A.1 Instructions to Offerors - Veterans Affairs
?Please see the draft statement of work below (beginning on page 6) and respond to this RFI with solutions to the following items. This is not a request for quotes. All responses shall be directed to John McClintock, HYPERLINK "mailto:john.mcclintock@" john.mcclintock@. Ability to utilize a centralized server in site’s main server roomIntegration with site’s existing pharmacy software (VISTA) and the VA’s electronic health record (CPRS) Automation must be compatible with RX-Framework interface and an anticipated bidirectional interface Ability to integrate with future IV compounding software solutions to meet USP 797 and USP 800 guidelines and pharmacy inventory management software solutions Offeror should specify any current IV compounding software and pharmacy inventory management software that integrates with automated dispensing softwareSystem should be configured so that software additions are possible Availability of a data analytics software that interfaces with automated dispensing softwareOfferor should specify whether automated dispensing software integrates with the site’s existing data analytics software (PANDORA) and should provide a list of all data analytics software that interfaces with their systemAvailability of an integrated system that supports multi-departmental use Other Services, besides Pharmacy, must be able to store and manage their inventory (Operating Room, Emergency Room and Logistics staff)For services other than pharmacy, who will be storing and managing inventory, each individual must be issued their own login which should be service specific Remote Functionality:Licensing for remote pharmacy management access (16 total pharmacy licenses)Licensing for remote queueing of medications by nurses at the bedside to streamline their medication administration process (minimum of 40 licenses for remote queueing needed)Setup/Implementation Details:Itemized cost schedule of all equipment, parts, software, software licensing fees, infrastructure including servers and other network infrastructure devicesServices required to implement the proposed solutionInstallation and Configuration Requirements:Installation process/schedule should not exceed 6 months and should be at discretion of VACT to allow for staging and appropriate staffingInstallation shall consist of the following:The Offeror shall furnish a detailed implementation plan to the government no later than the closing date of the solicitationThe Offeror shall conduct a site survey of each of the designated locations Site surveys must include the following:Confirmation of fit within existing footprints (planned footprints in the case of the designated locations for which automation is still desired but not yet implemented)Verification of adequate capacity for cart less medication delivery Comparison of line item capacity (showing current capacity vs. capacity that Offeror could give) and explanation of maximum capacity that could be offered with each machineDemonstration of how vendor’s line item capacity for each site will be adequate to support cartless medication delivery sufficient for both the number and complexity of patients Facility will supply necessary data for the vendor to use in addressing the above items as part of the site visit (data will include such items as number of doses of each medication given per location, current cabinet capacity, etc.) A technical plan must be detailed out for each site where automation will be placed after the site survey has been completed A detailed explanation of project management services provided during installation should include timeframe, logistics, staging, and infrastructure needs assessmentEach site survey shall include all electrical and information technology (IT) cable drops necessary for complete set up of any access equipment with required hardware necessary for complete installation of each display:Any necessary data line pulls Any necessary electrical work required to power machines and softwareConnection with uninterrupted power source Configuration shall consist of:Interface testing, with the following documentation:VA computer system (VISTA, CPRS) Test scriptsData analytics software Software patch descriptionsInstallation guidesImplementation and back out plansUnit Specific ConfigurationWork with hospital’s pharmacy staff to configure site-specific medication loading and standard stock designationsDefine access control list for users who can modify configurationDefine application URL and mechanism to deploy URL for use by authorized usersAnalytics package configuration requirements:Configure predefined reportsConfigure analytic cube to host data for above reportsDefine access control list for users who can access these reports Define application deployment for authorized usersVACT wants to maximize pre-configuration of the unitImplementation plan should spell out potential for phased delivery with partial shipments to align with facility space allowed for staging room and time to configure and load machinesShipping schedule must be at discretion of VACT in order to fit within space constraints and staffingVACT must be notified 90 days before shipments beginDeployment schedule must be at discretion of VACT in order to fit within space constraints and staffingDelivery of automated dispensing cabinets should be to the facility where they will be stored (shipped to specific campus)Newington Campus Address:555 Willard AveNewington, CT 06111West Haven Campus Address:950 Campbell AveWest Haven, CT 06516Removal of existing equipment (as listed in introduction and seen on site survey) should be included within the Offeror’s proposalOfferor should state how they can assist the facility to coordinate the simultaneous efforts to deploy new or upgraded automated dispensing technology while de-installing technology in these units and continuing to run current automated dispensing technology within other units Training RequirementsGo-live/Initial training on campus at both West Haven and NewingtonOnline, web-based training should be provided to each unit’s staff no more than one week prior to that unit’s automation deploymentHands-on