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Request for Information National Teleradiology Program (NTP) NextGen Picture Archive & Communications System (PACS) 1. Introduction This RFI is for planning purposes only and shall not be considered a... Request for Information National Teleradiology Program (NTP) NextGen Picture Archive & Communications System (PACS) 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 several components of a next generation Teleradiology PACS to integrate with the existing NTP NextGen PACS as described below. (1) VHA 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 1.4 million studies annually. NTP presently has small reading centers located in the following cities: Durham, NC; New York, NY; Dallas, TX; Menlo Park, CA; Sacramento, CA; Los Angeles, CA; Portland OR; and Honolulu, HI and has approximately 150 Radiologists working remotely. Seventy-five percent of the NTP workload is STAT with a 1-hour turn-around time, so every component of the NextGen PACS must integrate seamlessly with a common goal of optimizing workflow, improving quality and minimizing turn-around time. The vendor must be committed to initial and ongoing software development to customize their application to meet the evolving needs of NTP. (2) NTP is currently surveying industry to identify potential components of a best in breed, next generation modular PACS that is currently being deployed in the VA Enterprise Cloud (VAEC). The system must incorporate at a minimum the following features: Workflow/assignment engine for subspecialty assignment, image routing and turn-around time optimization Real-time productivity tracking for each Radiologist 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 (optional) HL7 integration to all instances from VistA and Cerner The system must be scalable such that VISNs could elect to deploy the system and would have their worklist, user database, and workflow tools separate and distinct from NTP. 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. QUESTIONS: What is your current market share for 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 deployment? What is your 2nd largest? Do you have any multi-site deployments hosted in a FedRAMP certified data center? 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. What does your high availability deployment look like? Can multiple virtual machines be active at the same time? Is active/passive only? What steps are required to failover to the passive server(s)? Service stop and starts? file copies? The NTP Microsoft SQL cluster is configured using AG, multi-subnet, and synchronous replication. If product requires Microsoft SQL please describe any concerns with these settings? What are the processor and memory requirements for any SQL databases? Responses are due no later than 10:00AM EST, Friday, March 7, 2025, via email to Heera Polanco, Contract Specialist at Heera.Polanco@va.gov and Kathryn Pantages, Contracting Officer at Kathryn.Pantages@va.gov. Please note NTP NextGen PACS Components ( 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 The NTP system will have the following major characteristics: Intuitive, stable and easy to use user interface for the system, designed to optimize Radiologist and PACS Assistant productivity and quality. System should be designed with a focus on human factors to optimize efficiency, while minimizing viewer fatigue and the incidence of repetitive motion injuries. The Contractor shall design, deploy, and support the system to handle receiving all VHA Radiology HL7 messages, covering 12 to 15 million annual exams. Of those, up to 2 million exams/studies will be read by the NTP team. The additional HL7 messages are used for patient history. Full activation to be completed no later than September 1, 2025. Phase 2/Optional Task 1 shall include expansion of up to 7 VISNs and up to 9 million annual exams total will be read within the NTP NextGen PACS (combined NTP and VISNs). 50-100 million reports are available in the NTP legacy PACS system. Product must be capable of either importing the legacy studies for the patient jacket or receiving the historical studies using just in time delivery via HL7. System must be optimized for WAN use. System shall have an integrated Radiologist worklist with study locking across the application in less than 0.5 seconds to prevent duplicate reading. NTP shall have a distinct worklist with designated assignment engine/workflow tools, while VISN PACS shall have the option to set up unique VISN-based or site-based worklists for their use. System provides an integrated tool for instant messaging (IM) communication within the system 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. Upon receipt of a preliminary or final HL7v2 encoded report generated by a VA customer site, the study shall automatically be removed from the NTP unread worklist and the system shall prevent NTP interpretation of the study. For sites using NextGen PACS, their worklist shall include a designation that the study was assigned to NTP, but the HL7 message shall still be broadcast to VistA or Cerner for study tracking purposes. 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. Worklist options to include community/shared worklist, subspecialty group worklist, and user specific worklist assigned via assignment engine. TECHNICAL SUPPORT Vendor must provide 24x7x365 technical support via the prime vendor help desk 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 system remains on the most current version deployed. Application updates must not require elevated privileges to install on client workstations. Vendor must agree to comply with all applicable VA security requirements, to include DISA STIGS 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 utilizng the VA baseline of RedHat 8 or 9, vendor will be responsible for managing updates independent of the VA satellite server. Software maintenance for 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 AND SECURITY The NTP system is a mission critical application that is required to be online 24x7x365. The system shall be designed and deployed with appropriate redundancy and fault tolerance to eliminate single points