Justification Exception to Fair Op MHS Redacted.pdf

Mental Health Suite Software Control Number VA-21-00054129 Licenses and Maintenance Support

JUSTIFICATION

FOR AN EXCEPTION TO FAIR OPPORTUNITY

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

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

2. Description of Action: The proposed action is for the issuance of a firm-fixed-price (FFP) delivery order under the National Aeronautics and Space Administration (NASA) Solutions for Enterprise-Wide Procurement (SEWP) V Government-wide Acquisition Contract (GWAC), for the renewal of 155 Document Storage System (DSS), Inc. brand name Mental Health Suite (MHS) term software licenses, associated maintenance and Tier 3 technical support.

3. Description of the Supplies or Services: VA Office of Information and Technology (OIT), Information Technology Operations and Services, Service Management Planning has a requirement for the renewal of 155 DSS MHS term software licenses, software maintenance and Tier 3 technical support for use at healthcare facilities throughout the nation. The 155 DSS brand name MHS term software licenses are needed to cover 67 Large Hospitals; 68 Medium Hospitals; and 20 Small Hospital licenses. VA requires a software system that facilitates treatment planning in mental health care settings and that interfaces with VA’s Veterans Health Information System Technology Architecture (VistA) and its Computerized Patient Record System (CPRS). The existing DSS brand name MHS software facilitates such treatment planning as it interfaces with CPRS and VistA to allow VA mental health clinicians to use the graphical user interface (GUI) functionality to easily enter information related to the Veteran’s mental health care (e.g., problems and medications). The software interface also allows for seamlessly documenting the completed treatment plan in the CPRS Progress Note Tab and completing the VistA clinical encounter in the Veteran’s electronic health record (EHR).

In addition, the DSS brand name MHS software allows multiple clinicians to contribute to the same treatment plans, making possible true interdisciplinary care planning. This increases the completeness and accuracy of the Veteran’s Mental Health treatment plan, minimizing the impact of errors due to copy and paste and providers adding multiple addendums. DSS brand name MHS software focuses on incorporating the Recovery Model of treatment in Veteran care and planning, while supporting compliance with requirements set forth by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities. Both of these organizations have requirements associated with care planning for behavioral healthcare settings that are very detailed, specific, and difficult to meet without utilizing care planning software tools.

Deficits in care planning are among the most frequent issues identified in accreditation site visits, resulting in the need for care planning software. The utilization of the DSS brand name MHS software alleviates these deficits.

The maintenance support shall include upgrades, bug fixes, minor-release upgrades, and troubleshooting Monday through Friday, 8:00 am to 7:00 pm Eastern Time, via electronic, telephone, and on-site tasking. Emergency maintenance is also provided for all MHS licenses 24 hours a day, 7 days a week, 365 days a year. Tier 3 technical support includes Tier 3 resolution of problems experienced using the DSS brand name MHS software. The period of performance for this effort consists of a 12-month base period and two (2) 12-month option periods for the renewal of the 155 DSS MHS software licenses, maintenance support, and Tier 3 technical support. The total estimated price of this proposed action is inclusive of option periods.

4. Statutory Authority: Pursuant to Federal Acquisition Regulation (FAR) 16.505(a)(4), the following brand name requirement is being justified and approved as an exception to fair opportunity under the statutory authority of Section 41 U.S.C. 4106(c)(2) as implemented by FAR 16.505(b)(2)(i)(B), entitled “Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services ordered are unique or highly specialized.”

5. Rationale Supporting Use of Authority Cited Above: Based on market research, as described in paragraph 8 of this document, it was determined that limited competition is available among resellers for brand name DSS MHS software licenses and support services. No other brand name software can meet all of VA’s requirements.

Specifically, no other brand name treatment planning software can meet all of VA’s requirements for interoperability and compatibility with VA’s existing EHR infrastructure.

Any other brand name software would require an extensive, time-consuming redesign and redevelopment effort to meet this requirement as detailed below.

