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Incorporating Health Information Technology Into Workflow Redesign

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Request for Proposal

OMB 0990-0115

Contents

PART I
   Section A: Solicitation
   Section B: Supplies or Services & Prices/Costs
   Section C: Description/Specification/Work Statement
   Section D: Packaging and Marking
   Section E: Inspection and Acceptance
   Section F: Period of Performance/Delivery Schedule
   Section G: Contract Administration Data
   Section H: Special Contract Requirements
PART II
   Section I. Contract Clauses
PART III
   Section J: List of Attachments
PART IV
   Section K: Representations and Instructions
   Section L: Instructions, Conditions & Notices to Offerors
   Section M: Evaluation Factors for Award
Attachments
   1. Past Performance Questionnaire and Contractor Performance Form
   2. Proposal Intent ResponseSheet

PART I—THE SCHEDULE

Request for Proposal No. AHRQ-2008-10036

SECTION A—SOLICITATION FORM

Date Issued: July 29, 2008
Date Questions Due: August 11, 2008
Date Notice of Intent Due: August 15, 2008

Date Proposals Due: August 29, 2008 12:00 PM EDT

You are invited to submit a proposal to the Agency for Healthcare Research and Quality (AHRQ) for Request for Proposal (RFP) No. AHRQ-08-10036, entitled "Incorporating Health Information Technology Into Workflow Redesign". Your proposal must be developed and submitted in accordance with the requirements and instructions of this RFP.

The Government anticipates awarding one (1) contract from this solicitation with the contract estimated to have a maximum budget of $500,000.  A firm fixed price contract is contemplated for a 12 month period of performance.  Please go to Section L.10 Technical Proposal Instructions for further information.  The North American Industry Classification System (NAICS) code that best describes the requirement is 541611. The small business size standard is $6.5 million (provided for information only, this procurement is advertised on a full and open competition basis).

Offerors shall submit the following:

A. Technical Proposal (Go to Section L.10) (Original, 10 copies, 1 electronic copy)

B. Past Performance Information (Go to Section L.11) (Original and 3 copies)

C. Business Proposal (Go to Section L.13) (Original and 3 copies, 1 electronic copy)

Your technical proposal must be concisely written and should be limited to 50 typewritten pages (double-spaced, single sided), exclusive of cover page, table of contents, bibliography, personnel qualifications (i.e., resume, etc., see Section L.10 for additional details).  Your appendices are limited to 50 pages (single sided) including all resumes, bibliographies, exhibits and attachments.  This limitation is for administrative purposes only and exceeding the limitation shall not, of itself, be considered a basis for rejection of your proposal.

Your proposal must provide the full name of your organization, the address, including county, Tax Identification Number (TIN), DUN and Bradstreet No., and if different, the address to which payment should be mailed. 

YOUR ATTENTION IS CALLED TO THE LATE PROPOSAL PROVISIONS PROVIDED IN SECTION L.3 OF THIS RFP.  YOUR ATTENTION IS ALSO DIRECTED TO THE TECHNICAL PROPOSAL INSTRUCTIONS PROVIDED IN SECTION L.10 OF THE SOLICITATION.

If you intend to submit a proposal in response to this solicitation, please inform the Contract Specialist of your intent by completing the Proposal Intent Response Form (attached) and submit the form no later than August 15, 2008.  Please fax it to 301-427-1740, Attention: Linda Simpson, Contract Specialist, or E-mail to: Linda.Simpson@ahrq.hhs.gov.

Questions regarding this solicitation shall be received in this office no later than August 11, 2008. (Go to Section L.7).   All questions shall be submitted electronically by E-mail to the Contract Specialist, at the following E-mail address: Linda.Simpson@ahrq.hhs.gov.

