The Department of Homeland Security, Immigration and Customs Enforcement, Office of Enforcement and Removal Operations, ICE Health Service Corps (IHSC) has a requirement for procurement of an electronic Health Record System.

The Department of Homeland Security (DHS) Immigration and Customs Enforcement (ICE) Office of Enforcement and Removal Operations (ERO) enforces the nation’s immigration laws. ERO identifies and apprehends removable aliens, detains those individuals when necessary and removes aliens from the United States. In fulfilling this mission, ERO is concerned with the wellbeing of the thousands of Undocumented aliens who are processed through its detention facilities each year.

ICE Health Service Corps (IHSC) serves as the health authority for ICE/ERO on all matters related to alien health care. ICE/ERO/IHSC healthcare includes several distinct activities and services required by DHS to support the enforcement of immigration law and maintain national security. In fiscal year 2024, IHSC administered and managed a health care system that provided direct care to more than 131,000 aliens housed at 18 IHSC-staffed facilities across the nation. The health care provided by U.S Public Health Service officers, General Schedule Civil Servants, and contracted medical professional includes medical, dental, mental health care, as well as public health and disease prevention programs. In fiscal year 2023, IHSC also oversaw compliance with ICE detention standards related to health care for more than 191,500 detained aliens housed in 128 non-IHSC-staffed facilities, totaling more than 41,500 beds.

IHSC utilizes an electronic health record (EHR) to increase operational efficiency, enhance reporting capabilities, and improve the quality of alien health care. The ICE Office of the Chief Information Officer (OCIO) leads the program management and execution for the IHSC information technology (IT) suite of products. The current EHR suite of products is comprised of eClinicalWorks (eCW), Fusion Health KALOS CIPS™ Correctional Institution Pharmacy Software, Fusion Health sMARt Medication Administration Record Technology software, eCW Dental Software (for charting), ICE Radiology Software and Repository (for imaging) and Medical Payment Authorization Request (MedPAR2) software (approximately 800 users).

This PWS includes a request for an integrated, multi-module correctional EHR, pharmacy, medication administration record, dental, and referral management, utilization management, claims management, medical payment software also known as the EHR system. The vendor must assess if the proposed system will be able to provide a holistic integrated solution encompassing all the functionality of the current EHR subsystems. If it is assessed that the proposed system will not be able to provide the functionality of any of the current individual EHR subsystems, the vendor’s EHR must interface with those current and future versions of the individual subsystems to maintain the desired functionality. The vendor’s proposed solution will be certified by the Office of the National Coordinator for Health Information Technology (ONC-HIT). If it is not ONC-HIT certified, the vendor shall obtain certification within one year of implementation.

To acquire, customize, implement, and deploy an integrated, multi-modal correctional EHR that shall interface with required ICE component interfaces. The vendor’s proposed solution shall include the following EHR functionalities, support, and services below and those detailed in Section 3 of the PWS:

• Pharmacy capability that shall support pharmacists, providers, and pharmacy staff members to process prescriptions in-house and remotely for IHSC patients,
• Medication administration record,
• Dental capabilities, including radiology technology that shall support the scope of practice for dentists, dental hygienists, and dental assistants,
• Referral management/medical payment software, and
• Reporting capabilities.

If the vendor must develop or maintain custom software for IHSC then the vendor shall follow the ICE Agile Software Development framework. The vendor shall provide Tier II/III Software Support Services to provide the full range of software development, technical and project management services required to develop, implement, integrate, deploy, train IHSC, as well as support and sustain the correctional multi-module system.

Objective

• The objective of this effort includes acquisition, customization, implementation, integration, and deployment of an EHR system; the supplying of associated software licenses; conducting EHR end-user training, and perform the necessary Tier II/III support, and Operations and Maintenance support for the contractor’s proposed EHR solution to include pharmacy, medication administration record, dental, referral management utilization management, claims management/medical payment software, and reporting capabilities. The contractor’s system must support the correctional medical health care environment to meet the needs of IHSC and to ensure high quality health care for detained aliens. The contractor shall comply with IHSC, ICE, and DHS directives and policies as written, and national correctional accreditation directives and polices, where applicable to the EHR, to ensure it conforms to the appropriate standards and requirements.

