(P03) JA Intersystems SUTA Signed Redacted.pdf

Control Number VA-23-00001861

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 a firm-fixed-price (FFP) delivery order to be issued under the National Aeronautics and Space Administration (NASA) Solutions for Enterprise-Wide Procurements (SEWP) V Government-Wide Acquisition Contract (GWAC) for the procurement of brand name lnterSystems Software Updates and Technical Assurance (SUTA) for the existing perpetual enterprise license software products, as well as for a bundle of additional annual InterSystems Intuitive, Reliable, Interoperable, and Scalable (IRIS) software licenses and HealthShare and Healthconnect licenses.

3. Description of the Supplies or Services: The Department of Veterans Affairs, Office of Information and Technology (OIT), Development, Security and Operations (DSO) has a requirement for Software Updates and Technical Assistance (SUTA) for the following brand name perpetual software products currently running within the VA:

InterSystems IRIS Software; InterSystems HealthShare Health Connect Software; and InterSystems HealthShare Heath Information Exchange Software. These requirements maintain the current infrastructure supporting VA’s current Electronic Health Record (EHR) database as the VA transitions to a new EHR. The HealthShare software functionality permits the routing and transfer of patient data to VA’s EHR systems and allows for data exchanges supporting third party Community Care initiatives to meet the Government and private sector interoperability needs.

VA’s EHR resides in a database operating system and application platform called InterSystems IRIS. Every EHR of every Veteran serviced by VA resides on this platform. It is, therefore, deemed a mission-critical platform. The application which operates on this platform is the Veterans Information System and Technology Architecture (VistA). VistA, itself, includes over 184 mission-specific applications. The requirements above support maintenance of the current infrastructure of the VistA platform as well as VA’s EHR Database. The required InterSystems brand name software provides the database platform for storing, securing and retrieving Veteran patient data within this platform. Additionally, VA has committed to and is implementing numerous continuous updates to this platform supporting multiple initiatives including, but not limited to, VistA Evolution, VistA Read Only (VRO) and Community Care. In order for VA to update these platforms, the database software must be able to work with VistA data, both natively and in Application Structure and Integration Support, operate on Health Interoperability Buses (ESB – Enterprise Service Bus) and facilitate Health Information Exchange operations with outside health providers and other health record products. The InterSystems HealthShare products will support current and future VistA Architecture and Platform Development initiatives and replacement activities;

lnterSystems SUTA Control Number VA-23-00001861 specifically allowing for the seamless transfer of Veteran patient data to community care providers outside the VA healthcare network. Finally, VA is in the process of transitioning to a new EHR. The InterSystems HealthShare products will enable the routing and transfer of patient data to a new EHR as well as community care providers.

VA requires SUTA on all existing InterSystems IRIS, InterSystems HealthShare Health Connect and InterSystems HealthShare Heath Information Exchange perpetual enterprise licenses which includes upgrades and updates to the InterSystems products as well as dedicated 24 hours per day, 7 days per week support. This action is for software maintenance and technical assurance services only for VA’s current IRIS perpetual licenses (210,000 licenses). However, this lnterSystems SUTA bundle will also provide an additional 57,000 IRIS annual licenses and an unlimited Healthshare license. These additional licenses support VA’s growth in the VistA system and support VA’s need to secure sharing of health data.

To ensure continued successful operation of the current VistA system, continued access to the software and continuation of SUTA, a new delivery order must be in place no later than October 1, 2022. The current delivery order, VA118-18-F-2526 expires on September 30, 2022. Therefore, it is necessary to put a new delivery order in place by October 1, 2022.

The period of performance for this proposed contract action will consist of a one 6-month base period with five, 6-month option periods. VA anticipates utilizing the current InterSystems infrastructure for a minimum of three years which supports the proposed period of performance. The total estimated price of the proposed action, inclusive of all option periods, is

4. Statutory Authority: The statutory authority permitting an exception to fair opportunity is Section 41 U.S.C. 4106(c)(2) as implemented by the Federal Acquisition Regulation (FAR) Subpart 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 extensive market research as described in paragraph eight of this document, it was determined that limited competition is viable among resellers for the aforementioned brand name lnterSystems IRIS and HealthShare software products and associated maintenance support.

VistA is an enterprise-wide information system built around an EHR which has been used throughout VA for over three decades and was developed using the Massachusetts General Hospital Utility Multi-Programming System programming language. VistA consists of nearly 184 integrated software modules for clinical care, financial and other business functions and infrastructure. As the largest integrated health care system in the United States, VA provides care at over 1,233 health care facilities of varying complexity, conducting nearly 130 million patient encounters with more than 8.9 million Veterans per year supported by over 340,000 employees throughout the continental U.S., Alaska and Hawaii on a single electronic healthcare information network.

