Risk Analysis Industry Engagement_5FEB2024.pdf

Health Care Delivery Solutions Risk Analysis

February 2024

Unclassified Distribution A: Approved for public release: distribution is unlimited

BLUF

Through its technology partnerships, Program Executive Office (PEO) Defense Healthcare Management Systems (DHMS) and its programs endeavor to maximize delivered value in a rapidly evolving Healthcare industry.

As Military Health System (MHS) GENESIS® approaches full deployment and as the current contract comes to an end, we are requesting industry input for ongoing sustainment and capability delivery efforts to help inform our strategy for successful contracting efforts.

MHS GENESIS Overview

Organizational Overview

The Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) was established March 24, 2014, by the Under Secretary of Defense (USD) for Acquisition, Technology, and Logistics (AT&L) (now, USD Acquisition and Sustainment (A&S)) to further DoD modernization efforts by:

1. Leading competitive acquisition for new Electronic Health Record (EHR) System

2. Ensuring interoperability with the Department of Veterans Affairs (VA)

Under the authority of the USD (A&S), the PEO devotes its full-time attention to the acquisition and life-cycle management responsibilities for three assigned programs:

• DoD Healthcare Management System Modernization

(DHMSM)

• Joint Operational Medicine Information Systems

(JOMIS)

• Enterprise Intelligence and Data Solutions (EIDS)

Secretary of Veterans Affairs

Deputy Secretary of

Veterans Affairs

Secretary of Defense

Deputy Secretary of Defense

Federal Electronic Health Record Modernization

(FEHRM) Office

USD for Acquisition and Sustainment

USD for Personnel and Readiness

ASD, Health Affairs

Defense Health Agency (DHA)

Program Executive Office Defense Healthcare

Management Systems

(PEO DHMS)

Secretary of Homeland Security

United States Coast Guard

Direct Reporting Chain Partnership

Veterans Health Administration

Office of Electronic Health

Record Modernization

Office of Information Technology

PEO DHMS organizational relationships

DHMSM Mission and Strategic Objectives

Enhance the technical operation of MHS

GENESIS into a highly reliable and high performing EHR experience for all end users

Continuously deliver high value capabilities via a clear, prioritized capability needs process

Create a superior end-user experience that drives patients and providers to adopt the products we deliver

Drive the success of

Deployments and

Implementations

System Technical Performance

Deliver High Value CapabilitiesSuperior User Experience Deployment &

Implementation

Pi l lars

Mission

To operate and improve Federal Health Care Delivery solutions to maximize value to partner health systems while improving Customer and Stakeholder Experience

4Unclassified

Proposed DHMSM updated Guiding Principles

Standardization of clinical and business processes across the Services and the Military Health System (MHS)

Design a patient-centric system focusing on quality, safety and patient outcomes that meet readiness objectives

Flexible, open, and interoperable system of enterprise solutions that support the full patient continuum of care

Maximizing value through business process reengineering, adoption, and implementation over technology

Leverage transformative technology advancements to provide continuous improvement and state-of-the-art patient care

Decision-making and design will be driven by frontline care delivery professionals

Decisions shall be based on doing what is best for the MHS as a whole – not a single individual area

Drive towards rapid decision making to keep the program on time and on budget

Provide timely and complete communication, training and tools to ensure optimal Stakeholder Experience

Build collaborative partnerships outside the MHS to advance national interoperability

Enhance patient safety through solutions that reduce harm, improve care, reduce waste, and improve efficiency

Enable full patient engagement in their health by prioritizing their User Experience

Industry Feedback: Given the continuing technology advancements, please provide input on the proposed updates to the Guiding Principles.

Replaced ‘single enterprise solution that addresses both garrison and operational healthcare’ with blue text

New Guiding principle

Enhanced with blue text

Replaced ‘configure not customize’ with blue text

Enhanced with blue text

MHS GENESIS – A look back

Features

• Proven commercial EHR facilitates the continuum of care across garrison, operational, and enroute care

• Provides world class healthcare delivery solutions for Service

Members, their families, and our Allies across the globe

Benefits

• Enables critical information sharing across health care providers such as the DoD, VA, and private sector healthcare

• Utilizes industry-standard longitudinal health care tracking to assist healthcare providers in making high-quality, responsive, and personalized healthcare decisions

• Allows greater access to personal healthcare information for patients and support increased engagement in health-related activities

In 2015, the Government awarded a ten-year contract to implement MHS GENESIS. DHMSM designed, configured, and tested MHS GENESIS prior to deployment, and it is expected to reach full deployment in March 2024.

