DEFENSE HEALTH AGENCY
7700 ARLINGTON BOULEVARD, SUITE 5101
FALLS CHURCH, VIRGINIA 22042-5101

Component
Acquisition Executive
(J-4)

JUSTIFICATION AND APPROVAL FOR OTHER THAN FULL AND OPEN COMPETITION

NUMBER JA18-0052

Upon the basis Of the following justi?cation, which I hereby approve as the senior procurement executive
of the agency, the contract action described below may be solicited and awarded without full and open
competition pursuant to the authority of 10 USC 2304 

(1) Identi?cation Of the Agency and Contracting Activity

(2)

(3)

Defense Health Agency (DHA), Contracting Of?ce Defense Healthcare Management Systems (CO-
DHMS)

Nature and Description of the Action Being Approved

This Justi?cation Approval supports a modi?cation to contract N00039-15-D-0044 with
Leidos, Inc. to add additional ceiling and scope supporting the efforts described in Paragraph 3, which
are necessary to 1) support the incorporation Of the United States Coast Guard (USCG) into the
existing Department of Defense (DOD) MHS GENESIS Electronic Health Record (EHR)
implementation, and 2) tO establish a common standardized EHR baseline with the USCG and the
Department Of Veterans Affairs (VA). The VA will contract for and conduct its own implementation
Of MHS GENESIS, while the USCG will join the DOD enterprise implementation under this subject
contract that is already under way.

Description Of Supplies/Services

Contract N00039-15-D-OO44 was awarded on July 29, 2015 to Leidos, Inc. after a full and open
competition. The total award ceiling was $4,336,822,777 across a potential 10-year ordering period,
if all optional ordering periods are exercised and award terms are earned. The contractor is providing
an off-the-she1f(OTS) electronic health record (EHR) system for deployment across the Department
Of Defense (DOD) enterprise. Leidos, the prime contractor, serves as the service provider-integrator
(SPI). MHS GENESIS consists of inpatient and outpatient software solutions from Cemer and a
dental solution provided by Henry Schein, as well as an enterprise service bus (ESB), interfaces,
third-party clinical content, solution-unique hardware, infrastructure, and clinical application services.
MHS GENESIS is replacing functionality of core legacy systems (AHLTA, CHCS, and Essentris,
among others), and is being deployed to both ?xed medical treatment facilities and operational
medicine facilities worldwide. In addition to the solution being provided, the Leidos Partnership for
Defense Health is providing services for the integration, con?guration, testing, initial deployment,
training, operational management, and sustainlnent Of MHS GENESIS for the DOD.

On July 01, 2017, the Secretary of the VA issued a Determination and Findings pursuant to 41
USC. 3304(a)(7) that it was in the public interest for VA to issue a solicitation directly tO Cemer
for the acquisition of the EHR system being deployed by the DOD, speci?cally the DOD Healthcare
Management System Modernization Program Management Of?ce, in order to enable
seamless healthcare to Veterans and quali?ed bene?ciaries. The ?ndings described in the 



delineated many reasons that a single standard solution baseline would bene?t both Departments and
the bene?ciaries they support.

On March 22. 2018. the Deputy Commandant for Mission Support United States Coast Guard.
formally requested to partner with PEO to implement MHS GENESIS for the USCG. The
analysis indicated that all of its requirements would be satis?ed by the MHS GENESIS
solution and that it would achieve the same critical bene?ts of a single standard solution as and
VA: most notably to ensure that every military bene?ciary and retiree has access to a single. uni?ed
Electronic Health Record.

In addition to the existing MHS GENESIS capabilities. the VA contract will implement extended
capabilities that were not available at the time of the original contract and/or were not
proposed against the Government?s identi?ed requirements. needs to acquire the same core
capabilities as the VA is acquiring to ensure consistency (the standard solution baseline) among the
Agencies to achieve the bene?ts described in Paragraph (5) below. The standard solution baseline
will consist of. among other components. common ?Best of Suite? and ?Best of Breed? off-the-shelf
so?ware, common clinical application services. common interfaces and ESBs. and common shared
infrastructure. that. when con?gured. results in much greater commonality in practical work?ows.
roles. order sets. plans. and reports. as well as the training materials that support them.

Some of these extended capabilities necessary to maintain a single standard solution baseline with the
VA and USCG are provided as clinical application services (CAS) not covered by the original
contract. 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. Paragraph (5)
describes the analysis supporting these conclusions.