VA entered into a contract with Cerner in May 2018 to replace the existing EHR system as described in the preceding paragraph. Additionally, there are other projects currently underway to replace the administrative modules (e.g. Finance/Billing, Engineering/Inventory, etc.) with anticipated completion over the next five years.

While replacements are underway, it is imperative to keep the existing VistA system in a steady-state operationally. Introducing a short term replacement would require a code re-write on approximately 184 VistA modules and associated client applications. These modules and applications were built utilizing InterSystems and work in tandem with lntersystems software to store, share and retrieve data. Only through continued use of InterSystems can VA utilize the modules and applications that are based on custom proprietary coding and configuration that VA has performed over the past 35 years. This duplicative VistA re-write is estimated to take longer than the current replacement activities timeline for Cerner Millennium and would result in significant duplication of cost. Specifically, the effort to re-write the approximately 184 VistA modules and associated applications is estimated to take a minimum of five years and produce duplicative estimated costs of approximately $42 million in labor. This estimate is based on previous development efforts and utilizes a very conservative minimum labor cost to develop and reintegrate any alternative software to the approximately 184 VistA modules and applications. Additionally, there would be significant cost and effort associated with re-procuring and re-engineering any alternative Commercial of the Shelf products to run on the VistA platform. Specifically, based on previous acquisition history, it is estimated that the use of any alternative software would produce duplicative costs of approximately $100 million. In addition, there is a high risk of data corruption while transferring the data during a re-coding of the applications to another brand name software. When code is transposed from one language to another, judgments and compromises are made as one language never has the exact approach to resolve a problem as another. Given that the lnterSystems coding language is proprietary and unique, the risk of data corruption would be amplified during any potential transfer of data. A line-for-line translation of the code could not be achieved. In addition, modifying the current state of the application platform would change the scope of Cerner/Admin re-engineering efforts, causing delays in development and deployment due to integration control documentation being altered. This would require extension of tasks of those contracts, delaying delivery and creating potential for patient safety issues.

Additionally, from the data storage perspective, the internal data structures of the InterSystems IRIS database are entirely different from that of other products. Any other product used to store data utilizes a "relational" schema. That is, it is comprised of tables of records. IRIS' data is constructed to be available via any approach (in particular a canonical model for messaging), and not just the records and relational approach. A specific data point is stored and referenced as its own entity (key/value).

Further, this data is broken down into blocks that are internally referenced via a data-chaining algorithm. This means the data would need to be translated, interpolated and transposed in ways it was never designed or architected to do; thereby, introducing corruption risk and the possibility of incurring data loss should another brand name product be used. As the data being discussed pertains to medical history and documentation, the corruption of data could endanger the health of the Veterans and could lead to possible Veteran patient deaths.

InterSystems HealthShare provides the added functionality that VA requires. While this software provides a multitude of features, the most critical ones are the Enterprise Service Bus functionality, the provision of text analysis tools for unstructured text conversion and the inter-EHR translation of medical data that are provided out of the box by InterSystems without requiring translation, transposition or conversion of VA data in its native format, which would be required if VA switched to a like product. Only InterSystems HealthShare products and services can meet VA’s needs and ensure complete interoperability, compatibility and continuity of operations. Use of any other brand name product or service would result in various interoperability and compatibility issues with the current VistA infrastructure. InterSystems has middleware servers that communicate with VistA to directly replicate VistA data. No other software is compatible natively with VistA databases, or able to natively read the IRIS .dat file which would make it impossible to share data with providers including external providers outside the VA healthcare network. HealthShare code is a mix of database accesses and code execution and any perturbation to this system with incompatible protocols will cause the application programs to fail.

Finally, only lnterSystems and its authorized resellers can meet VA's needs for updates and services and ensure complete interoperability, compatibility and continuity of operations. lnterSystems owns the proprietary source code and is the only source able to facilitate all lnterSystems license and service requirements. lnterSystems has proprietary rights to the software code for the lnterSystems software associated with this acquisition requirement and, as such, is the only known vendor, along with its authorized resellers, that can provide this software and the required lnterSystems SUTA services. Without the aforementioned proprietary source code, no other sources can ensure the services provided are properly configured to meet VA's needs. lnterSystems was contacted in May of 2022 to ascertain if its proprietary technical data was for sale and the company advised VA that it was not for sale.

Based on the above information, the Government's technical experts determined that only lnterSystems brand name products and services can meet all of VA's needs.

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 authorized resellers for this brand name item. In accordance with FAR 5.301 and 16.505(b)(2)(ii)(D), the award notice for this action will be synopsized on the Federal Business Opportunities Page (FBO) and this justification will be made publicly available within 14 days of award.

