P03 JA eHealth Exchange-Final_Redacted.pdf

Control Number: VA-21-00049806

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 1701 Directors Blvd.

Austin, TX 78744

2. Description of Action:

The proposed sole source action is for a firm-fixed price (FFP) effort for participant access membership and Hub solution connection to the eHealth Exchange, which operates as an independently governed initiative of Healtheway, Inc., 1600 Tysons Boulevard, 8th Floor, McLean, VA 22102. Healtheway, Inc. (doing business as eHealth Exchange) is a non-profit, public-private large business.

3. Description of Supplies or Services:

The proposed action is to renew eHealth Exchange (eHX) membership and connectivity to the Hub. The eHX is a federated network of exchange partners that enables widespread exchange of health information across providers and geographies to improve the health and welfare of all Americans. Participating in the eHX enables the Veterans Health Administration (VHA) to improve upon current access to information, exchange health records with public and private sector providers in support of the Veterans Health Information Exchange (VHIE), the Veterans Choice Act, and the MISSION Act, and allow VHA to meet its requirement for total network connectivity and coverage. The eHX enables nationwide connectivity with other health information exchange partners that is based upon industry standards and supported by robust testing requirements and processes. In order to sustain the network, participants pay annual participant membership and Hub fees to gain access to centrally managed infrastructure supporting nationwide exchange, Coordinating Committee operations and input privileges, organized data content quality testing and improvements, single trust agreement across all eHX participants, single Application Programming Interface (API) to connect to all eHX participants, a real-time reporting Hub Dashboard that shows granular and aggregated traffic data, and performs 24/7/365 monitoring of gateway connectivity and health. The period of performance will be a 12-month base period with two (2) 12-month options. The total estimated value of the proposed effort, inclusive of options is

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.”

eHealth Exchange Participation and Hub Control Number: VA-21-00049806

5. Rationale Supporting Use of Authority Cited Above:

The purpose of interoperability is having access to accurate, complete patient information such as health summaries, discharge summaries, lab results, diagnostic reports, and clinical notes. Access to this data enables the Veteran patient’s clinician to make informed decisions and minimizes disruptions to care during transitions, ultimately improving patient outcomes. This technology enables VHA to retrieve electronic patient records from exchange partners instantly which reduces time and effort spent to obtain hard copy patient records, improves protection of Veteran Protected Health Information (PHI) and Personally Identifiable Information (PII), and reduces need for duplicate, unnecessary tests. The requirement of interoperability is to enable this electronic exchange seamlessly across all providers, public and private. Although there are other national networks that provide similar technical capability, each network hosts a different membership base. In order to achieve interoperability goals across all providers, VHA must be active in both national networks, one of which is eHX. Only through renewal of its membership in eHX can VHA meet its requirement for total network connectivity and coverage. The eHX is a public-private structure whose network is available to both Government and commercial entities. The eHX is a major, highly-specialized, national network of exchange partners who can connect with thousands of US hospitals, medical groups, dialysis centers, and pharmacies across the US. There is no other network that allows VHA to securely and efficiently connect to the same group of participants.

Specifically, the eHX is the largest national network covering approximately 4 federal agencies, 77% of state and regional HIEs, 75% of hospitals, and 85% of dialysis centers. Participants exclusive to eHX include state and regional HIEs, Social Security Administration, Indian Health Services, and many large-scale, private healthcare organizations which are critical to enabling VHA to improve Veteran care.

The eHX is a federated network of exchange partners who securely share information with each other in accordance with a common trust agreement and oversight authority by a network governing body, the eHX Coordinating Committee. All eHX participants voluntarily agree to share data in a standardized way and do so by complying with a set of technical and policy requirements, formalized by signing a common trust agreement shared among all network participants. The Data Use and Reciprocal Support Agreement (DURSA) was collaboratively developed by a group of federal agencies and private sector organizations and serves as the foundation for trusted data sharing at a national level. By signing the DURSA, eHX participants have authorized the Coordinating Committee to delegate certain responsibilities to a third party, Healtheway.

Responsibilities exclusively delegated to Healtheway include, but are not limited to: evaluating and qualifying potential exchange partners, facilitating technical testing to verify that partner systems will interoperate, managing eHX digital certificates which ensures the secure transmission of data between participants, maintaining the eHX directory of exchange partners which is how an eHX participant finds and electronically connects to other partners, maintaining the eHX technical specifications and operating policies and procedures, and supporting the Coordinating Committee in its work.

The only alternative to renewal of membership in the eHX would be for VHA to recreate and maintain its own national network, which would require the development of a legal agreement similar to the DURSA and convince each partner to sign this point-to-point contract in addition to all the above listed responsibilities Healtheway takes on. This would be a costly endeavor and would disrupt the ability to exchange with the 237 partners VHA is currently connected to through eHX. Healtheway, Inc. is the only organization authorized to fulfill the tasks outlined above on behalf of the eHX Participants, including the capabilities needed for VHA to securely share health data with its federal and private sector partners.

Without renewal of membership to eHX, VHA would otherwise be unable to supplement existing access to information to meet its requirement of total network connectivity and coverage. Only through this renewal can access to data continue improving VHA clinicians ability to make quick and informed decisions on Veteran care. Specifically, without continuation of the eHX membership, VHA would no longer have complete and instant ability to retrieve Veteran patient records from exclusive eHX partners which comprise an overwhelming majority of state and regional HIEs, hospitals, and dialysis centers across the United States which will dramatically decrease VHA clinicians ability to provide optimal care to Veterans.

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. There is no competition anticipated for this acquisition. 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 beta.SAM.gov Contract Opportunities 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 in March 2021 to determine if there were other health information exchange networks capable of providing similar services and assess marketplace capabilities.

Commonwell Health Alliance (CW) is an HIE network that provides similar exchange capability, but with a different participant base (i.e. CCPs exchanging within CW are different from those in eHX). In order to achieve interoperability goals, VHA is a member of both networks. CareQuality is an HIE framework that also enables electronic exchange of standard health documents, but it is only accessible through a second-degree connection, the first degree connection being either CW or eHX.

Healtheway is the sole custodian/operational entity of the eHeaIth Exchange. In March 2021, the Government technical expert contacted Healtheway directly to obtain additional information and ascertain whether there were additional resellers to procure the eHX participation and Hub access. On March 18, 2021, Healtheway responded stating the following:

“No, eHealth Exchange does not have a reseller network or similar structure to procure our services. Our services are uniquely available to eHealth Exchange participants.”

In addition, the Contract Specialist (CS) conducted market research in April 2021 by posting a special notice announcement intent to sole source to Healtheway on beta.SAM.gov Contract Opportunities. The announcement closed on April 13, 2021 with no responses. Based on this market research, the CS determined that only Healtheway can meet the Government’s requirement.

9. Other Facts: None