Redacted JA - TXCC Saas License Subscriptions.pdf

Control Number: VA-25-00053023

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, New Jersey 07724

2. Description of Action: The proposed action is for a firm-fixed price (FFP) delivery order (DO) issued under the National Aeronautics and Space Administration (NASA) Solution for Enterprise-Wide Procurement (SEWP) V Governmentwide Acquisition Contract (GWAC) for the renewal of brand name DSHI Systems, Inc. (DSHI) TriageXpert Contact Center (TXCC) software-as-a-service (SaaS) license subscriptions and related technical support.

3. Description of Supplies or Services: The mission of the Department of Veterans Affairs (VA), Office of Information and Technology (OI&T), Veterans Experience Services (VES), Veterans Relationship Management (VRM) is to provide benefits and services to Veterans of the United States by providing supportive Information Management/Information Technology systems. To meet organizational goals, The Veterans Health Administration (VHA) has a requirement for the renewal of the brand name TXCC SaaS license subscriptions and related technical support, which is used by approximately 1,000 nurses across all VHA Veterans Integrated Service Network (VISN) sites by Clinical Contact Center staff to provide telephone triage and informational services to Veterans. The Government requires that the decision support tool (DST) must be compatible with Veterans Health Information Systems and Technology Architecture (VistA) and the Computerized Patient Record System (CPRS). TXCC is a highly specialized application that supports nurse clinical decision-making by systematically assessing a Veteran’s symptoms by providing reference health information for Veterans, and by providing bio and syndromic surveillance data used in predictive modeling for the VA. The solution is designed to identify emergencies, while reducing unnecessary emergency department and clinic visits by systematically assessing a Veteran's symptoms using electronic algorithms with branching clinical logic. TXCC thereby allows VA to comply with VHA Directive 2007-033 for 24/7 access to medical advice.

TXCC uses proprietary artificial intelligence and natural language processing to guide the user through a targeted medical history. The goal of TXCC is to standardize triage recommendations, improve outcomes, and improve workflow efficiency for the Clinical Contact Center nurses. TXCC supports nurse clinical decision-making by systematically assessing a Veteran’s symptoms, while providing reference health information (a 28,000-topic medical library used to provide patients with web-based patient instructions on diseases, tests, and medications) during the process. Moreover, TXCC guides the nurse through the medical history and creates a triage note, which is passed to the patient progress note in VA Health Connect (VAHC) Customer Relationship Management (CRM). The CRM solution records the

TriageXpert Contact Center SaaS Control Number: VA-25-00053023 License Subscriptions encounter in the VA medical record where it becomes immediately viewable by the provider.

The purpose of this action is to renew TXCC SaaS license subscriptions and related technical support to accommodate the continued use of VAHC CRM across all eighteen (18) VISNs, which includes a development environment, a production environment, technical support, application update, and nurse training sessions. The required TXCC SaaS license subscriptions and technical support are sold exclusively by DSHI. through one of its authorized resellers. The period of performance shall be six (6) months from the date of award, with one (1) three (3)-month option period. The total estimated value of this proposed action, inclusive of the option period, is .

4. Statutory Authority: Pursuant to Federal Acquisition Regulation (FAR) Subpart 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 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 market research, as described in Section 8 of this justification, and based on VA’s current use/experience with TXCC, it was determined that limited competition is available among authorized resellers of DSHI, specifically for TXCC SaaS license subscriptions and related technical support.

TXCC SaaS license subscriptions and related technical support were initially purchased in June 2021 to accommodate a pilot rollout implemented for nurse and nurse triage leads, taking place at VISN 8 and VISN 20, as both proof of concept and for priority COVID-19 response. TXCC was subsequently rolled out nationally across all VHA VISNs between 2021 and 2023. In 2024, a new DO was awarded for the continued support of TXCC software products and support to maintain operability.

On February 25, 2025, OI&T VES VRM awarded a DO for a new SaaS Triage Decision Support Tool to provide triage decision support and informational services to nurses providing direct patient support for Veterans through the VAHC CRM system at clinical call centers across the VA Enterprise. The new DO was awarded to Minburn Technology Group for the brand name, ClearTriage (CT). CT will replace TXCC at all VISNs. Staff in 16 of 18 VISNs, that will utilize the CT Decision Support Tool, must be trained and certified on how to properly operate the tool before they can successfully provide care for Veterans. Training plans must be scheduled and coordinated by management since the CT training requires nurses to take a specific course that will temporarily remove them from their work which interferes with the ability of the call centers to maintain workflows that involve processing 45 million calls annually. Until all clinical call center staff have been trained and certified to use CT in production, access to TXCC is required to prevent service disruption.

Only TXCC software meets the VA interoperability and compatibility requirements of connecting to both the CPRS and the VistA Imaging System, where updates are made directly into the patient’s electronic medical record. Nurses and Medical Service Assistants across the VA have been trained to use TXCC, so the implementation and integration of another decision support tool would require significant re-training of staff. The TXCC SaaS software has been in use across VHA VISNs since 2021. TXCC is integrated with VAHC CRM and is a component of the VAHC CRM solution. Specifically, TXCC software is a baseline commercial-off-the-shelf software that VHA clinical staff use to provide VHA nursing with a telephone liaison care management system commonly referred to in VHA as the VAHC CRM System. This VAHC CRM System is available across all VISNs following completion of a national rollout in 2023. TXCC is a proprietary software product owned by DSHI.; therefore, support for this product can only be provided by DSHI or one of its authorized resellers. Only these sources have access to DSHI’s proprietary source code, which is needed to support the TXCC software subscriptions and ensure all services provided are properly configured.

