, including key activities, tasks, timelines, resources, and dependencies.

c) Describe your approach to the change management process in implementing an

EHRS.

3.6 Network and Security Architecture

a) Describe your approach to network and security solutions. The Government intends to use a dedicated health network that will run on the Defense Information Systems

Network (DISN) as a logical network as part of the Non-classified Internet Protocol

Router Network (NIPRnet). The Government will be responsible for the network from the datacenters down to the end user devices.

b) Describe your approach to disconnected operations. How does your EHRS support continued operations in a disconnected (low (256KB) or no bandwidth) mode?

c) Describe your approach to access control. Is it role-based, attribute-based, or both?

3.7 Architecture/Systems Engineering (A/SE)

a) Describe your approach to software, languages used, hardware, and systems architectures that will support the implementation of an EHRS and its integration into the DoD environment.

b) Describe any hardware or software requirements that are necessary to implement your

EHRS (e.g., databases, severs, bandwidth, etc.).

c) Describe your approach to data storage solutions. The Government is interested in your assessment of using multiple regional data centers in a federated architecture, with multiple virtualization sites located closer to the care delivery organizations

(CDOs).

d) Describe your approach to disaster recovery.

3.8 Identity Management

a) Describe your approach to using an external identity management system in your

EHRS. The Government intends to use the Defense Manpower Data Center (DMDC) who provides an external identity management service and a unique electronic data interchange personal identifier (EDIPI).

b) Describe your approach to identity management and access control for individuals who have more than one role (patient, provider, dependent, etc.).

c) Describe your approach to Single Sign On capability and the ability to extend it to products that might be added in the future.

d) Describe your approach to Context Management capability and the ability to extend it to products that might be added in the future.

3.9 Data

a) Describe your data strategy, including storage, persistence, data model, architecture, security, distribution, transformation, and presentation; and how you will provide standardized and normalized data sharing between the DoD and VA using with the

3M HDD.

b) Describe your data management approach to address scale, data format (structured, unstructured, multi-media, and extensibility), consistency, quality and quality management, redundancy, availability, patient safety, and operational performance objectives.

c) Describe your data management approach to include the use of legacy data and data stores, and how data will be managed across system components (e.g., Pharmacy, Lab, etc.).

d) Describe the ability of your EHRS to support data operations offline (if appropriate), to include data availability, replication of data between servers, resynchronization of data, automatic conflict resolution for concurrency issues, and modification of the data.

e) Describe how your EHRS would support data federation across repositories external to the boundaries of your EHRS, and how you would approach data migration from the Clinical Data Repository (CDR) to your EHRS data store, and federation of your

EHRS data store with VA and other systems. How would you account for data volume and performance requirements?

f) Describe your approach to addressing continued support of legacy systems during the migration of data.

g) Describe either the use of a federated data model that serves as the single authority for patient data, or a single physical data repository that provides global access, and the expected performance of your recommended EHRS.

h) Describe your approach to using the eHealth Exchange from the Office of the

National Coordinator (ONC), Health and Human Services (HHS), and the Connect protocol and the Direct protocol to exchange data with the private sector.

3.12 User Interface

Describe your approach for the system user interface, to include, but not limited to, the ability to support the user interface configuration and customization. Describe your approach to implementing a third-party user interface with the EHRS.

3,13 Workflow Describe your approach to configurability of the workflow through a user interface, modify and cancel the workflow on the fly, create reports, and operate in an offline environment.

4. Submission Instructions

Only electronic submissions will be accepted. Electronic files larger than 10 MB should be broken down into multiple files with no one (1) file exceeding 10 MB. Each electronic submission shall include:

a) RFI number and “Capability Statement” in the subject line.

b) If the submission includes more than one (1) electronic email, the file number and total files being submitted (e.g., File 1 of 4, File 2 of 4, etc.) in the subject line.

c) A brief summary of the email’s content, the vendor’s name, and mailing address.

d) The capability statement attachment.

e) A Rough Order of Magnitude (ROM) life cycle cost for the Government to acquire and EHRS core, and the full EHRS, including the following categories: (Separate cost for each category by Core and full EHRS)

i. Software, to include licensing arrangements / pricing model

ii. Hardware

iii. Implementation, to include development, test, and integration (e.g., network, external devices, external systems)

iv. Deployment, with your timeline, for the following:

a) Development and Test Center environment for test prior to deployment

b) 13 academic medical centers with 144,692 admissions, 214, 812 procedures (2012 data)

c) 43 community hospitals with 95,017 admissions, 119,875 procedures

(2012 data)

v. Training

vi. Business process reengineering and change management

vii. Sustainment

All capability statements sent in response to the RFI must be submitted electronically (via e-mail) to: Jake Lewis, at the following email address, jake.lewis@tma.osd.mil, no later than 5:00 pm EST, on 27 February 2013. Capability statement receipt time will be determined by the recorded time of receipt in the Contract Officer’s email box. In the event submissions include multiple electronic files, all files must be received in the electronic mail box by the due date specified above to be considered timely.

This RFI is being sought strictly for the purpose of gaining knowledge of available services and solutions and should not be construed as intent, commitment, or promise to acquire such services or solutions.