T-5 Draft RFP Attachment J-XX T-5 MHS Genesis Performance Work Statement (PWS) - Draft RFP.pdf

Attachment J-XX Genesis Interface PWS

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Performance Work Statement (PWS) for Legacy Replacement Bi-

Directional Interface from MHS Genesis to the Managed Care Support

Contractor, {insert contract name}

May 29, 2020

Introduction/Background

The connectivity for referrals and authorizations between the Military Treatment Facilities (MTF) and the Purchased Care Sector are managed through an interface between the Managed Care Support

Contractor (MCSC) and t h e Composite Occupational Health and Operational Risk Tracking Referral

Management System (COHORT/RMS) from SpinSys. The existing Composite Health Care System

(CHCS), Care Point Health Care Application Suite (CHAS), and COHORT/RMS have all been deemed Legacy Systems and will be replaced by MHS GENESIS [the new DoD Electronic Health

Record (EHR) being managed by the Defense Healthcare Management Systems Modernization

(DHMSM) Program Management Office (PMO)]. When MHS GENESIS is deployed to an MTF, those MTFs will discontinue input into COHORT/RMS. Existing CHCS, CHAS, COHORT/RMS interfaces will continue to be used at MTFs that have not been deployed MHS GENESIS. The

MCSCs shall be required to run dual interfaces until the MHS GENESIS deployment is completed in their region of support.

1.0 Overall Objectives

The objective of the MHS GENESIS to MCSC bi-directional interface is to ensure all required data to perform referral management and all referral management messages are properly exchanged with

MCSC’s Referral and Authorization system. The MHS GENESIS to MCSC’s Referral and

Authorization interface, once established, will be maintained to ensure all MHS facilities utilizing MHS

GENESIS will have the capability to conduct referral management activities. Additionally, the introduction of MHS GENESIS to MCSC’s Referral and Authorization interface will not interfere or affect the operation and maintenance of the Legacy S y s t e m s interface for all MHS facilities utilizing

Legacy Systems.

2.0 MHS GENESIS/MCSC Interface Requirements/Scope

This PWS is for the establishment and maintenance of a new MHS GENESIS to MCSC’s Referral and

Authorization system interface to facilitate referral management activities for all applicable MHS

GENESIS facilities. Because the MHS GENESIS product is a Commercial off the Shelf (COTS) product different from the Legacy Systems and provides new/different functionalities and capabilities, there may be data differentials, which will affect the MCSC’s Referral and Authorization system data intake, compliance, functionality, and through-put processing. In order to properly plan, develop, test, and field the interface, an output -based, phased approach is required.

2.1 Key Facts and Assumptions

2.1.1 The MCSC shall have the appropriate personnel to engage i n all aspects of the planning, development, testing, and fielding of any associated changes (including but not limited to infrastructure, platform, software, and cybersecurity) required to support the creation and sustainment of the MHS GENESIS interface with

MCSC’s Referral and Authorization system.

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2.1.2 The MCSC shall support the MHS GENESIS interface to enable proper performance of all referral management activities conducted by the MCSC for

MTFs without impacting the stabilization and sustainment of the MCSC’s

Referral and Authorization system.

2.1.3 A standard 278 Electronic Referral Management Interface has been built to facilitate a connection to the MCSC’s Referral and Authorization system. The

MCSC shall comply with the MHS GENESIS standard 278 electronic interface.

2.1.4 The MCSC shall perform all activities in accordance with the time sensitive overarching DHMSM PMO's MHS GENESIS schedule – To be published upon completion of revisions.

2.1.5 The Phases detailed in sections 2.2.1-2.2.3 will repeat throughout the lifecycle of

MHS GENESIS as interface upgrades and new capabilities are introduced.

2.2 Specific Tasks

A phased, output-based approach will be utilized for the development of MHS GENESIS to MCSC’s Referral and Authorization system bi-directional interface and the evolution of the interface to include the MCSC Right of First Refusal (ROFR).

