Notice Type: Sources Sought
This Request for Information (RFI) is being released to solicit preliminary capability information from vendors and the open source community on solutions for a need related to the integrated Electronic Health Record (iEHR) Joint Immunization Capability (JIC) for the Department of Defense (DoD)/Veteran’s Administration (VA) Interagency Program Office (IPO). In support of the JIC initiative, the IPO is seeking potential vendor solutions and approaches on how to acquire a shared capability to document, monitor, forecast, and report immunization information for DoD and VA beneficiaries.
THIS IS A REQUEST FOR INFORMATION IAW FAR 15.201. This notice is solely for market research and planning purposes and does not constitute a request for proposal, request for quote, or invitation for bid, nor does its issuance in any way restrict the Government to its ultimate acquisition approach. No award will be made from this RFI and the Government will not pay for any effort expended in responding to this notice.
The DoD and VA are committed to full and seamless electronic exchange and record portability of healthcare information in a secure and private format, wherever needed, to ensure the highest quality and effective delivery of healthcare services. To this end, the DoD and VA are jointly implementing an iEHR that allows for full interoperability of patient’s health care information between the two Departments. Immunization management has been prioritized as a component of the first set of iEHR clinical capabilities to be developed and delivered.
The DoD and VA currently manage immunizations using separate IT systems, with separate data repositories, and complex sharing processes. The use of multiple IT systems can lead to inconsistent or duplicative non-associated documentation within an individual’s immunization record with the potential for unnecessary and excessive vaccinations, increased cost, and inventory waste. Uniting DoD and VA business processes and capturing immunization documentation in a common system achieves the desired outcome of shared information interoperability to better support force health protection and readiness activities, and ensure the health of all beneficiaries receiving vaccinations.
- SOLUTION SOUGHT
The IPO is requesting market information on proposed approaches on shared capability to document, monitor, forecast, and report immunization information for DoD and VA beneficiaries. Specific consideration is requested with respect to how proposed user facing capability can be developed/delivered in such a way as to:
- Operate congruently with existing DoD and VA immunization information systems as described in section 4.1 below (consistent with the Technical Specification Package (TSP) Overview section 6.1 Legacy Reach-back Strategy and 6.2 Legacy Reuse Strategy) until such time as existing immunization systems are no longer required to operate.
- Evolve to leverage additional iEHR infrastructure and services as they emerge along the path to Initial Operational Capability (IOC) (currently being defined) and ultimately the iEHR Target Architecture as described in section 4.2 below.
- Immunization Functionality and Capabilities
This section contains a summary of key functionality and capability areas required to support the Joint Immunization Capability. These areas are derived from functional requirements and process models developed by DoD and VA immunization functional proponents as part of the JIC integrated Business Justification Package (iBJP). The iBJP serves as the functional baseline for the JIC. References to the artifacts contained in the iBJP can be found in section 10.0 REFERENCES below.
Immunization System Core Functionality
This functionality includes the ability to manage immunization schedules, manage patient lists/cohorts, manage immunization history, document immunizations administered, document immunity status, document adverse reactions, manage exemptions, and manage exceptions. The iEHR subject matter experts defined these functional areas under the following broad categories (reference Joint Immunization Capability integrated Business Requirements Document (iBRD)):
- Manage Immunization
- Determine Need for Immunization
- Order Immunization
- Administer Immunization
- Complete Immunization Documentation
- Manage Patient Health Record in Disconnected Mode
- Prepare to Disconnect
- Reconcile on Network Reconnect
Immunization System Core Capabilities
This capability includes the ability to track immunization/vaccine stock from manufacturer to patient administration, including intermediate inventory management at the facility and clinic levels. This capability must include all required elements of vaccine documentation including manufacturer, lot numbers, expiration dates, etc. This capability also includes automatic decrement from inventory by lot when vaccinations are administered.
This capability includes the ability to record Vaccine Information Statement (VIS) data, documenting the offer of the VIS to the patient or patient representative, the date of such offer, and the date of the VIS being offered.
This capability includes the ability to utilize standard protocols to exchange immunization data with authorized organizations or individuals for the purposes of reporting adverse reactions, general public health, and the ability to track immunization progress in the event of pandemic disease outbreaks. The capability includes the ability to share immunization history data to legacy VA/DoD Electronic Health Record (EHR) systems and DoD service readiness systems in order to promote continuity of care at facilities not yet implementing the JIC system. The capability also includes the ability to exchange data with designated Personal Health Record viewer, as reflected in Service Member readiness systems, TRICARE Online, and My HealtheVet.
