eHR Questions Answers.docx

DHS ICE EHR

Questions RFI-121064-SB / RFI - FY26-DHS-ICE-eHR

1. The page limit is noted as 30 pages. As there are only 6 questions in this RFI, is the Government expecting a 30-page response? Or was this large page limit an error?

a. Reference Document-NITAAC Cover Letter

b. Reference Paragraph-Instructions IHSC Response: The government requests responses be limited to 30 pages. Vendors are not required to submit a 30-page response if they don’t feel it’s necessary.

2. Does the Government intend to award this contract via CIO-SP3 Small Business?

IHSC Response: The government is evaluating potential contract vehicles to include CIO-SP3 as part of ongoing market research.

3. Can you provide the features required to provide a "comprehensive modernized EHR system"?

IHSC Response: A comprehensive, modernized electronic health record (EHR) system for IHSC will be designed to streamline the management of patient information, enhance the quality of care, and improve operational efficiency within healthcare settings. In addition to requirements outlined in the Performance Work Statement (PWS), additional system features should include:

· Interoperability: The ability to seamlessly exchange and use information across different healthcare systems and providers, ensuring that patient data is accessible wherever and whenever needed.

· User-Friendly Interface: An intuitive and easy-to-navigate interface that reduces the learning curve for healthcare providers and minimizes the risk of errors.

· Comprehensive Patient Records: Detailed records that include medical history, diagnoses, dental and behavioral health care, medications, treatment plans, immunization dates, allergies, radiology images, laboratory test results, referrals, consents and refusals.

· Real-Time Data Access: Immediate access to up-to-date patient information, enabling healthcare providers to make informed decisions quickly.

· Advanced Security Measures: Robust security protocols to protect patient data from unauthorized access, including encryption, multi-factor authentication, and regular security audits.

· Clinical Decision Support Tools: Integrated clinical decision support systems (CDSS) that provide evidence-based recommendations, alerts for potential drug interactions, and reminders for preventive care.

· Referral Management: This feature allows IHSC and non-IHSC facility providers to efficiently submit, manage, and track patient referrals to specialists or external healthcare providers (this includes durable medical equipment, ground and air ambulance). It ensures that all necessary information is communicated, the referral is reviewed and adjudicated (approved, rejected, cancelled), and that follow-up appointments are scheduled and monitored.

· Diagnostic Imaging Viewing and Storage: This feature provides the ability to view and store diagnostic images such as X-rays (dental and medical) and ultrasound scans within the EHR system. It ensures that images are easily accessible to authorized healthcare providers for review and diagnosis.

· Dental Services: The dental services module manages dental records, treatment plans, and procedures for patients. It includes features for scheduling dental appointments, recording dental histories, and documenting treatments and outcomes to include odontograms.

· Medication Administration Records (MAR): MAR tracks the administration of medications to patients, ensuring accurate and timely delivery of prescribed drugs. It includes features for recording dosages, administration times, and any missed or refused doses.

· End-to-End Pharmacy Management: This comprehensive feature manages the entire medication lifecycle, from prescribing and dispensing to inventory management and reporting. It ensures that medications are available when needed and helps prevent errors in medication administration.

· Diagnostic Lab Management: This feature handles the ordering, tracking, and results reporting of laboratory tests. It ensures that lab orders are processed efficiently, results are accurately recorded in the EHR, and providers are notified of critical findings.

· Telehealth: Telehealth capabilities enable remote consultations between inmates and healthcare providers, reducing the need for physical transportation to external medical facilities. This feature supports video conferencing, secure messaging, and remote monitoring

· Remote and Offline Accessibility: Enabling healthcare providers to access patient information and update records while working remotely. Or during special operations such as air operations, when unable to connect to the ICE network, the record syncs when network connectivity restores.

· Analytics and Reporting: Tools for data analysis and reporting that help healthcare organizations track performance metrics, identify trends, and improve patient outcomes.

· Customization and Scalability: The ability to customize the system to meet the specific needs of the correctional environment/agency requirements and scale as the organization grows.

· Integration with Other Systems: Seamless integration with other systems such the jail management system, radiology and laboratory vendors.

· Multi-Module Software: Provides integrated pharmacy, dental, referral, billing, and scheduling, modules.

· Compliance with Regulations: Adherence to relevant healthcare regulations and standards, such as HIPAA (Health Insurance Portability and Accountability Act) in the United States and is FedRAMP certified.

4. Is it acceptable to submit as a team with an EHR vendor providing the system and the implementation, O&M provided by an IT services provider?

IHSC Response: It is acceptable to submit a proposal as a team with an EHR vendor and a separate IT services provider, provided that the vendor understands the following:

· The prime should clearly delineate the roles and responsibilities of both the EHR vendor and the IT services provider. This includes specifying who will be responsible for system implementation, integration, operations, maintenance, and support.

