May 14, 2019 VIA CERTIFIED MAIL Secretary Robert Wilkie U.S. Department of Veterans Affairs 810 Vermont Ave., NW Washington, DC 20420 Dear Secretary Wilkie, American Oversight writes to inform you that we have discovered evidence that federal records of the Department of Veterans Affairs (“VA”) appear to have been unlawfully removed from the VA’s custody in violation of the Federal Records Act, 44 U.S.C. §§ 3101 et seq., and to request that you take action to recover these records. Specifically, VA produced records in response to Freedom of Information Act (“FOIA”) requests submitted by American Oversight that show senior VA officials, including former Secretary David Shulkin, used personal electronic messaging accounts to communicate with private individuals—including associates of the president—regarding agency business and appear to have failed to follow proper procedures for transferring those records to agency custody. As described in greater detail below, the evidence contained in records VA has produced to American Oversight alone give you clear “reason to believe [records] have been unlawfully removed” from VA’s custody, and you are required to initiate action for the recovery of those federal records. 44 U.S.C. § 3106. Background In May and August of 2018, American Oversight submitted FOIA requests to VA seeking to shed light on whether associates of President Trump from his Mar-a-Lago club—including Isaac “Ike” Perlmutter, Marc Sherman, and Bruce Moskowitz—were improperly influencing VA policies while not formally holding any government positions.1 The records VA subsequently produced in response to these requests have revealed the powerful influence the president’s Mar-a-Lago associates have exercised over VA by consistently communicating directly with senior officials 1 See Arthur Allen, ‘Who the Hell Is This Person?’ Trump Mar-a-Lago Pal Stymies VA Project, POLITICO (Apr. 30, 2018, 5:01 AM), https://www.politico.com/story/2018/04/30/trump-doctorhealth-technology-508297; Isaac Arnsdorf, The Shadow Rulers of the VA, PROPUBLICA (Aug. 7, 2018, 6:29 PM), https://www.propublica.org/article/ike-perlmutter-bruce-moskowitz-marcsherman-shadow-rulers-of-the-va; FOIA to VA Seeking Communications with Outside Influences at the Agency, American Oversight, May 4, 2018, https://www.americanoversight.org/document/ foia-to-va-seeking-communications-with-outside-influences-at-the-agency. 1 regarding important policy matters.2 This influence has been a matter of great concern to the public and congressional committees.3 In part, public concerns have arisen because these individuals (none of whom are officially employed by VA) are not subject to the ethics requirements, hiring standards, or public scrutiny that government officials face—including the transparency that results from being subject to the Freedom of Information Act. These concerns of improper influence are compounded by the prospect that the full sway these private individuals have had over the nation’s veterans’ policy may be hidden from the public’s view as a result of VA officials’ impermissible use of personal email accounts to conduct agency business. Such problematic record-keeping practices could prevent the public and Congress from gaining transparency into VA communications with these individuals or understanding the scope of their influence on VA policy. Unfortunately, documents produced by the VA to American Oversight indicate that senior VA officials, including former Secretary Shulkin, likely communicated with private individuals about agency business on private channels. The records produced by the VA show that former Secretary Shulkin received multiple emails to his personal Gmail account from the president’s Mar-a-Lago associates regarding official government business, including policies related to the provision of healthcare to our nation’s veterans, 4 and the records also suggest other officials may also have used personal electronic messaging accounts to communicate with these individuals. See Exhibits A & B. Moreover, there is ample reason to believe that these few documents do not capture the full extent of the emails between the Mar-aLago associates and high-ranking VA officials. See Arnsdorf, supra note 1; VA Records Regarding Concerned Veterans of America and the President’s Mar-a-Lago Associates, AMERICAN OVERSIGHT (Feb. 25, 2019), 2 https://www.americanoversight.org/document/va-records-regarding-concerned-veterans-of-america. 3 Arthur Allen, Takano Opens Probe Into Mar-a-Lago Influence at VA, POLITICO (Feb. 8, 2019, 12:22 PM), https://www.politico.com/story/2019/02/08/mar-a-lago-veterans-takano-1159355; Press Release, Chairman Takano: VA’s Failure to Meet Deadline, Provide Documents in Mar-A-Lago Investigation Demonstrates “Lack of Good Faith Effort,” Feb. 26, 2019, https://veterans.house.gov/news/press-releases/chairman-takano-va-s-failure-meet-deadline-providedocuments-mar-lago; Letter from Rep. Elijah Cummings, then-Ranking Member of the House of Representatives Committee on Oversight and Government Reform, to Robert Wilkie, Secretary of the Department of Veterans Affairs, Aug. 14, 2018, https://oversight.house.gov/sites/democrats. oversight.house.gov/files/documents/2018-08-14.EEC%20to%20Wilkie-VA%20re%20improper %20influence%20doc%20and%20briefing%20request.pdf; Arnsdorf, supra note 1; Anne Harkavy & Will Fischer, Are Mar-a-Lago Cronies Running VA? Secretary Wilkie Owes Answers to Veterans, Voters, USA TODAY (Dec. 19, 2018, 8:15 AM), https://www.usatoday.com/story/opinion/2018/12/19/veterans-affairs-secretary-wilkie-owes-answerssecret-mar-lago-council-column/2350956002/. 4 The relevant FOIA requests form the basis of the ongoing matter American Oversight v. U.S. Dep’t of Veterans Affairs et al., Case No. 18-cv-2463 (KBJ) (D.D.C. filed Oct. 25, 2018). 2 Secretary Shulkin’s Use of Personal Email to Communicate with Associates of the President The email records American Oversight has received from VA show that former Secretary Shulkin appears to have shared his personal Gmail account email address with the president’s associates— including, at least, Mr. Moskowitz and Mr. Perlmutter—as Shulkin received email communications regarding VA agency business through this personal email account. See Exhibit A. The use of nonofficial electronic messaging accounts for communicating about VA business violates VA’s current records management policy.5 As can be seen in the excerpt re-produced below, and in this and other messages attached in Exhibit A, Secretary Shulkin received email messages related to agency business to his Gmail account from both Mr. Moskowitz and Mr. Perlmutter. DEP’T OF VETERANS AFFAIRS, VA Directive 6300, Records and Information Management, Sept. 21, 2018, at 7, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8113 (“Non-official, electronic messaging accounts will not be used to conduct official VA business transactions.”). Although the current policy was not yet published at the time of the email messages contained in Exhibit A, VA has represented to American Oversight that its electronic messaging policy obviated the need to search former Secretary Shulkin’s personal email accounts. 5 3 VA policy and federal law further require that emails concerning official business on non-official accounts must copy the officer or employee’s official account or be forwarded to the officer or employee’s official account with 20 days.6 The records produced to American Oversight show that Secretary Shulkin apparently failed to follow this policy or comply with the requirements of 44 U.S.C. § 2911. VA has produced no records showing Mr. Shulkin forwarding the emails in Exhibit A, or any others from his personal account, to his official account. But such records would be responsive to American Oversight’s FOIA requests and presumably would have been located and produced if they existed. The emails VA has produced instead show that Mr. Shulkin appears to have, on occasion, merely incidentally forwarded some emails from the president’s Mar-a-Lago associates from his personal email account to a subordinate VA official in order to request that his subordinate act upon their requests. These forwarded emails also appear to demonstrate independent violations of federal law, as Secretary Shulkin created additional federal records using a non-official email account by sending messages directing his subordinate to take action from his personal Gmail account while failing to copy his official account or forward the messages to that account. 44 U.S.C. § 2911. Although these incidentally forwarded emails have been retained by VA and produced in response to FOIA requests, Secretary Shulkin’s failure to comply with VA policy and federal law by failing to copy his official account or forward messages to his official account strongly suggests that there are other messages that were not forwarded to a VA records system, as any message that did not require forwarding to a subordinate for action would not have been transferred to VA custody for retention or transparency through release under FOIA.7 The content of the messages, moreover, indicates that Secretary Shulkin almost certainly sent messages regarding agency business from his personal account to the Mar-a-Lago associates. In one message, below, Secretary Shulkin noted that he would “respond back” to Mr. Moskowitz’s email to his personal account. See Exhibit A at 4. 6 Id. (“If a VA employee uses a non-official electronic messaging account, the employee must copy the message to his/her official electronic messaging account when the record is first transmitted, or must forward a complete copy of the record to their official electronic messaging account within 20 days”); 44 U.S.C. § 2911. 7 Secretary Shulkin’s failure to forward the messages to his official email account also creates a substantial recordkeeping problem even for those messages that, by happenstance, were forwarded to another VA employee’s official account, because those messages would be unlikely to be found if Congress or a FOIA requester were to seek records specifically involving Mr. Shulkin, as the messages would not be located in his official email account. 4 This evidence strongly suggests that former Secretary Shulkin has personal email account messages regarding agency business with Mr. Moskowitz and Mr. Perlmutter—and perhaps other individuals—that have not been transferred to the custody of VA to be retained as federal records in compliance with VA policy and the Federal Records Act. American Oversight raised these concerns with VA’s counsel in the course of the matter American Oversight v. U.S. Dep’t of Veterans Affairs et al., Case No. 18-cv-2463 (KBJ), and requested that VA take steps to search for responsive personal email messages. VA responded that its policy requiring that an officer copy or forward agency records on personal accounts to the officer’s official email account obviated the need to conduct a further search of for personal emails despite the evidence American Oversight cited demonstrating Secretary Shulkin’s failure to follow this policy.8 American Oversight urges you to initiate action—including, if necessary, through the Attorney General—in accord with your obligations under the Federal Records Act, 44 U.S.C. § 3106(a), to recover and preserve all federal records within former Secretary Shulkin’s personal email accounts. Other VA Officials’ Use of Personal Accounts to Communicate with the President’s Associates Another record VA produced to American Oversight suggests that other VA officials subordinate to Secretary Shulkin, including former Chief of Staff and Acting Secretary Peter O’Rourke, may have also used personal electronic messaging accounts to communicate with the president’s Mar-aLago associates regarding official VA business. In an email VA produced to American Oversight, attached as Exhibit B and partially re-produced below, then-Chief of Staff O’Rourke provided Mr. Perlmutter, Mr. Sherman, and Mr. Moskowitz with his “Personal email” address and his “Personal cell” number. After American Oversight raised this issue repeatedly, VA’s counsel represented that VA would send a letter to former Secretary Shulkin to gain “clarity” on this matter. 8 5 Mr. O’Rourke’s provision of this information alone plainly gives reason to believe that he also likely used personal accounts to communicate with these individuals about VA business, and the additional content of his email gives even greater reason for concern. Mr. O’Rourke also noted that “as instructed by the Secretary” he would not “discuss the content” of his conversations with the president’s associates with certain unnamed individuals. Exhibit B. Mr. O’Rourke’s message shows that, at the direction of the Secretary, he was acting to keep the content of his official communications with the president’s associates confidential. It is reasonable to infer that Mr. O’Rourke’s provision of his personal email and cellphone number may have been motivated by his intent to conceal these communications—including from preservation under the Federal Records Act and public release under FOIA. There is plainly reason to believe that former Acting Secretary O’Rourke has improperly removed federal records from VA’s custody by using a personal email account and personal cell phone to conduct agency business, and you should also initiate action through the Attorney General to recover these records. Moreover, Mr. O’Rourke’s indication that his actions to conceal communications with the president’s associates may have been taken at the direction of former Secretary Shulkin strongly suggest that other VA employees may have communicated with these individuals using non-official accounts at the then-Secretary’s direction. VA should also undertake an investigation to determine whether any other subordinates of former Secretary Shulkin improperly conducted VA business through non-official electronic messaging accounts. American Oversight Urges VA to Take Required Action American Oversight requests that VA take the following steps within sixty (60) days: 1) Notify the Archivist of the United States of the evidence highlighted here, and any other evidence VA uncovers, giving reason to believe former Secretary Shulkin, former Acting Secretary O’Rourke, and any other officials have removed records of official communications with the president’s associates from VA’s custody; 2) Seek to recover all records reflecting official communications with the president’s Mara-Lago associates from former Secretary Shulkin and former Acting Secretary O’Rourke and ensure their preservation in compliance with the Federal Records Act; and 3) Refer former Secretary Shulkin and former Acting Secretary O’Rourke’s use of nonofficial electronic messaging accounts to communicate with the president’s Mar-a-Lago associates to the Attorney General for the purpose of initiating an enforcement action to recover all such records. We respectfully request that VA respond to this letter in writing within sixty (60) days to confirm that it has undertaken the steps above in compliance with its obligations under the Federal Records 6 Act. To the extent the Secretary fails to take these steps, we respectfully request that the Archivist request that the Attorney General initiate an enforcement action to recover the federal records described in this letter. Please direct your correspondence to foia@americanoversight.org or American Oversight, 1030 15th Street NW, B255, Washington, DC 20005. If you have any questions or seek additional information please contact Dan McGrath at (202) 897-4213. Sincerely, Austin R. Evers Executive Director American Oversight Cc: The Honorable David S. Ferriero Archivist of the United States National Archives and Records Administration 700 Pennsylvania Avenue, N.W. Washington, D.C. 20408 The Honorable Mark Takano Chairman Committee on Veterans’ Affairs U.S. House of Representatives B234 Longworth House Office Building Washington, DC 20515 The Honorable Elijah E. Cummings Chairman Committee on Oversight and Reform U.S. House of Representatives 2157 Rayburn House Office Building Washington, DC 20515 Michael J. Missal, Inspector General U.S. Department of Veterans Affairs VA Inspector General Hotline (53E) 810 Vermont Ave. NW Washington, DC 20420 Enclosures: 7 Exhibit A – Email Records of Former VA Secretary David Shulkin Exhibit B – Email Records of Former Chief of Staff and Acting Secretary Peter O’Rourke 8 EXHIBIT A From: To : Subject : Date: David Shulkin Blackburn ScottB [EXTERNAL] Fwd : Call with Secretary Shulkin Sunday, March 11, 2018 5:55:30 PM Can you join me at morning report in the am- 8 or 815 am to discuss next step s on thi s Note the emai ls below Sent from my iPhon e Begin forwarded message: From: Bruce Mo skowit z Date: March 11, 2018 at 12:57:53 PM EDT To: Ste hani e Re el ~h u.edu> , ,.... (b-)(-6)-....._ (b)(6) facs .org" b 6 fa.cs.or >, sutterhea lth.or , 1(b)(6)@ (b)(6) ma o.ed u, "Karson, Andrew Scott, M. D. " 1(b)(6) [g")mgbbarvard.edu> Cc: David Shulkin 1.:.: (b~ )(,=.,6 ):....__~ ~ .......=~·>, IP ®@ frencban~s9:com>, l(b)(6) l@gmail.com (b)(6) ,l(b)(6) ~~p.com Subject: Call with Secre ary The Secretary w ill send out an emai l to set up a conference ca ll to discu ss the review of the EMR contra ct for the VA. This has tremendou s importan ce not ju st for the VA, but setting a standard for interop erability for the nation and also EMR innovation. I want to take the opportunity to thank everyone for their service to the Veteran s and advancing health care for the nation Sent from my iPhone VA-18-0298-C, VA-18-0299-C-000004 4 of 220 From : David Shulkin To : BlackburnScottB Subject : Date: [EXTERNAL] Fwd : Contact review Monday, March 12, 20 18 4: 19:03 PM Can we get them the nda as well? Sent from my iPhone Begin forwarded message: From: IP ~ @frenchangel59.com> Date: Mar~12 , 2018 at 2:50 :52 PM EDT To: David Shulkin 1(b)(6) @gmai).~ Cc: (b)(S) · " i (b)(6 ) mail.c m" 1(b)(6) b 6 mac .com> Subject : RE: Contact review (b)(6) _~...J!lailcom>, @gma il.com>, Bruce Mo skowitz David, How quick can you send the NDA to the people ? And why not send it to Bruce, Marc and myself so we can work around the clock to fini sh this? Thank you. l@mac.com] om> o-mail.com; mail.com Subject: Re: Cont act review The follo wing may be discussed on the review however if not, we need to be sure there is a platform for the plann ed device registry. Separately there needs to be the ability to insert a mental health tracker, nutriti onal tracker and wellness tracker. We do not want to find out there is add on charges for these essential elements of the EMR. It also needs to be worked out how mental health records, treatments and appointm ents do not fall through the cracks during this lengthy implementation . The head of Columbi a Psychiatry will Dr. Lieberman can assist with this aspect. Thank you. Sent from my iPad Bruce Moskowit z M.D. VA-18-0298-C, VA-18-0299-C-000005 5 of 220 From : David Shulkin To : BlackburnScottB Subject : Date: Tuesday, March 06, 2018 7: 10 :27 AM [EXTERNA L] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forward ed message: From: Bruce Mo skowit z ~(b)(G) Date: March 5. 2018 at 6:49:58 AM EST =~ To:l(b)(G) @gmail.com1(b) (6l Cc:l(b)(6) ~~ail.com, IP lb )(@french l(b)(6) @gmail.c _m l@mac.com> ~~ ~ >, Subject : EMR I would like to underscore the importanc e of getting the "Cloud"conec tly and the other four issues with the new CIO ' s. Also the compos ition of the phy sician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and espec ially in mental health we need a portabl e EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple proj ect can and can not do in terms of solving this probl em. Sent from my iPad Bruce Moskowitz M.D . VA-18-0298-C, VA-18-0299-C-000006 6 of 220 EXHIBIT From: COS-PMO O'Rourke, Peter M. wrote: Pete, You beat me to it-- just sat down to email all to you... It was truly a pleasure and honor to meet you yesterday. Please feel free to contact any of us at anytime.... I thought it was an extremely productive meeting yesterday and look forward to achieving the goals discussed. Warm regards.....(b) (6) On Wed, Feb 28, 2018 at 6:58 AM, COS-PMO wrote: (b) (6) I didn’t type your email right the first time, please see the original email below. Thank you, Pete Sent with Good (www.good.com) VA-18-0298-A-000208 ________________________________ From: COS-PMO Sent: Wednesday, February 28, 2018 3:37:19 AM To: (b) (6) ; ip; mbsherman; brucemoskowitzmd Subject: Contact information All, It was an honor to meet you all yesterday. I want to ensure that you have my VA and personal contact information. VA cell: 202-823-(b) (6) Personal cell: 202-997-(b) (6) Direct VA email: CoS-PMO@va.gov Personal email: (b) (6) I will protect our conversations from yesterday and as instructed by the Secretary last night, not discuss the content with any of the individuals what were mentioned. Thank you for your support of the President, the VA, and me as we work to make the VA great. Pete Sent with Good (www.good.com) VA-18-0298-A-000209 VAi U.S.Department of Veterans Affairs Daniel McGrath American Oversight 1030 5th Street , NW Suite 8255 Washington , DC 20005 AUG 23 2019 Re: Freedom of Information Act Tracking Number 18-07440-F Dear Mr. McGrath , This is the final response to your Freedom of Information Act (FOIA) request to the Department of Veterans Affairs (VA) dated May 8, 2018, in which you requested all records reflecting communications (including emails, email attachments , text messages , messages on messaging platforms (such as Slack, GChat or Google Hangouts , Lyne, Skype , or WhatsApp) , telephone call logs, calendar entries/invitations , meeting notices, meeting agendas , informat ional material , draft legislation , talking points, any handwritten or electronic notes taken during any oral communications, summaries of any oral communications , or other materials) between 1) the Office of the Secretary, the Office of the Assistant Secretary for Information and Technology and the Chief Information Officer, or the Electronic Health Records Modernization (EHRM) Program Executive Office and 2) Isaac "Ike" Perlmutter , Bruce Moskowitz, or Jared Kushner ". On May 8, 2018, you amended your request to read as follows: All records reflecting communications (including emails , email attachments, text messages , messages on messaging platforms (such as Slack , GChat or Google Hangouts, Lyne, Skype, or WhatsApp), telephone call logs, calendar entries/invitations, meeting notices, meeting agendas , informat ional material , draft legislation , talking points, any handwritten or electronic notes taken during any oral communications , summaries of any oral communications , or other materials) between 1) political appointees and Senior Executive Service (SES) employees within the Office of the Secretary , the Office of the Assistant Secretary for Information and Technology and the Chief Information Officer and, the Electronic Health Records Modernization (EHRM) Program Execut ive Office and 2) Isaac "Ike" Perlmutter , Bruce Moskowitz, or Jared Kushner . On May 17, 2018, you agreed to aggregate two of your requests as follows: All emails , text messages and messages on messaging platforms (such as Slack , GChat or Google Hangouts, Lyne, Skype, or WhatsApp) of political appointees3 and Senior Executive Service (SES) employees within 1) the Office of the Secretary, 2) the Office of the Assistant Secretary for Information and Technology and the Chief Information Officer and, 3) the Electronic Health Records Modernization (EHRM) Program Executive Office that contain any of the following terms: FOIA Request 18-07440-F McGrath Page 2 a. b. c. d. e. f. g. h. i. j. k. Moskowitz; Perlmutter; Ike; "Trump's friend"; "Trump's Doctor"; "POTUS friend"; "POTUS's friend"; "POTUS' friend"; "POTUS doctor''; "POTUS's doctor''; "POTUS' doctor''; I. "President's friend"; m. "friend of POTUS"; n. "friend of President"; or o. "friend of the President". o All records reflecting communications (including emails, email attachments, text messages, messages on messaging platforms (such as Slack, GChat or Google Hangouts, Lyne, Skype, or WhatsApp), telephone call logs, calendar entries/ invitations, meeting notices, meeting agendas, informational material, draft legislation, talking points, any handwritten or electronic notes taken during any oral communications, summaries of any oral communications, or other materials) between 1) political appointees and Senior Executive Service (SES) employees within the Office of the Secretary, the Office of the Assistant Secretary for Information and Technology and the Chief Information Officer and, the Electronic Health Records Modernization (EHRM) Program Executive Office and 2) Isaac "Ike" Perlmutter, Bruce Moskowitz, or Jared Kushner. Please provide all responsive records from May 15, 2017, to the date of the search. The FOIA Service received your request on May 7, 2018, and assigned it FOIA tracking number 18-07440-F. Please refer to this number when communicating with the VA about this request. On March 25, 2019, we released two hundred and twenty (220) pages that specifically addressed your request for information. On May 28, 2019, we released 5 pages of an amended interim response. On June 4, 2019, we released six hundred and seventy-nine (679) pages of responsive documents, On June 26, 2019, we released fourteen hundred and one (1401) pages of responsive documents. On July 19, 2019, we released one thousand and sixty-six (1066) pages of responsive documents. FOIA Request 18-07440-F (McGrath) Page 3 We are releasing eight hundred and seventy-one (871) pages of responsive documents on CD at no cost to you. "5 U.S.C. ? 552(b)(5) permits withholding of information under the deliberative process privilege , including pre-decisional documents , inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency , or information that could be withheld under civil discovery , attorney-client privilege , or attorney work product privileges. Here the information withheld consists of communications under the deliberative process and VA Office of General Counsel attorneys-client and work product privileges . Furthermore , some information consists of executive privileged White House communications and was withheld pursuant to White House Liaison review and guidance ." FOIA exemption 6 permits an Agency to withhold from disclosure personnel and medical fi les and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. The information withheld , such as names , email addresses , and phone numbers are of a type that the privacy interest of the individual(s) to whom this informat ion belongs outweighs any public interest in disclosure of this information. You have the right to appeal this partial response if you do not agree with this determination. You may appeal in writing to: Department of Veterans Affairs General Counsel (024) 81O Vermont Avenue Washington, DC 20420 You may also submit your appeal via facsimile to (202) 273-6388 or via email to ogcfoiaappeals@va .gov. If you do appeal this determination , you must specify which part of the determination you are appealing. Please include a copy of your request and my letter with your appeal, and clearly state why you disagree with this determination. If you mail your appeal , both the front of the envelope and the letter should be clearly marked "FOIA Appeal ". Please also include a daytime telephone number in case the Office of General Counsel needs additional information. As an alternative to submitting an appeal, you may contact the VA FOIA Public Liaison, which was created to offer mediation services to resolve disputes between FOIA requesters and the VA. Using the VA FOIA Public Liaison does not affect your right to appeal. You may contact the VA FOIA Public Liaison at: Department of Veterans Affairs VA FOIA Public Liaison (005R1C) 810 Vermont Ave ., NW Washington , DC 20420 Email: vacofoiaservice@va .gov Telephone: (877) 750-3642 Facsimile: (202) 632-7581 / FOIA Request 18-07440-F (McGrath) Page4 You also have the option, as an alternative to submitting an appeal, to contact the Office of Government Information Services (OGIS) whom was created to offer mediation services to resolve disputes between FOIA requesters and Federal agencies. Using OGIS does not affect your right to appeal. You may contact OGIS in any of the following manners: Office of Government Information Services National Archives & Records Administration 8601 Adelphi Road College Park, MD 20740-6001 Email: ogis@nara.gov Phone: (202) 741-5770 Toll-free: 1-877-684-6448 Facsimile: (202) 741-5769 This concludes the FOIA Service's response to your request. We appreciate your interest in the Department of Veterans Affairs. If you have any questions concerning this letter, you may contact Ms. Jacqueline Short of my staff at (202) 632-7426. Sincerely, '11/1~":JL ~/)(' Johnson Director, VACO FOIA Service Quality, Performance, and Risk (QPR) Office of Information and Technology (OIT) Enclosure Document ID: 0.7.1705.395185 Bruce Moskowitz From: ?(bl(6l @mac.com> To: Sandova l, Cami lo J . Cc: Bee: Subject: [EXTERNAL] How is patient-centric interoperability leading the revolutionary healthcare transformation? Date: Mon Apr 02 2018 06:34:55 EDT Attachments: https :/!www.beckershospitalreview.com/healthcare-informat ion-technology/how- is-patient-centricinteroperability-leading-the-revolutionary-healthcare-transformation.htm l Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000001 Page891 of2318 1 ofB? 1 Document ID: 0.7.1705.510037 From: Blackburn, Scott R. To: Myklegard, Drew Cc: Short, John (VACO) ; Zenooz , Ashwini ; Windom, John H. Bee: Subject: RE: [EXTERNAL ] RE: VA EHR Call Update Date: Tue Mar 20 2018 22:21 :00 EDT Attachments: I agree with you . If you think it is helpful , I'd be happy to connect you directly with Dr. Cooper so you guys can talk this through and make sure we didn't miss a point (or make sure he understands what we are doing) . I am afraid of the back-channel talk that happens with these guys . From: Myklegard , Drew Sent: Tuesday, March 20, 2018 10:19 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: VA EHR Call Update I don't get it. What is said below is where we are trying to go with standards. Our contract could site the spec ific standards (no argument here). But even if you did everything below there is still quite a bit of daylight between what he was saying on the phone (semantic interoperab ility, machine learning) and having the data appended to the EMR when the initiating institution passes the data using a standard. I don't see anything about how you make the sender adhere to standards, especially how you have Gerner "make " the other EHRs do it. Drew Myklegard (208) 841-1397 From: Blackburn, Scott R. VA-18-0298-B-000002 Page 1154 of 2318 of 871 2 Sent: Tuesday , March 20, 2018 7:34:36 PM To: Myklegard, Drew Subject: FW: [EXTERNAL] RE: VA EHR Call Update From: Cooper, Leslie T., M.D.l(bJ(6l @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM 6J (bJ(6J To? Blackburn Scott R ? (bJ( Short, John (VACO) cc: Windom, John H.; (bl Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficient ly serve patients, maximize safety and lower medical costs, medical records from the military, VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file. The date on the Outside Material file is the date of entry into the Cerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperabi lity at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from VA-18-0298-B-000003 Page 1155 of 2318 3 of 871 Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to AT L is delayed slightly, but schedu led to land at 7:05 pm . Leslie T. Cooper, Jr ., MD Chair, Enterprise Department of Cardiovascular Medic ine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 20 18 at 2:39 PM To:(bl(5l (bH6l "Cooper , Leslie T. , M.D." ._l (b_ J5(_i _ _. (bl(5l mayo .e u> (b_H5_i _________ ~ @va.gov>, "Short , Cc: "Windom, John H." l._ John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am think ing we cove r that issue from 7:30-8pm ET before others jo in at 8pm. Tha nk you again for the support . Scott I Fromj(bl(5l Sent: Monday, March 19, 20181:38 PM To : Cooper, Leslie T., M.D. (b_l(6_l ____ Cc: Blackburn , Scott R.; Windom, John H.;._! Subject: RE: [EXTERNAL] VA EHR Call Update ~ Dr. Cooper, thank yo u for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to partic ipate in as well as the 8PM EST with the group . Please let me know if you have any questions. Thanks, l(b)(6) VA-18-0298-B-000004 Page 1156 of 2318 4 of 871 From: Cooper, Leslie T., M.D.l(bl(5l ~mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To:~(bl(6l I 5 Cc: Blackburn , Scott R.; Windom, John H.;~l (b_l( _l ---~ Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High J Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie Froml(bl(6l l(bl(6l Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ."l(bl(5l Cc: "Blackburn. Scott R.", "Windom , John H." , l(bl(6l l~va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone . Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs VA-18-0298-B-000005 Page 1157 of 2318 5 of 871 Desk: 202-461-6288 ce11 l..... co_i<6_J ___ ____, VA-18-0298-B-000006 Page 1158 of 2318 6 of 871 Document ID: 0.7.1705.510033 From: Myklegard, Drew To: Blackburn, Scott R. Cc: Bee: RE: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 22:18:47 EDT Date: Attachments: I don't get it. What is said below is where we are trying to go with standards . Our contract could site the specific standards (no argument here). But even if you did everything below there is still quite a bit of daylight between what he was saying on the phone (semantic interoperability, machine learning) and having the data appended to the EMR when the initiating institution passes the data using a standard. I don't see anything about how you make the sender adhere to standards, especially how you have Gerner "make" the other EHRs do it. Drew Myklegard (208) 841-1397 From: Blackburn, Scott R. Sent: Tuesday , March 20 , 2018 7:34:36 PM To: Myklegard, Drew Subject: FW: [EXTERNAL] RE: VA EHR Call Update 5 From: Cooper, Leslie T. , M.DJ(bl( > kaJmayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To : Blackburn, Scott R.; (bl(6> (bJ(6l Cc: Windom, John H.;(b)(5) hort, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, VA-18-0298-B-000007 Page 1159 of 2318 7 of 871 I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis . We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda , March 19, 2018 at 2:39 PM 6l 6l 6l (b)( (bH To: (b)( 5l (bl< mayo .edu> 6 6l "Cooper , Leslie T., M.D." l j._ , "Short , VA-18-0298-B-000008 Page 1160 of 2318 8 of 871 John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support . Scott I From: l(bJ(6J Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R.; Windom , John H.; .... l(b_l(5_l ___ Subject: RE: [EXTERNAL] VA EHR Call Update __. Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions . Thanks, ~ From: Cooper, Leslie T. , M.D.l(bl(5l @mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To: ~(bl(5l J Cc: Blackburn , Scott R.; Windom, John H.;._l (b_l(5_l ___ ___, Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie VA-18-0298-B-000009 Page 1161 of2 318 f 90 871 From:l(bl(6l l(bl(6l Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D.'1(bl(6l Cc: "Blackbur: Scott R.","Windom,John H." , l(bl(5> @va .gov> Subject: [EXT RNAL] VA ERRCall Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 l..... Cell : (b_J(6_> ____ _, VA-18-0298-B-000010 Page 1162of231~0ofB? 1 Document ID: 0.7.1705.509988 From: Blackburn , Scott R. Cooper , Leslie T., M.D. To: l(bl(6l ~mayo .edu> Cc: Bee: RE: [EXTERNAL] RE: RE: RE: VA EHR Call Update Subject: Tue Mar 20 2018 20:23:02 EDT Date: Attachments: And thank you for your service . I didn 't realize you are a Navy Veteran . (I am an Army Veteran - don't hold it against me) . ~(b)(6) 6 ,..-r------' l@mayo.edu] From: Cooper, Leslie T. , M.D.~ ,........,.....-Sent: Tuesday , March 20 , 208 8:17 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] RE: RE: RE: VA EHR Call Update Glad to help! Leslie Sent from my iPhone On Mar 20, 2018, at 8:04 PM, Blackburn, Scott R. wrote : THANK YOU so much . That was extremely valuable . We appreciate your support and input. Scott 5 From: Cooper, Leslie T. , M.D.l(bH l @mayo.edu] Sent: Tuesday , March 20, 2018 5:24 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] RE: RE: VA EHR Call Update In air now. Will make 7:30 call. Boarding for JAX at 8:08. Will miss most of larger group discussion . Leslie Sent from my iPhone VA-18-0298-B-000011 Page 1165 of 231~ of 1 871 On Mar 20, 2018, at 4:13 PM, Blackburn, Scott R. wrote: Dr. Cooper - thank you so much . This is incredibly helpful. . Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 VA-18-0298-B-000012 Page 1166 of 231 ~ of 2 871 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects). This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From: ~l (b_J(B _J-----~ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. ~----~ 5 Cc: Blackburn , Scott R. ; Windom, John H.:l._ (b_ J(_l ___ Subject: RE: [EXTERNAL] VA EHR Call Update ____. Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. VA-18-0298-B-000013 Page 1167 of2 31~ f 30 871 Thanks, Liz @mayo.edu] From: Cooper, Leslie T. , M.D.l(bl(5l Sent: Saturday , March 17, 2018 9:36 PM To: l(b)(6J Cc: Blackburn , Scott R.; Windom, John H.; ._l (b_ H5_l ___ _. Subject: Re: [EXTERNA L] VA EHR Ca ll Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I ca ll in as soon as I land? Wednesday I could make a ca ll after 6:30 pm. Leslie l(bJ(6J From: l(bJ{6J Date: Saturday, March 17, 20 ,_...__,....._.__._ ......... ........,.. To: "Cooper, Leslie T., M.D ." (bl(5l mayo.edu> Cc: "Blackburn , Scott R." , "Windom, John H." , l(bl(6l ~va .gov> Subject: [EXTERNAL] VA EHR Ca ll Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tue sday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary VA-18-0298-B-000014 Page 1168 of 231 ~ of 4 871 Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell :._l (n_>B (_>___ _. VA-18-0298-B-000015 Page 1169of231~SofB? 1 Document ID: 0.7.1705.509983 From: Cooper , Leslie T., M.D. 5 l(bJ( J @mayo.edu> To: Blackburn , Scott R. Cc: Bee: Subject: Re: [EXTERNAL] RE: RE: RE: VA EHR Call Update Date: Tue Mar 20 2018 20 :17:08 EDT Attachments: Glad to help! Leslie Sent from my iPhone On Mar 20, 2018 , at 8:04 PM , Blackburn , Scott R. wrote : THANK YOU so much . That was extremely valuable . We appreciate your support and input. Scott 5 From : Cooper, Leslie T. , M.D. l(bJ( l @mayo.edu] Sent: Tue sday , March 20 , 2018 5:24 PM To : Blackburn , Scott R. Subject: Re: [EXTERNAL] RE: RE: VA EHR Call Update In air now . Will make 7:30 call. Boarding for JAX at 8:08 . W ill miss most of larger group discussion . Leslie Sent from my iPhone On Mar 20, 2018 , at 4 :13 PM , Blackburn , Scott R. wrote : Dr. Cooper - thank you so much. This is incred ibly helpful.. Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott VA-18-0298-B-000016 Page 1170of231~ f 60 871 Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis . We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects). This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. VA-18-0298-B-000017 Page 1171 of2 31~?ofB? 1 Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM 5 (b_ l<_ l _ _, (bl(6l "Cooper , Leslie T., M.D." ~.... mayo .edu> 5 l@va.gov>, "Short , c: indom, John H." , l(blCl John (VACO)" ._ _________ _. Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: j(bJ(6J Sent: Monday, March 19, 20181:38 PM To : Cooper , Leslie T. , M.D. ~-----~ 5 Cc: Blackburn , Scott R.; Windom, John H.;._l ____ Subject: Re: [EXTERNAL] VA EHR Call Update Importanc e: High ~ Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8 :48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From:l(bl(6l l(b)(6l Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper , Leslie T ., M.D."l(bl(5l Cc: "Blackburn. Scott R.", "Windom, John H." , l(bl(5l l@va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 5 Cell ~.... (b-l(_> ___ ___. VA-18-0298-B-000019 Page 1173o f2 31~ f 90 871 Document ID: 0.7.1705.509951 From: Blackburn, Scott R. To: Cooper, Leslie T., M.D. l Cc: Bee: Subject: RE: [EXTERNAL] RE: RE: VA EHR Call Update Date: Tue Mar 20 2018 20:04:14 EDT Attachments: THANK YOU so much . That was extremely valuable . We appreciate your support and input. Scott 5 From: Cooper, Leslie T. , M.D. i wrote : Dr. Cooper - thank you so much. This is incredibly helpful.. Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott l<5l @mayo.edu] From: Cooper, Leslie T. , M.0 J Date-;ondav March 19 <018 at 2?39 PM ! To t l~ J bl(6l "Cooper , Leslie T., M.D." ._l 5 Cc: "Windom, John H." , l.... , "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott 0 From: l(b)(6) n(b)(6) Sent: Monday, March 19, 2018 1:38 PM To: Cooper , Leslie T., M.D. l To : "Cooper, Leslie T., M.D." 1(0 l<6l Cc: "Blackburn, Scott R.", "Windom , John H." , l(0 l<5l ~va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) I l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell : l(o_ ....HG_J ___ ....., VA-18-0298-B-000023 Page 1178 of 231 ~ of 3 871 Document ID: 0.7.1705.390040 From: Bruce Moskowitz l(bJ(6l @mac.com> To: Sandova l, Cami lo J. Cc: Bee: Subject: Fwd: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 20:03:43 EDT Attachments: Sent from my iPad Bruce Moskowitz M.D. Begin forwarded message: From: "Blackburn, Scott R." Date: March 20, 2018 at 7:33 :11 PM EDT @mac.com> To: Bruce Moskowitz l(bl<5l Subject: FW: [EXTERNAL] RE: VA EHR Call Update l@mayo.edu] From: Cooper, Leslie T. , M.D. l(bl(6l Sent: Tuesday , March 20 2018 4:25 PM To: Blackburn, Scott R.? (bl(6l -,,...--------r-~Short, John (VACO) Cc: Windom, John H.; (bl<5 l Subject: Re: [EXTERNA L] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to effic ient ly serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system . VA-18-0298-B-000024 Page 1179 of 231 ~ of 4 871 In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperabil ity Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts . I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM 6l To:( b)(GJ (b)( "Cooper , Leslie T. , M.D."~l (bJ< , "Short , Cc: "Windom, John H." , i.... John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from VA-18-0298-B-000025 Page 1180 of 231 ~ of 5 871 7:3O-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: 0(bJ(6l !(bJ(6l II Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. (b_l(5_l ___ Cc: Blackburn , Scott R. ; Windom, John H.;._l Subject: RE: [EXTERNAL] VA EHR Call Update ____. Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions . Thanks, l(b)(6) 5 From: Cooper, Leslie T. , M.D.l(bH l @mayo.edu] Sent: Saturday, March 17, 2018 9 :36 PM To : l(b)(6J 5 Cc: Blackburn , Scott R. ; Windom , John H.;~l Cc: "Blackburn, Scott R.", "Windom , John H." , l(bl(5l l@va.gov> VA-18-0298-B-000026 Page 1181 of 231 ~ of 6 871 Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461 -6288 Cell :l._ (b_ )(5_l ___ _. VA-18-0298-B-000027 Page 1182 of 231 ~ of 7 871 Document ID: 0.7.1705.509949 Blackburn, Scott R. To: Myklegard, Drew Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 20:00:46 EDT Attachments: @mayo.edu] From: Cooper, Leslie T. , M.D.l(bl(5l Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn, Scott R.; (bl(6l (bJ(6l 6 Cc: Windom, John H.; (bl(l Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract VA-18-0298-B-000028 Page 1183 of 231 ~ of 8 871 and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these resu lts be linked to relevant parts of the internal VA records by date and medical discipline . For example, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organizat ion system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition, and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL? Fast Healthcare Interoperabil ity Resource standards and industry-led Argonaut and SMART projects). This recommendatio n has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair, Enterprise Departm ent of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday, March 19, 2018 at 2:39 PM 5l 5l l(bH To: l(blC 5l @mayo .edu> l, l Subject: [EXTERNAL] RE: VA EHR Call Update I"Cooper, 5l Leslie T., M.D." l(blC .____ __. @va.gov >, "Short , Thank you, Dr. Cooper. Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I 5l From: l(bH Sent: Monday, March 19, 20181:38 PM To: Cooper, Leslie T., M.D. 5 To: "Cooper, Leslie T ., M.D ." l(bl(6l Cc: "Blackburn , Scott R." , "Windom, John H." , l(bl(6l @va.gov > Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for eve ryone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! VA-18-0298-B-000030 Page 1185 of 231 ~ of 0 871 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l._ (b_ l(B _>___ _. VA-18-0298-B-000031 Page 1186 of 231 ~ of 1 871 Document ID: 0.7.1705.509936 Blackburn, Scott R. To: Myklegard, Drew Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 19:34:36 EDT Attachments: ~mayo.edu] From: Cooper, Leslie T. , M.0. l(b)(GJ Sent: Tuesday , March 20 , 2018 4:25 PM (bl(6l To: Blackburn, Scott R.; ,.,.,.,..,,,..--------,,,::--:---' Cc: Windom, John H.; (bl{6l Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the materia l you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to effic ient ly serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Mate rial" w ith no way to identify file content or correlate internal study results with similar outside studies. For examp le a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Mate rial" file. The date on the Outside Materia l file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable . The effort required of provide rs to open and read all pages of each file is infeas ible and therefo re tests are needlessly repeated at substantia l cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interope rability strategy be operat ional at the time of initial EMR implementat ion . The amended contract VA-18-0298-B-000032 Page 1187 of 231 ~ of 2 871 and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these resu lts be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organizat ion system used at Mayo Clinic called Synthesis . We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL? Fast Healthcare Interoperabil ity Resource standards and industry-led Argonaut and SMART projects) . This recommendatio n has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts . I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair , Enterprise Departm ent of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday , March 19, 2018 at 2:39 PM To: l(bl(6l l(b)(GJ l(bl(6l @mayo .edu > 5 Cc: "Windom , John H." P l( l John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update I"Cooper , Leslie T., M.D." l(bl( l 5 ~--~ @va.gov >, "Short , Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm . Thank you again for the support. Scott (b_J(G _l -----~ From: ~l Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. 5 (b_ l( _l ---~ Cc: Blackburn, Scott R.; Windom, John H.:l~ Subject: RE: [EXTERNAL] VA EHR Call Update VA-18-0298-B-000033 Page 1188 of 231 ~ of 3 871 Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks , l(b)(6) From: Cooper, Leslie T. , M.D.l(b)(GJ ~mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To :l(bJ(6J 5 Cc: Blackburn , Scott R.; Windom, John H.;....,l (b-l( _l ---~ Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tue sday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie I l(bJ(6l From: l(bJ(6l Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ." !(bl(5l Cc: "Blackburn , Scott R." , "Windom, John H." , !(bH6l @va.gov > Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for eve ryone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! VA-18-0298-B-000034 Page 1189 of 231 ~ of 4 871 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affa irs Desk: 202-461-6288 Celli... ____ _. VA-18-0298-B-000035 Page 1190 of 231 ~ of 5 871 Document ID: 0.7.1705.509933 Blackburn , Scott R. 6) @gmail.com> Marc Sherman l Date: Monday, March 19, 2018 at 2:39 PM I<0 l<5l To: l<0 l<5l 0 6 I Cc: "Windom, John H." ,l<0 J<5J John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update I"Cooper , Leslie T. , M.D." l , "Short , Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott n (b)(6) n From: n(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. <0_ l<5_l ___ Cc: Blackburn , Scott R.; Windom, John H : l._ Subject: RE: [EXTERNAL] VA EHR Call Update ___, VA-18-0298-B-000037 Page 1192 of 231 ~ of 7 871 Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, From: Cooper, Leslie T. , M.DJ(bl(5> Sent: Saturda , March 17, 2018 9:36 PM To: (bl(6l (b)(6l Cc: Blackburn , Scott R.; Windom, John H.;l,.... (b_ l(5 Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High _> @mayo.edu] ___ __. Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie l(bJ(6l From: l(b}(6J Date: Saturday , March 17, 2018 at 12:13 PM 6> @mayo.edu> To: "Cooper, Leslie T ., M.D." l(bH Cc: "Blackburn, Scott R.", "Windom, John H." , 5 l(bH > @va .gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time. If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! VA-18-0298-B-000038 Page 1193 of 231 ~ of 8 871 l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell:~l (b_)<6_l ---~ VA-18-0298-B-000039 Page 1194 of 231 ~ of 9 871 Document ID: 0.7.1705.509931 Blackburn, Scott R. To: DJS Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 19:33:35 EDT Attachments: 5 l @mayo.edu] From: Cooper, Leslie T. , M.D.l(bl< Sent: Tuesday , March 20 , 2018 4:25 PM 6l To: Blackburn, Scott R.; (bl< 6 Cc: Windom, John H.; (bl( l Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update ..