A.02.04_J_and_A_(Final_Redacted).pdf

Control Number: 17-RHCO-C-374

For Official Use Only (See FAR 2.101 and 3.104-4)

(1 October 2015)

Sole Source Justification and Approval

Under FAR 13.501

1. Contracting Activity: This requirement is for Carl R. Darnall Army Medical Center (CRDAMC), Fort Hood, TX. The contracting activity is Regional Health Contracting Office – Central, Fort Hood Contracting Cell.

2. Description of Action: CRDAMC is requesting the approval for a new sole source maintenance service contract for Dictation and Transcription License and Software from the 3M Corporation. This will be a Firm Fixed Price contract and Subject to the Availability of FY17 Funds. The GFEBS Purchase Request number is 0010978192.

3. Description of Supplies/Services: The dictation/transcription software product allows medical professionals the ability to input voice dictation by calling a toll free number via landline and/or mobile devices (e.g. cell phones, Smart phones, etc.). The software includes Back End Speech Recognition (BESR). This allows transcriptionists to review and edit BESR generated notes and the capability to transcribe dictated notes without BESR. The software allows both processes to work securely and remotely on laptop and personal computers from geographically separated locations. The dictation software has transcription electronic signature capability, which allows dictating professionals to review, edit and sign transcribed documents electronically, and patient administration personnel the capability to audit who & when the transcription is signed. In addition, the electronic signature capability will accommodate medical residents, medical student’s dictation, and electronic signature workflows.

The software also has dictation and transcription management and reporting tools that allow detailed analysis of electronically signed documents, rapid dictation & transcription turnaround times, and lines of transcription produced by the transcription service provider that include sufficient detail to validate invoicing from the transcription service provider. The software provides audit trail capabilities to record changes to the dictated and transcribed notes. The software is configured to include an electronic document upload interface with the capability to interface with the Defense Health Agency’s inpatient Electronic Health Record (EHR) Commercial off the Shelf (COTS) product Essentris. The anticipated period of performance is 1 June 2017 to 30 September 2017 with three (3), 12-month option periods ending 30 September 2020. This period of performance will allow the contract to stay in line with the hardware and maintenance already owned by the Government. The estimated value of this acquisition is

4. Authority Cited: 41 U.S.C. 1901 as implemented by Federal Acquisition Regulation 13.501(a)(1)(ii), sole source (including brand name) under the authority of simplified procedures for certain commercial items.

5. Reason for Authority Cited: The Secure Enterprise Dictation & Transcription Solution (SEDTS) hardware by 3M is currently owned by the Government and has successfully passed

Dictation and Transcription License and Software Fort Hood, Texas 76544

(25 February 2016) the DoD Information Assurance Certification and Accreditation Process (DIACAP). SEDTS also has a Business-to-Business (B2B) connection from the Defense Information Systems Agency (DISA) to 3M’s secure hosted data center in Austin, TX. B2B allows medical dictations (HIPAA Data) to securely return to the Medical treatment Facilities (MTF’s). The 3M SEDTS product includes agile software modification and development capability, which allows a variety of commercial dictation input devices to function with the bundled dictation and transcription solution, and meets both the Army Medical Department’s (AMEDD’s) and local security requirements, e.g. foot pedals, and microphone input.

3M’s software already contains the required Information Assurance (IA) certifications and the software has already been tailored for Military Treatment Facilities (MTF). It is the only dictation product that meets both Army and AF cybersecurity requirements with an Authority to Operate in both environments. It is in the Governments best interest utilize the existing hardware and procure only the additional software needed.

6. Efforts to Obtain Competition:

a. Effective competition. N/A

b. Subcontracting competition. N/A

7. Actions to Increase Competition: The dictation software product industry is expanding and it is possible that more companies will start offering these types of products. While alternative dictation software products built to the above specifications are not available today, it is likely that a full and open competition at the end of hardware lifecycle would result in several capable vendors being able to compete. Over the next seven years, the Department of Defense will deploy a new clinical electronic health record that will be an industry standard product versus the current electronic medical eco system that exists now using multiple systems built or tailored specifically for the DoD. Over the course of this time, it will become easier to find vendors meeting the common criteria described in this document.

8. Market Research: For the procurement of the hardware, market research included looking at Microsoft, IBM, Nuance and GE. All vendors were contacted either by phone, onsite meetings or at trade shows. All were found to be lacking in quality Natural Language Processing (NLP) as well as Backend Speech Recognition (BESR). No vendor had an Information Assurance certification and none had a direct interface from their products to a government electronic health information system. IBM and Nuance are working to acquire these capabilities but thus far are not at the level of 3M. These automated capabilities can significantly reduce or eliminate the need for additional transcription staff, which will otherwise complete these tasks manually.