The MCSC shall be required to support the MHS GENESIS Interface through multiple phases of activity throughout the life cycle of MHS GENESIS. The phases are listed in detail in sections 2.2.1-2.2.3

The MCSC may build multiple test environments for MHS GENESIS to support multiple testing and evaluation events or to support multiple MHS GENESIS activities. If the

MCSC provides only one development and test environment, the MCSC must support movement of connections between their environment and MHS GENEISIS environments.

2.2.1 Phase I Analysis

2.2.1.1 Baseline Capability

MCSC shal l provide Subject Matter Experts (SMEs) to engage with the

DHMSM PMO SMEs to determine the technical and programmatic details required to establish a successful interface between MHS GENESIS and

MCSC’s Referral and Authorization system. These activities will include the planning and subsequent development, testing, and fielding activities for the exchange of referral information initiated by MHS GENESIS and the exchange of referral information initiated by the MCSC Referral and

Authorization System. The initial sessions of the Analysis Phase will consist of a detailed mapping of the new interface to include, but not limited to, defining responsibilities, data elements, data ingest, infrastructure, platform and software changes, cybersecurity impacts, testing and sustainment processes.

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2.2.1.2 Technical- Determining the technical approach for the MCSC’s Referral and Authorization system interface with MHS GENESIS requires a clear understanding of how MHS GENESIS currently exchanges data. The following topics will be addressed, and appropriate SME(s) will be required to support this effort:

2.2.1.2.1 DHMSM PMO, the MHS GENESIS vendor and the MCSC

s h a l l e s t a b l i s h t he referral management data mapping requirements based on the native data in MHS

GENESIS and data required to process and authorize a referral by the MCSC.

2.2.1.2.2 For rejected/returned referrals, MCSC shall provide responses and text explanations using the HIPAA compliant

278 transaction code set. The text explanations shall describe why the MCSC is returning or rejecting the referral. This shall include the name of the data element that needs to be corrected and what the MCSC wants the MTF to correct on the referral before resubmitting the referral for re-review. In cases where the Government cannot resolve issues associated with rejected/returned referrals via the interface with MHS GENESIS, referral-related information may be faxed for clarification (categories of patients that will require fax referrals will be identified by the Government).

2.2.1.2.3 HIPAA Compliant 278 Referral Processing for Level 2

Rejections Requiring Additional Information:

2.2.1.2.3.1 When processing level 2 rejections for additional information, the MCSC shall not cancel the 278 transaction. Instead, the MCSC shall append the referrals and send the submitting MTF a 278 response message with the reason for rejection.

2.2.1.2.3.2 The contractor shall allow a referral to be modified and resubmitted if cancelled when processing a 278 transaction Level 2 rejection

2.2.1.2.4 The MCSC’s Referral Management functional

requirements SME shall support determination of criticality of the data and the business impact corrupted data will have on the current capability provided by the

MCSC to the DOD.

2.2.1.2.4.1 The MCSC’s Data Structure and Mapping SME

shall determine flexibility and accommodations needed to support native MHS GENESIS data elements correlating to MCSC’s Referral and

Authorization system data elements.

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2.2.1.2.4.2 The MCSC’s testing support SME for planning, execution and testers for all testing events, shall validate the consumption and business capability for all agreed data elements mapped to functional requirements.

2.2.1.2.4.3 The MCSC’s Technical

infrastructure/communications SMEs for initiating and completing necessary B2B requirements and supporting all test phases, shall ensure the availability of t h e dot mil system required for interface and functionality testing.

2.2.1.2.4.4 The MCSC shall have an Interface SME with

expertise in file transmission and receipt for informational exchanges between MHS GENESIS and the MCSC’s Referral and Authorization systems.

2.2.1.2.4.5 The MCSC’s Information Assurance (IA) support

SME shall be responsible for Ports, Protocols and

Services Management (PPSM), as wells as determining the NIST Certifications necessit ies

2.2.1.3 System Upgrades - MCSC shall provide Subject Matter Experts (SMEs) to engage with the DHMSM PMO SMEs to determine the technical and programmatic details required to establish a successful interface between

MHS GENESIS and MCSC’s Referral and Authorization system. The sessions of the Analysis Phase will consist of a detailed mapping of the new interface to include, but not limited to, defining responsibilities, data elements, data ingest, infrastructure, platform and software changes, cybersecurity impacts, testing and sustainment processes. Content will include but is not limited to:

2.2.1.3.1 The MCSC shall send Right of First Refusals (ROFRs) to an

MTF/eMSM via a HIPAA compliant 278, or other process as identified by the Government. The request shall contain the minimum data set and requirements that will be provided by the Government.

