RFI 25-0046 Radiology Picture Archiving System - FINAL.pdf

State of Colorado

Colorado Department of Correction

04/23/25

RFI #2025000046

Radiology Picture Archiving and Communication System

(PACS)

Sole Point of Contact for this Request for Information (RFI) is:

Sheila Lucero – Purchasing Manager (sheila.lucero@state.co.us)

Please do not contact any other CDOC employee.

Offerors are urged to read the solicitation document and attachments thoroughly before submitting requested information.

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1. REQUEST FOR INFORMATION

Market Research Only

This is a Request for Information (RFI) and is intended only for market research purposes. In accordance with §24-103-201.5, C.R.S. and the associated Colorado Procurement Rules, this is not a solicitation. No award will result from any response to any vendor responding to this RFI. This RFI is considered formal market research for the purposes of §24-37-302(1) (a.5), C.R.S., if applicable.

Confidentiality

i. All responses to this RFI shall be considered confidential until after an award based on a subsequent solicitation has been made or until the procurement official from the issuing agency determines that the state will not pursue a solicitation based on this RFI.

After such time, the responses to this RFI shall be open to public inspection in accordance with the provisions of the Colorado Open Records Act. Reference §24-103- 201.5(4), C.R.S.

ii. The State reserves the right to have information submitted in response to this RFI be reviewed by other entities within the State for purposes of compiling and analyzing possible options.

Introduction

On behalf of the State of Colorado, Colorado Department of Corrections (CDOC) is issuing this RFI for a Radiology Picture Archiving and Communication System.

Background, Overviews and Goals

The current image review and archive system, Merge eFilm is that the end-of-life and poses risks such as data loss and lack of support. A new archiving system will provide benefits such as improved access, workflow, and data security. CDOC Clinical Services Unit is seeking information from other companies or manufactures that supply and support radiological picture imaging storage and communication systems for image migration. The information collected from this RFI will be used to develop a scope of work/goods and publish a future solicitation that will meet all of the department’s needs.

Schedule of Activities

i. This Schedule of Activities is for information and planning purposes only. Schedules for Activities listed as “Estimated” may be subject to change depending on the needs of the State. All times are stated in Mountain Time (MT), as appropriately adjusted for daylight savings.

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Activity Date

RFI Published via Colorado VSS, https://www.colorado.gov/vss and bidnetdirect.com//cdoc

April 24, 2025

Response Submission Deadline

Responses must be submitted in the method described below

May 8, 2025 @ 3:00 pm

2. RESPONSE SUBMISSION INFORMATION

Offerors are asked to submit responses via Bidnetdirect.com//cdoc. The response submission should include the subject line: “Response submission from (insert Offeror’s name) for RFI 2025000046 for Radiology Archiving and Communication Systems (PACS).

This RFI is posted on Colorado VSS and Bidnetdirect.com//cdoc. Please submit your RFI and attachments electronically to bidnetdirect.com//cdoc. No other electronic submission methods, hard copy submittals, or emails will be accepted. Responses should be included as one or more attachments of commonly accessible file types.

Desired Response Format and Content

i. Submit information, product description, and service specifications as an attachment in Bidnet direct. We are not accepting proposals or bids at this time.

3. GLOSSARY OF ACRONYMS, ABBREVIATIONS AND DEFINITIONS

AGFA CR means a computed radiography system; AGFA is the company that develops and manufacture’s imaging systems, CDOC uses the system for digital x-ray images; allows you to view the image.

ABMRA GATEWAY means the gateway that connects CDOC to radiology imaging associate (ria) via encryption to protect medical image data transmitted through its platform, ensuring compliance with HIPAA regulations and other healthcare privacy standards; all data transfer between the AMBRA Gateway and the cloud is encrypted, making it a secure way to share medical images between health care providers.

CDOC means Colorado Department of Corrections or State.

CHP means Correctional Health Partners CJI means criminal justice information collected by criminal justice agencies needed for the performance of their authorized functions, including, without limitations all information defined as criminal justice information by the U.S. Department of adjustment, Federal Bureau of Investigation, Criminal Justice Information Services Security Policy, as amended and all Criminal Justice Records as defined under C.R.S. 24-72-302.

CR means computer radiography, a digital imaging technique that uses a special x-ray sensitive plate to capture x-ray images. The equipment used is on an AGFA CR workstation.

DICOM means digital imaging communications and medicine.

DTC means Denver Technology center.

EOMIS means electronic offender management information system.

