VCB Scribes SOW Final.docx

Statement of Work (SOW) VA Texas Valley Coastal Bend Health Care System– VISN 17 2601 Veteran Dr.

Harlingen, TX 78550 VCB Scribe Service Solution

A. GENERAL INFORMATION

1. Contract Title: VCB Scribe Service Solution

2. Scope of Work:

This statement of work defines the need for VA Texas Valley Coastal Bend Healthcare System (VATXVCBHCS) for procurement of virtual scribe services. This service is to include a group of providers throughout all sites: Harlingen Care Center (HCC) 2601 Veterans Drive Harlingen TX 78550; Harlingen Outpatient Clinic (HOPC) 2106 Treasure Hills Blvd. Harlingen TX 78550; McAllen Outpatient Clinic (MOPC) 901 E. Hackberry Ave. McAllen TX 78503; Corpus Christi Outpatient Clinic (CCOPC-old) 5283 Old Brownsville Road Corpus Christi, TX 78405; Corpus Christi Outpatient Clinic (CCOPC-new) 925 South Padre Island Drive Corpus Christi, TX 78416; Corpus Christi Specialty Outpatient Clinic (CCSC) 205 S. Enterprize Parkway Corpus Christi TX 78405; Laredo Outpatient Clinic (LOPC) 4602 N Bartlett Ave. Laredo TX 78041.

3. Background:

a. VA Mission Act Section 507 mandated a two-year medical scribes’ pilot in specialty and ER departments across 12 sites. Half of the scribes were contracted, half were GS-4. Several sites have begun to add scribes to their org chart. Medical scribes are intended to ease administrative burden, and reduce burnout, of the physician or Licensed Independent Practitioner (LIP) so these providers can focus on diagnosis and treatment during the visit. Scribes are popular with some non-VA practices in part because they allow providers to see more patients during their day.

b. The main role of scribes is to provide documentation assistance to a physician or LIP. The scribe listens and records relevant information from the discussion between the provider and patient per the direction of the provider or enters relevant charting information based on a summary provided by the provider. This information, while documented by the scribe, is the provider record for all medical purposes. The provider is ultimately responsible and must review, edit, and ultimately verify the record.

c. VATVCBHCS already has Dragon software that transcribes verbatim. However, VATVCBHCS seeks an established physician customized program where physicians summarize a medical encounter. While a transcriptionist is told via dictation what to type, often with the expectation that it is verbatim, a medical scribe instead must extract the relevant medical information from a brief summary provided by the physician to complete a chart note. This method minimizes strain on the physician as compared to verbatim transcription.

4. Performance Period: The period of performance (POP) of this contract shall consist of a base period of nine-months. At the discretion of the Contracting Officer (CO), the Government may exercise up to four, twelve-month option periods. Work at the Government site shall not take place on Federal holidays or weekends unless directed by the CO.

Base: 07/01/2023 – 4/30/2024 Option Year 1: 05/01/2024 – 04/30/2025 Option Year 2: 05/01/2025 – 04/30/2026 Option Year 3: 05/01/2026 – 04/30/2027 Option Year 4: 05/01/2027 – 04/30/2028

5. Type of Contract: Firm fixed price and additional years exercised at the discretion of the government.

6. Place of Performance: Community Based Outpatient Clinics (CBOCs) of VA Texas Valley Coastal Bend Health Care System.

1. Harlingen Care Center (HCC) 2601 Veterans Drive Harlingen TX 78550

2. Harlingen Outpatient Clinic (HOPC) 2106 Treasure Hills Blvd.

Harlingen TX 78550

3. McAllen Outpatient Clinic (MOPC) 901 E. Hackberry Ave.

McAllen TX 78503

4. Corpus Christi Outpatient Clinic (CCOPC-old) 5283 Old Brownsville Road Corpus Christi, TX 78405

5. Corpus Christi Outpatient Clinic (CCOPC-new) 925 South Padre Island Drive Corpus Christi, TX 78416

6. Corpus Christi Specialty Outpatient Clinic (CCSC) 205 S. Enterprize Parkway Corpus Christi TX 78405

7. Laredo Outpatient Clinic (LOPC) 4602 N Bartlett Ave.

Laredo TX 78041

B. CONTRACT AWARD MEETING

The contractor shall not commence performance on the tasks in this SOW until the CO has conducted a kickoff meeting or has advised the contractor that a kickoff meeting is waived.