2.2.1.3.2 HIPAA ICD-10 Codes Standard List Changes

(annual ly)

2.2.1.3.3 Future Versions of the MHS GENESIS interface control document (ICD) (as needed)

2.2.1.3.4 Perform issue analysis as requested

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2.2.1.3.5 The MCSC shall put in place a process to communicate major infrastructure upgrades to the DHMSM PMO to enable sufficient time to perform regression testing prior to test events.

2.2.2 Phase II Development/Configuration/Testing/Implementation

2.2.2.1 Development/Configuration:

2.2.2.2 The MCSC shall develop/configure the Referral and

Authorization system 278 interface based on the approved MHS

GENESIS Interface Control Document (ICD) mapping specifications.

2.2.2.3 The MCSC shall meet all MHS GENESIS security requirements as outlined in the approved MHS GENESIS Interface Control

Document (ICD) section 4.6 Security Requirements.

2.2.2.4 The MCSC shall configure the Referral and Authorization system to connect to MHS GENESIS using a B2B .mil connections. If MCSC’s system is a .com, a B2B .com to B2B

.mil connection will be required for connections with MHS

GENESIS .mil.

2.2.2.5 Testing Implementation - In addition to the technical details, the

DHMSM PMO's MHS GENESIS schedule shall be met to support

MHS GENESIS at all existing sites and all future sites as identified in the PMO implementation wave schedule. To support MHS GENESIS at the existing sites and successive waves of MTFs in CONUS, the

MCSC’s interface must be available to suppor t testing in the MHS

GENESIS test environments for multiple phases of tests to include but not limited to:

2.2.2.5.1 Commercial upgrades (tentatively every 6 months)

2.2.2.5.2 Interface system upgrades

2.2.2.5.3 MHS GENESIS releases

2.2.2.5.4 Technical review of MCSC ICD

2.2.2.5.5 Environment Refresh (All DHMSM Pre-Prod

environments): Interface upgrade support in MHS GENESIS

Test Environments or Production Environment as needed

2.2.2.5.6 Change Requests - Defects and Fixes; Testing support activities - supports testing and validation activities for defects, fixes, and changes

2.2.2.5.7 MCSC’s Integrator Test – All applicable TRICARE

Regions

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2.2.2.5.8 Provide production logs and or test logs for MCSC /MTF as requested by DHMSM PMO in support of MHS GENESIS test activities

2.2.2.5.9 Update interface configuration changes

2.2.2.5.10 Test support for issue analysis as requested

2.2.2.5.11 Data preparation/seeding for testing

2.2.2.5.12 Test Activities in Support of the following:

2.2.2.5.12.1 Connection Line of Sight (LOS) and Smoke Test

2.2.2.5.12.2 Engineering Test (ET) and Test & Evaluation (T&E)

2.2.2.5.12.3 Regression testing

2.2.2.5.12.4 DT&E testing

2.2.2.5.12.5 IV&V testing if required by the DHMSM PMO

2.2.2.5.12.6 Integration Validation (IV) testing as part of

Deployment Waves

2.2.2.5.12.7 Production Cutover Support for new MHS

GENESIS sites if required by the DHMSM PMO for

Reconciliation reporting during first 90 days after each site “Go Live”

2.2.2.5.13 HIPAA ICD-10 Codes Standard List Changes

(annual ly)

2.2.2.6 Dates established for testing in support of each individual MHS

GENESIS implementation site will be communicated via e-mail from the

DHMSM PMO PM and/or DHMSM PMO T&E team to MCSC’s

Contract Management team and Testing SME(s).

2.2.2.7 The MCSC shall provide support for regression testing in the test environment due to any and all remediation of testing deficiencies which occur in testing or implementation of the sites. This testing is in addition to testing directly related to implementing MHS GENESIS at the scheduled implementation sites.