· The prime should provide a robust coordination and communication plan to ensure seamless collaboration between the EHR vendor and the IT services provider. This plan should address how potential issues will be managed and resolved efficiently.

· Both parties must demonstrate a commitment to accountability and provide assurances that they will work together to meet the project's objectives and timelines. This includes establishing clear points of contact and escalation procedures.

· The prime must ensure that all activities related to the EHR system, including implementation and O&M, comply with relevant federal regulations, security standards, and best practices. This is critical to safeguarding sensitive health information and maintaining system integrity.

· Both the EHR vendor and the IT services provider should have a proven track record of successfully delivering similar projects. The prime should include evidence of past performance and relevant qualifications.

· IHSC encourages innovative approaches that enhance service delivery and improve outcomes for our stakeholders.

Regarding the billing requirements mentioned in the RFI, please provide more details about:

5. The expected volume of external medical service referrals IHSC Response: On average 2,224 referrals are submitted weekly. This includes referrals submitted from non-IHSC sites.

6. The process for managing and onboarding service providers outside of your primary facilities IHSC Response: Outside/community service providers to whom IHSC refers patients are credentialed and tracked in a separate credentialing system (outside the EHR) to ensure compliance and visibility. They are not onboarded into our EHR system, as they do not enter clinical notes or directly utilize our internal systems.

7. The claims processing workflow for patient services rendered by external clinics or pharmacies IHSC Response:

· External pharmacies will receive a benefits letter in addition to the prescription. Script Care processes/approves routine claims. IHSC pharmacy leadership will review and send approval to the VA to pay for the medications. If medication is not approved, then the claim is not processed, and pharmacy does not fill the order.

· IHSC utilizes a 3rd party for reimbursement. IHSC staffed facilities submit referrals in the current EHR. Non-IHSC staffed facilities submit referrals in the Medical Payment Authorization Request (MedPAR), that are adjudicated in the current EHR. MedPAR is the system IHSC uses to authorize and manage payments for essential healthcare services provided to individuals in ICE detention by external providers and facilities.

· Once a referral has been approved and the patient has been seen by the referred provider, the referred provider submits the claim with the authorization number given by the approving entity (IHSC). The claims will be submitted to the 3rd party for reimbursement with all required data fields and approval language so there is close to 100% match with the 3rd party reimbursement.

Other questions:

8. Does the current solution integrate services from 3rd parties for reimbursement processes (medical coding, billing, prior authorizations, referrals, etc.)? If YES, how many solutions are in use currently and is support of these integrations a requirement for the future solution, or is the aim to include medical coding and billing capabilities within the new solution only? (3.1.1.4) IHSC Response: The current EHR does not include built-in medical coding or billing functionalities, and we do not use internal coders. Instead, we have relied on a separate third-party reimbursement process. Referrals are created and approved internally using our custom-built workflows. We anticipate that the reimbursement process in the future solution will remain a similar process. Comment by Willis-Marsh, Jeanean: May want to clarify to say that the referrals are created and approved in MedPar, a separate, customized module integrated into the EHR

9. How many records are expected to be ingested by the new solution? (3.1.3.1) IHSC Response: To date there are approximately 15,310,000 encounters in the current EHR. The government estimates approximately 1.25 million medical encounters annually, or 3,500 encounters/day.

10. What are your specific security requirements (e.g., encryption standards, access controls, audit logging)?

IHSC Response: The EHR system must comply with all federal security requirements, including but not limited to Federal Information Security Modernization Act, moderate baseline controls, and FedRAMP Moderate or High authorization. The system must support role-based access controls, multi-factor authentication, data encryption in transit and at rest, audit logging, and integration with DHS identify and access management systems. Compliance with HIPAA and 42 CFR Part 2 is also required, given the handling of protected health and substance use information.

11. What are the primary pain points or limitations with the current system that have led to this RFI process?

IHSC Response: The government currently uses multiple applications that are not seamlessly integrated into our current EHR. This configuration has significantly increased the burden of documenting encounters for our clinicians.

12. Can you describe key clinical and pharmacy workflows that the system needs to support? Are there any highly customized workflows that you anticipate requiring?

IHSC Response: We are looking for an EHR system that includes a fully integrated pharmacy module that supports end-to-end medication management, including prescribing, dispensing, inventory control, medication reconciliation, and drug interaction checks. It should ensure compliance with formulary standards, enhance patient safety, and provide real-time data for clinical decision support and supply chain management.

Because the majority of ICE medical facilities (IHSC) have a pharmacy within the clinic, we want a system that provides comprehensive inventory management, supporting streamlined replenishment of stock while preventing excess/expired medications.