The subject line should be marked "Proposal Questions RFP No. AHRQ-08-10036" 

Answers to questions will be provided in the form of an Amendment to this solicitation and will be posted on AHRQ's Web page: http://www.ahrq.gov/fund/contraix.htm and the Federal Business Opportunities Web page: www.fedbizopps.gov. It is your responsibility to monitor the Web sites where the RFP will be posted to learn about any amendments to the solicitation. 

Discussions with any other individual outside the Division of Contracts Management, may result in rejection of the potential offeror's proposal.

The proposal shall be signed by an authorized official to bind your organization and must be received in our Contracts Office no later than 12 noon, EST, on August 29, 2008.  Your proposal must be mailed to the following address:

Agency for Healthcare Research and Quality
Division of Contracts Management
540 Gaither Road, Room 4315
Rockville, Maryland  20850

Hand carried proposals may be dropped off at the above location.  However, please allow ample time as proposals cannot be accepted until they have gone through security.  We will not be held responsible for any delays that may be incurred getting your proposal through security. 

NOTE: The U.S. Postal Service's "Express Mail" does not deliver to our Rockville, Maryland address.  Packages delivered via this service will be held at a local post office for pick-up.  The Government will not be responsible for picking up any mail at a local post office.   If a proposal is not received at the place, date, and time specified herein, it will be considered a "late proposal."

The RFP does not commit the Government to pay any cost for the preparation and submission of a proposal.  It is also brought to your attention that the Contracting Officer is the only individual who can legally commit the Government to the expenditure of public funds in connection with the proposed acquisition.

In accordance with Federal Acquisition Circular (FAC) 2001-16, all contractors must be registered in the central contractor registration (CCR) database in order to conduct business with the government [Go to Section I—FAR clause 52.204-7 Central Contractor Registration (OCT 2003), Alternate 1 (Oct 2003)]. As stated in paragraph (h) of this clause, additional information can be obtained at http://www.ccr.gov or by calling 1-888-227-2423, or 269-961-5757. 

Requests for any information concerning this RFP should be referred to the Contract Specialist at Linda.Simpson@ahrq.hhs.gov.   Please note E-mail requests should state subject as RFP AHRQ-08-10036.

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SECTION B—SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 BRIEF DESCRIPTION OF SUPPLIES OR SERVICES

The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services (HHS)  will award a contract to develop a practical and easy to use toolkit on workflow analysis and redesign that can be used by both small and large practices as well as other ambulatory settings in the selection and implementation of health information technology (IT) to support practice design entitled "Incorporating Health IT into Workflow Redesign."

Go to Section C for a complete description

B.2 FIRM FIXED PRICE

1.  For this Firm Fixed Price contract, the Contractor may bill in accordance with the payment schedule set forth herein.

2.  Total funds currently available for the base period are: __________________.

3.  This contract is for period as set forth below:

The Government anticipates the period of performance shall begin on or about September 30, 2008 and run through September 29, 2010.*

*Actual Dates To Be Inserted At Award.

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SECTION C—DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

Statement of Work

Independently and not as an agent of the Government, the Contractor shall furnish all  the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government as needed to perform the Statement of Work below:

A. Overview

A contract is being solicited to address how redesign of clinician workflow can be supported by health IT.   Specifically this contract will develop a practical and easy to use toolkit on workflow analysis and redesign that can be used by both small and large practices as well as other ambulatory settings in the selection and implementation of health IT to support practice redesign.  This contract will leverage currently existing guides such as the work of the Centers for Medicare and Medicaid Services' Quality Improvement Organization (QIO) Program Doctor's Office Quality Information Technology (DOQ-IT), California Healthcare Foundation and the World Health Organization and enhance it with other work in the areas of workflow, task analysis, and health IT by AHRQ grantees, other researchers, and the National Resource Center for Health IT.

Independently and not as an agent of the Government, the Contractor and its subcontractors shall furnish all  the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the Government as needed to perform the specific requirements below.