B. GENERAL REQUIREMENTS

· For every task, the contractor shall identify in writing all necessary subtasks (if any), associated costs by task, and together with associated sub milestone dates. The contractor's subtask structure shall be reflected in the proposal.

· All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms.

· The contractor shall ensure a customized working program with only U.S. based domestic, highly qualified scribes.

· The contractor shall have an established protocol for training scribes in customized physician documentation style.

· The contractor shall maintain compliance with relevant governing standards set forth by federal, state, and local laws and rules for healthcare facilities including The Joint Commission and Health Insurance Portability and Accountability Act of 1996 (HIPPA).

· The contractor shall maintain general liability insurance, deficiencies, and workers compensation.

· The contractor must utilize the Software as a Service (SaaS)/Federal Risk and Authorization Management Program (FedRAMP) approved software, BOX (TXVCB procured/established license).

· The software application, BOX, shall capture and temporarily hold the recorded patient/provider visit as an audio file for the duration as deemed by Chief Wellbeing Officer upon which the encounter shall be deleted.

· Non-VA owned equipment must be used by contracted staff to fulfill the requirements of the contract.

· The contractor shall only charge a fixed price per completed chart/encounter and provide a monthly/quarterly utilization report or tally. The contractor must not charge per audio minute, hour, or per line.

· The contractor shall invoice monthly.

Program Start – up Contractor program build

· The contractor shall provide consultation through a representative(s) that will assess and map the operational workflow of VCB providers and their respective clinics to maximize the efficiency of the program.

· The contractor shall not exceed a 90-day start-up timeline.

· Start-up timeline shall include consultation, recruitment, and onboarding as well as a complete training program.

· The contractor representative assigned by contractor company shall hold a meeting with VATXVCBHCS Chief Wellbeing Officer and Program COR to work collaboratively on program build and reporting requirements.

Recruitment, training and onboarding:

· The contractor shall recruit and train scribes.

· The contractor shall provide all necessary training and annual retraining for staff to ensure they meet standard qualifications. Including: Medical Terminology, custom trained to adapt to their assigned provider team, and PHI/HIPAA/HITECH training. At the minimum, contractor must demonstrate a comprehensive training program to include pre-clinical classroom courses, after which scribes progress to training under a master or lead scribe to test competencies.

· Local Manager’s area of focus includes monitoring the accurate preparation/documentation of medical records under assigned team, compliance with their scope of practice, focus on efficiency, and appropriate use of PHI.

· All contracted personnel are required to take VHA-provided records management training, Talent Management System (TMS) Item #10176, Privacy and Information Security, Rules of Behavior.

· Role includes documentation and efficiency management for the provider.

Contracted Local Manager duties and responsibilities:

· Shall provide assistance to scribes with CPRS

· Shall staff scribes with providers

· Shall manage scribe schedules/trainings

· Shall evaluate scribe performance at initial 90 day and annually.

· Shall conduct monthly multiple chart reviews

· Shall monitor accuracy of medical records

· Shall monitor compliance and use of PHI

· Shall provide quality assurance review and reports

Scribe duties and responsibilities:

· Scribes shall be virtual and should report to contracted local manager

· Scribes shall access the provider and patient encounter and document on the provider’s behalf.

· Scribes shall utilize recorded provider/patient encounter or provider summary within the BOX application to document in CPRS on patient’s respective electronic health record.

· Scribes shall be able to locate and access prior medical history, previous charts and progress notes, past results, and recent studies.

· Scribes shall be able to document the history, physical exam, results, procedures, treatment plan, and physician consults.

· Scribes shall be able to access and document lab results and radiology findings.

· Scribes shall be able to access x-rays for physician review and shall be able to document x-ray and ECG interpretations.

· Scribes shall create an accurate electronic medical record with an eight to twelve hours.

D. SPECIFIC MANDATORY TASKS AND ASSOCIATED DELIVERABLES

Task One: Program Start-up

Deliverable One: Contractor shall meet with TX Valley Coastal Bend Chief Wellbeing Officer to collaborate on a scribe program. Contractor representative shall visit each site and provider to map out workflow and discuss physician documentation style. The contractor shall recruit and train scribing staff. The contractor shall report progress on recruitment and strategy to Chief Wellbeing Officer. Program build and start up shall not exceed 90 days from the beginning of the base period of performance unless program is fully operational sooner. Program shall be fully operational no later than 91 days from contract award date.

