SOW - OCAO Pacs Imaging Requirement.docx

SCOPE OF WORK

OKC Area Indian Health Service Picture Archiving and Communication System (PACS) Replacement

1. Purpose

The purpose of this Scope of work is to provide for Oklahoma City Area Indian Health Service’s Area Wide PACS enterprise. The intent and desire for this acquisition is to improve and update performance efficiencies, reduce unexpected maintenance costs, and provide an all-inclusive annual support structure that provides all software updates and upgrades, hardware updates, upgrades, and any required system refresh. The intent of this acquisition is to replace our current PACS systems with properly scaled, technician and clinician focused, efficient, economical, secure, and effective PACS enterprise well fitted to the needs of our radiology departments and the capabilities of our network infrastructure.

Site Locations:

The Oklahoma City Area Indian Health Service currently has 6 local PACS sites, that include two hospitals and 4 ambulatory health clinics. These are the Lawton Indian Hospital, Claremore Indian Hospital, Clinton Indian Health Clinic, Haskell Indian Health Clinic, Pawnee Indian Health Clinic, and the Wewoka Indian Health Clinic. These locations have imaging modalities that include general radiography systems, bone densitometry, mammography systems, CT, MRI, Echocardiogram, and diagnostic ultrasound.

Each of these sites’ PACS is configured to house the entire history of their digital imaging studies. These local archives are copied to an Area-Wide PACS archive to serve as back up for those previously mentioned facilities located at the Oklahoma City Area Office. The Area Office back up archive is then copied to another Disaster Recovery archive located at the Clinton Indian Health Clinic. This has been the basic configuration for the Oklahoma City Indian Health Service PACS network for approximately thirteen years.

Notes of Exception: The PACS at Haskell in not currently in use and would only be used for diagnostic ultrasound procedures for the foreseeable future. This PACS currently does not include an HL7 interface. Imaging procedures for Haskell are performed by referral to a local imaging provider.

In addition to the above Indian Health Service sites, we have one additional Tribally owned and operated outpatient clinic that utilizes the Area Office backup archive as their local PACS archive backup. This PACS is not included in this PACS project, other than the prospect of continuing to utilize backup archiving services.

2. Technical Requirements and Preferences The requirements are to provide all required hardware, software, installation, initial configurations, training, and ongoing full maintenance support of the proposed systems. Successful proposals must include full integration with all modalities and modality vendors across our imaging network. These include MRI, CT, Mammography, General Radiography, bone densitometry, and diagnostic ultrasound systems from a variety of manufacturers. Currently, our PACS network houses approximately 25-30 TB of image data that will require migration.

All proposals must integrate completely with our existing HIS/RIS systems (RPMS Resource and Patient Management System), develop and distribute modality worklists to the local imaging devices, and be compatible with VistA (Veterans Information Systems & Technology Architecture) Imaging https://www.ihs.gov/vistaimaging/clinicalcapturedisplay/ Each of our medical facilities has a separate RPMS System (RIS) with VistA Imaging as a component of the electronic health record.

2.1The Oklahoma City Area Indian Health Service does not have staff Radiologists at any of our locations and will not require diagnostic level workstations at their facilities. The systems should be focused around the needs of the Radiology Technicians with regard to quality control, annotations, and exposure tracking for Mammography. Diagnostic reading services are provided by an outside contractor. PACS proposals shall be required to efficiently send studies to our contracted reading service and receive those diagnostic reports and images as a package to be stored in the archives. These stored images shall be accessible to all clinicians from all locations. There shall be an efficient and effective means of providing images to patients who may be required to provide images to an outside referral provider, or directly to any outside contracted providers (via secure web interface or other means). The information provided below contains a general overview of pertinent requirements related to our network infrastructure and desirable features of a potential PACS solution. The information contained in this Scope of Work is intended to allow interested parties a general overview of the technical requirements, challenges, end user preferences, and Federal regulations adherence in efforts to allow potential vendors the necessary information to develop valid proposals for the most suitable PACS solution. Included here is a basic block diagram of our current PACS network configuration.

