JA - BHL -Redacted.pdf

Control Number: VA-22-00062887

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION

1. Contracting Activity: Department of Veterans Affairs (VA)

Office of Procurement, Acquisition, and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724

2. Description of Action: The proposed sole source action is for a firm-fixed price contract with Capital Solution Design (CSD), LLC, 1061 North George Mason Drive, Arlington, Virginia 22205 for the renewal of brand name CSD Behavioral Health Lab (BHL) software inclusive of software maintenance and technical support.

3. Description of Supplies or Services: VA, Veterans Health Administration (VHA), Office of Mental Health Services, Veterans Integrated Service Network (VISN) 4, Mental Illness Research Education and Clinical Center (MIRECC), has a requirement for the renewal of brand name CSD BHL software inclusive of software maintenance and technical support for CSD BHL software used throughout VA Medical Centers (VAMCs) for delivering evidence-based and measurement-based mental health care within various clinical settings with a focus on supporting integrated primary care/behavioral health care. BHL support and maintenance services include BHL desktop licenses for enterprise use of the software within VA for the duration of the contract. The enterprise license allows VA to operate the BHL Desktop software at all VAMCs for use by all VA clinical users without restriction. However, the enterprise license is only viable so long as VA elects to renew software support and maintenance services; without this support and maintenance, CSD shall work with VA to decommission the software within the VA enterprise. This software is currently installed in 128 VAMCs and provides for regular structured assessments to monitor patient progress and determine when treatment adjustments or additional resources are needed to ensure Veterans are contacted and monitored on a regular basis. This software also provides clinical program informatics support that allows for tracking patients over time, monitoring patients’ symptoms, and accessing patient and program level data. The required software maintenance shall consist of all updates, patches, fixes, and security resolutions developed by CSD. The technical support services are required via email, telephone, or web portal, and shall provide for the analysis, troubleshooting, and resolution of any software product-related problems or questions encountered by Government users with the CSD software products. In addition, the Contractor shall provide technical support for site audits, site inspections, backup, and security issues to be handled through a help desk service operating Monday through Friday, 9:00AM until 5:00PM Eastern Standard Time. This includes Suicide Prevention (SP) and Northeast Program Evaluation Center (NEPEC) tasks and support. These software maintenance and technical support services will ensure the current software is continually updated and remains fully operational.

inclusive of a 12-month base period and two (2) 12-month option periods for continued software maintenance renewal, technical support, SP and NEPEC assessments configuration support, and

BHL Software and Maintenance Control Number: VA-22-00062887 one (1) SP Optional Task for additional assessment configuration support which may be exercised, at the Government’s discretion, one time during each of the Base and Option Periods, for a total of up to three (3) times.

4. Statutory Authority: The statutory authority permitting other than full and open competition is 41 U.S.C. 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

5. Rationale Supporting Use of Authority Cited Above: The proposed source for this action is CSD, LLC, 1061 North George Mason Drive, Arlington, VA 22205. Based on extensive market research, as described in section 8 of this justification, it was determined that competition is not viable for the renewal of the existing BHL software licenses or the software maintenance and technical support for the existing BHL software in use throughout VAMCs. Since BHL software can only be used within VA in connection with a support and maintenance services contract, without a support and maintenance services contract, CSD shall work with VA to decommission the software within VA, thus rendering the BHL software, and all associated clinical applications and assessments, unavailable for use by VAMCs. BHL software is a commercial-off-the-shelf software package designed and developed by CSD in collaboration with VISN 4 MIRECC in 2004. However, the software was not designed and developed in its entirety under contract with VA. The software’s programming code was written by CSD based on the clinical guidance and best practices of VA. The source code is owned by CSD, which grants the Philadelphia VAMC the right to install, use, and distribute the BHL software application throughout VA. BHL is a model of Primary Care-Mental Health integration that is required at all VA facilities. Currently there are 86 active BHL assessments used by VA clinical practices and over 850,000 Veterans have been assessed with BHL. Different clinical practices, such as Mental Health, Primary Care- Mental Health Integration (PCMHI) and Suicide Prevention, utilize assessments based on their specific functions, resulting in the large number of required assessments.

