75H704 – Sources Sought – Health Information Technology (HIT) Modernization

Mar 17, 2021 | Sources Sought

REQUEST FOR INFORMATION

This is a Small and Large Business Request for Information (RFI) notice. This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this RFI is to obtain knowledge and information for project planning purposes.

This RFI is issued solely for information and planning purposes – it does not constitute a Request for Proposal (RFP) or a promise to issue an RFP in the future.  Further, the Indian Health Service is not at this time seeking proposals and will not accept unsolicited proposals. Responders are advised that the U.S. Government will not pay for any information or administrative costs incurred in response to this RFI; all costs associated with responding to this RFI will be solely at the interested party’s expense. Not responding to this RFI does not preclude participation in any future RFP, if any is issued.

DESCRIPTION

The U.S. Department of Health and Human Services (HHS) Indian Health Service (IHS) is seeking information from qualified companies about the agency’s approach to modernization of its Health Information Technology (HIT) systems.  The purpose of this RFI is to obtain information on specific capabilities, costs, and business practices to inform future IHS HIT Modernization acquisitions. IHS anticipates an initial RFP to support IHS HIT Modernization in Fiscal Year 2021.

NAICS Codes: 541512 – Computer Systems Design Services

622110 – General Medical and Surgical Hospitals

BACKGROUND

The IHS is the principal federal health care provider and health advocate for American Indian and Alaska Native (AI/AN) people, and its mission is to raise their physical, mental, social, and spiritual health to the highest level. The IHS supports a comprehensive direct and public health service delivery system through a network of hospitals and clinics located in 37 states across the country, largely in extremely rural areas. IHS headquarters is in Rockville, MD, and the agency's health care operations are administered through twelve Area (regional) Offices.  More detailed information on the location and types of facilities and services is available through the IHS website (www.IHS.gov/aboutihs/). 

The Indian health care system is comprised of three broad components, collectively known as the I/T/U:

  • I (IHS) – 24 hospitals (including five Critical Access Hospitals (CAH)), 51 health centers (outpatient at least 40 hours per week), 24 health stations (less than 40 hours per week), and six Youth Regional Treatment Centers (YRTC) directly managed by the IHS;
  • T (Tribal) – 22 hospitals (9 CAH), 279 health centers, 79 health stations, 59 Alaska Village Clinics, and six YRTCs operated by Tribes that have exercised their self-determination prerogatives under the authority of the Indian Self-Determination and Education Assistance Act (ISDEAA) (Public Law 93-638, as amended); and
  • U (Urban) – 41 Urban Indian Health Programs funded under the Indian Health Care Improvement Act of 1976. 

The scope of capabilities and services touched by the IHS HIT modernization initiative is broad.  The IHS is a cradle-to-grave healthcare provider, and in most locations offers a variety of services in an integrated setting, typically including:

  • Primary care for all ages
  • Prenatal care
  • Behavioral health
  • Dental
  • Eye care (optometry and/or ophthalmology)
  • Physical therapy
  • Telehealth services

Most locations have ancillary services on site as well, including:

  • Outpatient pharmacies
  • Laboratory services
  • Radiology/imaging services, including use of a Picture Archiving and Communications System (PACS) system

IHS and Tribal hospitals and Critical Access Hospitals tend to be small, but all have Emergency Departments, and several offer labor and delivery, general or specialty surgery (e.g. orthopedic, podiatric), specialty inpatient care, and intensive care units.

Population and public health are important components of the IHS mission. These services are delivered through community-based providers including Public Health Nurses, Community Health Aides and Practitioners, and Community Health Representatives.

IHS is federally funded, but a significant proportion of operational costs at all facilities are recovered through third party revenues. At the same time, IHS is also a purchaser of healthcare services for eligible beneficiaries under certain circumstances through its Purchased and Referred Care (PRC) program.  Financial systems that support IHS’ role as a provider of healthcare services, as well as a self-insured payer for certain services, are therefore an essential part of the agency’s HIT portfolio.