Specific Product Description and tasks

• EHR Functionalities
  • The Contractor shall deliver an integrated multi-module correctional EHR, pharmacy, medication administration record, dental, referral management, utilization management, claims management, and medical payment software, enabled to interface with existing and future systems, and provides all mandatory functionality as identified in this PWS and attachments. If any IHSC mandatory functionality is not currently implemented in the EHR product(s), the Contractor shall modify their EHR product(s) or propose a solution to meet the mandatory requirement.
  • The Contractor shall deliver an EHR system which provides the desired functionality that is required in the EHR product(s) as identified in Attachments 1, 2, and 3 to this PWS; EHR Required Functionality. The contractor’s EHR software must have required functionalities to meet the needs of the unique environment of immigration detention. The following lists a brief synopsis of high-level functional requirements from IHSC for the EHR.
• EHR Customization and Integration of Multi-Module EHR
  • The contractor shall provide customization of the EHR software module to meet the functional and business requirements of IHSC’s correctional environment ensuring Performance Based National Detention Standards (PBNDS) are met prior to deployment of the software. When the contractor assesses the list of customizations requested by IHSC based off IHSC’s submitted RTM (see Attachments 1, 2, and 3) during the initial development, the contractor shall provide an estimated time when all specific items shall be deployed. Modifications requested by IHSC to meet the functional and business requirements, shall not be considered a customization due to the Contractor failing to meet the requested requirements.
• EHR Enterprise Software Licenses
  • The contractor shall provide all applicable software licenses, for approximately 1,600 users, 500 concurrent users, in accordance with all clauses, identifications and assertions, terms, and conditions related to commercial and non-commercial technical data, computer software, and computer software documentation to support the configuration, integration, custom development, test, software management, training, deployment, and end-user usage of the contractor’s EHR solution.
  • If identified in an applicable Task Order, the Government shall receive Unlimited Rights to intellectual property first produced and delivered in the performance of this contract IAW FAR 52.227-14, Rights in Data-General (DEC 2007). This includes all rights to source code and all documentation created in support thereof. For sake of clarity, this does not include minor modifications made to Contractor’s Commercial Computer Software.
• Interfaces and Data Sources Support
  • The Contractor shall support the ability of the integrated multi-module EHR system to connect and exchange data with all interfaces that feed into and out of the EHR components. The contractor shall provide ability to securely and reliably transmit health records and related data in near real time to the Office of Health Security (OHS) Medical Information eXchange (MIX) systems, using techniques and technologies acceptable to OHS, such as, for example, SFTP servers, RESTful APIs, HL7 vs messaging, and/or FHIR messaging.
  • The term “interface” also includes communication between EHR and other sources using web services. The Contractor shall provide on-going support, and provide enhancements as appropriate, for all interfaces that provide data to various EHR component and reports.
  • While eCW Dental is listed as a current dental module, the Contractor shall propose an alternative dental solution since eCW Dental will not be sustained.
• Applications Maintenance
  • The contractor shall provide application maintenance which includes the following:
    • Perform user account set-up and management.
    • Develop templates and enhance/modify workflows.
    • Produce and develop reports.
    • Plan and install product upgrades.
    • Maintain and develop application system documentation (including SELC documents), as necessary.
    • Manage application change request and problem resolution process.
    • Develop and maintain a configuration management process, while adhering to ICE configuration management policies and procedures
    • Provide end-user training, updates to end-user training material including, but not limited to end-user manual and job-aids and 508 compliant computer based trainings.
    • Perform quality assurance testing.
    • Perform application code testing.
    • Track performance and provide end-to-end application and transaction monitoring of IHSC applications.
• Software Tools
  • The Contractor shall use the Government-provided virtual environment including development workstations, development integration, testing and production. The Contractor shall support the Government in the stand-up of the environments including application specific software components, as well as application specific infrastructure implementations, such as load balancing. The Contractor shall be responsible for shake-out and validation of each environment.
  • The Contractor shall use the Government-provided Product Backlog Repository and defect management tool, currently JIRA, to track user story and task progress.
  • The Contractor shall use the Government-provided help desk ticketing system, currently ServiceNow, to track help desk tickets.
  • The Contractor shall use the Government-provided Source Code Version Management tool, currently GitHub, for version control of the code base.
  • The Contractor shall use the Government-provided Continuous Integration (CI) toolset, currently CloudBees, for automated builds and deployments to all environments.
  • The Contractor shall use a government approved industry standard unit testing library, currently JUnit, to execute all unit tests. The Contractor shall use the Government-provided code coverage toolset to report on unit testing code coverage. The unit testing and code coverage toolset is integrated with the CI toolset to provide reports on unit testing. The Contractor shall ensure that required integration points with the developed code base shall be supported in order to enable the reports in the CI toolset.