training should be provided on-site, concurrent with each deployment. This should include user interface, system applications, and features training for all shifts of pharmacy (pharmacists, pharmacy technicians, and pharmacy administrators), nursing (staff nurses and nurse managers), biomedical support, and anesthesia (anesthesiologist, nurse anesthetists, and anesthesia techs) On-site support should be provided for each deploymentAt least one piece of demo equipment for both automated dispensing cabinets and anesthesia specific software should be provided on-site for the duration of the implementation for hands on training that will not interfere with patient care. The demo equipment should be actual pieces of equipment housed on-site and provided for the duration of the implementation for hands on training that does not interfere with patient care. Demo equipment should be capable of showing all potential configurations and features that staff should be familiar with when using the automated dispensing cabinets and anesthesia specific software.Training shall be provided on the user interface, applications, and featuresTraining shall provide administrators and end-users with the goal of being self-sufficient with medication restocking, medication administration, machine trouble-shooting, discrepancy documentation, and discrepancy resolutionQuick notes or reference guides must be provided during on-site training Technical TrainingProvide technical training for maintenance and service for technical personnel at site. Training should at minimum address:Corrective preventative maintenanceTroubleshootingServer maintenance and back up procedures Provide technical training for configuration of each interfaceProvide technical training for configuration of each type of displayProvide details as to whether this training will be on site or remoteWarranty CoverageThe Offeror shall specify the warranty period for all software and hardware provided to the VA by the OfferorThe Offeror shall provide any and all equipment service programs, such as remote diagnostics and equipment replacement, during the warranty periodUpdates/Upgrade RequirementsThe Contractor shall ensure that all software, hardware, and servers are the most recently designed versions at implementation. The Contractor shall provide the Contracting Officer with the following information:A list of specific awarded items to be updated (with changes proposed);Product literature for the new items and a detailed description of the differences between awarded items and the new items, and a specific analysis of the comparative advantages/disadvantages of the items involved. A.1 Instructions to OfferorsVA Connecticut Healthcare System (VACT) was officially formed in 1995 with the integration of the VA medical centers in West Haven and Newington. We serve veterans in Connecticut and southern New England. The West Haven facility is a tertiary care facility classified as a Clinical Referral Level I Facility. It is a teaching hospital, providing a full range of patient care services, with state-of-the-art technology and a renowned research program. Comprehensive healthcare is provided through primary, acute, tertiary, and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. A Women’s Health Center is located at the West Haven campus. Newington is an ambulatory care center that provides primary and specialty care. VA Connecticut is part of the VA New England Healthcare System, which includes facilities in Maine, Vermont, Rhode Island, Massachusetts and New Hampshire. In addition to our main campuses, VA Connecticut operates six community-based primary care centers in Danbury, New London, Stamford, Waterbury, Winsted and Willimantic. VACT is seeking to improve our accountability of high risk, high alert, and high cost medications, including controlled substances, in all areas where medications are stored. This includes expanding the use of automated dispensing cabinetry to assure all medications are available through this mode only, which will also maximize availability of medications at point of care for nurses. The facility is staffed by 568 registered nurses, 70 advanced practice registered nurses, and 69 pharmacists, and 43 pharmacy technicians. Currently the inpatient pharmacy regularly completes a unit dose cartfill for 7 wards within the West Haven campus. Each inpatient cartfill requires a minimum of a 24 hour supply of medications be filled for each patient and later returned to the pharmacy for pharmacy staff to restock every time patients are discharged. In a unit dose cartfill system, there is a delay in medication provision due to the time between the order being verified by the pharmacist and then medication delivered to the floor (which involves a medication being filled, checked, and delivered to the floor). A cartless system involves the use of an automated dispensing cabinet with many secure compartments for medication dispensing, with each compartment containing a supply of one specific medication. The automated dispensing cabinet allows a healthcare worker access to a specific drug’s compartment at the time the medication is due for administration and only after the medication has been prescribed by a provider with that order verified by a pharmacist. The only exception to this process is the case of drugs designated for emergency use, as they do not require an order for emergency cases and can be removed quickly from an automated dispensing cabinet if designated as stock for “override”. Automated dispensing cabinets support the Joint Commission’s regulation that a medication order have order verification by a pharmacist prior to dispensing or removal from an automated dispensing cabinet or ward stock. The medication supply kept on each unit is customized to contain the most commonly used drugs for that unit’s patient population. This is further modified by the removal of medications unused within a specified time frame and new medications loaded in response to new orders. Each automated dispensing cabinet’s medication capacity must be adequate to support the majority of medication doses given on that unit supplied through the automated dispensing