DOD Deployment 98% Complete…

MHS GENESIS will be fully deployed in March as one of the world’s largest single-system EHR

Current Operations by the Numbers…As of Jan 2024

Active projects in flight 48+

DoD Military Treatment Facility (MTF) Commands

Provisioned MHS GENESIS users

190K

Beneficiaries Served 9.5M

Total Locations 3,000+

DoD Deployment 99% Complete… MHS GENESIS will be fully deployed in March 2024 as one of the world’s largest single-system EHRs

MHS GENESIS has expanded its use to other government partners

National Security Agency

(Anticipated Q3FY24)

National Oceanic and Atmospheric Administration

Reserve Components

United States Coast Guard

United States Military Entrance Processing

Command

(USMEPCOM)

The DoD and Department of Veterans Affairs (VA) share a data center and a common federal baseline with department-specific configurations

Federal partners using the MHS GENESIS baseline (including data/workflows) and common endpoint

MHS GENESIS Current Operations As of Jan 2024

WAVES LANDSTUHL/

LAKENHEATH

WAVES OKINAWA AND

GUAM/SOUTH KOREA

Deployment Waves Completed Map legend/ colors

Active Projects in Flight 48+ DOD MTF Commands Messaging

20.6M daily at 72 external interfaces across 1027 endpoints

Provisioned MHS GENESIS Users

190K Beneficiaries Served

9.5M of 9.6M

DoD Deployment 99% Complete…

Total Locations Preparing Total Users Preparing

1,167 as of 16 JAN 2024

Current Operations by the Numbers…

IOC SITES (2017)

WAVE TRAVIS SITES (2019)

WAVE NELLIS SITES (2020)

WAVE PENDLETON SITES (2020)

WAVE SAN DIEGO SITES (2021)

WAVE CARSON+ SITES (2021)

WAVE TRIPLER SITES (2021)

WAVE BAMC SITES (2022)

WAVE LACKLAND SITES (2022)

WAVE BRAGG SITES (2022)

WAVE HOOD SITES (2022)

WAVE BEAUMONT SITES (2022)

WAVE GORDON SITES (2022)

WAVE EGLIN SITES (2022)

WAVE JACKSONVILLE SITES (2022)

WAVE DRUM (2023)

WAVE PORTSMOUTH (2023)

WAVE WALTER REED (2023)

WAVE BELVOIR (2023)

WAVE WRIGHT-PATTERSON (2023)

WAVE LANDSTUHL (2023)

WAVE LAKENHEATH (2023)

WAVE OKINAWA (2023)

WAVE SOUTH KOREA (2023)

WAVE GUAM (2023)

DOD sites deployed (completed)

Future Deployment Sites

US MEPCOM sites (completed)USMEPCOM SITES (2022)

*70 Locations/3,681 Users

USCG sites (completed)

USCG PILOT SITES (2020)

USCG PACIFIC SITES (2021)

USCG ATLANTIC SITES (2021) *109 Locations/2,184 Users

NOAA SITES (2023) NOAA sites (completed) *7 Locations/24 Users

FHCC sites "in flight"FHCC Deployment (2024) NSA sites "in flight"NSA SITES (2024)

Medical Community of Interest (Med-COI) Network

Med-COI Network

The Medical Community of Interest (Med-COI) network provides a secure connection framework from MHS GENESIS to DoD facilities and external interfaces

MHS GENESIS Capability Mapping

Configuration Facts:

• 975 number of workflows

• 211 number of user roles

• 3000+ change requests annually

(FY2023)

Government requirements: MHS GENESIS satisfies some or all of the 60 capabilities

Federal EHR Capability to MHS GENSIS mapping underscores the complexity and depth of the system of systems

Major solution components:

• Oracle Cerner Millennium – EHR

• Cerner Patient Accounting –

Revenue Cycle

• Dentrix – Dental

• Rhapsody – Integration Engine

• Phillips eCare – Virtual Health

Delivery

• Amwell Converge, Conversa, SilverCloud – Virtual Health and Behavioral Health

• HealtheIntent – Population health management and analytics

MHS GENESIS Workflow Example - Notional

Workflow example demonstrates the complexity of the configuration.