The scope being added under this modi?cation will allow for the ordering of all services and
additional non-software. ?as a service." capabilities necessary to maintain a standard solution baseline
with the VA and USCG as the solution is implemented. and to include the USCG in the enterprise
within the DoD?s existing implementation of the solution by using the same Service Provider
Integrator for integration. con?guration. deployment, training. operational management. and
sustainment. The total ordering ceiling will be updated to accommodate the additional services and
capabilities.

Examples of the ?as a service? requirements that the VA is acquiring that requires to maintain a
standardized system baseline include. but are not limited to:

 



In addition to the foregoing, certain Best of Suite and Best of Breed capabilities will be required, as
well as the associated services to con?gure, integrate, test, deploy, maintain, manage/operate, and
sustain the solution as a whole. The Request For Proposals (RF P), leading to the award of the
contract to Leidos, and resulting contract contemplated the ongoing expansion of the EHR solution to
meet emerging requirements and to account for changes in the practice of healthcare and the IT
market over the life of the contract. Offerors were instructed that:

1) ?The EHR System requirements are established at a strategic level and will guide the configuration
and implementation of the system in the MHS enterprise. In addition to the requirements in the
Government RTM [(Requirements Traceability Matrix)], the Government may place orders for
product enhancements or improvements to meet emerging needs, activate existing, but dormant
capabilities in the EHR system solution, or to address a need in the approved CONOPS not explicitly
extrapolated into the Government 

2) ?The contractor is required to deliver at least the capabilities listed in Attachment 2,

Government Requirements Traceability Matrix. Notwithstanding this requirement, the contractor
shall deliver any additional capabilities and software modules that are part of its commercial Best of
Suite package not listed in Attachment 2. If future releases of the contractor?s commercial Best of
Suite package include additional capabilities and software modules, those modules shall also be
delivered at no additional cost to the Government as part of a major release?;2 and

3) ?The Government may, during performance of this contract, purchase external Best of

Breed modules either from the contractor or a third-party vendor to enable a desired future capability.
As ordered under stand-alone task orders, the contractor will provide all integration and engineering
services necessary to integrate the external capability into the EHR solution.?3

The contract resulting from the RFP contained the terms above and the license agreements reached
with the contractor are consistent with these terms. As a result, these services and the B08
capabilities are considered to be within scope of the existing IDIQ contract, and are not the subject of
this and because ceiling is available under the existing IDIQ contract to order these capabilities
and services, they are not included in the dollar values in the table below.

The Government is not seeking, under this action, to procure a new or substantially modi?ed EHR
solution or implementation, but rather to extend certain existing capabilities necessary to meet its
standardization requirements of achieving a standardized enterprise software baseline and to
incorporate the USCG into the existing implementation. Further, the will not be contracting for
nor managing the VA implementation under this or any other contracting action. The Agencies
will establish interagency governance to establish, manage, and maintain the standard enterprise
baseline contemplated herein.

 

1 Contract Performance Work Statement, Section 1.2 EHR System Operational Capability.
2 N00039-15-D-0044 (Contract) and N00039-14-R-0018 (RFP) Clause H-2.
3 N00039-15-D-0044 (Contract) and N00039-14-R-0018 (RFP) Clause H-2.

(4)

(5)

Estimated Dollar Value (millions)

 

 

 

 

 

 

 

 

 

Contract Contract Contract Contract Contract
Total
$54,700 $257,042 $265,353 $287,870 $311,210 $1,176,175

 

 



Statutory Authority Cited Permitting Other Than Full and Open Competition

10 U.S.C. 2304(c)(1), One source or limited sources. FAR 6.302-1 -- Only One Responsible Source
and NO Other Supplies or Services Will Satisfy Agency Requirements.

Reason for Statutory Authority Cited

The three Agencies (DOD, VA, CG) must employ a standardized software baseline. Standardizing by
pursuing an approach that does not involve Leidos as the Service Provider Integrator utilizing Cerner
under the contract would increase complexity Of the implementation to a degree that would
substantially offset any bene?ts obtained from standardizing. Contracting with anyone else (other
than Leidos) to work with Cerner would create signi?cant redundancies, inef?ciencies, and other
issues. The following rationale contains the reasons that the three Agencies require EHR
standardization.