While many Tribal and Urban Indian healthcare organizations use the IHS Resource and Patient Management System (RPMS – see below) as their HIT solution, many others have adopted commercial off-the-shelf (COTS) systems to meet their clinical and business requirements.  Many of these organizations share patients with I/T/U facilities that use RPMS, and all share data with IHS concerning their healthcare operations.  In addition, IHS facilities have extensive regional consulting and referral networks with which they share patients.  Therefore, interoperability and health information exchange, both within and outside the I/T/U system, are extremely important to the overall mission of the agency.

Finally, as a federal agency, the IHS is responsible for understanding and reporting on the success of its mission to HHS, Tribes and Tribal Health Organizations, the Office of Management and Budget, the Administration, and Congress.  Accordingly, analytics solutions capable of working with clinical, public health, financial, and other data sources, and accessible to users at all tiers of the organization, will be an important component of a comprehensive, modernized HIT infrastructure.

IHS HIT MODERNIZATION

The health information system in use at IHS, as well as many Tribal and Urban Indian healthcare organizations, is the Resource and Patient Management System (RPMS), a comprehensive health information suite that supports a broad range of clinical, population health, and business processes from patient registration through the billing cycle.  RPMS was internally developed by IHS, leveraging a decades-long collaboration with the Department of Veterans Affairs (VA), and is certified to the 2015 Edition criteria published by the Office of the National Coordinator for Health Information Technology (ONC). 

RPMS is a distributed system, with hundreds of separate databases located at facilities nationwide, managed and supported locally or through Area Offices.  The IHS Office of Information Technology (OIT) develops and updates the system regularly, issuing patches that are installed on each instance by local staff.  In recent years, advances in health-related standards and technologies, an increasingly complex regulatory environment around HIT, and the decision of the VA, IHS’ long-time collaborative partner, to move to a commercial off-the-shelf HIT solution, have combined to make the current approach to IHS HIT development and support non-sustainable going forward.  At the same time, the HIT industry has matured to a level where the IHS can be confident that commercial solutions are available that will enable the agency to move forward with a truly modern system that will not only support but improve its healthcare operations into the future.

In 2018-19, IHS, in collaboration with HHS, engaged in comprehensive research and analysis of the current state of its HIT infrastructure and options for modernization.  More information and many deliverables from the HHS/IHS HIT Modernization Research Project are available at:

https://www.hhs.gov/cto/initiatives/public-health-innovation/indian-health-service-health-it-modernization/index.html

IHS has published its intent to move forward with modernization by transitioning from its legacy RPMS to state of the art, commercial off-the-shelf systems.  The selected systems must support a true enterprise approach to HIT, enabling the highest quality inpatient, ambulatory, behavioral health and other ancillary healthcare and business office services, with standards-based interoperability and analytics capabilities, positioning IHS in the best possible way to accomplish its mission in the coming years.

REQUEST FOR INFORMATION – WHITE PAPER

The purpose of this RFI is to solicit recommendations from the industry for the approaches IHS should consider as it takes steps to modernize its HIT infrastructure, taking into consideration the background described above.  Responses should ideally address, but not be limited to, the challenges outlined below: 

  1. Provision of high-quality, holistic, multi-disciplinary integrated care for geographically and culturally diverse populations;
  2. A need for highly usable systems built around human-centered design principles, with minimal training requirements and mitigation of the administrative/documentation burden imposed by typical electronic health record (EHR) systems;
  3. Transition from a multi-database HIT environment with decades of legacy patient data to a centrally-managed, preferably single-database solution for IHS-managed facilities;
  4. Recommendations for legacy data management, including such options as data migration to a modernized system, on-demand data access from a modernized system, data retention for archiving purposes, etc.; https://www.ihs.gov/scb/
  5. The ability to enable and support best and preferred practices in clinical and business workflows through a mature governance structure while permitting configuration that aligns with local operational and staffing needs;
  6. Support for or compatibility with a broad range of telehealth modalities, including remote specialty consultation to IHS facilities, primary care provider-to-patient telehealth in the home, and remote patient monitoring;
  7. Support for patient access to their health information and ability to communicate with their healthcare teams;
  8. Visibility into and understanding of population health status and organizational performance at all levels of the agency, including clinical quality measures published by the Centers for Medicare and Medicaid Services (CMS) and other bodies and Government Performance and Results Act (GPRA) clinical measures; https://www.ihs.gov/quality/government-performance-and-results-act-gpra/   
  9. Ability for the agency and its programs to be responsive to mandated and ad hoc Congressional, federal, state, and tribal reporting requirements;
  10. Interoperability within the I/T/U universe regardless of the EHR selected by Tribal and Urban partners, as well as between IHS, VA and other external entities from which  AI/AN patients receive care;
  11. Support for operations in very rural areas, some of which experience variable internet reliability and/or limited bandwidth capacity, ensuring that these organizations can still access essential data and provide care at times of service interruption;
  12. Future-proofing through the use of state-of-the-art architectures (e.g. cloud) and technologies (e.g. FHIR, RESTful APIs).

