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Request for Information National Teleradiology Program (NTP) PACS (Picture Archive & Communications System) 1. Introduction This RFI is for planning purposes only and shall not be considered an Invita... Request for Information National Teleradiology Program (NTP) PACS (Picture Archive & Communications System) 1. Introduction This RFI is for planning purposes only and shall not be considered an Invitation for Bid, Request for Task Execution Plan, Request for Quotation or a Request for Proposal. Additionally, there is no obligation on the part of the Government to acquire any products or services described in this RFI. Your response to this RFI will be treated only as information for the Government to consider. You will not be entitled to payment for direct or indirect costs that you incur in responding to this RFI. This request does not constitute a solicitation for proposals or the authority to enter into negotiations to award a contract. No funds have been authorized, appropriated or received for this effort. Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. The Government does not intend to pay for the information submitted in response to this RFI. Any information received from a contractor in response to this RFI may be used in creating a solicitation. Any information received which is marked with a statement, such as proprietary or confidential, intended to restrict distribution will not be distributed outside of the Government, except as required by law. This RFI is issued for the purpose of collecting information about a next generation Teleradiology PACS (Picture Archive & Communications System) as described below. (a) VHA National Teleradiology Program (NTP) is VA s in-house teleradiology service and has been providing 24x7 service to VA facilities for the past decade. NTP is currently supporting over 120 sites across all VISNs and is projected to interpret between 1.0 and 1.5 million studies annually. NTP presently has reading centers located in the following cities: Durham, NC; New York, NY; Dallas, TX; San Bruno, CA; Menlo Park, CA; Sacramento, CA; Los Angeles, CA; Portland OR; and Honolulu, HI and has approximately 100 Radiologists working remotely via home PACS workstations with VA VPN connections. (b) NTP is currently surveying industry to identify potential vendors who would be capable of providing NTP with a best in breed, next generation modular PACS that incorporates at a minimum the following preliminary features: Cloud-based vendor neutral archive with local image cache at reading centers for optimal display and reading performance. Workflow/assignment engine for subspecialty assignment, image routing and turn-around time optimization Real-time productivity tracking for each Radiologist Master patient index to address VA s conversion from VistA to Cerner EMR and the change in primary identifier from SSN to EDIPI. System must be able to seamlessly function with both VistA and Cerner EMR interfaces and be able to utilize the appropriate primary patient identifier for each respective system to uniquely identify patients and ensure a patient s data appears as a singular instance within the PACS. Zero footprint web viewer for referral viewing and internal NTP Support use Workflow tools such as integrated ad-hoc and assigned peer review, Tech/image quality feedback, critical result notification/callback, NTP PACS Assistant image intake portal for pre-read QC, etc. Multiple voice recognition system options that can be integrated with the VA PACS Artificial Intelligence functionality, with integrated image routing and analysis at a minimum to include intracranial hemorrhage detection and lung nodule detection with measurement and classification HL7 and DICOM integration to all VA PACS, Cerner image archives, and HL7 instances from VistA and Cerner. Must be able to query all connected image archives using the primary patient identifier within each respective PACS instance. The system will be scalable such that VISNs could elect to deploy the system as their in-house PACS and would have their worklist, user database, voice recognition and workflow tools separate and distinct from NTP. However, the images and reports would reside in a common VNA accessible by all users of the system and the VISNs would be provided with an optional local image cache housing 5 years worth of images if required for application performance. For optional VISN PACS deployments, the archive/storage requirements will fall into 1 of 3 configurations based on their Cerner deployment status Pre-Cerner deployment, PACS option will provide full VNA storage of all PACS images for the VISN with local image storage as required. Post-Cerner deployment, PACS storage may switch to Cerner CAMM for local and central image storage. PACS will be configured to utilize the Cerner storage as a VNA. Post-Cerner deployment, PACS storage may continue with full VNA storage of images as listed above if performance of Cerner CAMM is not sufficient to meet PACS performance requirements. The Government anticipates a base procurement with a fixed cost for initial implementation and training and a separate cost for data migration of reports (per million reports) and images (per 100 TB). Ongoing costs will be an all-inclusive fee per study model, to cover all PACS hardware and software updates and upgrades with a hardware tech refresh at least every 3 years. Full service and support will be provided 24x7x365. 