Care provided across the intersection of the three Agencies (DOD, VA, and USCG), for all military
service members, retirees, and other bene?ciaries, all over the world, in times of peace and war,
involves a continuum of care that is among the most complex in the healthcare industry. VA operates
approximately 1,600 facilities with 300,000 employees who provide care for millions of patients per
year. DOD has approximately 205,000 users in nearly 700 facilities as well as hundreds of forward
operating platforms. USCG operates 166 facilities to provide care for its 50,000 service members.

Further, the Agencies service essentially the same patient population at their respective locations,
which supports a reasonable need for a standardized software baseline given that the accuracy and
reliability the EHR is essential for safe operations and providing patient care for this same population
regardless of where they receive care. Approximately 5.7 million patients have received healthcare at
both a VA and DOD facility within the last seven years. USCG military members receive medical
and dental care at DOD Medical Treatment Facilities (MTFs), VA healthcare facilities, and from
commercial providers under TRICARE contracts. Further, the USCG provides medical and dental
treatment and care to DOD bene?ciaries at USCG clinics.

VA and DOD have worked together for many years to advance EHR interoperability between their
many separate applications and certi?ed to Congress that the medical record interoperability
requirements of Section 713 of the National Defense Authorization Act (NDAA) for Fiscal Year (FY)
2014 had been satis?ed through the use the Joint Legacy Viewer (JLV). While JLV meets the
statutory requirements and is an important tOOl for the agencies, it does not allow users to change or
add information. Although LV is able to present patient's critical medical health data, simply
presenting read-only data does not take advantage Of full capabilities of a modern EHR to create
improvements in the way each Agency practices healthcare.

On July 1, 2017, the Secretary of the VA signed a Determination and Findings to adopt the same
commercial EHR solution as the DOD, ?nding that:



single common system across VA and will facilitate the transition of
active duty military members to VA and improve their timely access to the
highest quality of care in a way never before experienced. Records residing in a
single common system will eliminate the reliance on complex clinical interfaces
or manual data entry between and VA. A single common system and the
adoption of common clinical workflows and order sets pre-defined
templates that provide support in making clinical decisions for a speci?c
condition or medical procedure) will signi?cantly reduce, and potentially
eliminate, the variations between VA and facilities, thereby facilitating a
more consistent patient experience. Common work?ows, common cybersecurity
architecture, and terminology based on national standards, along with a patient
portal that transitions with the patient from active duty to Veteran status, will
result in improved medical outcomes, improved patient safety, and a consistent
patient-physician relationship. VA will be able to leverage and bene?t ?om
DoD?s data hosting investments, standard work?ows, and enhanced
cybersecurity posture. Sharing the same EHR system with common con?guration
standards will enable computerized decision support. This support will allow for
reliable electronic interpretation of data to produce valid care recommendations
while considering the complete health history contained in a single patient
record. Acquiring the same EHR system will also enable VA to capitalize on
investments, including integration of the dental capability, pharmacy
enhancements and con?guration e??orts. In addition, adopting the EHR
system will allow VA to bene?t from lessons learned by BOB during their Initial
Operating Capability phase, participate with the work?ow standardization
process and jointly adopt and develop national standards in coordination with
O?ice of National Coordinator, Department of Health and Human Services. 

On March 22, 2018, the Deputy Commandant for Mission Support United States Coast Guard,
requested that PEO DHMS include the USCG in its implementation of MHS GENESIS. This request
resulted from an analysis performed by the USCG that concluded, among other things, ?the 
deployment of MHS GENESIS would eliminate risks that exist in joint military operations, in the
day-to-day provision of medical and dental care, and in the participation in the US. Military
Entrance Processing Command?s (USMEPCOM) military accession process? and:

?Wor?Zow Design. A considerable number of existing work?ows for MHS
GENESIS can be re-used to support the USCG due to similarity in operational
mission between USCG and the other military armed forces. At the request of
the USCG, the program conducted a review of its existing library of
documented business process work/lows and identi?ed 1 3 3 that they assessed to
closely match the USCG enterprise outpatient and readiness missions for
potential future re?use by the USCG.

System Configuration. Existing MHS GENESIS system con?gurations can be
re-used to support the USCG. The program provided USCG with
copies of the functional requirements and workflows that were used to procure
and con?gure MHS GENESIS. The USCG performed a comparison of these
requirements and workflows against the USCG mission need and requirements.
This comparison resulted in a determination that the MHS GENESIS
configuration matches the mission need and desired con?guration of a USCG
EHR.