  • The Contractor shall use the Government-provided static code analysis tools, currently SonarQube, and integrate the execution of the analysis with the CI toolset for automated execution and reporting of results.
  • The Contractor shall perform code peer reviews and document the results via an electronic medium, such as a Confluence, JIRA, or using a Government-provided tool if available.
  • The Contractor shall develop automated test cases using an industry standard automated functional testing toolset, currently Selenium. An automated test case suite shall be maintained and executed on a regular basis, at least weekly. The automated testing toolset shall be integrated with the CI toolset to allow for automated scheduled execution and results reporting.
  • The Contractor shall support the full lifecycle of integration testing with interface partners, including test planning, test script creation, data staging, test execution, troubleshooting, and test result reporting.
  • The Contractor shall support performance testing of the application. The Government is responsible for performance test creation and execution. The Contractor shall work to resolve defects and/or performance issues that are identified during performance test execution.
  • The Contractor shall prepare an annual ranking of dependencies (libraries) that should be upgraded or replaced.
• Program Management and Technical Oversight
  • The Program Management and Technical Oversight task includes the oversight of the execution of requirements analysis, code development, testing, configuration, deployment, administration, monitoring, and maintenance of the EHR solution. The Contractor shall provide integrated program management support, including personnel management, program reporting and cost management, technical risk and issue management, and technical system documentation. The Contractor shall provide a release planning team that works closely with the Government program manager to ensure streamlined, effective, and productive communications and work products.  The Contractor shall ensure all contractor personnel and subcontractors adhere to the Department security policies, directives, and guidance. The Contractor shall provide deliverables identified in Section 11 of the PWS as well as deliverables as mandated by Section 2, 3, 6, 14, 15, 16 and Appendix B through J of this PWS.
  • The Contractor shall use Agile Scrum development methodology. The Contractor shall be primarily concerned with the implementation cycle, which in the case of Scrum includes sprint planning, application design, development and testing, deployment, sprint review, and sprint retrospective. The requirements for the EHR system are divided into user stories using an Agile system development methodology and the Scrum Framework.
  • The Contractor shall provide a scrum master that leads and manages multiple sprints and their associated releases. The scrum master shall provide management and oversight of the activities associated with sprint completion including:
    • Creating user stories
    • Developing automated test scripts
    • Creating architecture design documents
    • Writing software code components
    • Creating/updating/running manual and automated unit tests
    • Creating/updating/running manual and automated functional qualification tests
    • Creating/updating/running automated regression tests
    • Supporting performance testing
    • Conducting code review
    • Updating master installation documents
    • Delivering and deploying code with automated build and deployment capability
    • Managing databases and associated design documents
    • Monitoring integration tests
  • The user acceptance criteria are based on the user stories mutually agreed upon by the Product Owner, Government Project Managers, and the Scrum Team. In addition, the Contractor shall be responsible for delivering the system documentation artifacts that contain business and technical information. The Contractor shall provide frequent updates to the ICE issue and project tracking tool (technical tasks, blockers, dependencies, story points, issue tracking). The Contractor shall provide system documentation artifacts at each release unless a request for deviation has exempted them.
  • The Contractor shall follow the DevOps software engineering practice of Continuous Integration and Continuous Delivery (CI/CD) for all releases.
• Requirements Analysis and Code Development
  • The Contractor shall resolve existing bugs and system issues as determined by the Government. Using the information from the service desk tickets or other source issue documentation (e.g., JIRA), the Contractor shall review the business’ requirements and develop technical requirements/tasks accordingly. The Contractor shall document constraints and dependencies and determine the level of effort to complete development of the requirements using story points. The Contractor shall provide tools, graphics, and user interfaces that allow requirements analysis discussions with the business which demonstrate a clear understanding of business requirements and options for system implementation.
  • Testing
  • The Contractor shall support multiple levels of testing for the EHR systems. The Contractor shall write unit tests once user stories are finalized and before code is developed using JUnit or another Government approved product.
  • Functional testing shall include both unit testing and end-to-end system testing. The Contractor shall support user acceptance testing that shall be conducted by the Product Owner.
  • The Contractor shall lead integration testing, regression testing, and engineering testing, including the setup of production-like data sets in lower environments using data replication tools provided by ICE.
  • The Contractor shall develop and conduct automated regression testing using Katalon, Selenium, Playwright, or another Government approved product. The goal is to ensure that regression tests are no more than two releases behind each application’s current release.
  • The Contractor shall have an underlying familiarity with the business processes, understanding the impact and severity of defects and how they would impact operations and deployment decisions.
