APPLIED RESEARCH IN NOVEL APPLICATIONS OF FRAMEWORKS LEVERAGING THE NASCENT SINGLE FEDERAL ELECTRONIC HEALTH RECORD (EHR)

The Defense Health Agency (DHA) - Contracting Division - Defense Healthcare Management Systems (CD-DHMS), in support of the Program Executive Office for Defense Healthcare Management Systems (PEO DHMS) Enterprise Intelligence Data Solutions (EIDS) and the Federal Electronic Health Record Modernization (FEHRM) Program Office, intends to issue a sole source order under Federally Funded Research and Development Center (FFRDC) IDIQ vehicle, TIRNO-99-D-00005, under an approved Non-Sponsor Agreement with the Department of Treasury, with The MITRE Corporation of McLean, VA, for all elements of the solution required to maximize the long-term prospects of leveraging the new paradigm to turn data into the information/intelligence that can support the operation of the Agencies’ medical businesses and the provision of excellent care.

The contract action described below may be solicited and awarded without full and open competition pursuant to the authority of 10 USC 2304 (c)(3)(B).

Multiple Agencies have begun the establishment of an electronic health record (EHR) to securely document, store, retrieve, share, and analyze information about individual patient care and enable a digital version of a patient’s health record. This is a necessary step to provide state of the art care for our service members and veterans. To fully realize the benefits of EHR, the VA and DoD recognized the need for a single common EHR that enables seamless information exchange. In support of this mission, the FEHRM was chartered in December 2019 to work closely with the Department of Defense (DoD), the Department of Veterans Affairs (VA) and other partners. 

FEHRM partners closely with PEO DHMS and its subordinate Program Offices, and, like the PEO and its Program Offices, is supported by CD-DHMS for awarding contract vehicles.

The primary mission of FEHRM is to ensure a single, common electronic health record (EHR) that enhances patient care and provider effectiveness, wherever care is provided. To achieve this mission requires an understanding of the current state, short, and long-term plans of the DoD, VA, and others that need access to the medical data as well as how the EHR software is expected to evolve. 

The FEHRM is achieving its mission by:

•             Actively managing risks and the operation of the joint Federal Data Center, where all federal health data resides.

•             Minimizing risk to EHR deployment and implementation.

•             Identifying opportunities for efficiency, standardization, and system and process optimization.

•             Advancing interoperability across the federal and private sectors

One of the Programs under PEO DHMS, the Enterprise Intelligence and Data Solutions (EIDS) program office supports the strategic goals of the MHS and facilitates informed decision-making through the delivery of robust information services and data in a timely, relevant and actionable manner. The Enterprise Intelligence and Data Solutions (EIDS) program office oversees a number of program activities to bring together data, information technology and data science, delivering analytics-driven insights for customers.

To fully embrace the new paradigm of having a true single record among the three agencies across the entire continuum of care (DoD, VA, USCG), as well as other agencies, a single enclave for all agencies has been created and investments in a single record and data warehouse platforms have accelerated.  During these implementations, it has become clear that there are many opportunities for the agencies to leverage these investments to the collective benefit of the agencies and private sector healthcare providers.  The EHR solution is a software intensive system of systems that provides a unified platform allowing the Agencies to leverage and manage data.  The data constructed as a medical record is the core asset of each Agency’s mission in the provision of care.

Prior to the single record paradigm, sharing data required physical dependencies to support the exchange of medical records resulting in increased complexity to maintain the disparate systems and the interfaces between them and increased complexity in the maintenance of regulatory and meaningful use terminology, which results in a loss of computable data necessary to fully enable automated clinical decision support and analytical digest.  Further, the old paradigm negatively affected the timing of synchronization of data resulting in lower availability of data and the potential of deviations in the records between two or more systems. 

The new paradigm, if implemented well, will increase the quality, availability, integrity and the timeliness of data all while reducing the complexity of managing multiple baselines, including the implementation of software updates, patches, and upgrades to new functionality.

At this point in the implementation of the single record paradigm, two immediate opportunities have merged to maximize the long-term prospects of leveraging the new paradigm to turn data into the information/intelligence that can support the operation of the Agencies’ medical businesses and the provision of excellent care.

First, the FEHRM testing framework will complement the testing being done individually and collectively by the Departments using the Federal EHR. FEHRM activities help mitigate risk to the joint program. This framework of continuous assessment contemplated by this acquisition will allow responding to the National Defense Authorization Act (NDAA) functional test requirement, the cybersecurity testing requirement, the data interoperability test requirement, and the relationship of previous and on-going testing activities to set context for the next set of tests.  Additionally, the FEHRM testing activities will include organizations that offer a different perspective, building on and connecting the work done in previous assessments.

