MED_Consultation_PWS__Final_Revs_3.docx

SECTION C

PERFORMANCE WORK STATEMENT

INTEGRATED INTERNATIONAL MULTIMEDIA MEDICAL DECISION SUPPORT CONSULTATION PROGRAM

Request for Proposal (RFP)

Prepared by

Department of State Office of Medical Services (MED/QI) Washington, DC20522-0102

1.0 GENERAL

1.1 Purpose. This work statement defines the requirements for Urgent Medical Care Decision Support Consultation Services needed by the medical providers employed by U.S. Department of State (DoS), Office of Medical Services (MED), in providing care for eligible members of the Foreign Service, their eligible family members, and other eligible members of U.S. Government (USG) Agencies serving under Chief of Mission Authority. The precise number of DoS employees deployed overseas is considered sensitive but a rough order of magnitude that includes family members also eligible for medical care is approximately 50,000. Most of the urgent decision support consultations included under this PWS will likely utilize mobile telephone connections. However, an ability to use additional multimedia communication technology, some of which may be specific to certain medical applications, conditions, or instruments, is desirable. Extensive installation of additional communication or instrumentation equipment in Department of State facilities is not requested or anticipated. The requirements described for this RFP are not currently being provided by any source known to MED for the geographic distribution requested. The Contractor will be responsible for all labor necessary to perform the requirements of the PWS. Feedback, information reports, and subsequent surveys in support of MED data documentation efforts are required to decrease MED’s dependence on external medical services in the future.

1.2 Background. The Department of State, Office of Medical Services (MED), provides medical support for U.S. diplomatic missions in many remote, high-risk, and/or medically austere locations which presents complex challenges for MED’s health care providers who have a heterogeneous range of experience and training. The American model (and standards of care) assumes ready access to medical specialists and well equipped hospital emergency departments to manage urgent or rapidly evolving medical conditions at any time. However, MED’s medical providers must often operate without the readily available resources commonly available within the United States. Combining USG directly hired independent medical providers and local employed medical personnel around the world, approximately 600 employed medical personnel may be considered eligible to request these decision support consultation services. A review of MED/QI case management data supports the need to acquire urgent global consultation services as a means to provide prompt, patient centered, performance based, medical decision support for MED providers assigned abroad. MED requires collaborative, expert consultation services provided by experienced, United States equivalent medical-board certified* specialists who can supply the medical decision support that is currently unavailable to most MED providers overseas. This program is not intended to replace MED’s current consultation programs that are more elective and less time sensitive. As indicated, MED has not identified a contracting entity that currently provides the exact service requirements cited in the PWS. Although MED does not have sufficient data to determine the volume of these consultation services required under this contract, as a Rough Order of Magnitude based on the DoS annual urgent medical evacuation and hospitalization data, MED estimates the initial volume of consultation service requests could be between 200 and 400 annually. Although the volume is uncertain, MED will use an initial average estimate of 300 consultation requests per year for purposes of this RFP.

2.0 SCOPE

2.1 General Requirement for Contractor to supply highly specialized consultants: MED requires provision of real time, 24/7/365, continuously available, telemedicine consultation services to advise and assist individual MED clinicians to provide optimal urgent and emergent medical management for individual patients on an intermittent, as-needed basis worldwide. MED personnel are required to provide urgent medical care for a wide variety of medical conditions, in a wide range of locations, some of which are in high threat areas and/or are austere. MED is committed to facilitate provision of the highest quality levels of care possible. To do so requires that MED providers have prompt access to competent, experienced and specialized medical resources that can provide consultations to enable optimal treatment of a full spectrum of illnesses and injuries. The Contractor must be capable of demonstrating they can routinely provide sources of appropriate medical advice to MED providers who have differing levels of experience, training, and English language proficiency. The Contractor must be capable of providing telemedicine access to such experts in a manner to accommodate the likelihood that the MED practitioners requesting assistance will not have access to the medical diagnostic (electronic, radiographic and laboratory) resources commonly available in the United States.

2.2 Specific Areas of Scope.

2.2.1 Clinical Consultation Services – Director, Call Center & Tiered High Level Specialty Consultants. The Contractor shall provide a single physician Director with at least 10 years of documented active clinical post-graduate experience in a trauma and emergency medical practice to manage the Telemedicine Consultation program (Director, Telemedicine Contract Program). “Active clinical experience” is intended to refer to physicians and surgeons consistently, routinely managing clinical care on site in the Emergency Department and/or performing procedures in surgical operating room facilities on a frequent and regular basis.