2. Submittal Information: All responsible sources may submit a response in accordance with the below information. NO MARKETING MATERIALS ARE ALLOWED AS PART OF THIS RFI. Generic capability statements will not be accepted or reviewed. Your response must address capabilities specific to the services required in the attached General Requirements and must include the following: (a) Interested Vendors shall at a minimum, provide the following information in the initial paragraph of the submission: Name of Company Address Point of Contact Phone Number Fax Number Email address Company Business Size and Status For VOSB and SDVOSBs, proof of verification in VIP. NAICS code(s) Socioeconomic data Data Universal Numbering System (DUNS) Number Existing Contractual Vehicles (GWAC, FSS, or MAC) (b) Provide a summary of your capability to meet the requirements contained within the draft General Requirements for the following areas: Provide a summary of your technical capability to meet the General Requirements as well as responses to specific questions at the end of the General Requirements. Corporate experience or expertise in performing these services and specific examples or references. Specific examples or references provided must include the agency, point of contact, dollar value, and contract number. Your company s intent and ability to meet the set aside requirement in accordance with VAAR 852.219-10 (NOV 2020) (DEVIATION) VA Notice of Total SDVOSB and 13 CFR §125.6, which states the contractor will not pay more than 50 percent of the amount paid by the Government to it to firms that are not SDVOSBs. Your response shall include information as to available personnel and financial resources; full names of proposed team members and the PWS requirements planned to be subcontracted to them, which must include the prime planned percentage or the names of the potential team members that may be used to fulfill the set aside requirement. Responses are due no later than 10:00AM EST, Friday, March 12, 2021, via email to Heera Polanco, Contract Specialist at Heera.Polanco@va.gov and Kathryn Pantages, Contracting Officer at Kathryn.Pantages@va.gov. Please note National Teleradiology Program (NTP) PACS (Picture Archive & Communications System in the subject line of your response. Mark your response as Proprietary Information if the information is considered business sensitive. The email file size shall not exceed 10 MB. 3. General Requirements NTP NextGen PACS will have the following major characteristics which will be described in detail in a subsequent RFP: Intuitive, stable and easy to use user interface for the PACS viewer, designed to optimize productivity and quality. Viewer should be designed with a focus on human factors to optimize viewing efficiency, while minimizing viewer fatigue and the incidence of repetitive motion injuries. Viewer must be optimized for WAN use with full fidelity streaming using selective compression with a default of lossless compression. Image streaming will be encrypted traffic, ideally utilizing a fixed TCP port greater than 1023. Note that VA utilizes Riverbed WAN optimizers and QoS for WAN traffic management. In your response, please identify any issues previously seen with either Riverbed or QoS with your PACS application and implementation. Viewer supports on the fly 3D reformatting Viewer provides an integrated tool for instant messaging (IM) communication within the PACS between radiologists and/or support staff with the ability to send embedded study links in the messages. IM tool will have the ability to broadcast messages to online users with individual and group responses. Viewer must provide support for archive teaching cases with deidentification of patient information PACS must support export of deidentified reports and images via DICOM and local media Integrated worklist/viewing application with enterprise study locking across the application within milliseconds to prevent duplicate reading. Upon receipt of a final report generated by a VA customer facility, the study will be removed from the NTP worklist and the PACS will prevent NTP interpretation of the study. Provide automated auto-linking/registration of multi-slice images across series among current and prior exams Integrated ACR compliant peer review functionality with on demand and assigned workflows. Peer review will incorporate separate workflow and scoring methodologies for internal NTP peer reviews and separately focused/ongoing peer reviews that NTP performs for VA customer facilities. Seamless API integration with vendor provided voice recognition system. Vendor will provide multiple VR options for NTP to select from. NTP will select a single voice recognition system that shall be supported by the vendor. As part of the scalability, other VISNs could select from the VR options for their deployment and that would need to be supported by the vendor. Enterprise-based VR profiles allowing users to rotate workstations and/or reading centers with minimal to no user reconfiguration required. VR reporting system must be able to support connection to all VA facilities each with their own HL7 interface. VR system must also be able to support an interface to Cerner OpenLink as sites convert over at least the next decade. VR system must be able to handle parent/descendent exams and be able to copy/paste reports into unlinked/associated accession numbers. VR system and all system components will be designed with 99.99% uptime goal with failover redundancy. VR system must support global and user specific templates. VR system must support VA defined diagnostic codes. VR system shall incorporate capabilities of prepopulating measurements, contrast, and radiation dose information into structured reporting format Seamless API integration with Cerner VDI. Seamless API integration with VA/DoD Joint Legacy Viewer, which requires the use of CCOW. All PACS and associated applications must support application authentication using Single-SignOn (SSO) or LDAP via PIV/CAC cards. Worklist options to include community/shared worklist, subspecialty group worklist, and user specific worklist assigned via assignment engine. NTP workflow falls into 4 different categories, CRIT, STAT, ASAP, and Routine, and the system shall be designed to accommodate multiple order priority levels. Typically, routine studies will be pulled through the Q/R process as activated by pre-programmed business rule (BR) logic, which the vendor will provide as a component of image acquisition/routing process, while STAT cases are routed on demand from the sites with accompanying priors. For unread cases designated for NTP interpretation, the system will issue a preliminary stub report back to the originating site via HL7, indicating that the study has been sent to NTP for interpretation. CRIT exams have a 15-minute