of failure. The target uptime threshold for the overall system must be 99.99%. The Contractor s design and technical support infrastructure must meet or exceed that level of performance. System shall be designed for 99.99% uptime as measured by 24x7 availability with performance penalties applied when uptime falls below 99.9% as calculated monthly. Downtime will be defined as failure of one or more components that measurably impacts VA s ability to receive or interpret studies or transmit reports to the originating EMR. Contractor shall provide NTP and VISNs with a monthly uptime report with adjusted billing of the ongoing service/support cost per the discount rate below. Note that scheduled downtime such as work to complete software upgrades and maintenance is excluded from the downtime calculation. Fail-over and/or test servers shall be used to perform these activities with little or no impact to the clinical operations. Microsoft SQL requirements must support multi-subnet SQL AG configurations. System shall be deployed with Federal Information Processing Standards (FIPS) 140-2 or successor compliant 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. The system has three possible deployment methods. First, virtual machines within the VA subscription of the Azure GOVCLOUD Virginia using Availability Zone 1 and 2 for redundancy. Second, a private cloud deployment within the VA Azure GOVCLOUD Virginia subscription that supports multiple AZs for failover. Third, SaaS with a current FedRAMP authorization for high impact. For the private cloud deployment within the VA Azure GOVCLOUD Virginia scenario all Azure Native services must be approved by the VA for use. The availability of Azure Native services in GOVCLOUD does not mean it has been approved by the VA. All system components will be covered under NTP s NextGen PACS Authority to Operate (ATO) and vendor must meet all of the design, development, documentation and sustainment requirements of the ATO for initial deployment and on an ongoing basis. Annual order/report capacity should be sized for 20M studies combined across both EMRs. Contractor shall provide database access to NTP's analytics application, Foundations by Health Level Inc., such that data can be extracted from the system to Foundations. Additionally, the system shall provide workflow status messages to Foundations via HL7 messages for tracking and analytics report creation. Sample workflow status messages include but are not limited to, image receipt, QA approved to dictate, study opened, report started, final report signed, etc. System will utilize normalized 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 will utilize an MPI. The VA has four possible patient identifiers, EDIPI, SSN, ICN, and DFN (Vista only). System must support multiple patient identifiers. All reports within the NextGen PACS system, both NTP generated and those that are created at local sites, will be viewable within the patient jacket of the worklist. Contractor shall provide a fully operational test instance of the system with all components. This shall be used for Cerner interface testing, application upgrade testing and potentially as a backup in case of either catastrophic failure and/or serious cybersecurity events. The system shall be capable of simulating at least 10% load of current production. Deployment with final validation to be completed no later than September 1, 2025. Post NTP deployment, VISNs may elect to exercise optional line items on the IDIQ to utilize the system with a separate organizational structure. For VISN options, vendor will also handle report migration and will provide 5 years on-site data storage at a central VISN location if required for application performance. System shall interface with existing NTP STAT web portal. STAT and Critical cases sent to NTP have 2 separate submission components: DICOM export of case to be read along with relevant priors and an accompanying web portal submission. The web portal submission is used by the Techs at the site to notify NTP that a case has been sent and it provides contact information if a callback is required, image count, exam notes, etc. The existing web portal sends PACS an HL7 message with the submitted information. That data shall be incorporated into PACS for pre-read QC and Radiologist viewing. The STAT portal HL7 messages do not include the PID segment. Vendor must support adding the STAT portal data based on accession number and only update the HL7 data provided by the STAT portal and not erase other HL7 fields not provided by the STAT portal HL7 message. System shall be designed and deployed such that it is installed on Medical Device Virtual Local Area Networks (VLANs) and behind Access Control Lists (ACLs) or firewalls. For all contractor deployed components, all unused services shall be disabled. The systems shall be hardened to the greatest extent possible without impacting clinical performance or utility. All HL7 traffic shall utilize resilient links that shall auto-restart with message/data failure/rejection/time-out and the system shall include a notification mechanism to the contractor and NTP support when failure is detected. HL7 interfaces shall support TLS 1.2 or its successor for connection to VA Data Access Services (DAS) (VA's centralized HL7 broker and gateway) and Rhapsody CorePoint. The system shall support HL7 ADT, ORM and ORU messages from all VA EMRs. System shall be designed to optimally utilize bandwidth across the Wide Area Network (WAN) and to/from the cloud-based components. At a minimum, the system shall log transactions in an audit trail at the following time points: user logon/logoff, receipt of images by PACS, each instance of a study being opened and who viewed and closed that study, on which workstation it was viewed (including if it was opened from the EMR), start of reporting, signature of report, successful upload of report, deletion of study and/or report, and any change to demographic or study information. Logs shall be maintained while the study is on the system. If a study is deleted and subsequently repulled, the original audit trail shall be reinstated. The audit trail shall be kept for no less than three