Any other source would have to develop the capability to integrate with VA’s Text Integration Utility (TIU) software suite. Specifically, any other brand name product would need to adapt its capabilities to operate within VA’s TIU framework to (a) generate and format text and other data for storage within the VistA platform; (b) store data and documents using standardized TIU file structures; (c) interface with TIU document management tools that allow users to create, complete, amend, delete, lock, authenticate, send, assign, and reassign documents; (d) incorporate the TIU hierarchy for generated documents, resulting in interdisciplinary “parent” and “child” notes; (e) incorporate all requisite TIU definitions, parameters, and components, and (f) incorporate various types of data, data capture processes, and data sources. In addition to interoperability with TIU, any other source would have to develop the capability to interface fully with the VistA EHR and its various components, such as the patient registration and eligibility system, the patient scheduling system, problem lists, consult and referral management systems, historical document libraries, the patient care encounter/visit tracking system, incomplete record tracking, clinical and administrative reporting systems, the patient record flag system, and various additional systems within the VistA Mental Health software package. For examples of the latter,

(1) the product must interface bidirectionally with the Mental Health Assistant (MHA) software, a VistA/CPRS tool that enables mental health clinicians to administer psychological tests to Veterans as part of their care. The treatment planning software product must interface broadly with MHA in order to locate and retrieve specified test scores and embed these into treatment plans over time in order to monitor Veterans’ progress, and (2) the product must be able to retrieve and embed into Veterans’ treatment plans data from VistA, reflecting patients’ diagnoses, medications, allergies, adverse reactions, past and future appointments, hospital discharge summaries, general health summaries, and the results of imaging studies, laboratory studies, and interdisciplinary consults. Capabilities required of another source would also include functional integration (launch and operation) within the CPRS graphic user interface (GUI) as well as interoperability with various specific CPRS components and processes;

including but not limited to, the clinical reminder system, note templates, encounter completion processes, patient record flag/alerts, various EHR graphic displays, the generation of printable documents, and others. Required capabilities also include compatibility with all other VistA and CPRS add-on tools and software packages maintained by VHA and its subordinate clinical services. Only the DSS brand name MHS software can meet all of the aforementioned interoperability and compatibility requirements. VA estimates that for another source to complete all the integration required for an alternative solution as outlined above, it would take a minimum of 18 months and approximately in duplicated costs that would not be recovered through competition. These estimates are based on previous efforts for similar design and development work. The effort would require a team consisting of, at minimum, a Project Manager, a Massachusetts General Hospital Utility Multi-Programming System Developer, a GUI Developer and at least two (2) Quality Assurance Analysts. This estimate of the required team is also based on previous efforts for similar design and development work. Additionally, due to the complexities associated with treatment planning software, additional time and costs would be required to re-train all VA mental health clinicians to use any new brand name software suite resulting in additional delivery delays and duplicated costs that would not be recovered through competition.

The DSS MHS brand name treatment planning suite is the only software capable of enabling VA mental health teams to develop and implement interdisciplinary treatment plans that incorporate the TIU data framework and functionalities, that live and operate within the VistA EHR environment, and that are developed, managed, and displayed by way of the CPRS GUI. This systemic interoperability and compatibility is a critical requirement, as it ensures that treatment planning for Veterans with mental health is integrated as part of Veterans’ overall healthcare documentation and planning. This thorough degree of integration with VA systems has been developed incrementally by DSS over the past 15 years.

Failure to procure treatment planning software would negatively impact the quality and safety of mental health care provided to Veterans nationwide. Documentation of care planning would be splintered and disjointed. Continuity of care would be negatively impacted each time a Veteran transitions between mental health providers and programs, lacking a cohesive, collaborative plan of care. Not having the existing DSS brand name MHS software would make treatment planning by VA mental health clinicians more time consuming, less coordinated, and less effective, reducing the timeliness and efficiency of care provided to Veterans needing mental health services.

The safety of care would also be compromised, as goals for suicide risk mitigation, safety planning, and symptom reduction would fail to transfer between levels of care or adapt as Veterans’ needs change. Veterans’ experience of care would also be negatively impacted, as it would become impracticable for providers to develop and present to Veterans a personalized, integrated, recovery-focused plan for their care.

Failure to procure treatment planning software would also place at risk the accreditation of all Veterans Affairs Medical Centers (VAMC) facilities by Joint Commission and other accrediting bodies, as VA’s existing sophisticated, integrative interdisciplinary treatment plans would be replaced over the course of a few months by new stilted, silo-specific care plans inefficiently assembled by mental health clinicians who lack the appropriate tools.

Selecting another product in lieu of DSS’s brand name MHS software would abruptly disrupt the creation and use of mental health treatment plans across VHA. This disruption would continue for at least 18 months as a new vendor worked to develop the interoperability and compatibility with VistA/CPRS needed for the product to function.

During this time, clinicians would have no ability to develop a living, integrative, interdisciplinary mental health treatment plan any Veteran. Documentation of care planning would be disjointed and focused only on specific mental health programs.