Capability Support Phase

What is Next | Capability Support

With the conclusion of the deployments in March 2024, the focus shifts to “What is next”: Capability Support

DHMSM has three goals for Capability Support:

• Keep the System Operational and Compliant

• Keep the System Modern (continuous capability delivery)

• Promote maximum value from the use of Health Care Delivery solutions

A risk analysis (at the Work Breakdown Structure (WBS) level) was completed for each of the three goals to evaluate the risk of transitioning the work in support of the identified goal

The following charts define each goal

Goal 1 | Keep the System Operational and Compliant

Maintaining the current Health Care Delivery solutions:

• Cybersecurity: Apply Information Assurance Vulnerability Alerts (IAVAs), update Plan of Action and Milestones (POA&Ms), maintain authority to operate documentation

• Defect Resolution/Fixes: Resolve and fix all defects identified per the terms and agreement of the license

• Upgrades: Apply commercial system upgrades typically twice per year to maintain the commercial baseline

• System / Database Administration: Maintain the system / database

• Hosting: Centrally host the fully integrated system of systems to ensure reliable, secure, and high-performing service

• Data Maintenance: Translate data from one format to another, including data transition from legacy systems

• Configuration specification items: Ensure system configuration items approved through formal configuration control boards are updated and documentation is reflective with a focus on broad understandability to support future competition

• Enhanced end user experience

• Maximizing value while minimizing the cost

Goal 2 | Keep the System Modern

New requirements are derived from evolving Military Health System (MHS) identified needs and/or the advancements in technology.

Throughout the Capability Support phase, DHMSM will continue to:

• Provide continuous capability delivery as new requirements are approved

• Enhance the end user experience

• Leverage new technologies (e.g. transition to cloud capabilities)

Goal 3 | Promote maximum value from the use of Health Care Delivery Solutions

Cost Which choice causes the government to spend the least?

Performance Which choice achieves the highest quality standard and efficiency on behalf of the government?

Adoption Which option has the greatest adoption, understanding, and usefulness for the functional community?

Value from use is defined as the optimization of the solution to provide maximum benefits from the solution (e.g., performance and adoption) to end users and patients.

Key components of value are the performance of the solution, its user adoption, and its cost.

Industry Feedback Requested

WBS Title and Description Source: MIL-STD-881F

Risk Level to Transition Key

Risk Level to Transition Reason

N/A Does not apply or risk was completed at a lower Work Breakdown Structure (WBS) level

Rationale for Government’s risk level assessment

Low The risk to transition is minimal or can be predicted with an acceptable degree of certainty

Medium The risk to transition is moderate due to system level complexity and may impact end user performance, cost, and/or schedule

High

The risk to transition is significant due to the high level of system complexity with a high probability of impact to end user performance, cost, and/or schedule

Input requested:

Leverage the attached excel workbook (Attachment 3 – WBS Risk Analysis)

For each tab: The Government has assessed the risk associated with each WBS in context with the goal identified. At the WBS level, the Government is requesting industry to review the Government’s preliminary risk assessment and provide their assessment of the risk to transition.

Populate the risk level to transition (n/a, low, medium, high) leveraging the key and then provide a reason for the assessment.

Government’s Preliminary Assessment Contractor’s Assessment

Contractor’s Assessment

Excerpt from Attachment 1 – Risk Analysis_5FEB2024

Additional Strategy Topics

Additional Strategy Topics

Along with the three goals for Capability Support, the Government is requesting industry for feedback on the best approach for:

• System Integration/ Vendor Management

• Licenses Management

• Simplified EHR system configuration support

The following slides give a high-level overview of how each is supported today

System Integration/ Vendor Management

In the current contract, the single system integrator was responsible for the entire system to include license management, vendor management, deployment, sustainment, training, and user adoption.

The major contractors and Commercial-off-the-shelf (COTS) solutions as part of MHS GENESIS include but are not limited to:

• Oracle Cerner – Millennium and HealtheIntent Solutions

• Henry Schein – Dentrix Solution

• Leidos – Rhapsody (integration engine)

• 3M – 3M 360e (revenue cycle)

• Phillips - Tele-Critical Care

• Amwell – Converge, Conversa, SilverCloud

• Artera – Pharmacy refill and patient reminders (e.g. appointments, prescriptions, etc.)