Initial Testing (Developmental, Operational and vaer-securitv). As stated in
the AA and a separate RT analysis completed by the eHRa PM IPT,
the MHS GENESIS system meets 100% of Coast Guard ?s functional and
technical requirements. The USCG should be able to apply the test
plan and report artifacts with some minor validation activities to meet the
USCG test and evaluation requirements for use of MHS GENESIS.

Training Delivery and User Documentation Development. Due to the similarity
in and USCG business processes as military services, USCG deployment
of MHS-GENESIS would reduce the need for duplicative training time and cost
to include joint training sessions and re-use of existing training materials
and user documentation. 

Organizations adopt information technology tools to support organizational changes that reduce
complexity, improve operations, and lower risk. Information technology is especially important in
the delivery of healthcare given the unique requirements for high levels of knowledge and
information necessary to deliver care successfully. The adoption by the three Agencies of the same
EHR creates a unique opportunity to standardize the enterprise baseline thereby enabling the
Agencies to realize maximum bene?ts from their EHR solutions and maintain operational continuity
across the enterprise.

As discussed above, the continuum of care for a Service Member is very complex. A standard
enterprise baseline will enable ef?cient, highly reliable, safe, and quality care across the continuum of
care among the DOD, USCG, and VA while a Service Member is on active duty and after the
transition of care from the or USCG to the VA upon retirement or separation from active duty.
The common EHR will become the primary source of health, injury, and treatment information for
Service Members during their career from initial enlistment to service, to battle?eld injury, disease
and non-battle injury, and life-long disability care in the VA.

Given the continuum of care from battle?eld injury while on active duty in the or USCG to
potentially life-long injury-related disability care in the VA, a common standard baseline will reveal
critical bene?ts that will provide opportunities for an unparalleled repository of evidence that will
inform improved injury prevention for the Service Member while on active duty and post-inj ury long-
term care as a Veteran. Access to the detailed history associated with an injury is expected to provide
for better decision making along the continuum of care, whether the patient be an active duty Service
Member or a Veteran. With an uninterrupted, seamless continuum of care and support, for Service
Members who are wounded or injured as a result of their service a standard baseline provides an
unprecedented opportunity to improve and unify (reduce the number of ?seams?) in the Integrated
Disability Evaluation System (IDES) process, moving away from a process that involves multiple
systems and databases. A common standard baseline is expected to improve speed of the process and
accuracy of available data for better-informed decision making. Such information decreases the
number of unnecessary tests and procedures, which allows the healthcare team more time to focus on
providing a care experience that is patient and family centered, compassionate, convenient, equitable,
safe and always of the highest quality. Introducing or using different systems among the same
population would undermine the advantage of having a single standard baseline, thereby increasing
the risk of problems during transitions of care and with the availability of accurate patient medical
information (and the ability to update or correct such information, as required). Therefore, it logically
follows that having a standardized enterprise baseline decreases these safety risks for bene?ciaries
and clinicians.



Further, a primary complaint of transitioning Service Members is the requirement to collect a paper
copy of their medical records from separate USCG and medical systems, review it for
completeness, and transport the pages to the VA for disability evaluation. The problem is substantial
and resulted in the establishment of dedicated ?navigation? services within Veteran Support
Organizations (VSO) to assist Service Members in the process. Creating a standard enterprise
baseline will reduce fragmentation of the Service Member?s health record, eliminate the need to
transport paper records, and deliver a more complete health record to the Service Member?s caregiver
at the time of care. The common standard baseline will also improve the disability evaluation process
by providing more readily accessible health care data for the substantiation or refutation of disability
claims.

In addition to individual Service Member bene?ts, a common standard baseline will provide an
unprecedented repository of longitudinal health information for all Service Members who receive
care in the USCG, and VA. This availability of population-level data will enable study of the
association between injuries or exposures and long-term functional outcomes in turn, enabling
modi?cations of equipment, training, and policies to improve long-term outcome. The population
data will also provide near-real-time monitoring of new and evolving health or exposure concerns 
such as geographic outbreaks of viral illnesses. This information can enable rapid measures for
response and containment.

