The contractor shall provide services, support, and facilitation as they relate to health informatics. Health IT enables advancements in healthcare by providing the tools which set knowledge in motion. Informatics is a foundation to modern health care services. It ensures the appropriate use of health IT, applied to clinical, and business concepts and the human aspects of delivering health related services.

Informaticists improve the effectiveness, efficiency, and safety of health-related services by leveraging health IT to support end user experience and improve care for Veterans. Health informatics is inclusive of the following areas of focus – Clinical informatics, Biomedical Informatics, and Public Health Informatics.

• Clinical Informatics is the application of informatics and information technology to deliver healthcare services. It is also referred to as applied clinical informatics or operational informatics.
• Biomedical informatics is the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.
• Public Health Informatics is the application of informatics in areas of public health, including surveillance, prevention, preparedness, and health promotion. Public health informatics and the related population informatics work on information and technology issues from the
  perspective of groups of individuals. Public health is extremely broad and can even touch on the environment and work and living places and includes the development and use of interoperable information systems for public health functions such as bio-surveillance,
  outbreak management, electronic laboratory reporting and prevention.

3.3.4.1 4A Informatics Risk Analysis and Mitigation

The contractor shall conduct risk analysis applying a risk stratification framework using risk management standards and methods to provide assessments to document potential issues and risks associated with existing or emerging technologies, tools, or methods. Services shall include

providing recommendations to maximize effectiveness and reduce risks and associated costs. The contractor shall propose strategies to reduce the likelihood or severity of harm through errortolerant design and mitigation implementation on risks or perceived issues. The contractor shall identify potential issues and risks with decisions made, with a particular focus on any usability, information security and safety impacts. The contractor shall identify and summarize workarounds established by users that mitigate potential issues, including potential policy adaptations.

3.3.4.2 4B Solutions Engineering and Issue Resolution

The contractor shall lead business process reviews and recommend enhancements to elements of the socio-technical system (STS). The contractor shall assess deployment of health information systems (HIS) and post-implementation status to determine the impact on ongoing operations, including progress assessments related to defined key performance indicators (KPI). The contractor shall perform analysis efforts that inform candidate solution development resulting in recommendations for changes to the system design or functionality or other optimal mitigation strategies to an identified issue to enhance policy, procedures, organizational / leadership, education / training, manpower / personnel / staffing, or some combination of those listed. 

The contractor shall perform workflow evaluations that apply best practices or standardized procedures to improve service delivery with measurable health outcomes, or craft new methods based on literature. The contractor may support activities that explore the variance and design constraints of workflow adoption issues. The contractor shall validate workflows, suggest enhancements, enable performance optimization, and identify latent risks and design inefficiencies, challenges, and opportunities for system enhancement. The contractor shall identify HIS deployment issues that can be explored and quantified so alternative STS design options can be considered, including design recommendations or proposed process redesigns. The contractor may measure performance changes and design enhancements that informs future trade off analyses. The contractor may perform analysis that identifies sub optimal workflows and assess user reported interface and functionality issues. The contractor shall perform and have working knowledge and specialized experience in analytics related to processes (e.g., operations research, clinical pathways, Business Process Modeling and Notation (BPMN+), causal inference, machine learning and artificial intelligence, and master data management in context of healthcare data and electronic health records (EHR) data. The contractor shall perform research, decision support, and analysis related to diagnostic reasoning, clinical practice understanding, and guideline application.

3.3.4.3 4C Simulation

The contractor shall perform simulation studies that delineate the current performance from the potential system performance with identified variable factors for short-term solutions and longerterm solutions to inform operational and strategic planning. The contractor shall identify the system components, flow, and interactions as appropriate for the model’s aims to predict and subsequently validate the model’s performance. The contractor shall provide simulation to support predictive data and information on operational performance issues and define functions and tasks to enable assessing workload, evaluating alternative configurations, assessing operating procedures, workflow integration, and identifying accident or error-provocative situations.

3.3.4.4 4D System Testing

The contractor shall perform pre- and post-implementation assessments in-situ and virtually that analyze Key Performance Indicators (KPI) and identifies established workarounds or pain points from user-discovered usability issues. The contractor shall establish appropriate usability objectives and KPIs for targeted user roles in specified domains for common, core, and safety critical tasks. The contractor shall provide performance-based assessments that provide clarity on the operational impact of a system design and qualitative testing that identifies underlying usability concerns and workflow integration challenges. The contractor shall establish performance baseline usability metrics that provide a reference point to determine quantitative impact of applied interventions.

