IHS1527469 - PWS Template.docx

Belcourt IHS Hospital

Chance Wilkie

Data Ray Service Agreement

Performance Work Statement for the Data Ray

May 7, 2026

Document Revision History

[Example – Post-award]

0X

0Y

0Z

[Note: The document revision history is most useful for tracking changes in a major acquisition. It may not be needed for less complex acquisitions. Pre-award, it can be used internally by the agency to track the origin of and/or changes to specific requirements (not included in the solicitation when released). Post-award, it can be used to provide a centralized list of changes incorporated by modification.]

Table of Contents

Note that while, as a matter of policy, some agencies require the government to prepare the PWS, the guidance at FAR 37.602(a) stipulates that “a Performance work statement (PWS) may be prepared by the Government or result from a Statement of objectives (SOO) prepared by the Government where the offeror proposes the PWS.”

Performance Work Statement (PWS) for the Data Ray

The mission of the Belcourt IHS is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. The mission of the Chance Wilkie is to ensure the Data Ray devices are covered under service agreement to avoid delays in service.

This acquisition will allow the customer to call DataRay during business hours 8am-5pm Central Time, M-F 800-477-5317 for technical and user support on the D3 interface. In order for DataRay to provide support there must be a current active support agreement in place between the customer and DataRay. For questions regarding the thermal printer call the printer manufacturer or DataRay. In order to provide support for DataRay products and services, the customer must provide VPN access to DataRay support staff in order to allow electronic communication with the customer’s installed DataRay devices. The below support guarantee applies during normal business hours, with the assumption that the customer stocks required backup units, has an active service/support agreement, and that DataRay is provided with the required access through VPN.

1.2 Objective

IHS is mandated to provide bar code administration when serving its customers. Data Ray is the only vendor who has the capability to work with the RPMS database to reformat the data and print it out in the required format for bar code administration. We have been using Data Ray since 2012.

1.3 Scope of Work

OFFSITE DATARAY INTERFACE SETUP AND SUPPORT: OFFSITE SUPPORT REQUIRES THAT THERE EXIST AN ACTIVE DATARAY MANAGED SERVICES AGREEMENT BETWEEN THE CUSTOMER AND DATARAY. OFFSITE INTEGRATION INCLUDES THE FUNDAMENTAL COMPONENTS AND CUSTOM SETUP REQUIRED TO GET THE D3 OPERATIONAL WITH A PARTICULAR HOSPITAL SYSTEM. THIS INCLUDES DATARAY INSTALLING UTILITIES NEEDED TO CAPTURE DATA OUTPUT FROM THE CUSTOMER’S SYSTEM, ANALYZING THE DATA STREAM, AND DEVELOPING CUSTOM FORMATTING INSTRUCTIONS TO MEET THE LABEL FORMATTING NEEDS OF THAT SYSTEM.

IN ORDER FOR DATARAY TO PROVIDE SUPPORT FOR THE PRODUCT, IT IS ESSENTIAL THAT THE CUSTOMER GRANT DATARAY VPN ACCESS TO THE D3 NETWORK DEVICES. THE D3 DEVICES PROVIDE DATARAY ADVANCED TOOLS AND DIAGNOSTICS TO TROUBLESHOOT NETWORKING PROBLEMS, SYSTEM OUTPUT CHANGES, PRINTER STATUS, AND OTHER ISSUES. DATARAY NEEDS DIRECT NETWORK ACCESS TO THE D3 DEVICES TO OPERATE THESE UTILITIES. DATARAY ALWAYS PROTECTS THE INTEGRITY OF THE HOSPITAL’S NETWORK AND OF PROTECTED HEALTH INFORMATION, AS IS REQUIRED BY THE SIGNED HIPAA BUSINESS ASSOCIATES AGREEMENT.

ONSITE DATARAY PROFESSIONAL SERVICES SETUP AND INSTALLATION: DATARAY PERSONNEL WILL MEET WITH THE HOSPITAL TECHNICAL TEAM IN A “TRAIN THE TRAINERS” SESSION, TO DISCUSS INSTALLATION PROCEDURES, END USER TRAINING, AND POTENTIAL PROBLEM CALLS. THE INSTALLATION CAN THEN PROCEED BY GOING TO EACH AREA RECEIVING A PRINTER, INSTALLING THE PRINTER, AND TESTING FOR CORRECT OPERATION, AS DESCRIBED IN THE “IMPLEMENTATION” SECTION BELOW. IF DATARAY CUSTOM LABEL FORMATTING WORK HAS BEEN COMPLETED PRIOR TO THE THERMAL HEALTHCARE INTEGRATION SOLUTION INSTALLATION, THEN TRAINING, INSTALLATION, AND VERIFICATION OF THE DATARAY FORMATTING CAN BE INCLUDED AS PART OF THE ONSITE DATARAY PROFESSIONAL SERVICES. DATARAY WILL ASSIST WITH INSTALLATION OF A MINIMUM OF UP TO HALF THE PURCHASE UNITS, AT WHICH TIME THE HOSPITAL TECHNICIANS WILL HAVE ENOUGH EXPERIENCE TO INSTALL REMAINING UNITS, AND ANY FUTURE UNITS PURCHASED, AND WILL ALSO BE ABLE TO TRAIN THE END USERS.