Beyond the bene?ts of reducing complexity and risk across the continuum of care, Section 717 of the
NDAA for FY 2017 requires that ?The Secretary of Defense shall authorize a veteran to be
evaluated and treated at a military treatment facility if . .. the evaluation and treatment of the
individual is necessary to attain the relevant mix and volume of medical casework required to
maintain medical readiness skills and competencies of health care providers at the facility,? and
directs the VA to reimburse MTFs for the ?evaluation or treatment? of eligible veterans ?using a
prospective payment methodology.? A single standard baseline that appropriately co-mingles clinical
and ?nancial data will provide visibility and transparency regarding the cost of evaluation and
treatment necessary to inform a ?prospective payment methodology.? This will allow for more
accurate ?nancial planning for both the and the VA while providing the opportunity to
reduce the variation in cost and expected cost across the and VA. Further, a common
standard baseline would allow for a reduction in unnecessary variation of clinical services to Service
Members who receive care at a different Agency?s facilities. Updates to standards-based clinical
practice, such as immunization recommendations by the CDC, can be quickly adopted across the
Agencies by updating the common standard baseline. A common standard baseline allows for
consistent training, work?ows, user roles, and order sets across the Agencies. This would make it
much easier for providers who move between different Agency facilities to provide patient care.
Finally, having a common standard baseline supports Section 207 of Public Law 115-46, VA Choice
and Quality Employment Act of 2017, which encourages providers as they transition from
service to seek employment with the VA. Standardizing to the maximum extent practical is expected
to reduce complexity in the provision of care resulting in improved healthcare outcomes.

In addition to the clinical bene?ts of adopting a standard solution baseline, the Government expects
several technical bene?ts to accrue by maximizing standardization. The EHR solution is a software
intensive system of systems that provides a uni?ed 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. Sharing data between disparate domains would require physical dependencies
to support the exchange of medical records resulting in increased complexity to maintain the disparate
systems and the interfaces between them. Sharing data across disparate baselines requires 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. Using disparate baselines negatively affects the timing of of data resulting in
lower availability of data and the potential of deviations in the records between two or more systems.
Utilizing a common standard baseline 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.

Further, the maintenance of disparate baselines complicates the cybersecurity posture of the Agencies
and interfaces between disparate baselines would introduce potential ingress points for adversaries.
Presidential Executive Order on Strengthening the Cybersecurity of Federal Networks and Critical
Infrastructure, issued May 11, 2017 (E0 13800) requires that ?Agency heads shall show preference in
their procurement for shared IT services, to the extent permitted by law, including email, cloud, and
cybersecurity services.? By maintaining one baseline for all three Agencies with an increased
cybersecurity posture (as required by BOB), the contemplated way ahead described in this is
consistent with this Executive Order?s principles.

The MHS GENESIS solution includes a mix of components including Best-of-Suite and Best-of-
Breed software, interface software, enterprise service bus software, clinical application services
(CAS), high-assurance clinical application services (HA-CAS), production and pre-production
domain environments. Adoption of the single standard baseline within these environments allows for
maximum use of shared CAS and HA-CAS solutions. Doing so is not only consistent with E0
13800, but affords the VA and USCG the opportunity to bene?t from the use of shared-service
environments that the has spent considerable time hardening, resulting in many lessons learned,
and a greatly improved cybersecurity posture.

Utilizing a non-standardized baseline would result in the implementation of different infrastructure
domains, which will result in a weaker cybersecurity posture and require duplicative work to address
vulnerabilities that the has already resolved. Additionally, the has established processes
and infrastructure that achieve a balance between commercial and Government cybersecurity
strategies relative to the tradeoff between performance, availability, differences in end point security,
differences in alerting thresholds, provisioning Government cybersecurity tools, and Government
timelines for remediating vulnerabilities.

Utilizing a common standard baseline would allow the USCG and VA to reap bene?ts already in
place under the current contract, such as: de?ned access controls to entry/exit points of the 
datacenter cages hosting the system, database realized through the use of NIST 
algorithms that comply with Privacy Act and information system assurance controls, PHI and P11 data
with IPS 140-2 validated DOD-approved modules, Passive (Auditing),
Active (Agents) and Behavior (Event Driven Triggers) monitoring safeguards to identify
inappropriate or unusual activity, cybersecurity service provider tools inside the Cerner commercial
hosting facility to monitor MHS GENESIS system and network behaviors for malicious activities,
con?guration guidelines for end-point systems in the datacenter, harmonized and Cerner
commercial audit pro?les and alerting thresholds, and standards for timelines to ?x cyber
de?ciencies.