3.3.4.5 4E Informatics Applied Analysis

The contractor shall support the establishment of and business process planning for maturing applied systems analysis services, architecture, and analytic capabilities The contractor shall conduct current state assessments through environmental scans and literature reviews, processes, and needs to inform a strategy for maturing applied systems analysis practices in VHA. For supporting applied systems analysis theoretical and technical guidance capability expansion the contractor shall perform technology scouting to collect and curate a list of required, available, and approved analytic tools and methods. The contractor shall produce technical references, language, and use cases, as well as create illustrative figures and graphics to provide stakeholders with effective and efficient data visualizations, dashboards, and publications. The contractor shall organize resources through the development and evaluation of an interactive online theoretical and technical reference hub.

For the applied systems analysis continuous planning and business process development, the contractor shall perform and/or design external review of applied analysis plan, collect and review Data Scientist position descriptions (PDs) and related information, develop an initial library of applied systems analysis use cases, and formulate planning around publication and presentation development. The contractor shall develop educational materials and tools to support local analytic projects and administer training on key related topics. In addition, the contractor shall assess the feasibility and facilitate initial infrastructure to foster a community of practice around Human Factors Engineering (HFE) applied analysis principles and practices.

The contractor shall support and provide consultative services in establishing the foundational requirements for the data platform, copying of data from EHR systems to its enterprise data management and data governance platforms.

3.3.4.6 4F Systems Safety Analysis

The contractors shall support Systems Safety activities that include establishment of a training plan and content as well as support on local, Veterans Integrated Services Network (VISN), and National project teams to facilitate understanding of context of use and Work as Done (WAD) in ways that will promote safety and resilience within the system. The contractor may develop training materials tailored for VHA informaticists as well as a plan for the creation, curation, and distribution of content. The contractor may conduct environmental scans of existing trainings, methods, tools, and best practices used across VA and industry to inform trainings materials and recommendations to improve local operations.

The contractor may conduct user interviews to understand current attitudes and awareness around systems safety for national program offices. The contractor may develop educational materials to support local projects and demonstrate the importance of systems safety to stakeholders. The contractor may create illustrative figures, graphics, technical references, and language to use intrainings, educational materials, and publications.

Contractors may support the expansion of a systems safety infrastructure that promotes Safety-II (Productive Safety) and Resilience Engineering activities while complementing Safety-I (Protective Safety) efforts. This includes gap analysis and the identification of things that are going well in various settings in VHA. Additionally, contractors shall analyze and investigate how to promote suchactivities, how to build capacity for this work, and how to identify pathways for dissemination.

3.3.4.7 4G Human Centered Design and Human Systems Services

The contractor shall support a systems-based approach that aims to improve usability, information security, safety, and overall user experience with VA services and HIS in alignment with existing federal government policies, regulations, and international standards, while developing new techniques and approaches for VA to efficiently adopt and demonstrate the value of involving users throughout the systems development lifecycle.

The contractor shall support the design of products, processes, and tools to optimize overall system performance, by employing methods with demonstrable success in reducing development costs, improving overall system efficiency, heightened user satisfaction, increased safety, and improved employee experience.

The contractor shall apply human factors methods and analysis, mastering the fundamental concepts of observational, experimental, and correlational research methods that include both qualitative and quantitative data. The contractor shall have expertise and skill applying statistical analysis, interviews, contextual inquires, focus groups, inspections, evaluations, survey development, rapid ethnography, systems design, data coding and literature reviews. The contractor shall have experience in administering the NASA Task Load Index (TLX), System Usability Scale (SUS), Post-Study Usability Questionnaire (PSSUQ), Health Information Technology Usability Evaluation Scale (ITUEs) and other standard usability and satisfaction instruments. The contractor shall benchmark user performance measures on the as-is system and iterate the design and configuration of any new UI and work system as appropriate. The contractor shall identify and define the gaps, risks, limitations, capabilities, system constraints, functionalities, affordances, findings, lessons, and factors contributing to the productivity, comfort, motivation, safety, and satisfaction of users.

3.3.4.8 4H Informatics Field Usability Support

The contractor shall support embedded Usability Specialists within local and regional field locations. The contractor shall support improving Human Centered Design (HCD) competencies for local, regional, and national informatician roles that are responsible for analyzing current-state systems, capturing clinician needs, engaging clinicians in solution design, and assessing the impact of solutions on care delivery. The contractor shall support the delivery of practice guidance, on-demand training, and hands-on coaching to informatics staff at VISN/VA Medical Center facilities that have requested support to establish a local HCD competency. The contractor shall support identifying skills gaps and facility priorities for improved health IT usability. The contractor shall support the content delivery platform to improve access, measurement, and continuous improvement of HCD practice guidance and on-demand training, expand the scope of HCD guidance and training to include EHR transition work, and deliver hands-on HCD coaching across the enterprise.