years and all messages shall be synced with an internal VA time server. Transmission of any data outside of the VA network shall be via a VA approved VPN solution and is allowed only with FIPS 140-2 compliant encryption. Sensitive patient information shall not be stored outside of VA organizational control for purposes other than for short term troubleshooting purposes. After the requirement for the data has been satisfied, the data shall be securely erased. Workstations and servers shall run anti-virus software and accept automated patching. Non-diagnostic workstations for Tech and PACS Admin access shall utilize the standard VA baseline PC image and shall operate with the full suite of VA security controls. All applications, web-apps and associated components required for non-diagnostic support, workflow, management, administration, and operation shall be required to be fully functional on a VA baseline image PC. Web-based applications for diagnostic and non-diagnostic workstations shall be fully functional with VA baseline versions of Edge and Chrome browsers and accept the VA browser security settings. System shall operate without external Internet access per VA Medical Device Protection Program guidelines (exclusive of VPN connectivity). The database shall be dedicated solely to the system and comingling storage of VA PHI data with any non-federal data is not permitted. SYSTEM ADMINISTRATION The selection of a critical results diagnostic code by a Radiologist shall automatically initiate a support request via the communication tool and Support worklist to initiate a callback to the referring provider. INTEGRATION System shall interface with the VA s Master Person Index (MPI), which is the primary system for assigning and maintaining unique person identifiers and provides enterprise-wide identity management. The NTP Rhapsody system will query the VA MPI and provide the EDIPI and ICN patient identifiers. The Worklist software must be able to accept MPI maintenance messages to correct any patient ICN identifier misconfigurations that MPI identifies and report the status of the correction. System shall support multiple identifiers for each patient via internal Master Patient Index (MPI) functionality internal to the system. 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 system. Seamless HL7 integration with NTP NextGen PACS Rhapsody CorePoint HL7 Engine. Seamless integration with NTP NextGen PACS voice recognition system (Nuance PowerScribe One 2019). Seamless integration with NTP NextGen PACS Mach7 eUnity Viewer. Seamless integration with NTP NextGen PACS Blackford AI suite of applications for Intracranial Hemorrhage (ICH) identification, large vessel occlusion (LVO) breast density and breast cancer/nodule detection. AI results will be incorporated into study prioritization. The system shall provide seamless integration with VA/DoD Joint Legacy Viewer (JLV), which requires the use of Clinical Context Object Workgroup (CCOW). This shall include a button to launch JLV directly from within the PACS application, have it pass patient context via CCOW to JLV, and then maintain patient context as different studies are viewed within the PACS (i.e. update CCOW context). System must support application authentication using Single Sign-On (SSO). Options for SSO include VA Active Directory and Azure Entra ID. CLIENT VIEWER The system shall be designed to accommodate 4 different categories/priorities: CRIT, STAT, ASAP/Inpatient, and Routine, with distinct turn-around times (TATs) for each level. The worklist shall display the time remaining before expiration of TAT for each unread exam and TAT shall be calculated from the time, new, unread images are received and available for NTP interpretation. The system in conjunction with the PACS diagnostic viewer and associated voice recognition window shall fully launch and be ready for review/dictation within 3 seconds after study selection from the worklist or activation of the Next Study function. Performance target shall be met for users working within a VA site and home users working via VPN at 10 Mb/s minimum throughput. The Radiologist viewing client shall run on VA-provided hardware with Windows 10 LTSC or Windows 10 Enterprise operating system or Windows 11. Workstations shall support VA approved anti-virus software (currently Windows Defender but may change with subsequent VA-wide AV award). AV shall be deployed with contractor provided file or folder exclusions. PACS workstations shall permit automated Windows patching. Any software running on the Radiologist desktop must be able to be updated without requiring administrative privileges on the desktop. A pop-up indicating a client update that the Radiologist can run as a user, not administrator, on the desktop is acceptable. End user applications shall be made compatible with any new Windows major versions within 24 months of its commercial release. The system shall be a cloud-native design with dynamic streaming as a fundamental design feature. The system shall be fast, intuitive, stable, easy to use, and designed to optimize productivity and quality and reduce repetitive motion injuries. Data cached/stored on the workstation shall be deleted from the system at the close of the study or application. System shall include a real-time productivity tracking tool visible for each respective Radiologist within their PACS worklist. The tool shall be configurable to display daily wRVU or adjusted wRVU (NTP specific wRVU values per CPT code and LOINC codes for Cerner sites). System shall include an integrated collaboration tool for communication within the system between Radiologists and/or support staff with the ability to send embedded study links in the messages. Collaboration tool shall have the ability to broadcast messages to online users with individual and group responses and shall incorporate logging as well. The system shall provide the ability for Radiologists to jointly confer on a study in real time while they view it. The system shall provide visual cues on the worklist that indicate a study is approaching expiration of the assigned turn-around-time within the 4 priorities (CRIT, STAT, ASAP, and Routine). The system shall