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HIPAA means health insurance portability and accountability act.

HSA means health services administrator MWL means modality worklist; is an electronic list used in medical imagining to streamline and automate the workflow of imaging procedures. It provides imaging modalities like MRI, CT, X-ray, and ultrasound systems with essential information about scheduled imaging procedures and patient details. Here are some key points about modality worklists:

ii. Patient Information: includes patient demographics such as name, date of birth, and medical record number.

iii. Procedure Details: Lists the specific imaging procedure to be performed, including the type of exam and any relevant clinical information.

iv. Workflow Efficiency: Helps reduce manual data entry errors and improves the efficiency of imaging equipment and operators.

v. Modality Worklists: are part of the DICOM standard, which ensures interoperability between different medical imaging devices and systems.

Offender means a member of the CDOC inmate population (including YOS).

PACS means picture archiving and communication system PHI means any protected health information, including, without limitation any information whether oral or recorded in any form or medium: (i) that relates to the past, present, or future physical or mental condition of any individual; the provision of health care to an individual;

or the past, present or future payment for the provision of health care to an individual; and

(ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information defined as individually identifiable health information by the federal health insurance portability and accountability act.

PII means personally identifiable information including, without limitation, any information maintained by the state about an individual that can be used to distinguish or trace an individual, such as medical, educational, financial, and employment information. PII includes, but is not limited to, all information defined as personally identifiable information in C.R.S. §24-73-101.

RIA means radiology imaging associates.

State Confidential Information means any state records not subject to disclosure under

CORA State confidential information shall include, but is not limited to, PII, PHI, PCI, tax information, CJI, and state personnel records not subject to disclosure under CORA. State confidential information shall not include information or data concerning individuals that is not deemed confidential but nevertheless belongs to the state, which has been communicated, furnished, or disclosed by the state to contractor which (i) is subject to disclosure pursuant to CORA; (ii) is already known to contractor without restrictions at the time of its disclosure to contractor; (iii) is or subsequently becomes publicly available without breach or any obligation owed by contractor to the state; (iv) is disclosed to contractor, without confidentiality obligations, by a third party who has the right to disclose such information; or

(v) was independently developed without reliance on any state confidential information.

VSS means the state of Colorado’s vendor self-service system website located at www.colorado.gov/vss. All solicitations published by state agencies and institutions are published on VSS, unless specific entities have been granted to opt out of the program.

Vendors have access to this website.

4. PROGRAM OVERVIEW

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This Request for Information (RFI) will be used to identify other potential solutions, create a scope of work for a future solicitation, and learn about alternative products that could support our needs and goals. The current ‘Picture Archiving and Communication System’(PACS) is no longer supported and will either need to be replaced or an alternative system must be implemented.

Currently, Medical Imaging Technologies/Radsource provides CDOC with X-Ray merge eFilm storage. The CDOC radiology department was informed at the start of fiscal year 2024 that the ‘Merge eFilm application’ utilized at nine (9) locations throughout the state to store X-rays (eFilm program) has reached end-of-life support. No further assistance will be provided nor has it been available since June 30, 2022. There are around 10,000 X-rays performed per year. As the diagram below shows CDOC reviews the image but has an overread server do the radiology review and reporting.

Medical Imaging Technologies/Radsource suggested that eFilm consumers immediately choose another reading source as the system is no longer supported. CDOC has some locations with a real possibility of running out of room to store X-rays, updates, or support without a new PACS system. Current licenses are no long valid and the system version is unsupported. CDOC is having to send patients out into the public for required care, which is costly and not always the best for the patient who could have been seen on-site.

The CDOC Radiology department is at risk if something happens to the application Merge eFilm because there will be no more product development or security improvements, no assistance with the eFilm support such as data/study migration, and no ability to get a replacement license key for hardware failures from operating system installations.

If CDOC needs to reinstall eFilm on the workstation software due to hardware failure, the vendor cannot provide the software fixes because it is at the end-of-life support. The eFilm eStore will be unavailable for license creation and other functions.