2.2.3 Phase III Sustainment

The MCSC shall maintain this interface throughout its performance period inclusive of all exercised option periods as required. Sustainment shall include but is not limited to the following tasks:

2.2.3.1 Final Operational Test & Evaluation (FOT&E) (30-60 days after wave

1 "Go-Live")

2.2.3.2 Update interface configuration changes

2.2.3.3 Commercial upgrades (tentatively every 6 months)

2.2.3.4 Interface system upgrades

2.2.3.5 MHS GENESIS releases

2.2.3.6 Technical review of MCSC ICD

2.2.3.7 Environment Refresh (All MHS GENESIS Pre-Prod and Production environments): Interface upgrade support in MHS GENESIS Test

Environments or Production Environment as needed

2.2.3.8 Change Requests – Defects and Fixes; Testing support activities -supports testing and validation activities for defects, fixes, and changes

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2.2.3.9 MCSC’s Integrator Test – All applicable TRICARE regions

2.2.3.10 Provide productions logs and or test logs for MCSC/MTF as requested by DHMSM PMO in support of MHS GENESIS test activities

2.2.3.11 Test Support for issue analysis as requested

2.2.3.12 Data preparation/seeding for testing

2.2.3.13 Support other MHS GENESIS tasks as requested by the DHMSM

PMO

2.2.3.14 Test Activities in Support of:

2.2.3.14.1 Connection Line of Sight (LOS) and Smoke Test

2.2.3.14.2 Engineering Test (ET) and Test and Evaluation (T&E)

2.2.3.14.3 Regression testing

2.2.3.14.4 DT&E Testing

2.2.3.14.5 IV&V Testing if required by the DHMSM PMO

2.2.3.15 Reconciliation reporting during first 90 days after each site “Go Live”

2.2.3.16 Data preparation/seeding for testing

2.2.3.17 Support other MHS GENESIS tasks as requested by the

DHMSM PMO

2.2.3.18 MTF wave deployment testing as required

Discussion locations:

Tele-conference

Washington, D.C. Metro Area –TBD

MCSC– Facilities as needed – TBD

Primary POC for coordinating discussions:

Lt Col Christina L Sheets

APM, Baseline

DHMSM Program Management Office christina.l.sheets.mil@mail.mil

Alternate POC for coordinating discussions:

Jeffrey M Fox

APM, Systems Engineering

DHMSM Program Management Office jeffrey.fox@navy.mil mailto:christina.l.sheets.mil@mail.mil mailto:jeffrey.fox@navy.mil

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11.0 MILITARY HEALTH SYSTEM (MHS) GENESIS REQUIREMENTS

MHS GENESIS is the DoD Electronic Health Record (EHR), managed by the Defense Healthcare

Management Systems Modernization (DHMSM) Program Management Office (PMO).

11.1 The contractor shall ensure that all required data to perform referral management for MHS

GENESIS and all referral management messages are properly exchanged with the MCSC’s Referral and Authorization system.

11.1.1 The contractor shall establish a bi-directional interface to MHS GENESIS system to ensure that all required data to perform referral management for MHS GENESIS and all referral management messages are properly exchanged with the contractors Referral and

Authorization system.

11.1.2 The contractor shall ensure that the contractor’s Referral and Authorization system, once the interface to MHS GENESIS is established, will have the capability to conduct referral management activities. Additionally, the introduction of the MHS GENESIS referrals to contractor’s Referral and Authorization interface will not interfere or affect the operation and maintenance of the Composite Health Care System (CHCS) COHORT / Referral

Management Suite (RMS) (aka, SPIN) Legacy interface for all MHS facilities utilizing

CHCS COHORT/RMS (SPIN) system.

11.1.3 The contractor shall ensure that the appropriate personnel to engage in all aspects of the planning, development, testing, and fielding of any associated changes (including but not limited to infrastructure, platform, software, cybersecurity) required to support the creation and sustainment of the interface to MHS GENESIS.