  • Implementation and Deployment of EHR Module and Ancillary Applications
  • The contractor shall implement and deploy the EHR system and supporting ancillary applications to all IHSC detention facilities and to all end-users outside of clinical facilities (Deliverable 18). This task includes all tasks required from current state of review, development, configuration, testing, training, change management, deployment, and transition to sustainment.
• Training
  • The Contractor shall employ training methodologies specific to the IHSC environment and workflows that shall meet the needs of end-users and medical facilities based on information obtained during deployment site visits. Training methodologies shall include: instructor-led classroom and over-the shoulder training (for go-live), and Computer Based Training (CBT). The Contractor shall utilize IHSC Quality Training Standards Checklist 508.
  • The vendor must provide comprehensive training materials, including training files and guides, in industry-standard formats used by IHSC, (currently SCORM 1.2). Additional formats may also include mp4, ppt, and ppsx (Deliverable 12). CBT training files must be compatible with IHSC’s Learning Management Systems (LMSs) (Deliverable 13). Training shall be conducted in accordance with IHSC Directive 01-04 Medical Education and Development.
  • The Contractor shall be responsible for providing training to the medical facilities’ trainers and end-users (functional, technical, and administrative). Training for clinical champions, super users, and local trainers shall begin at least 90 days prior to Go-Live. Instructor-led training (ILT) for end-users shall begin at least 60 days prior to Go-Live and conclude approximately one week prior to Go-Live to ensure optimal knowledge retention. The Contractor shall provide Over-the-Shoulder training to end-users for at least 14 days post Go-Live. “Train-the-trainer” (T3) training shall include clinical champions, super users, and local trainers. Site-specific training timeframes shall be specified by IHSC.
  • The Contractor shall:
    • Propose a training schedule for IHSC to review and approve.
    • Customize the national training playbook for site-specific requirements.
    • Provide EHR training to end-users including but not limited to the following personnel: functional, technical, administrative, and help desk staff.
    • Ensure EHR IHSC trainers and end-users obtain the skill sets necessary to utilize EHR and incorporate it into their daily workflows.
    • Validate adequacy of training facilities and resources to meet site training requirements (e.g., computers, printers, projectors, connectivity, etc.) and provide alternate training facilities and/or resources as required.
    • Update EHR Training Materials including but not limited to end-user manual and job aids, to reflect site-specific workflows in preparation for training support and change management.
    • Develop role-based training scenarios for training content aligned to the Business Process Workflows
    • Plan, develop and execute multi-platform training strategies including instructor-led classroom, CBT, and over-the-shoulder training to ensure preparation and facilitate adoption of EHR functionality.
    • Provide an optional certification training program to IHSC training staff (trainers/education) that shall enable the IHSC to train and certify IHSC trainers/end users in the EHR training content provided by the Contractor.
    • Provide enhanced training to super users and clinical champions.
    • Administer competency tests and conduct User Experience Satisfaction Surveys in accordance with the Training Materials. Report the percentage of users who have passed the competency test and summary of User Experience Satisfaction Surveys in the Monthly Status Report (Deliverable 8).
  • At the request of IHSC leadership, update the site training schedule to accommodate Government approved changes.
  • Ensure that all training materials are accessible and available to staff prior to training sessions and whenever changes to the EHR system occur.
• Roles and Access Management
  • IHSC provides a variety of medical services to the alien population. These services are reflected through the use of an EHR. Below are the roles and responsibilities of the IHSC health providers who shall be using the EHR. The vendor’s EHR must have different levels of roles and functionality for the different health care providers who shall be using the system.
  • ICE “provider” users must be able to e-prescribe and issue medications for the patient using the EHR. “Provider” roles include Doctor of Medicine or Osteopathy (MD, DO), Physician Assistant (PA), Nurse Practitioner (NP), Psychiatrist (PS), and Dentist (DDS, DMD), Clinical Pharmacists (PharmD). Registered Nurse (RN).
  • ICE “non-prescribing providers” are “Mid-level” roles include Psychologists, Social Workers, and Dieticians, Pharmacists.
  • ICE “non-provider” users must also be able to lock notes. These users include Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Dental Hygienist, Behavioral Health Technician (BHT), Medical Assistant (MA), Certified Nurse Assistant, Radiology Technician, and Dental Technician.
  • ICE “administrative” include Health Service Administrator, Pharmacy Technician, Medical Records Technician (MRT), Epidemiology, Registered Health Information Administrator, Health Informaticist, System Administrator / Analyst, and Management.
• EHR Tier Support
  • The vendor shall provide two-tiered priority system to log applications support service requests, to include interfacing applications, based off government defined performance standards (see Quality Assurance Surveillance Plan). The vendor shall provide technical support as identified by the government prioritized issues based off government approved guidelines. For critical and high defined issues, the contractor shall be available by telephone.
• Software and License Management
  • At the option of the government, the vendor shall manage EHR affiliated software and license subscriptions which may include Lexicomp, NIC & NOC, Lippincott, UpToDate, eFax, and MySQL Enterprise.