  • Conduct a literature and environmental scan of current practice redesign efforts that use health IT as a tool, health IT impact on clinical workflow, and available workflow analysis and redesign methods and tools.
  • Draft a federal request for information (RFI) to be issued by AHRQ to obtain information regarding currently developed methods and tools or initiatives focusing on workflow analysis and redesign and how health IT can support workflow redesign .
  • Synthesize responses to RFI.
  • Develop a summary report that combines findings from the literature review, environmental scan, and RFI.
  • Develop a toolkit on workflow analysis and redesign that provides a description of available tools and methods and a decision framework on how to determine when health IT can be used as part of practice redesign.
  • User test the toolkit and modify as needed.
  • Disseminate the toolkit to professional societies and other relevant stakeholders.

The product of this contract will be a summary report synthesizing the information from the literature review, environmental scan, request for information (RFI) and a toolkit.  The final report will also identify gaps in the field and make recommendations regarding future AHRQ research in this area.

B. Objectives

The purpose of this contract is to develop a toolkit that teams can use to easily asses their practice's or setting's workflow to determine when and how health IT may be used in larger practice redesign efforts by:

  • Assessing existing research and evidence in the area of the impacts of health IT on workflow, its linkage to clinician adoption, and its links to the safety, quality, efficiency, and effectiveness of care delivery.
  • Identifying currently available resources for workflow assessment in healthcare as well as proven workflow analysis methods and instruments used in the field of human factors and ergonomics that could be applied in healthcare settings.
  • Synthesizing the information gained into a toolkit that summarizes commonly used methods for workflow assessment, explains the purpose of each method, describes how to implement them as well as resources needed to do so, explains the advantages and disadvantages of each approach, cites available resources for more in-depth information on each tool, and provides a decision guide for how and when health IT can be used in practice redesign efforts.

C. Tasks to be Performed

  1. Kick-Off Call

    Participate in a conference call with the Project Officer (PO) and other appropriate AHRQ staff to discuss the overall objectives and specific elements of work to be performed. Contact information for participants beyond those listed in this solicitation will be provided from the AHRQ PO to the contractor, who will schedule and host the call. The contractor will provide an electronic summary of the discussion to everyone who participated in the call.

  2. Develop Work Plan

    Submit a comprehensive work plan to the PO. The work plan shall include the following elements:

    • Key contact information.
    • Brief background on the topic.
    • Plan describing the proposed approach and methodology for conducting the literature review, environmental scan, drafting a Request for Information and synthesizing the results and delivering the Summary Report.
    • Plan to synthesize the information into a Summary Report and toolkit.
    • Also, the contractor shall deliver to the PO an electronic project plan including deliverables, tasks and schedule and provide updates for the completion of the project, using Microsoft Office Project (version 2003).  The electronic plan should include a work breakdown structure (WBS) with a minimum of 3 levels of detail with unique numbering, deliverables, milestones, and Gantt chart.  Also, the contractor shall deliver to the PO a hierarchical-type Project Organizational Chart and a Responsibility Assignment Matrix (RAM).  Document the proposed timeline using actual dates for the delivery schedule rather than days from effective date of contract (EDOC).

  3. First Required TEP Call

    In consultation with the Project Officer, identify a small number of individuals (6-8) including workflow redesign experts (e.g., human factors and industrial engineers, such as from the Human Factors and Ergonomics Society or Institute of Industrial Engineers Society for Health System members, or the TransforMED project), ambulatory clinical workflow experts (e.g. practice managers, clinicians, architects and relevant organizations such as IHI or MGMA), health IT experts (e.g. vendors, researchers, implementers), and other content and methods experts. These individuals will comprise a Technical Expert Panel (TEP) with which the contractor will consult, as appropriate, in conducting the literature review and environmental scan and developing and testing the toolkit. Submit the names, CV's, and completed disclosure of interest forms for proposed technical experts to the PO for approval. Once TEP members are approved, the contractor will arrange an initial TEP conference call to discuss approaches to the literature search and toolkit development. An electronic summary of the call shall be distributed to all participants.