-"------..-=-:-- Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers. For the new VA EMR to effic ient ly serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correla te internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material " file. The date on the Outside Material file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeas ible and therefore tests are needlessly repeated at substantia l cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and VA-18-0298-B-000040 Page 1195 of 231 ~ of 0 871 searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline. For example, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition, and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T . Cooper, Jr ., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM 6l To:(bl<6l (bl< "Cooper, Leslie T., M.D."~l l, "Short, c: "Windom, John H." ,..... John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you, Dr. Cooper. Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I I !(bJ(6l I From: H(bJ(6l Sent: Monday, March 19, 2018 1:38 PM To: Cooper, Leslie T., M.D. ...----,,------, 5 Cc: Blackburn, Scott R.; Windom, John H.; (b_ l<_l ___ Subject: RE: [EXTERNAL] VA EHR Call Update l..... ____. VA-18-0298-B-000041 Page 1196o f2 31~ 1 ofB? 1 Dr. Cooper , thank yo u for your respo nse. I have sent two outlook invites, one starti ng at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Tha nks, l(b)(6) From: Cooper, Leslie T., M.D .....,l (b_H5~l ~~~__ __,@mayo.edu] Sent: Saturda , March 17, 2018 9:36 PM To: (bJ(6J ~(b_J6 (_J -~ Cc: ac urn, cott .; indom, John H.;~l (b_J(5_i ____ ~ Subject: Re: [EXTERNA L] VA EHR Call Update Importance: High Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie l(bJ(6J From: l(bJ(6J Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D." l(bl(5l Cc: "Blackburn. Scott R.", "Windom , John H." , l Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble findi ng a time that works for eve ryone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Tha nks again ! VA-18-0298-B-000042 Page 1197 of 231 ~ of 2 871 (b)( 6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 Cell :l< .... b_J<6_J ___ __, VA-18-0298-B-000043 Page 1198 of 231 ~ of 3 871 Document ID: 0.7.1705.509920 Blackburn, Scott R. @mac .com> Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 19:33:11 EDT Attachments: 1> From: Cooper, Leslie T. , M.D. l(bl(5> @mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn, Scott R.; (bl(6> (bl(6l 6 Cc: Windom, John H.; (bl( l hort, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to effic ient ly serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correla te internal study results with similar outside studies. For examp le a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material " file. The date on the Outside Material file is the date of entry into the Gerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeas ible and therefore tests are needlessly repeated at substantia l cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and VA-18-0298-B-000044 Page 1199 of 231 ~ of 4 871 searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline. For example, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition, and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T . Cooper, Jr ., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday, March 19, 2018 at 2:39 PM To:l(bl<5l l(bl<6l "Cooper, Leslie T., M.DJ.... ~b -J(5_i __ _. ~ @mayo.edu> 5 Cc:"' Windom, John H." ,i-,"Short, John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update I Thank you, Dr. Cooper. Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From:l Cc: "Blackburn. Scott R.", "Windom , John H." , l(b)(Gl @va.gov> Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend ! Sorry for the extra emai l but we are having trouble findi ng a time that works for eve ryone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Tha nks again ! VA-18-0298-B-000046 Page 1201 of 23 1~ of 6 871 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 Cell : ._l (b_J(6_l ___ __, VA-18-0298-B-000047 Page 1202 of 231~ of 7 871 Document ID: 0.7.1705.475801 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandova l, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; l~ 6 /o=va/ou=visn 03/cn=recip ients/cn=vhaeastruexm>; Bruce (bl( l Moskowitz lJ(bl<6l @Bru ce Moskowitz .MD (bl(6l mail.com> ; Marc She rm an l; IP (bl{6l frenchangel59.com>; Foster, Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz, Ashw in i ; Short, John (VACO) ; t.,.,., iv""" e~~--. Myklegard, Drew ; ~--~ {bl{5l (bl(6l ; Cooper, Les lie @mayo .ed u> T., M .D.l(b)(6l Cc: Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:02:30 EDT Date: Attachments: StartTime: Tue Mar 20 18:30 :00 Central Daylight Time 2018 EndTime?] Tue Mar 20 19;00?00Ce r tral Dayl ight Time 2018 Location : (b)(GJ ~.,...--------~ Recurring: No ShowReminder: Yes Rem inderM inutes: 15 ReminderTime: Tue Mar 20 18:15:00 Central Daylight Time 20 18 Accepted: No Part 1. Jw Sent with Good (www.good.com) All times listed are in the following time zone:(UTC-05:00) Eastern Time (US & Canada) VA-18-0298-B-000048 Page 1203 of 231~ of 8 871 From: VA CIO Executive Schedule Sent: Monday, March 19, 2018 1:32:31 PM l'Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom , John H.;l(bl(5l Moskowitz'; !(bl(6l @Bruce Moskowitz .MD'; 'Marc Sherman' ; 'IP' ; Foster, Michele SES ; Nostrant , (b _l(5_l __ ...____ _, David K.; Draper , Anne; Zenooz , Ashw ini; Short , John (VACO); Myklegard , Drew ;,._ 'Cooper , Lesl ie T ., M.D.' Subject: VA EHR Call When: Tuesday , March 20, 2018 7:30 PM-8:00 PM . Where :!(b)(6l I All, Dr. Cooper will not be able to part icipate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper . Thanks .~ Scheduling POC: ._l (b_ l(5_ l __ ____,l 202-631-0640 _l! (b _l(5_l _______ ~ VA-18-0298-B-000049 Page 1204 of 231~ of 9 871 Document ID: 0.7.1705.390035 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandoval, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; l._ ; Bruce (bJ(Gl 6l l@mac.com> ;l(b)(GJ @Bruce Moskowitz l(bl< 6l Moskowitz ,MD ; Marc Sherman l(bJ(6l @gmail.com>; IP(bl{6l frenchangel59.com>; Foste r, Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz , Ashwini ; Short , John (VACO) ; Myklegard, Drew ; .__ (bl(6__ l ___, (bl(6l /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipient s/cn=vacocallae2 >; Cooper , Leslie l@mayo .edu > T., M .D.l(bl(6l Cc: Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:02 :30 EDT Date : Attachments: _ StartTime: Tue Mar 20 18:30 :00 Central Daylight Time 2018 EndTime : Tue Mar 20 19:00:00 Central Dayl ight Time 2018 Location :l(bl<6l Recurring: No ShowReminder : No Accepted : No I Part 1. Jw Sent with Good (www .good .com) All times listed are in the following time zone:(UTC-05:00) Eastern Time (US & Canada) VA-18-0298-B-000050 Page 1205 of 231~ of 0 871 From: VA CIO Executive Schedule Sent: Monday, March 19, 2018 1:32:31 PM l 'Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H_;l'bl(5> Moskowitz';!(bl(6> ~Bruce Moskowitz.MD'; 'Marc Sherman' ; 'IP' ; Foster, Michele SES ; Nostrant , (b_l(6_>__ ....L.!======='--' David K. ; Draper, Anne; Zenooz , Ashwini; Short , John (VACO); Myklegard, Drew; 1.. 'Cooper , Lesl ie T. , M.D.' Subject: VA EHR Call When: Tuesday, March 20, 2018 7:30 PM-8:00 PM . Where : l(bl(5l I All, Dr. Cooper will not be able to participate in the entire session so we are going to sta rt at 7:30PM to get feedback from Dr . Cooper . Thanks , Liz (b_l(6_>___ Scheduling POC: ._! __,1 202-631-0640 ... l(b-l(6_> ________ _. VA-18-0298-B-000051 Page 1206 of 231~ of 1 871 Document ID: 0.7.1705.390034 From: Windom, John H. on behalf of VACIO Executive Schedule To: Sandova l, Cami lo J. Cc: Bee: FW: VA EHR Call Subject: Tue Mar 20 2018 19:02:28 EDT Date: Attachments: Part 1. Jw Sent with Good (www.good.com) All times listed are in the following time zone:(U TC-05:00) Eastern Time (US & Canada) From: VA CIO Executive Schedule Sent: Monday , March 19, 2018 1:32:31 PM l'Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H.:l(bl(5> 5 Moskowitz'; l(bH > l@Bruce Moskowitz .MD'; 'Marc Sherman' ; 'IP'; Foster, Michele SES ; Nostrant , 6> (bH David K. ; Draper, Anne; Zenooz , Ashwini; Short , John (VACO); Myklegard, Drew; (bl(6> 'Cooper, Leslie T., M.D.' Subject: VA EHR Call When: Tuesda y, March 20, 2018 7:30 PM-8:00 PM. Where :l(bl(5> I All, Dr. Cooper will not be able to partici pate get feedback from Dr. Cooper . Thanks , 1(bl(6> 5 S~hedul ing POC:l~ (b_ H_ > --~I t the entire session so we are going to start at 7:30PM to 202-631-0640 =l (b=l(6=>=====...---~ VA-18-0298-B-000052 Page 1207 of 231~ of 2 871 Document ID: 0.7.1705.475785 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandova l, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; l(b)(GJ ; Bruce (b)(Gl l@mac .com>;l(bl<6l @Bru ce Moskowitz !(bl(6l @gmail.com> ; Marc She rm an Moskowitz ,MDl; IP ~fr enchange l59.co m>; Stephanie Reel {bJ(6J 'hu .edu> ; Mary Riordan (bl(6l 'hu.edu>; Ashley Johnson (bl<6l jhmi.edu>; (bl(6l ~------~ ; Rasu Shrestha (bl(6l gmai l.com>; Man is, Jonathan (Jon) (bJ(6l sutterhealth.org>; Shrestha, Rasu B (bl(6l upmc .edu>; Cooper, Leslie T. , M.D. (bl(6l mayo.edu >; Karson, Andrew Scott,M.D. (bl(6l Wmgh.harvard.edu >; Zuccala , Kandace (Kandi) R. . l@sutterhealth.org > Clifford Ko (b)(6J facs.org>; Mehwe sh Cc: Khalid (b)(6l facs.org >; Stan Huff l~ (b-l(6-l -~ t@imail.org> Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:01 :52 EDT Date: Attachments: l StartTime: Tue Mar 20 19:00 :00 Central Daylight Time 2018 EndTime: Tue Mar 20 20:30:00 Central Dayl ight Time 2018 Location : l(bl(6l I Recurring: No ShowReminder: Yes Rem inderM inutes: 15 ReminderTime: Tue Mar 20 18:45:00 Central Daylight Time 20 18 Accepted: No Here you go. Jw Sent with Good (www.good.com) All times listed are in the following time zone:(UTC-05:00) Eastern Time (US & Canada) VA-18-0298-B-000053 Page 1208 of 231~ of 3 871 From: VA CIO Executive Schedule Sent: Sunday , March 18, 2018 2:30:57 PM To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H.;l(bl(5l !Bruce Moskowitz ; (bl(6l Bruce Moskowitz.MD' ; Marc Sherman; IP; Stephanie Reel; Mary Riordan; Ashley (bJ(5l Rasu Shrestha ; Manis, Jonathan (Jon); Shrestha , Rasu B; Cooper , Johnson ; (bH5l Leslie T. , M.D. ; Karson , Andrew Scott ,M.D.; Zuccala, Kandace (Kandi) R. Cc: Clifford Ko; Mehwesh Khalid; Stan Huff Subject: VA EHR Call When : Tuesday March 20 2018 8:00 PM-9:30 PM. Where :l(bl(5l I 5 Schedul ing POC: ~' (b-l( _l --~I 202-631-0640 and L!:ll (b =J(=6l=======-----' All, I am inc luding everyone in the group in case anyone has any last minute scheduling changes. Thanks, ~ VA-18-0298-B-000054 Page 1209 of 231~ of 4 871 Document ID: 0.7.1705.390033 From: VAC IO Executive Schedu le To: VACIO Execu tive Schedule ; Sandova l, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; l(b){G) (b)(G) /o=va/ou=visn 03/cn =recip ients/cn =vhaeastruexm> ; Bruce @mac .com> ;i'bH5 l @ Bruce Moskowitz (b)(6) 6 Moskow itz .MD (b)( ) mail.com> ; Marc She rman l(b)(6J @gmail.com>; IP (b)(6 frenchan el59.co m>; Stephanie Ree l (b)(6l 'hu .edu> ; Mary Riordan (b)(6l 'hu .edu> ; Ashley jhmi.edu >;,__ (bl(6l Johnson (bl(6l ; Rasu Shrestha ,,___;....;___~ _ __,.__..gmai l.com >; Manis, Jonathan (Jon) sutterhealth .org >; Shrestha , Rasu B ......,.,, (b..,.., )(6 """ )--'= --, upmc .edu> ; Cooper, Les lie T., M.D. t::-7'::::-----,_ ...i=-mayo.edu >; Karson, And rew Scott,M.D. :::::===== ~ mgh .harvard .edu >; Zuccala , Kandace (Kandi) R. !(bJ(6) @sutterhea lth.o rg> Cc : facs .org >; Mehwe sh.-----. Clifford Ko (bH6l Khalid (b)(6) facs.org >; Stan Huff l(b)(5) ~ima il.org > Bee: FW : VA EHR Call Subject: Tue Ma r 20 2018 19:01 :52 EDT Date : Attachments: I ______ ~ StartTime: Tue Mar 20 19:00 :00 Central Daylight Time 2018 EndTime : Tue Mar 20 20 :30:00 Central Dayl ight Time 2018 Location :l(b)(5) Recurr ing: No ShowReminder : No Accepted : No I Here you go. Jw Sent with Good (www .good .com) All times listed are in the following time zone:( UTC-05:00) Eastern Time (US & Canada) VA-18-0298-B-000055 Page 1210 of 231~ 5 of 871 From: VA CIO Executive Schedule Sent: Sunday , March 18, 2018 2:30:57 PM 5 Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H.;l(bl( l Moskowitz ; (bl(5l Bruce Moskowitz,MD'; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley Johnson ; (bl(6l (bl(6l Rasu Shrestha ; Manis, Jonathan (Jon); Shrestha , Rasu B; Cooper , Leslie T. , M.D. ; Karson , Andrew Scott ,M.D.; Zuccala, Kandace (Kandi) R. Cc: Clifford Ko; Mehwesh Khalid ; Stan Huff Subject: VA EHR Call When: Tuesday , March 20, 2018 8:00 PM-9:30 PM. Where : l(bl(5l I I ---~I 202-631-0640 an~~t!(=bl=(6l======--~ Scheduling Poc l~ (b-J(G _l All, I am including everyone in the group in case anyone has any last minute schedul ing changes. Thanks, l(b)(6) I VA-18-0298-B-000056 Page 121 1 of 231~ of 6 871 Document ID: 0.7.1705.390030 From: Windom, John H. on behalf of VACIO Executive Schedule To: Sandoval, Camilo J. Cc: Bee: FW: VA EHR Call Subject: Tue Mar 20 2018 19:01 :51 EDT Date: Attachments: Here you go . Jw Sent with Good (www.good .com) All times listed are in the following time zone:(U TC-05:00) Eastern Time (US & Canada) From: VA CIO Executive Schedule Sent: Sunday, March 18, 2018 2:30:57 PM Bruce To : VACIO Executive Schedule; Blackburn, Scott R.; Windom, John H.: !(bl(5> 5 Bruce Moskowitz.MD' ; Marc Sherman; IP; Stephanie Reel; Mary Riordan; Ashley Moskowitz ; (bl( > (bl(6> Rasu Shrest ha; Manis, Jonathan (Jon); Shrestha, Rasu B; Cooper, Johnson ; (bl(6> Leslie T. , M.D.; Karson, Andrew Scott,M.D.; Zuccala, Kandace (Kandi) R. Cc: Clifford Ko; Mehwesh Khalid ; Stan Huff Subject: VA EHR Call When: Tuesday , March 20, 2018 8:00 PM-9:30 PM. 5 > ] Where : l(bl< I Scheduling POC: ~l (b_ l(5_> --~I 202-631-0640 and l..... !(b_l(6_>________ ..... All , I am including everyone in the group in case anyone has any last minute schedul ing changes. Thanks, ~ VA-18-0298-B-000057 Page 1212 of 231~ of 7 871 Document ID: 0.7.1705.1225558 From: Karson, Andrew Scott,M.D. l(bJ(Gl @mgh.harvard.edu> VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; l(bH 6 i ; Bruce 6l @mac.com>;(bH6 l Bruce Moskowitz l(bH 6 Moskowitz ,MD l ; arc erman l(b)( GJ @gma1l.com> ; IP~frenchangel59.com>; Stephan ie Reel !(bJ(GJ @Jhu.edu>; Mary Riordan (bl(6l ?hu.edu> ; Ashley Johnson l ; (bl(5l -------~ ; Rasu Shrestha (b)(6J gmail.com >; Manis , Jonathan (Jon) @sutterhealth.org >; Shrestha , Rasu B (bl(6l (bl(6l upmc .edu >; Cooper, Leslie T., M.D. (bl(6l mayo .edu>; Zuccala , Kandace (Kandi) R. ~:!.,.._...Jl:=~~ health. org> Cc: ~~,-,=,facs.org>; Mehwe sh facs.org >; Stan Huff l..,,... (b,..,., l(6.,.... l -----. @imail.org>; Khalid (bl(5l 6 Karson, Andrew Scott,M .D.l(bl(l @mgh.harvard.edu > Bee: [EXTERNAL] RE: VA EHR Call Subject: Tue Mar20 201818 :04 :17 EDT Date: Attachments : I 5 (bJ _<_l Dear ~l -~I et al, I will be taking the call from my car as I drive from NY to Boston . I reviewed the documents and I have two lingering question s that I may figure out between now and our call, but I thought that I would send along while I still had ema il access: 1.How do users who are on the legacy system see data that will be in the new EHRM/Cerner product (during the transition phase ; as some VA users will be on the legacy system and others will be on the new system) 2.Do we have a list of the actual medical device s for which there will be device data integration? (I tried to find that list, but cannot seem to find it on review.) I look forward to joining the call at 8pm. Thanks and best, Andy Karson -----Original Appointment----From: VA CIO Executive Schedule [mailto:vacocioexe@va.gov] VA-18-0298-B-000058 Page 1213 of 231~ 8 of 871 Sent: Sunday , March 18, 2018 2:32 PM Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John HJ bl(5> 6 Moskowitz; (bl(l Bruce Moskowitz.MD' ; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley (bl(6> Rasu Shrestha ; Manis, Jonathan (Jon); Shrestha , Rasu B; Cooper , Johnson ; (bl(6> Leslie T. , M.D.; Karson , Andrew Scott ,M.D.; Zuccala, Kandace (Kandi) R. Cc: Clifford Ko; Mehwesh Khalid ; Stan Huff Subject: VA EHR Call When: Tuesday, March 20, 2018 8:00 PM-9:30 PM (UTC-05:00) Eastern Time (US & Canada) . 5 > Where : l(bl< I I 5 Scheduling POC: ._l (b_l( _> All, I am ~ Thanks (bl(5> __ ___.1 202-631-0640 and ~lf fo_'N6 _'>________ ~ ? g everyone in the group in case anyone has any last minute scheduling changes. I The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www .partners.org/complianceline . If the e-mail was sent to you in error but does not conta in patient information , please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000059 Page 1214 of 231~ of 9 871 Document ID: 0.7.1705.509901 Karson, Andrew Scott,M.D. From: l(bl(6l @mgh .harvard .edu> To: VACIO Executive Schedule ; Blackburn, Scott R. ; Windom, John H. ; (bl(5l ; l(bl<6l @Bruce Moskowitz,MD (bJ(6J gmail.com>; Marc Sherman l(bl(6l @gmail.com>; IP Cb><5> frenchan el59 .com> ; 6 Stephanie Reel (bl( l 'hu.edu>; Mary Riordan (bl(6l 'hu.edu>; 6 Ashley Johnson (bl( l jhmi.edu> ; ,...._ (bl(6 l ______ ; Manis, Jonathan Jon) (bJ(5l sutterhealth.org>; Shrestha , @upmc.e u>; Cooper , Leslie T., M.D. Rasu B (bJ<5l (bl(6l mayo .edu>; Zuccala, Kandace (Kandi) R. i Clifford Ko ~ facs.org>; Mehwesh Cc: @facs.org >; Stan Huff l,_ (b-J5(-l -----. ~imail.org >; Khalid l(b)(6J 6 Karson , Andrew Scott,M .D. l(bH l @mgh .harvard.edu> Bee: [EXTERNAL] RE: VA EHR Call Subject: Tue Mar20 201818:04:17 EDT Date: Attachments: ~ Dear .... l(b_ J5<_l _ ___,l et al, I will be taking the call from my car as I drive from NY to Boston . I reviewed the documents and I have two lingering questions that I may figure out between now and our call, but I thought that I would send along while I still had emai l access: 1.How do users who are on the legacy system see data that will be in the new EHRM/Cerner product (during the trans ition phase ; as some VA users will be on the legacy system and others will be on the new system) 2.Do we have a list of the actual medical devices for which there will be device data integration? (I tried to find that list, but cannot seem to find it on review.) I look forward to joining the call at 8pm . Thanks and best, Andy Karson VA-18-0298-B-000060 Page 1215 of 231~ 0 of 871 -----Original Appointment----From: VA CIO Executive Schedule [mailto:vacocioexe@va.gov] Sent: Sunday , March 18, 2018 2:32 PM 0 5 To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H.;l To: Windom, John H. ; Blackburn , Scott R. Cc: Draper , Anne ; ,_! ; Short, John (VACO) Bee: RE: [EXTERNAL] RE : VA EHR Call Update Subject: Tue Mar 20 2018 17:45:06 EDT Date: Attachments: Team , we have specifically contracted to have information coming in from CC to be parsed and injected into the right components of EHR. We will have some transition time since not all data is structured to do this , but Cerner has agreed to do this for notes, encounters, labs etc . Imaging will fall into batch 2 of ingestion . Sent with Good (www.good .com) From: Windom, John H. Sent: Tuesday , March 20, 2018 2:32:38 PM To: Blackburn, Scott R. 5-l ----~I Cc: Draper , Anne; -l(b-J< Zenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update Not an accurate depiction of what we are acquiring. Jw Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Tuesday , March 20 , 2018 2:12:59 PM To: Cooper , Leslie T., M.D.- (bJ(6l (bJ(6l 5 Cc: Windom, John H.; (bH l Short, John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update VA-18-0298-B-000062 Page 1217 of 23 1~ of 2 871 Dr. Cooper - thank you so much. This is incredibly helpful.. Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott 5 From: Cooper, Leslie T., M.D. l(bH l ra.tmayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To : Blackburn, Scott R.;l!(b)(5l Cc: Windom , John H.;l(bl(5l Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update I I I Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work . I have one area of concern regard ing the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maxim ize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g. , Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of VA-18-0298-B-000063 Page 1218 of 231~ of 3 871 Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recom mendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM 6l (0 l<6l "Cooper , Leslie T. , M.D."I~ (0_l(6_l __ ...., To : (bJ( 0 5 < l< l mayo .edu> 6 Cc: "Windom, John H." J~ (o_ J(_l _________ ___, @va.gov>, "Short , John (VACO)" Subject: [EXTE RNAL] RE: VA EHR Call Update Thank you , Dr. Cooper. Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-Bpm ET before others join at 8pm. Thank you again for the support. Scott From: ijL.. (0_l<6_l -----~ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D._ l(b)(6l Cc: Blackburn , Scott R.; Windom, John H.;.______ Subject: RE: [EXTERNAL] VA EHR Call Update _, Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. VA-18-0298-B-000064 Page 1219 of 231~ of 4 871 Thanks, l(b)(6) From: Cooper, Leslie T. , M.D.l(0 H5l @mayo.edu] Sent: Saturday, March 17, 20 18 9:36 PM To: l(bJ(6l 0 5 Cc: Blackburn , Scott R.; Windom, John H.; ~l ( _H _l ---~ Subject: Re: [EXTERNA L] VA EHR Call Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2:00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From:l(bl(6l l(bl(6l Date: Saturday , March 17, 2018 at 12:13 PM To : "Cooper , Leslie T ., M.D." !(0l(6l @mayo.edu> Cc: "Blackburn . Scott R." , "Windom , John H." , l(bl(5l @va.gov> Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Coope r, I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone . Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work ? Tha nks again! (b)(6) Executive Assistant to the Assistant Secretary VA-18-0298-B-000065 Page 1220 of 231~ of 5 871 Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: .... l(b_H_6 J___ _. VA-18-0298-B-000066 Page 122 1 of 231~ 6 of 871 Document ID: 0.7.1705.509892 From: Zenooz, Ashwini Windom, John H. To: ; Blackburn, Scott R. Draper , Anne Cc: ; Bee: RE: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 17:45:06 EDT Date: Attachments: Team , we have specifically contracted to have information coming in from CC to be parsed and injected into the right components of EHR. We will have some transition time since not all data is structured to do this , but Gerner has agreed to do this for notes , encounters, labs etc. Imaging will fall into batch 2 of ingestion . Sent with Good (www.good .com) From: Windom, John H. Sent: Tuesday , March 20 , 2018 2:32:38 PM To: Blackburn, Sc~tt R, 5 Cc: Draper, Anne; } bl( l lzenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update Not an accurate depiction of what we are acquiring. Jw Sent with Good (www.good .com) VA-18-0298-B-000067 Page 1222 of 23 1~ of 7 871 From: Blackburn, Scott R. Sent: Tuesday, March 20, 2018 2:12:59 PM 6 M.,..,., .D ::'-'-" :<_bJ _<_ l ---,..--------' To: Cooper, Leslie T. , ;,;5 Cc: Windom, John H.; {bl{l Short, John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update Dr. Cooper - thank you so much . This is incredibly helpful. . Will look forward to discussing at 7:30pm . Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott 5 l ~mayo.edu] From: Cooper, Leslie T. , M.o. l Date: Monda , March 19, 2018 at 2:39 PM To: (b)(6) (b)(6) (b)(6) "Cooper , Leslie T. , M.D." ._l (b_ l<5_ l _ _. 6l (bl< mayo .edu> Cc: "Windom, John H." , ._l (b-l(5_l _________ __,l@va.gov> , "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From: l(b)(6) I Sent: Monday, March 19, 2018 1:38 PM To: Cooper , Leslie T., M.D. Cc: Blackburn , Scott R.; Windom, John H.;~l (b_l(6_l ____ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-B-000069 Page 1224 of 231~ of 9 871 Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) From: Cooper, Leslie T. , M.D. l(bl{6l l@mayo.edu] Sent: Saturda , March 17, 2018 9:36 PM (b)(6l To: (bl(6l l Cc: "Blackburn , Scott R.", "Windom, John H." , 6l l Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! l(b)(6) VA-18-0298-B-000070 Page 1225 of 231~ of 0 871 l Blackburn, Scott R. Draper , Anne ; ._l (b_l( _l ____ _. ; Zenooz , Ashwini ; Short, John (VACO) Bee: Subject: RE: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 17:32:38 EDT Attachments: Not an accurate depiction of what we are acquiring. Jw Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Tuesday , March 20 , 2018 2:12:59 PM To : Cooper , Leslie T. , M.D.; (bl(Bl (bl(Bl 5 Cc: Windom , John H.; (bl( l Short , John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update Dr. Cooper - thank you so much. This is incred ibly helpful.. Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott . l mayo.edu] From: Cooper, Leslie T. , M.D . 1~~ .________ _,_ty Sent: Tuesday , March 20 , 2018 4:25 PM (bl(Bl To: Blackburn, Scott R.; (bl( 6l Cc: Windom , John H.; (bl(6l Short , John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update VA-18-0298-B-000072 Page 1227 of 231~ of 2 871 Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers. For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or cor relate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file. The date on the Outside Material file is the date of entry into the Gerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts . I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic VA-18-0298-B-000073 Page 1228 of 23 1~3 of 871 From: "Blackburn, Scott R." Date: Monda , March 19 2018 at 2:39 PM 6) (b)( To: (b)(6) (b)(G) mayo.edu> "Cooper , Leslie T., M.D." l(b)(6) .____ 5 c: indom, John H." , .... l Subject: [EXTERNAL] RE: VA EHR Call Update __. ..... @va.gov> , "Short , Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: l(b)(G) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. Cc: Blackburn , Scott R. ; Windom, John H.;l._ (b,)(5.,.... l ____ Subject: RE: [EXTERNAL] VA EHR Call Update __. Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) From: Cooper, Leslie T. , M.D. l(b)(G) @mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To: H(b)(5l l Cc: Blackburn , Scott R. ; Windom, John H.;~l (b,.... )(5..,... l ____ _. Subject: Re: [EXTERNAL] VA EHR Ca ll Update Importan ce: High I Tuesday I am in Rochester , MN. Meetings 10:30-2:00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? VA-18-0298-B-000074 Page 1229 of 231~ of 4 871 Wednesday I could make a call after 6:30 pm. Leslie From:l(bJ(6J l(bJ(6J Date: Saturday, March 17, 2018 at 12:13 PM g}mayo.edu> To: "Cooper, Leslie T., M.D." !(bJ(6l Cc: "Blackburn, Scott R.", "Windom , John H." , l(bl(6> @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 6 Cell : -l(b-)(_> ---~ VA-18-0298-B-000075 Page 1230 of 231~ of 5 871 Document ID: 0.7.1705.509674 Windom , John H. Blackburn, Scott R. Draper , Anne Cc: ;l ; Short , John (VACO) Bee: RE: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 17:32 :38 EDT Date: Attachments: Not an accurate depiction of what we are acquir ing. Jw Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Tuesday , March 20, 20 18 2:12:59 PM To : Cooper , Lesl ie T., M.D.; Date: Monday , March 19, 2018 at 2:39 PM ;ro:& l(bl<6l ~ mayo.edu> 5 Cc: "Windom, John H." , l(bl Subject: [EXTERNAL] RE: VA EHR Call Update !"Cooper, Lesl ie T. , M.D." l(b)(GJ ._ _ _.. l@va.gov>, "Short, Thank you, Dr. Cooper. Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cove r that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From:l(bJ(GJ Sent: Monday , March 19, 20181:38 PM To: Cooper, Leslie T., M.D. 5 Cc: Blackburn , Scott R.; Windom, John H.;l~ (b_ l( _l ---~ Subject: RE: [EXTERNA L] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any question s. Thanks, From: Cooper, Leslie T. , M.D. l(bl(5l l@mayo.edu] Sent: Saturda y , March 17, 2018 9:36 PM To: H(bJ(GJ J I Cc: Blackburn, Scott R. ; Windom , John H.;l~ (b_ J5(_i ____ ~ Subject: Re: [EXTE RNAL] VA EHR Ca ll Update VA-18-0298-B-000078 Page 1233 of 231~ of 8 871 Importance : High Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From: l(b)(6J l(b)(6l Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T., M.D." !(b)(6l Cc: "Blackburn , Scott R.", "Windom , John H." , l(bl(6l ~va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone . Right now , Tue sday evening seem s to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)( 6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 (b_l(6_l ---~ Cell : ~' VA-18-0298-B-000079 Page 1234 of 231~ of 9 871 Document ID: 0.7.1705.1225459 From: Windom , John H. To: Short, John (VACO) ; Blackburn , Scott R. Zenooz, Ashwini ; Draper, Anne ; l(bl(5l Bee: RE: VA EHR Call Update Subject: Tue Mar20 201817:30:17 EDT Date: Attachments: I All of this is in our contract and being done in phases. Jw Sent with Good (www.good .com) From: Short, John (VACO) Sent: Tuesday , March 20, 2018 2:24:14 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: VA EHR Call Update On Day one of GoLive we will have the ability to parse many portions of all the Community Care CCD and CCDAs directly into the Cerner Millennium EHR. I'll have the details for you shortly . From: Blackburn, Scott R. Sent: Tuesday , March 20, 2018 5:13 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] RE: VA EHR Call Update Thoughts? From: C o ooper, Leslie T. , M.D .l(b){6) ._______ __. I@mayo.edu) VA-18-0298-B-000080 Page 1236 of 231~ of 0 871 Sent: Tuesday, March 20 2018 4:25 PM To: Blackburn, Scott ~ <~l<5l 0 Cc: Windom, John H.;; !Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update I I Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file. The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file conten ts. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis . We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects). This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. VA-18-0298-B-000081 Page 1237 of 231~ of 1 871 Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday , March 19, 2018 at 2:39 PM ~ l(bl<5 l ~ mayo .edu> Cc: "Windom , John H." ,l Subj ect: [EXTERNA L] RE: VA EHR Call Update I"Cooper , Leslie T., M.D." l(bl(l 5 ~-~ @va.gov> , "Short , Thank you, Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspect ive on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: l(bJ(6J Sent: Monday, March 19, 20181:38 PM To : Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R. ; Windom , John H.;l~ (b_ l(5_l ---~ Subject: RE: [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) From: Cooper, Leslie T. , M.D. l(bl(5l l@mayo.edu] Sent: Saturda ?, March 17, 2018 9:36 PM To: H(bJ(6l l !(b)(6J 11 Cc: Blackburn , Scott R. ; Windom, John H.; .... l To: "Cooper. Leslie T ., M.D ." l, "Windom, John H." , 6l l Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l~ <_ b J Short, John (VACO) To: ; Blackburn, Scott R. Zenooz, Ashwini Cc: ; Draper , Anne ; (bJ( l Date: Monday, March 19, 2018 at 2:39 PM To: l(bJ(Gl l(b)(GJ l(bl(6l @mayo .edu> Cc: "Windom , John H." ,l(bl(6l John (VACO)" Subject: [EXTERNAL) RE: VA EHR Call Update !"Cooper , Leslie T., M.D." l(bl( l 6 .____ _, l@va.gov> , "Short , Thank you, Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support . Scott I From:l(bl(5l Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. .-------, 5 Cc: Blackburn, Scott R.; Windom , John H.; ..... l(b_l( _l ___ Subject: RE: [EXTERNAL] VA EHR Call Update __, Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, VA-18-0298-B-000086 Page 1242 of 231~ 6 of 871 From: Cooper, Leslie T. , M.D.l(bl(5l l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM n(b)(6) To: wb)(6) 5 Cc: Blackburn , Scott R.; Windom, John H.;._l (b-l(_l ____ _. Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High o Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From: (b)(6J (bJ(6l Date: aturday , March 17, 18 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ." l(bl(5l Cc: "Blackburn , Scott R." , "Windom, John H." , l(bl(6l @va .gov> VA ERRCall Update Subject: [EXTERNAL] Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work ? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs VA-18-0298-B-000087 Page 1243 of 231~ of 7 871 Desk: 202?461-6288 sen: Page 1244 of 231%8 of an Document ID: 0.7.1705.1225431 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: VA EHR Call Update Date: Tue Mar 20 2018 17:24:14 EDT Attachments: On Day one of GoLive we will have the ability to parse many portions of all the Community Care CCD and CCDAs directly into the Cerner Millennium EHR. I'll have the details for you shortly. From: Blackburn, Scott R. Sent: Tuesday , March 20, 2018 5:13 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] RE: VA EHR Call Update Thoughts? 5 From: Cooper, Leslie T ., M.DJbl( l ~mayo .edu] Sent: Tuesday , March 20, 20 1 4:25 PM To: Blackburn, Scott R.? (bl(6l (bJ(6l Cc: Windom, John H.; (bl(5l Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update a Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers. For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. VA-18-0298-B-000089 Page 1245 of 231~ 9 of 871 In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperabil ity Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts . I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM To: (bl(6l (b)(6l "Cooper , Leslie T. , M.D."~l (0_l(5_l -~ 0 5 mayo.edu> < l< l 0 5 < _l<_i _________ _, @va.gov>, "Short , Cc: "Windom, John H." , i.... John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from VA-18-0298-B-000090 Page 1246 of 231~ 0 of 871 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I 5l From: ll(blC Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. 5 Cc: "Blackburn, Scott R.", "Windom , John H." , l(bl{6l l@va.gov> VA-18-0298-B-000091 Page 1247 of 231~ of 1 871 Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461 -6288 Ce11 : l~ (b_H6_) ---~ VA-18-0298-B-000092 Page 1248 of 231~ of 2 871 Document ID: 0.7.1705.509663 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: VA EHR Call Update Date: Tue Mar 20 2018 17:24:14 EDT Attachments: On Day one of Golive we will have the ability to parse many portions of all the Community Care CCD and CCDAs directly into the Cerner Millennium EHR. I'll have the details for you shortly . From: Blackburn, Scott R. Sent: Tue sday , March 20 , 2018 5:13 PM To : Short , John (VACO) ; Windom , John H. Subject: FW: [EXTERNAL] RE: VA EHR Call Update Thoughts? @mayo.edu] From: Cooper, Leslie T ., M.D. l Date: Monda , March 19, 2018 at 2:39 PM 6l (bl(6l (bH ? (b)(6) mayo.edu> (bl<5l 5 "Cooper , Leslie T., M.D.'l, .... l Subject: [EXTERNAL] RE: VA EHR Call Update __. ___, @va .gov>, "Short , Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your VA-18-0298-B-000094 Page 1250 of 231~ of 4 871 perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From fl (bl(6l Sent: Monday , March 19, 20181:38 PM To : Cooper , Leslie T., M.D. Cc: Blackburn , Scott R. ; Windom, John H.;j._ Cc: "Blackburn, Scott R.", "Windom, John H." , VA-18-0298-B-000095 Page 125 1 of 231~ of 5 871 l(bl<5l @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l.... (b-H6_l ___ _. VA-18-0298-B-000096 Page 1252 of 231~ of 6 871 Document ID: 0.7.1705.1537739 From: Coo er, Leslie T., M.D. (bl(6l mayo.edu> To: Blackburn , Scott R. Cc: Bee: Subject: Re: [EXTERNAL] RE: RE: VA EHR Call Update Date: Tue Mar 20 2018 17:23:44 EDT Attachments: In air now. Will make 7:30 call. Boarding for JAX at 8:08 . Will miss most of larger group discussion . Leslie Sent from my iPhone On Mar 20, 2018 , at 4 :13 PM, Blackburn , Scott R. wrote : Dr. Cooper - thank you so much . This is incred ibly helpful. . Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott l.aJmayo.edu] From: Cooper, Leslie T. , M.D.l(bl(5l Sent: Tuesday , March 20 2018 4:25 PM To : Blackburn , Scott R.r""!,----->--,------' ? (bl(6l Cc: Windom , John H.; (b)(G) hort, John (VACO) Subje ct: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work . I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. VA-18-0298-B-000097 Page 1253 of 231~ of 7 871 In my experience using 3 versions of the Cerner EMR, the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should spec ify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For examp le, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition, and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . Thi s recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday, March 19, 2018 at 2:39 PM 6l To :l(bl(5l l(bH l(bl(5l @m ayo.edu> Cc: "Windom, John H." J(b)( GJ John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update !"Cooper , Leslie T. , M.D."~l(b_l(5_i __ - @va.gov >, "Short , Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. VA-18-0298-B-000098 Page 1254 of 231~ of 8 871 Thank you again for the support. Scott I I From: ij(b)(5l Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. 5 'b-)(_l ____ Cc: Blackburn , Scott R. ; Windom, John H.;~l Subject: RE: [EXTERNAL] VA EHR Call Update ~ Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks , l(b)(6) From: Cooper, Leslie T. , M.D. l(b)(5) @mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To ffi(b)(5J l Cc: Blackburn , Scott R. ; Windom, John H.; ~l 'b_l<5_l ____ ..... Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6 :30 pm . Leslie From: l(b)(6) l(b)(6) Date: Saturday, March 17, 2018 at 12:13 PM 6l To: "Cooper, Leslie T., M.D." (bH mayo.edu> tt.,.... _........ a-cr-r-u-rn - '""'-va .gov>, "Windom, John H." , Cc: "Blackburn , Scott R." Subject: [EXTERNAL] VA EHR Call Update VA-18-0298-B-000099 Page 1255 of 231~ of 9 871 Good afternoon Dr. Coope r, I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 (o_) To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 17:13:07 EDT Attachments: Thoughts? @mayo.edu] From: Cooper, Leslie T. , M.D. l(bl(5l Sent: Tue sday, March 20 , 2018 4:25 PM ,.....,_._ _, (bl(6l To: Blackburn, Scott R.; Cc: Windom, John H.; (b)(G) Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update _____ _ ~ Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers. For the new VA EMR to effic ient ly serve patients, maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to ident ify file content or correla te internal study results with similar outside studies. For examp le a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantia l cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core VA-18-0298-B-000101 Page 1257 of 23~i 1 of 871 interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM 5J To :(bJ( va.gov>, "Cooper , Leslie T. , M.D." ..... l(b_J5(_J__ _. 6 mayo .edu > (bJ(J Cc: "Windom, John H." , l, "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: l(bJ(GJ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R.; Windom, John H.;l._ (b_ J6(_l ___ __. VA-18-0298-B-000102 Pa ge 1258 of 23~i 2 of 871 Subject: RE: [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) 5 From: Cooper, Leslie T. , M.D.l(Dl< l l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM 5l To: l(bl< Cc: Blackburn , Scott R.; Windom, John H.; .... l Date: Saturday , March 17, 2018 at 12:13 PM 6l l@mayo.edu> To: "Cooper, Leslie T ., M.D ." l, "Windom , John H." , 6l l Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time. If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? VA-18-0298-B-000103 Pa ge 1259 of 23~i 3 of 871 Thanks again! (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: ~l To: Short, John (VACO) ; Windom , John H. Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 17:13:07 EDT Attachments: Thoughts? ? l(b)(6) 6 From: Cooper, Leslie T. , M.D ..'"'=---,--=-=-=-=-=----~ ig!mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn , Scott R.; (bl<6l -----~-~ Cc: Windom , John H.; (bl{ 6l Short , John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott , I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care provider s. For the new VA EMR to eff iciently serve patients , maxim ize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require th is of the Cerner system . In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material" with no way to identify file content or correlate internal study results with similar outside studies . For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material " file . The date on the Outside Material file is the date of entry into the Cerner EMR , with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . VA-18-0298-B-000105 Page 126 1 of 23~i 5 of 871 I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL? Fast Healthcare Interoperability Resource standards and industry- led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T . Cooper, Jr ., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda March 19 2018 at 2:39 PM To : (bH5l @va .gov>, "Cooper , Leslie T., M.D."-l(b_l(5_l --~ 5 mayo .edu> (bl(l Cc: "Windom , John H." J, "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From:.... l(b_J(G _l ______ _, VA-18-0298-B-000106 Page 1262 of 23~i 6 of 871 Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. l(b_l(5_> ___ Cc: Blackburn , Scott R.; Windom, John H.;.... Subject: RE: [EXTERNAL] VA EHR Call Update ____, Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) From: Cooper, Leslie T. , M.D. l(bl(5> Sent: Saturday , March 17, 2018 9:36 PM To: l(b)(6l Cc: Blackburn , Scott R.; Windom, John H.; .... l(b_l(5_> ___ Subject: Re: [EXTERNAL] VA EHR Call Update Importanc e: High @mayo.edu] I _. Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From:l(bl(5> @va.gov > Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To : "Cooper, Leslie T ., M.D."l(bl(6> Cc: "Blackburn , Scott R.", "Windom, John H." , l(bl(6> l@va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? VA-18-0298-B-000107 Pa ge 1263 of 23~i 7 of 871 Thanks again! (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell : -l To: Cooper , Leslie T., M.D. j(bJ(6J @mayo .edu> ; l(bl(6l Windom , John H. ; (bH 03/cn =recipients/cn=vhaeastruexm >; Short , John (VACO) Bee: RE: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 17:12:59 EDT Date: Attachments : Dr. Cooper - thank you so much. This is incredibly helpful.. Will look forward to discussing at 7:30pm. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott From: Cooper , Leslie T ., M.D.l(bl(5l @mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To : Blackburn, Scott R.j(b)(6) Cc: Windom , John H.; ?l(b tt.';--;; H5::-l '------1-,I S_h_o_rt...J , John (VACO ) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work . I have one area of concern regard ing the interoperability of the system with community care providers . For the new VA EMR to eff iciently serve patients, maxim ize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outs ide studies . For example a fax with a coronary angiogram report VA-18-0298-B-000109 Page 1265 of 23~i 9 of 871 and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents . These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Oat : M n M r h 1 2 1 2: PM To : (b)(G) va.gov>, "Cooper , Leslie T., M.D." ~l (b-l(5_l __ ~ 5 (b)(l mayo.edu> ~va.gov> , "Short , Cc: "Windom , John H." Jb)(G) John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-Bpm ET before others join at 8pm. Thank you again for the support. VA-18-0298-B-000110 Page 1266 of 23~~ of 0 871 Scott From: .... l(b_J(B _l _____ ____. Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. 5 (b_ H_l ---~ Cc: Blackburn , Scott R. ; Windom, John H.; l~ Subject: RE : [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, ~ From: Cooper, Leslie T. , M.D .._l (b_H5_l _____ ___. @,_,mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6J 5 Cc: Blackburn , Scott R. ; Windom, John H.; 1..,. '.b--, l( _l ---~ Subject: Re: [EXTERNAL] VA EHR Call Update Importanc e: High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a ca ll after 6:30 pm. Leslie From: l(bl(5l @va.gov > Date: Saturday, March 17, 2018 at 12:13 PM 5 l @mayo.edu> To: "Cooper, Leslie T., M.D." l(bl< Cc: "Blackburn, Scott R.", "Windom , John H." , l(b){BJ @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , VA-18-0298-B-000111 Page 1267 of 23~~ of 1 871 I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: ~l(b-l( 6_l ---~ VA-18-0298-B-000112 Page 1268 of 23~~ of 2 871 Document ID: 0.7.1705.509636 Blackburn, Scott R. Coope r, Leslie T ., M.D. To: !(bl(5l l@mayo.edu>; ._l (b_l(5_l _____ __, ; (bl(5l administrative group (fydibohf23s dlt /cn=rec ipients/cn=045f8eff429f45888be 795fbaa 1d 9ef2 (bl(6l ; Short, John (VACO) RE: [EXTERNAL] RE: VA EHR Call Update Tue Mar 20 2018 17:12:59 EDT Dr. Cooper - thank you so much. This is incredibly helpful .. Wi ll look forward to discuss ing at 7:30pm. Hopefu lly flights are on time - but just let me know if there are any issues and we will adjust. Scott From: Cooper, Leslie T. , M.D. l(bl(5l @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott R""' .:..,,! (b,,... H6_l ___ __,_~ Cc: W indom, John H.; l(bl(5l js hort, John (VACO) Subject: Re: [EXTERNA L] RE: VA EHR Call Update Scott, I reviewed the mate rial you sent regard ing the proposed VA EMR contract and statement of work . I have one area of concern regarding the interoperability of the system w ith community care providers . For the new VA EMR to efficient ly serve patients, maximize safety and lower medical costs, medical records from the military, VA and communi ty care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system . VA-18-0298-B-000113 Page 1269 of 23~~ of 3 871 In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantia l cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should spec ify that that all community care provider materials be indexed and searchable by specif ic diagnosis and test result, and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For examp le, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperabi lity at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition, and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g ., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . Thi s recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts. I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but schedu led to land at 7:05 pm. Leslie T. Cooper, Jr ., MD Chair, Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday , March 19, 2018 at 2:39 PM 5 To: l(bH l @va .gov>, "Cooper , Leslie T., M.D." ~ l(b_J6 (_l -~ l(b)(6) @mayo.edu> Cc: "Windom , John H." ,l(bJ(5l @va.gov> , "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your VA-18-0298-B-000114 Page 1270 of 23~~ of 4 871 perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I 5l From: l(bl< Sent: Monday , March 19, 20181:38 PM To : Cooper , Leslie T., M.D. 5 Cc: Blackburn , Scott R. ; Windom, John H.;~l (b.,.... l( _l ----~ Subject: RE: [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, ~ 5 From: Cooper, Leslie T. , M.D. l(bl< l @mayo.edu] Sent: Saturday , March 17, 2018 9:36 PM To :l(b)(6) Cc: Blackburn , Scott R. ; Windom, John H.;l._ Date: Saturday, March 17, 2018 at 12:13 PM 5 To: "Cooper, Leslie T., M.D." l(bl< l @mayo.edu> Cc: "Blackburn , Scott R.", "Windom , John H." , VA-18-0298-B-000115 Page 127 1 of 23~~ of 5 871 @va.gov> l(b)(6) Subject: [EXTERNA L] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone . Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! {b){6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: ._l (b_H6_J ____ _. VA-18-0298-B-000116 Page 1272 of 23~~ of 6 871 Document ID: 0.7.1705.1225395 From: Cooper, Leslie T., M.D. l(bl(6> @mayo.edu> Blackburn, Scott R. -~ f dibohf23spdlt)/cn=recipients/cn=vacoblacks 1>; ~l 6 (bH > Windom , John H. ; (bH 5> 03/cn=recipients/cn=vhaeastruexm>; Short , John (VACO) Bee: Re: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 16:25:09 EDT Date: Attachments: Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers . For the new VA EMR to efficiently serve patients, maximize safety and lower medical costs , medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Cerner system. In my experience using 3 versions of the Cerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correlate internal study results with similar outside studies. For example a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Cerner EMR, with no relation to the date of the file contents. These results are neither indexed nor searchable . The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeated at substantial cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strategy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materials be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Cerner Mayo installations) on the date of the study. Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g. , the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from VA-18-0298-B-000117 Page 1273 of 23~~ of 7 871 Mayo Clinic experts. I look forward to discussing the VA EMR du ring the conference call at 7:30. My flight to AT L is de layed slightly, but schedu led to land at 7:05 pm. Leslie T . Cooper, Jr., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monda y, March 19, 20 18 at 2:39 PM To:l(bJ(5J l@va .gov>, "Cooper , Leslie T. , M.D.'1(bJ(5J 5 l(b)( l @ mayo .edu> ~--~ 5 Cc: "Windom , John H." , l(bJ( J @va.gov> , "Short , John (VACO)" Subject: [EXTERNA L] RE: VA EHR Call Update Thank you, Dr. Cooper . Dr. Moskowitz mentioned very specifica lly to me that we should get your perspect ive on cloud so that we know we have that part correct. I am think ing we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From: ..... l(b_J5(_J~------' Sent: Monday, March 19, 2018 1:38 PM To : Cooper , Lesl ie T., M.D. 5 Cc : Blackburn , Scott R. ; Windom, John H.;..... l(b_J(_l ____ Subject: RE: [EXTERNAL] VA EHR Call Update _. Dr. Cooper, thank you for your response. I have sent two outlook invites , one starting at 7:30PM EST for you to partic ipate in as we ll as the 8PM EST with the group . Please let me know if you have any questions . Thanks , l(b)(6) From: Cooper, Les lie T ., M.D . l(bJ(5J l@mayo.edu] Sent: Satu rday, March 17, 2018 9:36 PM To :i(bH5J Cc: Blackburn, Scott R.; Windom , John H.;l~ (b_ J6(_J ____ _. Subject: Re: [EXTERNA L] VA EHR Ca ll Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flig ht to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Cou ld I ca ll in as soon as I land? Wednesday I could make a ca ll after 6:30 pm. Leslie From: l(bJ(5J @va .gov> Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper, Lesl ie T., M.D.' '!(bJ(5J @ mayo .edu> Cc: "Blackburn , Scott R.'' , "Windom , John H." , l(b)(6l l@va.gov> VA-18-0298-B-000118 Page 1274 of 23~~ of 8 871 Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? r,J~anks again! I Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: .... l(b-)(6_) ____ ...., VA-18-0298-B-000119 Page 1275 of 23~~ of 9 871 Document ID: 0.7.1705.509447 From: Cooper, Leslie T., M.D. j(bJ(6l @mayo.edu> Blackburn, Scott R. ; ~l 6 ; (bl( l administrative group (fydibohf23spdlt)/cn=recipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2 j(bJ(6l I; Short , John (VACO) Bee: Re: [EXTERNAL] RE: VA EHR Call Update Subject: Tue Mar 20 2018 16:25:09 EDT Date: Attachments: Scott, I reviewed the material you sent regarding the proposed VA EMR contract and statement of work. I have one area of concern regarding the interoperability of the system with community care providers. For the new VA EMR to efficiently serve patients , maximize safety and lower medical costs, medical records from the military , VA and community care providers under contract must be viewable in a seamless electronic format. The language of the contract and statement of work do not require this of the Gerner system. In my experience using 3 versions of the Gerner EMR , the records from outside providers are imported as a CCD or CCA file and labeled as "Outside Material " with no way to identify file content or correla te internal study results with similar outside studies. For examp le a fax with a coronary angiogram report and a colonoscopy report will be included in the same "Outside Material" file . The date on the Outside Material file is the date of entry into the Gerner EMR , with no relation to the date of the file contents. These results are neither indexed nor searchable. The effort required of providers to open and read all pages of each file is infeasible and therefore tests are needlessly repeat ed at substantia l cost and risk to patients . I recommend that the VA EMR contract and statement of work be amended to require that a core interoperability strate gy be operational at the time of initial EMR implementation. The amended contract and statement of work should specify that that all community care provider materia ls be indexed and searchable by specific diagnosis and test result , and that these results be linked to relevant parts of the internal VA records by date and medical discipline . For example , a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardiology Testing (nomenclature from Gerner Mayo installations) on the date of the study . Current operational examples of successful EMR interoperability at the level required include EPIC to EPIC data exchange or a VA-18-0298-B-000120 Page 1276 of 23~~ of 0 871 proprietary intra-organization system used at Mayo Clinic called Synthesis. We would recommend that you utilize standards for this as promulgated by the Federal government (e.g., Meaningful Use 2015 edition , and the Trusted Exchange Framework and Common Agreement initiated by the Department of Health and Human Services) and by industry (e.g., the HL7 Fast Healthcare Interoperability Resource standards and industry-led Argonaut and SMART projects) . This recommendation has been reviewed by Mayo Clinic leadership and we believe is consistent with other feedback you have received from Mayo Clinic experts . I look forward to discussing the VA EMR during the conference call at 7:30. My flight to ATL is delayed slightly, but scheduled to land at 7:05 pm. Leslie T. Cooper, Jr., MD Chair , Enterprise Department of Cardiovascular Medicine Mayo Clinic From: "Blackburn, Scott R." Oat : M r h 1 2 2: PM va .gov> , "Cooper , Leslie T. , M.D." ._l (b_l(5_l __ _. To : (b)(G) (bl(6l @mayo .edu> Cc: "Windom , John H." J bJ(GJ @va.gov>, "Short , John (VACO)" Subject: [EXTERNAL] RE : VA EHR Call Update Thank you, Dr . Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that iss ue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From:l(bJ(GJ Sent: Monday , March 19, 20181:38 PM To : Cooper , Lesl ie T., M.D. l(b_l(6_l ___ Cc: Blackburn , Scott R. ; Windom, John H.; ..... Subject: RE : [EXTERNAL] VA EHR Call Update ___, Dr. Cooper , thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group . Please let me know if you have any questions. ~ From: Cooper , Leslie T ., M.D .l(b)(G) @mayo .edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b){G) Cc: Blackburn , Scott R. ; Windom, John H.;l._ (b_ l(5_l ___ _. Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High I Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm . Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie VA-18-0298-B-000121 Page 1277 of 23~~ of 1 871 From:l(bl(5l @va .gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D ."l(bl(5l @mayo .edu> Cc: "Blackburn , Scott R.", "Windom, John H." , 6l l(bl< l@va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks aaaio' I' "'' Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l(b)(6l I VA-18-0298-B-000122 Page 1278 of 23~~ of 2 871 Document ID: 0.7.1705.1225173 From: VAC IO Executive Schedule To: Windom, John H. ; Blackburn , Scott R. : l(blC '--;:=:=== ;:::::-:::-' :l ; Bruce Moskowitz Moskowitz ,MD Cc: Bee: Canceled: EHR VA Call Subject: Tue Mar 20 2018 12:33:29 EDT Date: Attachments: VA-18-0298-B-000123 Page 1279 of 23~~ of 3 871 Document ID: 0.7.1705.1773132 From: Blackburn, Scott R. To: DJS ; Windom, John H. ; Zenooz, Ashwini ; Short, John (VACO) ; Bruce Moskowitz !(bl(5l J@mac.com>; Marc Sherman l(bl(5l @gmail.com> 6 l(bl( l l Bee: EHR calls tomorrow night Subject: Date: Mon Mar 19 2018 21 :55:27 EDT Attachments: We will start at 7:30pm tomorrow night. Dial in is: 1-800-767-1750,,,22712# 7:30-8:00pm : Dr. Leslie Cooper , Mayo Clinic. We will focus on the issue of using Cloud . (Bruce suggested Dr. Cooper for this specific issue) 8:00-9:30pm: Dr. Rasu Shretha (UPMC) , Jon Manis (Sutter Health) , Stephanie Reel (Johns Hopkins) and Dr. Andy Karson (Mass General Hospital) Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-B-000124 Page 1280 of 23~~ of 4 871 Document ID: 0.7.1705.508899 Blackburn , Scott R. DJS ; Windom , John H. ; Zenooz, Ashwini ; Short, John (VACO) ; 5189-short , john> ; Bruce Moskowitz l(bl(5l Marc Sherman j(b)(6) @gmail.com> l(b) (6) Cc: To: Blackburn, Scott R. 6l Marc Sherman Cbl< gmail.com> ; Cc: Windom , John H. ; (bl(5l /o=va/ou=excha nge administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: [EXTERNAL] Re: Dr. Coooper - Cloud expertise Subject: Mon Mar 19 2018 17:59:25 EDT Date: Attachments: Perfect Sent from my iPad Bruce Moskowitz M.D. On Mar 19, 2018, at 2:45 PM, Blackburn, Scott R. wrote : FYI. Dr. Cooper 's time tomorrow night is limited (he will be in between flights). Given he is a "single issue" guy; we are going to start the call at 7:30 and cover the Cloud issue from 7:30-8pm ET before everyone else joins at 8pm ET. I think we will have everyone except Stan Huff and Dr. Ko on the call. l(b){GJ lis working a time on Wednesday to get them on a call. Scott From: Blackburn, Scott R. Sent: Monda , March 19, 2018 2:40 PM To:(bl<6l Cooper, Leslie T. , M.D. Cc: Windom, John H.; (bl(6l Short, John (VACO) Subject: RE: [EXTERNAL] VA EHR Call Update Thank you , Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. VA-18-0298-B-000126 Page 1282 of 23~~ of 6 871 Scott From:._! (0_l(5_l ______ _. Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. (0_l(5_l ---~ Cc: Blackburn , Scott R.; Windom, John H.;~l Subject: RE: [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, ? I From: Cooper, Leslie T. , M.D. 1~~ ~------~ @mayo .edu] Sent: Saturday, March 17l 2018 9:36 PM To: l(bJ(6l 0 5 Cc: Blackburn , Scott R.; Windom, John H.; ~1 ( _ l( _l ---~ Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday , I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From:!(OJ(6l @va.gov> Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T., M.D." l(oJ(6l Cc: "Blackburn , Scott R.", "Windom , John H." , 6l l(Ol( @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , VA-18-0298-B-000127 Page 1283 of 23~~ of 7 871 I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell :~l (b_J(G _l ---~ VA-18-0298-B-000128 Page 1284 of 23~~ of 8 871 Document ID: 0.7.1705.1772937 From: Blackburn , Scott R. To: Bruce Moskowitz 6l l(bH @mac .com> ; Marc Sherman i Cc: Windom , John H. (b)(5l administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Dr. Coooper - Cloud expertise Subject: Mon Mar 19 2018 14:45:08 EDT Date: Attachments: FYI. Dr. Cooper 's time tomorrow night is limited (he will be in between flights). Given he is a "single issue" guy; we are going to start the call at 7:30 and cover the Cloud issue from 7:30-8pm ET before everyone else joins at 8pm ET. I think we will have everyone except Stan Huff and Dr. Ko on the call. i Date: Saturday, March 17, 2018 at 12:13 PM 5 l@mayo.edu> To: "Cooper, Lesl ie T ., M.D.'!, "Windom , John H." , 5 l Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tuesday starting at 5pm, 6pm, 7pm or 8pm ET would you be able to make that work? Thanks again! VA-18-0298-B-000130 Page 1286 of 23~~ of 0 871 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 Cell : .... l(b-H6_l ___ ___. VA-18-0298-B-000131 Page 1287 of 23~~ of 1 871 Document ID: 0.7.1705.508064 From: Blackburn , Scott R. Bruce Moskowitz To: j(o)(6l @mac .com>; Marc Sherman 1(0 >(5> @gmail.com> Windom , John H. Cc: ; l(0 >< > 7b33 (0>< Bee: Subject: Dr. Coooper - Cloud expertise Date: Mon Mar 19 2018 14:45:08 EDT Attachments: I FYI. Dr. Cooper's time tomorrow night is limited (he will be in between flights). Given he is a "single issue" guy; we are going to start the call at 7:30 and cover the Cloud issue from 7:30-8pm ET before everyone else joins at 8pm ET . I think we will have everyone except Stan Huff and Dr. Ko on the call. j<0 >(6l lis working a time on Wednesday to get them on a call. Scott From: Blackburn, Scott R. Sent: Monda March 19 2018 2:40 PM 5 > Coo er Leslie T. , M.D . To: (0 >< Cc: Windom , John H.;(0 l(5l Short, John (VACO) Subject: RE: [EXTERNAL] VA EHR Call Update Thank you, Dr. Cooper. Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cover that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From:~l (o_ J(6 _>-----~ Sent: Monday, March 19, 20181:38 PM To: Cooper, Leslie T., M.D. 0 5 Cc: Blackburn , Scott R.; Windom , John H.; 1~ ( _ >< _>---~ VA-18-0298-B-000132 Page 1288 of 23~~ of 2 871 Subject: RE: [EXTERNAL] VA EHR Call Update Dr. Cooper, thank you for your response . I have sent two outlook invites, one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, l(b)(6) From: Cooper, Leslie T. , M.D. l(b){G) @mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To:l(b)(6) 5 Cc: Blackburn , Scott R. ; Windom, John H.; l...., Date: Saturday, March 17, 2018 at 12:13 PM 5 l l@mayo.edu> To: "Cooper, Leslie T ., M.D ." l(bl< Cc ? "Blackburn Scott R " , "Windom, John H." , l(b){G) ~v a.gov> Subject: [EXTERNAL] VA EHR Ca ll Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra emai l but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time. If we made the call later on Tuesday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? VA-18-0298-B-000133 Page 1289 of 23~~ of 3 871 Thanks again! (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce11:l~ (b_ J< 6_l ---~ VA-18-0298-B-000134 Page 1290 of 23~~ of 4 871 Document ID: 0.7.1705.508053 From: Blackburn , Scott R. (bJ (5l /o=va/ou=exchange To: administrative group (fydibohf23s dlt /cn=recipients/cn=vacocallae2>; Cooper, Leslie mayo .edu> T., M.D. (bl(5l Cc: Windom , John H. ; (bl(6l 03/cn=recipients cn=v aeastruexm>; Short, John (VACO) Bee: RE: [EXTERNAL] VA EHR Call Update Subject: Mon Mar 19 2018 14:39:52 EDT Date: Attachments: Thank you, Dr. Cooper . Dr. Moskowitz mentioned very specifically to me that we should get your perspective on cloud so that we know we have that part correct. I am thinking we cove r that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From:~l (b_J(6 _J------~ Sent: Monday, March 19, 2018 1:38 PM To: Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R. ; Windom, John H.; ..... l(b_J5(_l ____ Subject: RE: [EXTERNAL] VA EHR Call Update _. Dr. Cooper, thank you for your response . I have sent two outlook invites , one starting at 7:30PM EST for you to participate in as well as the 8PM EST with the group. Please let me know if you have any questions. Thanks, 5 From: Cooper, Les I.1eT ., M .D .L(b_l( _l ______ Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6J bmayo.edu] ~ I VA-18-0298-B-000135 Page 1291 of 23~~ of 5 871 0 5 Cc: Blackburn, Scott R.; Windom, John H.;l._ ( ,_l( ..,... l ____ Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High _. Tuesday I am in Rochester , MN. Meetings 10:30-2 :00 and a 4 pm flight to Atlanta. If the call needs to be Tuesday, I have a layover in ATL 7:05-8:48 pm. Could I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie 5l From:l(OJ( @v a.gov> Date: Saturday , March 17, 2018 at 12:13 PM @mayo .edu> To : "Cooper, Leslie T ., M.D.'j(0 l(5l Cc: "Blackburn. Scott R.", "Windom, John H." , 1(0 l(5l @va.gov > Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , I hope you are having a nice weekend! Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now , Tuesday evening seems to be the best time . If we made the call later on Tue sday starting at 5pm , 6pm , 7pm or 8pm ET would you be able to make that work? Thanks again! (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l(o ...._J(6 _l ---- VA-18-0298-B-000136 Page 1292 of 23~~ of 6 871 Document ID: 0.7.1705.1772891 VAC IO Executive Schedule From: VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; l(b)(G) (b)(5) /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce 6l Moskowitz !(b)(6) @mac.com> j(bH @Bruce 5 Moskowitz.MD l ; Marc Sherman l(b)(5l l@gmail.com>; IP~ frenchangel59.com>; Foster , Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz , Ashwini ; Short, John (VACO) ; Myklegard, Drew ; ..... (b_l<6_l -~ (b)(6l ; Cooper, Leslie T., M.D. l(bH6l @mayo .edu> Cc: Bee: VA EHR Call Subject: Mon Mar 19 2018 13:32 :31 EDT Date: Attachments: I StartTime: Tue Mar 20 18:30:00 Central Daylight Time 2018 EndTime: Tue Mar 20 19:00:00 Central Dayl ight Time 2018 Location : l(b)(5l 5 Invitees : Blackburn , Scott R. ; Windom, John H.; l(bl(l Bruce Moskowitz ;l(b)(5) @Bruce Moskowitz .MD'; Marc Sherman; IP; Foster, Michele SES ? Nostrant David K.; Draper , Anne ; Zenooz, Cooper, Leslie T., M.D . Ashwini; Short, John (VACO); Myklegard, Drew; (b){5l Recurring: No ShowReminder: Yes ReminderMinutes : 15 ReminderTime: Tue Mar 20 18:15:00 Central Daylight Time 2018 Accepted: Yes AcceptedTime: Mon Mar 19 13:39:00 Central Daylight Time 2018 I I All, Dr. Cooper will not be able to participate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper . Thanks ,l(b)(6) I 5 Scheduling POC J..... (b-)(_l ___ 5 .....,1 202-631-0640 ..... l(b-)(_) _____ _,~va.gov VA-18-0298-B-000137 Page 1294 of 23~~ of 7 871 Document ID: 0.7.1705.1772892 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Blackburn, Scott R. ; Windom, John H. ; ~l (b_ l(5_l -~ (bl(6l /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce Moskowitz (b)(6l mac.com>; l(b)( 6) @B ruce 6 Moskowitz .MD (bl( l mail.com> ; Marc Sherman l; IP (bH5l frenchange l59.com>; Foster , Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz , Ashwini ; Short, John (VACO) ; Myklegard, Drew ; ~(b_l<6_l -~ (bl(6l ; Cooper, Leslie mayo.edu> T., M.D. (bl<6l Cc: Bee: VA EHR Call Subject: Mon Mar 19 2018 13:32:31 EDT Date: Attachments: StartT ime: Tue Mar 20 18:30:00 Central Daylight Time 20 18 EndTime: Tue Mar 20 19:00:00 Central Daylight Time 2018 Location : l VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; l(bl< 6 l(bJ(l ~/o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce Moskowitz (bl(5l mac.com> ;l(bl(6l @Bruce 5 Moskowitz .MD (bJ(J mail.com> ; Marc Sherman 6 l(bl(5l @gmail.com>; IP (bl< frenchangel59.com>; Foster , Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz , Ashwini ; Short, John (VACO) ; Myklegard, Drew ; ~(b_l(6_l -~ (bl(6l ; Cooper, Leslie T., M.D.l(bl(6l @mayo .edu> Cc: Bee: VA EHR Call Subject: Mon Mar 19 2018 13:32 :31 EDT Date: Attachments: I StartTime: Tue Mar 20 18:30:00 Central Daylight Time 2018 EndTime: Tue Mar 20 19:00:00 Central Dayl ight Time 2018 Location : l(blC5l 5 Invitees: Blackburn , Scott R. ; Windom, John H.;l(bl(l !Bruce Moskowitz ; l(bl(5l @Bruce Moskowitz .MD'; Marc Sherman; IP; Foster, Michele SES ? Nostrant David K.; Draper , Anne; Zenooz, 5 l Cooper, Leslie T., M.D. Ashwini; Short, John (VACO); Myklegard, Drew; (bl< Recurring: No ShowReminder: No Accepted: Yes AcceptedTime: Mon Mar 19 13:39:00 Central Daylight Time 2018 I All, Dr. Cooper will not be able to participate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper. Thanks ,i(bl(6l I Scheduling POC:l.... ___ 5 __.I 202-631-0640 l~ (b-l( _l _____ __. @va.gov VA-18-0298-B-000139 Page 1296 of 23~~ of 9 871 Document ID: 0.7.1705.1223600 VAC IO Executive Schedule From: Blackburn, Scott R. ; Windom, John H. ; ~l (b_l(5_l -~ (bl(6l /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce Moskowitz (bl(6l mac.com> ; Carolyn@Bruce mail.com>; Marc Sherman Moskowitz .MD (bl(5l l(bl(6l @gmail.com>; IP(b)(GJ frenchangel59.com>; Foster , Michele (SES) ; Nostrant , David K. ; Draper , Anne ; Zenooz, Ashwini ; Short, John (VACO) ; Myklegard , Drew ; ,__ (bH l __, 6 (bl(l ; Cooper, Leslie mayo .edu> T., M.D.(bl(6l Cc: Bee: Subject: VA EHR Call Date: Mon Mar 19 2018 13:32:29 EDT Attachments: ~--__ All, Dr. Cooper will not be able to partici ate in the entire session so we are going to start at 7:30PM to _, (bl(5l get feedback from Dr. Cooper . Thanks ,,__ ___ Scheduling POC:~l (b_ l(5_l ___ _.I202-631-0640 5 l~ (b-l( _l -----~ @va.gov VA-18-0298-B-000140 Page 1297 of 23~io of 871 Document ID: 0.7.1705.1772560 From: Blackburn , Scott R. @gmail.com> ; Marc Sherman l(b)(6) To: 6 Bruce Moskowitz l(bHl l@mac.com> 5l l Bee: RE: [EXTERNAL] Re: FW: VA EHR Call Subject: Mon Mar 19 2018 08:40:55 EDT Date: Attachments: I Great. Talk to you then . Sent with Good (www.good.com) From: Marc Sherman Sent: Monday, March 19, 2018 8:21 :07 AM To: Blackburn, Scott R.; Bruce Moskowitz Subject: [EXTERNAL] Re: FW: VA EHR Call Scott In response to your question, I will be on the call at noon today. Marc Marc Sherman (202) 758-8700 On Mar 18, 2018 3:11 PM, "Blackburn, Scott R." wrote: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12:45 tomorrow. The intent of this was to have our contracting 5 guys (John Windom, l(b)( l ~ walk you through how to read the government contract (which is obviously very different from typical private sector contracts). I just want to make sure you are clear on the purpose of this call and check to make sure you still want to do this . We did this with each of the CIOs/Doctors last week. Scott VA-18-0298-B-000141 Page 1298 of 23~i 1 of 871 I From:l(bl(5> Sent: Sunday , March 18, 2018 2:36 PM To: Blackburn, Scott R. Subject: RE: VA EHR Call Mr. Blackburn, I had schedu led this call with Dr. Bruce and Marc Sherman for the contract overview. Do you want to keep it or can I cancel it? Thanks, l(bl(5l I -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday, March 15, 2018 11:23 AM To : VACIO Executive Schedule; l(bl(5l Blackburn , Scott R. ; Windom, John H.; 5 i< > @Bruce Moskowitz.MD; Marc Sherman ; Bruce Moskowitz Subject: VA EHR Call When: Monday, March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada). Where : l 6l @gmail.com>; Marc Sherman l(bl< To: Bruce Moskowitz l(bl(6l @mac.com> l(b)(6) Cc: wrote: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12 :45 tomorrow. The intent of this was to have our contracting guys (John Windom, l(bl(6l walk you through how to read the government contract (which is obviously very different from typical private sector contracts). I just want to make sure you are clear on the purpose of this call and check to make sure you still want to do this. We did this with each of the CIOs/Doctors last week. I Scott VA-18-0298-B-000143 Page 1300 of 23~i 3 of 871 I From:!(bl(5l Sent: Sunday , March 18, 2018 2:36 PM To: Blackburn, Scott R. Subject: RE: VA EHR Call Mr. Blackburn, I had schedu led this call with Dr. Bruce and Marc Sherman for the contract overview . Do you want to keep it or can I cancel it? Thanks J(bl(6l I -----Original Appo intment----From: VAC IO Executive Schedule Sent: Thursday, March 15, 2018 11 :23 AM Blackburn , Scott R. ; Windom, John H.; To: VACIO Executive Schedule :l(bl(5l l(bl(5l @Bruce Moskowitz.MD; Marc Sherman; Bruce Moskowitz Subject: VA EHR Call When : Monday, March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada) . Where : l(bl(5l I I VA-18-0298-B-000144 Page 130 1 of 23~i 4 of 871 Document ID: 0.7.1705.1530986 (b-)(G -) -----. @gmail.com> From: Marc Sherman l,To: Blackburn, Scott R. ; Bruce 5l mac.com> Moskowitz (b)( Cc: Bee: [EXTERNAL] Re: FW: VA EHR Call Subject: Mon Mar 19 2018 08:21 :07 EDT Date: Attachments: Scott In response to your question, I will be on the call at noon today. Marc Marc Sherman (202) 758-8700 On Mar 18, 2018 3:11 PM, "Blackburn, Scott R." wrote: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12:45 tomorrow. The intent of this was to have our contracting walk you through how to read the government contract (which is guys (John Windom r )(G) obviously very different from typical private sector contracts). I just want to make sure you are clear on the purpose of this call and check to make sure you still want to do this . We did this with each of the CIOs/Doctors last week. I Scott I From: l(b)(G) Sent: Sunday, March 18, 2018 2:36 PM To: Blackburn, Scott R. Subject: RE: VA EHR Call Mr. Blackburn, I had scheduled this call with Dr. Bruce and Marc Sherman for the contract overview. Do 6 you want to keep it or can I cancel it? Thanks, l(bl< l I -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday, March 15, 2018 11:23 AM 5 To: VACIO Executive Schedule; l(b)( l !Blackburn , Scott R.; Windom, John H.; 5 l(bl( l @Bruce Moskowitz.MD; Marc Sherman; Bruce Moskowitz Subject: VA EHR Call When: Monday, March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada) . VA-18-0298-B-000145 Page 1302 of 23~i 5 of 871 Where: W153 8-0298-B-000146 Page 1303 of 23111316 of an Document ID: 0.7.1705.505892 Blackburn , Scott R. 5 (bH l Cc: Bee: FW : [EXTERNAL] Re : VA EHR Call Subject: Sun Mar 18 2018 17:46:02 EDT Date: Attachments: I guess this means keep it (b_J5<_l _______ From: Bruce Moskowitz ._l Sent: Sunday, March 18, 2018 4:58 PM To: Blackburn, Scott R. (b-)(6-l -----~ Cc: Marc Sherman; ~l Subject: [EXTERNAL] Re: VA EHR Call _. @mac.com] Noted Sent from my iPad Bruce Moskowitz M.D. On Mar 18, 2018, at 3:11 PM, Blackburn, Scott R. wrote: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12:45 tomorrow. The intent of this was to have our contracting guys (John Windom, i Blackburn , Scott R. gmail.com> ; Marc Sherman (b)(BJ Cc: (bJ(5l /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: [EXTERNAL] Re: VA EHR Call Date: Sun Mar 18 2018 16:57:45 EDT Attachments: Noted Sent from my iPad Bruce Moskowitz M.D. On Mar 18, 2018, at 3:11 PM, Blackburn , Scott R. wrote: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12:45 tomorrow. The intent of this was to have our contracting walk you through how to read the government contract (which is guys (John Windom ,!(bl(5l obviously very different from typical private sector contracts). I just want to make sure you are clear on the purpose of this call and check to make sure you still want to do this . We did this with each of the CIOs/Doctors last week. I Scott l(b_HB _J_____ ___. From: .... Sent: Sunday, March 18, 2018 2:36 PM To: Blackburn, Scott R. Subject: RE: VA EHR Call Mr. Blackburn, I had scheduled this call with Dr. Bruce and Marc Sherman for the contract overview. Do you want to keep it or can I cancel it? Thanks ,l(bl(5l I -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday, March 15, 2018 11 :23 AM 5 l Blackburn , Scott R. ; Windom, John H.; To: VACIO Executive Schedule ;l(bJ( 6 l(bJ(l @Bruce Moskowitz ,MD; Marc Sherman; Bruce Moskowitz Subject: VA EHR Call When : Monday , March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada). Where: l(bl(5l I I VA-18-0298-B-000149 Page 1306 of 23~i 9 of 871 Document ID: 0.7.1705.1772156 Blackburn, Scott R. 6) Marc Sherman l(b)( l@gmail.com>; To: 6 mac.com> Bruce Moskowitz (b)( l (b)(6l /o=va/ou=exchange Cc: administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: FW: VA EHR Call Date: Sun Mar 18 2018 15:11:28 EDT Attachments: Bruce/Marc - I hope you are both having a great weekend. We have a call scheduled from noon-12 :45 tomorrow . The intent of this was to have our contracting walk you through how to read the government contract (which is guys (John Windom, l(DH5l obviously very different from typical private secto r contracts). I just want to make sure you are clear on the purpose of this call and check to make sure you still want to do this. We did this with each of the CIOs/Doctors last week. I Scott From:._l (b_)(6 _) _____ _. Sent: Sunday, March 18, 2018 2:36 PM To: Blackburn , Scott R. Subject: RE: VA EHR Call Mr. Blackburn, I had schedu led this call with Dr. Bruce and Marc Sherman for the contract overv iew. Do you want to keep it or can I cancel it? Thanks ,i(bl{5) I -----Original Appointment----From: VA CIO Executive Schedule Sent: Thur sday, March 15, 2018 11 :23 AM 5 l !Blackburn , Scott R. ; Windom, John H.; To: VACIO Executive Schedule; l(bl< l(b)<5l l@Bruce Moskowitz,MD; Marc Sherman; Bruce Moskowitz Subject: VA EHR Call When : Monday, March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada) . Where :l mail.com>; Marc Sherman (bl( 6l To: mac.com> Bruce Moskowitz (blC5l (b)(6) Cc: To: Blackburn, Scott R. Cc: Bee: Subject: RE: VA EHR Call Date: Sun Mar 18 2018 14:35:50 EDT Attachments: Mr. Blackburn, I had schedu led this call with Dr. Bruce and Marc Sherman for the contract overv iew. Do you want to keep it or can I cancel it? Thanks ,l Blackburn, Scott R. ; Windom, John H. ; l(bJ(Gl (bl(5l /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm> ; Bruce Moskowitz !(bl(5l J @mac.com>: l(bl(5l l:w,Bruce Moskowitz .MD l(bl(5l @gma il.com>; Marc Sherman (bl(6l gmail.com>; IP~frenchan el59.com>; Stephanie jhu.edu> ; Mary Riordan (bl(5 l ?hu.edu> ; Ashley Reel (bl(5l Johnson (blC6l jhmi.edu> ; (bl(6l '-----------' ; Rasu Shrestha 6l (blC gmail.com>; Manis , Jonathan (Jon) 6 (bl( l sutterhealth.org>; Shrestha, Rasu B (bl(6l upmc.edu> ; Cooper, Leslie T., M.D. (b)(GJ mayo.edu>; Karson, Andrew Scott,M.D. 5 (bJC l @mgh.harvard.edu>; Zuccala, Kandace (Kandi) R. (bJ(GJ sutterhea lth.org> Clifford Ko (bl(5l facs.org>; Mehwesh Cc: (b,..,., )(6 ,l,... ----, @imail.org> Khalid (bl(6l facs.org>; Stan Huff l,.,,. Bee: Subject: VA EHR Call Date: Sun Mar 18 2018 14:31:22 EDT Attachments: I Scheduling POC:l._ (bl_(5_ l __ ____.I 202-631-0640 and l._ (b-J(G _J _____ _,@va.gov All , I am including everyone in the group in case anyone has any last minute scheduling changes. Thanks, l(bl(6l I VA-18-0298-B-000153 Page 131 1 of 23~~ of 3 871 Document ID: 0.7.1705. 1218053 VAC IO Executive Schedu le From: VACIO Execu tive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ;1(bJ(BJ !(bl(5l j: /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm> ; Bruce Moskow itz !(bJ(6l @mac.com>; l(bJ(5l @ Bruce 5 Moskow itz ,MD l(bJ( l @gma il.com> ; Marc Sherman gmai l.com>; l~ frenchange l59 .com>; Stephanie (bl(6l ?hu.edu> ; Mary Riordan (bl(6l 'hu.edu> ; Ashley Ree l (bl(6l Johnso n (bJ(5l j hmi.edu> ; (bJ(5l __, ; Rasu Shrestha CbJ(BJ gmai l.com> ; Man is, Jonathan (Jon) (bl(6l sutterhealth.org >; Shrestha , Rasu B (b)(BJ upmc .edu> ; Cooper , Les lie T., M.D. (bH6l mayo.edu > ; Karson , Andrew Scott ,M.D . 5 (bJ(l @mgh .harvard.edu> ; Zuccala, Kandace (Kand i) R. (bJ(6l sutterhea lth.org > Cc : Clifford Ko~ facs.org >; MehweSQ 5 6l ~ facs.org >; Stan Huff f.... Khalid l(bJC Bee: VA EHR Call Subject: Sun Mar 18 2018 14:30:57 EDT Date: Attachments: I _______ StartT ime: Tue Mar 20 19:00 :00 Central Daylight Time 20 18 EndT ime : Tue Mar 20 20 :30:00 Central Dayl ight Time 2018 Location :l(b)(BJ Invitees : Blackburn , Scott R. ; Windom , John H.; Truex , Matthew; Bruce Moskowitz ; 'Caro l n Bruce Moskowitz .MD'; Marc Sherman; IP; Stephanie Reel ; Mary Riordan; 'Ashley Johnson'; (bl(6l !(bl(6l ! 'Rasu Shrestha'; Manis, Jonathan (Jon) ; 'Shrestha, Rasu B'; 'Cooper , Les lie.... T - .-, -M-.D - .,;.... Karson , Andrew Scott,M.D.; Zuccala , Kandace (Kandi) R. Recurring: No ShowReminder : Yes Rem inderMinutes : 15 Rem inderTime: Tue Mar 20 18:45 :00 Central Daylight Time 20 18 Accepted : No I l(b-J(B _J___ Schedul ing POC: .... 6 ..... 1202-631-0640 and l._ (b_ H_l _____ ..... @va.gov All, I am including everyone in the group in case anyone has any last minute schedul ing changes . Tha nks, l VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; .... (bl(5l ; Bruce 5 Moskowitz l(bl(6l @mac.com>; l ; Marc Sherman (bl(5l gmail.com>; IP~frenchan el59 .com>; Stephanie ?h .e u>; Mary Riordan(bl(5l 'hu.edu> ; Ashley Reel (bl(5l 5 Johnson (bH l jhmi.edu> ..,.._ (bl(6l ; Rasu Shrestha (bJ( 6J gmail.com> ; Manis , Jonathan (Jon) (bl(6l sutterhealth.org >; Shrestha , Rasu B (bJ(6J upmc .edu> ; Cooper , Leslie T., M.D. (bl(6l mayo.edu > ; Karson , Andrew Scott ,M.D. (bJ(6J mgh .harvard.edu> ; Zuccala, Kandace (Kandi) R. (bl<5l sutterhealth.org > facs.org >; Mehwesh Cc: Clifford Ko~ Khalid l(bl(6l @facs.org >; Stan Huff .-l (b-J6 < -l ----, @imail.org > Bee: VA EHR Call Subject: Sun Mar 18 2018 14:30:57 EDT Date: Attachments: ______ ~ StartTime: Tue Mar 20 19:00:00 Central Daylight Time 2018 EndTime : Tue Mar 20 20 :30:00 Central Dayl ight Time 2018 Location :l(bl(5l Invitees : Blackburn , Scott R. ; Windom , John H.;l(bl(5l !Bruce Moskowitz ; (bl(5l Bruce 6 Moskowitz .MD'; Marc Sherman; IP; Stephanie Reel ; Mary Riordan; 'Ashley Johnson'; (bl( l !(bl(6l 'Rasu Shrestha'; Manis, Jonathan (Jon) ; 'Shrestha, Rasu B'; 'Cooper , Leslie.... T - .-, -M-.D - .~,; Karson , Andrew Scott,M.D.; Zuccala , Kandace (Kandi) R. Recurring: No ShowReminder : Yes ReminderMinutes : 15 ReminderTime: Tue Mar 20 18:45:00 Central Daylight Time 2018 Accepted : Yes AcceptedTime: Sun Mar 18 13:54:00 Central Daylight Time 2018 I I <_ b l(6_l ---~1 Scheduling POC:l~ 202-631-0640 and l~ VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; l(bl< (bl(6l ; Bruce Moskowitz !(bl(Bl 7@mac.com>; ~ @Bruce Moskowitz .MD l(bl(5l @gma il.com> ; Marc Sherman gmail.com>; IP~frenchangel59 .com>; Stephanie (bl(6l 6l ?hu.edu> ; Mary Riordan (bl< 'hu.edu> ; Ashley ee (bl(6l Johnson (bl(5l jhmi.edu> ; (bl(5l --------' ; Rasu Shrestha (bl(6 l gmail.com> ; Manis , Jonathan (Jon) (bl(6l sutterhealth.org >; Shrestha , Rasu B (bl(6l upmc .edu> ; Cooper , Leslie T., M.D. (b)(Bl mayo.edu > ; Karson , Andrew Scott ,M.D . 5 (bl(l mgh .harvard.edu> ; Zuccala, Kandace (Kandi) R. (bl(6l @sutterhealth.org > 5 l facs.org >; Mehwesh Clifford Ko (bl< Cc : 5 Khalid (bl( l facs.org >; Stan Huff !. Bee: VA EHR Call Subject: Sun Mar 18 2018 14:30:57 EDT Date: Attachments: I StartTime: Tue Mar 20 19 :00 :00 Central Daylight Time 2018 EndTime : Tue Mar 20 20 :30:00 Central Dayl ight Time 2018 5 Location : !(bl< l Invitees : Blackburn , Scott R. ; Windom , John H.; l(bl(5l Bruce Moskowitz ; (bl(5l Bruce 6 Moskowitz .MD'; Marc Sherman; IP; Stephanie Reel ; Mary Riordan; 'Ashley Johnson'; (bl( l !(bl(6l ! 'Rasu Shrestha'; Manis, Jonathan (Jon) ; 'Shrestha, Rasu B'; 'Cooper , Leslie,_T __ _, -M-.D - .~,; Karson , Andrew Scott,M.D.; Zuccala , Kandace (Kandi) R. Recurring: No ShowReminder : No Accepted : Yes AcceptedTime: Sun Mar 18 13:54:00 Central Daylight Time 2018 I (b_ J(5_l __ Scheduling POC: ,_l _..1 202-631-0640 and !,_ (b_ l(5_l -----~ I @va .gov All, I am including everyone in the group in case anyone has any last minute scheduling changes. 5l Thanks, l Blackburn, Scott R. ; Windom, John H. ; l._ 6 ; Bruce (bl( l Moskowitz i(bl(5l @mac.com> ;l(bl(6l !@Bruce mail.com>; Marc Sherman Moskowitz .MD (bl(6l ................... ....,1 59.com>; Stephanie (bl(6l gmail.com>; I (bl(5l f,,........ 5 Ree1 ; Mary Riordan (bJ(Gl ?hu.edu>; Ashley jhmi.edu>; ._ ; Rasu Shrestha (bJ(6l gmail.com>; Manis , Jonathan (Jon) 5 (bl( l sutterhealth.org>; Shrestha, Rasu B (bl(6l upmc.edu>; Cooper, Leslie T., M.D. (bH6l mayo.edu >; Karson, Andrew Scott,M.D. (bl(5l mgh.harvard.edu> ; Zuccala, Kandace (Kand i) R. (bl(6l sutterhea lth.org> Clifford Ko~facs .org>; Mehwe s;.,..h __ ~ Cc: Khalid l(bl(6l @facs.org >; Stan Huff! Bee: VHA EHR Call Subject: Sun Mar 18 2018 14:30:55 EDT Date: Attachments: Scheduling POC : ._r_ l<5_l --~1 202-631-0640 and l._ (b-)(G _ ) ____ ___.@va.gov All, I am including everyone in the group in case anyone has any last minute scheduling changes. 5 l Thanks , j 6l (bJC Cc: Bee: Subject: RE: [EXTERNAL] Re : VA EHR call Date: Sun Mar 18 2018 14:19:24 EDT Attachments: Yes please I From: l wrote: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We will have at least 4 people confirmed (Manis, Reel, Shretha and Karson; likely Stan Huff as well which would make 5). Dr. Cooper I know is a single issue SME so we can probably do that one separately . Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call , on the call at that time . Thanks again for the help, Scott From: l(0 l<5l I Sent: Saturday , March 17, 2018 5:29 PM To : Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu VA-18-0298-B-000159 Page 1317 of 23~~ of 9 871 Karson (probably joining late) I know Dr. Ko is on travel Tuesday , but I haven 't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... l(b)(6) From: Blackburn, Scott R. Sent: Saturda y, March 17, 2018 2:28 PM To :l(bJ(6J Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High I Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we shou ld just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www .good .com) From: Karson , Andrew Scott ,M.D. Sent: Saturday, March 17, 2018 2:23:32 PM To: l(bJ{GJ I Cc: Blackburn , Scott R. ; l(bl<5l Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I I 5 Dea rl(bl< l I am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time VA-18-0298-B-000160 Page 1318 of 23~io of 871 before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy 5J From: !(bJ( @va .gov] Sent: Saturday, March 17, 2018 12: 15 PM 5 To: Karson, Andrew Scott,M.D. l(bH J @mgh.h~a;,.,.; rv""a~rd=?~e= du~>_______ 5 Cc: Blackburn, Scott R. ; l(bJ( l Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High _,, l@va.gov>; Good afternoon Dr. Karson, Thank you again for confi rming Tue sday works best for you. If we started the ca ll later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone. Thanks again! l(b)(6) 5 From: Karson, Andrew Scott,M.D. l(bJ( l @mgh.harvard .edu] Sent: Friday, March 16, 2018 7:22 PM To: !(bJ(6J I Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dea ~ so sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emails now. The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy 5 J @va .gov] From: l; Cooper, Leslie T., M.D. L... (b_ J5(_J --~~ -<.:...:.=..i....; To: Stan Huff (bJ( 5 Andrew Scott,M.D. (bJ(J mgh.harvard.edu>; Shrestha, Rasu B L... (b_J5(_J__ 5 Rasu Shrestha (bH J gmail.com> ___Jo: ~ VA-18-0298-B-000161 Pa ge 1319 of 23~i 1 of 871 Cc: Blackburn , Scott R. ; Windom , John H. ; l(bl(5l l(bl(6l ka2va.gov> ~-~ Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, ~ I From: l(b)(6J Sent: Friday, March 16, 20181:06 PM To : 'Stephanie Reel' ; 'Stan Huff'; ~ facs .org'; 'Cooper , Leslie T., M.D.'; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B'; 'Rasu Shrestha' 5 Cc: Blackburn , Scott R.; Windom, John H.;l(bl(5l 'Bruce Moskowitz': l(bl( l @Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Good afternoon, A friendly reminder to please let me know which date works best for your schedule . Please feel free to call me with any questions. Thank you , l(b)(6) From: ._l (b_ J(6 _J _____ _, Sent: Thursday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)';~ facs .org' ; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' 6l Bruce Moskowitz; !(bJ( l@Bruce Cc: Blackburn , Scott R.; Windom, John HJbl( 5l Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I VA-18-0298-B-000162 Page 1320 of 23~i 2 of 871 Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you, l(b)(6) l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 l(b_H6_l Cell: .... ___ __. The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www .partners.org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000163 Pag e 1321 of 23~i 3 of 871 Document ID: 0.7.1705. 1530082 l(bl(5l l To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re: VA EHR call Date: Sun Mar 18 2018 14:17:43 EDT Attachments: Yes , I think that wi ll work . I am going to invite everyone just in case folks have last minute changes to the ir schedu les. Do we want to do 90 minutes? From: Blackburn, Scott R. Sent: Sunda y , March 18, 2018 2:17 PM To: l(bH5l Subj ect: RE: [EXTERNAL] Re: VA EHR call Importance : High I Yes , let's do it. I know Stan Huff can 't jo in. Perhaps we have a second call on Wed nesday for anyone who couldn't jo in. I From: l(bl(6l Sent: Sunday , March 18, 2018 2:16 PM To: Blackburn, Scott R. Subject: FW: [EXTERNAL ] Re: VA EHR call Mr. Blackburn, let me know if I can send the invite out for Tuesday at 8PM. It looks like Dr. Cooper can now join for the first half of the call. Thanks, l(bl(6l I 5 From: Bruce Moskowitz ._l (b_l( _> _______ Sent: Sunday , March 18, 20 18 1:50 PM To: Blackbu rn, Scot,'t _R_. --------. Cc: Marc Sherman; ,...l (b_l(5_> _____ _., Subject: [EXTERNAL] Re: VA EHR call ____. @mac .com] VA-18-0298-B-000164 Page 1322 of 23~i 4 of 871 Ok Sent from my iPad Bruce Moskowitz M.D. On Mar 18, 2018 , at 12:28 PM, Blackburn , Scott R. wrote: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors . We will have at least 4 people confirmed (Manis, Reel , Shretha and Karson; likely Stan Huff as well which would make 5). Dr. Cooper I know is a single issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call, on the call at that time . Thanks again for the help , Scott I From: l(bJ(6J Sent: Saturday , March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probably joining late) I know Dr. Ko is on travel Tuesday , but I haven't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. VA-18-0298-B-000165 Pa ge 1323 of 23~i 5 of 871 So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... From: Blackburn, Scott R. Sent: Saturday , March 17 [ 2018 2:28 PM To: l(b)(6) Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we should just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www.good.com) From: Karson , Andrew Scott,M.D. Sent: Saturda March 17, 2018 2:23:32 PM To : (b)(6) Windom, John H. Cc: Blackburn, Scott R. ; (bl{5l Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dearl(bl<5l I am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy From:~l Cc: Blackburn , Scott R. Jb)(G) Windom, John H. Subject: RE: Schedu ling a Cal l Regarding Feedback on VA EHR Impo rtance : High ...., l@va.gov> ; Good afternoon Dr. Karson, Thank you again for confirming Tuesday works best for you . If we started the call later in the evening , between 5-8PM EST would you still be available? So far Tuesday seems to work best for eve ryone . Thanks again! l(b)(6) From: Karson , Andrew Scott ,M.D. l(b)C5l @mgh.harvard .edu ) Sent: Friday, March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTE RNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dea rl(b)(G)lso sorry for the delay getting back to you ; I have been on the road most of yesterday/today and first catching up on emai ls now . The only time among those three that I can do is the Tuesday time . (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy From: !(Dl<6l @va .gov] Sent: Friday , March 16, 2018 7:12 PM .....,,..,.:-:::-='-'-='-'-i To : Stan Huff (b)(6) imai l.org>; Cooper, Leslie T., M.D. L; Shrest ha, Rasu B .... Cc: Blackburn, Scott R. ; Windom , John H. ; l(b)(6) @va.gov> --l(b)(5l Subject: RE: Schedu ling a Call Rega rding Feedback on VA EHR Importance : High Good evening , VA-18-0298-B-000167 Page 1325 of 23~i 7 of 871 Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening , l(b)(6) From: ._l ---~ The information in this e-ma il is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information , please contact the Partners Compliance Helpline at http://www.partners.org/comp liance line . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000169 Page 1327 of 23~i 9 of 871 Document ID: 0.7.1705.505774 Blackburn , Scott R. (bl(5l Cc: Bee: Subject: RE: [EXTERNAL] Re: VA EHR call Date: Sun Mar 18 2018 14:16:40 EDT Attachments: Yes , let's do it. I know Stan Huff can 't jo in. Perhaps we have a second call on Wednesday for anyone who couldn 't jo in. I From: l(bJ(6) Sent: Sunday , March 18, 2018 2:16 PM To : Blackburn , Scott R. Subje ct: FW: [EXTERNAL ] Re: VA EHR call Mr. Blackburn , let me know if I can send the invite out for Tue sday at 8PM. It looks like Dr. Cooper can now join for the first half of the call. Thanks ,l(bl<5l I From: Bruce Moskowit z ... l(b...,. H6..,. l ---,----,-------_, Sent: Sunday , March 18, 2018 1:50 PM ~-~-------, To : Blackburn, Scotti-'R Cc: Marc Sherman ; l._ w rote: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We wi ll have at least 4 people confi rmed (Manis, Reel, Shretha and Karson; likely Stan Huff as well which VA-18-0298-B-000170 Page 1328 of 23~~ of 0 871 would make 5) . Dr. Cooper I know is a single issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call , on the ca ll at that time . Thanks again for the help, Scott I From: l(b)(6 l Sent: Saturday, March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE : [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probably joining late) I know Dr . Ko is on travel Tuesday , but I haven't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... l(b)(6) VA-18-0298-B-000171 Page 1329 of 23~~ of 1 871 From: Blackburn, Scott R. Sent: Sat~rdav March 17, 2018 2:28 PM To: l(bH5l Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we shou ld just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www.good .com) From: Karson , Andrew Scott ,M.D . Sent: Saturda , March 17, 2018 2:23:32 PM To : (b)(6) 5 Cc: Blackburn , Scott R. ; (bH l Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR 5 Dea rl(bl< l 11 am participating in a ceremony at 630 pm on Tuesday, but I could be on the VA call any time before that. (Also , I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy From: {b)(5l @va .gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott,M.D. !(b){6) @mgh.h,..;a a"'"" rv'""" aa.;.. rd = .~e"'" d= u> _______ 5 Cc: Blackburn , Scott R. : l(bHl Windom, John H. Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High ...., @va.gov> ; Good afternoon Dr. Karson, Thank you again for confirming Tuesday works best for you . If we started the call later in the evening, VA-18-0298-B-000172 Page 1330 of 23~~ of 2 871 between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson, Andrew Scott ,M.D. i; Karson, To: Stan Huff (bl(6l imail.org>; Cooper, Leslie T., M.D. (bl<5l 5 mgh.harvard .edu >; Shrestha , Rasu B (bl(5l upmc .edu>; Andrew Scott ,M.D. (bl(l 5 Rasu Shrestha (bl< l gmail.com > 5 Cc: Blackburn. Scott R. ; Windom , John H. ;l,..... (b_ l( _l _ _, 5 l taJva.gov> l(bH Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) From: l(bl(5l Sent: Friday, March 16, 20181:06 PM facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; To: 'Stephanie Reel'; 'Stan Huff ;~ 0 VA-18-0298-B-000173 Page 133 1 of 23~~ of 3 871 'Shrestha, Rasu B'; 'Rasu Shrestha' 'Bruce Moskowitz'; l(bl(5l @Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(bl(5l Moskowitz.MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman '; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Good afternoon, A friendly reminder to please let me know which date works best for your schedule. Please feel free to call me with any questions. Thank you, l(b)(6) From: ~l 'b_l' _l _____ ~ Sent: Thursday, March 15, 2018 7:27 PM facs.org'; 'Cooper , Leslie T. , M.D.'; To: Stephanie Reel; 'Stan Huff; 'Manis, Jonathan (Jon)' ; ~ 'Karson , Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' 5 Bruce Moskowitz; l'bl( l ~Bruce Cc: Blackburn, Scott R. ; Windom, John H.; l(bl(6l Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR 5 I Good evening, We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule. Feel free to call me with any questions and I look forward to hearing from you . Thank you, l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology VA-18-0298-B-000174 Page 1332 of 23~~ of 4 871 US Department of Veterans Affairs Desk: 202 -461-6288 Cell : l.... (b_J To: Blackburn, Scott R. Cc: Bee: Subject: FW: [EXTERNAL] Re: VA EHR call Date: Sun Mar 18 2018 14:16:00 EDT Attachments: I Mr. Blackburn, let me know if I can send the invite out for Tuesday at 8PM . It looks like Dr. Cooper can now join for the first half of the call. Thanks ,i(bH5l I From: Bruce Moskowitz ._l wrote: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We will have at least 4 people confirmed (Manis, Reel, Shretha and Karson; likely Stan Huff as well which would make 5) . Dr. Cooper I know is a sing le issue SME so we can probably do that one separately . Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call, on the call at that time . Thanks again for the help, Scott VA-18-0298-B-000176 Page 1334 of 23~~ of 6 871 From: ~l(b_)(6_) -----~ Sent: Saturday , March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probably joining late) I know Dr. Ko is on travel Tuesday , but I haven 't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 2:28 PM To: l(b)(6) I Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we should just pick one (either Mon , Tues or Wed night) and just go with it. VA-18-0298-B-000177 Page 1335 of 23~~ of 7 871 Sent with Good (www.good .com) From: Karson, Andrew Scott ,M.D . Sent: Saturda March 17, 2018 2:23:32 PM To: (b)(6) Cc: Blackburn , Scott R.; {bl(5J Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dear l(bl(5ll I am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy @va .gov] From: l(bl<5l Sent: Saturday, March 17, 2018 12:15 PM @mgh.h;;;a;,.,.; rv,,._ a-rd- ?-e-du- >_______ To : Karson, Andrew Scott,M.D. l(bl(5l Cc: Blackburn , Scott R. ; l(bl(5l Windom , John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High _, @va.gov> ; Good afternoon Dr. Karson , Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone. Thanks again! From: Karson, Andrew Scott ,M.D. l(b)(5l l@mgh.harvard.edu ] Sent: Friday , March 16, 2018 7:22 PM To: l(bH5l I Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR VA-18-0298-B-000178 Page 1336 of 23~~ of 8 871 5 Dear i; Cooper, Leslie T., M.D. L; Shrestha , Rasu B (bl<5l upmc .edu> ; gmail.com> Rasu Shrestha (bl(5l 5 Cc: Blackburn , Scott R. ; Windom , John H. ; i Blackburn, Scott R. gmail.com> ; Marc Sherman (bl<5> !(bl(6l I l(bl(5> To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Re: VA EHR call Sun Mar 18 2018 13:50:25 EDT Ok Sent from my iPad Bruce Moskowitz M.D. On Mar 18, 2018, at 12:28 PM, Blackburn , Scott R. wrote: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We will have at least 4 people confirmed (Manis, Reel , Shretha and Karson; likely Stan Huff as well which would make 5) . Dr. Cooper I know is a sing le issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the ca ll, on the ca ll at that time . Thanks again for the help, Scott From: .... l(b_J(6 _>_____ _. Sent: Saturday , March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: VA-18-0298-B-000181 Page 1340 of 23~i 1 of 871 Manis Reel Rasu Karson (probably joining late) I know Dr. Ko is on travel Tuesday , but I haven't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed. Let me know ... l(b)(6) From: Blackburn, Scott R. Sent: Saturda y , March 17, 2018 2:28 PM To :l(bJ(6l Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High I Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we should just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www.good .com) From: Karson , Andrew Scott ,M.D. Sent: Saturday , March 17, 2018 2:23:32 PM VA-18-0298-B-000182 Page 134 1 of 23~i 2 of 871 To: (b)(6J Cc: Blackburn , Scott R.; (bl(5l Windom , John H. Subject: [EXTERNA L] RE: Scheduling a Call Rega rding Feedback on VA EHR Dea rl(bl(5l 11 am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time before that. (Also, I'll try to learn more about the tim ing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy From:l(bl(5l @va .gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott ,M.D. l(bl(5l @mgh.h""" a__ rv-'a"-r-= d""" .e"'"" d-= u_>______ 5 Cc: Blackburn , Scott R. ;l(bH l Windom, John H. Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High __, @va.gov >; Good afternoon Dr. Karson , Thank you again for confirming Tuesday works best for you . If we started the call later in the even ing, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson , Andrew Scott ,M.D. l(bl<5l @mgh.harvard .edu] Sent: Friday, March 16, 2018 7:22 PM To :l(bJ(6l Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dea ~ so sorry for the delay getting back to you ; I have been on the road most of yesterday/today and first catching up on emai ls now . The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy VA-18-0298-B-000183 Page 1342 of 23~i 3 of 871 From: l(bl(5l @va .gov] Sent: Friday, March 16, 2018 7:12 PM imail.org>; Cooper, Leslie T., M.D. L. ; Shrestha , Rasu B (bl(5l upmc .edu> ; gmail.com> Rasu Shresth (bl(5l 5 Cc: Blackburn; Scott R. ; Windom , John H. ; l l(bJ(6J Subject: RE: chedu ling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friend ly reminder to please let me know which dates works best for your schedule. Have a great evening , l(b)(6) From: ._l (b_H5_l _____ _. Sent: Friday, March 16, 20181:06 PM To : 'Stephanie Reel' ; 'Stan Huff';~ facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John HJ bl(5l 'Bruce Moskowitz': l(bl(5l @Bru ce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regard ing Feedback on VA EHR Importance : High I Good afternoon, A friendly reminder to please let me know which date works best for your schedule . Please feel free to call me with any questions. Thank you , l(b)(6) From: ... l(b_J6 (_l -----~ Sent: Thursday, March 15, 2018 7:27 PM To: Stephan ie Ree l; 'Stan Huff; 'Manis, Jonathan (Jon)' ;~ facs.org' ; 'Cooper , Leslie T., M.D.' ; 'Karson , Andrew Scott ,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' VA-18-0298-B-000184 Page 1343 of 23~i 4 of 871 Cc: Blackburn , Scott R.; Windom, John H.; l(bl(5l !Bruce Moskowitz;!(bl(5l @Bruce Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you, (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461-6288 Cell :~l (b_J(6 _J---~ The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www .partners .org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000185 Pa ge 1344 of 23 ~i 5 of 871 Document ID: 0.7.1705. 1529943 Marc Sherman l(bl(5l @gmail.com> From: To: Blackburn, Scott R. Cc: Bruce Moskow itz l(b)(6l @mac.com>; ~l (b_J(6 _l _____ Bee: Subject: [EXTERNAL ] Re: VA EHR call Date: Sun Mar 18 2018 12:36:53 EDT Attachments: ~ Yes, that works for me. Marc Sherman (202) 758-8700 On Mar 18, 2018 12:28 PM, "B lackburn, Scott R." wrote : Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We wi ll have at least 4 people confirmed (Manis, Reel, Shretha and Karson; likely Stan Huff as well which would make 5). Dr. Cooper I know is a single issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call, on the call at that time . Thanks again for the help, Scott From: ~l (b_HG _l _____ ___, Sent: Saturday, March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNA L] RE: Schedul ing a Call Regard ing Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis VA-18-0298-B-000186 Page 1345 of 23~i 6 of 871 Reel Rasu Karson (probab ly joining late) I know Dr. Ko is on travel Tuesday , but I haven 't heard what time he lands . I think Dr. Cooper is also on trave l and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know .. . l(b)(6) From: Blackburn, Scott R. Sent: Saturda y, March 17, 2018 2:28 PM To: l(b)(GJ Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Maybe pulse Monday/Wednesday nights as we ll (seems after 6pm might work best for these folks)? Then i think we shou ld just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www.good .com) From: Karson, Andrew Scott ,M.D. Sent: Saturda y, March 17, 2018 2:23:32 PM To: l(bJ(6l I VA-18-0298-B-000187 Page 1346 of 23~i 7 of 871 I Cc: Blackburn , Scott R. ; l<0 l<5l Windom , John H. Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Dea~ I am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy @-va.gov] From: <0 l<5l Sent: Saturday , March 17, 2018 12:15 PM l@mgh.harvard.edu> To: Karson, Andrew Scott,M.D. i<0 l<5l Cc: Blackburn , Scott R. ;""i <0""" l<5,.,.... l ----------. Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High ~va.gov> ; Good afternoon Dr. Karson, Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)( 6) From: Karson , Andrew Scott ,M.D.I<0 l<5l @mgh.harvard .-edu] Sent: Friday , March 16, 2018 7:22 PM To :l; Cooper, Leslie T., M.D. (bl(5l .edu> ; Karson, 6 mgh.harvard.edu>; Shrestha , Rasu (b)(G) upmc.edu> ; Andrew Scott,M.D. (b)(l gmail.com> Rasu Shrestha (bl(5l Cc: Blackburn, Scott R. ; Windom , John H. ; l(b)(G) l(b)(6) l@?va.gov> .____ __. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, r )(6) I From: l To: Bruce Moskowitz 5 (bl<5l mac.com>; Marc Sherman ~l (b_ l<_l --~ Cc: ._,__.......,...__,.,. _. /o=va/ou=exchange a m1nistrat1ve group (fydibohf23spdlt)/cn= recipients/cn=vacocallae2> Bee: Subject: VA EHR call Date: Sun Mar 18 2018 12:28:34 EDT Attachments: (R)gmail.com> ___ Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Doctors. We wi ll have at least 4 people confirmed (Manis, Ree l, Shretha and Karson; likely Stan Huff as well which would make 5). Dr. Cooper I know is a sing le issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I wi ll get everyone from VA who needs to be on the call, on the call at that time. Thanks again for the help, Scott From: ~' (b_JG (_J-----~ Sent: Saturday, March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNA L] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probab ly joining late) VA-18-0298-B-000191 Page 1350 of 23~i 1 of 871 I know Dr. Ko is on travel Tuesday , but I haven't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... l(b)(6) From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 2:28 PM To: l To: Karson, Andrew Scott,M.D. l(bl(5l Cc: Blackburn , Scott R. ; ,....l (b_, l<6,.... l ------------.l Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High @va.gov> ; Good afternoon Dr. Karson , Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson , Andrew Scott ,M.D Jbl(5l l@mgh.harvard .edu] Sent: Friday, March 16, 2018 7:22 PM To: l(b)(6l l Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dearl(bl(5l so sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emails now. The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy 5 From:l(bH l @va.gov] Sent: Friday, Mar h 1 2018 7:12 PM imail.org>; Cooper, Leslie T., M.D. L='-'-'-"'-'"-, To: Stan Huff (bl(5l 5 Andrew Scott,M.D . (bl(l mgh.harvard.edu>; Shrestha , Rasu B (bl(5l upmc .edu> ; gmail.com> Rasu Shrestha (bl(5l 5 Cc: Blackburn , Scott R. ; Windom , John H. ; .... l Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High VA-18-0298-B-000193 Pa ge 1352 of 23~i 3 of 871 Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening , l(b)(6) From: ._l (b_J(6 _>______ _. Sent: Friday, March 16, 20181:06 PM To: 'Stephanie Reel'; 'Stan Huff';~ facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson, Andrew Scott,M.D.'; 'Shrestha, Rasu B'; 'Rasu Shrestha' l'Bruce Moskowitz'; l(bl(6> @Bruce Cc: Blackburn , Scott R.; Windom, John H.; l(bl(5> Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High Good afternoon, A friendly reminder to please let me know which date works best for your schedu le. Please feel free to call me with any questions. Thank you, l(b)(6) From: ._l (b_JB < _>______ _, Sent: Thursday , March 15, 2018 7:27 PM To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)' ;~ facs.org'; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' Bruce Moskowitz: l @Bruce Cc: Blackburn , Scott R.; Windom, John H.;l Moskowitz.MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to VA-18-0298-B-000194 Page 1353 of 23~i 4 of 871 schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you , (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: l< .... b_)<6_) ___ ___, The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www.partners.org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000195 Page 1354 of 23~is of 871 Document ID: 0.7.1705.505723 From: Blackburn, Scott R. To: Bruce Moskowitz 5 l'bl(5> ' mac .com>; Marc Sherman l'bl( > ~ gmail.com> l(b) (6) _ Cc: Bee: Subject: VA EHR call Date: Sun Mar 18 2018 12:28:34 EDT Attachments: Bruce/Marc - it is looking like Tuesday 8pm ET is going to work best for our CIOs/Docto rs. We wi ll have at least 4 people confirmed (Manis, Reel, Shretha and Karson; likely Stan Huff as well which would make 5) . Dr. Cooper I know is a sing le issue SME so we can probably do that one separately. Dr. Ko has a tough schedule all this week. Would Tuesday 8pm work for you/Marc? If so - we will press for that time. I will get everyone from VA who needs to be on the call, on the call at that time . Thanks again for the help, Scott 5 From: ~l 'b_ >,_>-----~ Sent: Saturday, March 17, 2018 5:29 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probab ly joining late) VA-18-0298-B-000196 Pag e 1355 of 23~i 6 of 871 I know Dr. Ko is on travel Tuesday , but I haven't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last email. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed. Let me know ... 1(0)(6) From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 2:28 PM To:l(b)(6l Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we shou ld just pick one (either Mon, Tues or Wed night) and just go with it. Sent with Good (www.good.com) From: Karson , Andrew Scott,M.D. Sent: Saturda March 17, 2018 2:23:32 PM To: (0)(6l 6l Cc: Blackburn, Scott R. ; (Ol( Windom, John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR 5 Dea rl(Ol(l 11 am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy VA-18-0298-B-000197 Pa ge 1356 of 23~i 7 of 871 From: r l(5l t@va.gov] Sent: Satu rday, Marc h 1 7, 2018 12: 15 PM l@mgh.hr"a'-'rv.:..:: a=r=d = .e=d=u_>______ To: Karson, Andrew Scott,M.D. l'b)(BJ Cc: Blackburn , Scott R. ; l'bl<5l Windom, John H. Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance: High ~ ~va .gov>; Good afternoon Dr. Karson, Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone. Thanks again! ~ 5 From: Karson , Andrew Scott ,M.D .l(bJ( l @mgh .harvard .edu] Sent: Friday , March 16, 2018 7:22 PM To l(bJ(BJ Subject: [EXTERN AL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dea ~ o sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emai ls now. The on ly time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy From:l(bJ(BJ @va .gov] Sent: Friday , March 16 2018 7:12 PM 5 To: Stan Huff (bl<5l imail.org>; Cooper, Leslie T., M.D. (bl< l Andrew Scott,M.D. (bl<6l mgh.harvard.edu>; Shresth ~a -, ....-=as=u..,...,..,.-r:: ; Rasu Shresth (bJ(5l gmail.com> Cc: Blackburn, Scott R. ; Windom , John H. ; l ~-~ Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importanc e: High VA-18-0298-B-000198 Page 1357 of 23~ia of 871 Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening , l(b)(6) __. From: ..... l(b_J(6 _l _____ Sent: Friday, March 16, 2018 1:06 PM facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; To : 'Stephanie Reel' ; 'Stan Huff' ; ~ 'Shrestha, Rasu B'; 'Rasu Shrestha' 'Bruce Moskowitz': l(bl(5l @Bruce Cc: Blackburn , Scott R. ; Windom, John H.:l(bl(5> Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan' ; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regard ing Feedback on VA EHR Importance : High I Good afternoon, A friendly reminder to please let me know which date works best for your schedule . Please feel free to call me with any questions. Thank you , r )(6) From: ..... l(b_J(6 _>_____ __, Sent: Thursday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)'; ~ facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B': 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.:l(bl(5l Bruce Moskowitz ;l(bl(5l @Bruce Moskowitz .MD' ; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have VA-18-0298-B-000199 Page 1358 of 23~i 9 of 871 been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule. Feel free to call me with any questions and I look forward to hearing from you. Thank you, (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell: .... l To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL ] RE: Scheduling a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 17:29:11 EDT Attachments: It looks like if we do 8PM on Tuesday we can get: Manis Reel Rasu Karson (probably joining late) I know Dr. Ko is on travel Tuesday, but I haven 't heard what time he lands. I think Dr. Cooper is also on travel and has not responded to the last emai l. Dr. Huff has not responded to the last email. So maybe we go with Tuesday at 8PM. Depending on what Ko, Cooper and Huff say we can let Dr. Bruce engage with them if needed . Let me know ... l(b)(6) From: Blackburn, Scott R. Sent: Saturday , March 17, 2018 2:28 PM To: l(b)(6l I VA-18-0298-B-000201 Page 1360 of 231i 1 of 871 Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High Maybe pulse Monday/Wednesday nights as well (seems after 6pm might work best for these folks)? Then i think we should just pick one (either Mon, Tues or Wed night) and just go with it. Sent with Good (www.good.com) From: Karson, Andrew Scott ,M.D. Sent: Saturda March 17, 2018 2:23:32 PM To: (bJ(6l 6l Cc: Blackburn , Scott R. ; (bl< Windom, John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR 5 Dearl(bH ll I am participating in a ceremony at 630 pm on Tuesday, but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy From:r )(G) l@va .gov] Sent: Saturday, March 17, 2018 12:15PM l@mgh.h~a_rv_a_rd _ ._e_d_ u> _______ To: Karson, Andrew Scott,M.D. l(b)(GJ 5 Cc: Blackburn , Scott R. ; l(bH l Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High ~ ~va.gov> ; Good afternoon Dr. Karson, Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone. Thanks again! ~ VA-18-0298-B-000202 Pa ge 1361 of 231i 2 of 871 From: Karson, Andrew Scott,M.D. l(bl<6l @mgh.harva rd.edu ] Sent: Friday, March 16, 2018 7:22 PM To: l(bl(6l Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dearl(bl(5l lso sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emails now. The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday.) Many thanks and best, Andy @va .gov] From: (bl(5l Sent: Friday, March 16, 2018 7:12 PM @imail.org>; Cooper, Leslie T ., M.D . {bl{5l To: Stan Huff l(bl(5l L....-=- - =-r:=-~.;;;.;...,.... ,_:__? Andrew Scott,M.D . l(bl(6l @mgh.harvard.edu>; Shrestha , Rasu B L... Cc: Blackburn , Scott R. ; Windom , John H. ; l(bl(6l l(bl<6l @va.gov> ._ _ _, Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High ___J = Good evening , Another friend ly reminder to please let me know which dates works best for your schedule. Have a great evening, ~ From: .... l(b_J< G _l _____ __, Sent: Friday, March 16, 20181:06 PM To: 'Stephanie Reel'; 'Stan Huff';~ facs .org'; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; .---------. c6 1........ 'Shrestha, Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.:l 5 (bJ< l Cc: Bee: Subject: FW: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 14:27:57 EDT Attachments: Maybe pulse Monday/Wednesday nights as we ll (seems after 6pm might work best for these folks)? Then i think we shou ld just pick one (either Mon , Tues or Wed night) and just go with it. Sent with Good (www .good .com) From: Karson , Andr ew Scott ,M.D . Sent: Saturday , March 17, 2018 2:23 :32 PM To: (b)(6) Cc: Blackburn , Scott R. ; (bl<5l Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR II Dearl______ Cc: Blackburn , Scott R. ; l Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Impo rtance : High _, l@va.gov> ; Good afternoon Dr. Karson , VA-18-0298-B-000206 Page 1365 of 231i 6 of 871 Thank you again for confirm ing Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b) (6) From: Karson, Andrew Scott,M.D. [mailto:AKARSON@mgh.harvard.edu) Sent: Friday, March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Isa Dea rl(b)(5) sorry for the delay getting back to you ; I have been on the road most of yesterday/today and first catching up on emai ls now. The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy From: l(bl(5l @va .gov] Sent: Friday, March 16 2018 7:12 PM To : Stan Huff(b)<5l ?1org>; Cooper, Leslie T ., M.D. L.. (b-)(5_l ____ ..,,..,..,:::----' =:..:..::::.ic...; Andrew Scott, (bJ(5l mgh.harvard.edu>; Shrestha, Rasu B (b)(5) upmc .ed u>; Rasu Shrestha (b)(G) gmai l.com> 5 Cc: Blackburn, Scott R. ; Windom , John H.< John .Windom@va.gov >; l.._ (b)_( _ l ____. l(b)(G) @va.gov> Subject: RE : Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening, Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) VA-18-0298-B-000207 Page 1366 of 231i 7 of 871 From: ~l (b_ J5(_l _____ __. Sent: Friday, March 16, 2018 1:06 PM facs.org'; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; To: 'Stephanie Reel'; 'Stan Huff' ;~ 'Shrestha, Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.; l(bl(5l 'Bruce Moskowitz'; l(bl(5l l@Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I Good afternoon, A friendly reminder to please let me know which date works best for your schedule. Please feel free to call me with any questions. Thank you , l(b)(6) From: .... l(b_J(6 _l _____ __. Sent: Thursday, March 15, 2018 7:27 PM 6ll@facs .org' ; 'Cooper , Leslie T., M.D.'; To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)' ; l(bH 'Karson, Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' Bruce Moskowitz; !(bl(6l l@Bruce Cc: Blackburn , Scott R. ; Windom, John H.; !(bl(5l Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you, (b)(6) VA-18-0298-B-000208 Page 1367 of 231ia of 871 Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce11 :l~ (b_ J6 <_J ---~ The information in this e-mai l is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www.partners.org/comp liance line . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000209 Page 1368 of 231i 9 of 871 Document ID: 0.7.1705.505283 From: Blackburn , Scott R. (bJ(6J To: '-,------,------,----,---,---' ______ Cc: Blackburn , Scott R. ; l(0 H5l Windom, John H.< John .Windom@va .gov> Subject: RE: Scheduling a Call Regard ing Feedback on VA EHR Importance : High ___, l@va.gov> ; Good afternoon Dr. Karson , VA-18-0298-B-000210 Page 1369 of 231~o of 871 Thank you again for confirming Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson , Andrew Scott,M.D .l'bJ(GJ @mgh.harvard .edu] Sent: Friday , March 16, 2018 7:22 PM To: l(bJ(GJ Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I I Dea rl(b)(GJ so sorry for the delay getting back to you ; I have been on the road most of yesterday /today and first catching up on emails now . The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best, Andy @va .gov] From: l(bJ(GJ Sent: Friday , March 16, 2018 7:12 PM To: Stan Huff (b)(GJ imail.org>; Cooper, Leslie T ., M.D. (b)(GJ .edu >; Karson , mgh.harvard.edu>; Shrestha , Rasu B (b)(GJ upmc.edu> ; Andrew Scott,M.D. (b)(GJ Rasu Shrestha (b)(GJ gmail.com> Cc: Blackburn, Scott R. ; Windom , John H. ;l(bJ(GJ l(b)(GJ @va.gov> ~-~ Subject: RE : Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) VA-18-0298-B-000211 Page 1370 of 231~ of 1 871 From: 1(0)(6) I ""-l (o'--'J<6 -'J _ _. Sent: Friday, March 16, 2018 1:06 PM To: 'Stephanie Reel'; 'Stan Huff; 'cko@facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha, Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.; Truex, Matthew ; 'Bruce Moskowitz'; 'Ca rolyn@Bru ce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan' ; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good afternoon, A friendly reminder to please let me know which date works best for your schedu le. Please feel free to call me with any quest ions. Thank you , Liz I _! Cc: Blackburn , Scott R. ; ~l ; Windom, John H. Bee: Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 14:23:32 EDT Attachments: 1 5 Dearl(bH l 11 am participating in a ceremony at 630 pm on Tuesday, but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy @va .gov] From: l(bH5l Sent: Saturday, March 17, 2018 12:15 PM @mgh.harvard.edu> To: Karson, Andrew Scott ,M.D. l(b)(GJ Cc: Blackburn , Scott R. ; ,.... l Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High @va.gov>; Good afternoon Dr. Karson, Thank you again for confirm ing Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone. Thanks again! (b_l(5_i _____ From: Karson, Andrew Scott ,M.D. ~l @mgh.harvard.edu) VA-18-0298-B-000214 Page 1373 of 231~ of 4 871 Sent: Friday, March 16, 2018 7:22 PM To: l(b)(GJ Subject: [EXTERNA L] RE: Scheduling a Call Rega rding Feedback on VA EHR I Dear l(bl<5l lso sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emai ls now . The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday.) Many thanks and best, Andy From: l(bl(5l @va.gov] Sent: Friday, March 16, 2018 7:12 PM To: Stan Huff (bl(6 l ? ? org>; Cooper, Leslie T., M.D. (bl(5l 5 6,.... Andrew Scott,M.D. (blCl mgh.harvard.edu>; Shrestha._,--= R=-a-s-u"""' B,....,,,..., ; gmail.com> Rasu Shrestha (bl(5l 5 ; Windom , John H. ; l..... 5 l(bl( l @va.gov> Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) From: ,....l (b_ J6 (_l -----~ Sent: Friday, March 16, 20181:06 PM To: 'Stephanie Ree l'; 'Stan Huff' ;~ facs .org'; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha, Rasu B'; 'Rasu Shrestha' l'Bruce Moskow itz';l(bl(6l l@Bruce Cc: Blackburn , Scott R. ; Windom, John H.; l(bl(6l Moskowitz .MD'; 'Ash ley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High Good afternoon, VA-18-0298-B-000215 Page 1374 of 231~ of 5 871 A friendly reminder to please let me know which date works best for your schedule . Please feel free to call me with any questions. Thank you , l(b)(6) I From: l(b){6) Sent: Thursday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jonr;l ~ @facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson, Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' Bruce Moskowitz; l(b)(5) @Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6l Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST . Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you, (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell :l..... (b_ ) (b) (6) To: ____ __, (fydibohf23spdlt)/cn= recipients/cn =vacoblacks 1>;._l Bee: Subject: [EXTERNAL] RE: Scheduling a Ca ll Regarding Feedback on VA EHR Sat Mar 17 2018 14:23:32 EDT Date: Attachments: Dear l(bl(6>11am partic ipating in a ceremony at 630 pm on Tuesday, but I could be on the VA call any time before that. (Also, I'll try to learn more about the timing of my other event to see if/when I could break away after 6:30 if needed.) Thanks and best, Andy From: l(bl<5> @va .gov] Sent: Satu rday, March 17, 2018 12:15 PM To: Karson, Andrew Scott ,M.D. l(b){Bl @mgh.h~a_rv_a_rd ~ ._e_d_ u> _______ 5 Cc: Blackburn , Scott R. ; l(bH > Windom, John H. Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High ~ @va.gov> ; Good afternoon Dr. Karson, Thank you again for confirm ing Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be available? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) VA-18-0298-B-000218 Page 1377 of 231~ of 8 871 5 From: Karson , Andrew Scott ,M.0 J; Cooper, Leslie T. , M.D. (bl(6l mayo .edu> ; Karson, To: Stan Huff (bH L-- ;:::-- =-r:=--"""-----"-\.6 Andrew Scott ,M.D . (bl(l mgh.harvard.edu>; Shrestha , Rasu B (b)(6l upmc.edu>; Rasu Shrestha (bl(5l gmail.com> Cc: Blackburn, Scott R. ; Windom , John H.< John .Windom@va.gov>; l._ (bl_(5_ l ___, l@va.gov> l(b)(6) Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, From: ._l (b-)(6 _) _____ ___, Sent: Friday, March 16, 20181:06 PM facs.org'; 'Cooper , Lesl ie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; To: 'Stephanie Reel'; 'Stan Huff':~ 'Shrestha, Rasu B'; 'Rasu Shrestha' 5 Cc: Blackburn , Scott R. ; Windom, John H.; l(bH l 'Bruce Moskowitz'; l(b)(5l @Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High I VA-18-0298-B-000219 Page 1378 of 231~ of 9 871 Good afternoon, A friend ly reminder to please let me know which date works best for your schedu le. Please feel free to call me with any questions. Thank you, l(b) (6) From?r >(l ~ Sent:. hursday, March 15,018 7:27 PM To: Stephanie Reel; 'Stan Huff; 'Manis, Jonathan (Jon)' l(b)(fil l@facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B': 'Rasu Shrestha' Bruce Moskowitz; l(bl(5> l@Bruce Cc: Blackburn , Scott R.; Windom , John H.;l(bl(5> Moskowitz.MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Schedu ling a Call Regarding Feedback on VA EHR 5 I Good evening , We would like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedu le the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedu le. Feel free to call me with any questions and I look forward to hearing from you. Thank you , (b) (6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 (b_ J(6 _>---~ Cell : l~ VA-18-0298-B-000220 Page 1379 of 231~o of 871 The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www.partners.org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-B-000221 Page 1380 of 23 2~1 of 871 Document ID: 0.7.1705. 1222361 l(bl(5l l Karson , And rew Scott ,M.D . To: l(bH6l l@mgh .harvard.edu> Cc: Blackburn , Scott R. ; ._l (b_ l<_l ___ ___. ; W indom, John H. Bee: Subject: RE: Scheduling a Ca ll Regarding Feedback on VA EHR Date: Sat Mar 17 2018 12:15:27 EDT Attachments: Good afternoon Dr. Karson , Thank you again for confirm ing Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be ava ilable? So far T uesday seems to work best for everyone . Thank s again! 5 From: Karson , Andrew Scott ,M.D . l(bH l @mgh.harvard.edu ) Sent: Friday, March 16, 2018 7:22 PM To :l(b)(6) Subject: [EXTERNA L] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dear l(bl(6l !so sorry for the delay getting back to you ; I have been on the road most of yesterday /today and first catching up on emai ls now . The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday .) Many thanks and best , Andy From:!(b)(6) @va.gov) Sent: Friday, March 16, 2018 7: 12 PM imai l.org>; Cooper, Lesl ie T ., M.D .._ (b_l(5_l ____ ...,.... ....... =.:..:.:::..L.i To: Stan Huff (bH6l 5 And rew Scott,M.D. (bJ(l mgh .harvard .edu>; Shrest ha, Rasu B (b)(6l L.._ __ ~ VA-18-0298-B-000222 Page 1396 of 231~ of 2 871 Rasu Shrestha (b)(6) gmail.com> Cc: Blackburn , cott . < cott.Blackburn@va.gov>; Windom , John H. ; l.... Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) From:._l Karson, And rew Scott,M.D . To: l(b)(G) @mgh.harvard.edu> Cc: Blackburn, Scott R. ;._l Bee: RE: Scheduling a Ca ll Regarding Feedback on VA EHR Subject: Date: Sat Mar 17 2018 12:15:27 EDT Attachments: I Good afternoon Dr. Karson, Thank you again for confirm ing Tuesday works best for you. If we started the call later in the evening, between 5-8PM EST would you still be avai lable? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson, Andrew Scott,M.D Jbl(5l @mgh.harvard.edu ] Sent: Frida y, March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dea rl(bl<5l lso sorry for the delay getting back to you; I have been on the road most of yesterday/today and first catching up on emai ls now. The only time among those three that I can do is the Tuesday time. (I will be part of an out of town family event on Sunday and in the air on Monday.) Many thanks and best, Andy From: .... l(b_l<5_l _______________ __,@va.gov] VA-18-0298-B-000225 Page 1399 of 231~ of 5 871 Sent: Friday , March 16, 2018 7:12 PM To: Stan Huff (bl(6l imail.org>; Cooper, Leslie T., M.o. L; Shrestha , Rasu B ._ 5 l Cc: Blackburn, Scott R. ; Windom , John H. ; l Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, E:J 5 J From:~ l( l Sent:riday, March 16, 2011:06 PM facs .org'; 'Cooper , Leslie T ., M.D.'; 'Karson, Andrew Scott,M.D.'; To: 'Stephanie Reel' ; 'Stan Huff';~ 'Shrestha, Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.;l(bl(5l l'Bruce Moskowitz'; l(bl{5l @Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan' ; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance: High Good afternoon, A friendly reminder to please let me know which date works best for your schedu le. Please feel free to call me with any questions . Thank you, l(b) (6) From:~l (b_J(6 _l ______ ~ Sent: Thursday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff; 'Manis, Jonathan (Jon)': ~ facs.org' ; 'Cooper, Leslie T., M.D.'; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B': 'Ras u Sh~estha' Cc: Blackburn , Scott R. ; Windom, John H.:l(bl(5l ]: Bruce Moskowitz; l 6 ._ ___,; Cooper, Leslie 6l T. M.D. (bJ( mayo.edu> ; Karson, Andrew Scott,M.D. (bl(5l mgh.harvard.edu>; Shrestha, Rasu B 6,,.. (b)(6l upmc .edu> ; Rasu Shrestha ,,,..l Blackburn, Scott R. ; Windom, John H. ; i __. Bee: (EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Subject: Fri Mar 16 2018 19:18:29 EDT Date: Attachments: ______ l(b) (6) The best date for me is Monday 3/19 at 4PM EST . Thank s, Stan From: l; Cooper, Leslie T ., M.D. (blCl Andrew Scott, .. {b)(5l @mgh.harvard.edu>; Shresth L... a-, R :::::as- u---= B~<~ b)(~5,....l:ia::..:....:..;.=.L :;_:_-upmc.edu> ; 6l Rasu Shrestha (bH @gmail.com> 5 l; Windom , John H. ; ..... 5 i Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance: High WARNING : Stop. Think. Read. This is an external email. Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, l(b)(6) VA-18-0298-B-000228 Page 1427 of 231~ of 8 871 I From: l(bJ(6J Sent: Friday, March 16, 2018 1:06 PM To: 'Stephanie Reel'; 'Stan Huff';~ facs.org'; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; 'Shrestha, Rasu B'; 'Rasu Shrestha' 5 Cc: Blackburn , Scott R. ; Windom, John H.; l(bJ( J l'Bruce Moskowitz'; l(bJ (6l @Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High Good afternoon, A friendly reminder to please let me know which date works best for your schedule. Please feel free to call me with any questions. Thank you , l(b)(6) I From:l(bJ(6J Sent: Thursday, March 15, 2018 7:27 PM To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)' ;~ facs .org' ; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott,M.D.' ; 'Shrestha , Rasu B': 'Rasu Shrestha' 5 5 Cc: Blackburn , Scott R. ; Windom, John H.;i(bJ( J Bruce Moskowitz; l(bJ( J @Bruce Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you, (b)(6) VA-18-0298-B-000229 Page 1428 of 231~ of 9 871 Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell : l..... (b_)(6_) ___ ...., VA-18-0298-B-000230 Page 1429 of 231~o of 871 Document ID: 0.7.1705. 122 1485 j ~ imail.o r >; Stan Huff l ; Karson , Cooper , Leslie T ., M.D . (bl<6l mgh .harvard .edu> ; Shrestha , Rasu B Andrew Scott ,M.D. (bl(5l 6l l ; Rasu Shrestha l Blackburn , Scott R. ; Windom, John H. ; i___, Bee: Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Date: Fri Mar 16 201819:11:33 EDT Attachments: Good evening , Another friend ly reminder to please let me know whic h date s work s best for your schedule. Have a great evening , l To: Blackburn, Scott R. Cc: Bee: Subject: RE: EHR Call Status Update Date: Fri Mar 16 2018 13:06:37 EDT Attachments: image001.png Just sent a follow up email , I will get you another update by 5PM . Thanks ,~ From: Blackburn, Scott R. Se1t: fridav. March16. 018 11 :57 AM To: (b){6) 1 Subject: RE: EHR Call Status Update Importance: High Yes , please . I want to be ab le to give Bruce an update by end of the day. I From J Stephanie Reel !(b)(6) @jhu .edu>; Stan To: Huffl(bl(5l @ imail.or > (bl(5l facs .org ~ facs.org> ; 6 Cooper , Leslie T ., M.D. (bl(l mayo.edu>; Karson , 6l mgh.harva rd.edu>; Shrestha, Rasu B Andrew Scott,M.D . (b)( l; Rasu Shrestha ! Blackburn , Scott R. ; Windom, John H. ; l(bl(5l l; Bruce Moskowitz l(b)(6l @mac.com> ;~ H6l @Bru ce Moskowitz .MD l;s hley Johnson (bl(6l ?hmi.edu>; Mary Riordan (b)(6) jhu .edu>; Mehwesh facs .org>; Marc Sherman (bl(6l gmail.com>; Khalid (bl<6l IP~fr enchange l59.com> Bee: RE: Scheduling a Call Regarding Feedback on VA EHR Subject: Fri Mar 16 2018 13:05:45 EDT Date: Attachments: I Good afternoon, A friend ly reminder to please let me know which date works best for your schedu le. Please feel free to call me with any questions. Thank you, l(b)(6) I From: l(b)(6) Sent: Thursday , March 15, 2018 7:27 PM To : Stephan ie Reel; 'Stan Huff; 'Manis, Jonathan (Jon)' ;~ facs.org'; 'Cooper, Leslie T., M.D.'; 'Karson , Andrew Scott,M.D.'; 'Shrestha, Rasu B'; 'Rasu Shrestha' Cc: Blackburn , Scott R.; Windom , John H.;!(bl(6l !Bruce Moskowitz ; !(bl(6l @Bruce Moskowitz .MD'; 'Ash ley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Schedu ling a Call Regarding Feedbac k on VA EHR Good evening, VA-18-0298-B-000235 Page 1436 of 231~ of 5 871 We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST . Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you , (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 Cell : l~(b_l<6_l ---~ VA-18-0298-B-000236 Page 1437 of 231~ of 6 871 Document ID: 0.7.1705.1770593 Blackburn, Scott R. 6l (bJC Cc: Bee: Subject: RE: EHR Call Status Update Date: Fri Mar 16 201811:56:50 EDT Attachments: image001.png Yes , please . I want to be able to give Bruce an update by end of the day. l (b)(6) To: To: Blackburn, Scott R. Cc: Bee: EHR Call Status Update Subject: Fri Mar 16 2018 10:35 :59 EDT Date: image001 .png Attachments: Good morning Mr. Blackburn, I have only received responses from Dr. Moskowitz and Mr. Manis . Shou ld I sent out a follow up emai l? X = availab le Thanks, ._l To: Blackburn, Scott R. ; DJS ; Bowman, Thomas Cc: Bee: Subject: RE: [EXTERNAL] Re: Scheduling a Ca ll Regarding Feedback on VA EHR Date: Fri Mar 16 2018 07:21:20 EDT Attachments: Thank you Sir. Vr John John H . Windom, Senior Executive Service (SES) Program Executive for Electronic Hea lth Record Modernization (PEO EHRM) Special Adv isor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John .Windom@va .gov Office: (202) 461-5820 5 Mobile :~l (b-l( _> ----~ 5 Executive Assistant: ~l (b_l(_> 5 ~l (b_ l( _> -~ ---~I - Appointments and Schedu ling l@va.gov Office: 202-382-3792 VA-18-0298-B-000242 Page 1449 of of 231i 2 871 From: Blackburn, Scott R. Sent: Thursday , March 15, 2018 8:45 PM To: DJS ; Windom , John H.; Bowman, Thomas Subject: FW: [EXTERNAL] Re: Scheduling a Call Regarding Feedback on VA EHR We are pushing to get this done no later than Tuesday so we can wrap this up . Talked to Bruce and we are perfectly aligned. He is going to help push these folks for us. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thursday, March 15, 2018 7:27: 17 PM To j(bl(5l Cc: Stephanie Reel; Stan Huff; Manis, Jonathan (Jon); ~f acs.org ; Cooper , Lesl ie T., M.D.; Karson, Andrew Scott,M.D .; Shrestha, Rasu B; Rasu Shrestha; Blackburn , Scott R. ; Windom , John H.; l(bl(5l l(bl(5l @Bruce Moskowitz ,MD ; Ashley Johnson; Mary Riordan; Mehwesh Khalid ; Marc Sherman; IP Subject: [EXTERNA L] Re: Scheduling a Call Regarding Feedback on VA EHR I I All work for me Sent from my iPad Bruce Moskowitz M.D . 5 (b_ l( _> ____________ On Mar 15, 2018 , at 7:26 PM, ._l __, @va.gov> wrote: Good evening , We would like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedu le. Feel free to call me with any questions and I look forward to hearing from you. Thank you, l(b)(6) VA-18-0298-B-000243 Page 1450 of of 231i 3 871 l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461-6288 _l ___ Cell : _!(b_J To: DJS ; Windom, John H. ; Bowman, Thomas Cc: Bee: Subject: FW: [EXTERNAL] Re: Scheduling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 20:45:19 EDT Attachments: We are pushing to get this done no later than Tuesday so we can wrap this up . Talked to Bruce and we are perfectly aligned. He is going to help push these folks for us. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thursday . March 15, 2018 7:27:17 PM To :i'bH6l Cc: Stephanie Reel; Stan Huff; Manis, Jonathan (Jon);~facs.org; Cooper , Leslie T., M.D .; Karson, Andrew Scott,M.D .; Shrestha, Rasu B; Rasu Shrestha; Blackburn, Scott R.; Windom , John H.; !(bl(6l j(bl(6l @Bruce Moskowitz ,MD ; Ashley Johnson; Mary Riordan; Mehwesh Khalid; Marc Sherman; IP Subject: [EXTERNAL] Re: Scheduling a Call Regarding Feedback on VA EHR I I All work for me Sent from my iPad Bruce Moskowitz M.D. l(b_ l(5_l ____________ On Mar 15, 2018 , at 7:26 PM, ...... __, @va.gov> wrote: Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to VA-18-0298-B-000245 Page 1452 of 231is of 871 schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date will work best for your schedule . Feel free to call me with any questions and I look forward to hearing from you. Thank you , (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 Cell !.... To: DJS ; Windom, John H. ; Bowman , Thomas Cc: Bee: Subject: FW: [EXTERNAL] Re: Scheduling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 20:45:19 EDT Attachments: We are pushing to get this done no later than Tuesday so we can wrap this up. Talked to Bruce and we are perfectly aligned. He is going to help push these folks for us. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thur sday , March 15, 2018 7:27:17 PM To: 1<0 l<5l Cc: Stephanie Reel; Stan Huff; Manis, Jonathan (Jon) ;~ facs.org ; Cooper , Leslie T., M.D.; Karson, Andrew Scott,M.D .; Shrestha, Rasu B; Rasu Shrestha; Blackburn, Scott R.; Windom , John H.; i<0 l<5l 1<0 l<5l @Bruce Moskowitz ,MD ; Ashley Johnson; Mary Riordan; Mehwesh Khalid ; Marc Sherman; IP Subject: [EXTERNAL] Re: Schedul ing a Call Regarding Feedback on VA EHR I I All work for me Sent from my iPad Bruce Moskowitz M.D. 0 5 On Mar 15, 2018 , at 7:26 PM,~l <_ l<_l ------------~l @va.gov> wrote: Good evening , We would like to schedule a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on different dates and times next week, but we are going to schedule the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tue sday 3/20 at VA-18-0298-B-000247 Page 1454 of of 231i 7 871 4PM EST. Please let me know which date w ill work best for your schedu le. Feel free to call me w ith any questions and I look forward to hearing from you. Thank you , (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affa irs Desk: 202-461-6288 l..... Cell : l(bl(6l ] Stephanie Reell(bl(5l @ihu.edu>; Stan Cc: @imail.org> ; Manis, Jonathan (Jon) Huff l(bl(6l !(bl(6l @sutterhealth.or >; (bl(6l facs.org ~ facs.org> ; Cooper, Leslie T. , M.D. (bl<6l mayo .edu> ; Karson , Andrew Scott ,M.D. (bH6l mgh .harvard .edu> ; Shrestha , Rasu B l(bl(5l l@upmc.edu> ; Rasu Shrestha l(bl(6l @gmail.com> ; Blackburn , Scott R. ; Windom, John H. ; l._ ; (bl(6l mail.com>; Ashley Bruce Moskowitz.MD (bl(6l 'hmi.edu >; Mary Riordan (bl(6l jhu .edu>; Johnson (bl(6l facs .org> ; Marc Sherman Mehwesh Khalid (bl(6l l(b)(6J @gmai l.com>; l~ frenchange l59.com> Bee: [EXTERNAL] Re: Schedu ling a Call Regarding Feedback on VA EHR Subject: Thu Mar 15 201819 :27 :17 EDT Date: Attachments: All work for me Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 20 18, at 7:26 PM, ._l (b_J5<_i _____________ __. l@va.gov> wrote: Good evening , We wou ld like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been correspond ing with many of you on different dates and times next week, but we are going to schedu le the call for either Sunday 3/18 at 4P M EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know which date w ill work best for you r schedu le. Feel free to call me w ith any questions and I look forward to hearing from you. Tha nk you, VA-18-0298-B-000249 Page 1456 of of 231i 9 871 l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce11 :l..... r b)(G) To: Cc: (b-H6-l --.@jh u.edu>; Stan Ste hanie Reel !,_ 5 imail.org>; Manis, Jonathan (Jon) Huff {bl{ l facs.org> ; (bl(6l sutterhealth.org> (bl(6l facs.o rg~ Cooper, Leslie T., M.D. {bJ{ 6J mayo .edu>; Karson , mgh.harvard.edu>; Shrestha, Rasu B Andrew Scott ,M.D. (bl(6l l(bl(6l @upmc .edu>; Rasu Shrestha l(bl(6l @gmail.com> ; Blackburn , Scott R. ; Windom, John H. ; (bl(5l administrat ive group (fydibohf23s dlt cn=reci ients/cn=045f8eff429f45888be 795fbaa 1d Bruce Moskowitz .MD 9ef2 {bl(5l (bl(6l mail.com>; Ashley Johnson ,_! (b-J6 (-l -~ @jhmi.edu >; 5 Mary Riordan (bl( l jhu .edu>; Mehwesh Khalid !(bJ(6l @facs.org >; Marc Sherman !(bJ(6l @qmail.com >; IP ~ frenchange l59.com> Bee: Subject: Date: Attachments: [EXTERNAL] Re: Schedu ling a Call Regarding Feedback on VA EHR Thu Mar 15 201819:27:17 EDT All work for me Sent from my iPad Bruce Moskowitz M.D. 5 On Mar 15, 20 18, at 7:26 PM, ~l (b_H_i _____________ ~ @va.gov > wrote: Good evening , We would like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been corresponding with many of you on diffe rent dates and times next week, but we are going to schedu le the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST . Please let me know which date will work best for your schedu le. Feel free to call me w ith any questions and I look forward to hearing from you . Thank you, VA-18-0298-B-000251 Page 1458 of 231~ 1 of 871 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell : l~(b_H6_J ---~ VA-18-0298-B-000252 Page 1459 of 231~ 2 of 871 Document ID: 0.7.1705. 1220026 l Ste hanie Ree li; Stan To: Huff (bl<5l imail.org> ; Manis, Jonathan (Jon) l (bl(5l facs.org ~ facs.org> ; Coope r, Leslie T. , M.D (bl(6l @mayo .edu> ; Karson, Andrew Scott ,M.D . (bl{6l mgh .harvard .edu>; Shrestha , Rasu B l ; Rasu Shrestha l(bl(5l @gma il.com> Cc: Blackburn , Scott R. ; Windom, John H. ; ..... l(b_ H5_l ____, l ; Bruce @mac .com> ; l(bl(5l ta),Bruce Moskowit z !(bl(6l Moskowitz MD l(bl(6l @gmail.com> ; Ash ley Johnson l; Mary Riordan (bl<6l j hu .edu >; Mehwesh Khalid !(bJ(6l @facs .org >; Marc Sherman (bl<6l gmail.com >; IP~ frenchange l59.com > Bee: Subj ect: Schedu ling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 19:26 :32 EDT Atta chments: Good evening , We wou ld like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been corresponding w ith many of you on diffe rent dates and times next week, but we are going to schedu le the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tuesday 3/20 at 4PM EST. Please let me know wh ich date w ill work best for your schedu le. Feel free to call me w ith any questions and I look forward to hearing from you . Thank you, (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 VA-18-0298-B-000253 Page 1460 of 231~ 3 of 871 Page 1461 of 23121;4 of an Document ID: 0.7.1705.503799 l To: Ste Rhanie Ree l l; Stan Huff (blC5l imail.org> ; Manis, Jonathan (Jon) (bl(6l sutterhealth.org>;< bl(5l facs.o rg ~ facs.org> ; Coope r, Leslie T., M.D. (bl(6l mayo .edu> ; Karson, Andrew Scott ,M.D . (bH5l mgh .harvard .edu> ; Shrestha , Rasu B l ; Rasu Shrestha l Cc: Blackburn , Scott R. ; Windom, John H. ; (bl(5l ; 9ef2 (blC5l 6l (bH6l Bruce Moskowitz,MD l ; Ashley jhmi.edu> ; Mary Riordan l; Johnson (bl(6l Mehwesh Kha lid (bl(6l facs .org>; Marc Sherm an l; l~ frenchange l59.com > Bee: Subject: Schedu ling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 19:26 :32 EDT Atta chments: Good evening , We wou ld like to schedu le a call in the next few days to share feedback on the VA EHR contract. I have been corresponding w ith many of you on diffe rent dates and times next week, but we are going to schedu le the call for either Sunday 3/18 at 4PM EST, Monday 3/19 at 4PM EST or Tue sday 3/20 at 4PM EST . Please let me know wh ich date w ill work best for your schedu le. Feel free to call me w ith any questions and I look forward to hearing from you. Thank you , (b)(6) Executive Ass istant to the Assistant Secretary Office of Information and Technology US Depa rtment of Veterans Affairs VA-18-0298-B-000255 Page 1462 of 231~ of 5 871 Desk: 202-461-6288 5 (b)_( _l Cell : l._ __ ___. VA-18-0298-B-000256 Page 1463 of 231~ of 6 871 Document ID: 0.7.1705.1525910 l To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re: EHR VA Call Date: Thu Mar 15 2018 14:24:44 EDT Attachments: Okay , I will start over and get Mr . Marc and Dr. Bruce's availability first. From: Blackburn, Scott R. Sent: Thursday , March 15, 2018 2:21 PM To: l wrote : VA-18-0298-B-000257 Page 1464 of 231~ 7 of 871 Page 1455 of 23??8 of Document ID: 0.7.1705.1769743 From: Blackburn, Scott R. To: j<0 l<6l j Cc: Bee: FW: [EXTERNAL] Re: EHR VA Call Subject: Thu Mar 15 2018 14:21 :06 EDT Date: Attachments: Let's see if we can do one big call next week . Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thursday, March 15, 2018 1:27:32 PM To: Windom, John H.; Blackburn , Scott R. ;!..... <0-l<6-l ------, 0 6 @gmail.com; IP; O'Rourke , Peter M. Cc j wrote : VA-18-0298-B-000259 Page 1466 of 231~ 9 of 871 Document ID: 0.7.1705.503504 From: Blackburn, Scott R. (bJ(6J To: ~------~ wrote : VA-18-0298-B-000260 Page 1467 of 231io of 871 Document ID: 0.7.1705.983013 From: Bruce Moskowitz @mac.com> Windom, John H. ; Blackburn , Scott R. ; ~l(b_l( 6_l ---~ (b)(6l ~gmail.com ____ _.@gmail.com>; l~ frenchangel59.com>; O'Rourke, ,__ Peter M. l(bl( 6l To: Cc: Bee: Subject: Date: Attachments: l [EXTERNAL] Re: EHR VA Call Thu Mar 15 2018 13:27:32 EDT I want to make sure we are all in agreement of how this is structured. Marc and I want to be on every call that the group is on to discuss the contract. The whole group needs to be on the same call so we all give input to the whole contract and hear the same considerations and comments . Let me know if there is any discrepancy to this. Thank you Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 2018 , at 12:28 PM, VACIO Executive Schedule wrote : VA-18-0298-B-000261 Page 1468 of of 231i 1 871 Document ID: 0.7.1705.503481 From: Bruce Moskowitz @mac.com> Windom, John H. ; Blackburn, Scott R. ; ~l (b_l<_> ---~ ; l~ frenchange l59.com>; O'Rourke, Peter M. l(bl(6> To: Cc: Bee: Subject: Date: Attachments: l [EXTERNAL] Re: EHR VA Call Thu Mar 15 2018 13:27 :32 EDT I want to make sure we are all in agreement of how this is structured. Marc and I want to be on every call that the group is on to discuss the contract. The whole group needs to be on the same call so we all give input to the who le contract and hear the same cons iderations and comments . Let me know if there is any disc repancy to this. Thank you Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 20 18, at 12:28 PM, VAC IO Executive Schedu le wrote : VA-18-0298-B-000262 Page 1469 of of 231i 2 871 Document ID: 0.7.1705.1218888 From: VAC IO Executive Schedule To: Windom, John H. ; Blackburn , Scott R. ; ._(b_l<6_,,l______ ; (bl( 5l gma il.com> ; Bruce Moskowitz Moskowitz MD (bl<5l (bl (5l mac .com> Cc: Bee: Subject: Date: Attachments : , _. Bruce EHR VA Call Thu Mar 15 2018 12:28:02 EDT VA-18-0298-B-000263 Page 1470 of of 231i 3 871 Document ID: 0.7.1705. 1769680 VAC IO Executive Schedu le From: VACIO Execu tive Schedule To: ; l.... ; Blackburn, Scott R. ; Windom, John H. ; (bJC5l Bruce Moskowitz,MD ! ; Marc Sherman; Bruce Moskow itz (bl<5l mac .com> Cc: Bee: Subject: VA EHR Call Thu Ma r 15 201811 :23 :07 EDT Date: Attachments: StartTime: Mon Mar 19 11 :00 :00 Centra l Day light Time 2018 EndTime : Mon Mar 19 11 :45:00 Central Daylight Time 2018 I Location : l VACIO Executive Schedule To: ; j ; Blackburn, Scott R. ; Windom, John H. ; 5 {bJ{5l Bruce Moskowitz,MD l; Marc 6 Sherman (bl(l gmail.com>; Bruce Moskowitz (bJ(6l mac .com> Cc: Bee: Subject: VA EHR Call Thu Mar 15 201811:23:07 EDT Date: Attachments: StartTime: Mon Mar 19 11 :00:00 Centra l Daylight Time 2018 EndTime : Mon Mar 19 11 :45:00 Central Daylight Time 2018 I Location : l VACIO Executive Schedule To: -; Blackburn, Scott R. ; Windom, John H. ; (bl{6l Bruce Moskowitz,MD l; Marc gmail.com>; Bruce Moskowitz Sherman (bl(5l (b)(6l mac.com> Cc: Bee: Subject: VA EHR Call Thu Mar 15 201811:23:07 EDT Date: Attachments: ;I StartTime: Mon Mar 19 11 :00:00 Centra l Daylight Time 2018 EndTime : Mon Mar 19 11 :45:00 Central Daylight Time 2018 I Location : l To: Truex , Matthew ; Blackburn , Scott R. ; Windom, John H. ; j(bl(6l @Bruce Moskowitz.MD l(bH5l @gmail.com>; Marc 6 @gmail.com>; Bruce Moskow itz Sherman l(bl( l l(bJ(6) @mac .com> Cc: Bee: VA EHR Call Subject: Thu Mar 15 2018 11 :23:05 EDT Date: Attachments: VA-18-0298-B-000267 Page 1474 of of 231i 7 871 Document ID: 0.7.1705.1219373 From: Bruce Moskowitz (bl(6l mac.com> Marc Sherman (bl(6l gmail.com> To: 5 l(bl( > l; Blackburn , Scott R. : IP ~ frenchangel59 .com>; Laura Perlmutte rl(bl(5> l@gmail.com>; Windom, John H. ; (bl(6> /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=rec ipients/cn=vacocallae2> Bee: Re: [EXTERNAL] Re: V HA EHR - 2 calls that my assistant will set up Subject: Thu Mar 15 201811:10:19 EDT Date: image001.jpg Attachments: Thank you just rece ived Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 2018, at 11 :08 AM, Marc Sherma ~.... (b_ l(6_> ---~ @gmail.com > wrote: Thanks ~ On Mar 15, 20 18 8:01 AM, .... l(b_H5_> _________ ___,l ~va.gov> wrote: Mr. Sherman - The notice was just resent to Dr. Moskow itz. He should receive an email from the following address, usarmy.redstone.rdecom-amrdec.-mbx.safe-team@mail.mil. Thanks, (b)(6) Contracting Officer Department of Veterans Affairs VA-18-0298-B-000268 Page 1475 of 231ia of 871 Office of Procu reme nt, Acquisition and Logis tics Techno logy Acq uisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile: .... l(b_l(5_>____ _. e-mail: .... l(b_l(5_> ___ _.