S03_JA_ClearTriage_VISN 4 and 12_Final_Fully Signed_Redacted.pdf

CONTROL NUMBER VA-25-00012991

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: The proposed sole source action is for a firm-fixed price purchase order for the renewal of brand name ClearTriage (CT) Decision Support Tool licenses and support for the VA Veterans Integrated Services Networks (VISN) 4 and

12. The proposed contractor is Minburn Technology Group, Inc, 9716 Arnon Chapel Road, Great Falls, Virginia, 22066.

3. Description of Supplies or Services: The mission of the VA, Office of Information and Technology, Veterans Experience Services, Veterans Relationship Management is to provide benefits and services to Veterans of the United States by providing supportive Information Management/Information Technology systems. To meet organization goals, the Veteran Health Administration (VHA) has a requirement for the renewal of brand name CT Decision Support Tool licenses and support which is currently in use by VHA VISNs 4 and 12 sites by telecare staff to provide telephone triage and informational services to Veterans. The period of performance shall be one, three-month base period and one, one-month option period. The total estimated value of the proposed action is inclusive of the option period.

4. Statutory Authority: The statutory authority permitting other than full and open competition for this acquisition is 41 U.S.C. 3304(a)(5), “Authorized or Required by Statute”, as implemented by Federal Acquisition Regulation (FAR) 6.302-5. For this action, 38 U.S.C. 8127(c), known as the Veterans First Contracting Program provides the authority to directly contract with a Service-Disabled Veteran-Owned Small Business (SDVOSB) or a Veteran-Owned Small Business (VOSB).

5. Rationale Supporting Use of Authority Cited Above: Based on the market research, as described in Section 8 of the document, Medical Minds, LLC doing business as (dba) as ClearTriage is the only authorized provider of the required CT licenses and support. Medical Minds, LLC dba ClearTriage has one authorized reseller of CT licenses and support. The proposed source for this acquisition is Minburn Technology Group, Inc (Minburn). Minburn is the sole authorized reseller of CT licenses and support. Minburn is a certified SDVOSB and is technically qualified to support the CT requirement for VISNs 4 and 12. The CT Decision Support Tool is currently deployed in VISN 4 and VISN 12 and implemented in production for nurse and nurse triage leads.

CT enables all individual symptoms to be addressed concurrently and provides a full list of recommendations for the nursing staff to make a final decision of override. CT adheres to industry best practices for optimal usability while leveraging the industry standard Schmitt-Thompson (STCC) protocols. CT provides access to the STCC Protocols, offering the standardized and evidence-based guidelines that are used in over 95% of US call centers. The protocols are reviewed and updated annually by a team of physicians and nurses, supported by extensive peer review and feedback from

ClearTriage Decision Support Tool VA-25-00012991 thousands of healthcare professionals. New protocols are added through a controlled 11-step process. Clinical references with National Institutes of Health (NIH) PubMed (a full-text archive of biomedical and life sciences journal literature at the NIH National Library of Medicine ) links accompany each protocol, supporting nurses and providing the rationale and supporting evidence for the protocol.

Failure to procure CT licenses and support would negatively impact the VA’s ability to perform triage on patients calling into the Clinical Call Centers (CCC) which will negatively impact patient care, call times, efficiency, and could represent a patient safety issue. On average through fiscal year 2024 VISNs 4 and 12 handled 888 Veteran triage calls every day. Both VISNs 4 and 12 would have to retrain their staffs to use a different decision support tool and would need to modify their call center processes which currently use CT and depend on the feature allowing the evaluation of multiple symptoms/conditions in a single triage session. Training over 60 registered nurses for four hours of in person facilitator led training that must be contracted to obtain. This training requires overtime to ensure call center coverage, travel for remote staff, and 480 hours of nurse availability.