Task Two: Onboarding Staff

Deliverable Two: Contractor shall ensure scribes complete training covering required medical terminology, physician customized, preferred documentation, efficiency management, and PHI/HIPPA education. Contractor shall ensure scribes are assessed by our initial competency, and subject to contractor monthly chart review and physician- evaluation monitoring. Recruitment and onboarding staff shall not exceed 90 days from the beginning of the base period of performance

Task Three: Program Execution

Deliverable Three: Provider accesses BOX software on their government furnished device and with patient consent records encounters, or voices specific documentation instructions for the scribe without recording the encounter. Scribes shall process physician/patient encounters and document on the physician’s behalf. Under the direction of the physician, scribes enter information into the patient’s electronic or written chart with a less than 12-hour turnaround time. All documentation is reviewed and/or edited by the physician. It is signed with an attestation by the provider that the scribed chart accurately reflects all work, treatment, procedures, and medical decision- making performed by them. Each month the contractor’s local manager will conduct multiple chart reviews and physician-scribe evaluations to monitor the performance of each scribe on staff. Furthermore, each new scribe receives a 90-day evaluation, preparing accurate medical records under the direction of the physician, compliance with the scribe scope of practice, assistance with the department efficiency, and respecting and demonstrating appropriate use of PHI.

E. SCHEDULE FOR DELIVERABLES

If for any reason any deliverable cannot be delivered within the scheduled time frame, the contractor is required to explain why in writing to the CO, CWO, and COR, including a firm commitment of when the work shall be completed. This notice shall cite the reasons for the delay, and the impact on the overall project. The CO will then review the facts and issue a response, in accordance with applicable regulations.

F. CHANGES TO STATEMENT OF WORK

Any changes to this SOW shall be authorized and approved only through written correspondence from the CO. A copy of each change will be kept in a project folder along with all other products of the project. Costs incurred by the contractor through the actions of parties other than the CO shall be borne by the contractor.

G. REPORTING REQUIREMENTS

1. The contractor will report as needed or no less than weekly

a. Contractor representative’s progress on mapping workflow. final findings and strategy on finalized operational workflow.

b. Contractor recruitment progress.

c. Progress on technical installation, recruitment, and scribe training.

d. Contractor assigned local manager’s progress when deployed to TX Valley Coastal Bend to learn CPRS.

e. The local manager shall report on chart reviews, scribe evaluations by contractor and provider, no later than the 5th day of every month.

f. Progress report covering all work completed during the preceding month to include identified problems that arose and its resolution. Should the problem not have been resolved this report shall include an explanation.

H. TRAVEL – Not Applicable

I. GOVERNMENT RESPONSIBILITIES

· Review of scribe documentation and/or edited for accuracy by the provider reflecting all work, treatment, procedures, and medical decision-making before signing record.

· Contracted program manager shall be trained to navigate and use Computerized Patient Record System (CPRS) and/or VHA’s current electronic medical record system and BOX.

Contracting officials will work with Contractor, Program Manager, and ISO to include appropriate risk designation based on PDAT in contract and to incorporate VA Acquisition Regulation Solicitation Provision and Contract Clause, and VA Information and Information System Security/Privacy Language for Inclusion into Contracts, as Appropriate, VA Handbook 6500.6. See Appendix B and Appendix C.

Contracting officials will also determine if protected health information is disclosed or accessed and if a BAA is required.

VA Police will issue photo identification badges directly to contractors’ and sub- contractors’ managers. These ID badges must be worn by these individuals at all times while on VA property. VA shall provide access into areas needed to perform the duties of this contract.

Texas Valley Coastal Bend Healthcare System is responsible for maintaining an internet connection and hardware device (smartphone, tablet or similar device) that can download and install application for VA providers.

CONTRACTOR EXPERIENCE REQUIREMENTS – KEY PERSONNEL

Contractor’s Past and Present Performance will be reviewed by the Contracting Officer (CO) and Contract Officer’s Representative (COR) on an annual basis. This survey will be documentation of the contractor acceptable or unacceptable performance during the contract period.

SECURITY

VA Police will issue photo identification badges directly to contractors’ and sub- contractors’ superintendents and foremen. These ID badges must be worn by these individuals at all times while on VA property.

Contractor Personnel Security ID badges must be worn by the contracted employees at all times while on VA property.

Background Investigation Will be performed.