The contractor shall support the usability community of practice (UCOP) that enables the sharing of standards, templates, processes, guidance, tooling, lessons, and priorities in bi-directional information sharing monthly office hours for each individual resource and group sessions for the community; and an annual in-person Showcase event.

3.3.4.9 4I Informatics Operations Review and Improvement

The contractor shall periodically assess templates, tools, techniques, approaches, processes, and procedures used by the Government team to assess applicability, update content, and reinforce efficiency. The contractor shall conduct user interviews, focus groups, environmental scans, literature reviews to understand how external groups are structured and operate in other health care systems. The contractor shall provide recommendations to improve operations and methodologies based on best practices used by other external groups. The contractors shall create and deliver content including new method descriptions, educational materials and sessions, checklist in support of study types, tool comparisons, heuristics and standard instruments (e.g. SUS, NASA, TLX).

3.3.4.10 4J Informatics Instructional System Design

The contractor shall apply current and innovative adult learning and instructional design theories and techniques to analyze, design, develop, implement, evaluate, and modify learning programs for informatics processes, principles, and tooling. The contractor shall provide instructional systems design (ISD) services to include determining stakeholder needs, identifying the services and timelines that best meet those needs, and providing those services to VA program offices. The contractor shall perform the systematic process for the assessments needed to design effective training solutions, specifically for the purpose of formal training delivery. The contractor shall support VA customers in the development of effective curriculum & training strategies that achieve organizational goals. The contractor shall conduct formative assessments of trainings and products. The contractor shall refine and uphold curriculum & training standards in line with design principles and learning design development best practices. The contractor shall assess implementation of curriculum on new and existing products for the user experience and outcomes. The contractor shall capture stakeholder feedback for continuous improvements of curriculum & training. The contractor shall align ISD services with ISO 30422:2022 Human resource management — Learning and development. The contractor shall support the continuous improvement of ISD practices, processes, and methods. The contractor shall conduct training effectiveness evaluation and formative training assessments.

3.3.4.11 4K Informatics Policy Analysis

The contractor shall continually scan policies, directives, and guidance with informatics dependencies for new requirements or changes to existing requirements. The contractor shall continually scan organizational knowledge and subject matter domains to identify and develop business requirements not fully supported by policies and propose one or more adjustments to policy to bridge identified gaps. The contractor shall identify non-policy alternatives to any proposed change to policy design as part of analysis of alternatives.

3.3.4.12 4L Informatics Patient Safety

The contractor shall use data to assess, monitor, implement and evaluate the effectiveness of patient safety interventions to reduce issues such as medication errors, reduce adverse drug reactions, improve compliance with practice guidelines, analyze impact of system performance on workflows, and create informatics solutions to ensure the outcomes are as intended and beneficial while minimizing risk of harm.

3.3.4.13 4M Clinical Practice Workflow Analysis

The contractor shall analyze individual tasks of a process completed during the customary means of delivering health care, to consider opportunities for improvement or optimization of the behavior of people, systems, information, and tools. to the contractor shall understand the various approaches for mapping the workflow of business and clinical processes to outline steps users follow and to develop a baseline for improvements or reengineering.

3.3.4.14 4N Informatics Partnership Management

The contractor shall engage in the practice of coalition building to cultivate and maintain effective relationships with key partners and stakeholders that impact informatics from the central office level, through the facility level. Services require working cooperatively with others, inside and outside the organization, to accomplish objectives to build and maintain mutually beneficial partnerships, leverage information, and achieve results.

3.3.4.15 4O Informatics Issue Management and Resolution

The contractor shall use a systematic process used to identify, document, and address informatics and health issues quickly and efficiently in ways that facilitates the resolution of future problems. This shall include identifying problems and uses logic, judgment, and data to evaluate alternatives and recommend solutions to achieve the desired organizational goal or outcome.

3.3.4.16 4P Application Support

The contractor shall enable healthcare capabilities and the evolution of technology of the EHR (such as CPRS/VISTA and Oracle Millennium) and tools adjoined to the EHR to deliver quality care. This shall include developing, testing, implementing, monitoring, maintaining, and optimizing informatics tools and facilitating access to them. Services require working on availability, functionality, integrity, and efficiency, and maintaining system configuration for informatics tools.