CT is already integrated with Veterans Affairs Health Connect Customer Relationship Management (VAHC) CRM, and the VAHC CRM solution is already fully integrated into the Veterans Integrated System Technology Architecture and Computerized Patient Record System systems. Integration of a new decision support tool would take several months to integrate, train staff, and roll out across the VA enterprise, and would result in an estimated cost of at least $300,000.00 for VISNs 4 and 12. These duplicative costs would include not only the cost of acquiring a separate, non-VAHC CRM integrated solution, but also the resources needed for retraining personnel in each VISN. These estimated duplicative costs and time are based upon previous integration and deployment efforts of similar size and scope. These estimated duplicative costs would not be recovered through competition. Having software that integrates with VA Health Connects IT platform as a service 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, which would severely negatively impact 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 situations. According to a study conducted by the NIH published in 2019 (Performance of triage systems in emergency care: a systematic review and meta-analysis – PMC; nih.gov), a significant patient safety concern was created when care providers were asked to use multiple triage systems resulting in some cases in different outcomes. Changing to an alternative triage system without months of prior training and practice may introduce a significant risk to patient safety. Without the CT and VAHC CRM solution, a Veteran being triaged might not be told to call 911 or be transferred to Tele-Emergency Care when it was necessary, due to human error or lack of a triage tool, which could result in harm or death. Additionally, training VA staff on multiple triage software products increases the opportunity for human error and degradation of Veteran care.

6. Efforts to Obtain Competition: Market research was conducted through November 2023, as discussed in Section 8. Upon the determination that a sole source award to Minburn was in the best interest of the Government, the Contracting Officer confirmed

ClearTriage Decision Support Tool VA-25-00012991 that Minburn meets all of the requirements detailed in VA Acquisition Regulation (VAAR) 819.7008. Consistent with the guidelines of the Veterans First Contracting Program, the proposed action described herein will be synopsized and this J&A will be posted on the Contracting Opportunities Page in accordance with FAR Part 5.

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 competed. With rapid changes in the industry with the implementation of Artificial Intelligence and natural language processing as well as enhancements to the interoperability of healthcare software, VA will continue to explore alternatives and new products that will fulfill the evolving need of the Government.

8. Market Research: The Government’s technical experts conducted web-based market research through November 2023. Through this market research, the Government’s technical experts discovered that other Software as a Service/cloud/on-prem telephone triage and informational services software products from three alternative manufacturers exist, CareXM, Microsoft Dynamics 365, and Triage Logic. These products, however, did not fulfill all VA requirements for ease of protocol selection, multi-symptom triage, override dispositions capability, ability to add VA standardized protocols, and identify when calls provider video visit may be applicable to support triage decision support care for Veterans through the CCC. Therefore, it was determined that only brand name CT can meet VA’s requirements.

Since CT licenses are proprietary, no other vendor can provide the required license maintenance and technical support. Only ClearTriage or its authorized reseller, Minburn, can provide the support services required. In order to continue to correct bugs or remediate security vulnerabilities in the software, access to the source code is required. No other vendor, other than the software developer and its authorized reseller, has access to this source code. Other software developers that offer similar products merely provide software maintenance and technical support for their own proprietary software products.

Furthermore, CT provided confirmation that Minburn Technology Group is the sole authorized provider of CT for the North American Market, and that the required software subscriptions and technical support are sold exclusively through one authorized reseller, Minburn, a Service-Disabled Veteran-Owned Small Business.

Additionally, the Contracting Officer reviewed all 832 of Minburn’s performance assessment ratings in the Contractor Performance Assessment Reporting System. An analysis of the Contractor’s past performance records identified only three adverse instances (ratings of Marginal) out of a possible 4992 rating categories (i.e., 832 assessment performance reports multiplied by six categories: Quality of Product/Service, Cost Control, Schedule, Small Business, Management, and Regulatory Compliance). The Contractor has demonstrated it is responsible with respect to performance.

9. Other Facts: The Procuring Contracting Officer has determined that this proposed action meets all the requirements of 38 U.S.C. 8127(c) and VAAR 819.7008. This acquisition is below the $5,000,000 threshold, Minburn is a responsible SDVOSB for

ClearTriage Decision Support Tool VA-25-00012991 performance of the services described herein, the proposed contract can be awarded at a fair and reasonable price, and award to Minburn is in the best interest of the Government.

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 comparison to the Independent Government Cost Estimate. Additionally, price analysis will be performed in accordance with FAR 15.404- 1(b).

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