@ va.gov "For Internal VA Use Only - Work ing Draft, Pre-Decisiona l, Deliberative Document: This e-mai l and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confident ial information. If you are not the intended rec ipient of this e-mail , you are hereby notified that any dissemination, distribut ion or copying of this e-mail , and any attachments thereto , is strict ly prohibited . If you have received this e-mail in error, please notify me via return e-ma il or telephone (732) 440 -9650 , and permanent ly delete the origina l and any copy of any e-mai l and any printout thereof. " From: Marc Sherman l(bH5> @gmai l.com] Sent: Thursday, March 15, 2018 10:54 AM To : Blackburn , Scott R. 0 5 Cc: IP; Laura Perlmutter ; Bruce Moskowitz J >( > !Windom , John H.; ~l (b_l(5_> -----~ Subject: [EXTERNA L] Re: V HA EHR - 2 calls that my assistant will set up (0_><5_>_ Scott and ~l .... I received a document download emai l w ith a password from AMR DEC Safe Access File Exc hange Howeve r, Bruce has not received a similar email. Can you please get tha t to him? Marc VA-18-0298-B-000269 Page 1476 of 231i9 of 871 On Mar 13, 2018 2:04 PM, "Blackburn, Scott R." wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We've got 100% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko, Dr Karson , Dr. Cooper , and Dr. Shretha) 6l and we are movin forward. l(bH kcc'd, our contracting officer) is making sure everyone has the 5 right material. (b)(l my assistant , cc'd here) will be organizing a few phone calls in 2 steps: Step 1 - Basic orientation to the government contract structure . This will be a 30-45 minute orientation so that folks know what they are looking at. John Windom and Matt Truex will host this and clue people into the parts to focus on and parts that are standard government things that are less relevant. This can be done in groups (ideally) or in one-offs to fit to accommodate people's busy schedules. !(b)(6) lhas already scheduled 2 times in case these work for you. If they do not , she will work with your schedule rs to find other times in the next 24-48 hours (sooner the better). * Thursday 8:30-9 :15am ET - Stephanie Reel confirmed * Thursday 11:30am-12:15pm ET - Stan Huff confirmed Step 2 - Feedback calls. Per Bruce 's idea, we'll schedule 2 separate feedback calls for early next week . Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest,i(bl(5l !will set these up. * CIOs (Reel , Huff, Manis, Shretha - and of course each of you are encouraged to join) * Doctors (Dr. Karson , Dr. Ko, and Dr. Cooper - and of course each of you are encouraged to join) Let me know how this sounds. Thank you again for your support and assistance on this critical matter. Scott 5 From: Marc Sherman l(bl< l @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. 6l Cc: IP; ! wrote: Ike, Bruce , Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. H5_l We will need you to sign the attached NOA. Please return to-l(b_ 1) 2) ~ --~I (cc'd) . will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your expertise will be most valuable . (bl(5l (who is the government contrac tin officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask (bl(6l (cc'd) here to help set up a time. We can either do this all together , if calendars match up, or separately if need be. We have also connected with Stephanie Reel, Stan Huff, Dr. Karson, Dr. Ko, Dr. Shretha , and Jon Manis who all have all received the NOA and we are working with them. I am hoping to connect with Dr. Cooper today. Thanks again! Scott VA-18-0298-B-000271 Page 1478 of 231~ 1 of 871 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000272 Page 1479 of 23 2~2 of 871 Document ID: 0.7.1705.1219367 ~- -==- ~ Marc Sherman (bl(5l gmail.com> From: (bJ(6l Cc: Blackburn, Scott R. ; IP ~ frenchangel59.com>; Laura Perlmutter l; @mac.com>;Windom, John H. '---Bruce Moskowitz l(bl(6l ; (bl(6l /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: RE: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up Date: Thu Mar 15 201811:08:01 EDT Attachments: image001.jpg Thanks ~ 5 On Mar 15, 2018 8:01 AM ,~l (b_l<_l ---------~ @va.gov> wrote: Mr. Sherman - The notice was just resent to Dr. Moskowitz. He should receive an email from the following address, usarmy .redstone.rdecom-amrdec.-mbx.safe-team@mail .mil. Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement, Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 VA-18-0298-B-000273 Page 1482 of 231~ of 3 871 Mobile:~ e-mail: l_b va.gov "For Internal VA Use Only-Working Draft, Pre-Decisional, Deliberative Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." From: Marc Sherman l wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce. We've got 100% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko, Dr Karson , Dr. Cooper , and Dr. Shretha) 6 and we are moving forward. l wrote: Ike , Bruce, Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 5 1) We will need you to sign the attached NOA. Please return to~l (b_l( _> --~ 2) Matt will then send you the latest package under separate cover. l(cc'd). 3) Given government contracts are different than what you are used to reading , we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your 5 expertise will be most valuable . l< > l(who is the government contractin officer) and John 5 > (cc 'd) here to help Windom (who is our EHR leader) will lead this from our side. I will ask (bl< set up a time. We can either do this all together , if calendars match up , or separately if need be. We have also connected with Stephanie Reel, Stan Huff, Dr. Karson, Dr. Ko , Dr. Shretha, and Jon Manis who all have all received the NOA and we are working with them. I am hop ing to connect with Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000276 Page 148 5 of 231~ 6 of 871 Document ID: 0.7.1705.1219342 l Marc Sherman i; To: Blackburn , Scott R. IP~ frenchan qel59.com>; Laura Cc: Perlmutte r!; Bruce Moskowitz 6l l ; Windom, John H. ; (bl<5l administrat ive group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: RE: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant wi ll set up Subject: Thu Mar 15 201811:01:08 EDT Date: image001.jpg Attachments: I Mr. Sherman - The notice was just resent to Dr. Moskowitz. He should receive an email from the following address, usarmy.redstone.rdecom-amrdec.mbx.safe-team@mai l.mil. Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown , New Jersey 07724 Office : 732-440-9650 Mobile :~ e-mai l: ~ va.gov VA-18-0298-B-000277 Page 1489 of 231~ 7 of 871 "For Internal VA Use Only-Working Draft, Pre-Decisional, Deliberative Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information. If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited . If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." 5 ) @gmail.com] From: Marc Sherman l wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We've got 100% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper , and Dr. Shretha) 5 (cc'd, our cont racting officer) is making sure everyone has the ) and we are movin forward. l wrote: Ike, Bruce, Marc : Tha nk each of you for agreeing to lend an extra set of outside eyes on the EHR cont ract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers . As we are incredib ly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 5 1) We wi ll need you to sign the attached NOA. Please return to ..... l(b_H_l __ 2) Matt w ill then send you the latest package under separate cove r. _.l(cc'd) . 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your (who is the government contractin officer) and John expertise w ill be most valuab le. l(bl<5l (cc'd) here to help Windom (who is our EHR leader) wi ll lead this from our side . I will ask (bl(6 l set up a time . We can either do this all together , if calendars match up , or separately if need be. I We have also connected wit h Stephanie Reel, Stan Huff, Dr. Karson , Dr. Ko, Dr. Shretha , and Jon Manis who all have all received the NOA and we are working with them. I am hop ing to connect with Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Depart ment of Veterans Affairs VA-18-0298-B-000280 Page 1492 of 23 1i o of 871 Document ID: 0.7.1705.502879 5 l 6l To: Marc Sherman l; Blackburn, Scott R. Cc: l~frenchan el59.com>; Laura Perlmutter (bl(5l gmail.com>; Bruce Moskowitz (bJ(6J mac.com>; Windom, John H. ; i wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We 've got 100% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper , and Dr. Shretha) 5 l l(cc'd, our contracting officer) is making sure everyone has the and we are movin forward. l wrote: Ike, Bruce, Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We app reciate you r support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredib ly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) We wi ll need you to sign the attached NOA . Please return to Matt T ruex (cc'd). 2) Matt w ill then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your expertise w ill be most valuab le. (b)(5l (who is the government contract in officer) and John Windom (who is our EHR leader) wi ll lead this from our side . I will ask( bH5l (cc'd) here to help set up a time. We can either do th is all together , if calendars match up , or separately if need be . We have also connected w ith Stephanie Ree l, Stan Huff, Dr. Karson, Dr. Ko , Dr. Shretha , and Jon Manis who all have all received the NOA and we are working with them. I am hoping to connect w ith Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000284 Page 1499 of of 231i 4 871 Document ID: 0.7.1705.1769673 From: Blackburn, Scott R. <0 l<6l /o=va/ou=visn To: 03/cn=recipients/cn=vhaeastruexm> Cc: Bee: Subject: FW: [EXTERNAL] EMR documents Date: Thu Mar 15 2018 10:55:53 EDT Attachments: Please help Bruce ... Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thursday, March 15, 2018 10:51:08 AM To: Windom, John H.; Blackburn , Scott R. Cc: IP; !<0 l<5l k@gmail.com Subject: [EXTERNAL] EMR documents I still have not received the EMR documents to review. You have my NOA. Please send ASAP. I am a reasonable speed reader so you can include all pages. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000285 Page 1503 of 2s1isof 871 Document ID: 0.7.1705.502863 Blackburn, Scott R. (b)(6) To: From: Blackburn, Scott R. l~ @frenchan qel59.com>; Laura Cc: Perlmutte rl; Bruce Moskowitz l(b)(G) @mac .com> ;l; Windom, John H. ; l(bH6l f /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: [EXTERNAL ] Re: VHA EHR - 2 calls that my assistant will set up Subject: Thu Mar 15 2018 10:53:37 EDT Date: Attachments: Scott and ~ I received a document download emai l with a password from AMRDEC Safe Access File Exchange However , Bruce has not received a similar email. Can you please get that to him? Marc On Mar 13, 2018 2:04 PM, "Blackburn, Scott R." wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We 've got 100% participat ion (Stephan ie Reel, Stan Huff, Jon Man is, Dr. Ko, Dr Karson , Dr. Cooper, and Dr. Shretha) and we are movin forward. l(bl<5l t cc'd, our contracting officer) is making sure everyone has the 6 right material.(b)( l (my assistant , cc 'd here) will be organizing a few phone calls in 2 steps: Step 1 - Basic orientation to the government contract structure. This will be a 30-45 minute orientation so that folks know what they are looking at. John Windom and Matt Truex will host this and clue people into the parts to focus on and parts that are standard government things that are less relevant. This can be done in groups (ideally) or in one-offs to fit to accommodate people 's busy schedu les. l(b)(G) has already scheduled 2 times in case these work for you . If they do not, she will work w ith you r schedulers to find other times in the next 24-48 hours (sooner the better). I ********* Thursday 8:30-9: 15am ET - Stephan ie Reel confirmed ********* Thursday 11 :30am-12 : 15pm ET - Stan Huff confirmed VA-18-0298-B-000287 Page 1505 of of 231i 7 871 Step 2 - Feedback calls. Per Bruce's idea, we'll schedule 2 separate feedback calls for ear ly next week . Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest. Liz will set these up. ********* CIOs (Reel , Huff , Manis , Shretha - and of course each of you are encouraged to join) ********* Doctors (Dr . Karson , Dr. Ko, and Dr. Cooper - and of course each of you are encouraged to join) Let me know how this sounds. Thank you again for your support and assistance on this critical matter. Scott From: Marc Sherman l(bl(5> l@gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. @gmail.com; Bruce Moskowitz; ._l (b_l(5_>____ Cc: IP;i(bl(6> Subject: [EXTERNA L] Re: VA EHR NOA Scott, ~ _.IWindom, John H.; DJS and John Thank you for the NOA draft that you sent along and the organized approach . I have attached the following to close the loop: 1.a marked up version of the NOA with a few necessary adjustments in red-line so you can see the changes that were made , 2.a blank copy of the amended NOA for Bruce and Ike to sign, and 3.a signed version by me of the amended NOA . Thanks and happy to help as requested. Marc On Tue, Mar 13, 2018 at 10:31 AM, Blackburn, Scott R. wrote: Ike, Bruce, Marc : VA-18-0298-B-000288 Page 1506 of 231ia of 871 Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time, we want to make this as easy as possible for you. Here are 3 next steps. 1) 2) ...._ H5_l We will need you to sign the attached NOA. Please return to l(b ~ _ ___,I (cc'd). will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your !(who is the government contractin officer) and John expertise will be most valuable. l(b)(5l Windom (who is our EHR leader) will lead this from our side. I will ask (b){G) (cc'd) here to help set up a time. We can either do this all together , if calendars match up, or separately if need be. We have also connected with Stephanie Reel, Stan Huff, Dr. Karson, Dr. Ko, Dr. Shretha, and Jon Manis who all have all received the NOA and we are working with them. I am hoping to connect with Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000289 Page 1507 of 231i 9 of 871 Document ID: 0.7.1705.502862 Marc Sherman l(bl(6l @gma il.com> From: To: Blackburn, Scott R. Cc: IP~ frenchangel59.com>; Laura Perlmutter; Bruce Moskowitz (b)(GJ mac.com>; l; Windom, John H. ;l(b)(GJ wrote: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We've got 100% participat ion (Stephan ie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper, and Dr. Shretha) (cc'd, our contracting officer) is making sure everyone has the and we are moving forwa rd. l wrote: Ike , Bruce, Marc: Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers . As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) We will need you to sign the attached NOA . Please return to .... l(b_H5_l __ 2) Matt will then send you the latest package under separate cover. _.I(cc'd) . 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your (who is the government contractin officer) and John expertise will be most valuable . (bl<6l Windom (who is our EHR leader) will lead this from our side . I will ask (bl{ 5l (cc 'd) here to help set up a time. We can either do this all together , if calendars match up, or separately if need be. We have also connected with Stephanie Reel , Stan Huff , Dr. Karson, Dr. Ko , Dr. Shretha , and Jon Manis who all have all received the NOA and we are working with them. I am hoping to connect with Dr. Cooper today . Thanks again! Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000292 Page 15 10 of 231i2 of 871 Document ID: 0.7.1705. 1219329 Bruce Moskow itz From: l(b)(5l @mac.com> To: Windom, Joh n H. ; Blackburn , Scott R. IP (bJ(5J frenchangel59.com>; Cc: gmail.com l""" (b.,...,, )(6,)----.l ,... @gmail.com> (b)(6) Bee: Subject: [EXTERNAL ] EMR documents Date: Thu Mar 15 2018 10:51 :08 EDT Attachments: ndom , I still have not rece ived the EMR documents to review. You have my NOA. Please send ASAP. I am a reasonable speed reader so you ca n include all pages. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000293 Page 151 1 of of 231i 3 871 Document ID: 0.7.1705.502857 Blackburn, Scott R. Windom, John H. ; Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] EMR calls Date: Thu Mar 15 201810:32:17 EDT Attachments: -----Original Message ---------------~ 5 From: Bruce Moskowitz l(bl< l @mac.com] Sent: Thursday, March 15, 2018 9:52 AM To: Blackburn, Scott R. @gmail.com ; O'Rourke, Peter M. Cc: IP; !(bl(6l Subject: Re: [EXTERNAL] EMR calls Thank you this is important information. I can walk everyone through the device registry and the nutritional platform. The crit ical area that is the main part of your due diligence which is much appreciated is remote patient monitoring. This will be the hospital platform of the very near future for the VA and is already well done in the private sector. Chris Ross CIO at Mayo made a good point that the contract shou ld not tie the VA to only this vendor for this important function. This technology is getting better at an accelerated pace. We could get stuck with a platform that is outdated and the contract will not allow us to innovate with another platform. Sent from my iPad Bruce Moskowitz M.D. > On Mar 15, 2018 , at 9:24 AM, Blackburn , Scott R. wrote: > > Bruce , thanks for raising this . Below is what I learned about what we have for intensive care units interacting with a centra l monitoring system. Let me know if this sounds right to you. Also you rattled off a couple of things (nutritional layout from Tufts, field to input the ser ial number for items in the device registry); if you cou ld send me those I can hunt those down as well to save time. I just got off the phone with Stephanie Reel and she is excited to help ; speaking to a few others at 11 :30am ET. > > The Gerner solution for ICU cent ral monitoring, as part of the VA EHR, utilizes Cerner's CareAware iAware framework through the Apache Outcomes so lution. This solution has the capability to configu re dashboard views to enable monitoring of high acuity areas, specifically around performance and patient care. This capability is included in the scope of the Gerner acquisition as the Critical Care System, Gerner Apache Outcomes solution and End User License Agreement. > > Does this capability also monitors emergency rooms, recovery rooms and telemetry beds? > The current acquisition solutions meet these requirements and can be configured into a central command center model. VA-18-0298-B-000294 Page 1512 of 231i 4 of 871 > * Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process . This solution has been included as an Emergency Medicine System and End User License Agreement. > * Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . This solution has been included as Perioperative System and End User License Agreement. > * Telemetry Beds: Traditional central monitoring systems as are used in telemetry , exist within the VA's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA. However, the acquisition includes integration of this capability. > > In addition to these monitoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. > > > -Scott > > -----Original Message----> From: Bruce Moskowitz ~l Sent: Wednesday , March 14, 2018 12:18 PM > To: Blackburn, Scott R. > Subject: [EXTERNAL] EMR calls > > To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system. > > Sent from my iPad > Bruce Moskowitz M.D. VA-18-0298-B-000295 Page 1513 of 231is of 871 Document ID: 0.7.1705.982785 From: Bruce Moskowitz l(b)( 5) To: Cc: Bee: Subject: Date: Attachments: @mac .com> Blackburn , Scott R. IP (bJ(6 frenchangel59.com>; (b)(6) gmail.com ,....l (b-)(6-)-'-----. @gmail.com>; O'Rourke , Peter M. Re: [EXTERNAL] EMR calls Thu Mar 15 2018 09:52:13 EDT Thank you th is is important information. I can walk everyone through the device registry and the nutritional platform. The critical area that is the main part of your due diligence which is much appreciated is remote patient monitoring . This will be the hospital platform of the very near future for the VA and is already well done in the private sector. Chris Ross CIO at Mayo made a good point that the contract should not tie the VA to only this vendor for this important function . This technology is getting better at an accelerated pace. We could get stuck with a platform that is outdated and the contract will not allow us to innovate with another platform. Sent from my iPad Bruce Moskowitz M.D. > On Mar 15, 2018 , at 9:24 AM, Blackburn , Scott R. wrote: > > Bruce , thanks for raising this . Below is what I learned about what we have for intensive care units interacting with a centra l monitoring system. Let me know if this sounds right to you . Also you rattled off a couple of things (nutritional layout from Tufts, field to input the serial number for items in the device registry) ; if you could send me those I can hunt those down as well to save time. I just got off the phone with Stephanie Reel and she is excited to help ; speaking to a few others at 11 :30am ET. > > The Gerner solution for ICU central monitoring, as part of the VA EHR , utilizes Cerner's CareAware iAware framework through the Apache Outcomes solution . This solution has the capability to configure dashboard views to enable monitor ing of high acuity areas, specifically around performance and patient care . This capability is included in the scope of the Gerner acquisition as the Critical Care System, Gerner Apache Outcomes solution and End User License Agreement. > > Does this capability also mon itors emergency rooms, recovery rooms and telemetry beds? > The current acquisition solutions meet these requirements and can be configured into a central command center model. > * Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process. This solution has been included as an Emergency Medicine System and End User License Agreement. > * Recovery Room: Surgical Management solution has track ing boards to monitor patient progress and efficiency of care provided. This solution has been included as Perioperative System and End User License Agreement. > * Telemetry Beds: Traditional central monitoring systems as are used in telemetry , exist within the VA's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA . However , the acquisition includes integration of this VA-18-0298-B-000296 Page 15 14 of of 231i 6 871 capability . > > In addition to these monitoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. > > > -Scott > > -----Original Message----~- --------~ > From: Bruce Moskowitz l Sent: Wednesday , March 14, 2018 12:18 PM > To: Blackburn, Scott R. > Subject: [EXTERNAL] EMR calls > > To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system . The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . > > Sent from my iPad > Bruce Moskowitz M.D. VA-18-0298-B-000297 Page 1515 of of 231i 7 871 Document ID: 0.7.1705.502783 From: BruceMoskowitz l To: Blackburn , Scott R. 6 frenchangel59.com>; IP (bJ< Cc: 6l (bJ< gmail.com l,.... ; O'Rourke , Peter M. Bee: Re: [EXTERNAL] EMR calls Subject: Thu Mar 15 2018 09:52:13 EDT Date: Attachments: Thank you th is is important information. I can walk everyone through the device registry and the nutritional platform. The critical area that is the main part of your due diligence which is much apprecia ted is remote patient monitoring. This w ill be the hospital platform of the very near future for the VA and is already well done in the private sector. Chris Ross CIO at Mayo made a good point that the cont ract shou ld not tie the VA to only this vendor for this important function. This techno logy is getting better at an accelerated pace. We could get stuck with a platform that is outda ted and the contrac t will not allow us to innovate w ith another platform. Sent from my iPad Bruce Moskowitz M.D. > On Mar 15, 2018 , at 9:24 AM , Blackburn , Scott R. wrote: > > Bruce , thank s for raising this . Below is what I learned about what we have for intensive care units interacting with a centra l monitoring system. Let me know if this sounds right to you . Also you rattled off a couple of things (nutritional layout from Tufts, field to input the seria l number for items in the device registry); if you cou ld send me those I can hunt those down as well to save time. I just got off the phone with Stephanie Reel and she is excited to help ; speaki ng to a few othe rs at 11 :30am ET. > > The Gerner solution for ICU centra l monitoring, as part of the VA EHR, utilizes Cerner's CareAware iAware framework through the Apache Outcomes solution. This solution has the capability to configure dashboard views to enable monitoring of high acuity areas, spec ifically around performance and patient care . This capability is included in the scope of the Gerner acqu isition as the Critical Care System, Gerner Apache Outcomes solution and End User License Agreement. > > Does this capab ility also mon itors emergency rooms, recovery rooms and telemetry beds? > The current acquisition solutions meet these requirements and can be configured into a central command center model. > * Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process. This solution has been included as an Emergency Medicine System and End User License Agreeme nt. > * Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . T his solution has been included as Perioperative System and End User License Agreement. > * Te lemetry Beds: Traditional centra l monitor ing systems as are used in telemetry , exist within the VA's current environment. During the acquisition process it was decided that these solutions will persist VA-18-0298-B-000298 Page 1516 of 231ia of 871 into the future state to reduce costs for the VA. However, the acquisition includes integration of this capability . > > In addition to these monitoring capabilities, CareAware Patient Flow , which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. > > > -Scott > > -----Original Message----,,,. - .,..,.,,,...---------, 5 > From: Bruce Moskowitz l Sent: Wednesday , March 14, 2018 12:18 PM > To: Blackburn, Scott R. > Subject: [EXTERNAL] EMR calls > > To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system. > > Sent from my iPad > Bruce Moskowitz M.D. VA-18-0298-B-000299 Page 15 17 of 231i9 of 871 Document ID: 0.7.1705.502762 Blackburn, Scott R. To: Short, John (VACO) ; Zenooz , Ashwini Cc: Windom , John H. Bee: Subject: RE: [EXTERNAL] EMR calls Date: Thu Mar 15 2018 09:25:08 EDT Attachments: Thanks. I passed this on. From: Short , John (VACO) Sent: Wednesday , March 14, 2018 8:45 PM To: Zenooz, Ashwini Cc: Blackburn , Scott R. ; Windom, John H. Subject: RE: [EXTERNAL] EMR calls Ash - Take a look at this DRAFT Response . Cerne r's proposed solution for ICU central monitoring, as part of the VA EHR , utilizes Cerner's CareAware iAwar e framework through the Apache Outcomes solution. This solution has the capability to configure dashboard views to enable monitoring of high acuity areas, spec ifically around performance and patient care. This capab ility is included in the scope of the Gerner acquisition as the Critical Care System , Gerner Apache Outcomes solution and End User License Agreement. Does this capab ility also monitors emergency rooms , recovery rooms and telemetry beds? The current acquisition solutions meet these requ irements and can be configu red into a central command center model. Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process. This solution has been included as an Emergency Medicine System and End User License Agreement. Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . This solution has been included as Perioperative System and End User License Agreement. Telemetry Beds: Traditional central monitoring systems as are used in telemetry , exist within the VA 's current environment. During the acquisition process it was decided that these solutions will persist VA-18-0298-B-000300 Page 1518 of 23j~Q of 871 into the future state to reduce costs for the VA. However, the acquisition includes integration of this capability . In addition to these monitoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. From: Windom, John H. Sent: Wednesday, March 14, 2018 7:00 PM To: Zenooz, Ashwini; Blackburn, Scott R.; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls I would it make the response over ly complex . Jw Sent with Good (www.good .com) From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 3:44 :50 PM To: Windom, John H.; Blackburn , Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls John Short and I are working on a response . He should have something back from John Short by 8p. Thx Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday , March 14, 2018 3:31:07 PM To: Blackburn, Scott R.; Zenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anything . This is a doctor to doctor tasking. Thx Jw VA-18-0298-B-000301 Page 1519 of 231~ 1 of 871 Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:55:20 AM To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time. From: Zenooz , Ashwini Sent: Wednesday, March 14, 2018 12:54 PM To: Windom, John H.; Blackburn , Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command. Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday , March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short, John (VACO) ; Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solut ions. The team will validate . John Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO); Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls VA-18-0298-B-000302 Page 1520 of 231~2 of 871 -----Original Message----~---------~ From: Bruce Moskowitz l(b)(GJ Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000303 Page 1521 of 23\i 3 of 871 Document ID: 0.7.1705.502761 Blackburn, Scott R. Bruce Moskowitz To: j(bl(6> @mac .com> Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Thu Mar 15 2018 09:24:22 EDT Attachments: Bruce , thanks for raising this . Below is what I learned abou t what we have for intensive care units interacting with a centra l monitoring system. Let me know if this sounds right to you . Also you rattled off a couple of things (nutr itional layout from Tufts, field to input the serial number for items in the device registry); if you cou ld send me those I can hunt those down as well to save time. I ju st got off the phone with Stephanie Reel and she is excited to help ; speaking to a few others at 11 :30am ET. The Gerner solution for ICU central monitoring, as part of the VA EHR, utilizes Cerner 's CareAware iAware framework through the Apache Outcomes solution . This solution has the capability to configure dashboard views to enable monitoring of high acuity areas , spec ifically around performance and patient care . This capability is included in the scope of the Gerner acqu isition as the Critical Care System, Gerner Apache Outcomes solution and End User License Agreement. Does this capab ility also monitors emergency rooms , recovery rooms and telemetry beds? The current acquisi tion solutions meet these requirements and can be configured into a central command center model. oEmergency Room : Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monito r progression of patients through the patient care process. This solution has been included as an Emergency Medicine System and End User License Agreement. oRecovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided. This solution has been included as Perioperative System and End User License Agreement. oTe lemet ry Beds: Traditiona l centra l monitor ing systems as are used in telemetry , exist within the VA 's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA. However , the acquisition includes integrat ion of this capab ility. In addition to these monitoring capabil ities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operational ize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. -Scott -----Original Message----.-------------. From: Bruce Moskowitz l(bH5> Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac .com] To save time can you tell me if the Gerner contract has a prov ision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command VA-18-0298-B-000304 Pa ge 1522 of 23 \ i 4 of 871 and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms , recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000305 Page 1523 of 231~s of 871 Document ID: 0.7.1705.1218826 From: Zenooz, Ashwini Short, John (VACO) Blackburn , Scott R. ; Windom, John H. Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 20:52:19 EDT Date: Attachments: Thanks. This looks accurate. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Wednesday , March 14, 2018 5:44 :58 PM To: Zenooz, Ashwini Cc: Blackburn , Scott R. ; Windom, John H. Subject: RE: [EXTERNAL] EMR calls Ash - Take a look at this DRAFT Respo nse. Cerner's proposed solution for ICU central monitoring, as part of the VA EHR , utilizes Cerner 's CareAware iAware framework through the Apache Outcomes solution. This solution has the capability to configure dashboard views to enable mon itor ing of high acuity areas, specifically around performance and patient care. This capability is included in the scope of the Cerner acquisition as the Critical Care System, Cerner Apache Outcomes solution and End User License Agreement. Does this capability also monitors emergency rooms , recovery rooms and telemetry beds? The current acquisition solutions meet these requirements and can be configured into a central command center model. ******* Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process. This solution has been included as an Emergency Medicine System and End User License Agreement. VA-18-0298-B-000306 Page 1524 of 231~6 of 871 ******* Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . This solution has been included as Perioperative System and End User License Agreement. ******* Telemetry Beds: Traditional central monitoring systems as are used in telemetry, exist within the VA's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA. However , the acquisition includes integration of this capability. In addition to these mon itoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. From: Windom, John H. Sent: Wednesday, March 14, 2018 7:00 PM To: Zenooz, Ashwini; Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls I would it make the respo nse overly complex. Jw Sent with Good (www.good.com) From: Zenooz , Ashwini Sent: Wednesday, March 14, 2018 3:44 :50 PM To: Windom, John H.; Blackburn , Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR ca lls John Short and I are working on a response. He sho uld have some thing back from John Short by 8p. Thx Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday, March 14, 2018 3:31 :07 PM To: Blackburn, Scott R.; Zenooz, Ashwini; Short, John (VACO) Subject: RE : [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anything. This is a doctor to VA-18-0298-B-000307 Page 1525 of 231~7 of 871 doctor tasking. Thx Jw Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:55:20 AM To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cut/paste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time. From: Zenooz , Ashwini Sent: Wednesday, March 14, 2018 12:54 PM To: Windom, John H.; Blackburn , Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command . Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday , March 14, 2018 9:50:28 AM To : Blackburn, Scott R.; Short, John (VACO) ; Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate . John Sent with Good (www.good.com) VA-18-0298-B-000308 Page 1526 of 231~8 of 871 From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO); Zenooz, Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message----(b-J(6-l ----------. From: Bruce Moskowitz l,,_ Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNA L] EMR calls @mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000309 Page 1527 of 23\ig of 871 Document ID: 0.7.1705.1218820 From: Short, John (VACO) To: Zenooz, Ashwini Cc: Blackburn , Scott R. ; Windom, John H. Bee: Subject: RE: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 20 :44:58 EDT Attachments: Ash - Take a look at this DRAFT Response . Cerner's proposed solution for ICU central monitoring, as part of the VA EHR , utilizes Cerner 's CareAware iAware framework through the Apache Outcomes solution . This solution has the capability to configure dashboard views to enable monitoring of high acuity areas, specifically around performance and patient care. This capability is included in the scope of the Cerner acquisition as the Critical Care System , Cerner Apache Outcomes solution and End User License Agreement. Does this capability also monitors emergency rooms , recovery rooms and telemetry beds? The current acquisition solutions meet these requirements and can be configured into a central command center model. ******* Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process . This solution has been included as an Emergency Medicine System and End User License Agreement. ******* Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . This solution has been included as Perioperative System and End User License Agreement. ******* Telemetry Beds: Traditional centra l monitoring systems as are used in te lemetry, exist within the VA's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA. However, the acquisition includes integration of this capability . In addition to these monitoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. From: Windom, John H. Sent: Wednesday , March 14, 2018 7:00 PM VA-18-0298-B-000310 Page 1528 of 23j~Q of 871 To: Zenooz , Ashwini; Blackburn, Scott R.; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls I wou ld it make the response overly complex . Jw Sent with Good (www.good.com) From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 3:44 :50 PM To: Windom, John H.; Blackburn , Scott R.; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls John Short and I are work ing on a response. He should have something back from John Short by 8p. Thx Sent with Good (www.good .com) From: Windom , John H. Sent: Wednesday , March 14, 2018 3:31:07 PM To: Blackburn, Scott R.; Zenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anyth ing. This is a doctor to doctor tasking . Thx Jw Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday , March 14, 2018 9:55:20 AM To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls VA-18-0298-B-000311 Page 1529 of 231~1 of 871 Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time. From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 12:54 PM To : Windom, John H.; Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command. Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday , March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short , John (VACO) ; Zenooz , Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR imp lementat ion practices/solutions. The team will validate . John Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday , March 14, 2018 9:37:42 AM To : Windom , John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message--- ~ ----------~ From: Bruce Moskowitz l(bl(5l Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is VA-18-0298-B-000312 Page 1530 of 23\~ 2 of 871 not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000313 Page 1531 of 231~3 of 871 Document ID: 0.7.1705.501994 Short, John (VACO) Zenooz, Ashwini To: Blackburn , Scott R. ; Windom, John H. Bee: Subject: Date: Attachments: RE: [EXTERNAL] EMR calls Wed Mar 14 2018 20:44:58 EDT Ash - Take a look at this DRAFT Response . Cerner 's proposed solution for ICU central monitoring, as part of the VA EHR , utilizes Cerner 's CareAware iAware framework through the Apache Outcomes solution . This solution has the capability to configure dashboard views to enable monitoring of high acuity areas, specifically around performance and patient care. This capability is included in the scope of the Cerner acquisition as the Critical Care System , Cerner Apache Outcomes solution and End User License Agreement. Does this capability also monitors emergency rooms , recovery rooms and telemetry beds? The current acquisition solutions meet these requirements and can be configured into a central command center model. Emergency Room: Emergency Department (ED) Dashboard is built into the Emergency Department Care Management to monitor progression of patients through the patient care process . This solution has been included as an Emergency Medicine System and End User License Agreement. Recovery Room: Surgical Management solution has tracking boards to monitor patient progress and efficiency of care provided . This solution has been included as Perioperative System and End User License Agreement. Telemetry Beds: Traditional centra l monitoring systems as are used in telemetry, exist within the VA 's current environment. During the acquisition process it was decided that these solutions will persist into the future state to reduce costs for the VA. However, the acquisition includes integration of this capability . In addition to these monitoring capabilities, CareAware Patient Flow, which is Cerner's capacity management solution that helps to operationalize patient care activities such as room cleaning offers specific dashboards that can be centralized to support a central command center model. VA-18-0298-B-000314 Page 1532 of 231~4 of 871 From: Windom, John H. Sent: Wednesday, March 14, 2018 7:00 PM To: Zenooz , Ashwini; Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls I wou ld it make the response overly complex. Jw Sent with Good (www.good.com) From: Zenooz, Ashwini Sent: Wednesday, March 14, 2018 3:44:50 PM To: Windom, John H.; Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls John Short and I are working on a response. He should have something back from John Short by 8p. Thx Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday, March 14, 2018 3:3 1:07 PM To: Blackburn, Scott R.; Zenooz, Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anything. This is a doctor to doctor tasking. Thx Jw Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:55:20 AM VA-18-0298-B-000315 Page 1533 of 231~s of 871 To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time . From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 12:54 PM To: Windom, John H.; Blackburn , Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a centra l command. Sent with Good (www .good.co m) From: Windom, John H. Sent: Wedne sday , March 14, 2018 9:50:28 AM To : Blackburn , Scott R.; Short, John (VACO); Zenooz , Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate. John Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday , March 14, 2018 9:37:42 AM To : Windom , John H.; Short , John (VACO); Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls - ----------. -----Original Message----.From: Bruce Moskowitz l(b)(G) Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNA L] EMR calls @mac.com] To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive VA-18-0298-B-000316 Page 1534 of 23\~ 6 of 871 care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expand ing this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000317 Page 1535 of 231~7 of 871 Document ID: 0.7.1705.1521240 From: Windom, John H. To: Zenooz, Ashwini ; Blackburn , Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 19:00:18 EDT Attachments: I would it make the response overly complex . Jw Sent with Good (www.good .com) From: Zenooz , Ashwini Sent: Wedne sday , March 14, 2018 3:44 :50 PM To : Windom , John H.; Blackburn , Scott R. ; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls John Short and I are working on a response. He should have something back from John Short by 8p. Thx Sent with Good (www .good .com) From: Windom , John H. Sent: Wednesday , March 14, 2018 3:31:07 PM To : Blackburn, Scott R. ; Zenooz , Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anything. This is a doctor to doctor tasking . Thx Jw VA-18-0298-B-000318 Page 1536 of 231~8 of 871 Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:55:20 AM To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time. From: Zenooz, Ashwini Sent: Wednesday, March 14, 2018 12:54 PM To: Windom, John H.; Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command. Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday, March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short, John (VACO); Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate. John Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short, John (VACO); Zenooz, Ashwini VA-18-0298-B-000319 Page 1537 of 23j~g of 871 Subject: FW: [EXTERNAL] EMR calls -----Original Message----From: Bruce Moskowitz ~l (b~H6~l -------~ Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000320 Page 1538 of 23\~ o of 871 Document ID: 0.7.1705.1218712 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn , Scott R. ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 18:44:50 EDT Date: Attachments: John Short and I are working on a response. He should have something back from John Short by 8p. Thx Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday, March 14, 2018 3:31:07 PM To: Blackburn, Scott R.; Zenooz , Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Ash Did you closeout this request from Mr Blackburn? I was not copied on anything. This is a doctor to doctor tasking. Thx Jw Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:55:20 AM To: Zenooz, Ashwini; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time . VA-18-0298-B-000321 Page 1539 of 231~1 of 871 From: Zenooz, Ashwini Sent: Wednesday, March 14, 2018 12:54 PM To: Windom, John H.; Blackburn, Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command. Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday , March 14, 2018 9:50:28 AM To : Blackburn, Scott R.; Short, John (VACO) ; Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR imp lementation practices/solutions. The team will validate . John Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday , March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message----(b-)(6-l ---------. From: Bruce Moskowitz ~l Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . VA-18-0298-B-000322 Page 1540 of 23\~ 2 of 871 Sent from my iF?ad Bruce Moskowitz MD. Page 1541 of 235% of 87.1 Document ID: 0.7.1705.1521215 From: Windom, John H. To: Blackburn, Scott R. ; Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 18:31 :07 EDT Date: Attachments: Ash Did you closeout this request from Mr Blackburn? I was not copied on anything. This is a doctor to doctor tasking . Thx Jw Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wedne sday, March 14, 2018 9:55:20 AM To : Zenooz , Ashwin i; Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls Thanks. Can you guys write me a short response to Bruce that I can cut/paste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time . From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 12:54 PM To: Windom, John H.; Blackburn , Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a centra l command. VA-18-0298-B-000324 Page 1542 of 231~4 of 871 Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday, March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short, John (VACO) ; Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate. John Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday , March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO); Zenooz, Ashwini Subject: FW: [EXTERNAL] EMR calls -----O riginal Message- ---From: Bruce Moskowitz ,....l (b-H6:-l---------. Sent: Wednesday , March 14, 2018 12:18 PM To : Blackburn , Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000325 Page 1543 of 23\~ s of 871 Document ID: 0.7.1705.1218251 From: Windom, John H. !(oJ(6l f /o=va/ou=visn To: 03/cn=recipients/cn=vhaeastruexm>; Blackburn , Scott R. Cc: Foster , Michele (SES) Bee: Subject: RE: any other NDAs come in? Date: Wed Mar 14 2018 13:50: 18 EDT Attachments: image001.jpg Tracking . Thx Jw Sent with Good (www.good .com) l(o_J(6 _J ____ ......, From: .... Sent: Wednesday , March 14, 2018 10:24 :21 AM To : Windom , John H.; Blackburn , Scott R. Cc: Foster , Michele (SES) Subject: RE: any other NDAs come in? John - To some extent , yes, however, in instances where VA is having specific individuals provide reviews/feedback I still prefer to have NDAs as we are pulling them behind the veil to some extent. briefly consulted with OGC and their recommendation is to continue to request the NDAs . Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics VA-18-0298-B-000326 Page 1544 of 23\~ 6 of 871 Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobil.e:I'"" '' I e-mail: ~-----~ @va.gov "For Internal VA Use Only - Working Draft, Pre-Decisional, Deliberative Document: This e-ma il and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information. If you are not the intended recipient of this e-mail, you are hereby notified that any dissemination, distribution or copying of this e-mail, and any attachments thereto , is strict ly prohibited. If you have received this e-mail in error, please notify me via return e-mail or telephone (732) 440-9650 , and permanent ly delete the original and any copy of any e-mai l and any printout thereof. " From: Windom, John H. Sent: Wednesday , March 14, 2018 12:48 PM 5 To: l(bl< l Blackburn, Scott R. Cc: Foster , Michele (SES) Subject: RE: any other NDAs come in? I NDAs are a moot point after the public posting, correct? Jw Sent with Good (www.good.com) I From: l(bl(6l Sent: Wednesday , March 14, 2018 9:45 :41 AM To: Blackburn, Scott R. Cc: Windom, John H.; Foster, Michele (SES) Subject: RE: any other NDAs come in? Mr. Blackburn, VA-18-0298-B-000327 Page 1545 of 23\~ 7 of 871 I have received NDAs for all individuals except Dr. Ko and Dr. Scott. NDAs are in hand for Dr. Cooper, Dr. Huff, Dr. Moskowitz , Mr. Sherman, Mr . Perlmutter, and Ms. Reel. Those with signed NDAs have all been sent a link to the RFP files . Thanks, (b){6) Cont racting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Techno logy Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :Db )(GJ e-mail: va .gov "For Internal VA Use Only - Working Draft, Pre-Decisiona l, Deliberative Document: Th is e-ma il and any attachmen ts are intended only for the use of the addressee(s) named herein and may contain privileged and/or confident ial information. If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribut ion or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-ma il or telephone (732) 440-9650 , and permanent ly delete the origina l and any copy of any e-mai l and any printout thereof." From:~l (b-)(6 _J____ ~ Sent: Tuesday , Marc h 13, 20 18 2:17 PM To: Blackburn, Scott R.; Windom, John H.; Foster , Michele (SES) VA-18-0298-B-000328 Page 1546 of 23\~aof 871 Subject: RE: any other NDAs come in? Mr . Blackburn -As you may have seen, NDAs were just received from Mr. Perlmutter and Mr. Sherman. I am in the process of providing Ms. Reel, Mr. Perlmutter and Mr. Sherman access to the RFP files via the Army's SAFE site. Thanks, {b){6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office : 732-440-9650 Mobile :r7 e-mail: L______k va.gov "For Internal VA Use Only - Working Draft, Pre-Decisional, Deliberative Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." From: -l To: Windom, John H. ; Blackburn , Scott R. Cc: Foster , Michele (SES) Bee: Subject: RE: any other NDAs come in? Date: Wed Mar 14 2018 13:24:21 EDT Attachments: image001.jpg I , John - To some extent , yes, however, in instances where VA is having specific individua ls provide reviews/feedback I still prefer to have NDAs as we are pulling them behind the veil to some extent. briefly consulted with OGC and their recommendation is to continue to request the NDAs . Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office : 732-440-9650 6 Mobile :Dbl To: Windom, John H. ; Blackburn, Scott R. Cc: Foster, Michele (SES) Bee: Subject: RE: any other NDAs come in? Date: Wed Mar 14 2018 13:24:21 EDT Attachments: image001.jpg John - To some extent , yes, however, in instances where VA is having specific individuals provide reviews/feedback I still prefer to have NDAs as we are pulling them behind the veil to some extent. briefly consulted with OGC and their recommendation is to continue to request the NDAs. Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :~ e-mail: l_______k va.gov VA-18-0298-B-000337 Page 1560 of 23\~ 7 of 871 "For Internal VA Use Only-Working Draft, Pre-Decisional, Deliberat ive Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information. If you are not the intended recipient of this e-mail, you are hereby notified that any dissemination, distribution or copying of th is e-mail, and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mail or telephone (732) 440-9650, and permanently delete the original and any copy of any e-mail and any printout thereof." From: Windom, John H. Sent: Wednesday, March 14, 2018 12:48 PM 6l !Blackburn , Scott R. To: l(b)C Cc: Foster, Michele (SES) Subject: RE : any other NDA s come in? NDA s are a moot point after the public posting, correct? Jw Sent with Good (www.good.com) From:~l @imail.o rg> Stan Huff !(b)(Bl To: Windom , John H. Cc: ; (bl(5> /o=exc hange labs/ou=exchange adm inistrat ive group (fydibohf23spdlt)/cn =recipients/cn =045f8eff 429f45888be 795fbaa 1d 9ef2- truex , matt>; Foster, Miche le (SES) ; l(bl(6> Foster, Michele (SES) ;._l (b_H5_> _____ Subject: [EXTERNA L] RE: VA EHR I __, Scott, I have attached my signed NOA. I look forward to visiting tomorrow . Thanks , Stan From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday , March 12, 2018 7:08 PM @imai l.org> To: Stan Huff l(bH6> Cc: Windom, John H.; 1~~ ,.......:..!::=========== Miche le (SES) j(bJ(6l Subj ect: RE: VA EHR . . kLeyva.gov>; Foste r, ::::!::::: :....._ ....:::..... _,t@va.gov> Stan: VA-18-0298-B-000342 Page 1568 of 23\i 2 of 871 Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expertise ; and want to make sure we get to the best place possible for Veterans , the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) (b-J(B _l --~ We will need you to sign the attached NOA. Please return to~l 2) Matt will then send you the latest package under separate cover. kcc'd). 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your expertise will be most valuable . Matt Truex will lead this from our side and has told me is available between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don 't work for l(cc'd) here to help set up a time. you. I will as~(bl(5l Thanks again! Scott b_l(_l ~~~~~~~~__, From: Stan Huttl.'..,.. Sent: Monday , March 12, 2018 4:34 PM To : Blackburn, Scott R. Subje ct: [EXTERNAL] Re: VA EHR 5 Yes , I would be glad to help . What is the next step? Stan Sent from Stan Huff's iPhone On Mar 12, 2018, at 6:54 AM , Blackburn, Scott R. wrote : Stan , I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz . VA-18-0298-B-000343 Pag e 1569 of 23\i 3 of 871 Thanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000344 Page 1570 of 231~4 of 871 Document ID: 0.7.1705. 1218221 From: Blackburn , Scott R. imail.o rg> Stan Huff {bJ<5l To: Windom , John H. {bl{6l ; Foster, Michele r'---~--, SES _. ; ._ {bl{6l l Bee: Subject: RE: VA EHR Date: Wed Mar 14 2018 12:56:12 EDT Attachments: __ Thanks so much, Stan! (@,imail.org) From: Stan Huff l To : Stan Huff l,.!J ;l._ ; l; Foste r, t@va.gov> Stan: Thank you for agreeing to be an extra set of outs ide eyes as we at VA fina lize our EHR contract. We app reciate you r vast expe rience and expert ise ; and want to make sure we get to the best place poss ible for Veterans, the country and taxpayers . As we are incredibly grateful to you for voluntee ring yo ur time, we want to make this as easy as possib le for you. Here are 3 next steps. VA-18-0298-B-000345 Page 157 1 of 23\is of 871 1) 2) We will need you to sign the attached NOA. Please return to ~l (b-)(G _) --~ ~ l{cc'd). ill then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your expertise will be most valuable . l(b)(6) lwill lead this from our side and has told me is available between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don 't work for 5 you. I will ask l wrote : Stan , I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR dea l with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott VA-18-0298-B-000346 Page 1572 of 23\i 6 of 871 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000347 Page 1573 of 231~7 of 871 Document ID: 0.7.1705.1769092 From: Blackburn , Scott R. To: Zenooz, Ashwini ; Windom , John H. ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 12:55:20 EDT Date: Attachments: Thanks. Can you guys write me a short response to Bruce that I can cuUpaste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time. From: Zenooz , Ashwini Sent: Wednesday , March 14, 2018 12:54 PM To : Windom, John H.; Blackburn , Scott R. ; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc . at a central command . Sent with Good (www.good .com) From: Windom , John H. Sent: Wednesday , March 14, 2018 9:50:28 AM To : Blackburn, Scott R.; Short, John (VACO) ; Zenooz, Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate . John Sent with Good (www.good .com) VA-18-0298-B-000348 Page 1574 of 231~ 8 of 871 From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO); Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -.,..,.,.,..----------. -----Original Message----,.,,. From: Bruce Moskowitz l(b)(GJ Sent: Wednesday, March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000349 Page 1575 of 23\ig of 871 Document ID: 0.7.1705.501276 From: Blackburn , Scott R. To: Zenooz, Ashwini ; Windom , John H. ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL ] EMR calls Subject: Date: Wed Mar 14 2018 12:55:20 EDT Attachments: Thanks. Can you guys write me a short response to Bruce that I can cut/paste? I want to nip these things in the bud so we can get this damn thing over the goalline! It is crunch time . From: Zenooz , Ashwini Sent: Wedne sday , March 14, 2018 12:54 PM To : Windom , John H.; Blackburn , Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] EMR calls That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command . Sent with Good (www .good .com) From: Windom, John H. Sent: Wednesday, March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short , John (VACO) ; Zenooz , Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solut ions . The team will validate . John VA-18-0298-B-000350 Page 1576 of 231~oof 871 Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message----~---------~ From: Bruce Moskowitz l(b)(GJ Sent: Wednesday, March 14, 2018 12:18 PM To: Blackburn , Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000351 Page 1577 of 23\~ 1 of 871 Document ID: 0.7.1705.1218208 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn , Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 12:54:18 EDT Attachments: That is correct. Through LightsOn and system config we would be able to view enterprise wide ICU, ED activity etc. at a central command. Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday, March 14, 2018 9:50:28 AM To: Blackburn, Scott R.; Short , John (VACO) ; Zenooz , Ashwini Subject: RE: [EXTERNAL] EMR calls This is part of contract and standard EHR implementation practices/solutions. The team will validate . John Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message----From: Bruce Moskowitz .-l (b-)(5-l ---------. Sent: Wednesday, March 14, 2018 12:18 PM To: Blackburn, Scott R. @mac.com] VA-18-0298-B-000352 Page 1578 of 23\~ 2 of 871 Subject: [EXTERNAL] EMR calls To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000353 Page 1579 of 231~3 of 871 Document ID: 0.7.1705.1218204 From: Windom, John H. To: Blackburn, Scott R. ; Short , John (VACO) ; Zenooz, Ashwini Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 12:50:28 EDT Attachments: This is part of contract and standard EHR implementation practices/solutions . The team will validate . John Sent with Good (www .good .com) From: Blackburn, Scott R. Sent: Wednesday, March 14, 2018 9:37:42 AM To: Windom , John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] EMR calls -----Original Message----(b-H6-l --------.. From: Bruce Moskowitz ,....l Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls @mac.com] To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a central monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000354 Page 1580 of 23\~ 4 of 871 Document ID: 0.7.1705.1218202 From: Windom , John H. l; Blackburn , Scott R. Cc: Foster , Michele (SES) Bee: Subject: RE: any other NDAs come in? Date: Wed Mar 14 2018 12:47:37 EDT Attachments: image001.j pg NDAs are a moot point after the public posting , correct? Jw Sent with Good (www.good .com) I From:l Blackburn, Scott R. Windom , John H. ; Foster , Michele (SES) Bee: Subject: RE: any other NDAs come in? Date: Wed Mar 14 2018 12:45:41 EDT Attachments: image001.jpg Mr. Blackburn , I have received NDAs for all individuals except Dr. Ko and Dr. Scott. NDAs are in hand for Dr. Cooper, Dr. Huff , Dr. Moskowitz , Mr. Sherman, Mr . Perlmutter, and Ms. Reel. Those with signed NDAs have all been sent a link to the RFP files . Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :~ e-mail: L______h va.gov VA-18-0298-B-000359 Page 1588 of 23\~g of 871 "For Internal VA Use Only - Working Draft, Pre-Decisional, Deliberative Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." 5J From:l(bJ( I Sent: Tuesday , March 13, 2018 2:17 PM To: Blackburn, Scott R.; Windom, John H.; Foster, Michele (SES) Subject: RE: any other NDAs come in? Mr. Blackburn - As you may have seen , NDAs were just received from Mr. Perlmutter and Mr. Sherman . I am in the process of providing Ms. Reel , Mr. Perlmutter and Mr. Sherman acces s to the RFP files via the Army 's SAFE site. Thanks , (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :~ e-mail: L______k va.gov VA-18-0298-B-000360 Page 1589 of 23\ioof 871 "For Internal VA Use Only - Working Draft, Pre-Decisiona l, Delibera tive Document: This e-mai l and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information. If you are not the intended rec ipient of this e-mail , you are hereby notified that any dissemination, distribut ion or copying of this e-mail , and any attachments thereto , is strict ly pro hibited. If you have received th is e-mail in error, please notify me via return e-ma il or telephone (732) 440-9650 , and permanent ly de lete the origina l and any copy of any e-mai l and any printout thereof. " From: ~l (b_J(6 _J____ ~ Sent: Tuesday , March 13 , 20 18 12:32 PM To: Blackburn, Scott R.; Windom, John H.; Foster, Michele (SES) Subject: RE : any other NDAs come in? Absolutely , will do Mr. Blackburn . The only NOA I have received is from Ms. Reel , as stated yesterday . l(b)(6) Contracting Officer Department of Veterans Affairs Office of Procu rement , Acquisition and Logistics Techno logy Acquisition Center 23 Christopher Way Eatontown , New Je rsey 07724 Office : 732-440-9650 Mobile :~ e-mail: L_______k va.gov "For Internal VA Use Only-Work ing Draft, Pre-Decisiona l, Deliberative Document: Th is e-ma il and any attachmen ts are intended only fo r the use of the addressee(s) named herein and may contain privileged and/or confident ial information . If you are not the intended recipient of th is e-mail , you are hereby VA-18-0298-B-000361 Page 1590 of 23\i 1 of 871 notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited . If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." From: Blackburn , Scott R. Sent: Tue sda y, March 13, 2018 11 :41 AM To: l(bl(5l Windom , John H.; Foster, Michele (SES) Subject: any other NDAs come in? I Let me know if/when they do. The Secretary is mon itoring very closely so I want to give him a little "here is where we are " by the end of the day. Once again - thanks for your patience and support with this. I want to make sure we do th is all in the right way so leaning on you guys for help. I do think this is important for external validation , buy-in, and maybe even a few slight course corrections before sign ing if they do find anything that we need to improve (extra sets of eyes and different perspectives is always good - especially on a contract of this significance and magnitude). Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000362 Page 159 1 of 23\i 2 of 871 Document ID: 0.7.1705.501220 Blackburn, Scott R. Windom, John H. ; Short, John (VACO) ; Zenooz, Ashwini Cc: Bee: Subject: FW: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 12:37:42 EDT Attachments: -----Original Message ----.... ------------. 5 From: Bruce Moskowitz l(bl< l Sent: Wednesday, March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] EMR calls l@mac.com] To save time can you tell me if the Cerner contract has a provision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system. The future is expanding this to monitor emergency rooms, recovery roo ms and telemetry beds. If it is not in place which should be a standard part of the contract we will have billions in further costs to the system. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000363 Page 1594 of 23\i 3 of 871 Document ID: 0.7.1705.501148 Bruce Moskowitz From: @mac.com> Blackburn, Scott R. l(b)(GJ To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL ] EMR calls Wed Mar 14 2018 12:18:30 EDT To save time can you tell me if the Gerner contract has a provision to have the EMR that is in Intensive care units interact with a centra l monitoring system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospitals in their system . The future is expanding this to monitor emergency rooms, recovery rooms and telemetry beds . If it is not in place which should be a standa rd part of the contract we will have billions in further costs to the system . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000364 Page 1595 of 23\i 4 of 871 Document ID: 0.7.1705.1218135 @imail.org> Stan Huff l(b)(GJ From: Blackburn, Scott R. Windom , John H. ; (bl(6l /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Foster, Michele r'---~--, SES _. ; ._ (bl(6l 6l l Bee: Subject: [EXTERNAL] RE: VA EHR Date: Wed Mar 14 201811 :52:19 EDT Attachments: NOA EHRM Stan Huff signed 180314.pdf __ Scott, I have attached my signed NOA. I look forward to visiting tomorrow . Thanks , Stan From: Blackburn , Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday, March 12, 2018 7:08 PM To : Stan Huff !(bJ(6J @ imail.org > 5 Cc: Windom , John H.P l; ""l Subject: RE: VA EHR @va.gov>; Foster , =- -'<-. l@va.gov> Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expert ise; and want to make sure we get to the best place possible for Veterans , the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 5 1) (b-l( _l __ We will need you to sign the attached NOA. Please return to._l 2) Matt will then send you the latest package under separate cover. _.~cc'd) . 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your lwill lead this from our side and has told me is available expertise will be most valuable . l(bl(5l between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don't work for 5 you . I will ask l wrote : Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR dea l with Cerner; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000366 Page 1597 of 23\i 6 of 871 Document ID: 0.7.1705.1769086 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; Windom , John H. ; Blackburn , Scott R. ; (bJ(5J '; r::(b~ J(6~J - -,;:::::--;:::B...... ruce 6 Moskowitz MD (bJ( J gmail.com> ; Bruce Moskowitz (bJ(5J mac.com> Cc: Bee: EHR VA Call Subject: Date: Wed Mar 14 2018 10:29:27 EDT Attachments: StartTime: Wed Mar 21 15:00:00 Central Daylight Time 2018 EndTime : Wed Mar 21 16:30:00 Central Daylight Time 2018 Location : l(bJ(BJ Invitees: Windom , John H.; Blackburn, Scott R.; .... l(b_J(5_J ______ Moskowitz Recurring: No ShowReminder: Yes ReminderMinutes : 15 ReminderTime: Wed Mar 21 14:45:00 Central Daylight Time 2018 Accepted : Yes AcceptedTime: Thu Mar 15 10:58:00 Centra l Daylight Time 2018 I ___.@Bruce Moskowitz.MD; Bruce VA-18-0298-B-000367 Page 1602 of 23\i 7 of 871 Document ID: 0.7.1705.1519161 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Windom , John H. ; Blackburn , Scott R. ; (bl<5 l ~......,,...,,=---=-=,...... ; (bJ<6l Bruce Moskowitz .MD (bJ(6l @gmail.com> ; Bruce os ow1tz (bJ(6l mac.com> Cc: Bee: Canceled: EHR VA Call Subject: Wed Mar 14 2018 10:29:27 EDT Date: Attachments: StartTime: Wed Mar 21 15:00:00 Central Daylight Time 2018 EndTime : Wed Mar 21 16:30:00 Central Daylight Time 2018 Location : l(bl<6l Invitees: Windom , John H.; Blackburn, Scott R.;l(bl(5l Moskowitz ~-------~ I @Bruce Moskowitz.MD; Bruce Recurring: No ShowReminder : Yes ReminderMinutes : 15 ReminderTime: Wed Mar 21 14:45:00 Central Daylight Time 2018 Accepted : Yes AcceptedTime: Thu Mar 15 10:58:00 Centra l Daylight Time 2018 VA-18-0298-B-000368 Page 1603 of 23\ia of 871 Document ID: 0.7.1705.1769056 From: Blackburn , Scott R. To: Myklegard, Drew ; ~ l(b_l(5_>---~ ___ _. Cc: Bee: Subject: RE: [EXTERNAL] Fwd : EMR Date: Wed Mar 14 2018 00 :03:46 EDT Attachments: Spoke to him today but Apple didn 't come up . Might be good for you to j o in a call or two next week . Sent with Good (www.good .com) From: Myklegard , Drew Sent: Tue sday , March 13, 2018 11 :56:51 PM To: Mulligan , Ricci; Blackburn , Scott R. Subj ect: RE : [EXTERNAL] Fwd : EMR Where are we with Dr. Moskowitz? Sent with Good (www.good .com) From: ~l (b_J(G _>---~ Sent: Tue sday , March 06, 2018 10:01 :05 AM To: Myklegard, Drew ; Blackburn , Scott R. Subject: RE: [EXTERNAL] Fwd: EMR Agree, when? l._ (b_ l(6_>__. Sent with Good (www.good .com) VA-18-0298-B-000369 Page 1610 of 23\ig of 871 From: Myklega rd, Drew Sent: Tuesday, March 06 , 2018 6:02:25 AM To: Blackburn, Scott R.Jbl(5l Subject: Re: [EXTERNAL] Fwd: EMR I Have a meet ing where our VA team and Apple (Ricky and/or Jacky) wa lk Bruce through their slide deck that explains what they are doing . Use it as an opportunity for Shaman to build a relationship with him as VA gets closer to making our announcement. Maybe an email like this: We wou ld like to get our team , Apple , and you on a phone call to walk you through the Veteran/patient experience and how it wi ll improve their care . On this emai l is our clinical leadf or the Apple engagement, Dr. Shaman Singh MD. He will take the lead for coordinating a meeting. From: "Blackburn , Scott R." Date: Tuesda y, March 6, 2018 at 5:42 AM 5 To:l, "Myklegard, Drew" ._l See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06, 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone VA-18-0298-B-000370 Page 161 1 of 23\~oof 871 Begin forwarded message: 5l From: Bruce Moskowitz l(bl< !@,mac.com> Date: March 5, 2018 at 6:49 :58 AM EST To: l(bl(5l @gmail.com , (b)(6J reagan .com 6l Cc: l , .-l (b-)(5,..... l ---.i Subject: EMR @gmail.com I would like to underscore the importance of getting the "Cloud"correctly and the other four issues with the new CIO's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspect ive. Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector . No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000371 Page 1612 of 23\~ 1 of 871 Document ID: 0.7.1705.500720 From: Blackburn , Scott R. To: Myklegard, Drew ;l(b)(5) Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Wed Mar 14 2018 00:03:46 EDT Attachments: I Spoke to him today but Apple didn't come up. Might be good for you to j oin a call or two next week. Sent with Good (www.good.com) From : Myklegard , Drew Sent: Tuesday, Marc h 13, 2018 11 :56:51 PM To : l(b)(5) I Blackburn , Scott R. Subject: RE: [EXTERNAL] Fwd : EMR Where are we with Dr. Moskowitz? Sent with Good (www.good .com) I From: l(b)(6) Sent: Tuesday , March 06 , 201810:01:05AM To : Myklegard, Drew ; Blackburn , Scott R. Subject: RE : [EXTERNAL] Fwd : EMR 5 l Agree, when 7l(bH Sent with Good (www.good .com) VA-18-0298-B-000372 Page 1613 of 23\~ 2 of 871 From: Myklegard , Drew Sent: Tuesday , March 06, 2018 6:02:25 AM To: Blackburn, Scott R.;l(bl(5l Subject: Re: [EXTERNAL] Fwd: EMR I Have a meeting where our VA team and Apple (Ricky and/or Jacky) walk Bruce through their slide deck that explains what they are doing . Use it as an opportunity for Shaman to build a relationship with him as VA gets closer to making our announcement. Maybe an email like this: We would like to get our team , Apple , and you on a phone call to walk you through the Veteran/patient experience and how it will improve their care . On this email is our clinical leadf or the Apple engagement, Dr. Shaman Singh MD. He will take the lead for coordinating a meeting. From: "Blackburn, Scott R." Date: Tue sday , March 6, 2018 at 5:42 AM To j(bl(6l @va.gov> , "Myklegard , Drew" ~l (b_ l(5_> ____ Subject: FW: [EXTERNAL] Fwd: EMR ~ @va.gov> See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone VA-18-0298-B-000373 Page 1614 of 23\~ 3 of 871 Begin forwa rded message: @mac .com> From: Bruce Moskowitz l(bl(5l Date: March 5, 2018 at 6:49:58 AM EST To:l(bH5l @gmail.com ,l(bl<5 l @reagan .com Cc: !(bJ(6J l@gmail.com, IP~ frenchangel59 .com> ,~! (b-l(6-l -~l Subject: EMR @gma il.com I wou ld like to underscore the importance of getting the "Cloud"correct ly and the other four issues with the new CIO's. Also the composition of the physician input has to change immediate ly so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and espec ially in mental health we need a portab le EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000374 Page 1615 of 23\~ 4 of 871 Document ID: 0.7.1705. 1518229 From: Myk legard, Drew l(b)(GJ l Cc: Bee: Subject: RE: [EXTERNAL] Fwd : EMR Date: Tue Mar 13 2018 23:56:51 EDT Attachments: p; Where are we w ith Dr. Moskowitz? Sent with Good (www.good .com) From: ~! (b_l(5_l ---~ Sent: Tue sday , March 06 , 20 18 10:01 :05 AM To: Myklegard, Drew; Blackburn , Scott R. Subj ect: RE : [EXTERNA L] Fwd : EMR Agree , when ? Ricci Sent with Good (www.good .com) From: Myklega rd, Drew Sent: Tue sday , March 06, 20 18 6:02:25 AM To: Blackburn, Scott R.;l(bl(5l Subject: Re: [EXTERNA L] Fwd: EMR I Have a meet ing where our VA team and Apple (Ricky and/or Jacky) wa lk Bruce through their slide deck tha t explains what they are doing . Use it as an opportunity for Shama n to build a relationsh ip with him as VA gets closer to ma king our announceme nt. Maybe an email like this: VA-18-0298-B-000375 Page 1616 of 23\~sof 871 We would like to get our team, Apple, and you on a phone call to walk you through the Veteran/patient experience and how it will improve their care. On th is email is our clinical leadf or the Apple engagement, Dr. Shaman Singh MD. He will take the lead for coordinating a meeting. From: "Blackburn, Scott R." Date: Tuesda~ March 6 2018 at 5:42 AM 5 5 To: l(b)( ) l : : @va.gov>, "Myklegard, Drew" l(b)( SubJect: FW: EXTERNAL] Fwd: EMR ...______ l@va.gov> ~ See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good.com) From: David Shulkin Sent: Tue sday, March 06 , 2018 7:09:43 AM To: Blackburn , Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz I(0 l<5l @mac .com> Date: March 5, 2018 at 6:49 :58 AM EST gmail.com, <0l<6l reagan.com ,--.,-----, To: (b)(6) Cc: (b)(6J gmail.com, IP(b)(5J frenchangel59 .com> , l(0H5l @gma il.com Subject: EMR I would like to underscore the importance of getting the "Cloud"correctly and the other four issues with the new Cl O's. Also the composition of the physician input has to change immed iately so that the EMR is patient centric and usable from the physician perspective. Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . VA-18-0298-B-000376 Page 1617 of 23\~ 6 of 871 Sent from my iPad Bruce Moskowitz MD. Page 1618 of 233%, of 87.1 Document ID: 0.7.1705.500671 From: Blackburn, Scott R. 6l (bl< /o=va/ou=exchange To: administrative group 0 5 _l<_l ---~ (fydibohf23spdlt)/cn=recipients/cn=vacocallae2>; l< __ Windom , John H. Bee: FW: [EXTERNAL] RE: VA EHR Subject: Tue Mar 13 2018 23:07:00 EDT Date: Attachments: Let's try to get everyone else lined up on the timeline I previously laid out. I don't want to ruin his vacation. At the same time I don't want this to drag on. From: Cooper, Leslie T. , M.D . 0_H5_l -----~ Sent: Tuesday , March 13, 2018 11:04 PM To : Blackburn, Scott R. ._1 ( @ ...... mayo.edu] Cc: l(b)(6J Subject: Re: [EXTERNAL] RE: VA EHR Tomorrow or next Thursday? I am on the Big Sur coast now on vacation . Cell coverage spotty . Leslie Cooper Sent from my iPhone On Mar 13, 2018, at 1 :46 PM, Blackburn, Scott R. wrote : Leslie - thank you so much! 2 next steps. 1) l<0 l<5l l(cc'd here) will send you the latest package of material to review . 2) l(0 l<5ll(also cc'd here) will reach out to you to schedule some time this week so that ~ eam can orient you to what 1(0 H6l will be sending to you. Government contracts are very different than typical private sector contracts longer and some would say more bureaucratic). So in order to help we'll jump on the phone so that (0 H6l can walk you through what sections to look at and what you can ignore. I Thanks again! Scott VA-18-0298-B-000378 Page 16 19 of 23\~aof 871 5 From: Cooper, Leslie T ., M.D ..... l(b_l( _l _____ Sent: Tuesday , March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR _.l @mayo.edu] Thank you for the invitation to provide input. I am glad for accept. Please let me know how I can be of service. I will be traveling largely out of cell coverage the next day. Leslie Cooper Sent from my iPhone On Mar 12, 2018, at 6:55 AM, Blackburn, Scott R. wrote : Dr. Cooper: I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000379 Page 1620 of 23\~g of 871 Document ID: 0.7.1705.1517939 Cooper, Leslie T., M.D. From: l Blackburn, Scott R. 6l i; L..l Bee: Subject: Re: [EXTERNAL] RE: VA EHR Date: Tue Mar 13 2018 23:04:20 EDT Attachments: I Tomorrow or next Thursday ? I am on the Big Sur coast now on vacation . Cell coverage spotty. Leslie Cooper Sent from my iPhone On Mar 13, 2018, at 1 :46 PM, Blackburn, Scott R. wrote : Leslie - thank you so much! 2 next steps. 1) ~ (cc'd here) will send you the latest package of material to review . 5 6) l(also cc'd here) will reach out to you to schedule some time this week so that l wrote: Dr. Cooper: I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Cerner; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-B-000381 Page 1622 of 231~1 of 871 Document ID: 0.7.1705.500670 From: Coo er, Leslie T., M.D. (b)(GJ @mayo.edu> Blackburn, Scott R. (b)(6) Cc: ; (bl(6l /o=exchange labs/ou=excha nge administrative group (fydibohf23spdlt)/cn =recipients/cn =045f8eff 429f45888be 795fbaa 1d 9ef2 ?bl(6l I Bee: Re: [EXTERNAL] RE: VA EHR Subject: Tue Mar 13 2018 23:04:20 EDT Date: Attachments: Tomorrow or next Thursday? I am on the Big Sur coast now on vacat ion. Cell coverage spotty . Leslie Cooper Sent from my iPhone On Mar 13, 2018 , at 1 :46 PM, Blackburn , Scott R. wrote : Leslie - thank you so much! 2 next steps. 1) ~ (cc'd here) will send you the latest package of material to review . 2) !(bl(5l l(also cc'd here) wi ll reach out to you to schedule some time this week so that ~ eam can orient you to what !(bl<6l lwill be sending to you . Government contracts are very different than typical private sector contracts longer and some wou ld say more bureauc ratic). So in order to help we'll jump on the phone so tha (bl(5l can walk you through what sections to look at and what you can ignore. Thanks again! Scott (b_H6_l ______ From: Cooper, Leslie T. , M.D. _! Sent: Tuesday , March 13, 20 18 12:43 PM To: Blackburn , Scott R. Subject: Re: [EXTERNAL] VA EHR ~mayo.edu] VA-18-0298-B-000382 Page 1623 of 23\i 2 of 871 Thank you for the invitation to provide input. I am glad for accept. Please let me know how I can be of service. I will be traveling largely out of cell coverage the next day. Leslie Cooper Sent from my iPhone On Mar 12, 2018, at 6:55 AM, Blackburn, Scott R. wrote : Dr. Cooper: I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Cerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000383 Page 1624 of 231~3 of 871 Document ID: 0.7.1705.1768778 Blackburn , Scott R. t:a2gmail.com> Marc Sherman l(b)(6) To: 6 I (bl < l frenchangel59.com>; Cc: !====::::::!::~g .:...:. m.:..: a:..:.: il.:...: .c:..: o..:.; m Cbl(6l mail.com>? Bruce Moskowitz l(bJ(6) @mac .com>;( bl(5l /o=va/ou=visn 03/cn=rec ipients/cn=vhaeastruexm>; Windom, John H. ; DJS ; l(b)( 6 l; Fleck , Robert R. ; Foster, Michele (SES) Bee: Subject: VHA EHR - 2 calls that my assistant will set up Date: Tue Mar 13 2018 17:04:27 EDT Attachments: Marc/Bruce/Ike - thank you so much for the prompt replies. I just spoke to Bruce . We've got 100% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper, and Dr. Shretha) l(cc'd, our contracting officer) is making sure everyone has the and we are movin forward. ! wrote: Ike, Bruce, Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible fo r you. Here are 3 next steps. VA-18-0298-B-000385 Page 1626 of 23\is of 871 1) We will need you to sign the attached NOA. Please return to ..... l(b_H6_l __ 2) Matt will then send you the latest package under separate cover. _,l(cc'd). 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your expertise will be most valuable .l(b)(G) kwho is the government contractin officer) and John (cc'd) here to help Windom (who is our EHR leader) will lead this from our side . I will ask (b)(G) set up a time. We can either do this all together , if calendars match up, or separately if need be. We have also connected with Stephanie Reel , Stan Huff, Dr. Karson, Dr . Ko , Dr. Shretha , and Jon Mani s who all have all received the NOA and we are working with them. I am hop ing to connect with Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-B-000386 Pa ge 1627 of 23\i 6 of 871 Document ID: 0.7.1705.499893 Blackburn , Scott R. ta2gmail.com> Marc Sherman l(b)(6) To: 5 I (b)( l frenchangel59.com>; Cc: (bH6l @gmail.com (bl(6l mail.com>; Bruce Moskowitz 6 (b)(5) (b)( ) mac.com>; .__ __. ; W indom, John H. ; DJS ; l(bH6l (b)(6) ; Foster, Miche le (SES) Bee: Subject: VHA EHR - 2 calls that my assistant will set up Date: Tue Mar 13 2018 17:04:27 EDT Attachments: ____ I Marc/Bruce/Ike - thank you so much for the prompt replies. I ju st spoke to Bruce . We've got 100% participation (Stephan ie Reel, Stan Huff , Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper, and Dr . Shretha) l(cc'd, our contracting officer) is making sure everyone has the and we are movin forward . l(bH6l right material. (b)(5) (my ass istant, cc'd here) will be organizing a few phone calls in 2 steps: Step 1 - Basic orientation to the government con tract structure. This will be a 30-45 minute orientation lwi ll host this and clue people so that folks know what they are look ing at. John W indom and l(b)(5l into the parts to focus on and parts that are standard government things that are less relevant. This can 6llhas be done in groups (ideally) or in one-offs to fit to accommodate people 's busy schedu les. l(bH already scheduled 2 times in case these work for you. If they do not, she will work with your schedulers to fi nd other times in the next 24-48 hours (sooner the better). Thursday 8:30-9: 15am ET - Stephanie Reel confirmed Thursday 11 :30am-12: 15pm ET - Stan Huff confirmed Step 2 - Feedback calls . Per Bruce 's idea, we'll schedule 2 separate feedback ca lls for early next 5 week. Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest.l @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. Cc: IP; l(bJ(6J @gmail.com; Bruce Moskowitz ; l~ (b_ J5(_> Subject: [EXTERNAL] Re: VA EHR NDA ---~I Scott, ~ Windom, John H.; DJS and John Thank you for the NDA draft that you sent along and the organized approach . I have attached the following to close the loop: 1.a marked up version of the NDA with a few necessary adjustments in red-line so you can see the changes that were made , 2.a blank copy of the amended NDA for Bruce and Ike to sign, and 3.a signed vers ion by me of the amended NDA . Thanks and happy to help as requested. Marc On Tue, Mar 13, 2018 at 10:31 AM, Blackburn, Scott R. wrote: Ike, Bruce, Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We VA-18-0298-B-000388 Page 1629 of 23\ia of 871 appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers . As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 5 1) We will need you to sign the attached NOA. Please return to ._l Cooper , Leslie T., M.D. To: l(bl<5l @m ayo.edu> l(bl(5l l; .._l (b_l(6_l ____ Bee: Subject: RE: [EXTERNAL] VA EHR Date: Tue Mar 13 2018 16:46:42 EDT Attachments: _. Leslie - thank you so much! 2 next steps. 1) ~ (cc'd here) will send you the latest package of material to review . team can 2) !(bJ(Gll(also cc'd here) will reach out to you to schedule some time this week so that ~ orient you to what l(bl(5l lwill be sending to you. Government contracts are very different than typical private sector contracts (longer and some wou ld say more bureaucratic). So in order to help we 'll jump on the phone so that ~ can walk you through what sections to look at and what you can ignore. Thanks again! Scott From: Cooper, Leslie T. , M.D. ~l (b_J5(_l -----~ Sent: Tuesday , March 13, 20 18 12:43 PM To : Blackburn , Scott R. Subject: Re: [EXTERNAL] VA EHR k.a2mayo.edu] Thank you for the invitation to provide input. I am glad for accept. Please let me know how I can be of service. I will be traveling largely out of cell coverage the next day. Leslie Coope r Sent from my iPhone On Mar 12, 20 18, at 6:55 AM, Blackburn , Scott R. wrote : Dr. Cooper: VA-18-0298-B-000390 Page 163 1 of 23 \ i o of 871 I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers. Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Infor mation & Technology Department of Veterans Affairs VA-18-0298-B-000391 Page 1632 of 231~1 of 871 Document ID: 0.7.1705.499839 From: Blackburn, Scott R. To: Cooper , Leslie T., M.D. l(bJ(6J @mayo .edu> l(b)(6) Cc: wrote : Dr. Cooper: VA-18-0298-B-000392 Page 1633 of 23\i 2 of 871 I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Cerner; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time /abil ity to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Infor mation & Technology Department of Veterans Affairs VA-18-0298-B-000393 Page 1634 of 231~3 of 871 Document ID: 0.7.1705.499656 Bruce Moskow itz From: l(bl(6l @mac .com> To: Blac kburn , Scott R. ; ._l (b_H5_l ___ ____. Cc: DJS ; IP ~ frenchange l59.com> ;l Bee: [EXTERNAL] NDA.pdf Subject: Tue Mar 13 2018 14:59 :21 EDT Date: NDA.pdf Attachments: I; Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000394 Page 1639 of 23\i 4 of 871 Document ID: 0.7.1705.499638 From: Bruce Moskowitz @mac .com> Blackburn, Scott R. l To: Blackburn, Scott R. ; Windom, John H. ; Foster , Michele (SES) Cc: Bee: RE: any other NDAs come in? Subject: Tue Mar 13 201814:17:15 EDT Date: Attachments: image001.jpg Mr. Blackburn -As you may have seen, NDAs were just received from Mr. Perlmutter and Mr . Sherman. I am in the process of providing Ms. Reel, Mr. Perlmutter and Mr. Sherman access to the RFP files via the Army's SAFE site. Thanks, (b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile:~ e-mail: L______k va.gov VA-18-0298-B-000396 Page 1644 of 23\i 6 of 871 "For Internal VA Use Only-Working Draft, Pre-Decisional, Deliberative Document: This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information. If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." From: .... l(b_J(G _J ___ _. Sent: Tuesday , March 13, 2018 12:32 PM To: Blackburn , Scott R.; Windom, John H.; Foster, Michele (SES) Subject: RE: any other NDAs come in? Absolutely, will do Mr. Blackburn . The only NDA I have received is from Ms. Reel, as stated yesterday. l(b)(6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office : 732-440-9650 Mobile: ~ e-mail: L_________k va.gov "For Internal VA Use Only-Working Draft, Pre-Decisional, Deliberative Document: This e-mai l and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination, distribution or copying of this e-mail , and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mai l or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mail and any printout thereof." VA-18-0298-B-000397 Page 1645 of 23\i 7 of 871 From: Blackburn, Scott R. Sent: Tuesday, March 13, 2018 11 :41 AM Windom , John H.; Foster, Michele (SES) To: l(b)(5J Subject: any other NDAs come in? I Let me know if/when they do. The Secretary is monitoring very closely so I want to give him a little "here is where we are" by the end of the day. Once again - thanks for your patience and support with this. I want to make sure we do this all in the right way so leaning on you guys for help. I do think this is important for external validation, buy-in, and maybe even a few slight course corrections before signing if they do find anything that we need to improve (extra sets of eyes and different perspectives is always good - especially on a contract of this significance and magnitude). Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000398 Page 1646 of 23\iaof 871 Document ID: 0.7.1705.820305 l~ frenchange l59.com> From: 6l Marc Sherman l; To: Blackburn , Scott R. gma il.com Cc: ...,.,__,...,,,,..... _ ___J =-"=m=a=il=.c::..::i om>; Bruce Moskowitz .________ -"= mac.com>; l; Windom, John H. ; DJS Bee: [EXTERNAL ] RE: VA EHR NOA Subject: Tue Mar 13 2018 14:07:06 EDT Date: Perlmutter.EHR NOA v2 mbs.pdf Attachments: Attached is my signed NOA. Thank you. From: Marc Sherman l wrote: VA-18-0298-B-000399 Page 1649 of 23\ig of 871 Ike, Bruce, Marc: Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) We will need you to sign the attached NOA. Please return to .... l(b_J5<_J__ 2) j From: 6l To: Marc Sherman l(bl< taJgmail.com>; Blackburn, Scott R. (bl(5l gm ail.com Cc: ,,.,..,_,,,,,...---=;L;.m .;.;. ;;;.; a i.l.c ;.;. ~om >; Bruce Moskowitz (b)(6l mac.com>; ~l (b_l(5_l ____ ~ ; DJS Bee: [EXTERNAL] RE: VA EHR NOA Subject: Tue Mar 13 2018 14:07:06 EDT Date: Perlmutter.EHR NOA v2 mbs.pdf Attachments: Attached is my signed NOA. Thank you. From: Marc Sherman l(bl(5l @gmail.com] Sent: Tuesday, March 13, 2018 1:40 PM To: Blackburn, Scott R. 5 Cc: IP; l(b)(5l l@gmail.com; Bruce Moskowitz ~~ (b_l( _l ---~' Subject: Re: VA EHR NOA Scott, ~ Windom , John H.; DJS and John Thank you for the NOA draft that you sent along and the organized approach. I have attached the following to close the loop: 1.a marked up version of the NOA w ith a few necessary adjustments in red-line so you can see the changes that were made, 2.a blank copy of the amended NOA for Bruce and Ike to sign, and 3.a signed version by me of the amended NOA. Thanks and happy to help as requested. Marc VA-18-0298-B-000401 Page 1654 of 23\i 1 of 871 On Tue , Mar 13, 2018 at 10:31 AM, Blackburn, Scott R. wrote: Ike , Bruce, Marc: Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers . As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) 2) 5 We will need you to sign the attached NOA . Please return to ._l (b_ H_l __ ~ _.l(cc'd) . will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your expertise will be most valuable . (bl(6l (who is the government cowractjna officr) and John 5 Windom (who is our EHR leader) will lead this from our side . I will ask t bl From: Marc She rman l I (bl(6l frenchangel59.com>; Cc: 6l (b)(5l mail.com l ; Bruce Moskowi tz 6 (bl( l mac .com> ;l; Windom, John H. ; DJS Bee: Subject: [EXTERNAL ] Re: VA EHR NOA Date: Tue Mar 13 2018 13:39:36 EDT Attachments : EHR NOA v2 mbs .pdf EHR NOA v2 RL.pdf EHR NOA v2 .pdf Scott, ~ and John Thank you for the NOA draft that you sent along and the organized approach . I have attached the following to close the loop : 1.a marked up version of the NOA w ith a few neces sary adjustmen ts in red- line so you can see the changes that were made , 2.a blank copy of the amended NOA for Bruce and Ike to sign, and 3.a signed version by me of the amended NOA. Thanks and happy to help as requested. Marc On Tue , Mar 13, 2018 at 10:31 AM , Blackburn, Scott R. wrote: Ike, Bruce , Marc : Thank each of you for agree ing to lend an ext ra set of outside eyes on the EHR cont ract. We app reciate your support and want to make sure we get to the best place possible for Vete rans, the country and taxpayers. As we are incredib ly grate ful to you for vol unteering your time , we wa nt to make this as easy as poss ible for you. Here are 3 next steps. 1) 2) ...._H5_l __ We wi ll need you to sign the attached NOA . Please return to l I (b){ 6l frenchangel59 .com> ; To: gmail.com i<0 l<5l @gmail.com>; l(bl<5l @gmail.com ~co::;::= ,(6 :::= )== :::!::::~;.;: mail.com>; Bruce Moskowitz coic6l mac.com> coJ(6l ; Windom, John H. ; DJS Bee: Subject: VA EHR NOA Date: Tue Mar 13 2018 10:31 :27 EDT Attachments: NDA_blank EHRM for signatu re.pdf Ike, Bruce , Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredib ly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) 2) 1(0_l<6_l __ We will need you to sign the attached NOA. Please return to .... _.I (cc'd). i<0 l<5l lwill then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your 0 5 l(who is the governmen t contract in officer) and John expertise will be most valuab le.l( H l (cc'd) here to help Windom (who is our EHR leader) wi ll lead this from our side. I will ask (bH 5l set up a time. We can either do th is all together , if calendars match up, or separately if need be. We have also connected with Stephanie Reel , Stan Huff, Dr. Karson, Dr. Ko, Dr. Shretha, and Jon Manis who all have all received the NOA and we are working w ith them. I am hoping to connect w ith Dr. Cooper today . Thanks again! Scott VA-18-0298-B-000405 Page 167 0 of 23\is of 871 Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000406 Page 1671 of 23 4~6 of 871 Document ID: 0.7.1705.499460 Blackburn, Scott R. I <0 l<6l frenchangel59 .com> : To: gmail .com l<0 l<5l @gmail.com>; i<0 H6 l ~~-......1 =c:,:,:.: mail.com>; Bruce Moskowitz ~---~ @gmail.com Cc: ; Windom, John H. ; DJS Bee: Subject: Date: Attachments: VA EHR NOA Tue Mar 13 2018 10:31 :27 EDT NDA_blank EHRM for signature.pdf Ike, Bruce, Marc : Thank each of you for agreeing to lend an extra set of outside eyes on the EHR contract. We appreciate your support and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredib ly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 0 5 1< _ '< _' We will need you to sign the attached NOA. Please return to ..... 1) 2) ~ __ __.l (cc'd). will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your (who is the government contractin officer) and John expertise will be most valuab le. <0 l<6l (cc'd) here to help Windom (who is our EHR leader) wi ll lead this from our side . I will ask <0 H6 l set up a time. We can either do this all together , if calendars match up , or separately if need be. We have also connected with Stephanie Reel, Stan Huff, Dr. Karson, Dr. Ko, Dr. Shretha , and Jon Manis who all have all received the NOA and we are wor king w ith them. I am hoping to connect w ith Dr. Cooper today. Thanks again! Scott VA-18-0298-B-000407 Page 1675 of 23\i 7 of 871 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000408 Page 1676 of 23 4~8 of 871 Document ID: 0.7.1705.1768443 Blackburn, Scott R. Stan Huff {bJ<5l imail.org> To: Windom, John H. ; {b){6l /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Foster, Michele r'---~--, SES _. ; ._ {bl{6l l Bee: Subject: RE: VA EHR Date: Mon Mar 12 2018 21 :44:49 EDT Attachments: __ Thanks Stan . We will make one of those times work . We will confirm tomo rrow . Thanks so much for doing this. Scott From: Stan Huff l To: Stan Huff l: l; i; Foster , =-~i!....:....:., l@va.gov> Stan: VA-18-0298-B-000409 Page 1680 of 23\ig of 871 Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expertise ; and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time, we want to make this as easy as possible for you. Here are 3 next steps. (b_H5_l --~l We will need you to sign the attached NOA. Please return to ~l 1) 2) ~ (cc'd). will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your lwill lead this from our side and has told me is available expertise will be most valuable. i wrote : Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. VA-18-0298-B-000410 Page 168 1 of 23\~oof 871 Thanks so much, Scott Scott Blackburn Acting C IO & Executive -in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000411 Page 1682 of 23 4~1 of 871 Document ID: 0.7.1705.498442 Blackburn , Scott R. Stan Huff i To: Windom , John H. Cc: ;!; l To: Stan Huff l; l~ @va.gov>; Foster , VA-18-0298-B-000412 Page 1683 of 23\~ 2 of 871 0 5 Michele (SES) ; l(..... _l(_l _____________ Subject: RE: VA EHR __, @va.gov> Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expertise ; and want to make sure we get to the best place possible for Veterans , the country and taxpayers. As we are incredibly grateful to you for volunteering your time, we want to make this as easy as possib le for you. Here are 3 next steps. 0 5 l( _H _l __ We wi ll need you to sign the attached NOA. Please return to ..... 1) 2) ~ will then send you the latest package under separate _.kcc'd). cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your expertise will be most valuab le. j(0 l(6l will lead this from our side and has told me is available between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don 't work for l(cc'd) here to help set up a time. you . I will ask l(0 l(5l I Thanks again! Scott 5 ~imail.org] From: Stan Huff l(Ol(l Sent: Monday, March 12, 2018 4:34 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: VA EHR Yes , I wou ld be glad to help. What is the next step? Stan Sent from Stan Huff's iPhone On Mar 12, 2018, at 6:54 AM, Blackburn, Scott R. wrote : Stan, VA-18-0298-B-000413 Page 1684 of 23\~ 3 of 871 I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers. Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Infor mation & Technology Department of Veterans Affairs VA-18-0298-B-000414 Page 1685 of 23 4~4 of 871 Document ID: 0.7.1705.1216001 Stan Huff l(bl(5l @imail.org> From: To: Blackburn, Scott R. Windom, John H. ; (bl(6l 03/cn=recipients/cn=vhaeastruexm>; Foster, Michele r'---~--, SES _. ; ._ (bl(6l 6l !(bH I Bee: Subject: [EXTERNAL] RE: VA EHR Date: Mon Mar 12 2018 21:25:23 EDT Attachments: __ Scott, I am at the AMIA Joint Summit in San Francisco so it will be Wednesday morning before I can return the signed NOA. I am currently available for a call on Wednesday 11 :00 am to noon, 2:00-2:30 pm, or 3:30-4:00 pm. If none of those times work I am free on Thursday morning. Let me know. Thanks, Stan From: Blackburn, Scott R. (mailto :Scott.Blackburn@va.gov] Sent: Monday, March 12, 2018 7:08 PM @imail.org> To: Stan Huff !