These assessments can be revised over time as clinical care and VA processes evolve.

Market research has determined that CSD is the only source that can meet the VA’s current requirements. Specifically, no other solution offers all 86 assessments that have been built out during the course of the last 18 years and no other solution includes the Veterans Health Information Systems and Technology Architecture (VistA), and Cerner interfaces required by VA. To meet VA’s requirements, a competing solution would need to develop and deploy each individual assessment currently offered by CSD.

Based on historical effort, developing a single assessment would take anywhere from 20 to 200+ hours since assessments vary in size, complexity, and formatting, impacting the amount of time required. For example, the following elements must be taken into account when developing an assessment: VA review and approval, the number of questions, answer validation, question skip logic, clinical alerts, the number of scores, and clinical reporting. The PHQ-9, the most frequently used assessment within VA, is a good representation of an average assessment in terms of size, complexity, and formatting. The assessment totals 10 questions and has a single total score calculation and standardized language, which means it went through the publication process, which helps simplify issues when preparing the assessment for electronic collection.

Considering these elements, configuring the PHQ-9 today within the BHL would take approximately 60 hours. In contrast, homegrown proprietary assessments of similar size, such as those created by OMHSP, take almost three times as long (180 hours) to configure due to the lack of peer review and standardization that published assessments go through. Further time is required when the assessment requires complex scoring elements, such as the algorithms needed for the multiple scores of Veterans RAND 12 (VR-12).

Any duplicative re-development effort to re-establish the 86 required assessments would require an estimated 17,200 hours, or nearly two (2) years of labor-intensive work. This estimate would not include any infrastructure or integration requirements.

Additionally, any proposed solution must be able to interface with VA systems that hold patient information in multiple applications such as VistA, Cerner, and Computerized Patient Record System (CPRS). The initial effort to integrate BHL with VistA was performed over a period of approximately 1.5 years. CSD also performed the EHR framework implementation and BHL interface with Cerner. BHL software includes an EHR framework that facilitates communication with the top EHR systems: VistA, Cerner, and EPIC and the BHL EHR framework is configurable to meet customers’ needs with their EHR system of choice. VA is unique because it requires concurrent support for two (2) EHR systems – VistA and Cerner. These interfaces are proprietary to CSD and cannot be transferred or shared with another company. No other alternative health care software currently has the ability to interface with VistA, Cerner and CPRS. The use of any alternative software would require a redevelopment effort to establish the aforementioned interfaces. Based on previous acquisition history, VA estimates that this effort would take approximately 1.5 years.

Only software maintenance and technical support provided by CSD can meet the requirements as the existing software source code is proprietary to CSD. Specifically, without access to CSD’s proprietary source code, no other source is able to provide software updates, patches, fixes, security resolutions, help desk services, and ensure these services are properly configured. Additionally, since the software source code is proprietary, no other source exists that can provide analysis, troubleshooting, and resolution of any software product-related problems other than CSD. CSD does not have an affiliation or agreement in place with any authorized resellers for the subject software maintenance and technical support; therefore, CSD is the only responsible source that can satisfy the Government’s requirements.

In the event BHL software maintenance and technical support are not renewed, the critical services it currently provides to our nation’s Veterans will no longer be operational (i.e. VAMCs will be unable to deliver evidence-based and measurement-based mental health care within various clinical settings; will be unable to provide structured assessments to monitor patient progress to determine whether treatment adjustments or additional resources are needed to ensure Veterans are contacted and monitored on a regular basis; and will be unable to provide clinical informatics which support allowing for tracking of patients over time, monitoring patients’ symptoms, and accessing patient and program level data). The VA network and Behavioral Health would have no means to provide informatics to assess Veterans’ mental health (depression, anxiety, Post-Traumatic Stress Disorder, Substance Use Disorder, etc.)

and no means to integrate care through a team-based primary-care/specialty-care approach. BHL software is currently in version 5.6.2 and continues to upgrade and update based on patient care needs and security issues. In addition, VA would not receive security updates, which could compromise VA’s network security posture.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in section eight of this justification. This effort did not yield any additional sources that can meet the Government’s requirements. There is no competition anticipated for this acquisition and the proposed action will be synopsized on the Contract Opportunities page at SAM.gov in accordance with (IAW) FAR 5.201. Any proposals that are received shall be evaluated. Additionally, IAW FAR 6.305(a) this Justification and Approval for Other Than Full and Open Competition will be made publicly available on SAM.gov within 14 days after contract award.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed.