  4. Revised Work Plan

    Following the initial TEP conference call, submit a comprehensive project and work plan highlighting any changes from the initial draft work plan regarding proposed literature search and review, environmental scan, toolkit development, etc.

  5. Compliance with the Paperwork Reduction Act

    User testing (as described under Task 15) may fall under the governance of the Paperwork Reduction Act, depending on the size and scope of the work. If this is the case, the contractor shall work with the AHRQ PO and the AHRQ OMB compliance officer (Doris C. Lefkowitz) to prepare a package for submission to the Office of Management and Budget (OMB). It will be the contractor's responsibility to prepare the package, including an estimation of the number of participants, discussion guide questions, and estimated burden.

    It is estimated this will require 4-5 full days of a Master level effort to prepare the package.  It will be the responsibility of the AHRQ PO to submit the package to the AHRQ OMB compliance officer and coordinate any follow-up discussion. If revisions are requested, the contractor shall provide these in a timely fashion.

  6. Bi-Monthly Conference Calls and Status Reports

    Participate in a bi-monthly conference call with the PO to summarize progress. Calls may be scheduled more or less frequently, as requested by the PO. Participation includes scheduling the call in advance and circulating an agenda at least two working days prior to the call. The PO may request that the agenda include attachments of working documents, such as reference lists, literature retrieval figures, draft summary tables, etc. Within one week after the call, submit an electronic summary of the call, which will serve as a status report. Submit via E-mail to the PO and the CO. This report must also document (even if not discussed during the call):

    • Progress during the prior period in completing tasks.
    • Any problems or major issues encountered, how they came to be and how they were addressed. Major issues include those that involve changes in scope of work, timeline, outcomes, inclusion/exclusion criteria, resources, or cost.
    • Any foreseeable problems and plans to eliminate or mitigate those problems.
    • Any expected change to the delivery schedule and budget, including rationale.
    • An updated Gantt chart using tracking Gantt feature.

  7. Literature Review and Environmental Scan

    The contractor shall conduct a literature review and environmental scan on:

    • Workflow issues encountered in the development, implementation, adoption and use of health IT and methodology currently being utilized in health IT for workflow assessment and redesign.
    • Applicable peer-reviewed and gray-literature research, tools and methods available for workflow analysis and redesign (in healthcare and other industries, where applicable).
    • Publicly available workflow design tools and methods applicable to ambulatory practice workflow analysis and redesign or related initiatives.

  8. Request for Information

    The contractor will draft a Request for Information (RFI) for AHRQ to disseminate asking for relevant parties to submit information regarding currently developed methods and tools or initiatives for ambulatory workflow analysis and redesign and how health IT can support workflow redesign.  The contractor shall synthesize all submissions to the RFI and use them in the toolkit development.

  9. Second Required TEP Call

    After reviewing the literature and learning what is available to address and inform toolkit development, convene another TEP conference call to discuss any further refinement of toolkit development. This is the second required TEP call, but additional calls are often useful and held at the discretion of the contractor or as requested by the PO.

  10. Peer Reviewers

    In addition to the experts identified for the TEP and to ensure opportunity to receive input from the range of clinical and professional interests in the topic, identify individuals who may serve as peer reviewers of the draft summary report, including appropriate Federal agencies. Submit the names and professional affiliations of these individuals to the PO. AHRQ also may provide names of individuals or organizations to be peer reviewers.

    The contractor shall send the report directly to reviewers as a hard copy (electronic copies should not be provided to peer reviewers, unless as requested by them). To be considered for the peer review task, the individuals must commit to reviewing the draft report and providing written comments within a very circumscribed time frame.