Continuity between levels of mental health care would be disrupted, as there would be neither a cohesive nor a collaborative plan of care to follow Veterans as their needs change. Not having the necessary tools would make treatment planning more time consuming, reducing the timeliness and efficiency of mental health care provided to Veterans. The safety of care would also be compromised, as goals for suicide risk mitigation, safety planning, and symptom reduction would fail to transfer between levels of care or adapt as Veterans’ needs change. Additionally, Veterans’ experience of care would be negatively impacted, as it would become impracticable for providers to develop and present to Veterans a personalized, integrated, recovery-focused Veteran-facing plan of care. Each of these challenges reflects a corresponding accreditation or VHA compliance standard: to acquire a mental health treatment planning product other than DSS MHS would place at risk the accreditation of VAMC facilities by Joint Commission and other accrediting bodies as well as compliance with VHA policies for the provision of care. As previously mentioned this risk/disruptrion would persist for at least 18 months, while another treatment planning product was being made capable of satisfying VA’s interoperability and compatibility requirements.

Maintenance and Tier 3 technical support for the DSS MHS software is required to ensure that MHS software continues to work with the various components of Vista/CPRS. Since the VistA & CPRS EHR applications themselves undergo frequent updates and modification, any interconnected software must also be updated to ensure it remains operational and compatible and interoperable with CPRS and VistA. To perform this needed software maintenance and provide technical support for MHS, a non-Original Equipment Manufacturer (OEM) would require access to DSS MHS’s proprietary data to include the source code. The Government does not possess the proprietary technical data and code for the DSS software to offer to a non- OEM. Without this technical data, no other source has the ability to provide the aforementioned MHS software maintenance and technical support other than DSS or a reseller. This code is required to ensure all services provided are properly configured.

Failure to acquire the aforementioned maintenance support and Tier 3 technical support would prevent obtaining software upgrades and risk interoperability concerns with VistA/CPRS applications.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that can meet the Government’s requirements. It was determined, however, that limited competition is viable among resellers for the brand name software licenses, maintenance, and technical support. In accordance with FAR 16.505(a)(4)(iii)(A)(1), this justification will be provided with the solicitation to all appropriate NASA SEWP V Government-Wide Acquisition Contract GWAC holders. Furthermore, in accordance with FAR 5.301, 16.505(b)(2)(ii)(D), and 16.505(a)(4)(iii), the award notice for this action will be synopsized on the SAM.gov website and this justification will be made publicly available within 14 days of award.

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

8. Market Research: Market research was conducted by the Government’s subject matter experts by reviewing similar software via internet searches from March 2021 through June 2021. Products reviewed included AdvancedMD/NueMD Mental Health EHR, AthenaHealth EHR, AZZLY Rize, Behave EHR, Cerner EHR, Cerner OnePlan, Credible Behavioral Health EHR, CureMD Behavioral Health EHR, eClinicalWorks, EHR Your Way, EPIC Behavioral Health Module, Kareo EHR, ICANotes, MedicsCloud EHR, Meditech EHR, MindLinc EMR, NetSmart myEvolv, NextGen Behavioral Health Suite, NextStep Solutions Behavioral Health EHR, PIMSY EHR, Practice Fusion, PRAXES Apogee, PRAXIS EHR, Procentive, Qualifacts CareLogic, RxNT, SimplePractice, TenEleven eCR, TheraNest, TherapyCharts, TherapyNotes, TheraScribe, Therasoft, and VALANT Behavioral Health EHR. This market research concluded that none of these brand name products can meet all of VA’s interoperability and compatibility requirements as outlined in Section 5 of this document. None of the reviewed products can support the integrated care system that VA requires, offering a living, integrated, interdisciplinary treatment plans that work within VA’s TIU data framework, operate within and interface with other elements of the VistA EHR environment, and are integrated within the CPRS GUI. Only DSS MHS software licenses can meet all of VA’s needs.

Additional market research was performed in June 2021 by utilizing the NASA SEWP V GWAC Provider Lookup tool, which resulted in the identification of multiple SDVOSB resellers of the required brand name DSS MHS software and services. As a result, there is a reasonable expectation for limited competition on the NASA SEWP V GWAC for the brand name DSS MHS software licenses, maintenance and technical support.

9. Other Facts: None.

Approval

In my role as Head of the Contracting Activity, based on the foregoing justification, I hereby approve the acquisition for the renewal of 155 Document Storage System, Inc.

brand name Mental Health Suite term software licenses, associated maintenance and Tier 3 technical support on an other than fair opportunity basis pursuant to the authority cited in Section 4 above, subject to availability of funds, and provided that the property and services herein described have otherwise been authorized for acquisition.

Date: ____________ Signature: ____________________

Head of the Contracting Activity Technology Acquisition Center

Office of Procurement, Acquisition, and Logistics