11.1.4 The contractor shall support the MHS GENESIS interface to enable proper performance of all referral management activities conducted by the contractor for MTFs without impacting the stabilization and sustainment of the contractor’s Referral and

Authorization system.

11.1.5 A standard 278 Electronic Referral Management Interface has been built to facilitate a connection to the contractor’s Referral and Authorization system. The contractor shall comply with the MHS GENESIS standard 278 electronic interface.

11.2 Specific Tasks

A phased, output-based approach will be utilized for the rapid development of the contractor’s

Referral and Authorization system bi-directional interface to MHS GENESIS. The first objective will be to conduct initial coordination discussions between the contractor, the DHMSM PMO, and its support contractors to discuss requirements of each phase.

11.2.1 Phase I –Analysis Phase. The Analysis Phase will be complete when the Interface

Control Document (ICD) has been completed and agreed to, and a master schedule has been coordinated and approved by both the DHMSM PMO and the contractor.

11.2.1.1 The contractor shall provide Subject Matter Experts (SMEs) to engage with the DHMSM PMO SMEs to determine the technical and programmatic details

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Authorization system and the MHS GENESIS system.

11.2.1.2 The contractor shall comply with established referral management data requirements, based on the data natively in the MHS GENESIS product and data required to process and authorize a referral by the contractor.

11.2.1.3 The contractor shall provide returned or rejected referral responses with text explanations via a HIPAA compliant 278.

11.2.1.4 The contractor shall allow a referral to be modified and resubmitted if cancelled when processing a 278 transaction Level 2 rejection.

11.2.1.5 The contractor shall send referrals to the Market/MTF via a HIPAA-compliant 278, or other process as identified by the Government.

11.2.1.5.1 The contractor’s request shall contain the minimum data set and requirements that will be provided by the Government.

11.2.1.6 The contractor shall ensure that all necessary SMEs are available for the transition of the interface from CHSC COHORT/RMS (SPIN) legacy to MHS

GENESIS.

11.2.2 Phase II- Development/Configuration/Testing/Implementation

11.2.2.1 Development/Configuration:

11.2.2.1.1 The contractor shall develop/configure the Referral and

Authorization system 278 interface based on the approved MHS GENESIS

Interface Control Document (ICD) mapping specifications.

11.2.2.1.2 The contractor shall meet all MHS GENESIS security requirements as outlined in the approved MHS GENESIS Interface Control

Document (ICD) section 4.6 Security Requirements.

11.2.2.1.3 The contractor shall configure the Referral and Authorization system to connect to MHS GENESIS using a B2B .mil connections. If

Contractor’s system is a .com, a B2B .com to B2B .mil connection will be required for connections with MHS GENESIS .mil.

11.2.2.2 Testing/Implementation:

11.2.2.2.1 In addition to the technical details, the contractor shall meet the

DHMSM PMO's MHS GENESIS Wave deployment schedule when implementing interfaces to the contractor’s Referral and Authorization system.

11.2.2.2.2 To support the interface to MHS GENESIS, the contractor must be available to support multiple phases of testing to include:

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1) Setup and setup validation (Connection Line of Sight (LOS) and

Smoke test)

2) Engineering Test (ET) and Test and Evaluation (T&E)

3) Government Developmental Testing and Evaluation (DT&E)

4) Independent Verification and Validation (IV&V) testing if required by the DHMSM PMO

5) Regression Testing as needed

11.2.2.2.3 The contractor may build multiple test environments for MHS

GENESIS to support multiple testing and evaluation events or to support multiple MHS GENESIS activities. If the contractor provides only one development and test environment, the contractor must support movement of connections between their environment and MHS GENEISIS environments.

11.2.2.2.4 The contractor shall provide SME support for testing the implementation for MHS GENESIS to include regression testing in the test environment due to any and all remediation of testing deficiencies which occur in testing or implementation of the sites.

11.2.2.2.5 The contractor shall put in place a process to communicate major infrastructure upgrades to the DHMSM PMO to enable sufficient time to perform regression testing prior to test events.

11.2.3 Phase Ill –Sustainment: The contractor shall maintain this interface throughout its performance period inclusive of all exercised option periods as required.