Contractor Responsibilities The contractor will be responsible for the actions of all individuals provided to work for the VA under this contract. In the event that damages arise from work performed by contractor provided personnel, under the auspices of this contract, the contractor will be responsible for all resources necessary to remedy the incident.”

Government Responsibilities VA shall provide access into areas needed to perform the duties of this contract.

CONTRACTOR EXPERIENCE REQUIREMENTS - Not applicable

CONFIDENTIALITY AND NONDISCLOSURE

It is agreed that:

The preliminary and final deliverables and all associated working papers, application source code, and other material deemed relevant by the VA which have been generated by the contractor in the performance of this task order are the exclusive property of the U.S. Government and shall be submitted to the COR at the conclusion of the task order.

The COR will be the sole authorized official to release verbally or in writing, any data, the draft deliverables, the final deliverables, or any other written or printed materials pertaining to this task order. No information shall be released by the contractor. Any request for information relating to this task order presented to the contractor shall be submitted to the COR for response.

Press releases, marketing material or any other printed or electronic documentation related to this project, shall not be publicized without the written approval of the COR.

CONTRACTOR PERSONNEL SECURITY REQUIREMENTS

All contractor employees who require access to the Department of Veterans Affairs’ computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to subcontractor personnel requiring the same access.

Position Sensitivity – The position sensitivity has been designated as Moderate (Insert High Risk, Moderate Risk or Low Risk.)

Background Investigation – The level of background investigation commensurate with the required level of access is Background Investigation (Insert Background Investigation, Minimum Background Investigation or National Agency Check with Written Inquiries).

Contractor Responsibilities

The contractor shall prescreen all personnel requiring access to the computer systems to ensure they maintain a U.S. citizenship, and are able to read, write, speak and understand the English language.

The contractor shall submit or have their employees submit the required forms (SF 86 or SF 85P, SF 85P-S, FD 258, Contractor Fingerprint Chart, VA Form 0710, Authority for Release of Information Form, and Optional Forms 306 and 612) to the VA Office of Security and Law Enforcement within 30 days of receipt.

The contractor, when notified of an unfavorable determination by the Government, shall withdraw the affected employee from working under the contract.

Failure to comply with contractor personnel security requirements may result in termination of the contract for default.

Government Responsibilities

The VA Office of Security and Law Enforcement will provide the necessary forms to the contractor, or to the contractor’s employees, after receiving a list of names and addresses.

Upon receipt, the VA Office of Security and Law Enforcement will review completed forms for accuracy and forward the forms to the office of Personnel Management (OPM) to conduct background investigations.

The VA Office of Security and Law Enforcement will notify the CO, and contractor, of adjudication results received from OMB.

Upon being notified about a favorable determination, the CO may issue a notice to proceed to the contractor.

NARA Records Management Language for Contracts Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

VA Texas Valley Coastal Bend Veteran Health Care System (VA TVCBHCS) and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of VA TVCBHCS or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to VA TVCBHCS. The agency must report promptly to NARA in accordance with 36 CFR 1230.

The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to VA TVCBHCS control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and VA TVCBHCS guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with VA TVCBHCS policy.

The Contractor shall not create or maintain any records containing any non-public VA TVCBHCS information that are not specifically tied to or authorized by the contract.

The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

The VA TVCBHCS owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which VA TVCBHCS shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA-provided records management training, Talent Management System (TMS) Item #10176, Privacy and Information Security, Rules of Behavior. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

VHA Supplemental Contract Requirements for Combatting COVID-19

Contractor employees who work in or travel to VHA locations must comply with the following:

Documentation requirements:

If fully vaccinated, contractors shall show proof of vaccination.

NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination.

If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (CORs) or other hospital personnel.

Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

Contractor employees are subject to daily screening for COVID-19 and may be denied entry to VA facilities if they fail to pass screening protocols. As part of the screening process contractors may be asked screening questions found on the COVID-19 Screening Tool. Check regularly for updates.

Contractor employees who work away from VA locations, but who will have direct contact with VA patients shall self-screen utilizing the COVID-19 Screening Tool, in advance, each day that they will have direct patient contact and in accordance with their person or persons who coordinate COVID-19 workplace safety efforts at covered contractor workplaces. Contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

Contractor must immediately notify their COR or Contracting Officer if contract performance is jeopardized due to contractor employees being denied entry into VA Facilities.

For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued prior to this modification when performance has already commenced.