turnaround time from ingest to final report, while STATs have 1 hour, ASAPs have 8 hours, and routines have 48 hours. Vendor system must be designed to optimize acquisition and display/interpretation of critical examinations, such as MR and CT for stroke, within the 15-minute turnaround time. TECHNICAL SUPPORT Vendor must provide 24x7x365 technical support with off-hours escalation to senior level support within 15 minutes of initial call. Vendor must provide an ongoing commitment to NTP for continuous product development and enhancement to ensure that the NTP PACS remains on the most current version of PACS. Remote support will be provided via VA site-to-site VPN with accompanying VA mandated annual information security and privacy training along with background investigations. Vendor and all subcontractors must agree to comply with all applicable VA security requirements. Vendor will be responsible for all OS patching, AV updates and application updates/upgrades to meet VA security requirements. Windows OS patches are available via an internal WSUS repository. Linux servers must also be patched and can be managed through the VA RHEL satellite server provided the Linux servers meet the VA baseline. If Linux based and not configured in accordance with VA baseline, vendor will be responsible for managing updates independent of the VA satellite server. Software maintenance for PACS application and associated components to include updates and upgrades and all requisite security maintenance to remain in compliance with NIST, FISMA, and VA security standards will be provided and installed by the vendor. The maintenance window for software updates will be limited to 15 minutes of downtime Tuesday-Thursday mornings unless otherwise specified by the VA. Maintenance updates/upgrades requiring longer than 15 minutes will be addressed on a case by case basis but should not exceed 60 minutes. ARCHITECTURE The overall system design shall have redundancy and fault tolerance for components to eliminate single points of failure as the NTP PACS is a mission/life critical application that is required to be online 24x7x365. The target uptime threshold for the overall system will be 99.99% and support penalties will be applied for performance that falls below 99.9% uptime on a monthly basis. All DICOM and HL7 traffic will provide resilient links that will auto-restart with message/data failure/rejection and provide notification mechanism to the vendor and NTP support. System is deployed with encryption of sensitive data at rest. System will be designed to optimally utilize bandwidth across the VA WAN and to/from the cloud-based components. All cloud-based components will be hosted in a FedRamp certified data center. For reading centers where local cache is required for application performance, the system will include intelligent study/workflow routing that directs study traffic to only those reading center where the assigned Radiologist is working. System will interface to VA s radiology HL7 engine which will require vendor custom configuration/mapping on a site by site basis. System will support VA s HL7 2.3 and 2.4 message formats. Additionally, the system will support a HL7 interface to Cerner OpenLink. Annual order/report capacity should be sized for 20M studies combined across both EMRs. System will be designed to accommodate site by site or VISN by VISN business rules for automated study Q/R based on pre-programmed criteria (CPT code, time of day, day of week, quantity and priority). System will incorporate an integrated analytics system that allows on the fly analysis and report creation of study workflow, volume, billing, productivity, billing etc. The features and functionality will meet or exceed NTP s current brand name analytics system, Foundations by Health Level Inc. or the offering could include provision of same system. System will normalize all VistA generated accession numbers to the following format: ###-MMDDYY-123 where ### is the 3 digit site code for the originating VistA instance and similarly all studies and reports that utilize SSN as the primary identifier will have their data normalized to the dashed format 000-00-0000. For sites that utilize Cerner as their EMR, the system will be able to uniquely identify the patient via both the EDIPI and SSN and must be able to utilize the appropriate identifier to issue a Q/R to a PACS that uses Cerner and simultaneously to one that uses VistA, e.g. patient in Spokane has a STAT x-ray and the site is using EDIPI as their primary identifier. That same patient has studies and reports in Bay Pines and within their PACS, the patient is identified via SSN. The NextGen PACS application will utilize an MPI such that a query from an end user on the PACS will correctly utilize the appropriate patient ID parameters in the query to successfully execute the Q/R. That patient will appear as a single instance within the NTP PACS and reports will be issued to the originating site utilizing the site s native patient ID parameters. System will provide PACS administrators with the ability to dynamically change DICOM Q/R targets as facilities change PACS vendors and/or servers, without a system downtime. Q/R will be available via GUI tool embedded within the NTP Support QC workspace and will also be available within the PACS viewer. Intuitive GUI based study management tool for image/demographic modification and reconciliation for NTP Support. System must include integrated artificial Intelligence (AI) application for no less than Intracranial Hemorrhage identification and lung nodule detection and measurement. AI results will be incorporated into study prioritization as well as structured reporting within the VR system. Vendor will import 50M+ reports from the existing NTP PACS via bulk export and will begin image ingest during system configuration/testing. The exact quantity of reports will be finalized prior to RFP. Deployment with final validation to be completed no later than December 1, 2023. Post NTP deployment, VISNs may elect to exercise optional line items on the IDIQ to utilize the PACS with a separate organizational structure. For VISN PACS