provide a separate visual cue on the worklist to indicate a study is overdue from the assigned turn-around-time within the 4 priorities (CRIT, STAT, ASAP, and Routine). The Radiologist shall be notified if another user is viewing the same exam on another workstation and shall be prevented from creating a duplicate report. The system shall immediately notify the Radiologist if a local report for a study they are viewing has been received. This can occur when a site disregards the stub message or initiates dictation before the NTP stub report is filed. The system shall also immediately notify the Radiologist if additional images are received on a case they are currently dictating. Worklist shall allow manual reassignment of studies to another radiologist, indicate what studies have been reported, and whether the report has uploaded to the EMR successfully. Manual reassignments shall be a logged event as this process needs to be highly monitored. Patient history and reason for study shall be mapped from the HL7 message and shall be available for review within the worklist. ARTIFICIAL INTELLIGENCE Positive AI findings shall trigger a change to a higher priority status in the system. Negative findings shall not decrement the submitted priority level. WORKFLOW TOOLS The system shall include a closed-loop support request tool between Support and the Radiologists to facilitate assistance requests and critical results. The Support tool shall provide a mechanism for Support to claim a request, so multiple individuals do not work on the same problem and the requestor knows who has the assignment. The Support tool shall track issues from initiation to resolution with time stamps along each step and export of data to Foundations for tracking. System shall include an internal collaboration tool. User list shall default to online users within the logged in user s organization (NTP, VISN X or site Y) but shall permit cross org communication via org drop down selection. System shall immediately assign critical exams (stroke and intraoperative radiograph) to a qualified Radiologist once processed by Support and shall be treated as the highest priority. Once cleared to read, the assigned Radiologist shall receive an automated notification within their worklist or viewing window alerting them that they have a case that needs immediate interpretation. Upon receipt of a STAT or CRIT web portal request, the system shall automatically upgrade the priority of the case within the system to the same status regardless of the HL7 ORM priority value and the escalated priority shall remain locked unless manually changed by Support. Subsequent HL7 messages cannot downgrade only upgrade the priority. The system shall incorporate a post-assignment problem list to track cases that the Radiologists identify which need to be addressed by Support prior to sign off. Worklist shall function similar to the pre-read QC list where Support will claim the case and will address the issue until resolved. The post-assignment problem list shall also incorporate workflow for critical callbacks where the Radiologist is notifying Support that a critical callback is required. Integrated American College of Radiology (ACR) compliant peer review functionality with on demand and assigned workflows shall be provided. Peer review shall incorporate separate workflow and scoring methodologies for internal NTP peer reviews, peer learning and peer reviews that NTP performs for VA customer facilities. Note the system shall include similar peer review capabilities for the VISN system, however the external review functionality is typically used by NTP. The specific scoring criteria that is used for each type of review (NTP internal versus VHA-site focused review) shall be specific for each org, e.g. NTP peer reviews will have RadPeer scoring as the displayed option while a review for site A would have met/not met criteria listed and site B review would display RadPeer. ASSIGNMENT ENGINE & WORKLIST The system shall include an assignment engine (AE) that is fully integrated with the PACS worklist. The AE design shall be designed to minimize report turn-around time while maximizing subspecialty interpretations. AE shall support no less than 12 distinct subspecialty designations for STAT and CRIT workflow and no less than 12 designations that are applicable for Routine and ASAP priority cases. AE shall utilize a combination of CPT codes, LOINC codes (for Cerner sites), study descriptions, and priorities to identify the subspecialty group(s) for each case to be interpreted. AE shall assign a fixed number of CRIT/STAT and ASAP/Routine cases to each logged in Radiologist. The system shall also support assignment of a fixed wRVU amount to each active Radiologist. System shall have a default setting of Auto Next to automatically open the next case on the Radiologist s worklist along with associated report template. Disabling Auto Next shall be an elevated system privilege. System shall incorporate a Skip function that shall allow a Radiologist to move to the next case and temporarily bypass Auto Next. If Skip is invoked, it shall require a comment from the Radiologist and it shall be an auditable/logged event. NTP and VISNs shall operate on unique instances of the AE so that NTP workflow shall not dictate subspecialty assignment for other VISNs who use the NextGen PACS. In other words, each Org, (NTP, VISN1, VISN2, site X) shall have their own worklist and AE setup and an administrative tool to manage AE configuration. AE shall continually update system status in the background and within 1 second of report signoff, it shall have the next available case assigned to any Radiologist. AE shall be configurable by PACS Administrators via GUI to change assignment parameters, subspecialty groups and subspecialty mapping. Multipart exams such as CT chest plus abdomen/pelvis shall be managed as separate exams if sent to the PACS with distinct image sets and shall be evaluated by the AE accordingly. System shall support the use of a fixed set of mandatory worklists or worklist filters that shall be the default configuration within the system. Example worklists may include: CRIT Exams, CRIT and STAT, etc.