PRICING QUESTIONS

  1. Please provide your relevant commercial pricing information, e.g., Monthly subscription prices, annual perpetual licensing prices.
  2. Please provide any costs that are not included in the rates above, e.g., installation, configuration, integration, training, maintenance, upgrades, hosting.
  3. Provide the pricing model for other services and solutions (HIE data sharing, Revenue Cycle Management (RCM), population health, etc.).
  4. Please list the third-party licenses for components such as commercial databases, web servers etc. that your system will require.
  5. Please provide discounts that you offer for volume buys, public health departments, or disadvantaged populations.

GENERAL ACQUISITION QUESTIONS

  1. What information do you need from IHS to adequately propose a solution and price?
  2. Do you participate on any Government-wide Acquisition Contracts (GWACs)? If so, as a Prime or Subcontractor?
  3. Please describe your anticipated role in this acquisition (e.g. Prime, Subcontractor, etc.) and describe any teaming arrangements.
  4. How would you structure the contract to establish pricing to allow for ordering in the future?
  5. Please provide any questions you would like addressed in a future industry engagement. (e.g. Draft RFP, Industry Day, etc.)

SUBMISSION INSTRUCTIONS

Responses provided must be submitted electronically via e-mail to Crystal Showell, crystal.showell@ihs.gov and Cole Cook, cole.cook@ihs.gov no later than close of business April 19th, 2021.

Responses to this RFI should include the following:

Cover letter with the following information at a minimum:

  • Company Name
  • POC and Contact Information
  • Small business status, if applicable
  • Socio-economic category.
  • DUNS Number

White Paper

  • No more than 10 pages in length

Pricing Questions

  • No page limit. Pricing lists can be attached separately.

General Questions

  • No more than two (2) pages in length

Please provide responses in the same order and structure as the question are provided below. Page size is 8.5 x 11 inches with 1-inch margins. Text must be a minimum font size/style of 10-point Time New Roman. Tables must be a minimum front size/style of 9-point in Times New Roman. Graphics must be at minimum 8-point in Times New Roman. Phone calls or emails outside or related to this RFI will not be accepted.

Questions regarding the contents of this RFI shall be submitted via email to Crystal Showell, crystal.showell@ihs.gov and Cole Cook, cole.cook@ihs.gov no later than close of business March 31st, 2021. Phone calls will not be accepted. The Government reserves the right to respond to some, all or none of the questions that will be submitted.

DISCLAIMER AND IMPORTANT NOTES

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY to identify sources that can provide Distribution of Public Service Announcements via Traditional and Non-traditional methods. The information provided in the RFI is subject to change and is not binding on the Government. The IHS has not made a commitment to procure any of the items discussed, and release of this RFI should not be construed as such a commitment or as authorization to incur cost for which reimbursement would be required or sought. All submissions become Government property and will not be returned.

This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed. Information provided will be used to assess tradeoffs and alternatives available for the potential requirement and may lead to the development of a solicitation. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

CONFIDENTIALITY

Proprietary information and trade secrets, if any, must be clearly marked on all materials.  All information received in this RFI that is marked “Proprietary” will be handled accordingly.

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