cabinet, with replenishment at a minimum of every other day. Due to all the services provided by this facility and the abundance of medications involved in providing care for these services, the facility needs to move to a cartless medication system where the majority of medications are provided through automated dispensing cabinets. This will allow medications to be available at point of care, which can significantly minimize the time between verification of an order and medication administration by the nurse. The facility is in need of a system which fully integrates with the VA’s existing pharmacy software (VISTA) and electronic health record (CPRS) to be used for all of their current automated drug storage in an efficient and integrated way. The current automation system needs to be replaced with a newer model that runs on Windows 7 and utilizes Windows 2012 as the current automated dispensing cabinetry software runs on Windows XP which is no longer a supported platform. American Society of Health System Pharmacists states that automated dispensing cabinets can benefit clinical practice if this distribution model frees up pharmacists for larger number of clinical tasks. Our current automation system limits us to accessing it through one main console located in the inpatient pharmacy, which must be accessed by one person at a time, and requires pharmacy personnel to be on-site to troubleshoot and manage the system to optimize its use. This is very limiting for workflow and remote access capability is needed. The majority of automation dispensing cabinetry is within the inpatient setting. However, to increase access to medication at point of care within the outpatient setting and to increase drug accountability, automated dispensing cabinetry is needed for every clinic, particularly those specialty clinics administering costly injections. Overall, the facility needs an automated dispensing cabinet system that utilizes a web-based platform. Automation dispensing cabinet upgrade or replacement is needed for all of the current inpatient and outpatient areas with automation as well as those desired for expansion (listed below).Our current automated dispensing cabinets include a total of 18 main cabinets, 12 auxiliary cabinets, 17 medication towers, and 8 tabletop mains. All automated dispensing cabinets at this facility are Pyxis brand Medstation 4000, which is used with Pandora brand analytics software. The automated dispensing system should allow for an expansion in the overall number of automation dispensing cabinets and support an upgraded platform to run on the Windows 7 platform. Requirements for this system include the following: Cabinetry and Anesthesia Specific StorageCabinets must contain the following required features: Durable cabinetry/fixed compartmentsMaximization of closed pockets rather than a matrix and carousel drawer designCapability to assign medications as standard stock for particular units (medication that must be available on that unit at all times for emergent/routine use)Capability to override ordering requirement for emergent situations Capability to receive both patient medication orders as well as ADT (admission, discharge, transfer) orders Capability to fit the majority of medications used by the unit within the automated dispensing cabinet in order maximize medication supply immediately available at point of care and allow transition to a cartless distribution systemCapability to fit within current space constraints as determined by site surveyCapability to restrict access to remote locations such as refrigerators, while capturing all transactionsCapability to assign individual, patient specific compartmentsCapability to profile all automated dispensing cabinetsMedication label printerReturn bin accessible only after appropriate electronic documentation Medication scanner meeting industry standards Anesthesia specific storage -must contain the following features: Storage capacity for both supplies and medications in one storage unit Capability to equip individual operating rooms and labs with mobile storage unitsCapability for storage units to connect wirelessly to VLANMedication label printer specific to each storage unitExisting Automated Dispensing Cabinet Equipment(all automated dispensing cabinets are located in a medication room in West Haven unless otherwise specified *)Surgery intensive care unit (SICU)-one main, one auxiliary, and two towers Surgery intensive care unit step down (SICU-SD)-one main and one towerMedical intensive care unit (MICU)-one main, one auxiliary, and two towersMedical intensive care unit- step down (MICU-SD)-one main, one auxiliary, and one towerMedical intensive care unit-flex unit (Flex)-one main, one auxiliary, and one towerMedical and surgical ward (4 West A)-one main, one auxiliary, and one tower*Medical and surgical ward (4 West B)-one main and one tower *currently located in a hallway Medical and surgical ward (6 East A)-one main, one auxiliary, and two towersMedical and surgical ward (6 East B)-one main and one towerCommunity living center (CLC)-currently one main and one auxiliary Psychosocial residential rehabilitation treatment program (PRRTP)-one tabletop mainAcute psychiatric unit (8 East)-one main and one auxiliary Medical emergency room (MED-ER)-one main, one auxiliary, and two towersPsychiatric emergency room (PSYCH-ER)-one main and one auxiliary Ambulatory procedure unit (APU)-one tabletop mainAmbulatory treatment unit (ATU)-one tabletop mainDialysis center-one mainCardiac Catheterization Labs (CCL)-one mainAnesthesia-one main, one auxiliary, and one towerOperating Rooms-Operating rooms (OR)-one main, one auxiliary, and one double tower (gives the equivalent of two individual towers)Endoscopy units-two tabletop mains (each in their own procedural room)Cancer center-one tabletop mainPost-anesthesia care unit (PACU)-one mainEye clinic-one tabletop main Cancer Center-one tabletop mainAutomation Expansion for the following areas (the equivalent of the following cabinetry is needed): *Community living center (CLC)-currently one main and one auxiliary cabinet (currently all premade antibiotics must be sent to this floor because