options, vendor will also handle study and report migration and will provide 5 years on-site data storage at a central VISN location if required for application performance. Routing/QR rules will be configured to retrieve relevant priors from the long-term cloud-based archive at study registration. Vendor will provide a web-based portal for CRIT and STAT study submission. The Web portal will incorporate notes from the submitting Technologist and will include callback information for NTP to use in case there is a critical finding. The information in the web portal will be incorporated into the PACS as part of the study QC process. The web portal will also incorporate a mechanism to message NTP support regarding case updates, etc. Web portal will not contain or display PHI. Due to the number of users that will access the Web portal, it shall utilize active directory via PIV/CAC for web portal authentication. Each study that is submitted to NTP for interpretation will be reviewed by the NTP Support team via a PACS application tool that allows NTP to assess the study for completeness and validate that relevant priors are available. If priors have not been sent by the site, the QC tool will allow NTP to query and retrieve from any PACS to which we are connected. The QC tool will incorporate automatic indexing of source PACS and will normalize all image and report accession numbers into a consistent format for data from VistA sites. Cerner order/report data will follow a different format but all data from Cerner will be in the same format due to the singular nature of the EMR deployment. System must include an integrated contingency report server with fax and e-mail capabilities to allow for report distribution in instances where there are HL7 interface issues preventing automated transmission. QUESTIONS: What is your current market share for PACS deployments over 500,000 annual cases? How many PACS deployments do you currently have in production that handle annual volumes in excess of 1M, 5M annual cases? What is the current yearly volume of your largest PACS deployment? What is your 2nd largest? Do you have any PACS deployments greater than 500,000 annual cases where image viewing/interpretation is done exclusively across the WAN/Internet? Describe the techniques used to optimize system performance across the WAN in respect to both image streaming and study ingest/acquisition. What compression methodology is used and what is the expected compression ratio for a typical 1500 slice CT scan? What is the minimum recommended bandwidth and maximum latency for image viewer and voice recognition functionality across the WAN? Do you have any multi-site PACS deployments hosted in a FedRAMP certified data center? What voice recognition systems do you support and what are your top 3 recommendations? Note NTP will select 1 VR system which will be provided as part of this procurement and subsequent VISN deployments may select a different system. Describe your full suite of workflow tools that optimize quality, timeliness and reading efficiency. Can your VNA accommodate storage of non-radiology DICOM images using tag mapping to uniquely associate the images to the correct patient? Describe the process and validation elements. How many deployments do you currently have that support Single-SignOn (SSO) or LDAP via CAC/PIV? What is the largest number of user accounts currently supported at a customer base? Describe your tools for advanced visualization such as PET/CT, image fusion, 3D reformatting, etc. Describe the viewing and analysis tools for nuclear medicine viewing to include cardiac nuclear medicine. Describe tools for viewing and image routing for mammography. Describe any tools for study/image routing (such as Laurel Bridge Compass) that have been incorporated into the PACS workflow. Describe any tools available for viewing and troubleshooting HL7 messages and user access. Describe the HL7 engine utilized by your PACS and whether that is accessible to PACS administrators. Describe all tools available for communication within the PACS between radiologists and/or support staff. Describe the methodology used to optimize hanging protocols (i.e. CPT, study description, etc.) with deployments across 100+ facilities, each with unique radiology procedure files. Provide recommended OS and hardware specifications (RAM, processor, HDD) for PACS workstations with integrated voice recognition. Note that VHA will be responsible for workstation procurement and maintenance. Describe all tools available for monitoring and notifying via email or SMS when there are system failures with HL7, DICOM queues, and/or PACS services. Describe the mechanism for automated prefetching of relevant prior exams (by exam type, body part, etc.) upon either order or image receipt within PACS. How does the system handle post-processed images that are sent to the PACS after the exam is completed? These could come from the local PACS or an independent workstation. How are these images associated with the original exam and if the Radiologist is currently reviewing the case while additional images arrive, will the system notify the Radiologist upon their arrival? Is it possible for new images/series to automatically load into the viewer on arrival? Describe how this is accomplished. System monitoring of critical servers and services is required to ensure 99.99% uptime. How is this accomplished? Is the system status data periodically transmitted back to the vendor? What data is in the message? Note that the message cannot include patient identifiers. All system software updates and full version upgrades shall be provided at no charge for the duration of this contract. In addition, all hardware upgrades associated with an update/upgrade will be solely the responsibility of the vendor. If the vendor takes exception to the above, please explain in your response. Provide a DICOM conformance statement for your PACS. What specific technical capabilities best position your company for success with such a large, complex deployment? What additional information will you need from VHA and NTP to create a system design and subsequent formal RFP response?