The contractor’s program must ensure that MED Providers have access to a call center utilizing one unique single global telephone access number that is continuously operational; accessible from worldwide networks; and equipped to route calls from the provider in the field to the Contractor’s clinical specialist within the contractually agreed upon timeframe. The Contractor shall operate the Call Center so that it is staffed with “Operator” personnel experienced in answering emergency calls that may originate from non-native English language speakers regarding diverse medical topics and capable of correctly routing the incoming calls appropriately to the Contractor’s initial level medical specialty consultants.

2.2.2 Contractor’s Initial (Level 1) Medical Specialists with highly specialized skill sets. The Contractor shall ensure that the Call Center Operator will initially route the consultation requests to an U.S. equivalent* Medical Board Certified General/Trauma Surgeon or Emergency Medicine Specialist with at least 8 years of documented active clinical experience in a medical center as and herein designated as the Level 1 Specialist who will be available to the MED provider within the contractually agreed upon time frame from the time the call was received. The clinical initial Level 1 Consultant will evaluate the presentation and case summary promptly as supplied by the MED provider; discuss the clinical aspects of the case; and subsequently advise the MED provider regarding the recommended optimal clinical management. Initial consultation and recommendations should include possible immediate measures to preserve life, limb and/or special senses (e.g. eye sight, neurological function, etc.); definition of additional studies or procedures to better manage the possible conditions; and indications and assessments of urgency for possible evacuation of the patient to a medical center of higher care relative to the patient’s current location if appropriate. This episode of care will constitute a “Level 1” consultation.

2.2.3 Contractor’s Additional Level 2 Medical Specialists with highly specialized skill sets. Any given clinical case situation may require medical knowledge outside the domain of the initial Level 1 trauma or Emergency Medicine Specialist to optimize management and medical outcomes. MED requires the Contractor to have a full array of additional (U.S. Equivalent*) Board Certified medical and surgical specialists with specialized skill sets who have at least six (6) years of documented active experience in post-graduate clinical practice who are available within the acuity context of the medical condition(s) under consideration but no less than an hour of being called to respond to MED’s medical personnel. Acuity context means that responses to calls involving patients in more immediate danger of loss of life, limb, or special senses must be more rapid and appropriate than responses to queries regarding patients in less peril as judged by the Initial Level 1 Consultant. Requirements for involvement of multiple specialists will ultimately be determined by the Initial Consultant in accordance with the MED provider requesting consultation. Specialists necessary to meet the requirement for additional consultants shall include but not be limited to those specialties listed by a U.S. Equivalent Certifying Medical Board as indicated in Appendix A.* This episode of care will constitute a “Level 2” consultation.

2.2.4 Contractors general key principle requirements for providing a broad range of Consulting Medical Specialists with highly specialized skill sets. MED has a requirement for an “in-depth” availability of additional consultants to provide immediate, expert medical advice covering almost the complete range of medical and surgical conditions. Both MED and members of its associated Foreign Affairs Agencies require commitment to attaining the highest quality of medical care possible for any given episode. The American College of Surgeons (ACS), the American College of Physicians, and other similar internationally recognized quality organizations have demonstrated a commitment to quality that is reflected in the many initiatives that have been developed and recognized by regulatory and certifying bodies throughout the world. MED requires evidence that U.S. medical facilities included in any of Contractor’s proposals have met the requirements for full facility JCAHO survey certification or its ISO equivalent. If MED providers experience unreasonable delays or lack of access to consultant’s resources, MED reserves the right to procure simultaneous, competitive facilities requests for Emergency Consultation services for its patients which may result in non-exclusive contracts.

2.2.5 Additional considerations for providing means to estimate costs and means to meet key principle requirements for providing a broad range of Consulting Medical Specialists with highly specialized skill sets. This proposal request seeks a means to acquire near immediate, unfettered access to a source of state-of-the-art medical knowledge for expedited application to a medical patient in urgent need at almost any place in the world at any time. Cost estimates to provide the services shall include costs of utilizing contractor’s existing staff and any additional personnel necessary (expressed in Consultation per Level) plus any additional equipment that the vendor would require to provide the services specified for 300 consultation episodes, the average of MED’s estimated consultation request volume (Base Cost). MED also understands that a given Consultation Episode may require only the services of a Level 1 consultant (Level 1 Consultation) or that it may require services provided by both Level 1 and Level 2 consultants (Level 2 Consultation). MED anticipates that Level 1 Consultations and Level 2 Consults may be priced differently due to differences in the number of physicians involved, the differing times of service and therefore differing amounts of total physician work plus the cost for work performed by non-physician personnel and equipment. Although Level 2 Consultations will likely be less frequent, MED does not have data to allow a reasonable estimate of the ratio between Level 1 and Level 2 Consultation episodes. Accordingly, MED expects that total base cost will include the sum of the cost for 150 Level 1 and 150 Level 2 consultation encounters per year. Additionally, MED anticipates that vendors will provide an estimate of costs to be paid per consultation if and when the number of consultations specified in the Base Cost exceeds 150 per contract year for Level 1 and Level 2 Consultations (considered separately).