8. Market Research: In March 2022, market research was conducted by the Government’s technical experts via internet research and review of industry publications to identify if there are other service providers or health care software vendors with products capable of providing similar capabilities. The Government reviewed products by PsyPack, HerdmanHealth and Neuroflow. PsyPack is an online psychometric testing software that offers 28 assessments, but only three (3) that are required by VA and included in the BHL Software. HerdmanHealth is a company that is a cloud-based assessment tool, listing four (4) common assessments, but its applications are designed for private practice. NeuroFlow also offers a robust library of existing content and clinically- validated assessments but would need to create a platform that integrates with VA systems. NeuroFlow currently has 12 assessments that match the BHL software. Additionally, no other mental health assessment products interface with VA infrastructure systems such as VistA/Cerner/CPRS. VA EHR interfaces are a primary requirement for ensuring data integrity, protecting PHI/PII, and reducing clinical burden.

Also, no other products contain the number of assessments (86) the BHL currently supports and that are required by VA clinical practices. Most medical software packages are custom designed to meet client needs developed by various vendors.

Market research revealed that while there are numerous mental health software packages available on the market none of these solutions could replace CSD’s BHL software or provide maintenance on the existing platform as they would not be able to access the source code owned by CSD. None of these solutions contain the number of required assessments or can currently integrate with VA’s systems or avoid the duplication of effort and time as described in Section 5 of this justification. Additionally, none can meet the VA’s current requirement for software maintenance and technical support needs because these contractors cannot access the source code and technical data of the VA’s current proprietary CSD BHL solution and their health care software solutions are not customized to fit the needs of the VA’s Behavioral Health and Primary

Care settings. Each software developer offers a proprietary system and associated services that will only operate with its respective software. In addition, review of Behavioral Health software packages revealed vendors who supply web-based products would not be able to interface with the VA’s VistA/Cerner/ CPRS. General Services Administration’s schedules (GSA) were also researched, but no results for hospital or behavioral health assessment software were found. Based on the above, VA technical experts determined that only CSD BHL software can meet all of the Government’s requirements.

In April 2022, the Contract Specialist performed market research by searching the Vendor Information Pages (VIP) database (www.vip.vetbiz.va.gov) to identify verified Service-Disabled Veteran-Owned Small Businesses (SDVOSBs) and Veteran-Owned Small Businesses (VOSBs) that may be capable of fulfilling the aforementioned requirements to satisfy the VA Rule of Two. A search was conducted utilizing North American Industry Classification System (NAICS) code 541511, Custom Computer Programming Services, which yielded 2,308 matches. However, only CSD can provide the required software maintenance as the source code is proprietary to CSD and CSD does not allow any other source, including SDVOSBs or VOSBs, to resell its maintenance and technical support services.

Additional market research was conducted in June 2022 by posting a Request for Information (RFI) on SAM.gov on June 9, 2022. The RFI sought interested and capable manufacturers or resellers of alternative brand BHL software that could provide an off the shelf solution. No vendor responses were received.

Additionally, the Government’s representative contacted CSD in March 2022 to ascertain if CSD was willing to sell their proprietary source code to VA. CSD responded, via email on March 29, 2022, that although they have not previously considered it, they may be willing to sell their code to VA and provided an estimate of $20,000,000.00.

This email has been saved to the contract file. VHA thereafter conducted a cost benefit analysis, which determined that it was not in VA’s best interest to procure the source code. Specifically, VHA does not currently anticipate using the software for a period of time that would be long enough to justify the cost of procuring the source code.

Finally, it has also been verified that there are no other authorized resellers. In July 2022, the Contract Specialist contacted CSD, which confirmed via email on July 14, 2022, that the company had no authorized resellers of its BHL software maintenance and technical support services. A copy of this correspondence has been saved to the contract file.

9. Other Facts: None