Computerized Provider Order Entry (CPOE)
This capability includes the ability to associate Immunization standing orders and provider’s patient-specific orders with a patient record to denote the authorization to administer an immunization. Standing order configuration must allow for tiered application, such as by Service, region, facility or specific patient population designation. These should be associated with a formulary standardization requirement. The system is expected to have the ability to receive patient-specific orders from legacy VA/DoD CPOE systems as well as the anticipated future-state iEHR CPOE system. The desired end-state user experience will incorporate the transmittal of orders identically whether the target system is the current (as-is) or revised (JIC) immunization program.
Clinical Decision Support (CDS)
This capability includes the ability to improve patient safety by identifying recommended immunization treatments based on nationally approved immunization schedules (reference sections 3.1.9, 3.1.10) leveraging the Health, Age, Lifestyle, and Occupation (HALO) structure and by preventing adverse reactions through data exchange of patients’ previous immunization history and evaluation of other contraindications available from the EHR system.
Alerts and Reminders
This capability includes the ability to notify the provider and/or beneficiary of upcoming recommended or required immunizations (see 3.1.6 and 3.1.9) to ensure all recommended and minimal standards are designated and tracked. For the provider, this applies to both the patient-specific level when viewed from the perspective of a patient health record, and to the cohort level when viewed from the perspective of a provider panel.
This capability includes the ability to generate template-driven and ad-hoc reports in order to manage population public health, cohort or panel immunization status. It includes information to support force readiness reporting, response to pandemic events, and patient compliance with recommended or required immunization schedules, to include reporting on vaccine refusal and patient call back reporting in periods of vaccine shortage.
This capability includes the ability to interface with legacy VA/DoD appointment scheduling systems and the future-state iEHR scheduling system in order to facilitate a coordinated effort between an identified immunization that is recommended or required, and the patient/beneficiary’s presence to receive that immunization.
This capability includes the ability to predict at the population, facility, and cohort levels the required inventory purchases of immunizations for a given time period, utilizing the available clinical decision support tools (3.1.6) and immunization histories (3.1.1) to define the anticipated need.
This capability includes the ability to provide the above services when disconnected from the network, syncing data upon reconnection with the system/network.
- ARCHITECTURE CONSIDERATIONS
- Existing Immunization Systems Overview
Figure 1 provides an as-is overview of the primary existing DoD and VA immunizations repositories and data exchanges.
Figure 1 – DoD and VA as-is overview
- DoD As-Is Immunization System Components
- Defense Enrollment Eligibility Reporting System (DEERS) - Serves as the repository of record for DoD Service member immunization data for purposes of readiness reporting. DEERS is also a database of military sponsors, families, and others worldwide who are entitled under the law to TRICARE benefits.
- Clinical Data Repository (CDR) - The military’s EHR, Armed Forces Health Longitudinal Technology Application (AHLTA) is an enterprise-wide medical clinical information system developed for use by medical clinicians in all fixed and deployed MTFs. Immunization data entered into AHLTA is stored in the CDR and shared with DEERS, Service applications, and other databases.
- Medical Protection System (MEDPROS) - The Army Medical Department designed MEDPROS to provide for the data entry, reporting and tracking of immunization information for Soldiers, Units, and Task Forces.
- Medical Readiness Reporting System (MRRS) - a web-based, real-time application with a central aggregating database which contains immunization data. Used by the Navy, Marine Corps, and Coast Guard.
- SNAP (Shipboard Non-Tactical ADP Program) Automated Medical System (SAMS) - used by Navy and Military Sealift Command and serves as the primary tool for shipboard immunization tracking and reporting. SAMS data is sent to MRRS for Force Medical Readiness Tracking.
- Air Force Complete Immunization Tracking Application (AFCITA) - As a module of the Air Force’s Aeromedical Services Information Management System (ASIMS), AFCITA provides the Air Force with a data management portal to all of its facilities in order to track immunization data for all Air Force personnel.
DoD As-Is Immunization Systems Interfaces
- There is a bi-directional connection between each Service system and DEERS
- There is a bi-directional connection between CDR and DEERS
- Immunization Bi-directional Interface (IBDI) – is an interface to synchronize immunization data between the Services’ systems and the CDR. The interface is currently not in use by all Services.
- There is an interface between AFCITA and MEDPROS to facilitate the exchange of Air Force and Army Service member immunization data.