Services Definition

Systems Integrator Party responsible for connecting and maintaining software products to ensure smooth interaction and data flow; responsible for engineering, configuring/customizing, and integrating systems

Vendor Management Party that oversees and manages vendor relationships and ensures that vendors meet their contractual obligations

License Management

In the current state, MHS GENESIS has numerous perpetual licenses managed by the System Integrator.

• Some licenses have been or are being transferred to Software as a Service (SaaS)

• The system integrator not only manages the licenses for DoD but also for the federal partners leveraging the DoD baseline (see slide 7)

• DoD has the option to transfer licenses at the conclusion of the current contract

Simplified EHR system configuration support

Type of Change Description Example Governance (approval) Standard Change List Content change to the MHS GENESIS System that effects only the site requesting the change

• New medication

• New lab order

• Remove lab order

Approved by the Site

Content/ Simple Configuration

Content or configuration changes to MHS GENESIS that impact the enterprise but does not impact the MHS GENESIS baseline*

• Update a drop-down list

• Patient education updates

• Quick visits

• New flowsheets

Approved by and enterprise Stabilization and Adoption Board (SaAB) Governance process

Simple Configuration impacting baseline*

Same as content/ simple configuration but impacts requirements or training and is a low complexity. Change impacts MHS GENESIS baseline.

• Note Types

• Anesthesia Provider

Approved by and enterprise SaAB Governance process

Complex Configuration Configuration changes to MHS GENESIS impacting enterprise requirements, information assurance, and/or the MHS GENESIS baseline

• New /update workflow

• New/ updated role

• Logic or business rule update to an existing interface

Requirements identified by the Functional Owner and contracted for once per year

Reports Developing, modifying, removing custom and/or publishing of reports.

• Discern Reports

• HeatheAnalytics Reports

Data Point of Contact (POC)

*MHS GENESIS baseline is defined as a configuration change that impacts the documentation defining the MHS GENESIS system (e.g., requirements, interface control document, workflows, authority to operate, training, etc.)

Currently the system integrator is responsible for making the changes based upon the approved governance structure

Proposed – For Feedback

1. System Integration/ Vendor Management

• How should system integration be satisfied as part of the overall strategy?

• How should vendor management be satisfied as part of the overall strategy?

2. License Management

• Describe best practices of license management, including pros and cons, especially given the volume of licenses, to include how to manage the terms and agreements of the licenses.

• Describe a strategy to migrate from a perpetual to a Software as a Service (SaaS) model license structure.

• How could a license concierge be leveraged to support the license management and enforce the terms and agreements as well as migration from perpetual to SaaS? What are the pros and cons of this approach?

3. Simplified EHR system configuration support

• How does industry manage and execute simplified system configuration across multiple integrated

Commercial-off-the-shelf (COTS) products?

• What are the current market Service Level Agreements (SLAs) to govern the evolution of the technology or capabilities?

Please submit responses no later than February 22nd at 5:00pm to:

• dha.ncr.peo-ipo.mbx.dhms-enablers@health.mil

In the submission please include:

• Cover Page: Include Company Name, Cage Code, Sam Unique Entity ID (UEI), document names of any additional documents as part of the submission, permission/ rejection of release of “proprietary information” to identified subcontractors

• Risk Analysis: Provide completed Attachment 3 – WBS Risk Analysis (see slide 18)

• Additional Strategy Topics: For each topic identified (total of 3 topics see slide 24)

• Word/ PDF: provide no more than a one and a half (1.5) page response that covers all questions proposed per topic. This will be no more than four and a half (4.5) pages using 10 or 12 font.

• Power Point/ PDF: provide no more than 4 slides per topic that covers all questions proposed. This will be no more than 12 slides using 10 or 12 font.

• Additional Industry Feedback: Provide as word/pdf with 10 or 12 font – no more than a total of two (2) pages.

• Proposed Guiding Principles – provide feedback on the updates to the proposed guiding principles (slide 5).

• Provide additional information that may be pertinent for the Government to consider than has not been covered by the Risk Analysis or additional strategy topics. This information is to be limited to the scope of this request.

Instructions mailto:dha.ncr.peo-ipo.mbx.dhms-enablers@health.mil

Thanks for reviewing the MHS GENESIS Follow-on effort

For informal discussions, please visit our HIVE Hub: https://connect.bidscale.com/hive-hub

Official draft and RFP documents available on SAM.gov!

https://connect.bidscale.com/hive-hub