As-is Process of CDOC Radiology Interfacing with Radiology Provider

i. Radiology enters patient data into the AFGA computed Radiography (CR) Workstation.

a. This computer is used to process the X-ray images.

b. Computed Radiography is a digital imaging technique that uses a phosphor plate to capture the X-ray images instead of film.

ii. The X-ray is taken and the imaging plate is entered into the AFGA CR Workstation processor.

a. The processor uses a laser beam that scans the plate, causing the electrons trapped in the phosphor to emit blue fluorescent light, a photomultiplier tube converts the light into electric signals, and then the software on the AFGA CR Workstation processes the signals to create a digital image.

iii. Once the exam is completed, the staff press the send button.

a. This sends over the images taken to the local X-ray storage computers (eFilm) at each of the nine facilities.

b. The two computers communicate with each other using their specific IP addresses.

c. Each Agfa CR Workstation was set up that way within their settings.

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iv. The images go to the local computer at each of the nine facilities where an X-ray is available.

a. The staff can only view the X-rays taken at the facility the staff is working from by using the program eFilm

v. Once the images are received on this computer, it is set up for the images to be auto-routed and sent out to CDOC’s radiology reading group, Radiology Imaging Associates

(RIA).

a. A gateway called ‘AMBRA Gateway’ connects CDOC to Radiology Imaging Associates via a downloaded application on each of the nine computers, with the computers' specific gateway IDs.

(a) It is sent with encryption, but this needs to be researched more

(b) This is a link to a one-page summary of the AMBRA gateway.

(c) Diagram of AMBRA gateway https://ambra-hosted.s3.amazonaws.com/CCF_ImageShareGateway_v2.pdf

(d) Within the settings and properties of eFilm, CDOC Radiology is connected to an overread vendor supplying Radiology services by using their IP address/port # to allow the images to be auto-routed in a Digital Imaging and Communications in Medicine (DICOM) format (has imagery and metadata).

vi. Once images are auto-routed to the radiology overread server, CDOC Radiology must use its ‘online tech portal’ to enter exam notes.

a. The included data is from the exam, the reason for the exam, and who is the referring physician. (priority is entered).

b. Once the exam data is on the CDOC online portal page, an RIA’s radiologist has access to interpret it.

c. CDOC Radiology must wait for the exam to be read by RIA.

vii. Once it has been read, CDOC Radiology downloads the PDF of the results and enters them into the patient's chart via the electronic health records (EHR) system called ‘eOMIS’. DOC Radiology does not have or use a modality worklist (MWL) because eOMIS doesn't communicate with our radiology computers.

viii. Once CDOC Radiology enters the PDF of the results, the referring physician from the order will be notified that the results are ready to be reviewed.

As-is Diagram Process Description

This description outlines the X-ray steps taken after the new solution is implemented.

i. An X-ray is taken.

a. There are nine (9) X-ray sites throughout CDOC.

b. Each has its own Gateway ID for access to Radiology Imaging Associates (RIA).

ii. The X-ray is processed at the facility's AGFA CR Workstation.

iii. Digital Imaging, Communications, and Medicine (DICOM) Image

iv. The New Solution will replace the ‘4a’, 4b’, and ‘4c’ parts of the ‘As-Is’ process.

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a. The X-ray is stored on a local personal computer (PC) using the eFilm application.

b. There is an automated process for the DICOM Format file.

c. There is an AMBRA Gateway between CDOC and RIA.

v. Once images are auto-routed to the RIA server (Denver Technology Center), CDOC Radiology must use its online tech portal to enter exam notes. Mark status

COMPLETE.

a. RIA

b. Tech Portal

c. Exam Reviewed

vi. The results are downloaded to a PDF.

vii. eOMIS HealthCare Management

a. The radiology staff manually enters the results into patients' charts on the CDOC’s electronic health record (EHR) system.

As-Is Process Diagram – Business Flow-Radiology Department

The diagram below shows the steps and X-ray takes. The gold highlighted area will be modified by the new solution.

Appendix for the As-Is Diagram

RIA – Overread Vendor

DTC – Denver Technology Center eOMIS – Electronic Offender Management Information System

AGFA CR-AGFA – This is the name of the software used to process images daily.

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CR – Computer Radiography. A digital imaging technique that uses a special X-ray sensitive plate to capture X-ray images. The equipment used is on an AGFA CT Workstation.

DICOM – Digital Imaging Communications and Medicine.

To-Be Process

Once the new vendor system is up and running with the new PACS, the CDOC Radiology setup must be the same as before.

i. The CDOC Radiology department should have a gateway connection to the overread vendor system.

ii. The new vendor must set up the radiology department with CDOC’s radiology reading group overread vendor.

a. The vendor must go into the ‘PACS program property setting’ and set it to continue to auto-route the images once the images are received on the PACS program and then set it to send these out to RIA.

b. The vendor must fill in the setting on the route name to “Ambra Gateway”.