2.2 General Technical Information

The Oklahoma Area Indian Health Service operates on a large Federal network. Successful proposals shall meet all Federal Regulations with regard to connection and integration with Federal Government networks. Potential vendors shall be required to have an Interconnection Service Agreement in place with the Indian Health Service and adhere completely to HIMSS/ACCE MDS2 and all relevant HIPAA requirements. There shall be a substantial antivirus architecture and security management structure.

Proposals for off-site data hosting must comply with Federal regulations regarding cloud based data hosting (see the FedRAMP website for information: https://www.fedramp.gov/ ) or meet Federal requirements for private data center hosting models. All submittals should include network block diagrams and data flow diagrams of the proposed configurations with pertinent information on quality assurance, uptime guarantees, on going service and technical support availability, full managed service options for subsequent years two, three, four, and five, and end user/PACS administrator training options.

2.2.1 Bandwidths and Annual Workload estimates

Successful proposals shall be capable of efficient and effective operation within the constraints of the IHS network infrastructure. Currently the bandwidth available at our PACS sites are 100MB at the Claremore, Lawton, and Clinton locations, with 50MB bandwidths at the Anadarko, Haskell, Pawnee, and Wewoka locations. Estimated imaging load is approximately 70,000 studies per year. Claremore and Lawton have the heaviest load with approximately 28,000 and 22,000 per year, respectfully. The Lawton Service Unit includes an off-site imaging department located in Anadarko, Oklahoma. Anadarko does not have a localized PACS, but feeds directly to the Lawton PACS. Clinton’s workload is approximately 7,000 annually. Pawnee and Wewoka locations are roughly 3500 per site, per year.

2.3 Technical Aspects and Preferences

2.3.1 The PACS shall not interfere with direct modality image output to DICOM printers/DICOM print servers. The intent is to preserve the means to print directly from modalities as part of a fail-over strategy if the modality-PACS interface or PACS were not functioning, or there is a known need for filmed images at the time a study is performed

2.3.2 The interface between a modality and the PACS shall not decrease the patient throughput of the modality and shall be based on the DICOM requirements

2.3.3 The PACS shall be ‘promiscuous’ and support integration of all image acquisition equipment (modalities).

2.3.4 The PACS shall be able to auto-detect and/or auto-configure DICOM connections with user confirmation

2.3.5 The PACS shall not have any modality integration fees

2.3.6 The PACS shall have unlimited modality connections

2.3.7 The PACS shall have unlimited concurrent user licenses

2.3.8 The PACS shall not have any per user licensing fees

2.3.9 Site PACS administrators shall have the ability to assign privileges to users without vendor/OEM assistance

2.3.10 Open architecture enabling retrieval of archived/stored images by any device that supports DICOM query and DICOM retrieve

2.3.11 Provision for redundant archiving and Disaster recovery

2.3.12 Automatic pre-fetching of related studies from archive/storage

2.3.13 Shall support basic 3D functionality without requiring the purchase of advanced 3D applications

2.3.14 The IHS desires that no irreversible compression be performed on an image before primary diagnosis has been completed. It is preferable that images be stored on a permanent basis using a lossless compression method. Specify compression technology (proprietary or not) that is use for archiving

2.3.15 PACS solutions shall interface with RPMS (via HL7 and/or DICOM) so as to be able to receive patient and exam information

2.3.16 The PACS shall be capable of communicating imaging reports back to the RPMS Radiology package

2.3.17 The PACS shall have a Mammography Tracking tool

2.3.18 The PACS shall include options to incorporate a Vendor Neutral Archive (VNA) for storage of non-DICOM images and records such as dental x-ray and optometry imgages.

2.3.19 The PACS shall have a Mammography Letter and Bi-Rads single sign on

2.3.20 The PACS shall have image annotation save/send

2.3.21 The PACS shall be single sign on and launch from Electronic Health Record

2.4 Export Capabilities

The IHS has need to export images to other facilities both inside and outside the IHS network, and import images from other sources such as patient provided media from other provider sources (CD/USB/DVD)

2.5 Information System Integration

2.5.1 The RPMS/PACS interface shall support:

2.5.1.1 Exam order entry transfer from RPMS to the PACS to support pre- fetching, transfer of patient demographic information and DICOM Modality Worklist