Clinical workflows will require an Intake workflow and transfer/discharge workflow.

13. What is the anticipated implementation timeline? Are there any critical milestones or deadlines?

IHSC Response: The government anticipates an implementation plan over a period of four years.

14. What are your expectations for end-user training?

IHSC Response: The vendor will develop IHSC specific training materials to include creating user guides, computer based trainings (CBT's), and lead training for end-users. The roll-out at each site should include in-person training. Training should be provided to all staff with each new upgrade or build so users are aware of the changes and the user guides/CBT's should incorporate the new changes.

15. Does the procuring agency have any long-term technology plans that would potentially integrate with or impact the proposed solution?

IHSC Response: The agency has long-term technology plans that may impact the proposed solution. These include broader efforts to modernize health IT infrastructure across the Department, enhance interoperability with internal DHS systems , and support integration with external federal partners. The proposed EHR solution should be flexible, standards-based (e.g. HL7 FHIR), and capable for scaling or integrating with future systems related to credentialing, claims management, and data analytics. Vendors should anticipate alignment with these strategic priorities to support long-term system sustainability and interoperability.

16. Is there a target budget range for this project for when it reaches the RFP stage?

IHSC Response: There is no target budget. We encourage vendors to provide detailed cost estimates based on their proposed solutions and to ensure that their proposals are comprehensive and competitive.

17. Does ICE plan on using the direct manufacturer vendor or consulting?

IHSC Response: At this time the government is considering all options to ensure the successful implementation of a correctional EHR. This includes evaluating both direct EHR manufacturers and consulting firms that can provide comprehensive solutions. The decision will be based on the ability to meet the specific needs and requirements outlined in the PWS, as well as the overall value and effectiveness of the proposed solutions.

18. When is the RFP planned to be released?

IHSC Response: The release of the RFP is subject to funding.

19. Could you please clarify the anticipated procurement vehicle for this engagement (e.g., GSA Schedule, state contract, or other competitive solicitation method?

IHSC Response: Contract vehicles continue to be assessed for feasibility

20. Could you please specify the scope and types of data, including historical data, that would require migration from the existing eCW system?

IHSC Response: IHSC anticipates @ 1.6 TB of data will need to be migrated to the new system. The data includes medical and dental records, lab results, diagnostic imaging, medication records, and possibly referrals for medical services.

21. Please elaborate on the referral management function described in the RFI.

IHSC Response: Utilization management should support end to end tracking and approval of referrals and specialty services. This includes configurable workflows for medical necessity review, prior authorization, and documentation of clinical justification. The system should enable secure communication between providers, case managers, and administrative reviewers, with audit trails and reporting to monitor timeliness, appropriateness, and outcomes of referred care. Integration with claims and scheduling modules is preferred to ensure continuity, cost control and compliance with agency and payer requirements.

22. Please elaborate on the medical claims processing and medical payments functionalities cited in this RFI. Are these related to Medicaid 1115b, or something else? What is the anticipated workflow for this functionality?

IHSC Response: We utilize a 3rd party for reimbursement, and is not related to Medicaid 1115b. Once a referral has been approved and the patient has been seen by the referred provider, the referred provider submits the claim with the authorization number given by the approving entity (which will be IHSC). The claims will be submitted to the 3rd party for reimbursement with all required data fields and approval language so there is close to 100% match with the 3rd party reimbursement.

23. Are you currently using telehealth and, if yes, through which method?

IHSC Response: Currently, telehealth is utilized with internal IHSC provider(s) at a location other than where the detainee is located utilizing ICE MS Teams. Telehealth equipment is also available to send images/sounds to a remote IHSC provider at a different location from where the detainee is located, utilizing equipment specific software at this time.

24. Can you please elaborate on the mobile care functionalities requested in the RFI?

IHSC Response: Mobile care is similar to care being provided inside the clinic with the exception that it is provided outside in a patient housing unit, segregation unit, recreation area, anywhere outside of the Medical Unit to include in flight on a plane. The provider should be able to access the patient record and document in the patient record when/if needed.

25. ICE notes in the RFI that it seeks a correctional EHR. To that end, what percentage of any given vendor's client base should be correctional clients for the purposes of this RFI?

IHSC Response: The government does not have a required percentage of a vendor's client base that should be correctional clients for the purposes of this RFI.

26. What is ICE's preferred web browser?

IHSC Response: EDGE and Google Chrome

27. Please confirm that ICE seeks a solution that will be cloud hosted by the vendor.

IHSC Response: Vendors may propose to host the solution on their cloud as long as it is FedRamp certified. Currently, if the vendor is not FedRamp certified, the solution must be hosted on the ICE cloud.