the space is inadequate to store manufactured IVs) *currently located in the nurses’ station Two additional mains so that one main is available in each of the hallways Acute psychiatric unit (8 West)-currently no automation One main and one auxiliary cabinet *Treatment room (Newington campus)-one main and one auxiliary cabinet*Specialty clinics (Newington campus)-one main and one auxiliary cabinet*Eye clinic (Newington campus)-one tabletop main*Ambulatory treatment unit (Newington campus) – one tabletop mainAutomation Replacement with Anesthesia Specific Storage Systems for following areas: Seven anesthesia storage systems for each of the seven operating rooms as replacement for the current anesthesia cabinetOne anesthesia specific storage system for interventional radiology (IR) procedural room (currently controlled substances used within IR must be kept within a lockbox in the procedure room) Two anesthesia storage systems for each of the two cardiac catheterization labs to replace the existing cabinetA.2.Delivery Schedule: Delivery should be dependent upon VA approval. Offeror should have an option for phased delivery to allow for the appropriate staging, set-up, and implementation of hardware and software based upon staffing and the demand for continuous patient care services. At minimum, a 90 day shipping notice is needed. Software: Software must integrate with the existing pharmacy software (VISTA) and electronic medical record (CPRS). Additionally, the software must integrate with current healthcare analytics tool (Pandora) or similar analytics tool offered by the company. If a similar analytics tool is offered, information regarding its performance and any additional costs should be included. Descriptions of software updates, outcomes of previous software updates, and a synopsis of any troubleshooting should be provided. Hardware: Hardware must have the capabilities outlined in the above requirements and must demonstrate adequate capacity for transition to cartless medication distribution. Communication: Project management services to be provided during planning and installation should be detailed. Consumables: The Offeror shall identify and describe all consumables which can be used by each component of the system and the cost for each item based on the hospital profile described earlier. All applicable quantity discounts shall be applied.Equipment Cleaning: Offerors shall include cleaning procedures and approved cleaning products for the offered equipment in the product literature.Customer Support: Offerors shall describe the customer support program, including but not limited to in-house training for clinical users, biomedical support, and handling trouble calls (including response time for trouble calls).Orientation/Training: Offerors shall describe the method of orientation and training of end users. The government requires training for end users and biomedical support personnel. Offerors should provide details on the vendor-provided training available and specify whether training is included with the equipment purchased or is priced separately. If multiple training options are available, Offerors should describe each in their offer. If a follow-up clinical training session can be provided, it should be described and any additional costs should be included. Past Performance: As part of their proposal, Offerors shall provide past performance information on their three most recent contracts of similar size and scope. Offerors shall complete RFQ attachment 1, Past Performance Reference Sheet and return along with their offer. The Offeror shall provide a list of all recalls and alerts pertaining to their product line for the past three (3) years from the date of the solicitation.Integration: As part of their proposal, the Offerors shall provide a list of tested and verified Electronic Medical Record systems (i.e., CPRS, VISTA, and data analytics tools like PANDORA) which their system has been tested and verified to communicate with. The level of communication should include but is not limited to medication orders and other patient care related data, in addition to user transactions and discrepancies.Specifications:Listed below are the functional parameters for the required automated dispensing cabinets. Products being offered shall include all features listed as required. Offerors shall not include equipment not meeting required features in their proposal.Offerors shall state whether the offered products includes features listed as optional. VACT Required FeaturesIDFeatureNote1Cabinetry?a. Assignment of Standard Stock?Assignment of Drugs on Override ??Access Restriction to Remote Locations (example, Refrigerators)??Fit Within Current Footprint??Medication Label Printer?Medication Scanner?Return Bin Requiring Electronic Documentation??Closed Pocket Design for Individual Drugs?Assignment of Patient Specific CompartmentsProfiling Capability ?2 Anesthesia Specific Software??a. Storage Capacity for Both Medications and Supplies??Ability to Store Anesthesia Specific Storage Units within Operating Room and Lab square footage??Medication Label Printer?3Software Compatibility a. Compatible with Current Interface? b. Compatibility with Bi-Directional Interface c. Availability of Compatible IV Compounding Software and Pharmacy Inventory Management Software?4 Management Functions?a. Data Analytics SoftwareFunctionality for Assignment of Specific Rights to UsersDefined Access Control for Configuration ModificationConfiguration of Pre-defined Reports5Functionality for Multi-departmental Use6 Remote Functionality?a. Licensing for Remote Pharmacy ManagementLicensing for Remote Queueing of Medications by Nurses VACT Optional FeaturesIDFeatureNote1Simplified Label Printing Features for Anesthesia Specific Storage 2Simplified User Sign-on Features for Cabinetry3Pre-Configuration of Cabinets Off-site4Physical Attachment of all Cabinetry Additions (medication label printer, medication scanner, etc.) 5Reporting Functions with Filtering 6FIPS 140-2 Compliant Wireless Connectivity DISCLAIMER This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. ................
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