3.3.4.17 4Q Informatics System Use and Training

The contract shall provide instruction and document guidance on using computer hardware and/or software to store, retrieve and communicate health information. The contractor shall have the ability to impart that knowledge, skill, and abilities to another system user. The contractor shall promote individual and organizational development through planning, designing, and managing employee development and training programs/services. The contractor shall organize, analyze, interpret, and visualize data to provide insights that guide effective decision making. The contractor shall seek or collect and synthesize information from a variety of stakeholders and sources in an objective, unbiased manner to reach a conclusion, goal, or judgment, and to enable strategic and leadership decision making.

3.3.4.18 4R Informatics Information Security

The contractor shall provide management of end-user access and protection against unauthorized use of business and clinical systems in accordance with VA information security and privacy policies. The contractor shall ensure the confidentiality, integrity, availability, reliability, and non-repudiation of the organization’s information contained in and transmitted from systems and networks by implementing security and privacy laws, regulations, policies, standards, and control techniques.

3.3.4.19 4S Standards and Interoperability

The contractor shall advance secure, standards-based interoperability and exchange of health information through standards engagement, development, adoption, conformance, and awareness activities contributing to the seamless exchange of health and social care information for Veteran care and Veteran access to their own health information.

3.3.4.20 4T Informatics Change Control

The contractor shall collaborate to develop and apply change control criteria and processes to prioritize and backlog changes to maximize the efficiency, likelihood, and impact of change adoption. Supported change control shall include changes to business requirements, technical applications (excluding data governance, information security governance, or CDS governance), and program office activities.

Support for change control shall include governance change requests explicitly captured as a class of change requests end-users could submit along with existing new service requests (NSRs) or break-fix requests using existing or minimally augmented change request infrastructure. The contractor shall facilitate and support visibility into other change requests already in progress that users may opt-out if desired. The contractor shall facilitate and support the ability for peer analysis or solutioning among end-users (resolution for change requests opting out of visibility to other end-users would accept longer time-to-resolve due to lack of peer resources). These interdependent potential change control process features could support continually emergent standardization at an enterprise scale.

3.3.4.21 4U Informatics Change Management

The contractor shall use communication, education, and leadership to support business and clinical teams with comprehension of and adaptation to enterprise updates, leveraging project management principles and environmental assessments to drive the adoption of informatics change. The contractor shall understand the need for change from current to future state and helps plan for and accommodate it as creatively and positively as possible.

3.3.4.22 4V Clinical Decision Support (CDS)

The contractor shall support CDS-related tasks that address one or more phases of the CDS Lifecycle.

Work under this area can include (singularly or in combination) any of the tasks outlined in this area:

The contractor shall provide support with respect to researching and quantifying current issues related to clinical and/or business processes/outcomes (Problem Identification) and conduct the appropriate analysis to determine whether CDS is an appropriate remedy for the identified problem (Solution Analysis). The contractor shall provide services and support to Government staff to develop and document a deep understanding of current clinical knowledge relevant to the identified need, utilizing the medical literature, clinical texts, guidelines, subject matter experts and other authoritative sources (Knowledge Management).

Using existing or newly captured in-depth clinical knowledge, the contractor shall provide subject matter experts and informaticians to work with VA clinical experts, clinical users, and informaticians, in an iterative process, to develop CDS interventions that implement the knowledge in relevant and useful ways (CDS Information Design). During creation of CDS artifacts, the contractor shall use Government designated information design artifacts to create a CDS intervention arranged in a structured or semi-structured manner specific to the CDS knowledge artifact type (e.g.Documentation Templates, Order Set(s), or ECA rules) according to applicable semantic and syntactic standards (Intervention Specification). The contractor shall be expected to collaborate with SMEs and other knowledge workers responsible for constituent components (e.g., terminology artifacts) to create and test standards based CDS content that is presentation layer independent. As platform agnostic CDS artifacts are intended to be used across multiple modalities, the contractorshall provide knowledge workers and user interface designers who shall be responsible for taking the standards based CDS artifact and, using an iterative process, transforming it into an executable format such as HTML5 for rendering by the HIT application (Presentation Design). Contractor staff shall pay careful attention to usability and user interface design guidelines while creating such artifacts.

