Redacted JA - Medicom.docx

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, NJ 07724

2. Description of Action: This proposed action is for a sole source firm-fixed-price contract for the renewal of Medicom Technologies, Inc.’s (Medicom) ImageX with Assistant Edition software and supporting services, maintenance, and training with Medicom Technologies, 555 Fayetteville Street Suite 300 Raleigh, NC 27601.

3. Description of Supplies or Services: VA, Veterans Health Administration (VHA), Veterans Integrated Service Network (VISN) 6 Office has a requirement to maintain its brand name Medicom diagnostic imaging system for storage, automated patient record retrieval and exchange services. This system accommodates VA Mid Atlantic Health Care Networks, including Asheville Veterans Affairs Medical Center (VAMC), Durham VAMC, Fayetteville VAMC, Hampton VAMC, Hunter Holmes McGuire VAMC, Salem VAMC, and Salisbury VAMC. The primary use of the system is to bidirectionally exchange medical images and diagnostic reports with the community and other VAMCs. The system facilitates the exchange of medical images and reports through encrypted, peer-to-peer conduits between providers of VA. The system must seamlessly connect to VA diagnostic and record keeping systems. Further, support services, maintenance, and training are required as part of the software subscription. The period of performance shall be one 12-month base period with three 12-month option periods. The total estimated value of the proposed action is $, inclusive of options.

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) 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: Based on market research, as described in Section 8 of this justification, it was determined that no competition is available for this procurement. No other products are capable of meeting all the Government’s requirements. Medicom’s ImageX is proprietary and the only vendor-agnostic patient record locator service, which allows clinicians to locate patient information without calling and waiting for private sector facilities to send information. Medicom is the only vendor to offer an automated patient record retrieval service, which is a specific requirement for achieving the VHA’s cost-savings goals associated with the procurement of an electronic, bi-directional DICOM image sharing service. Medicom will ensure the VA can continue to save diagnostic images to the current systems and pathways, and both authenticate and validate bi-directional, electronic exchange of DICOM images, radiology reports, and radiology orders. Medicom will allow Imaging Services to search the commercial imaging providers located within VISN 6, locate prior medical images and reports, and retrieve them to VA where they can be inducted to VA systems using a quality assurance step. In addition, the system will automatically match patient identifications to update the patient’s Medical Record Number (MRN) with VA’s MRN, when possible. VA technical experts also found that Medicom’s ImageX and support services, maintenance, and training are the only system that is designed to send and receive archived images and reports, capable of meeting federal government security standards, and cross individual healthcare systems securing or operating systems.

Medicom’s ImageX and support services are already in place across VISN 6. Each of the seven health care systems comprising VISN 6 has accrued access to community partner hospitals in their operating areas by pursuing agreements one by one over the last three years, resulting in 286 community partners on the network and another 42 in progress as of May 2024. This is usually a lengthy process that can take months, and in some cases years due to privacy laws and policies resulting in community partners having to go through extensive compliance reviews performed by their legal services prior to entering partnerships with VA. If VA were to switch vendors from Medicom, VA facilities would have to remove existing services from complete sites, and re-engage the legal teams of all 328 sites to interface with a new vendor’s system, which is estimated to take 3 years and 2 months to rebuild and is estimated to cost VA over $ according to Government technical experts. Therefore, longer periods of contract stability and option periods would prevent delays of care in the community care referrals, decreasing the probability of delayed treatment and the resulting lawsuits and investigations that could occur.

VA requires a system which enables electronic, bi-directional exchange of radiology imaging exams and reports with commercial healthcare facilities providing services to VA patients. Moreover, the Mission Act has enabled Veterans to seek diagnostic imaging services outside of VA. If VA loses Medicom’s ImageX and support services, digital image sharing would be unavailable. VA would have to use compact disks (CDs) and digital video disks (DVDs) that are hand-carried or mailed to and from VA facilities at the completion of a diagnostic test, ultimately creating bottlenecks and delays in the continuity of Veteran care. Delays in archiving images can also cause misplaced CDs or DVDs, repeated examinations, and “unreadable” images that are incompatible with some softwares in VA. All adverse factors add to unnecessary health risks of Veterans and additional costs to VA. Therefore, a peer-to-peer network that provides VA the ability to electronically exchange data within the community is required.

Medicom is the only vendor able to provide timesaving solutions to fit the unique needs of VA. Based on the above information, only Medicom meets all the Government’s requirements and is the only capable source.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in Section 8 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. Additionally, the proposed action will be synopsized on the Contracting Opportunities Page in accordance with FAR 5.201. Any proposals that are received shall be evaluated.

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 fully competed. VHA and VISN 6 will continue to research and monitor whether there are emerging products that enter the marketplace that are interoperable and compatible with VA community facilities, platforms, services, and software.

8. Market Research: VA technical experts conducted market research on December 28, 2023, by reviewing similar software products to ascertain if these items could meet VA’s requirements. The search included AbilityOne Services and Supplies, other mandatory sources per FAR 8.003, other governmentwide acquisition contracts, multi-agency contracts, existing agency indefinite-delivery, indefinite-quantity contracts, the System for Award Management, and a generalized internet search using the term “medical image sharing system.”

The Government’s technical experts also held technical discussions and conducted web-based research on other similar software. For instance, Ambra Imageshare (Ambra) and Nuance PowerShare (Nuance) were looked at in the course of an overall search for medical image sharing system. Systems offered by Ambra and Nuance, for example, provide for some capability but utilize cloud-based non-VA storage or are not sufficiently able to seamlessly connect to VA diagnostic and record keeping systems. Medicom is the only fully federated health information exchange provider that connects disparate silos or health information to be securely searched and shared via ImageX.

In addition, on April 23, 2024, the contract specialist obtained confirmation from Medicom that there are no authorized resellers of its ImageX software, support services, maintenance, and training are proprietary.

9. Other Facts: N/A

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.

Date:

Health Systems Specialist Signature:

VISN 6 Imaging Exam Transmission System (Medicom)

VA-24-00055536

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 historical prices and a comparison to the Independent Government Cost Estimate.

Date:

Procuring Contracting Officer Signature:

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

Date:

Procuring Contracting Officer Signature:

Approval In my role as procuring activity Advocate for Competition, based on the foregoing justification, I hereby approve the acquisition of Medicom’s ImageX with Assistant Edition software and supporting services, maintenance, and training on an other than full and open competition 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.

Advocate for Competition Technology Acquisition Center Office of Procurement, Acquisition, and Logistics Department of Veterans Affairs