Second, the Enterprise Intelligence and Data Solutions (EIDS) program office supports the strategic goals of the Military Health System and facilitates informed decision-making through the delivery of robust information services and data in a timely, relevant and actionable manner. EIDS oversees a number of program activities to bring together data, information technology and data science, delivering analytics-driven insights for customers, which is highly dependent on source data from the single record. The MHS has and will continue to see an increase in data and an increased need to predict patient outcomes accurately and plan accordingly as a health system to improve outcomes and lower costs. The MIP needs to measurably improve its ability and speed to create and run Machine Learning models for higher quality predictions by Sep 2022. The proposed framework will result in an enterprise-grade Machine Learning as a Service (MLaaS) for increased accessibility of machine learning model development and analysis with proximity to secondary data.

The MITRE FFRDC has had widespread and substantial involvement with the DoD and VA, as they have developed, acquired, and fielded health systems, and enabled the exchange of health data between the two Departments and private sector healthcare providers. 

The DoD/VA Interagency Program Office (IPO) was established so that both Departments could develop, together, an electronic health record system (iEHR) to be used by both Departments to promote interoperability of health data and services.  The iEHR initiative, while noble, did not take into account the functional, technical, social, and political issues that surrounded the effort, and ultimately failed as a result.  

MITRE, as support to the IPO and both Departments, experienced first-hand the challenges of embarking on a technical and programmatic effort without the correct socio-technical framework and enforcement mechanisms in place, as well as a clear functional and technical design, security  requirements for PII and PHI, impacts of joint workflows,  challenges of  the ecosystem for hosting a centralized capability, data sources and services, networking and cyber challenges, and the impacts of coexistence with the legacy infrastructure for a finite period of time during the deployment across the DoD and VA enterprise. 

When the iEHR initiative was sunset, MITRE continued to support the Departments’ separate EHR efforts, as well as their joint data sharing efforts with systems such as the Joint Longitudinal Viewer (JLV).

Further, given the architecture of the commercial solution, in order to achieve the goals of its standardization requirements, the Government requires technical services and infrastructure to enable and secure certain shared environments between the agencies.  MITRE’s organic understanding and application of IT to the health sector, as well as its involvement in legacy and previous initiatives provides them with unique and highly specialized understanding necessary to ensure success of the project.

MITRE, having been directly involved in the evolution of the DoD and VA EHR project, fills a unique role in the identification of stakeholders and the application of IT to the health sector.  MITRE has a detailed understanding of scientific, technical, and process issues, as well as its broad and specialized working knowledge of the underlying science, technologies, and test/evaluation methodologies. 

MITRE has access to information, data bases and networks, including data regarding planning for future enhancements and acquisitions and proprietary data from industry that requires the FFRDC to retain its conflict-free regime and trusted relationship with industry to ensure continuous free flow of information. MITRE's previous involvement, experience and comprehensive knowledge of the needs and problems of the DoD and VA  medical community, in order to truly provide unbiased systems engineering and assessment recommendations that will benefit the users of the system.

MITRE has been critically instrumental in the development of plans and the rapid implementation strategy of migration of the MHS Information Platform from on premise environments into the AWS-Gov Cloud. MITRE has not only proven competence in migration, but corporately they have an understanding of mission, governance process, environment, tools, and technologies critical to the rapid execution of these requirements.

Be advised that the aforementioned information is anticipatory in nature and is not binding. This notice is not a request for competitive proposals; however, any firm believing that they can fulfill the requirement of providing these services may be considered by the Agency. Interested parties shall identify their interest and capabilities in response to this synopsis within 15 calendar days of publication, and must clearly demonstrate their ability to successfully fulfill all of the above requirements, including the highly specialized knowledge relative to the previous iEHR, independent Agency efforts, and new single solution paradigm, as well as the unbiased long-term trusted relationship contemplated by the FFRDC paradigm.

The Government reserves the right not to respond to any expressions of interest received. Any comments, questions, or concerns regarding this notice may be submitted IN WRITING via e-mail to Matthew Hudson, Contracting Officer at matthew.g.hudson2.civ@mail.mil. No telephone responses will be accepted.

Submissions will NOT be reimbursed by the Government and the entire cost of any submission will be at the sole expense of the source submitting the information. A determination by the Government not to compete this proposed contract action based upon responses to this notice is solely within the discretion of the Government.

Information received will be considered solely for the purpose of determining whether to conduct a competitive procurement. This synopsis is for informational purposes only. Any Justification & Approval resulting from a decision to award the proposed sole source action will be posted on this website.

All information received in response to this notice that is marked Proprietary will be handled accordingly. The Government shall not be liable for or suffer any consequential damages for any proprietary information not properly identified. Proprietary information will be safeguarded in accordance with the applicable Government regulations. Submissions will not be returned nor will the Government confirm receipt of submissions.

In addition, respondents should be aware that the Government may utilize contractor support personnel from the below listed companies (under existing contracts) to review responses and information submitted. These companies and individual employees are bound contractually by Organizational Conflict of Interest and disclosure clauses with respect to proprietary information, and they will take all reasonable action necessary to preclude unauthorized use or disclosure of a respondent's proprietary data. Submissions MUST clearly state whether permission is granted allowing the program office support contractors identified below access to any proprietary information.

CloudPareto LLC
Frontier Technology Inc

Booz Allen Hamilton Inc