Furthermore, this will reduce the duplication of effort that providers currently do by eliminating copying and pasting medical notes. These efficiency gains go hand in hand with MHS Quadruple AIM efforts to reduce costs and improve efficiency.

Being able to dictate clinical notes that are then automatically placed into the electronic health record means that provider notes will be available much sooner for nursing staff and other providers to read and use in their care of the patients. In addition to this, the licensing of the 3M product by the numbers of dictated lines of texts versus the current process of named licenses will ensure that the service is available to most of the clinical providers within the facility. It will also prevent the waste that can occur when named licenses are not used or are shelved for long periods of time when providers are on leave or deployed. 3M SEDTS is the only product that meets DoD cybersecurity requirements. 3M is the only product that contains approved interfaces between existing Clinical Documentation Systems (CHCS and Essentris).

9. Interested Sources: Due to the proprietary nature of the services and the Information Assurance (IA) requirements, no other business can provide the requested service.

10. Other Facts:

a. Procurement history. Reasonable efforts to retrieve the following items from computer records, contract files, competition advocate office files or other sources are expected:

(1) Contract numbers and dates of the last several contracts for these same requirements.

W91YU0-13-P-0641 (Previous Fort Carson Contract), 1 October 2013 – 30 September 2015.

W91YU0-16-P-0661 (Current Fort Carson Contract), 1 October 2015 – 30 September 2020.

W81K00-16-P-0068 (Current Fort Hood Contract), 18 February 2016 – 17 February 2017 extended to 17 August 2017.

(2) The competitive status of these actions.

Sole source for maintenance due to proprietary rights on the equipment.

(3) Authority previously cited if less than full and open competition was used.

Fort Carson’s actions: FAR 6.302-1 – Only one Responsible Source and No Other Supplies or Services will Satisfy the Agency Requirements: 10 U.S.C. 2304(c)(1).

Fort Hood action: FAR 13.106-1 - Only One Source Reasonably Available.

(4) If a justification was prepared to support the procurement made before this one, a summary of the contents of paragraph 7 of the justification for that procurement and an explanation of the results.

Fort Carson: The current contract is with Nuance for maintenance and they have proprietary rights on the Software and Hardware elements of a Nuance Gold Solution. Maintenance and support cannot be obtained and are not authorized through any other source.

Fort Hood: The current contract is with Carahsoft for maintenance and they have proprietary rights on the Software and Hardware elements. Maintenance and support cannot be obtained and are not authorized through any other source.

(5) If any prior contract for this requirement was accomplished using full and open competition, include a detailed explanation of the changed circumstances causing this action to now limit the sources. N/A

(6) An explanation of any unusual patterns that may be revealed by the history, e.g., several consecutive, urgent buys. N/A

(7) If a justification was prepared to support the procurement made before this one, briefly describe the circumstances justifying the procurement and whether there have been any significant changes.

Nuance has proprietary rights on the Software and Hardware elements of a Nuance Gold Solution. Maintenance and support cannot be obtained and are not authorized through any other source. There has been a significant change; this requirement has grown beyond just the Fort Carson requirement. The current contract W91YU0-16-P-0661; also includes the ability for the new Fort Hood contract to “piggy back”, therefore the system must be much more robust and adhere to the security requirements of DICAP.

b. Other facts. Provide any other facts necessary to justify limiting competition that were not previously stated.

11. Technical Certification:

I certify that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Signature: ________________________________ Date: __________

Typed Name: _________________ Title: _______________________

12. Requirements Certification:

I certify that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Signature: ________________________________ Date: __________

13. Fair and Reasonable Cost Determination:

I hereby determine that the anticipated cost to the Government for this contract action will be fair and reasonable.

Signature: ________________________________Date: __________

14. Contracting Officer Certification:

I certify that this justification is accurate and complete to the best of my knowledge and belief.

Signature: ________________________________Date: __________

Approval

Based on the foregoing justification, I hereby approve the procurement of Dictation and Transcription License and Software, total dollar $________ ; on an other than full and open competition basis pursuant to the authority of 41 U.S.C. 1901 as implemented by FAR 13.501, subject to availability of funds, and provided that the services and property herein described have otherwise been authorized for acquisition.

Signature: _____________________________ Date: _______________