2.2.6 Contractor’s general requirement for providing a Telemedicine Capability. MED requires Contractor to provide a Telemedicine capability to facilitate acute consultation for those providing medical care for MED patients. That capability must include direct telephonic and optional visual communication with secure data transmission in accordance with Federal and Contractor’s NIST/ HIPAA standards via the best mode available to support the mission at hand. The contractor’s Telemedicine Capability shall provide prompt acquisition and maintenance of clinical communication links between MED providers at any location worldwide and Contractor’s Call Center. MED recognizes that the contractor cannot be held responsible for maintenance of commercial telephone services but the contractor’s systems must be resilient and flexible enough to adapt to the poor Information Technology (IT) and healthcare infrastructure that characterizes many host nations. The Contractor shall demonstrate a capability to provide connections to wider bandwidth U.S. media communications systems. If Contractor identifies a need for specific equipment necessary to meet the requirement of 2.2.5, the nature and cost of the equipment should be specified in the Contractor’s Proposal and included in line item – Initial Setup Cost. Contractor may be required to meet certain network security specifications if both MED and Contractor anticipate use of MED’s existing telemedicine capabilities (not required in this RFP) but contractor will not be permitted to install or maintain communications equipment in Department of State facilities.

2.2.7 Contractors general requirement for providing Records of Telemedical Consultations. To optimize the benefit to MED’s patients and providers that results from utilizing the consultation services, the Contractor must maintain and provide MED with appropriate digital text and image records of the consultation services provided and furnish integrated report documentation containing data in a format appropriate to MED’s data capabilities (e.g. Microsoft Office applications) each month. Both the MED provider and MED/QM WASHDC should receive a copy of a typed consultation report for each encounter. Standards for such documentation should be reasonably similar to those that are standard within contractor’s electronic medical record format. At a minimum, the report data should provide a very brief statement describing the patient’s problem/history, pertinent physical, laboratory, and imaging findings, probable diagnoses, and recommended management. MED also requires monthly summary reports including incidence (number of consultation requests per unit time -- day, week, month, etc.), most frequent diagnoses, most frequent problems (communication, connections, technical issues, etc.) and any recommendations the consultants may have for MED WASHDC to implement for optimal case management for the subject conditions.

3.0 ADDITIONAL REQUIREMENTS

3.4 Restricted Distribution of Documents. The Contractor, including its subcontractors, may be provided access to documents deemed “Sensitive” by the Government. Access to these documents, which must be appropriately labeled or marked as “sensitive,” shall be limited to members of the contract team on a need to know basis. The Government may limit the number of hard copies and prohibit electronic copies of such “Sensitive” documents. These documents shall be used for or under the provisions of this contract only and shall not be used for any other contract or given or sold to another company, person(s) or entity.

The Contractor, including its subcontractors, shall exercise the utmost discretion in regard to all matters relating to all Government documents. They shall not communicate to any person any information known to them because of their access to the Government documents. These documents are for use under this contract and are the exclusive property of the U.S. Government except as provided for elsewhere herein.

3.5 Media Relations. The Contractor and MED shall advise all employees and subcontractors of their guidelines for dealing with media, press and other inquiries about the company’s customers, business, and other information deemed by either entity to be important, confidential and/or business sensitive.

4.0 DELIVERABLES

The Contractor shall provide all Government requested documents pertaining to operations under this contract and not otherwise considered to be proprietary by the Contractor.

4.1 Written Clinical Consult. A written clinical consultant report shall be produced and electronically transmitted to the requesting MED provider and to MEDQI@state.gov, Washington D.C., within 24 hours of completion of the teleconsultation. Format for the report shall be negotiated at the task order level. The consultation report may be brief but shall include a time-date and duration notation and address at a minimum the critical elements of the history; physical examination findings, if any; any laboratory or imaging findings; clinical recommendations; and disposition relative to requirements for continued care. The report may be a transcription of a brief note dictated by the consulting specialist(s) at the time of consultation.