2.5.1.2 The RPMS/PACS interface shall be bi-directional

2.5.1.3 Transfer of radiographic report text from RPMS to the PACS

2.5.2 RPMS shall remain the primary source of data and exam order entry

2.5.3 Vendors shall be responsible for working with on-site and off-site IHS Information Technology Staff, IHS Clinical Engineering Staff, modality vendors, and other vendors/contractors as necessary to ensure acceptable DICOM interoperability and connectivity

2.6 System Support and User Training

Successful Proposals will include substantial on-site training for radiology technicians and PACS administrators and clinician end users. Full and complete warranty and service support in the first year that include any and all software updates and upgrades as well as system hardware upgrades shall be included.

2.7 Performance Measures

System reliability shall be at least 99% uptime. Initial response to submitted work requests for system support time shall be less than 60 minutes from initial submission of all request for system support.

2.8 System Security

The PACS shall comply with the HIPAA mandates and all regulatory guidelines. Vendors shall be prepared to discuss their approach to patient data security, encryption methods and compliance with HIPAA requirements.

2.8.1 The system shall support system-wide authentication of users through the use of a unique user-ID and password for each user or through an alternative approach with equivalent result.

· Ability to utilize the IHS LDAP interface for user-ID and password is an optional preference.

· Ability to utilize HSPD-12 (Homeland Security Presidential Directive 12) cards for double-authentication is an optional preference.

· Ability to utilize HSPD-12 (Homeland Security Presidential Directive 12) cards for double-authentication is an optional preference.

· Ability to enable/disable this feature on a user by user basis by the PACS administrator shall be available. The intent of this is to be able to disable this feature during authentication system communication failures to still allow for the review of images by otherwise authenticated users

2.8.2 Systems shall comply with all applicable IHS security and privacy regulations, as well as applicable non-IHS laws and regulations such as HIPAA, and to the extent possible, FISMA (Federal Information Security Management Act). IHS Information Technology staff to provide links or documentation for IHS regulations and specify other regulations to be addressed in addition to HIPAA

2.8.3 Systems shall have complete audit trails that include tracking when an individual sends images to an external device such as a CD/DVD burner or external hard drive/flash drive

2.8.4 Systems shall allow for the ability to prevent images from being sent to an external device such as a CD/DVD burner or external hard drive/flash drive without proper privileges

2.8.5 Systems shall allow for user customizable queries to be made using the audit information to produce reports

2.8.6 Active Directory compatibility shall be identified

2.9 Delivery Targets

The PACS replacement completion target is within 60 days after award of contract. Payment will be made upon full completion of all PACS installations, training, deployment and acceptance of the project.

2.10 Service Options – Years 2-5

Full Service and Support options in the years 2 through 5 will be renewed annually, at the option and discretion of the Oklahoma Area Indian Health Service and the availability of funds in that years. Invoicing should be billed on a quarterly basis, in arears, lined proportionately for each Local PACS location according to the local workload. Service and Support shall be all inclusive, full managed services to include 24/7 remote monitoring, technical service and support, and all hardware, software, updates, and upgrades.

2.11 Past Performance

Successful Proposals shall include performance references. Preferred references are for Federal Government facilities or Locations that have PACS systems from the proposed vendor.

Osage Nation Tribal clinic. This is a Non IHS clinic with their own private PACS (SMAART) who uses OKC as their current backup archive. They are not part of our PACS replacement but may still utilize our PACS enterprise for backup only Lawton Hospital PACS w/tech workstation and HL7 interface Includes one satellite clinic with tech workstation and HL7 but archives to Lawton Full local archive Oklahoma City Area Office PACS Backup Archive for Claremore, Lawton, Clinton, Pawnee, Wewoka, and Haskell. Also currently acts as backup for one small Tribal clinic. Future sites may be added Disaster Recovery archive for OKC Area Wide backup Haskell PACS w/tech workstation (no current in house imaging services) Wewoka PACS w/tech workstation and HL7 interface Full local archive Pawnee PACS w/tech workstation and HL7 interface Full local archive Clinton Clinic PACS w/tech workstation and HL7 interface Full local archive Claremore Hospital PACS w/tech workstation and HL7 interface Full local archive