- VA System Overview
The primary storage of immunization data for VA is in a VistA (Veterans Health Information Systems and Technology Architecture) file named V IMMUNIZATIONS, for which there is an instance at each VA Medical Center.Data arrives to this file as part of the Patient Care Encounter (PCE) process, either directly or through documentation tools afforded by the VistA Clinical Reminders package.Immunizations administered to VA hospital inpatients may also be documented through the Bar Code Medication Administration (BCMA) program, and this data also flows to the facility-specific V IMMUNIZATIONS file.
VA Systems Interface Overview
Data is then available to other VA facilities through the VistAWeb or CPRS (Computerized Patient Record System) Remote Data Views interfaces, making the information available on a nationwide basis. The data sharing is mediated through VA’s Health Data Repository (HDR), although HDR does not aggregate or store the immunization data, it merely facilitates the exchange.
Occupational Health related immunization data resides in a separate web-based system called OHRS (Occupational Health Record System) which does not exchange data with VistA/CPRS.
- DoD/VA Immunization Data Interfaces
On a selective basis, some VA stations are able to receive data about DoD administered immunizations via the C-32 document exchanged via Nationwide Health Information Network (NwHIN) as part of the Virtual Lifetime Electronic Record, or VLER process.This is exposed to VA clinicians through the above-referenced VistAWeb interface.
- iEHR Architecture
The DoD and VA have committed to converge their currently independent electronic health record architectures on a jointly agreed, common SOA-based architecture. This target architecture will be characterized by an integrated set of common services, interface and data standards, data centers, presentation layer, and information interoperability framework. Future clinical capabilities will leverage shared, common enterprise services.
This concept is important for purposes of this RFI because it is envisioned that many of the capability areas described in section 3.1 will be delivered as enterprise services at iEHR FOC. An important consideration for the implementation of JIC is how proposed functionality can either operate natively in this service-based environment, or offer capability that can be migrated in phased iterations to take advantage of emerging enterprise services as they are developed and deployed, to include IOC architecture (currently being defined).
Figure 2 provides an overview of the iEHR target architecture, which is the agreed-upon EHR target state architecture for DoD and VA. This common target state accommodates unique EHR applications and services within the DoD and VA, while demonstrating a commitment by both departments to converge the currently independent EHR architectures.
Figure 2: Notional iEHR Target Architecture
- ADDITIONAL CONSIDERATIONS
- Clinical Quality Requirements
Proposed solution capabilities deployed as part of the iEHR are required to meet the following Clinical Quality Requirements as outlined in section 4.0 of the Technical Specifications Overview document:
- iEHR Certification/Meaningful Use
- Healthcare End-User Usability
- Patient Driven Care and Coordination
- Cognitive Support/Knowledge Management/Clinical Decision Support
- Business Intelligence/Analytics
- Privacy, Security and Information Assurance Requirements
Proposed solution capabilities deployed as part of the iEHR are required to be compliant with privacy, security and information assurance requirements as outlined in section 5.0 of the Technical Specification Overview document.
- ANTICIPATED ACQUISITION APPROACH
The JIC iBRD serves as the requirements baseline document that will initiate the iterative design, development, testing, integration, deployment and sustainment activities that characterize the iEHR Agile process. Functional Immunization proponents will work collaboratively with the IPO to evaluate candidate material solution approaches to meeting the requirements of the JIC iBRD with an anticipated acquisition priority of commercial/open source purchase, federal application adoption, and joint application development in that order.
Responses to this RFI will provide insight into market capability and possible solutions to meet the requirements for this particular capability.
This RFI is issued solely for information and planning purposes and does not constitute a solicitation. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this RFI. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. All information received in response to this RFI that is marked proprietary will be handled accordingly. Responses to the RFI will not be returned.
- RESPONSE INSTRUCTIONS
Interested parties are asked to respond to this RFI and submit a capability statement, completed Immunization Questionnaire, recommended approaches, past experience with contracts of similar scope and magnitude, and Central Contractor Registration information. No written solicitation document is available at this time.
All responses should be complete; in 12-point font; and not exceed 15 pages total, including tables, graphics and appendices, but excludes responses in the attached Immunization Questionnaire excel spreadsheet. File size for total submission should not exceed 10 MB unzipped.
The information received from this RFI may support a future request for proposal.
Responses to this RFI are due by 5:00 PM EST on August 17, 2012. All feedback and information received may be used to determine the appropriate acquisition plan and strategy for possible future acquisitions. Please note that no solicitation has been developed at this time.
- CONTACT INFORMATION
Following is the POC for this RFI:
Acquisition Management Support (AM&S)
TRICARE Management Activity
Questions and Answers: Written questions via email only will be accepted through 5:00 PM EST on August 8, 2012. Please entitle the subject line: Company Name - Questions - RFI Joint Immunization Capability. Government responses to questions are expected to be posted to FedBizOpps within 5 days of receipt.