(bl(6l :.._l (b-l(5_l __________ Cc: Windom, John H. ,.... Michele (SES) ; l(bl(5l Subject: RE: VA EHR -=@;;,..v'-'a=.q.._o ~v>; Foster, @va.gov> Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expertise ; and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) 2) l(b_l(5_l __ We will need you to sign the attached NOA. Please return to .... ~ _.kcc'd). will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient you to the contract and help focus you on the parts where your lwill lead this from our side and has told me is available expertise will be most valuable. l(bl(5l VA-18-0298-B-000415 Page 1686 of 23\~sof 871 between tomorrow from 9 :30-11 am ET or I am sure he can also find other times if these don't work for cc 'd) here to help set up a time. you . I will ask j<0 l<6l I( Thanks again! Scott @imail.org] From: Stan Huff j<0 l<6l Sent: Monday, March 12, 2018 4:34 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: VA EHR Yes , I would be glad to help. What is the next step? Stan Sent from Stan Huff's iPhone On Mar 12, 2018 , at 6:54 AM , Blackburn , Scott R. wrote : Stan , I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000416 Page 1687 of 23\~ 6 of 871 Document ID: 0.7.1705.498168 Stan Huff l(bl(5l IPJimail.org> From: Blackburn, Scott R. Windom , John H. Cc: ; (bl(5 l ;l(bl(5l 5 Cc: Windom, John H. .,!..; ;l==; (b;:: l( =l ========== Michele (SES) ; l(bl(6l Subject: RE: VA EHR s@::....:v-=a~.g~o :....:.., v>; Foster , @va.gov> Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expert ise; and want to make sure we get to the best place possible for Veterans , the country and taxpayers. As we are incredibly grateful to you for volunteer ing your time, we want to make this as easy as possible for you . Here are 3 next steps . 1) We will need you to sign the attached NOA. Please return to -l(b_l(5_l __ -l (cc'd). VA-18-0298-B-000417 Page 1689 of 23\~ 7 of 871 2) ~ will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your expertise will be most valuable. (bl<5l will lead this from our side and has told me is available between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don't work for 5 l i(cc'd) here to help set up a time . you. I will ask l wrote: Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn VA-18-0298-B-000418 Page 1690 of 23\~aof 871 Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000419 Page 1691 of 23 4~9 of 871 Document ID: 0.7.1705.498 142 Blackburn , Scott R. David Shulkin (bl(5> gma il.com> To: Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 21:15 :06 EDT Attachments: NDA_blank EHRM for signature .pdf Attached is the NOA. Let me know if you'd like me to send it to Ike/Bruce/Marc directly. You can have them send it back to me directly and then I'll get someone from Windom 's team to send them the package and walk them through it. Stan Huff responded positively and we sent him the NOA. The only person that is yet to respond is Dr. Leslie Cooper from Mayo. My goal is for each of them to have the NOA signed, contract in hand , and someone has walked them through how to read the contract - by EOD tomorrow if possible . @gmail.com ] From: David Shulkin !(bl( 6> Sent: Monday , March 12, 2018 4:18 PM To : Blackburn , Scott R. Subject: [EXTERNAL] Fwd: Contact review Can we get them the nda as well? Sent from my iPhone Begin forwarded message: frenchangel59.com> From: IP~ Date: MaTcl{j' 2, 2018 at 2:50 :52 PM EDT @gma il.com> To: David Shulkin l(bl(6> @gma il.com" (bl(6l mail.com>, ..... l(b_J(5_> ___ Cc: l(bl(5> 6 com> , Bruce Moskowitz (bl( > mac .com> Subject: RE: Contact review l@gmail.com" l..... '.b_J(5_> __ ___, @gma il. David, How quick can you send the NOA to the peop le? And why not send it to Bruce, Marc and myse lf so we can work around the clock to finish this? Tha nk you. -----Original Message----- VA-18-0298-B-000420 Page 1692 of 23\~o of 871 From: Bruce Moskowitz l(b){G) @mac .com] Sent: Monday, March 12, 2018 2:03 PM 6) t.cz2gmail.com> To: David Shulkin l(b)( 6l Cc: IP~ frenchangel59.com>; l wrote: Bruce- we got 4 of 6 on board so far plus one add itional Manis Reel Karson Ko Also got Rasu Shrestha from Pittsburgh We are still waiting to hear from Dr Cooper and Huff and will add them if they agree All will sign an NOA and will receive a package today and we will either bring in or video connect within the next 48 hours- we cannot have a group meeting because of federal rules so we must connect or meet separately VA-18-0298-B-000421 Page 1693 of 23\~ 1 of 871 Thanks so much David Sent from my iPhone On Mar 11, 2018, at 12:42 PM, Bruce Moskowitz ~l (b_J5(_i _____ ~ @mac.com> wrote : He is a cardiologist and administration Sent from my iPhone On Mar 11, 2018 , at 12:31 PM, David Shulkin ~l (b_H5_l --~ @gmail.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone 5 On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz ._l (b_H_i _____ __,.l?v,mac.com> wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr VA-18-0298-B-000422 Page 1694 of 23\~ 2 of 871 Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000423 Page 1695 of 23 4~3 of 871 Document ID: 0.7.1705.498115 Blackburn , Scott R. Stan Huffl To: Windom , John H. Cc: ; (bJ(5l administrat ive group (fyd ibohf23spdlt)/cn=rec ipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2- truex, matt>; Foster, Michele (SES) ;l wrote: Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000425 Page 1700 of 23\~sof 871 Document ID: 0.7.1705.1215992 Blackburn, Scott R. 5 l imail.org> Stan Huff (bH To: Windom , John H. ; (bl(5l ; Foster, Michele r'---~--, SES _. ; ._ (bl(6l 6l l Bee: Subject: RE: VA EHR Date: Mon Mar 12 2018 21:08:16 EDT Attachments: NDA_blank EHRM for signature.pdf __ Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA finalize our EHR contract. We appreciate your vast experience and expertise ; and want to make sure we get to the best place possible for Veterans, the country and taxpayers. As we are incredibly grateful to you for volunteering your time , we want to make this as easy as possible for you. Here are 3 next steps. 1) 2) 5 We will need you to sign the attached NOA. Please return to ~l (b_H_l --~l ~ (cc'd). will then send you the latest package under separate cover. 3) Given government contracts are different than what you are used to reading, we would propose a quick phone call so that we can orient ou to the contract and help focus you on the parts where your 5 expertise will be most valuable . Cbl( l will lead this from our side and has told me is available between tomorrow from 9:30-11 am ET or I am sure he can also find other times if these don 't work for you. I will ask l(b)(5l (cc'd) here to help set up a time. I Thanks again! Scott From: Stan Huff l(bl(5l @imail.org] Sent: Monday, March 12, 2018 4:34 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: VA EHR VA-18-0298-B-000426 Page 1704 of 23\~ 6 of 871 Yes, I would be glad to help. What is the next step? Stan Sent from Stan Huff's iPhone On Mar 12, 2018, at 6:54 AM, Blackburn, Scott R. wrote: Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans, the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000427 Page 1705 of 23 4~7 of 871 Document ID: 0.7.1705.497775 From: Stan Huff ~! (b-l(5-l -~ @imail.org> To: Blackburn, Scott R. Yes , I would be glad to help. What is the next step? Stan Sent from Stan Huff's iPhone On Mar 12, 2018, at 6:54 AM, Blackburn, Scott R. wrote : Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000428 Page 1709 of 23\~aof 871 Document ID: 0.7.1705.497648 From: Blackburn, Scott R. To: Windom, Jo hn H. Cc: Bee: Subject: FW: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 16:23:10 EDT Attachments: What do you think of having Ike/Bruce/Marc sign NDA's as we ll? Seems they are willing to "work around the clock to finish this". @gmail.com] From: David Shulkinl(bl(5l Sent: Monday, March 12, 2018 4:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: Contact review Can we get them the nda as well? Sent from my iPhone Begin forwarded message: From: l~ frenchangel59.com> Date: March 12, 2018 at 2:50:52 PM EDT To: David Shulki (bl(6l mail.com> Cc:l(bl(5l @gmail.com" (bl(5l gmail.com> ,,__l (b_H5_l ___ com>, Bruce Moskowitz (bl(6l mac.com> Subject: RE: Contact review 6 @gmail.com" ,__l (b-l( _l --~ @gmail. David, How quick can you send the NOA to the people? And why not send it to Bruce, Marc and myself so we can work around the clock to finish this? Thank you. -----Or iginal Message ----~---------~ From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin j(bl(5l rcv,mail.com> change l59.com> (bl(5l gmail.com; ,__l (b_l(5_l __ Cc: l~fren __.@gmail.com VA-18-0298-B-000429 Page 1710 of 23\~g of 871 Subject: Re: Contact review The following may be discussed on the review however if not, we need to be sure there is a platform for the planned device registry. Separately there needs to be the ability to insert a mental health tracker, nutritional tracker and wellness tracker. We do not want to find out there is add on charges for these essential elements of the EMR. It also needs to be worked out how mental health records , treatments and appointments do not fall through the cracks during this lengthy implementation. The head of Columbia Psychiatry will Dr. Lieberman can assist with this aspect. Thank you . Sent from my iPad Bruce Moskowitz M.D. l(b_l(5_l __ On Mar 12, 2018, at 1:53 PM, David Shulkin .... __,@gmail.com> wrote: Bruce- we got 4 of 6 on board so far plus one additional Manis Reel Karson Ko Also got Rasu Shrestha from Pittsburgh We are still waiting to hear from Dr Cooper and Huff and will add them if they agree All will sign an NOA and will receive a package today and we will either bring in or video connect within the next 48 hours- we cannot have a group meeting because of federal rules so we must connect or meet separately Thanks so much VA-18-0298-B-000430 Page 171 1 of 23\~o of 871 David Sent from my iPhone On Mar 11, 2018, at 12:42 PM , Bruce Moskowitz ._l (b_H5_i _____ _. @mac.com > wrote : He is a cardiologist and administration Sent from my iPhone On Mar 11, 2018, at 12:31 PM, David Shulkin ._l (b_ J5(_l --~ @gm ail.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone 5 On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz .... l(b_l(_i _____ _. @mac.com > wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD .- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce VA-18-0298-B-000431 Page 1712 of 23\~ 1 of 871 Moskowitz MD. Page 1713 of231?2 of 8T1 Document ID: 0.7.1705. 1215097 From: Blackburn, Scott R. To: Windom, John H. Cc: Bee: Subject: FW: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 16:23:10 EDT Attachments: What do you think of having Ike/Bruce/Marc sign NDA's as we ll? Seems they are willing to "work around the clock to finish this". @gmail.com ] From: David Shulkin l(bl(5> Sent: Monday, March 12, 2018 4:18 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: Contact review Can we get them the nda as well? Sent from my iPhone Begin forwarded message: From: IP~ frenchangel59.com> Date: March 12, 2018 at 2:50 :52 PM EDT To: David Shulkin (bl(5> gmail.com> Cc:l(bH5> to)gma1.com (b)(6l gmail.com> ?-'(b_ l(5_> ___ com> , Bruce Moskowitz (b)(6) mac.com> Subject: RE: Contact review @gmail.com" -l(b_ l(5_> @gmail. ___ David, How quick can you send the NOA to the people? And why not send it to Bruce, Marc and myse lf so we can work around the clock to finish this? Thank you . -----Original Message-----------------. From: Bruce Moskowitz l(b)(G) @mac.com ] Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin !(bl(6> [@, gmail.com> Cc: l~ frenchange l59.com> ;l(bl(6> @gmail.com; l(b)(6) Subject: Re: Contact review ~--- l@gmail.com VA-18-0298-B-000433 Page 1714 of 23\~ 3 of 871 The following may be discussed on the review however if not, we need to be sure there is a platform for the planned device registry. Separately there needs to be the ability to insert a mental health tracker, nutritional tracker and wellness tracker. We do not want to find out there is add on charges for these essential elements of the EMR. It also needs to be worked out how mental health records , treatments and appointments do not fall through the cracks during this lengthy implementation. The head of Columbia Psychiatry will Dr. Lieberman can assist with this aspect. Thank you. Sent from my iPad Bruce Moskowitz M.D. l(b_ l(5_l __ On Mar 12, 2018 , at 1:53 PM, David Shulkin .... ..... @gmail.com> wrote: Bruce- we got 4 of 6 on board so far plus one additional Manis Reel Karson Ko Also got Rasu Shrestha from Pittsburgh We are still waiting to hear from Dr Cooper and Huff and will add them if they agree All will sign an NOA and will receive a package today and we will either bring in or video connect within the next 48 hours- we cannot have a group meeting because of federal rules so we must connect or meet separately Thanks so much VA-18-0298-B-000434 Page 1715 of 23\~ 4 of 871 David Sent from my iPhone 5 (b_H_l -----~ On Mar 11, 2018, at 12:42 PM, BruceMoskowitz ~l @mac.com> wrote : He is a cardiologist and administration Sent from my iPhone (b_ l(6_l --~ On Mar 11, 2018, at 12:31 PM, David Shulkin ~l @gmail.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone 5 (b_H_l _____ On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz ~l ~ @mac.com> wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000435 Page 1716 of 23\~sof 871 Document ID: 0.7.1705.497644 Blackburn , Scott R. David Shu lkin 1<0 l<6l @gma il.com> To: Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 16:22 :15 EDT Attachments: NOA has been sent to all who have responded. We are already moving on that as of this morning. We can absolutely send NDAs to Ike/Marc/Bruce as well. That shouldn't be a problem. 0 5 From: David Shu lkin l Date: Ma~12 , 2018 at 2:50:52 PM EDT gmail.com> To: David Shulkin <0 l<6l 5 Cc:1<0 J< l l@gmail.com" <0 l<6l mail.com >, ..... l<0_ l<5_l __ com>, Bruce Moskowitz <0 l<6l mac.com> Subject: RE: Contact review 0 5 ____. @gmail.com" ._l <_ i<_l __ ___,@gmail. David , How quick can you send the NOA to the peop le? And why not send it to Bruce, Marc and myself so we can work around the clock to finish this? Thank you. -----Original Message----From: Bruce Moskowitz ,..l 5 Cc: IP~fren change l59.com>; <0 J< l gmail.com ; ~1 <0_ J5<_l --~ @gmail.com VA-18-0298-B-000436 Page 1718 of 23\~ 6 of 871 Subject: Re: Contact review The following may be discussed on the review however if not, we need to be sure there is a platform for the planned device registry. Separately there needs to be the ability to insert a mental health tracker, nutritional tracker and wellness tracker. We do not want to find out there is add on charges for these essential elements of the EMR. It also needs to be worked out how mental health records , treatments and appointments do not fall through the cracks during this lengthy implementation. The head of Columbia Psychiatry will Dr. Lieberman can assist with this aspect. Thank you . Sent from my iPad Bruce Moskowitz M.D. On Mar 12, 2018, at 1:53 PM, David Shulkin ~l (b_ H6_l --~ @gmail.com > wrote: Bruce- we got 4 of 6 on board so far plus one additional Manis Reel Karson Ko Also got Rasu Shrestha from Pittsburgh We are still waiting to hear from Dr Cooper and Huff and will add them if they agree All will sign an NOA and will receive a package today and we will either bring in or video connect within the next 48 hours- we cannot have a group meeting because of federal rules so we must connect or meet separately Thanks so much VA-18-0298-B-000437 Page 1719 of 23\~ 7 of 871 David Sent from my iPhone 5 On Mar 11, 2018, at 12:42 PM , Bruce Moskowitz ~l (b-l( _l -----~ @mac.com > wrote : He is a cardiologist and administration Sent from my iPhone On Mar 11, 2018, at 12:31 PM, David Shulkin ~l (b_ J5(_l __ __, @gma il.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz ~l (b_H5_i _____ ~ l@mac.com > wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD .- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce VA-18-0298-B-000438 Page 1720 of 23\~a of 871 Moskowitz MD. Page 1721 of 231% of 8T1 Document ID: 0.7.1705.497639 5) David Shulk inj From: To: Blackburn, Scott R. Can we get them the nda as well? Sent from my iPhone Begin forwarded message: From: l~ frenchangel59 .com> Date: Ma~ 2, 2018 at 2:50 : 2 PM EDT mail.com> To: David Shu!kin ,~l _<>---~ ) com> , Bruce Moskowitz (bl<6> mac.com> Subject: RE: Contact review @ ...... gmail.com" 5 I~< _>--~l n@gmai l. David, How quick can you send the NOA to the peop le? And why not send it to Bruce, Marc and myse lf so we can work around the clock to fin ish this? Thank you . -----Original Message--- ,_ --------------. From: Bruce Moskowitz l To: David Shulkin l Cc: l~ frenchange l59.com> *b)C @gmail.com; ~l --~ @gmail.com> wrote: Bruce- we got 4 of 6 on board so far plus one additional Manis Reel Karson Ko Also got Rasu Shrestha from Pittsburgh We are still waiting to hear from Dr Cooper and Huff and will add them if they agree All will sign an NOA and will receive a package today and we will either bring in or video connect within the next 48 hours- we cannot have a group meeting because of federal rules so we must connect or meet separately VA-18-0298-B-000441 Pa ge 1723 of 23\i 1 of 871 Thanks so much David Sent from my iPhone On Mar 11, 2018, at 12:42 PM, Bruce Moskowitz l(b ...._l<5_l _____ _., @mac.com > wrote : He is a cardiologist and administration Sent from my iPhone On Mar 11, 2018, at 12:3 1 PM, David Shulk in._l wrote: Great list VA-18-0298-B-000442 Page 1724 of 23\i 2 of 871 Is leslie cooper from mayo- i could not find him or her Sent from my iPhone (b_H5_i _____ On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz ._l _. @mac.com> wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- amer ican college surgeons Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000443 Page 1725 of 23\i 3 of 871 Document ID: 0.7.1705.496938 facs.org> From: Clifford Ko~ To: Blackburn, Scott R. Dear Scott-I'd be happy to contribute. Clifford On Mar 12, 2018, at 6:54 AM, Blackburn, Scott R. wrote : Dr. Ko : I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help. We are very close to finalizing our EHR deal with Gerner; how ever we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000444 Page 1726 of 23\i 4 of 871 Document ID: 0.7.1705.496791 From: Blackburn, Scott R. Cc: Bee: Subject: VA EHR Date: Mon Mar 12 2018 09:55:22 EDT Attachments: 1> Dr. Cooper: I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR dea l w ith Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskow itz. Thanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000445 Page 1727 of 23\i s of 871 Document ID: 0.7.1705.496786 Blackburn, Scott R. To: Cc: Bee: Subject: VA EHR Date: Mon Mar 12 2018 09:54:47 EDT Attachments: 1> Dr. Ko: I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; however we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000446 Pag e 1728 of 23\i 6 of 871 Document ID: 0.7.1705.496777 From: Blackburn, Scott R. Cc: Bee: Subject: VA EHR Date: Mon Mar 12 2018 09:54:06 EDT Attachments: 1> Stan, I hope this finds you well. On behalf of Secretary Shulkin I wanted to see if we could enlist your help . We are very close to finalizing our EHR deal with Gerner ; howe ver we want to make sure we get a few extra set of eyes on it to make sure we are doing right by Veterans , the country and taxpayers . Would you have the time/ability to conduct a quick high level review and provide input in the next week or so? You were referred to us by Dr. Bruce Moskowitz. Thanks so much, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Infor mation & Technology Department of Veterans Affairs VA-18-0298-B-000447 Page 1729 of 23\i 7 of 871 Document ID: 0.7.1705.496414 Blackburn , Scott R. To: David Shulkin l Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Sun Mar 11 2018 12:36:59 EDT Attachments: Sounds good. I understand no meeting in Florida this week, correct? If so, I'll let Manis know he has a little more time. From: David Shulkin l Date: March 11, 2018 at 12:31:22 PM EDT (bl<5l mac.com> To: Bruce Moskowitz L......,-.......,,....--=~9 _: Cc: l~ frenchange l59.com>, (bl(5l gmail.com, .... l wrote: VA-18-0298-B-000448 Page 1730 of 23\ia of 871 These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskow itz M.D. VA-18-0298-B-000449 4~9 of 871 Page 1731 of 23 Document ID: 0.7.1705.386382 David Shulk in !(bl(5> @gmai l.com> From: Blackburn, Scott R. Scott lets discuss tommorow Sent from my iPhone Begin forwarded message: From : David Shu lkin !(bl(6l @gmail.com > Date: March 11, 2018 at 12:31 :22 PM EDT To: Bruce Moskowitz "(b,;..,;. l(6-'->------.-----1.1 ~mac .com> 5 Cc: l~ frenchange l59.com>, (bl( > gmail.com, l'b .... _l(5_>__ Subject: Re: Contact review __.@gma il.com Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone 5 On Mar 11, 20 18, at 11 :02 AM, Bruce Moskowitz ~l 'b_>,_>-----~ @mac.com > wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiunta in VA-18-0298-B-000450 Page 1732 of 23\~o of 871 Jonathan ManisCIO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000451 Page 1733 of 23 4~1 of 871 Document ID: 0.7.1705.1509396 l To: i; Blackburn , Scott R. ;l l; ._l ; (bl(5l : l~ <_b J<5_l ----~ Bee: RE: SecVA Subject: Fri Mar 09 2018 20:02 :47 EST Date: Attachments: I Just confirming the SecVA flights and itinerary shou ld go back to the original plans. Thank you. JV . I From:l l(bl(6l ~/o=va/ou=va To: martinsburg/cn=recipien ts/cn=vacoalamm>; Blackburn, Scott R. ; ..... /o=va/ou=va martinsburg/cn=recipients/cn=vacophamk> (bl(6l (bl(5l ; l._ ; ..... l(b_l(5_l --~ 6 /o=va/ou=va martinsburg/cn=recipien ts/cn=vacosteved>; (bl( l (bJ{6l Bee: Re: SecVA Subject: Fri Mar 09 20 18 16:17:23 EST Date: Attachments: Roge r that on our end. From: l(bl{5l @va.gov> Date: Friday, March 9, 2018 at 4:10 PM To: "Blackburn , Scott R.", (bH5l Cc:l(bJ(6l @va.gov>' .-(b-J6 (-l .------------gov> J(bl(6l @va .gov>, vac ..... (_bJ_<5i_____ !(bJ(6l @va.gov> Subject: RE: SecVA ---__.@va.gov> ,._ (b_l(5_l ___ __. Scott, this breakfast is off. Mr. Perlmutter can no longer do. No need to travel , Scott. Sorry about that. Thank you. From: Blackburn, Scott R. Sent: Friday , March 09, 2018 4:09 PM To: Cc: (bJ(6J l To: Blackburn, Scott R. ; l(bl(6l 6 (bl( l To: Blac kburn, Scott R. (DISAB LED ACCT) ; .... 6 (bl( l /o =va/ou =va martinsburg/cn =recipie nts/cn =vacophamk> l(bH6l ;l._ ; l(bl(5l !(b)(6J ~/o=va/ou=va martinsburg/cn=recipien ts/cn=vacosteved> ; l(bl(6l l; l._ (b_l(_l ----~ Bee: Subject: RE: SecVA Date: Fri Mar 09 20 18 16:10 :18 EST Attachments: I I Scott, th is breakfast is off. Mr. Perlmutter can no longer do . No need to travel , Scott. Sor ry about that. Thank you . From : Blackburn, Scott R. Sent: Frida y , March 09 , 2018 4 :09 PM To: l(bJ(6l Cc j(bJC 6l I !(b)( 6) j Subject: RE : SecVA Awesome! Thanks so much . From: l(b)(BJ l Sent: Friday , March 09 , 20 18 2:50 PM To: Blackburn , Scott R. Cc: l 6l (bJ< /o=va/ou=va To: martinsbur g/cn=recipien ts/cn=vacophamk> 5 l; l~ ; l; ~; (bl; l._ Bee: RE: SecVA Subject: Date: Fri Mar 09 2018 16:09 :21 EST Attachments: Awesome! Thanks so much . From: ~l ____ ____. Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. C c:l (b)(6) Subject: SecVA Scott - just a heads up that boss wants you to trave l with him to Mar-A-Largo on Tuesday. He will be meeting w/Mr. Perlmutter , Dr. Moskowitz, and Marc Sherman. We are trying to firm up the time . He may be depart ing early afternoon on Monday or ear ly on Tuesday . Please confirm if you are available to trave l with him. Thanks. VA-18-0298-B-000461 Page 1743 of 23\i 1 of 871 Document ID: 0.7.1705. 1508566 !(bJ(6l ! Blac kburn, Scott R. (bJ( 6l /o=va/ou=va Cc: _. martinsburg/cn=recipien ts/cn=vacocollij>; ._l (b_l(5_l ___ ; l(bl(5l l; ~(b_ l(6_l --~ 6 /o=va/o u=va martinsburg/cn=rec ipients/cn=vacosteved>; (bl( l !(bJ(6l I; ._ (b_J5(_l --=-=e------.--' To: Blackburn, Scott R. Cc: (bl(6l ,__--~--~ To: Blackburn, Scott R. (bl(5l ; ~l 'b_l( _l ----,-~ ; l(bl(5l f /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: RE: SecVA Subject: Fri Mar 09 2018 14:19:59 EST Date: Attachments: Perfect. Will let you know ASAP when we have details. Thanks! From: Blackburn, Scott R. Sent: Friday , March 09. 2018 2: 19 PM To: l'bJ(6J Cc: ~-----------------~ Subject: RE: SecVA I'll be there. I'll plan to mimic his schedu le. Sent with Good (www.good .com) l'b_ J(6 _l ____ _, From: .... Sent: Friday , March 09, 2018 2:18:28 PM To: Blackburn , Scott R. Cc: l.,_ (b_J(6..,... J -=-----,-,-,---------------~ Subject: SecVA Scott - just a heads up that boss wants you to trave l with him to Mar-A-Largo on Tuesday. He will be meeting w/Mr . Perlmutter . Dr. Moskowitz , and Marc Sherman . We are trying to firm up the time . He may be depart ing early afternoon on Monday or early on Tuesday . Please confirm if you are available to travel with him . Thanks . VA-18-0298-B-000466 Page 1748 of 23\i 6 of 871 Document ID: 0.7.1705.493490 l(bl(5l l Blackburn, Scott R. (b)(6) Cc: (b)(6) l; !~ ; l Bee: RE: SecVA Subject: Fri Mar 09 20 18 14:19:27 EST Date: Attachments: I'll be there. I'll plan to mimic his schedu le. Sent with Good (www.good.com) I From: ! (b)(6) To: To: Blackburn, Scott R. 5l (bl< ; l~ <_b J<5_l ___ ~ ; l(bH5l l Bee: Subject: Date: Attachments: SecVA Fri Mar 09 2018 14:18:28 EST Scott - just a heads up that boss wants you to travel with him to Mar-A-Largo on Tuesday. He will be meeting w/Mr. Perlmutter, Dr. Moskowitz, and Marc Sherman. We are trying to firm up the time. He may be departing early afternoon on Monday or early on Tuesday . Please confirm if you are available to travel with him. Thanks. VA-18-0298-B-000470 Page 1753 of 23\~o of 871 Document ID: 0.7.1705.493328 l(bl(5l l To: Blac kburn, Scott R. (b)(6) Cc: To: O'Rourke, Peter M . ; Bruce Moskow itz (bH6l mac .com> Cc: Sandoval, Cami lo J. ; Marc Sherman !; IP~ frenchange l59.com> Bee: RE: [EXTERNAL ] Re: App le vs Cerner Subject: Thu Mar 08 2018 08:44:42 EST Date: Attachments: Good morning, The conference call is scheduled for March 9th at 12:15pm . 6 On Mar 8, 2018, at 7:14 AM, O'Rourke, Peter M. wrote: > > I'll have my schedu ler set something up for Friday if that works fo r yo u all. > VA-18-0298-B-000472 Page 1755 of 23\~ 2 of 871 > Pete > > -----Original Message----,.,,. - ,..,,,,..--------. 5l > From: Bruce Moskowitz i Sent: Thursday, March 08, 2018 7:08 AM > To: O'Rourke, Peter M. > Cc: Sandoval, Camilo J.; Marc Sherman; IP > Subject: Re: [EXTERNAL] Re: Apple vs Cerner > > Thank you for your quick response. When convenient for you, let's set up a call to determine what can be done to rescue this very important initiative. > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Mar 8, 2018, at 7:04 AM , O'Rourke, Peter M. wrote: >> >> Bruce, >> >> What can I do to salvage that group's work and expertise and apply what we can to the developing product? >> >> Pete >> >> -----Original Message----.-------------. 5l >> From : Bruce Moskowitz i> Sent: Thursday, March 08 , 2018 6:45 AM >> To : Sandoval, Camilo J. >> Cc: Marc Sherman; IP; O'Rourke, Peter M. >> Subject: [EXTERNAL] Re: Apple vs Cerner >> >> Thank you and after reviewing, we had an excellent group assembled on the call with Tim Cook , his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health. >> >> Instead of taking the excellent resources from the five Academic centers donating their time to the VA , the VA dropped all contact and proceeded on its own. So now we have a product of limited value . >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> >>> On Mar 7, 2018 , at 10:46 PM, Sandoval, Camilo J. wrote: >>> >>> Bruce/Marc , >>> >>> Apparently I was suppose to share this Attachment with you last month per John's note below . >>> >>> My apologies if I didn't. I will update the tracker, and please do let me know if this helps answers questions around Apple's efforts or if additional clarification is required. >>> >>> Thank you. >>> Camilo >>> >>> >>> ------------- VA-18-0298-B-000473 Page 1756 of 23\~ 3 of 871 >>> From: Windom, John H. >>> Sent: Wednesday, March 07, 2018 7:26:08 PM >>> To: Sandoval, Camilo J. >>> Subject: FW: Apple vs Cerner >>> >>> >>> >>> Sent with Good (www .good.com) >>> >>> ------------>> > From: Windom , John H. >>> Sent: Tuesday, March 06, 2018 6:18:26 AM >>> To: Blackburn , Scott R. >>> Cc: Short, John (VACO); Zenooz, Ashwini >>> Subject: FW: Apple vs Cerner >>> >>> Sir, >>> As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. >>>Vr >>> John >>> >>> John H. Windom, Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Specia l Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >>> John.Windom@va .gov >>> Office: 202 461-5820 ,,,..,..,. -, (bJ(5J >>> Mobile: ....._ 5 >>> Executive Assistant: (bJ(J - A pointments and Schedu ling 5J 6J >>>l(bJ( @vL.. a-.g - o-v-r:(;:-;-b J( ;;;; ~-----~----,? va .gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> From: Windom , John H. >>> Sent: Friday, January 26, 2018 3:24 PM >>> To: Blackburn, Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini; >>> Short, John (VACO); Cox, Tim (VACO) >>> Subject: Apple vs Cerner >>> >>> Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities . Please don't let people confuse the two. These draft charts may help you with your messaging. >>> Vr >>> John >>> >>> John H. Windom, Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Specia l Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >>> John.Windom@va.gov >>> Office: (202) 461-5820 (b_J6(_J_____ -:-'-----------. >>> Mobile: ._ 5 >>> Executive Assistant: (bJ< J - A pointments and Scheduling 5J >>> l Office: (202) 461-6618 ____ ________ VA-18-0298-B-000474 Page 1757 of 23\~ 4 of 871 >>> >>> >>> >>> >>> >> Questions _final.docx> VA-18-0298-B-000475 Page 1758 of 23 4~5 of 871 Document ID: 0.7.1705.384327 Sandoval, Camilo J. To: Bruce Moskowitz l(bl<6l @mac .com> ; O'Rourke , Peter M. (Gl @gma il.com> ; IP Marc Sherman l l On Mar 8, 2018 , at 7:14 AM , O'Rourke , Peter M.< Peter .0Rourke@va.gov > wrote: > > I'll have my scheduler set something up for Friday if that works for you all. > > Pete > > -----Or iginal Message----> From: Bruce Moskowitz l.(b-J5<-l ---------. @mac.com] > Sent: Thursday, March 08, 2018 7:08 AM > To: O'Rourke, Peter M. > Cc : Sandoval, Camilo J.; Marc Sherman; IP > Subject: Re: [EXTERNAL] Re: Apple vs Cerner > > Thank you for your quick response. When convenient for you, let's set up a call to determine what can be done to rescue this very important initiative . > > Sent from my iPad VA-18-0298-B-000476 Page 1759 of 23\~ 6 of 871 > Bruce Moskowitz M.D. > >> On Mar 8, 2018, at 7:04 AM , O'Rourke, Peter M. wrote: >> >> Bruce , >> >> What can I do to salvage that group's work and expertise and apply what we can to the developing product? >> >> Pete >> >> -----Original Message----~---------~ 5 >> From : Bruce Moskowitz l(b)( l l@mac.com] >> Sent: Thursday, March 08 , 2018 6:45 AM >> To : Sandoval, Camilo J. >> Cc: Marc Sherman; IP; O'Rourke, Peter M. >> Subject: [EXTERNAL] Re: Apple vs Gerner >> >> Thank you and after reviewing, we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health . >> >> Instead of taking the excellent resources from the five Academic centers donating their time to the VA, the VA dropped all contact and proceeded on its own. So now we have a product of limited value . >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> >>> On Mar 7, 2018, at 10:46 PM , Sandoval, Camilo J. wrote: >>> >>> Bruce/Marc , >>> >>> Apparently I was suppose to share this Attachment with you last month per John's note below. >>> >>> My apologies if I didn't. I will update the tracker, and please do let me know if this helps answers questions around Apple 's efforts or if additional clarification is required. >>> >>> Thank you. >>> Camilo >>> >>> >>> ------------>> > From: Windom , John H. >>> Sent: Wednesday, March 07, 2018 7:26:08 PM >>> To: Sandoval, Camilo J. >>> Subject: FW: Apple vs Gerner >>> >>> >>> >>> Sent with Good (www.good.com) >>> >>> ------------>> > From: Windom , John H. >>> Sent: Tuesday, March 06, 2018 6:18:26 AM >>> To: Blackburn , Scott R. VA-18-0298-B-000477 Page 1760 of 23\~ 7 of 871 >>> Cc: Short, John (VACO); Zenooz, Ashwini >>> Subject: FW: Apple vs Cerner >>> >>> Sir, >>> As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. >>>Vr >>> John >>> >>> John H. Windom , Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Special Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 >>> John.Windom@va.gov >>> Office: 202 461-5820 5l ......._ __, (bl< >>> Mobile: .__ 5 >>> Executive Assistant: ._ (b_l(_l _.-- ______ ___._ - -'-A-"'pointments and Schedu ling >>> l(bl(6l l@va.gov (bl(5l va.gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> From: Windom , John H. >>> Sent: Friday , January 26, 2018 3:24 PM >>> To: Blackburn , Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini; Short, >>> John (VACO) ; Cox, Tim (VACO) >>> Subject: Apple vs Cerner >>> >>> Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercia l EHR. Apple will deliver less than 1% of commercial EHR capabi lities. Please don 't let people confuse the two. These draft charts may help you with your messaging. >>>Vr >>> John >>> >>> John H. Windom, Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Specia l Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >>> John.Windom@va .gov >>> Office: (202) 461-5820 >>> Mobile: (bl(6l --------------~ >>> Executive Assistant: (bl(5l - A pointments and Schedu ling 5"l'"______ >>>l(bl(6l @v._a_.g _o _v----r:: (b.)( .,., ......___.,va.gov> Office: (202) 461-6618 _____ _______ >>> >>> >>> >>> >>> >> Questions _final.docx> VA-18-0298-B-000478 Page 176 1 of 23\~aof 871 Document ID: 0.7.1705.384312 From: O'Rourke, Peter M. To: Bruce Moskowitz l(bl(5l @mac .com> Sandoval, Camilo J. ; Marc Sherman 6]@trenchange l59.com>; ~' (bl(6l gmail.com>; 1Pl(bH (b_ J5(_ l -~ 6 < o=va/ou=va martinsburg/cn=recipients/cn=vacomitchm 1> (bl( l Bee: RE: [EXTERNAL] Re: Apple vs Gerner Subject: Thu Mar 08 2018 07:22:42 EST Date: Attachments: Understood. I'll notify you today of a time and conference call in number. Pete -----Original Message---- ~----------~ From: Bruce Moskowitzl'bl( 5l Sent: Thursday, March 08 , 2018 7:16 AM To: O'Rourke , Peter M. Cc: Sandoval, Camilo J.; Marc Sherman; IP Subject: Re: [EXTERNAL] Re: Apple vs Gerner @mac.com] Thank you I have noon or after 4 or before 7 am. It w ill probably just be me on the ca ll Sent from my iPad Bruce Moskowitz M.D. > On Mar 8, 2018, at 7:14 AM, O'Rourke, Peter M. wrote: > > I'll have my schedu ler set something up for Friday if that works for you all. > > Pete > > -----Original Message---- .-- -----------. > From: Bruce Moskowitz l Sent: Thursday, March 08, 2018 7:08 AM > To: O'Rourke, Peter M. > Cc : Sandoval , Camilo J .; Marc Sherman; IP > Subject: Re: [EXTERNAL] Re: Apple vs Gerner > > Thank you for your quick response. When convenient for you, let' s set up a call to determine what can be done to rescue this very important initiat ive. > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Mar 8, 2018, at 7:04 AM , O'Rourke, Peter M. >> wrote: VA-18-0298-B-000479 Page 1762 of 23\~g of 871 >> Bruce, >> >> What can I do to salvage that group's work and expertise and apply what we can to the developing product? >> >> Pete >> >> -----Original Message----.------------. >> From: Bruce Moskowitz 1(0 )(5) @mac.com] >> Sent: Thursday, March 08, 2018 6:45 AM >> To: Sandoval, Camilo J. >> Cc: Marc Sherman; IP; O'Rourke, Peter M. >> Subject: [EXTERNAL] Re: App le vs Cerner >> >> Thank you and after reviewing, we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Tele medicine and of equal importance a platform for mental health. >> >> Instead of taking the excellent resources from the five Academic centers donating their time to the VA, the VA dropped all contact and proceeded on its own. So now we have a product of limited value . >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> >>> On Mar 7, 2018, at 10:46 PM, Sandoval, Camilo J. wrote: >>> >>> Bruce/Marc , >>> >>> Apparently I was suppose to share this Attachment with you last month per John's note below . >>> >>> My apologies if I didn't. I will update the tracker, and please do let me know if this helps answers questions around Apple's efforts or if additional clarification is required. >>> >>> Thank you. >>> Camilo >>> >>> >>> > >> From: Windom , John H. >>> Sent: Wednesday, March 07, 2018 7:26:08 PM >>> To: Sandoval, Camilo J. >>> Subject: FW: Apple vs Cerner >>> >>> >>> >>> Sent with Good (www.good.com) >>> >>> ------------>> > From: Windom , John H. >>> Sent: Tuesday, March 06, 2018 6:18:26 AM >>> To: Blackburn, Scott R. >>> Cc: Short, John (VACO); Zenooz, Ashwini >>> Subject: FW: Apple vs Cerner >>> >>> Sir, ------------- VA-18-0298-B-000480 Page 1763 of 23\io of 871 >>> As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. >>>Vr >>> John >>> >>> John H. Windom , Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Special Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >>> John.Windom@va.gov >>> Office : 202 461-5820 >>> Mobile: (bH5l '--------,.,,..,....,,.,----------, >>> Executive Assistant: (b)(5l - Appointments and Scheduling >>> l(b)(6l l@vL... a-.g - o_v....,. (=b)= (5l,-------......____., @va.gov> Office: (202) 46 1-6618 >>> >>> >>> >>> >>> From: Windom , John H. >>> Sent: Friday , January 26, 2018 3:24 PM >>> To: Blackburn , Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini; >>> Short, John (VACO); Cox, Tim (VACO) >>> Subject: Apple vs Gerner >>> >>> Apple will not produce an EHR/EMR. It is a health record elect ronic file cabinet and will likely ultimately align to a commercia l EHR. App le will deliver less than 1% of commercial EHR capabi lities. Please don't let people confuse the two. These draft charts may help you with your messaging. >>> Vr >>> John >>> >>> John H. Windom , Senior Executive Service (SES) Program Executive for >>> Electronic Hea lth Record Modernization (PEO EHRM) Specia l Advisor to >>> the Under Secretary for Health >>> 81 1 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >>> John.Windom@va.gov >>> Office: 202 461-5820 >>> Mobile: '-----~,-----------, (bH5l >>> Executive Assistant: (b)(5l - A pointments and Scheduling 1 >>~(b)(6l @vL... a-.g - o-v--r; (= bl(;6 -;;; l,-------~__._ :......va.gov>Office: (202) 461-6618 >>> >>> >>> >>> >>> >> Questions _final.docx> VA-18-0298-B-000481 Pa ge 1764 of 23\i 1 of 871 Document ID: 0.7.1705.384322 Bruce Moskowitz From: l(bl(6l l@mac.com> O'Rourke, Peter M. Sandoval, Camilo J. ; Marc Sherman (bl(6l gmail.com>; IP~frenchangel59.com> Bee: Subject: Re: [EXTERNAL] Re: Apple vs Gerner Date: Thu Mar 08 2018 07:15:56 EST Attachments: Thank you I have noon or after 4 or before 7 am. It will probably just be me on the call Sent from my iPad Bruce Moskowitz M.D. > On Mar 8, 2018, at 7:14 AM, O'Rourke, Peter M. wrote: > > I'll have my scheduler set something up for Friday if that works for you all. > > Pete > > -----Original Message----.... ------------. > From: Bruce Moskowitz l(bl(5l ~mac.com] > Sent: Thursday, March 08, 2018 7:08 AM > To: O'Rourke, Peter M. > Cc: Sandoval, Camilo J.; Marc Sherman; IP > Subject: Re: [EXTERNAL] Re: Apple vs Gerner > > Thank you for your quick response. When convenient for you, let's set up a call to determine what can be done to rescue this very important initiative . > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Mar 8, 2018, at 7:04 AM, O'Rourke, Peter M. wrote: >> >> Bruce, >> >> What can I do to salvage that group's work and expertise and apply what we can to the developing product? >> >> Pete >> >> -----Original Message---->> From : Bruce Moskowitz .--l (b-l(6-l ---------. @mac.com] >> Sent: Thursday, March 08, 2018 6:45 AM >> To: Sandoval, Camilo J. >> Cc: Marc Sherman; IP; O'Rourke, Peter M. VA-18-0298-B-000482 Page 1765 of 23\i 2 of 871 >> Subject: [EXTERNAL] Re: Apple vs Gerner >> >> Thank you and after reviewing, we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health. >> >> Instead of taking the excellent resources from the five Academic centers donating their time to the VA , the VA dropped all contact and proceeded on its own. So now we have a product of limited value . >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> >>> On Mar 7, 2018 , at 10:46 PM , Sandoval, Camilo J.< Camilo.Sandoval@va.gov> wrote: >>> >>> Bruce/Marc , >>> >>> Apparently I was suppose to share this Attachment with you last month per John's note below . >>> >>> My apologies if I didn't. I will update the tracker, and please do let me know if this helps answers questions around App le's efforts or if additional clarification is required . >>> >>> Thank you. >>> Cami lo >>> >>> >>> ------------> >> From : Windom , John H. >>> Sent: Wednesday, March 07 , 2018 7:26:08 PM >>> To: Sandoval, Camilo J. >>> Subject: FW: Apple vs Gerner >>> >>> >>> >>> Sent with Good (www.good.com) >>> >>> ------------>> > From: Windom , John H. >>> Sent: Tuesday, March 06 , 2018 6:18:26 AM >>> To: Blackburn, Scott R. >>> Cc: Short, John (VACO); Zenooz, Ashwini >>> Subject: FW: Apple vs Gerner >>> >>> Sir, >>> As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. >>> Vr >>> John >>> >>> John H. Windom , Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Special Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 >>> John.Windom@va.gov >>> Office: 202 461-5820 >>> Mobile: (b)(GJ ~----~ VA-18-0298-B-000483 Page 1766 of 23\i 3 of 871 l..... >>> Executive Assistant: (b_l(_> ____,,l'C'"'."".".,,...--------1 ..... - ~A.....,Q 0Ointments and Scheduling >>~(bl(6l l@va.go ~(bl(5> J@va .gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> From: Windom , John H. >>> Sent: Friday , January 26, 2018 3:24 PM >>> To: Blackburn , Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini ; Short, >>> John (VACO) ; Cox, Tim (VACO) >>> Subject: Apple vs Gerner >>> >>> Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercia l EHR. Apple will deliver less than 1% of comme rcial EHR capabi lities. Please don't let people confuse the two. These draft charts may help you with your messaging. >>> Vr >>> John >>> >>> John H. Windom, Senior Executive Service (SES) Program Executive for >>> Electronic Health Record Modernization (PEO EHRM) Specia l Advisor to >>> the Under Secretary for Health >>> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 >>> John.Windom@va.gov >>> Office: (202 461-5820 (b_H6_>____ _._ ________ __, >>> Mobile : ,_ 5 >>> Executive Assistant: (bH > - A pointments and Scheduling 5 6 >>> l(bl( > f@va.gov(bl( > va.gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> >> Questions _final.docx > 5 VA-18-0298-B-000484 Page 1767 of 23\i 4 of 871 Document ID: 0.7.1705.384306 From: O'Rourke, Peter M. To: Bruce Moskowitz 5> l(bJ( l@mac .com> Sandoval, Camilo J. ; Marc Sherman (bJ(6> @gmail.com>; IP~frenchangel59.com> Bee: RE: [EXTERNAL] Re: Apple vs Gerner Subject: Thu Mar 08 2018 07:14:42 EST Date: Attachments: I'll have my scheduler set something up for Friday if that works for you all. Pete -----Original Message----~---------~ From: Bruce Moskowitz l(bl(5> Sent: Thursday, March 08 , 2018 7:08 AM To: O'Rourke , Peter M. Cc: Sandoval, Camilo J.; Marc Sherman; IP Subject: Re: [EXTERNAL] Re: Apple vs Gerner l@mac.com] Thank you for your quick response. When convenient for you, let's set up a call to determine what can be done to rescue this very important initiative. Sent from my iPad Bruce Moskowitz M.D. > On Mar 8, 2018, at 7:04 AM, O'Rourke, Peter M. wrote: > > Bruce , > > What can I do to salvage that group's work and expertise and apply what we can to the developing product? > > Pete > > -----Original Message---- ..... - ----------. > From: Bruce Moskowitz l(bl(5> @mac.com] > Sent: Thursday, March 08, 2018 6:45 AM > To: Sandoval , Camilo J. > Cc: Marc Sherman ; IP; O'Rourke , Peter M. > Subject: [EXTERNAL] Re: Apple vs Gerner > > Thank you and after reviewing , we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health. > VA-18-0298-B-000485 Page 1768 of 23\isof 871 > Instead of taking the excellent resources from the five Academic centers donating their time to the VA , the VA dropped all contact and proceeded on its own . So now we have a product of lim ited value . > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Mar 7, 2018, at 10:46 PM , Sandoval, Camilo J. wrote: >> >> Bruce/Marc, >> >> Apparently I was suppose to share this Attachment with you last month per John 's note below. >> >> My apologies if I didn't. I will update the tracker , and please do let me know if this helps answers questions around Apple's efforts or if additional clarification is required. >> >> Thank you. >> Camilo >> >> >> ------------>> From : Windom , John H. >> Sent: Wednesday, March 07, 2018 7:26 :08 PM >> To: Sandoval, Camilo J . >> Subject: FW : Apple vs Cerner >> >> >> >> Sent with Good (www.good .com) >> >> > > From : Windom, John H. >> Sent: Tue sday, March 06, 2018 6:18:26 AM >> To: Blackburn, Scott R. >> Cc: Short , John (VACO); Zenooz , Ashwini >> Subject: FW: Apple vs Cerner >> >> Sir, >> As you ca n see, I also sha red with Cam who readily saw the difference and was to convey the message down South . Here you go. >> Vr >> John >> >> John H. Windom, Senior Executive Service (SES) Program Executive for >> Electronic Health Record Modern ization (PEO EHRM) Special Advisor to >> the Under Secretary for Health >> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >> John.Windom@va .gov >> Office: 202 461-5820 >> Mobile : (bl(6l '----------'---------, >> Executive Assistant: (bl(5l - A pointments and Scheduling 6l >> l Office: (202) 461-6618 >> >> >> >> >> From : Windom, John H. ------------- VA-18-0298-B-000486 Pag e 1769 of 23\i 6 of 871 >> Sent: Friday , January 26, 2018 3:24 PM >> To: Blackburn, Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini; Short, >> John (VACO); Cox, Tim (VACO) >> Subject: Apple vs Cerner >> >> Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities . Please don 't let people confuse the two. These draft charts may help you with your messaging. >> Vr >> John >> >> John H. Windom, Senior Executive Service (SES) Program Executive fo r >> Electronic Health Record Modernization (PEO EHRM) Special Advisor to >> the Under Secretary for Health >> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >> John.Windom@va .gov >> Office: (202) 461-5820 >> Mobile : '----------,'C""C".":''------------, (b)(6) 5 >> Executive Assistant: (b)C l - A pointments and Scheduling >>! Office: (202) 461-6618 >> >> >> >> >> > Questions _final.docx> VA-18-0298-B-000487 Pa ge 1770 of 23\i 7 of 871 Document ID: 0.7.1705.384303 Bruce Moskowitz From: j(bJ(6l @mac .com> To: O'Rourke, Peter M. Cc: Sandoval, Camilo J. ; Marc Sherman 6l@frenchangel59.com> l(bJ( 6J @gmail.com>; 1Pl~bl( Bee: Subject: Re: [EXTERNAL] Re: Apple vs Gerner Date: Thu Mar 08 2018 07:08:06 EST Attachments: Thank you for your quick response . When convenient for you, let's set up a call to determine what can be done to rescue this very important initiative. Sent from my iPad Bruce Moskowitz M.D. > On Mar 8, 2018, at 7:04 AM , O'Rourke, Peter M. wrote: > > Bruce , > > What can I do to salvage that group's work and expertise and apply what we can to the developing product? > > Pete > > -----Or iginal Message----(b-)(5-, -------~l @mac.com] > From: Bruce Moskowitz l~ > Sent: Thursday , March 08, 2018 6:45 AM > To: Sandoval, Camilo J. > Cc: Marc Sherman; IP; O'Rourke, Peter M. > Subject: [EXTERNAL] Re: Apple vs Gerner > > Thank you and after reviewing , we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health . > > Instead of taking the excellent resources from the five Academic centers donating their time to the VA, the VA dropped all contact and proceeded on its own. So now we have a produc t of lim ited value. > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Mar 7, 2018, at 10:46 PM, Sandoval, Camilo J. wrote: >> >> Bruce/Marc, >> >> Apparently I was suppose to share this Attachment with you last month per John 's note below. VA-18-0298-B-000488 Page 177 1 of 23\iaof 871 >> >> My apologies if I didn 't. I will update the tracker , and please do let me know if this helps answers questions around Apple's efforts or if additional clarification is required. >> >> Thank you. >> Camilo >> >> >> ------------>> From : Windom, John H. >> Sent: Wednesday, March 07, 2018 7:26 :08 PM >> To : Sandoval, Camilo J. >> Subject: FW: Apple vs Gerner >> >> >> >> Sent with Good (www.good.com) >> >> ------------>> From : Windom, John H. >> Sent: Tuesday, March 06, 2018 6:18:26 AM >> To: Blackburn, Scott R. >> Cc: Short, John (VACO); Zenooz , Ashwini >> Subject: FW: Apple vs Gerner >> >> Sir, >> As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. >> Vr >> John >> >> John H. Windom, Senior Executive Service (SES) Program Executive for >> Electronic Health Record Modern izatio n (PEO EHRM) Specia l Advisor to >> the Under Secretary for Health >> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 >> John .Windom@va .gov >> Office: (202) 461-5820 >> Mobile : (bl<6l >> Executiv._e~ A-s""""' si,.... s.,.... ta_n....,.. t:....,.,,..., (bl""' <6._ l ----------. _ A pointments and Scheduling 5 6 l@va.go (bJ( l @va.gov> Office: (202) 461-6618 >> j(bl( l >> >> >> >> >> From : Windom , John H. >> Sent: Friday , January 26, 2018 3:24 PM >> To: Blackburn, Scott R.; Sandoval , Camilo J. ; Zenooz , Ashwini ; Short , >> John (VACO); Cox , Tim (VACO) >> Subject: Apple vs Gerner >> >> Apple will not produce an EHR/EMR. It is a health record electronic file cabi net and w ill likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilit ies. Please don 't let people confuse the two . These draft charts may help you with your messaging . >> Vr >> John >> VA-18-0298-B-000489 Page 1772 of 23\ig of 871 >> John H. Windom, Senior Executive Service (SES) Program Executive for >> Electronic Health Record Modernization (PEO EHRM) Specia l Advisor to >> the Under Secreta ry for Health >> 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 >> John.Windom@va.gov >> Office: (202) 461-5820 >> Mobile: (bl<5l '--,---,-----,,--L---------, >> Executive Assistant: ._> l Office: (202) 461-6618 >> >> >> >> >> > Questions _final.docx> VA-18-0298-B-000490 Page 1773 of 23\io of 871 Document ID: 0.7.1705.384302 From: O'Rourke, Peter M. Brnce Moskowitz To: l(bl(5l @mac .com>;Sandova l, Cami lo J. @gmail.com> ; IP Marc Sherman j(bl(6l Cc: ~ frenchange l59.com> Bee: RE: [EXTERNAL] Re: Apple vs Cerner Subject: Thu Mar 08 2018 07:04:39 EST Date: Attachments: Bruce , What can I do to salvage that group's work and expertise and apply what we can to the developing product? Pete -----Original Message----(b-)(5-l ---------, From: Bruce Moskowitz .