1.4 Background

We have been using Data Ray since 2012 where they have met our bar code administration needs.

1.6 Period of Performance

June 1, 2026 through May 31, 2027.

1.7 Place of Performance

The work will be done remotely via VPN as it has always been done.

1.1. Applicable Documents

See the attached SOW from Data Ray

2.1.1. None

2.2 Task Two

2.1.2. None

2.3 Task Three (etc.)

The DataRay Patient Safety Solution Thermal Printer Interfaces provide barcode safety solutions for Quentin Burdick Memorial Hospital, as described below:

The DataRay D4 hardware includes the DataRay’s MedMap Patient Safety Suite software, and interfaces with Hospital Information Systems to parse and interpret output data streams, to merge parsed data with graphical label templates, to provide department specific patient safety features, and to provide utilities that allow for advanced customer support.

Description of formatting The formats are responsible for defining where on the label to print required data, and for specifying what size fonts to use. The position and size of the data on your label can be altered to enhance the readability of key information: providing enhanced patient safety due to enhanced print legibility.

Description of parsing The parsers are responsible for analyzing the print job and determining the required data to be printed on the label. The parser looks for key text strings to determine what data in the print job is required to be present on the label.

DataRay D4-MMP Patient Safety Suite products and services provided for Quentin Burdick Memorial Hospital include:

Hardware: DataRay D4 Advanced Network Interface with parsing filter, formatting, and patient safety software Software: DataRay D4 Network Interface with the following software packages:

SafetyPrint for Inpatient Pharmacy Medications ScriptPrint for RPMS eRx package for electronic Prescriptions MedBand Barcoded Patient ID System Chart Label and On-Demand Document Identification System (ODDISY) LAB-Enhance Accession Label System EHR-Connect Ward Collect Label System and Medical Access Record (MAR) Update Label Solution

3.0 Contractor Quality Assurance.

Prior performance.

Not applicable.

6.0 Required Travel and Other Direct Costs (ODCs)

Not applicable.

7.0 Special Instructions

None.

8.0 Government Furnished Property/Equipment/Information

None.

9.0 Glossary of Abbreviations and Acronyms

Not applicable.

PWS for <Project> Page 2 of 15

Source Selection Information—See FAR 2.101 and 3.104 [This footer applies during internal development of the PWS. Remove the footer when officially releasing the PWS to vendors as a draft for comment or in the formal solicitation] Source Selection Information—See FAR 2.101 and 3.104 Developed by Virtual Acquisition Office™ for federal government use and customization.

Table 1: Model for List of Deliverables For fixed-price line items:

OR

Period of performance Destination

OR

Place of performance SOW reference*

Typically one, but If multiple accounting classifications for a single deliverable apply, include the dollar amount for each

Due date or frequency

Not required in the line item if there are associated deliverable subline items that include the actual detailed identification

002-01

002-02

For informational (administrative) subline items, an accounting classification citation is not required

Add rows as needed

For cost-reimbursement line items:

OR

Period of performance Destination

OR

Place of performance SOW reference*

Typically one, but if multiple accounting classifications for a single deliverable apply, include the dollar amount for each

Due date or frequency

002-01

002-01

Add rows as needed

CONTRACTOR AUTHORITY:

1. Authority

1.1. No person other than the Contracting Officer has authority to bind the Government with respect to this contract.

1.2. No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract.

1.3. In no event shall any of the following be effective or binding on the Government or imputed to the Contracting Officer with respect to this contract:

1.3.3.A promise by anyone other than the Contracting Officer to provide additional funding or make payments; or

1.3.4. An order, direction, consent, or permission from anyone other than the Contracting Officer to:

1.3.4.1. Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling; or

1.3.4.2. Expend hours in excess of a specified level of effort.

COR INFORMATION:

Yvette Wallette Quentin N Burdick Memorial Health Care Facility Belcourt Indian Health Service 1300 Hospital Loop PO Box 160 Belcourt, ND 58316 Yvette.wallette@ihs.gov image1.jpeg