(a) if the files are compressed “no”

(b) the device type is “DICOM”, and

(c) The device's name is “Ambra Gateway”.

c. This is how Radiology is set up on the current program running “eFilm”.

To-Be Diagram Process Description

The description and diagram below should be used to understand the steps an X-ray will take after the new solution is implemented.

i. An X-ray is taken.

a. There are nine (9) X-ray sites throughout CDOC.

b. Each site has its own Gateway ID for access to Radiology Imaging Associates

(RIA).

ii. The X-ray is processed at the facility's AGFA CR Workstation.

iii. Digital Imaging, Communications, and Medicine (DICOM) Image

iv. The New Solution will replace these three parts of the process The New Solution will replace these three parts of the process.

a. The X-ray is stored on a local personal computer (PC) using the eFilm application.

b. There is an automated process for the DICOM Format file.

c. There is an AMBRA Gateway between CDOC and RIA.

v. Once images are auto-routed to the RIA server (Denver Technology Center), CDOC Radiology must use its online tech portal to enter exam notes from the exam review.

Mark status COMPLETE.

a. RIA

b. Tech Portal

c. Exam Review

vi. The results are downloaded to a PDF.

vii. eOmis Healthcare Management

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a. The radiology staff manually enters the results into patients' charts on the CDOC’s electronic health record (EHR) system.

viii. See a visual of the ‘Business Flow for Radiology PACS’ below.

ix. Challenge Awareness

a. Getting the new PACS successfully connected to the overread vendor.

b. Data migration to the new PACS

c. Setting up the Agfa Workstations so that once DOC radiologists are done taking

X-ray images, the images successfully cross over to the new PACS, and the images are stored securely.

Benefits of a new PACS

Instead of the existing setup where CDOC Radiologists can only view images at the specific location where they were taken from, using a PACS System, the staff could access patient information or medical images from any CDOC facility and review the most up-to-date scans and reports almost instantly.

Unlike film-based storage, PACS would reduce the staff time needed to retrieve, distribute, or display a medical image. Using digital imaging technologies like PACS provides clinicians with immediate access to older scans and reports and more up-to-date patient medical data. Expedited patient care will allow for improved care because PACS software can communicate patient information electronically.

There would no longer be a need to manually file, store, or retrieve images or other patient data because that information could be securely stored digitally on-premises or in the cloud.

Improving the workflow with additional tools will empower doctors to enhance the process of formulating a diagnosis and the patient's treatment plan. Automating this process for

RFI 2025000046 Page 9 of 12 sending and receiving data and results to the provider from CDOC and back to CDOC would eliminate the chance of errors.

5. PROGRAM OBJECTIVES

To update the outdated radiology equipment and practices by replacing or upgrading X-ray software and support infrastructure with modern digital models and implanting streamlined workflows for X-ray delivery.

i. Replace the legacy system for the radiology image and routing.

a. Success Criteria: CDOC radiology will have additional storage to save patient images by implementing a PACS, and this would eliminate concerns about a workstation malfunctioning.

(a) Instead of only having the images taken and viewed at one specific facility, CDOC Radiology would have access to view all patient images at any one of the clinical workstations. Refraining from repeating X-rays would be safer for the patient’s health and efficiently allow for images to be more readily available for review.

ii. Consideration of other medical devices such as sonograms.

iii. Integrating with EOMIS.

Business Requirements:

The work involves AGFA Musica version NX 22.00 installed on nine Computer Radiography (CR) workstations at CDOC. This is where X-ray images from this app are processed. This system crosses over to the application to store the X-ray eFilm. eFilm Workstation with Modules can be used to communicate, process, and display medical images. Users have access to various image processing and measurement tools to assist them in viewing images

i. Ensure compatibility with the current CDOC hardware at the nine locations with the new PAC system.

ii. Ensure software compatibility with external CDOC providers.

a. The X-rays would send the image to an external contracted provider using the

CDOC VPN.

b. There is one company used now called Radiology Images, but more companies could be added in the future.

iii. Identify the X-ray machines by model numbers, year, and manufacturer. Note: The nine X-ray machines are at least eight years old with the last upgrade in 2016.

iv. Ability to migrate CDOC’s current studies by the new PACS system from the eFilm

Workstation version 4.3, installed on all nine eFilm workstations.

v. Convert existing legacy eFilm images and data to be compatible with the vendor PAC system.

a. The PACS vendor may need to migrate data using a hard drive containing the

CDOC eFilm which is no longer supported.

vi. Configure the new solution to run on the internal network.

a. Non-network, there should be no access to the CDOC site and system.

vii. Provide image archiving, image management, and visualization tools by the vendor.

a. Determine how many years to hold about 3 Terabytes of data.