7. Actions to Increase Competition: In order to remove or overcome barriers to competition in future acquisitions for this requirement, the Government will continue to perform market research to determine if there are any new products available that are capable of fulfilling the Government’s requirements. Noteworthy, much of this functionality is due to be replaced over the coming years by the Cerner Millennium deployment.

8. Market Research: During April and May 2022, the Government’s technical experts performed web-based research and conducted testing in a sandbox environment of other similar commercial products. Five database and one enterprise bus system products and providers were identified as market competitors including Greystone Technology M (GT.M), YottaDB, International Business Machines Database 2, Microsoft Structured Query Language (SQL) Server, Teradata and MuleSoft ESB. Their product documentation was reviewed as well as their support databases when available.

Despite these efforts, no other database product or provider was found to meet all of VA's requirements as described in section 5 of this justification. None met the requirement to provide a database that could natively read or interoperate with VA's existing lnterSystems IRIS .dat files, without conversion, translation or transposition.

More specifically, no other product can read the IRIS .dat file, offer key-value, multidimensional schema-less database structures or operate on multiple platforms such as Linux and Windows. Further, no other alternative solution can provide a canonical information model library, which is a foundational requirement for Vista Data Access Architecture as well as libraries, or avoid the risk of data loss and corruption identified above. Lastly, use of any other alternative solution would require a rewrite of existing downstream dependencies and applications as described in Section 5 of this justification.

A Request for Information (RFI) was posted on March 4, 2022, for resellers of the Intersystems products on General Services Administration eBuy to all Service-Disabled Veteran-Owned Small Businesses (SDVOSBs). The RFI did not yield any responses.

Additionally, on March 4, 2022, an RFI was submitted to all contract holders under North American Industry Classification System code 541519 NASA SEWP GWAC to determine whether there were resellers available to provide lnterSystems SUTA services. Two responses were submitted by InterSystems authorized resellers, Four Points Technology (SDVOSB) and All Points Logistics, LLC (Large Business). The technical experts determined that the resellers met VA’s requirement and demonstrated their ability to provide the required SUTA services. Although the Government technical experts determined that the resellers could meet VA’s requirement, VA determined that the requirement should be revised and sunsequently issued a new RFI. Again, two responses were submitted by InterSystems authorized resellers, Four Points Technology and All Points Logistics, LLC. The technical experts determined the resellers could meet VA requirements. In July 2022, VA issued an RFI to NASA SEWP to all contract holders within groups B, C, and D to determine if SDVOSBs could perform this work as a set-aside. Once again, All Points Logistics and Four Points

Technology responded; however, the one SDVOSB respondent indicated that the limitations on subcontracting required for a small business set-aside could not be met.

The NASA SEWP V GWAC Provider Lookup Tool was also utilized in June 2022 to gather additional market research information. It was determined that there are three authorized resellers (two SDVOSBs and one Small Business) of InterSystems products/services on the NASA SEWP V GWAC. Therefore, limited competition is expected for this proposed action on NASA SEWP V GWAC.

As detailed above, market research indicates that at least two NASA SEWP V GWAC contract holders are interested and capable of providing the brand name InterSystems software products/services. However, as result of the SDVOSB response indicating the limitations on subcontracting could not be met, the Government did not identify two or more small businesses capable of supporting this requirement, and as such, this effort could not be set aside to SDVOSBs. Accordingly, the proposed action will be issued for a firm-fixed-price delivery order issued to all contract holders in NASA SEWP V GWAC Groups B, C and D.

9. Other Facts: None

10. Technical and Requirements Certification: I certify that the supporting data under my cognizance, which are included in this justification, are accurate and complete to the best of my knowledge and belief.

Name

Title:

11. Fair and Reasonable Cost Determination: I hereby determine that the anticipated price to the Government for this contract action will be fair and reasonable based on anticipated competition. Additionally, NASA SEWP V has already determined the prices on contract to be fair and reasonable. Finally, the successful quote will be compared with the Independent Government Cost Estimate.

Name

Title:

12. Procuring Contracting Officer Certification: I certify that this justification is accurate and complete to the best of my knowledge and belief.

Name:

Title: P

Concurrence

In my role as Head of the Contracting Activity, based on the foregoing justification, I hereby concur on the acquisistion of lnterSystems Software Updates and Technical Assurance, as well as for a bundle of additional annual IRIS software licenses and HealthShare and Healthconnect licenses 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: ____________

Approval

In my role as Agency Senior Procurement Executive, based on the foregoing justification, I hereby approve the acquisition of lnterSystems Software Updates and Technical Assurance, as well as for a bundle of additional annual IRIS software licenses and HealthShare and Healthconnect licenses 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: __________ S