To complete the CDS Lifecycle, the contractor shall support efforts to conduct a thorough clinical review and organization vetting of existing or newly created CDS artifacts prior to deployment (Organizational Vetting). As every CDS intervention must undergo periodic review to ensure that it remains current and useful, the contractor shall support assessments which may include impacts of CDS on workflow, care processes or patient outcomes (Impact Assessment), as well as periodic review of an intervention’s impact on meeting stated goals and of the currency of its clinical knowledge. Results of this step could be confirmation of an intervention as-is, modification, retirement or replacement of the intervention if needed (Periodic Review).

3.3.4.23 4W Agile Development Methodology

The contractors shall provide consultation on the effective use of agile methodologies including but not limited to the use of Scrum, Kanban, and Scaled Agile Framework for solution development. The contract shall enhance team agility and maturity by developing coaching plans and conducting maturity assessments. The Contractor shall facilitate the organization’s transition to a continuous delivery model and adoption of an agile mindset across stakeholders by using change management techniques to generate organizational buy-in. The Contractor shall participate in development and application of guiding principles and standards to guide product management practices. The Contractor shall develop ecosystem and business capability models, value stream and customer journey maps to guide product teams in developing their minimum marketable and minimum viable products, value propositions and drive business outcomes.

3.3.4.24 4X Terminology

The contractor shall provide support for knowledge-based systems terminology standards creation, terminology versioning, evolution and maintenance, terminology mapping and harmonization, structural and semantic integration, terminology configuration, publication, and submission for the VHA Office of Health Informatics (OHI), Clinical Informatics and Data Management Office (CIDMO), Knowledge Based Systems (KBS) Program Office using Agile principals. The TermMed and Symedical terminology tools shall be secured by the contractor to maintain the enterprise terminology.

The contractor shall perform and maintain terminology mappings from VistA data representations to standard codes. Where terminology standards are inadequate to enable mapping of a data set, the contractor shall propose and model new concepts for the VA SNOMED Extension (VSE). New terms that arise shall be prepared for proper submission to Standards Development Organizations (SDOs) that may consider them for incorporation into the standard. Comprehensive documentation shall be provided of Standard Operating Procedures (SOP), business rules, mapping rules, Quality Assurance (QA) processes and a dashboard summary detailing metrics related to product delivery and QA.

The contractor shall create new content as needed to support VA use cases. Content includes the concepts themselves as well as appropriate modeling of inter-concept relationships consistent with terminology modeling guides such as the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) modeling guide. VA has implemented a process called New Term Rapid Turnaround (NTRT) to meet this need and to respond to clinician requests for new or expanded content. This process enables users of the VistA system to submit requests for new content. The contractor shall analyze and process requests. Terms deemed appropriate shall be added to the relevant standardized domain.

The contractor shall ensure that terminology products produced harmonize with messaging and modeling standards such as those provided by Health Level 7 (HL7). Alignment of the HL7 Fast Healthcare Interoperability Resources (FHIR) standard in the VA enterprise shall be adhered to by the contractor so that we are not on different versions of the standard and so that interoperability is enhanced.

The contractor shall actively participate in terminology standards activities to continue to understand how our VA efforts can inform and be informed by terminology standards so that maximum interoperability can be achieved. Examples of relevant SDOs/Standard Relevant Organizations (SRO) include SNOMED CT, Logical Observation Identifiers Names and Codes (LOINC),and HL7.

3.4 Labor Categories

Attachment A, IHT Labor Categories, provides a comprehensive list of labor categories, descriptions, minimum education and experience requirements, as well as identification for which Functional Category(s) the labor categories are applicable. Individual Task Orders may provide additional requirements for experience or education, including certifications.
It is expected that the minimum education and experience will be in a field or specialty that directly relates to the labor category and task order requirements. The CO reserves the right to grant waivers for the education and experience requirements. Waivers for education may be based on additional years of experience, industry certifications, or equivalent trainings. Waivers for experience may be based on additional years of education and exceptionally specialized experience. Individual Task Orders may cite additional equivalencies that will be recognized. Contractor’s request for waiver must be provided in writing to the CO, and the CO’s authorization must be provided in writing to the contractor.

4.0 MANDATORY TASKS AND DELIVERABLES

The base contract and any subsequent task orders require general contract management to provide oversight, maintain schedules, monitor costs, and assure quality of services, performance, and deliverables. The contractor may be asked to attend virtual meetings, provide meeting minutes, prepare agendas, review deliverables, and participate in ad hoc communication to discuss contract or task order status. In addition to tasks and deliverables defined in individual task orders, the contractor shall perform the tasks and provide the deliverables that follow throughout the performance period. All tasks and deliverables listed in this section shall not be separately priced, nor will separate task orders be issued