4.2 Monthly Activity Reports. The Contractor shall submit to the Director of Quality Management (MED/QM) a monthly activity report, detailing the summary of the teleconsultation reports with sufficient detail as to allow MED to monitor and report system efficiency, quality, and effectiveness. Minimal report requirements are outlined in paragraph 4.1.

5.0 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

This Quality Assurance Surveillance Plan (QASP) provides a systematic method of evaluating the services the Contractor is required to perform in accordance with the PWS. The Contractor, and not MED, is responsible for management and quality control actions to meet the terms of the contract unless specified otherwise. MED’s role is to solicit input from Contractor; specify MED’s measures of quality assurance; define Process Key Matrices; and audit defined elements of performance to ensure contract standards and standards of good medical practice are achieved.

The Government requires the contractor to submit a QASP that reflects adequate surveillance performance measures. 3 performance objectives have been listed below that shall be included in the contractor’s QASP and received with or as a part of the Monthly Activity Report

Consultant Response Time Connection to Appropriate Requested Specialist within contractual agreement

MED Provider Time Report & Call Center Log confirms consults W/I time limit > 90%

Activity Report Complete and W/I Time Intervals 100%

80% of MED Providers requesting Urgent Consultation Services must rank Contractors Services favorably on the post-encounter survey approved in advance by contractor.

6.0 KEY PERSONNEL

6.1 Contractor’s Director, Telemedicine Contract Program;

6.2 Contractors Board Certified Trauma Surgeons or Emergency Medicine Specialists, herein designated as a Level 1 Specialists

6.3 The Contractor agrees to assign to this contract those key personnel whose resumes were submitted with the proposal. No substitutions shall be made without prior notification and concurrence of the Contracting Officer’s Representative. During the first thirty (30) days of performance, the Contractor shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. The Government reserves the right to interview candidates replacing key personnel.

The Contractor shall ensure that the personnel under this contract possess the skills, training, and expertise needed to perform the required tasks. Any training, consulting, etc. (except specific to the Department of State) necessary to ensure that the requirements are met shall be the responsibility of the Contractor. All proposed substitutes shall meet or exceed the qualifications of the person to be replaced. The Contracting Officer’s Representative shall be notified in writing of any proposed substitution at least fourteen (14) days in advance of the proposed substitution. Such notification shall include: (1) an explanation of the circumstances necessitating the substitution; (2) a complete resume of the proposed substitute; and (3) any other information requested by the Contracting Officer’s Representative to enable that person to judge whether or not the Contractor is maintaining the same high quality of personnel.

7.0 SECURITY CLEARANCE REQUIREMENTS: There are no security clearance requirements for this requirement.

8.0 APPENDICIES

Appendix A: U.S. Equivalent Medical Specialty* / Subspecialty Board Representative – Availability required but not necessarily limited to meet Requirement 2.2.3

1. Cardiology (Including ‘Invasive’ Subspecialists)

2. Obstetrics & Gynecology

3. Cardiothoracic Surgery

4. Vascular Surgery

5. Urology

6. Orthopedic Surgery

7. Rheumatology

8. Internal Medicine and Family Practice

9. Infectious Disease and Tropical Medicine

10. Pulmonary Medicine/Critical Care

11. Neurology

12. Dermatology

13. Otorhinolaryngology

14. Anesthesiology

15. Radiology including ‘Invasive’ Radiology Subspecialists

16. Psychiatry

17. Nephrology including Dialysis Center Specialists

18. Ophthalmology

Appendix B:

Information to be submitted as part of Proposal:

Are personnel proposed to provide services for this contract also employed by or under contract to an established U.S. medical facility? Yes No

If yes, does facility include an ACS designated and certified Level I Trauma Center?

Yes No

If yes, are personnel and facilities part of a U.S. academic medical center training both medical and surgical post-graduate specialty residents and/or subspecialty fellows?

Yes No

Please provide the following additional aggregated information regarding medical facilities associated with Proposal:

Total number of beds devoted to adult in-patient care:

Total number of full time adult medical and surgical certified specialty staff members:

Total number of full time pediatric medical and surgical certified specialty staff members:

Total number of Adult Intensive Care beds:

Total number of beds devoted to Pediatric in-patient care:

Total number of Pediatric Intensive Care beds:

Total number of annual OB deliveries:

Total number of annual adult Emergency Department patient visits:

Total number of annual pediatric Emergency Department patient visits:

Total number trauma service case activation/admissions annually:

4 * American Board of Medical Specialties (ABMS), and the American Osteopathic Association (AOA) and Equivalent Canadian and United Kingdom certifying bodies