The Department of Veterans Affairs, Veterans Health Administration (VHA) has a requirement for National Enterprise Imaging Systems.

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• The VHA Enterprise Imaging (EI) initiative, currently in the market research phase, is evaluating current and future capabilities for solutions that provide secure acquisition, storage in a FedRAMP-certified cloud, retrieval, communication, viewing, reporting, documentation, importing/exporting/exchange, workflow management, referring clinician and patient access and review, image integration into VHA electronic health record (EHR), and other critical functionality for all VHA clinical domains using imaging. Clinical domains include, but are not limited to, the following areas: radiology (including nuclear medicine), speech pathology, cardiology/vascular imaging (invasive and noninvasive), endoscopy, scope and other light-based imaging, medical photography, anatomic pathology and cytology, dental imaging, eye/ophthalmologic imaging, radiation oncologic imaging and treatment planning data, wound imaging, procedural imaging, and point of care ultrasound (POCUS).
• Estimated annual volume of VHA imaging may exceed 30 million exams when all imaging specialties are included.
• Important features of interest for VHA EI will include, but are not limited to, integration with current and future VHA EHR, universal availability of images and reports on all VA desktops, specialty-specific diagnostic viewers and clinical tools or compatibility with third party specialty-specific diagnostic viewers, specialty-specific integrated artificial intelligence (AI) functionality, integrated voice recognition, reporting, communication, quality improvement, quality assurance, and data mining capabilities for use in all clinical domains, interfaces for all image acquisition modalities/devices as well as workflow capabilities in each clinical domain, ability to manage and archive DICOM and non-DICOM images, bidirectional exchange of images with DOD and community (non-VHA) partners, and viewing capabilities for ordering/referring providers and patients.  Multimedia integration of image data for use in VHA’s EHR is also preferred.
• VHA is currently surveying industry to identify potential vendors who would be capable of providing VHA with a best in breed, next generation enterprise imaging archive and supporting infrastructure that incorporates at a minimum the following preliminary features:
  • Hybrid cloud-based vendor neutral archive with local image cache at VHA facilities, if required, for optimal display, redundancy, and contingency operations;
  • Rapid, on-demand access to images across the enterprise.
  • Master patient index (MPI) to address VA’s conversion from VistA to Cerner EMR and the change in primary identifier from SSN to EDIPI.  System must be able to seamlessly function with both VistA and Cerner or other potential EMR interfaces and be able to utilize the appropriate primary patient identifier for each respective system to uniquely identify patients and ensure a patient’s data appears as a singular instance within the enterprise imaging archive.
  • Migration of all studies currently in Vista Imaging, Cerner CAMM 7, and other VHA clinical image repositories, including non DICOM imaging and scanned documents to the Enterprise Imaging system. This is approximately 100 petabytes comprising >17 billion individual images. Some studies may need to be migrated from the systems of origin.
  • Zero footprint web viewer compatible with VA baseline PC image and associated browser.
  • Advanced Artificial Intelligence (AI) support including third-party vendor integration/support across all listed imaging specialties. Response should not be limited to imaging. VHA is interested in how AI can be applied to provider workflow management, EI system study routing, work prioritization, patient safety and demographic information verification, system administration, and research.
  • System must be expandable to diagnostic review, interpretation and reporting of multi-specialty imaging.
  • Parties answering this RFI should note VHA considers all listed imaging specialties equally important to the enterprise imaging system. Vendor responses should consider that some specialties may need to provide end-to-end workflows within their proposed system.
  • Innovative ways research data can be collected and accessed during the following image migration and presented to quality management and research personnel.
  • Research data must be archived in a secure anonymized silo within the EI system.