In addition, TXCC is used by the VA Office of Public Health for bio and syndromic surveillance. The data points captured by TXCC are used by the VA Office of Public Health to report seamlessly on year over year trends and use that uniform data structure for future predictions because the symptoms captured are used in predictive modeling (i.e., enables VA to predict upcoming hotspots for influenza outbreaks). TXCC’s syndromic (pre-diagnostic) data source, streaming from nurse interactions in the call center and in clinics, provide VA with a treasure trove of surveillance data.

The current workforce is trained and familiar with using TXCC. TXCC triage content has been written specific to VHA requirements and is currently the only triage support tool offering a one for one match for all medical classifications in VistA.

Having software that integrates with VistA and CPRS is critical so clinicians can access and evaluate a patient’s medical records during the triage process. Failure to access patient records would result in incomplete information with which to advise the patient, and this would have a significantly negative impact on the quality-of-care VA can offer to its Veterans, causing degradation of service and impacts to life-or-death situations, especially in emergency triage cases. During the transition, without the TXCC VAHC CRM solution, a Veteran being triaged might not be told to call 911 or be transferred to TeleUrgent Care when necessary, due to human error or lack of a triage tool, which could result in harm or death.

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. However, the undersigned VA technical representative determined that limited competition is available among authorized resellers for brand name DSHI subscriptions, as well as software maintenance and 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 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 Contracting Opportunities website and this justification will be made publicly available within 14 days of award.

7. Actions to Increase Competition: The period of performance of the newly awarded CT Triage Decision Support Tool contained a 12-month base period along with two 12-month option periods. Once the period of performance on the CT Triage Decision Support Tool is expired, any future actions are anticipated to be competed. The period of performance of this action will enable the Government to have a continued Triage Decision Support Tool and support without negatively impacting the care to our nation’s Veterans.

8. Market Research: Market research was performed for this action from March 2024 to February 2025. Specifically, the Government’s technical experts conducted internet-based market research, and three (3) triage decision support SaaS solutions were evaluated: TXCC, CareXM, and Microsoft Dynamics 365.

CareXM and Microsoft (MS) Dynamics 365 are additional solutions that were evaluated for suitability and is the primary factor used to assess the solutions described below as the Government requires that the decision support tool be readily compatible with the VistA and the CPRS.

CareXM offers a comprehensive triage system, including after-hours triage, clinical triage support, and centralized triage solutions, designed to improve patient care, reduce costs, and enhance staff efficiency for home health, hospice, and other healthcare providers. While CareXM offers a technology-driven, after-hours triage service, specific limitations include high volume bottleneck issues, a lack of continuous training options for nurses, and a significant level of interoperability infrastructure costs, which would be required to successfully integrate a third Decision Support Tool. Additionally, CareXM’s solution includes triage nurses; however, VHA already has triage nurses and because CareXM’s solution cannot not be separated from the nurses, CareXM would not be interoperable with the current CRM solution and would require significant development work to integrate with VAHC and VistA/CPRS.

MS Dynamics 365 provides a solution that contains an integrated suite of enterprise resource planning and customer relationship management applications with functions for customer service and triage options that are designed to help customer service teams understand the nature and urgency of incoming issues, allowing them to assign cases to the appropriate agents or teams and prioritize tasks. MS Dynamics 365 does not offer an out-of-the-box solution specific to clinical triage and would require significant custom development work to make it a suitable solution. Similarly to CareXM, MS Dynamics 365 would require initial setup and substantial customization.

In February 2025, VA’s technical experts conducted market research to ascertain the extent of competition among resellers of the required TXCC SaaS license subscriptions and related technical support. Through the use of the Provider Look-up tool on the NASA SEWP V GWAC website, three Service-Disabled Veteran-Owned Small Businesses (SDVOSB) were identified as resellers of the TXCC SaaS license subscriptions. Additionally, the Government’s technical experts submitted a Request for Information (RFI) on NASA SEWP for the brand name TXCC Triage Decision Support Tool in February 2025. Despite identifying multiple SDVOSB resellers, only a single response from IronBow Technologies (large business) was received. This response was reviewed and found to be technically acceptable.

The Contract Specialist conducted additional market research in March 2025 by utilizing the NASA SEWP V GWAC Market Research Tool by searching for the provider listed within the Product Description. The search revealed that there are four (4) NASA SEWP V SDVOSB contract holders that are resellers for the brand name TXCC SaaS license subscriptions and related technical support.

Furthermore, NASA SEWP has a dynamic catalog where line items can be added based on customer requests provided the required item or service is within the scope of the NASA SEWP V contract suite; therefore, additional competition may be achieved.

Based on the information detailed above, there is a reasonable expectation that competition exists on the NASA SEWP V GWAC within SDVOSBs for the brand name TXCC SaaS license subscriptions. Therefore, given that there is a reasonable expectation of competition between at least two (2) capable SDVOSBs, it has been determined by the Contracting Officer that the subject Request for Quote (RFQ) will be released as an SDVOSB set-aside under the existing NASA SEWP V contract vehicle, under the Value-Added Reseller NAICS code 541519.

9. Other Facts: None.

10. Technical/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.

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 limited competition. Additionally, NASA SEWP V has already determined the prices on contract to be fair and reasonable and more competitive pricing may result from competition. Finally, the successful quote may be compared with the Independent Government Cost Estimate.

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

Approval

In my role as procuring activity Advocate for Competition, based on the foregoing justification, I hereby approve the acquisition for the brand name TXCC SaaS license subscriptions and related 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 services herein described have otherwise been authorized for acquisition.