Digital Front Door Plus

Problem Statement. The Military Health System (MHS) is at an inflection point, reflecting risks and challenges that are both unique to military medicine, and reflect overall health care challenges in the United States (e.g., increased utilization of high-cost services; shortages of nurses, technicians, and physicians; rapid and costly changes in technology; access challenges for individuals living in remote and medically underserved communities). 

The MHS cannot sustain the readiness of the medical force in the present operating model. The accelerating shift in healthcare to digitalization, patient-centeredness and hyper-specialization requires the Defense Health Agency (DHA) to adapt or see a reduced readiness of the medical force, deteriorating retention of medical staff, and reductions in direct care capability and capacity that will be almost impossible to reverse. 

Priorities. A new model for delivering care and a technology-enabled framework for adapting and evolving is required. The new model and framework will center on several priorities that take advantage of available and emerging technologies and allow new technologies to be added within the military healthcare ecosystem. These priorities are:

●   Human centered. The MHS is woefully behind the patient-centered technology offerings of most large health plans and healthcare delivery systems. Tools are needed that allow its 9.5 million beneficiaries to better manage their own health and wellness requirements. The desired solution is a “digital front door” that successfully integrates with or replaces our current architecture, is data centric and platform agnostic, and is capable of rapid adaptation. The expectation is for beneficiaries to self-schedule with virtual, asynchronous, and in person visit options; use secure messaging; participate in patient intake; utilize satisfaction surveys; seek referrals; engage with live chats; find providers; and access patient education, medical records and lab results.

●   A Competitive Health Ecosystem. Technologies that military health workers have access to must match or exceed what civilian health workers enjoy today. A competitive Health Ecosystem removes administrative, cognitive, and repetitive burdens from the workforce. The initial focus is on the outpatient setting and begins with primary care and behavioral health. Proceeding from an outpatient to inpatient setting, the health ecosystem will adapt currently available solutions.

DHA will prioritize its investment strategy to deliver the capabilities the DoD needs today and in the near future; rapidly partnering with leaders in healthcare technology and services; incorporating TRICARE contractors and network providers in solutions; and better using commercial tools available now to improve both patient and provider experiences.  

Desired Capabilities. DHA seeks commercial, platform agnostic solutions to support a patient experience that is frictionless for its beneficiaries; ensure patient interactions and data are collected in the MHS Information Portal (MIP); enable enterprise-managed multipurpose mobile devices, provider applications, digital assistants, and wearables that serve as the foundation to grow future initiatives; anticipate advances in the health sciences (precision medicine, pharmacovigilance, bio-surveillance).

DHA is seeking to continue to expand its suite of tools based on private sector advancements that assist in the transformation of patient care. The focus will be organized across three lines of effort (LOEs).

●   (LOE) 1: Patient Experience – Changing the Care Model for Healthcare. DHA seeks a commercial solution(s) that enables the following priorities: frictionless access to care and services for beneficiaries; seamless integration with the existing Electronic Health Record; and complete interoperability with wearables and devices. 

A frictionless experience means that patients can securely access the full suite of health services with a single-sign-on, facilitated by machine learning and chatbots, that provides a longitudinal health record (medical history, medications, test results, reminders), connects patients to wellness and self-care packages, and/or assists patients in virtual, in-person or asynchronous visits within the Direct Care System or Private Sector Care. User interfaces are designed for mobile devices (phones, tablets, augmented/virtual reality), intuitive and require minimal customer support. 

Interoperability includes compatibility with enterprise or personally owned peripherals, wearables or medical devices.

Successful commercial solutions that focus on changing the care model will also offer access to recognized academic or thought leaders in healthcare systems, healthcare economics, health services research, wellbeing, public health and life sciences. Changing the value equations requires moving from a transactional, systems-based model to human centered model while maintaining quality and safety and retaining fiscal responsibility. The new model will place the business and mechanical aspects of healthcare in the background, while recentering on MHS patients as human beings and returning joy to the MHS workforce, reminding them why they entered healthcare in the first place.

●   LOE 2: Provider Supported Technology in the Health Ecosystem. This effort will remove administrative, cognitive, and repetitive burdens from the workforce. The Health Ecosystem includes provider applications such as digital assistants that use generative AI to recognize speech and assist with workflows.

Over time, the Health Ecosystem will include applications for scheduling, virtual nursing, preventing alert fatigue, chart search, telemetry, remote patient monitoring and hospital command centers.

●   LOE 3: Data Management Support - Foundation for Future Initiatives. This LOE is based on the intelligent and actionable use of data contained in the MHS Information Portal (MIP). The MIP consists of a logic layer (API Gateway, Data Exchange, File Transfer) that supports MOVEi, FHIR, JSON and HL7. The data layer (common data model, enterprise data, warehouse, structured data storage and enterprise data lake) support OMOP, SGL, S3 and Redshift. The MIP operates as the central integrated data broker and service provider for all healthcare operations. 

Commercial solutions build upon the MIP and will allow users at all levels of the MHS to access, manipulate, and present patient-specific and enterprise-wide health information for making policy, management, and resource allocation decisions. 

Background Information 

These LOEs may be executed by a single vendor bringing a comprehensive solution or by multiple vendors working in a teaming arrangement and demonstrating interoperability. 

Prototypes will be implemented through the DHA Accelerator, whose purpose is to identify, test and implement emerging solutions in ways that adapt our healthcare delivery model. The Accelerator operates across five MTFs serving a beneficiary population of approximately 260,000. The Accelerator will validate solutions at the five Military Treatments Facilities and prepare those solutions for enterprise-wide adoption. Minimally viable offerings from LOE 1 will be implemented at those five sites in six to twelve months from acceptance. 

Multiple agreement awards are anticipated, and a single company is not expected to provide a solution that covers all solution areas. Preference may be given to product mixes that include solutions with evidence of similar deployments. The DoD may facilitate teaming arrangements among submissions offering complimentary capabilities to achieve desired effect. Companies are also welcome to present their own teaming arrangements in their solution briefs. If technology solutions are proprietary, performing companies will be expected to establish business to business safeguards that permit information sharing amongst teaming members in pursuit of solutions. Academic research proposals are not desired. 

Successful prototypes will need network accreditation to ensure full functionality and deployment on DoD systems. Existing authority to operate (ATO) or certification as a system of record are a plus. Vendors must possess or be able to obtain necessary accreditations to deploy/operate their solutions in Defense Information Systems Agency (DISA) Impact Level 6 (IL6) environments.

*Note to offerors: It is anticipated human subjects research may be required in performance of any subsequent agreement(s). Therefore, offerors should be aware that compliance with 32 CFR 219, DoDI 3216.02 will be mandatory, as applicable.