  11. Draft Summary Report for Peer Review

    Prepare the draft summary report and appendices. The draft summary report is expected to be complete and of the same quality as a final report so that the peer review process can function effectively. A draft Summary Report that is not complete and/or which does not follow AHRQ's format will be returned as incomplete. The Summary Report shall include:

    • An executive summary.
    • A background section on workflow issues encountered in the development, implementation, adoption and use of health IT, any studies that use health IT as part of practice redesign, and methodology currently being utilized in health IT for workflow assessment and redesign.
    • A summary of the literature review of applicable peer-reviewed and gray-literature research and methods available for workflow analysis and redesign (in healthcare and other industries, where applicable).
    • An assessment of the state of the field, as evaluated through the  literature review and environmental scan, in workflow redesign as part of ambulatory practice redesign and how health IT is being used for practice redesign.
    • A description of the methodology used in the literature review, environmental scan, and background report.
    • A description of the TEP and how it was used.
    • List of existing tools found through the literature review, environmental scan, and RFI with descriptive information.
    • Identification of gaps in knowledge.
    • An annotated list of references (both included and excluded in/from the report).

    The report is to be concise and written in sufficient detail and clarity for key health IT and workflow stakeholders to understand. Reports should follow AHRQ's current required format. Questions about any part of the AHRQ Style Guidelines should be directed to the Julius Patterson (301-427-1896 or julius.patterson@ahrq.hhs.gov).

    Submit the draft report for peer review to the PO and the Peer Reviewers as identified above.

  12. Reviewer Comments and Disposition of Comments

    Review and analyze peer reviewers' comments and revise the draft summary report as appropriate. Once all comments have been received for the draft report, the contractor should schedule a conference call with the PO to discuss the general tenor of the comments and review the plan for disposition of the comments, including how disparate comments will be handled. Document the process for reviewing and analyzing peer review comments, including a detailed description of the disposition of all comments. Submit one (1) complete copy of each reviewer's comments to the PO, and submit a report of the disposition of all comments to PO.

  13. Final Summary Report

    Submit the final summary report and appendices to the PO, along with a completed 2005 Style Guideline checklist. Follow the requirements of AHRQ's Style Guidelines in preparing the final report and appendices. Questions about any part of the AHRQ Style Guidelines should be directed to Julius Patterson (301-427-1896 or julius.patterson@ahrq.hhs.gov). 

    The report and appendices are to be submitted in hard copy and electronically for preparation of Web publication. This will occur via a secure Web site or on re-writable disks (Microsoft® Word® for the body of the report). Electronic files for charts, etc., prepared in another program (e.g., Excel®) must be submitted. Tables and charts must be unlinked from underlying  databases.

  14.   Develop Prototype Toolkit

    The contractor shall use findings from the literature review, environmental scan, and RFI to develop a practical and easy to use toolkit of available workflow analysis and redesign methods and tools that ambulatory care practitioners can use.  The purpose of the toolkit is to help ambulatory care providers to better define their practice problems and identify how and where health IT can help in practice workflow redesign.  The toolkit shall provide summaries of each of the analytic tools and methods that include:

    • Tool or method name.
    • Purpose of the method.
    • Advantages or disadvantages of the method.
    • Resources (time, personnel, materials) needed to use this tool.
    • Expected results.
    • Reference to other publicly available materials on the tool.

    The contractor shall look for tools to include that are available in the public domain.  If the contractor finds tools that are proprietary, the contractor will work to obtain permission to use them in the toolkit. The Toolkit is required to be in the public domain.  Tool copyright holders must make their tools freely available.

    The toolkit shall make use of relevant examples of how some of the tools were used in practice.  It will also include a decision guide or framework about when and how to adopt health IT to enhance workflow and shall include information about publicly available resources on each of the different types of health IT applications currently available.  Also refer to H.1 Release And Use And Copyright Of Data First Produced From Work Performed Under This Contract (See Section H - SPECIAL CONTRACT REQUIREMENTS).