Responses to RFI: Please submit written responses via e-mail in .pdf format. Please entitle the subject line: Company Name – Response – RFI iEHR Joint Immunization Capability.
All questions and responses must be sent to the following e-mail address: Jake.Lewis@tma.osd.mil. No hardcopies will be accepted. The IPO POC will not respond to any inquiries on any potential future acquisition activities or timelines.
References made in this document are contained on the TMA Vendor Information web page located at the following URL:
The Technical Specifications Overview Document is comprised of six sections and two Appendices, and can be found at the following URL:
Information contained in section 2.0 through 6.0 is further described by files which can be accessed through the following links:
Information Specific to the JIC is documented in 4.0 Clinical Requirements (B.4.3) of the Technical Specifications Package.
Immunization RFI Questionnaire
1 Describe how your solution implements the iEHR Immunization functional capabilities IAW the JIC iBRD
2 Describe how your system's user interface will integrate to the existing legacy VA/DoD systems and to the proposed future-state iEHR system as a whole.
3 How does your solution track immunization inoculations?
4 Describe how your solution distinguishes between a vaccine administered elsewhere that has all of the required elements to demonstrate its administration vs. an anecdotal report of historical immunization
5 Describe how your system is customizable so that selected business rules may be implemented differently assuming that a single installation may be utilized by two different geographic areas (e.g., East Coast vs. Midwest, with different influenza seasons, sharing one immunization system)
6 Describe how your system can receive vaccine administration data from an external source other than the user interface, such as a bar code medication administration system.
7 Describe data quality, de-duplication, reminders & recalls within your solution.
8 Describe your solution’s patient population.
9 Describe how your solution allows a user to enter a customizable immunization regiment. (e.g., anthrax, smallpox)
10 Provide a logical system architecture for your solution that describes standards, patterns, and technologies that are implemented. List all third party packages within your solution.
11 Describe the platform/hardware/infrastructure requirements for supporting/implementing your solution.
12 Provide a description of your solution’s data model. Is your solution’s data model proprietary or open standard?
13 Describe the users interface framework for your solution.
14 Describe the scalability of your solution - What are the largest installations of the system in terms of number of the users, records, and time-zones?
15 "Does your solution support disconnected (no network available) mode? If so, how?
How does the solution ensure data integrity in above scenario?"
16 Does your solution exchange information with third party applications? If so, provide a list of the third party applications and the information exchange standards that are used.
17 What are the offerings/packaging options available for your solution?
18 Describe your solution’s capability to produce ad hoc reports, if applicable.
19 What contract vehicles are available to procure the solution?
20 Describe how your solution complies with iEHR Architecture, Standards, Open APIs, and Common Interface Standards as outlined in iEHR program documentation to include the iEHR TSP, Version 1.5, 30 May 12 or later version.
21 Describe how your solution includes the following capabilities and/or has been integrated with the following services/capabilities IAW the requirements as defined in the iEHR TSP, Version 1.5, 30 May 12 or later version:
22 Access Management
23 Identity Management
24 Network and Security
26 Health Data Dictionary (HDD) and Custodial Agent (CA)
27 Common Information Interoperability Framework (CIIF)
28 SOA/SOE/Enterprise Service Bus (ESB)
30 Presentation Layer
31 Data Infrastructure
32 Patient Education
33 Alerts and Reminders
37 Describe how your product includes the following capabilities and/or has been integrated with the following services/capabilities IAW the requirements as defined in the iEHR TSP, Version 1.5, 30 May 12 or later version:
38 Clinical Decision Support
39 Computerized Provider Order Entry (CPOE)
40 Inventory Management
Privacy, Security, and Information Assurance Requirements
41 Describe your compliance and experience with the following solution requirements as described in the iEHR TSP, Version 1.5, 30 May 12 or later version:
42 Privacy and Security
43 Software Assurance/Information Assurance
44 Software Security, Certification and Accreditation
45 DoD Information Assurance policies
46 Software Reviews and Scans
47 Code reviews
48 Fortify Scans
49 Software Vulnerability
50 Information Assurance
Additional Information and Requirements
51 Describe your experience in implementing your solution in a transition environment where your system had to operate/integrate with legacy systems while transitioning to a new architecture.
52 Describe how you might implement your solution in the iEHR environment as described in the iEHR TSP, Version 1.5, 30 May 12 or later version.
53 Describe your experience with implementation of your product in using an Agile Approach
54 Describe your product support capability to include maintenance, training, modifications, etc.
55 Describe your licensing structure