Additionally, utilizing a common standard baseline in this manner will lessen the logistical burden on
the Agency, in part by reducing the effort required for administration. For example, retraining on
different systems will be unnecessary if the same solution baseline is implemented among all three
Agencies with common training, work?ows, roles, and order sets as described above.

The reasons detailed above support the conclusion that establishing a common standard baseline is
expected to greatly reduce complexity between the three Agencies, lower risk, and improve



healthcare outcomes. In addition to the clinical bene?ts to Service Members and their bene?ciaries,
the Government considered the technical bene?ts. Beyond those bene?ts, the Government also
anticipates gaining signi?cant ef?ciencies throughout its enterprise by adopting a standardized
solution. Some potential ef?ciencies include, but are not limited to: l) retiring additional business
intelligence programs, 2) not replacing legacy business intelligence programs with discrete
modernized capabilities, 3) reducing infrastructure costs circuits/bandwidth between disaster
recovery/COOP sites, which Cerner includes in its managed service), 4) lower complexity related to
implementing Cerner code changes, and 5) economies in managing the solution centrally.

Given: (1) the legitimate and critical bene?ts of the additional capabilities to clinicians, bene?ciaries,
and MHS IT operations; (2) the ability to leverage the functionality to improve patient care;
and 3) additional potential organizational ef?ciencies, pursuing a single standard enterprise baseline
through this contemplated sole source award is the only way to achieve the Agency?s standardization
goals.

The Government?s reasonable standardization requirements cannot be realized unless they are
implemented as part of the MHS GENESIS solution as part of standard commercial ?as a service?
offerings provided by Cerner as part of the Leidos Partnership for Defense Health. Utilizing any
other solution would prevent access to these capabilities and render it impossible to maintain a single
standard baseline solution with the VA and USCG.

Cerner has asserted that it does not provide these solutions through other resellers in a way that would
enable the Government to continue to utilize the Cerner solution but in a competitive environment for
these extended capabilities. Therefore, no vendor other than Cerner, as a member of the Leidos team,
can satisfy the requirement for a standard enterprise baseline.

Further, while Cerner is a critical component of the MHS GENESIS solution, it is not the only
component. Leidos, the service provider integrator and prime contractor, is essential to the provision,
support, and implementation of the entire solution, including Cerner and non-Cerner components.
For the same reasons the Government determined that a single-award contract for the solution was
appropriate, it continues to believe that one single contract for the partnership is in its
best interest because the projected work are so integrally related that only a single prime contractor
can reasonably perform it.

A single contract minimizes the signi?cant integration risks by requiring a single contractor to be
accountable for the performance and management of the complex modernization of the military
health system. A single contractor is the sole point of accountability to ensure the entire
implementation is successful. Conducting a deployment and sustainment of this complex system,
while coordinating multiple contractors, would create a high risk to execution.

Further, a single implementation provides for a uni?ed and consistent training approach for
clinicians who regularly rotate amongst different Medical Treatment Facilities (MTFs).
A single implementation will notably improve the clinicians? ability to provide quality patient care as
they move from facility to facility.

Issuing new contract(s) to other service providers, whether directly to Cerner on a non-competitive
basis, or on a competitive basis would create unacceptable execution risk because it would be dif?cult
for the Government to ascertain which contractor is responsible for de?ciencies between
implementations and signi?cantly increase the complexity of managing multiple implementations,
which would nullify many of the bene?ts of reducing the complexity of a standard solution. As a

 A 8-0052

result, the will modify its existing contract with Leidos, Inc. for the implementation of the
solution, which is already substantially underway and successfully deploying. The USCG has
determined that it will join the implementation underway rather than conducting its separate
implementation or joining the VA implementation, which is being conducted independently and not
considered under this 

(6) Efforts to Obtain Competition

To assess the interest and capability present in the commercial marketplace, the Government issued a
synopsis as required by FAR Subpart 5.2, through its edBizOps portal that
advised industry of its intent to proceed on a sole source basis. Because of the Government?s
signi?cant investment in its Cerner-based solution, respondents were informed of the Government?s
strategy to pursue a standard solution baseline and asked to demonstrate how they could obtain access
to Cerner solutions because of Cemer?s assertions that they do not provide access outside of their
managed service offerings. The synopsis established a deadline for responses of April 24, 2018. The
Government received two responses from interested parties. The parties, their responses, and the
Government?s disposition thereof are described in Paragraph (10) below. Because the Government
synopsis informed all interested parties that they must clearly demonstrate an ability to obtain access
to Cerner solutions while satisfying the requirements for a single standard baseline, and none of the
responses did so, the Government determined that competition was not a viable method to satisfy its
reasonable standardization requirements.