  15. User Test

    The contractor will identify ambulatory care practitioners to participate in a users' group that will vet the prototype toolkit and provide feedback on whether they would use it, how they would use it, its usefulness and potential utility, and whether it is missing any areas.  Submit the names and professional affiliations of these individuals to the PO. AHRQ may provide names of individuals or organizations to user test.  The contractor will summarize all the users' comments and provide a summary to the PO.  The contractor and PO will discuss the users' feedback and agree on how to revise the toolkit and how to incorporate users' suggestions.

  16.   Dissemination Activities

    The contractor will develop and submit a dissemination plan for PO review.  The contractor will conduct dissemination activities, as agreed upon with the PO, to promote the toolkit and make it available to relevant stakeholders (e.g. Quality Improvement Organizations (QIOs), Medical Group Management Association (MGMA), professional medical societies).  The contractor will work with the PO to coordinate dissemination efforts with the Agency's Office of Communication and Knowledge Transfer (OCKT) and also disseminate the tool through the National Resource Center for Health IT.  The Project Officer will coordinate the activities between the Contractor and OCKT.

  17.   Final Toolkit

    Based on agreed upon feedback from the users and the PO the contractor will revise the toolkit.

  18.   Presentation Slides

    The Contractor will prepare and submit a PowerPoint presentation that can be used to summarize the report findings to stakeholders. The presentation should be 20-30 slides and suitable for non-technical audiences.   

D.  Section 508 Compliance

This language is applicable to Statements of Work (SOW) or Performance Work Statements (PWS) generated by the Department of Health and Human Services (HHS) that require a contractor or consultant to (1) produce content in any format that could be placed on a Department-owned or Department-funded Web site; or (2) write, create or produce any communications materials intended for public or internal use; to include reports, documents, charts, posters, presentations (such as Microsoft PowerPoint) or video material that could be placed on a Department-owned or Department-funded Web site.

Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d) requires Federal agencies to purchase electronic and information technologies (EIT) that meet specific accessibility standards. This law helps to ensure that Federal employees with disabilities have access to, and use of, the information and data they need to do their jobs. Furthermore, this law ensures that members of the public with disabilities have the ability to access government information and services.

There are three regulations addressing the requirements detailed in Section 508. The Section 508 technical and functional standards are codified at 36 CFR Part 1194 and may be accessed through the Access Board's Web site at http://www.access-board.gov. The second regulation issued to implement Section 508 is the Federal Acquisition Regulation (FAR). FAR Part 39.2 requires that agency acquisitions of Electronic and Information Technology (EIT) comply with the Access Board's standards. The entire FAR is found at Chapter 1 of the Code of Federal Register (CFR) Title 48, located at http://www.acquisition.gov. The FAR rule implementing Section 508 can be found at http://www.section508.gov. The third applicable regulation is the HHS Acquisition Regulation (HHSAR).

Regardless of format, all Web content or communications materials produced for publication on or delivery via HHS Web sites—including text, audio or video—must conform to applicable Section 508 standards to allow Federal employees and members of the public with disabilities to access information that is comparable to information provided to persons without disabilities. All contractors (including subcontractors1) or consultants responsible for preparing or posting content intended for use on an HHS-funded or HHS-managed Web site must comply with applicable Section 508 accessibility standards, and where applicable, those set forth in the referenced policy or standards documents below. Remediation of any materials that do not comply with the applicable provisions of 36 CFR Part 1194 as set forth in the SOW or PWS, shall be the responsibility of the contractor or consultant retained to produce the Web-suitable content or communications material.

1 Prime contractors may enter into subcontracts in the performance of a Federal contract, but the prime remains obligated to deliver what is called for under the contract.

References:

HHS Policy for Section 508 Electronic and Information Technology (E&IT) (January 2005): http://www.hhs.gov/od/Final_Section_508_Policy.html

HHS Section 508 Web site: http://508.hhs.gov/

HHS ASPA Web Communications Division Web site: http://www.hhs.gov/Web/policies/index.html

US General Services Administration (GSA) Section 508 Web site: http://www.section508.gov/index.cfm

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