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b. For medical files, the data must be stored for ten (10) years but it may be different based on the offender’s release date.

viii. Require the vendor to make the images and data viewable from any location.

ix. Require the vendor to upgrade existing or provide integrated display workstations

(WS).

x. Require the vendor to include operational maintenance and 24/7 on-call system support.

a. The vendor should define the Disaster Recovery services provided.

xi. Require the vendor to provide optimal storage options (server, or cloud) based on customer preference.

xii. Require OIT-CDOC and the vendor to ensure agency security requirements are addressed.

Vendor Requirements

xiii. Product or system’s ability to meet requirements as listed

xiv. Cloud or Server Architecture (Cloud Preferred, both are options)

xv. References. (Corrections or State Hospital systems preferred)

xvi. Total Year 1 Costs

a. Setup Costs

b. Hosting/Licensing

c. Gateway Costs

xvii. Total Year 2-5 Costs

xviii. Image Migration Costs

xix. Number of exams included in that if applies (At lease 7,500/year)

xx. Any additional costs such as hosting or server/database software costs

6. GENERAL ADMINISTRATIVE INFORMATION

Colorado Vendor Self Service

i. This solicitation is being published on Colorado Vendor Self Service (Colorado VSS) and BidnetDirect.com//cdoc, so that Offerors who have an interest may submit the requested information to BidnetDirect.com//cdoc in accordance with the terms of this solicitation.

ii. Offerors can self-register for Colorado VSS and BidnetDirect.com free of charge. On Colorado VSS click on “Public Access” on the website to view solicitation documents and modifications without registering. Offerors are encouraged but not required to register prior to or at the time they submit their response. The State also recommends that interested Offerors check Colorado VSS and BidnetDirect.com//cdoc on a regular basis throughout this solicitation process.

News Releases and Announcements

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Offerors shall not issue any news releases, communications or announcements of any kind pertaining to this solicitation, without prior written approval by the State.

Response Material Ownership

All material submitted in response to this RFI becomes the property of the State.

Submission of Pricing information

In order to assist the state in gathering information, this RFI may request that Offerors submit pricing information. Submission of pricing information is not mandatory and such information may be voluntarily included in a response.

Submission of Confidential or Proprietary Information

i. As per §24-103-201.5, C.R.S, all responses to requests for information are confidential until after an award based on a subsequent solicitation has been made or until the procurement official determines that the state will not pursue a solicitation based on the RFI. After such time, the responses to an RFI shall be open to public inspection in accordance with the provisions of the “Colorado Open Records Act”, part 2 of the article 72 of this title 24.

ii. An Offeror may submit, as a part of its Response, a written request for classification of certain portions of the response as a trade secret or other confidential or proprietary information. Material for which the Offeror is requesting confidentiality shall be readily identifiable and separated from other portions of the response to facilitate public inspection of the non-confidential portion of the response. Commingling of confidential and non-confidential information is not acceptable. Neither price information nor any information that will be included in a resulting Contract or purchase order will be considered confidential.

iii. The Offeror must include the rationale for any request to classify portions as a trade secret or confidential or proprietary, including references to the authority that allows for such treatment.

iv. A complete redacted response should also be included along with an unredacted Response and confidentiality justification.

v. Except as provided in Section 1.2 above, in no event shall an entire response be classified as confidential. The Procurement Official or his or her designee shall determine if the information identified in the Offeror’s request is exempt from disclosure in accordance with §24-72-204, C.R.S., and shall inform the Offeror in writing of his or her determination. If the Offeror does not agree with the determination, the Offeror may protest the determination in accordance with article 109 of the Colorado Procurement Code and the terms of this solicitation. Reference Procurement Rule R-24-101-401-03.

Vendor Assistance

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Any Offerors needing support responding to solicitations may contact the Colorado Supplier Diversity Navigator at the Statewide Equity Office of Supplier Diversity. Services provided include assistance with responding to solicitations, interpretation of solicitation documents, technical assistance referrals, availability of resources, and bond assistance through the Construction Statewide Bond Assistance Program. The office can be reached during normal business hours by calling 303-866-5765 or emailing DPA_SupplierDiversityHelp@state.co.us.