(7) Methods to Overcome Barriers

The Acquisition Strategy anticipates one or more competitive follow-on contracts to sustain
the EHR solution, for which the Government owns a perpetual license, at the conclusion of the period
of performance of the basic contract, which includes four distinct ordering periods. The Government
is committed to 1) its duty under the Competition in Contracting Act to develop a performance
speci?cation that will support competition for future acquisitions of the same or similar items after
the expiration of the initial contract and full implementation of the system, and 2) ensuring
it meets its requirements in the most cost-effective way, especially given the relative immaturity of
the nascent market for advanced clinical capabilities.

Given the developing market, there is a high potential for change in the market place during the
Government?s full implementation. Further, the legal and regulatory environment is evolving,
particularly in relation to the ownership of healthcare data, interoperability, cybersecurity, and other
dynamic issues affecting information technology in general, and health IT speci?cally. Given these
circumstances, the Government has determined that the conclusion of full deployment is a reasonable
time to re?evaluate its ability to compete the services contemplated in this 

In order to facilitate this re-evaluation, the Government anticipates it may be able to take actions such
as: 1) attempting to identify future alternatives to Cerner managed solutions, 2) monitoring the
marketplace for cost-effective alternatives to the Cerner capabilities, 3) re-con?guring the baseline to
enable the use of alternative cloud, shared, or managed services, and 4) exploring options to leverage
the large body of data from other Govermnent sources, such as the Department of Veterans Affairs,
Department of Health and Human Services, and the'Department of State.

If the Government determines, after full deployment, that competition is not viable, a new will
be executed that will describe the rationale behind that determination, and document the outcome of
actions taken in the meantime, such as the ones above, to remove the barriers to competition, and why
those actions proved to be unsuccessful.

10

(8)

(9)



Finally, as discussed in Paragraph (8) below, the Government actively participates in extensive
continuous market research, one of the primary goals of which is to monitor the marketplace for
solutions that would enable greater competition in any follow-on efforts.

Market Research

The approach for market research consisted of a series of steps to collect and analyze healthcare
market data. As a descriptive method, the intent was to understand what actions were taken and what
experience exists in the market based on a sample of large-scale healthcare delivery organizations in
relation to the implementation and sustainment of enterprise EHR software and related IT services
integration, implementation, training, sustainment, etc.). Data for this research was collected
and reviewed from many sources including:

- Publically available information to include healthcare systems websites and academic libraries
(ProQuest) that describes EHR software capabilities and documents the experience of companies
providing IT services for integration, implementation, and sustainment to large healthcare delivery
organizations

- Information extrapolated from documentation provided by a variety of EHR software vendors,
integration vendors and specialty-niche vendors who submitted responses to numerous RFIs issued
throughout the Program lifecycle

- Third party reports providing health IT (HIT) domain assessments KLAS, Gartner, and
HIMSS)

- Additional data obtained by the VA or USCG as part of their independent solution analyses.

In addition to static data sources, the Contracting Of?ce engages in multiple industry days, one-on-
one meetings with industry partners, participates in conferences (HIMSS, DHITS, AFCEA, etc.), and
provides panelists for Government-Industry panels. Further, the Contracting Of?ce will participate in
upcoming reverse industry days intended to allow industry ?exibility to describe unique and
innovative solutions.

Finally, the Contracting Of?cer and Program Of?ce engage in site visits with other healthcare
industry partners such as Tenet Healthcare, InterMountain Health, and others to ascertain lessons
learned and obtain information from those who have implemented similar scale solutions recently.

Other Facts

In order to fully enable the capabilities and environments necessary to achieve a standard baseline,
given the Government?s investment in the Cerner-based solution, MHS GENESIS requires direct
access to proprietary Cerner intellectual property (IP), such as Clinical Application Services, which is
only available from Cerner. As this IP is proprietary and the result of private expenditures and
research and development, the Government does not have rights to access or use this IP, or to provide
it to other entities for use. Allowing a third-party to have access to the Cerner IP could adversely
impact Cerner?s ?nancial viability and competitive market advantage.

The Contracting Of?cer inquired with the Leidos Partnership as to whether Cerner would be willing

to negotiate the rights to the IP necessary to enable competition. On May 24, 2018, Cerner declined,
in writing, to enter into such negotiations for its own business reasons.

11



(10) Interested Sources

 

 

 

 

 

 

(1 1) Company Address Response Date
Chicago. IL Apn'124, 2018
CACI International Inc Chantilly. VA April 24, 2018

 

 

The Government received two responses ?om interested parties that challenged the sole source
noti?cation. and expressed an interest in competing to satisfy the Govemment?s requirements.

asserted that it could support the standard solution baseline through its EHR

so ution. While its response addressed how it satis?es the Government?s require ctronal
capabilities. and based on the Government?s knowledge and evaluation of that solution, the
Government considers that the EHR would be a viable solution if pursuing an alternate
EHR solution: their response we require the acquisition of a new EHR solution and could not be
used to extend capabilities as contemplated in this Further. the solution would not be the same
as the one in use by the and being procured by the VA. The response did not address how a
single standard solution baseline would be maintained throughout the three Agencies with different
EHR solutions. in a way that would satisfy the Government?s reasonable standardization
requirements.

  

*asserted based on its past performance of creating interfaces and coordinating with Cemer, as
we as implementing numerous information technolo ro ams, that it could satis the
Govemment?s re uirements

    

a 0V6.

The Government responded in writing to each interested party and invited them to meet with the
Program Executive O?icer and Contracting O?icer face-to-face to provide an opportunity for mutual
understanding of the Government?s standardization strategy and to discuss other competitive
opportunities within the PEO portfolio. The interested parties were further informed that adopting a
new solution or implementation would not satisfy the Govemment?s requirements for
standardization.

 A 18-0052

Coordination:
1. Technical Representative:

I certify that the supporting data under my cognizance which are included in the justi?cation is
accurate and complete to the best of my knowledge and belief.

Typed Name:? Date: 12 JUN 2018
Title: Chief Engineer, Program Of?ce Signature:

12. Requirements Certi?cation:

 

I certify that the supporting data under my cognizance which are included in the justi?cation is
accurate and complete to the best of my knowledge and belief.

Typed Name:_ Date: 13 June 2018

Title: MHS Chief Health Informatics Of?cer Signature: 

13. Fair and Reasonable Cost Determination:

Prior to issuance of any task orders under the IDIQ contract, the Contracting Of?cer will perform
cost/price analysis on proposals received from the contractor and request any certi?cates of
certi?ed cost and pricing data as required by regulation. I hereby determine that the anticipated
cost to the Government for this contract action will be fair and reasonable.

9.019

   

Typed Name: Matthew G. Hudson Date:

   

Title: Contracting Of?cer Signatur 
14. Legal Review:
I have reviewed this and it is deemed to be legally suf?cient.

Typed Name:? Date:

Title: Associate General Counsel Signature:



    

15. Contracting Of?cer:
I certify that this justi?cation is accurate and complete to the best of my knowledge and belief.

Typed Name: Matthew G. Hudson Date: [3 04/ 10 1?

Title: Contracting Of?cer Signatur-

 



16. Competition Advocate (CA):

Based on the foregoing justi?cation, I concur with the procurement of additional EHR
functionalities required to create a single standardized baseline with the VA and USCG on an
other than and open competition basis pursuant to the authority of 10 U.S.C. 2304(c)(1).

Typed Name: - Date: _6/14/2018
Title: _Chief, Proc. Policy and Acq. Signature: 

 

 18-0052

A roval:
17. Senior Procurement Executive (SPE):

Based on the foregoing justi?cation, I hereby approve the procurement of additional EHR
functionalities required to create a single standardized baseline with the VA and USCG on an
other than full and open competition basis pursuant to the authority of 10 U.S.C. 2304(c)(l 
subject to availability of funds, and provided that the supplies and/or services herein described
have otherwise been authorized for acquisition.

Typed Name: John M. Tenaglia, SES DateTitle: interim Component Acquisition Executive Signatu-