-l Sent: Thursday , March 08, 2018 6:45 AM To: Sandova l, Camilo J. Cc: Marc Sherman; IP; O'Rourke, Peter M. Subject: [EXTERNA L] Re: App le vs Cerner @mac.com] Thank you and after reviewing, we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that wou ld have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health . Instead of taking the excellent resources from the five Academic centers donating their time to the VA , the VA dropped all contact and proceeded on its own. So now we have a product of limited value. Sent from my iPad Bruce Moskowitz M.D. > On Mar 7, 2018, at 10:46 PM, Sandova l, Camilo J. wrote : > > Bruce/Marc, > > Apparently I was suppose to share this Attachment with you last month per John's note below . > > My apologies if I didn't. I will update the tracker , and please do let me know if this helps answers questions around App le's efforts or if additio nal clarification is required. > > Thank you . > Camilo > > VA-18-0298-B-000491 Pag e 1774 of 23\i 1 of 871 > ------------> From: Windom, John H. > Sent: Wednesday , March 07 , 2018 7:26:08 PM > To : Sandoval , Camilo J. > Subject: FW: Apple vs Cerner > > > > Sent with Good (www.good.com) > > ------------> From: Windom, John H. > Sent: Tuesday , March 06 , 2018 6:18:26 AM > To: Blackburn, Scott R. > Cc: Short, John (VACO); Zenooz, Ashwini > Subject: FW: Apple vs Cerner > > Sir, > As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. > Vr > John > > John H. Windom, Senior Executive Service (SES) Program Executive for > Electronic Health Record Modernization (PEO EHRM) Special Adv iso r to > the Under Secretary for Health > 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 > John.W indom@va .gov > Office : (202 461-5820 Mobile: 1-5 > Executive Assistant: (bHl - A pointments and Scheduling 6l >l Office : (202) 461-6618 > > > > > From: Windom, John H. > Sent: Friday , January 26, 2018 3:24 PM > To : Blackburn, Scott R.; Sandova l, Camilo J .; Zenooz , Ashw ini; Short , > John (VACO); Cox , Tim (VACO) > Subject: Apple vs Cerner > > Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercia l EHR. Apple will deliver less than 1% of commercial EHR capabi lities. Please don 't let people confuse the two . These draft charts may help you with your messaging . > Vr > John > > John H. Windom, Senior Executive Service (SES) Program Executive for > Electronic Health Record Modernization (PEO EHRM) Special Advisor to > the Under Secretary for Health > 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 > John .Windom@va .gov > Office : 202 461-5820 Mobile: ._ 5 > Executive Assistant: (bJ( l - Appointments and Scheduling VA-18-0298-B-000492 Page 1775 of 23\i 2 of 871 > l(b)(6) > 5 l@va .gov ~..... 'b_ l< _l ______ __,@va.gov> Office : (202) 461-6618 > > > > Questions _final.docx> VA-18-0298-B-000493 Page 1776 of 23\i 3 of 871 Document ID: 0.7.1705.384300 From: Bruce Moskowitz @mac.com> Sandoval, Camilo J. gmail.com> ; IP Marc Sherman (bl<5l ~ frenchangel59.com>; O'Rourke, Peter M. l(bl(6l To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Re: Apple vs Gerner Thu Mar 08 2018 06:45:13 EST Thank you and after reviewing , we had an excellent group assembled on the call with Tim Cook, his staff and our five Academic centers and the VA to proceed with an EMR that would have solved many of the problems faced by the choice system, Telemedicine and of equal importance a platform for mental health . Instead of taking the excellent resources from the five Academic centers donating their time to the VA , the VA dropped all contact and proceeded on its own. So now we have a product of limited value. Sent from my iPad Bruce Moskowitz M.D. > On Mar 7, 2018, at 10:46 PM, Sandoval, Camilo J. wrote : > > Bruce/Marc , > > Apparently I was suppose to share this Attachment with you last month per John's note below . > > My apo logies if I didn't. I will update the tracker, and please do let me know if this helps answers questions around Apple 's efforts or if additional clarification is required. > > Thank you . > Camilo > > > ------------> From: Windom, John H. > Sent: Wednesday , March 07, 2018 7:26:08 PM > To: Sandoval , Camilo J. > Subject: FW: Apple vs Gerner > > > > Sent with Good (www .good.com) > > ------------> From: Windom, John H. > Sent: Tuesday, March 06, 2018 6:18:26 AM > To: Blackburn, Scott R. VA-18-0298-B-000494 Page 1777 of 23\i 4 of 871 > Cc: Short, John (VACO); Zenooz, Ashwini > Subject: FW: Apple vs Cerner > > Sir, > As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. > Vr > John > > John H. Windom, Senior Executive Service (SES) > Program Executive for Electronic Health Record Modernization (PEO EHRM) > Special Advisor to the Under Secretary for Health > 811 Vermont Avenue NW (5th Floor Suite 5080) > Washington, DC 20420 > John.Windom@va.gov > Office: 202 461-5820 5l > Mobile: (b)( '---------.-----'---------, > Executive Assistant: .... 'b_ l(5_l -~:c-------- -A....., pointments and Scheduling 5l 6l > l(b)( l@va.gov (bH va.gov> Office: (202) 461-6618 > > > > > From: Windom, John H. > Sent: Friday, January 26, 2018 3:24 PM > To: Blackburn, Scott R.; Sandoval, Camilo J.; Zenooz, Ashwini; Short, John (VACO); Cox, Tim (VACO) > Subject: Apple vs Cerner > > Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities. Please don't let people confuse the two. These draft charts may help you with your messaging. > Vr > John > > John H. Windom, Senior Executive Service (SES) > Program Executive for Electronic Health Record Modernization (PEO EHRM) > Special Advisor to the Under Secretary for Health > 811 Vermont Avenue NW (5th Floor Suite 5080) > Washington, DC 20420 > John.Windom@va.gov > Office: (202) 461-5820 (b.:..:.. )<6-'-) ____ ___ ....,_ _______ > Mobile:i.:... 5 > Executive Assistant: (bl< l - A pointments and Scheduling 6 6 ~ Office: (202) 461-6618 > > > > > > VA-18-0298-B-000495 Page 177 8 of 23\isof 871 Document ID: 0.7.1705.384150 Marc Sherman l From: To: Sandoval, Camilo J. Cc: Bruce Moskowitz 5 l ; IP~fre nchangel59.com>; O'Rourke, Peter M. Bee: Subject: [EXTERNAL] Re: FW: Apple vs Gerner Date: Thu Mar 08 2018 00:40:48 EST Attachments: Thank you . I will review tomorrow. Marc Sherman (202) 758-8700 On Mar 7, 2018 10:46 PM, "Sandoval , Camilo J ." wrote: Bruce/Marc , Apparently I was suppose to share this Attachment with you last month per John 's note below. My apologies if I didn 't. I will update the tracker , and please do let me know if this helps answe rs questions around Apple 's efforts or if additional clarification is required. Thank you . Camilo From: Windom , John H. Sent: Wednesday, March 07, 2018 7:26 :08 PM To : Sandoval , Camilo J. Subject: FW: Apple vs Gerner Sent with Good (www.good .com) From: Windom , John H. Sent: Tuesday , March 06 , 2018 6:18:26 AM To: Blackburn, Scott R. Cc: Short, John (VACO); Zenooz, Ashwini Subject: FW: Apple vs Gerner Sir, As you can see , I also shared with Cam who readily saw the difference and was to convey the message VA-18-0298-B-000496 Page 1779 of 23\i 6 of 871 down South . Here you go. Vr John John H . Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office : (202) 461-5820 (b.:.:.. J(6 .:.... l ---~~---------, Mobile : i:.... Executive Assistant: (b){GJ - A ointments and Scheduling 5 5l i Office: (202) 461-6618 From: Windom, John H. Sent: Friday, January 26, 2018 3:24 PM To: Blackburn , Scott R.; Sandoval , Camilo J. ; Zenooz , Ashwini; Short , John (VACO) ; Cox , Tim (VACO) Subject: Apple vs Gerner Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and w ill likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities . Please don't let people confuse the two . These draft charts may help you with your messaging. Vr John John H . Windom , Senior Executive Service (SES) Program Executive for Electronic Health Record Modern ization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Su ite 5080) Washington , DC 20420 John.Windom@va.gov Office : 202 461-5820 5l Mobile : (bl< L-----r,:~---------, 5 Executive Assistan t: L.. (b_l<_l -~------......__ - ..:.. A..:.c.J;' ointments and Scheduling l(bl{6l ~va .gov < Office: (202) 461-6618 VA-18-0298-B-000497 Pa ge 1780 of 23\i 7 of 871 Document ID: 0.7.1705.384147 From: Sandoval, Camilo J. To: Blackburn, Scott R. Cc: Bee: Subject: FW: Apple vs Gerner Date: Wed Mar 07 2018 22:52:39 EST Attachments: Apple App Background and Questions _final.docx EHRM Gerner Apple Compare _final.pptx FYI. .. will update tracker . Thanks From: Sandoval, Cami lo J. Sent: Wednesday, March 07 , 2018 7:46 :02 PM To: Bruce Moskowitz; Marc Sherman; IP Cc: O'Rourke , Peter M. Subject: FW: Apple vs Gerner Bruce/Marc, Apparently I was suppose to share this Attachment with you last month per John 's note below. My apologies if I didn 't. I will update the tracker , and please do let me know if this helps answers questions around Apple's efforts or if additional clarification is required. Thank you. Camilo From: Windom, John H. Sent: Wednesday, March 07, 2018 7:26:08 PM To: Sandoval , Camilo J. Subject: FW: Apple vs Gerner Sent with Good (www.good .com) VA-18-0298-B-000498 Page 178 1 of 23 4~8 of 871 From: Windom, John H. Sent: Tuesday , March 06, 2018 6:18:26 AM To: Blackburn, Scott R. Cc: Short, John (VACO); Zenooz, Ashwini Subject: FW: Apple vs Gerner Sir, As you can see , I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office : (202) 461-5820 5 Mobile :-l(b_J(_i ----Executive Assistant: ._l (b_ H5_l ____ 5 ._l (b_l( _l ________ _.I - Appointments and Scheduling _.l@va .gov Office: (202) 461-6618 From: Windom, John H. Sent: Friday, January 26, 2018 3:24 PM To: Blackburn, Scott R.; Sandoval , Camilo J.; Zenooz, Ashwini; Short , John (VACO); Cox, Tim (VACO) Subject: App le vs Gerner VA-18-0298-B-000499 Page 1782 of 23\ig of 871 Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities. Please don't let people confuse the two. These draft charts may help you with your messaging. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office : (202) 461-5820 (b_ l(5_l ---~ Mobile: l~ 5 Executive Assistant: ~l (b_l<_l l~ (b)_( 6 l____ --------~I - Appointments and Scheduling ~ @va .gov Office: (202) 461-6618 VA-18-0298-B-000500 Page 1783 of 23Y6o of 871 Document ID: 0.7.1705.384147-000001 Owner : Sandoval, Camilo J . Filename: Apple App Background and Questions _final.docx Last Modified: Wed Mar 07 21:52:39 CST 2018 VA-18-0298-B-000501 Page 1784 of 23 5~1 of 871 Apple App Background and Questions _f inal.docx for Printed Item: 653 ( Attachment 1 of 2) Apple Health App Backgroundand Questions EHRvs.PMR CernerMillennium is classified as an EHRsystem and is used by medical professionals to document care and treatmen t (e.g. order s and assessments), it also provides clinical workflow capabilities, and based on user profile (e.g., doctor, patient, lab technician, administrator, and biller) o Apple Health is a Personal Medical Record (PMR) th at aggregates summary level medical information from multiple EHRs. It pro vide s a view of the patient's medic al record via receiving Community of Care (CCD)records that are generated by EHRsystem s. Cerner also has an app that performs this function Apple App Background: o On 24 January Apple issued an updat e to its existing health app available to use rs with iOS l l .3beta who are patients in partner facilities* o The updated functionality enables the Apple health app to ingest CCDrecords using an industry standard know n as Fast Healthcare Interoperability Resource (FHIR). This standard is used by all major EHRvendors, including Cerner, and means that VAwill be able to feed and receive records o CCDrecords are currently available to patients of Cerner facilities using Cerner Patient Portal, which includes a mobile enabled app available on both iOS and Android o CCDsrecord s that both the Cerner and Apple app will rece ive include summ ary level data about - Allergies - Lab res ults - Clinical vitals - Medications - Immunizations - Procedure o The Apple health app receives data via a Health Information Exchange (HIE) o The Apple health app does not represen t a choice between the two but rather it is an expansion of offerings available to the Veteran o The Apple health app potentially relates to functions performed in seve n (7) of the 151 Cerner modules VAis buying Potential Questions: o We do not have a clear understanding of how the data is secured after it leaves the hea lth system. How is it stored securely? How is it transmitt ed securely? o Apple iOSmarket share in the US is 40% whereas Android is 60% 1 - how is the access overcome? * Current beta facilities are: 1. CernerHealthe Clinic 2. Johns Hopkins Medicine 3. Cedars-Sinai 4. Penn Medicine 5. Geisinger Health System 6. UC San Diego Health 7. UNCHealth Care 8. Rush University Medical Center 9. Dignity Health 1 10. Ochsner Health System 11. MedStar Health 12. OhioHealth http://www.businessinsider.com/apple -ios-market -share-us -europe -japan-20 18-1 VA-18-0298-B-000502 Page 1785 of 23sB2 of 871 Document ID: 0.7.1705.384128 From: Sandoval, Camilo J. To: Bruce Moskowitz 5 (bl(6l mac .com>; Marc Sherman ._l < >@frenchangel59.com> O'Rourke , Peter M. Bee: FW: Apple vs Gerner Subject: Wed Mar 07 2018 22:46:02 EST Date: Apple App Background and Questions _final.docx Attachments: EHRM Gerner Apple Compare _final.pptx _. @gmail.com>; Bruce/Marc, Apparently I was suppose to share this Attachment with you last month per John 's note below. My apologies if I didn 't. I will update the tracker , and please do let me know if this helps answers questions around Apple 's efforts or if additional clarification is required. Thank you . Camilo From: Windom, John H. Sent: Wednesday , March 07 , 2018 7:26:08 PM To : Sandoval, Camilo J. Subject: FW: Apple vs Gerner Sent with Good (www.good.com) From: Windom, John H. Sent: Tue sday, March 06 , 2018 6:18:26 AM To: Blackburn, Scott R. Cc: Short, John (VACO); Zenooz, Ashwini Subject: FW: Apple vs Gerner Sir, VA-18-0298-B-000503 Page 1788 of 23Y6 of 3 871 As you can see, I also shared with Cam who readily saw the difference and was to convey the message down South. Here you go. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windo m@va.gov Office: (202) 461-5820 (b_H5_l ___ Mobile: ~l _ ExecutiveAssistant:~r -)(G-) l._ (bl_(6l____ --------~I -Appointmentsand Scheduling _. @va .gov Office: (202) 461-6618 From: Windom, John H. Sent: Friday , January 26, 2018 3:24 PM To: Blackburn, Scott R.; Sandoval , Camilo J.; Zenooz, Ashwini; Short, John (VACO); Cox, Tim (VACO) Subject: Apple vs Cerner Apple will not produce an EHR/EMR. It is a health record electronic file cabinet and will likely ultimately align to a commercial EHR. Apple will deliver less than 1% of commercial EHR capabilities. Please don't let people confuse the two. These draft charts may help you with your messaging. Vr John John H. Windom, Senior Executive Service (SES) VA-18-0298-B-000504 Page 1789 of 23Y6 of 4 871 Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office : (202) 461-5820 5 (b_ l<_l ---~ Mobile: l~ Executive Assistant: l(bl(5l l(bl(5l I- Appo intments and Schedu ling ~va .gov Office : (202) 461-6618 VA-18-0298-B-000505 Page 1790 of 23Y6 of 5 871 Document ID: 0.7.1705.384128-000001 Owner : Sandoval, Camilo J . Filename: Apple App Background and Questions _final.docx Last Modified: Wed Mar 07 21:46:02 CST 2018 VA-18-0298-B-000506 Page 179 1 of 23 5~6 of 871 Apple App Background and Questions _f inal.docx for Printed Item: 656 ( Attachment 1 of 2) Apple Health App Backgroundand Questions EHRvs.PMR CernerMillennium is classified as an EHRsystem and is used by medical professionals to document care and treatmen t (e.g. order s and assessments), it also provides clinical workflow capabilities, and based on user profile (e.g., doctor, patient, lab technician, administrator, and biller) o Apple Health is a Personal Medical Record (PMR) th at aggregates summary level medical information from multiple EHRs. It pro vide s a view of the patient's medic al record via receiving Community of Care (CCD)records that are generated by EHRsystem s. Cerner also has an app that performs this function Apple App Background: o On 24 January Apple issued an updat e to its existing health app available to use rs with iOS l l .3beta who are patients in partner facilities* o The updated functionality enables the Apple health app to ingest CCDrecords using an industry standard know n as Fast Healthcare Interoperability Resource (FHIR). This standard is used by all major EHRvendors, including Cerner, and means that VAwill be able to feed and receive records o CCDrecords are currently available to patients of Cerner facilities using Cerner Patient Portal, which includes a mobile enabled app available on both iOS and Android o CCDsrecord s that both the Cerner and Apple app will rece ive include summ ary level data about - Allergies - Lab res ults - Clinical vitals - Medications - Immunizations - Procedure o The Apple health app receives data via a Health Information Exchange (HIE) o The Apple health app does not represen t a choice between the two but rather it is an expansion of offerings available to the Veteran o The Apple health app potentially relates to functions performed in seve n (7) of the 151 Cerner modules VAis buying Potential Questions: o We do not have a clear understanding of how the data is secured after it leaves the hea lth system. How is it stored securely? How is it transmitt ed securely? o Apple iOSmarket share in the US is 40% whereas Android is 60% 1 - how is the access overcome? * Current beta facilities are: 1. CernerHealthe Clinic 2. Johns Hopkins Medicine 3. Cedars-Sinai 4. Penn Medicine 5. Geisinger Health System 6. UC San Diego Health 7. UNCHealth Care 8. Rush University Medical Center 9. Dignity Health 1 10. Ochsner Health System 11. MedStar Health 12. OhioHealth http://www.businessinsider.com/apple -ios-market -share-us -europe -japan-20 18-1 VA-18-0298-B-000507 Page 1792 of 23 5e7 of 871 Document ID: 0.7.1705.487663 From: Blackburn, Scott R. Sandoval, Camilo J. To: Cc: Bee: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Mar 07 2018 02:43:22 EST Date: Attachments: From: Bruce Moskowitz l(b)(GJ l@mac.com] Sent: Wednesday , February 28, 20 18 4 :53 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(GJ @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4:36 PM, Blackburn, Scott R. wrote : Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition . Our new Cerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Cerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cerner without any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they VA-18-0298-B-000508 Page 1837 of 23Y6 of 8 871 would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report . The med duplication is configured similarly to test and parameters will determine how the system acts . Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering. As an aside, while the DoD Cerner implementation has been far from perfect this is one area where it has been very successful; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented. Streamlined SOAP notes . Yes , the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs . From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To: 'Bruce Moskowitz' @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; IP; l(b)( 5l Subject: RE : [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Bruce - we certainly aren 't going to let you get tar and feathered! Again , we really appreciate all the support you've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you 've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott From: Bruce Moskowitz .... l(D_H5_l _______ ___. @mac.com] VA-18-0298-B-000509 Page 1838 of 23Y6 9 of 871 Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; l(bH6l !@gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication, over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018, at 12:52 PM, Blackburn, Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... ********* The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VNCerner system. ********* Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now . Again, the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ********* Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ********* DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the VA-18-0298-B-000510 Page 1839 of 23~ 0 of 871 DoD CIO/team. This will help not just Veterans , but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear . Scott From: Bruce Moskow itz l(b)(5) l@mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; IP;l(b)(G) Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l (b-)(5_l _____ ~ t@mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. <_ b H6_l -----~ On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz l~ @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud VA-18-0298-B-000511 Page 1840 of 23~ 1 of 871 Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . ********* The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ***** **** In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. I #3) Below is the IP lanquaqe that we neqotiated . l(bl(5l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. VA-18-0298-B-000512 Page 1841 of 23~ 2 of 871 Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g ., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets , etc. This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." VA-18-0298-B-000513 Page 1842 of 23 5~3 of 871 Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000514 Page 1843 of 23 5~4 of 871 Document ID: 0.7.1705.474783 Blackburn, Scott R. To: Sandoval, Camilo J. Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Mar 07 2018 02:43:22 EST Attachments: From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Wednesday , February 28, 2018 4 :53 PM To: Blackburn , Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(bl(6l l@gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4 :36 PM, Blackburn, Scott R. wrote : Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts . - Scott Voice Recognition . Our new Gerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner w ithout any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source , be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line. Even if they are not exactly named the same the results review VA-18-0298-B-000515 Page 1844 of 23~ 5 of 871 flowsheet allows for 2 different lab values to be graphed together . Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor , via report . The med duplication is configured similarly to test and parameters will determine how the system acts . Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking , dupes , dose range checks , and interactions are checked at time of ordering. As an aside , while the DoD Cerner implementation has been far from perfect this is one area where it has been very successful ; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented . Streamlined SOAP notes. Yes, the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To : 'Bruce Moskowitz' l@gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(b)(5) Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren't going to let you get tar and feathered! Again , we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by .. . Scott l(b_l<5_l _______ ___. l@mac.com] From: Bruce Moskowitz .... Sent: Wednesday , February 28, 20181:13 PM VA-18-0298-B-000516 Page 1845 of 23~ 6 of 871 To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(bl(5 l Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognition All entering lab data on a graph from any source Catching test dupl ication , over utilization and medication duplication /errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into th is th is more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morning .. . ***** **** The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. ********* Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the prov ider meets certain standards (these standards are dictated by GSA, not VA). ********* Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ********* DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans , but servicemembers still in uniform . VA-18-0298-B-000517 Page 1846 of 23~ 7 of 871 Thanks again for the feedback and support. We are going to make sure this is crystal clear . Scott From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l l@gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. (b_l(5_l _____ On Feb 27, 2018 , at 9:20 PM , Bruce Moskowitz ~l ~ @mac.com > wrote : To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. (b_l<6_l _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ._l _. @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms . VA-18-0298-B-000518 Page 1847 of 23~ 8 of 871 Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use inv itation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... ********* The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ********* In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCar e Innovations. #3) Below is the IP language that we negotiated. i VA-18-0298-B-000521 Page 1850 of 23 5~1 of 871 Document ID: 0.7.1705.1764157 From: Blackburn, Scott R. To: Sandoval, Camilo J . Cc: Bee: FW: [EXTERNAL] Fwd: EMR Subject: Tue Mar 06 2018 17:04:54 EST Date: Attachments: Sent with Good (www.good.com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNA L] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: 5 From: Bruce Moskowitz l(bl< l@mac.com> ) Date: March 5, 2018 at 6:49 :58 AM EST 6l To: l(b)<5l @gmail.com, (b)( reagan .com Cc:l(b)(6) @gmail.com, IP ,,-l (b-)(6-l ----, Subject: EMR ~gmail.com I would like to underscore the importance of getting the "Cloud"correctly and the other four issues with the new Cl O's. Also the composition of the physician input has to change immed iately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especia lly in mental health we need a portable EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000522 Page 1857 of 23~ 2 of 871 Document ID: 0.7.1705.487 153 From: Blackburn, Scott R. To: Sandova l, Cami lo J . Cc: Bee: Subject: FW: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 17:04:54 EST Attachments: Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06 , 20 18 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we beg in to address and then ill respond back? Sent from my iPhone Begin forwa rded message: From: Bruce Moskowitz l(b)(5) !@,mac.com> Date: March 5, 2018 at 6:49:58 AM EST To :i(bl<5l k@gmail.com, (b)(6l @reagan .com ---Cc:l(b)(6) (mgmail.com, I (b)(G) frenchangel59 .com> , l(b)(G) Subject: EMR @gmail.com I wou ld like to undersco re the importance of getting the "Cloud "correctly and the othe r fou r issues wit h the new C lO's. Also the composition of the physic ian input has to change immed iately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and espec ially in mental health we need a portab le EMR solution that works with the DOD , the VA and the private sector . No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000523 Page 1859 of 23~ 3 of 871 Document ID: 0.7.1705.383911 From: Blackburn, Scott R. To: Sandoval, Camilo J . Cc: Bee: FW: [EXTERNAL] Fwd: EMR Subject: Tue Mar 06 2018 17:04:54 EST Date: Attachments: Sent with Good (www.good.com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNA L] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz l(bH5l @mac.com> Date: March 5, 2018 at 6:49 :58 AM EST To l(bl(5l @gmail.com, !(bl{6l l@reagan.com ~--~ 6 Cc: l(bl ,l(bl<5 l Subject: EMR @gmail.com I would like to underscore the importance of getting the "Cloud"correctly and the other four issues with the new Cl O's. Also the composition of the physician input has to change immed iately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especia lly in mental health we need a portable EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000524 Page 1861 of 23~ 4 of 871 Document ID: 0.7.1705.1492481 i; Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 10:01 :05 EST Attachments: Agree, when? ~ Sent with Good (www.good .com) From: Myklegard , Drew Sent: Tuesday , March 06 , 2018 6:02:25 AM To: Blackburn, Scott R.; l VA-18-0298-B-000525 Page 1863 of 23~ 5 of 871 Date: Tuesda , March 6, 2018 at 5:42 AM To: (b)(6l va.gov>, "Myklegard, Drew" SubJect: F : E T R L] Fwd: EMR See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good.com) From: David Shu lkin Sent: Tuesday, March 06, 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: ~mac.com> From: Bruce Moskowitz l(bH5l Date: March 5, 2018 at 6:49:58 AM EST To: l(bl(5l @gmail.com, !(b)(6l [Q2reagan.com~--~ 5 6 @gmail.com, IP~fr enchangel59.com> ,l; Myklegard, Drew Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 10:01 :02 EST Attachments: Scott, Drew and I will put something together, btw, Patty in VHA has been trying to set up the conversation with Bruce. Ricci Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Tuesday , March 06, 20 18 5:42:23 AM Myklegard, Drew To : l(bl(5l Subject: FW: [EXTERNAL] Fwd: EMR I See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: VA-18-0298-B-000527 Page 1865 of 23~ 7 of 871 From: Bruce Moskowitz l(bl(6l @mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: l(bl(6l @gmail.com, (bl(6l reagan.com Cc: l(bJ(6l @gmail.com, IP (b>C5> frenchangel59.com> ,.-l (b-H6,..... l ---.l Subject: EMR @gmail.com I wou ld like to underscore the importance of getting the "Cloud"correct ly and the other four issues with the new CIO's. Also the composition of the physician input has to change immediate ly so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especia lly in mental health we need a portab le EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000528 Page 1866 of 23~ 8 of 871 Document ID: 0.7.1705.1208963 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn , Scott R. ; Short , John (VACO) Cc: Bee: RE: [EXTERNAL] Fwd: EMR Subject: Tue Mar 06 2018 09:45:38 EST Date: Attachments: On physician and patient centric EHR: creating workflows with front line providers in-mind and engaged is the core part of change management strategy. Business and Clinical Requirements for Phase 1 of the acquisition were provided by Integrated Teams comprised of 200+ front line clinicians. Phase 2: indepth workflow development for Gerner to implement at each site with follow a similar model. We are NOT adopting run-of-the-mill Gerner workflows . They will be configured based on requirements set forth by VA Clinical teams and Clinical Practice Guidelines. Patient Perspective: We have engaged with VA patient centered design teams since day 1 of the project and our baseline discussions with Gerner started with the Veteran journey. Additionally, VSOs have been very engaged and have been/will be part of the design input and review as we implement patient portal, mobile schedu ling etc. Patient Centric EHR: Our focus is on providing high quality, value-based care and that was the basis of the "Choose VA" campaign. The goal of this implementation is to enable reliable metrics and data returns, measure outcomes so that patients have faster, access to quality care. Please let me know if there are questions. I'll be at the Venetian all day. 202-695-9147 or 650-213-6204. Ash Sent with Good (www.good .com) From: Windom, John H. Sent: Tuesday, March 06, 2018 6:16:13 AM To: Blackburn, Scott R.; Zenooz , Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] Fwd: EMR Ash and John S ., VA-18-0298-B-000529 Page 1867 of 23 5~9 of 871 Please provide a one short paragraph technical and functional response for Mr. Blackburn to these elements that we have covered as part of our efforts. I can tell that our journey is coming to a close in the good Doctor's mind. Please do not create any ambiguity or open up any cans of worms in your responses. "Clear and concise." Thank you. Break Mr. Blackburn/I provided you the Apple comparison matrix awhile back but will send you again. My e-mail highlighted that the Apple solution that was announced is effectively portable electronic file cab inet not an EHR/EMR. V/r, John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office: (202) 461-5820 Mobile:l(b ...._l(5_> ___ ___, 5 Executive Assistant: .... l(b_H_> _______ 5 l._ (bl-( _> ____ ~I - Appointments and Schedu ling _.@va .gov Office : (202) 461-6618 From: Blackburn, Scott R. Sent: Tuesday, March 06 , 20 18 8:42 AM To : Windom , John H.; Zenooz, Ashwini ; Short, John (VACO) Subject: FW: [EXTERNAL] Fwd: EMR See email below. Any thoughts on how to respond? Sent with Good (www.good.com) VA-18-0298-B-000530 Page 1868 of 23~ 0 of 871 From: David Shulkin Sent: Tuesday , March 06, 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz l(bl(6l @mac .com> Date: March 5, 2018 at 6:49:58 AM EST @gmail.com, (bl(6l reagan.com .------. To: l(bl(6l Cc: l(b)(6J @gmail.com, IP (bJC5l frenchangel59 .com> , l(bl<5 l Subject: EMR @gmail.com I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with the new Cl O's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector . No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000531 Page 1869 of 23~ 1 of 871 Document ID: 0.7.1705.486623 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn, Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 09:45:38 EST Attachments: On physician and patient centric EHR: creating workflows with front line providers in-mind and engaged is the core part of change management strategy. Business and Clinical Requirements for Phase 1 of the acquisition were provided by Integrated Teams compr ised of 200+ front line clinic ians. Phase 2: indepth workflow development for Gerner to implement at each site with follow a similar model. We are NOT adopting run-of-the-mill Gerner workflows . They will be configured based on requirements set forth by VA Clinical teams and Clinical Practice Guidelines. Patient Perspective: We have engaged with VA patient centered design teams since day 1 of the project and our base line discuss ions with Gerner started with the Veteran journey. Additionally, VSOs have been very engaged and have been/will be part of the design input and review as we implement patient portal, mobile schedu ling etc. Patient Centric EHR: Our focus is on providing high quality, value-based care and that was the basis of the "Choose VA" campaign. The goal of this implementation is to enable reliable metrics and data returns , measure outcomes so that patients have faster, access to quality care. Please let me know if there are questions . I'll be at the Venetian all day. 202-695-9147 or 650-213-6204 . Ash Sent with Good (www.good .com) From: Windom, John H. Sent: Tuesday , March 06 , 2018 6:16:13 AM To: Blackburn, Scott R.; Zenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] Fwd: EMR VA-18-0298-B-000532 Page 1870 of 23 5~2 of 871 Ash and John S., Please provide a one short paragraph technical and functional response for Mr. Blackburn to these elements that we have covered as part of our efforts. I can tell that our journey is coming to a close in the good Doctor's mind. Please do not create any ambiguity or open up any cans of worms in your responses. "Clear and concise." Thank you. Break Mr. Blackburn/I provided you the Apple comparison matrix awhile back but will send you again. My e-mail highlighted that the Apple solution that was announced is effectively portable electronic file cabinet not an EHR/EMR. V/r, John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office : (202) 461-5820 l(b_H5_l ___ Mobile: .... ____. 5 Executive Assistant: ~l (b-l( _l --------~ ~i From: Bruce Moskowitz l(bH Date: March 5, 2018 at 6:49:58 AM EST To: (b)(6) gmail.com,( b)(6) reagan .com ~-~ 6l Cc: (b)( gmail.com, Ip ,i(bl{6l @gmail.com Subject: EMR I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with the new C lO's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective. Second this is going to take years to implement and especia lly in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000534 Page 1872 of 23~ 4 of 871 Document ID: 0.7.1705.1208671 From: Windom, John H. To: Blackburn, Scott R. ; Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL] Fwd: EMR Subject: Tue Mar 06 2018 09:16:13 EST Date: Attachments: Ash and John S ., Please provide a one short paragraph technical and functional response for Mr . Blackburn to these elements that we have covered as part of our efforts. I can tell that our journey is coming to a close in the good Doctor's mind. Please do not create any ambiguity or open up any cans of worms in your responses . "Clear and concise ." Thank you. Break Mr. Blackburn/I provided you the Apple comparison matrix awhile back but will send you again. My e-mail highlighted that the Apple solution that was announ ced is effectively portable electronic file cabinet not an EHR/EMR. V/r , John John H. Windom , Senior Executive Serv ice (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office: (202) 461-5820 (b_H5_l Mobile: ._l ___ __. Executive Assistant: l Date: March 5, 2018 at 6:49:58 AM EST To j(bl(6l @gmail.com , (b)(Gl reagan.com @gmail.com, IP (bJ(Blfrenchangel59 .com> ,,.,,.l (b.,..,, H6,,.... l ----, Cc: l Blackburn, Scott R. ; ..... l(b_l(6_l _ 6 (b)( l /o=va/ou =exc hange administrative group (fydibohf23spdlt)/cn=recipients/cn=ricci .mulligan> Cc: Bee: Re: [EXTERNAL] Fwd: EMR Subject: Tue Mar 06 2018 09:02:25 EST Date: Attachments: _. Have a meeting where our VA team and Apple (Ricky and/or Jacky) wa lk Bruce through their slide deck that explains what they are doing. Use it as an opportunity for Shama n to build a relationship with him as VA gets closer to making our announcement. Maybe an email like this: We wou ld like to get our team , Apple, and you on a phone ca ll to wa lk you through the Veteran/patient experience and how it will improve their care . On this ema il is our clinical leadf or the Apple engagement, Dr. Shaman Singh MD. He will take the lead for coordinating a meeting. From: "Blackburn, Scott R." Date: Tuesda y, March 6, 2018 at 5:42 AM @va.gov> , "Myklegard, Drew" To: l(b)C5l Subject: FW: [EXTERNAL ] Fwd : EMR See note below on App le project. Thoughts on how to respond? Sent with Good (www.good .com) VA-18-0298-B-000537 Page 1875 of 23~ 7 of 871 From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskow itz l(bl(6l @mac .com> Date: March 5, 2018 at 6:49 :58 AM EST 6l 6l To :l(bl< @gmail.com , (bl< reagan .com ___ Cc:l(bl<6l @gmail.com, Ip Jbl(5l Subject: EMR @gmail.com I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with the new CIO's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000538 Page 1876 of 23~ 8 of 871 Document ID: 0.7.1705.1763804 From: Blackburn, Scott R. 6l To: 1<0 J< l Cc: Bee: FW: [EXTERNAL] Fwd: EMR Subject: Date: Tue Mar 06 2018 08:42:23 EST Attachments: I: See note below on Apple project. Thoughts on how to respond? Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz !<0 l<6l @mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: 1<0l<6l @gmail.com ,l ,--! <0-l<6 -l ----.! @gmail.com Subject: EMR I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with the new Cl O's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . VA-18-0298-B-000539 Page 1877 of 23 ~ 9 of 871 Sent from my iF?ad Bruce Moskowitz MD. Page 1878 of 23g?0 of 87.1 Document ID: 0.7.1705.485961 From: Blackburn, Scott R. To: (bl(5> (Disabled) administrative group (fyd ibohf23spd lt)/cn=reci pients/cn=46555f3bdf3c4 7 c0b36ecd6c3c 14 9d 90-myklega rd,> Cc: Bee: Subject: FW: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 08:42:23 EST Attachments: See note below on App le project. Thoughts on how to respond? Sent with Good (www.good.com) From: David Shulkin Sent: Tuesday , March 06 , 20 18 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNA L] Fwd: EMR Can we beg in to address and then ill respond back? Sent from my iPhone Begin forwarded message: @mac .com> From: Bruce Moskowitz l(bl<5> Date: March 5, 2018 at 6:49:58 AM EST To: l(bl<6> @gmail.com , (bH5 > reagan .com ,.,...,....,,,,....---. 5 Cc: l frenchangel59 .com> . i @gmail.com Subject: EMR I wou ld like to underscore the importance of getting the "Cloud "correctly and the othe r fou r issues with the new C lO's. Also the composition of the physician input has to change immed iately so that the EMR is patient centric and usable from the physician perspective . Second this is goi ng to take years to implement and especia lly in mental health we need a portab le VA-18-0298-B-000541 Page 1879 of 23~ 1 of 871 EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000542 Page 1880 of 23 5~2 of 871 Document ID: 0.7.1705.485954 From: Blackburn, Scott R. To: Windom, John H. ; Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: FW: [EXTERNAL] Fwd: EMR Subject: Date: Tue Mar 06 2018 08 :41 :41 EST Attachments: See emai l below. Any thoughts on how to respond? Sent with Good (www .good .com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To : Blackburn , Scott R. Subject: [EXTERNA L] Fwd: EMR Can we beg in to address and then ill respond back? Sent from my iPhone Begin forwarded message: @mac .com> From: Bruce Moskowitz l(bl(6l Date: March 5, 2018 at 6:49:58 AM EST To: l(bH6l @gmail.com, (bl(5l reagan.com Cc:!(b)(6) @gmail.com, I (bH5l frenchangel59 .com> , ~l (b-)(6-l -~ Subject: EMR @gmail.com I wou ld like to underscore the importance of getti ng the "Cloud "correctly and the othe r fou r issues with VA-18-0298-B-000543 Page 1881 of 23~ 3 of 871 the new Cl O's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especially in mental health we need a portable EMR solution that works with the DOD , the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000544 Page 1882 of 23 5~4 of 871 Document ID: 0.7.1705.1208625 Blackburn, Scott R. Windom, John H. ; Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 201808:41 :41 EST Attachments: See email below. Any thoughts on how to respond? Sent with Good (www.good .com) From: David Shulkin Sent: Tuesday , March 06 , 2018 7:09:43 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: From: Bruce Moskowitz !(bH6l @mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: 1(bl<5l ~gm ail.com , (b)(G) reagan .com .-----, Cc: _____ ._ @gmail.com, 1p , l(b)(G) Subject: EMR @Jgmail.com I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with the new C lO's. Also the composition of the physician input has to change immediately so that the EMR is patient centric and usable from the physician perspective . Second this is going to take years to implement and especia lly in mental health we need a portab le EMR solution that works with the DOD, the VA and the private sector. No one at the VA got back to me on what the Apple project can and can not do in terms of solving this problem . VA-18-0298-B-000545 Page 1883 of 23Ya of 5 871 Sent from my iF?ad Bruce Moskowitz MD. Page 1884 of 23g?6 of 87.1 Document ID: 0.7.1705.485695 David Shulkin l To: Blackburn, Scott R. Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: 5 From: Bruce Moskowitz l Date: March 5, 2018 at 6:49:58 AM EST To: l(bJ(6J ~gmail.com, (bJ(6l reagan .com~--~ Cc: .____ __., @gmail.com, Ip J To: EOP/WHO 1:.-; (b=J(6 =J====== =P who.eop .gov> Cc: ~/o=va/ou=exchange ~l (b_l(6_> -----~ administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: RE: [EXTERNAL] RE: interoperability Date: Mon Mar05201816:31:37 EST Attachments: Sounds good J(bH5> lwill help schedule time . If helpful I can also send him a few bullet points that might be helpful before his speech tomorrow (on interoperable generally) . Let me know . Sent with Good (www.good.com) 5 > IEOP/WHO From:~>( Sent:onday , March 05, 2018 4:15:39 PM To : Blackburn , Scott R. Subject: RE: [EXTERNAL] RE: interoperability Scott - I apologi ze. Jared believes it's better to speak in person about this when you all are back . I'll Ito schedule! work with l(bl(6> -----Original Message----From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 4:15 PM .---------, 5> 5> To: l(bH IEOP/WHO l(bH Subject: RE: [EXTERNAL] RE: interoperability @who .eop.gov > Available anytime now. Just standing by whenever Jared is ready. Sent with Good (>www .good.com<) IEOP/WHO From: l(bl(6> Sent: Monday , March 05, 2018 10:55:04 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; .... l(b_l(6_> _____ Subject: [EXTERNAL] RE: interoperability __, VA-18-0298-B-000548 Page 1886 of 23Ya of 8 871 Scott Jared arrives around 10pm tonight so it might be better to have call. Would anytime between 3 and 5 work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Sunday, March 4, 2018 11 :35 AM,'----------. To: l(b)(5l IEOP/WHO (b){5l ~,,,......,,=---,-------r,~....<..,;..;.c....;_;;_,;..;;.,,.;;,""'-'-"-L.;;....;.,-------, Cc: Berkowitz, Avrahm J. EOP/WHQ; (b)(6l @va.gov> ~----------~ l(bH6l Subject: RE: interoperability Hi l(b)( 6) I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he would even have time when in Las Vegas) , but I could also do it there. Let me know. Scott (202) 430-9139 From: l(bH5l IEOP/WHO .... l> 5 Cc: Berkowitz, Avrahm J. EOP/WHO (b)(6) who.eop .go (bH l @who.eop.gov>> VA-18-0298-B-000549 Page 1887 of 23~ 9 of 871 Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned ._(b_J(5_l ________________ l(b)( 5) I If so, let me know and I'll make time this week. ____. Scott Scott Blackburn Acting CIO & Executive-in-Charge, Department of Veterans Affairs Office of Information & Technology VA-18-0298-B-000550 Page 1888 of 23Ysoof 871 Document ID: 0.7.1705.485102 From: Blackburn , Scott R. (b)(6) EOP/WHO To: !(b)(6l @who.eop .gov> l(b) (6) Cc: lwill help schedule time . If helpful I can also send him a few bullet points that might be helpful before his speech tomorrow (on interoperable generally) . Let me know . Sent with Good (www.good .com) 5 > IEOP/WHO From: l(bH Sent: Monday , March 05, 2018 4:15:39 PM To : Blackburn, Scott R. Subject: RE: [EXTERNAL] RE: interoperability Scott - I apologize. Jared believes it's better to speak in person about this when you all are back . I'll work with Elizabeth to schedule! -----Original Message----From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 4:15 PM To ;i(bl(5l IEOP/WHO ,-l (b-H6-l ---------. Subject: RE: [EXTERNAL] RE: interoperability @who .eop.gov > Available anytime now. Just standing by whenever Jared is ready. Sent with Good (>www .good.com<) From:i(bl(5l IEOP/WHO Sent: Monday, March 05, 2018 10:55:04 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; (b_ l(5_> _____ l..... _, VA-18-0298-B-000551 Page 1889 of 23~ 1 of 871 Subject: [EXTERNAL] RE: interoperability Scott Jared arrives around 10pm tonight so it might be better to have call. Would anytime between 3 and 5 work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Sunda y, March 4, 2018 11 :35 AM 0 6 To: l<0 l<5l :::-l~~~~~~~~~~~:~_: -=..:..:c.:..===.:...:i.=....:. _____ EOP/WHO;:;...z.."" <_ .,.,, H...,.. 0 5 Cc: Berkowitz, Avrahm J. EOP/WH < l; <0 l<6l l@va.gov> .____________ I<0 l<5l I ---. __, Subject: RE: interoperability Hi l>; (b)(6) va .govjcoJ (6l 1@va.gov>> Subject: RE : interoperability Great. We will find time . 0 5 From: Kushner, Jared C. EOP/WHO !< l> To: Kushner , Jared C. EOP/WHO ~ VA-18-0298-B-000552 Page 1890 of 23~ 2 of 871 Cc: Berkowitz, Avrahm J. EOP/WHO ~ Subject: interoperability who.eop .go vi.,b __)(6_l __ ....J @-=who.eop.gov>> Jared, I just spoke to Secretary Shulkin and he (b)(S) l'bH5l If so , let me know and I'll make time this week . I ~--------------------~ Scott Scott Blackburn Acting CIO & Executive -in-Charge, Office of Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-B-000553 Page 1891 of 23~ 3 of 871 Document ID: 0.7.1705.485097 i To: Blac kburn, Scott R. Cc: Bee: RE: [EXTERNAL] RE : interoperabil ity Subject: Mon Mar 05 2018 16:15:39 EST Date: Attachments: f--.----, '----' ize. Jared believes it's better to speak in person about this when you all are back . I'll to schedule! -----Original Message- ---From: Blackburn, Scott R. [mai lto :Scott.Blackburn@va.gov] Sent: Monda , Ma rch 5, 2018 4:15 PM~------~ To : (bH6l M. EOP/WHO i Available anytime now. Just standing by whenever Ja red is ready. Sent with Good (>www .good .com <) From: i Cc: Berkowitz, Avrahm J. EOP/WHO ~ who.eop .gov>; ~l Subj ect: RE : interope rability Hi l(b)(6) I can make that time wo rk if we do a phone ca ll. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas) , but I cou ld also do it there. Let me know. Scott VA-18-0298-B-000554 Page 1892 of 23~ 4 of 871 (202) 430-9139 From: l(b)(G) IEOP/WHO ._! (b_l(5_l --------~ Sent: Sunday, March 04 , 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; l._ (b_ l<5_l _____ Subject: [EXTERNAL] RE: interoperability ~who.eop.gov] __. Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference. Would tomorrow afternoon around 3pm work? who.eop Great. We will find time . 5 l@who.eop.gov] From: Ku shner , Jared C. EOP/WHO l(bl( l Sent: Wednesday, February 28, 2018 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability (b)(5) From: Blackburn, Scott R. [mailto :Scott.Blackb urn@va .gov] Sent: Monday, February 26 , 2018 ? PM 5 To: Kushner, Jared C. EOP/WHO (bl> who.eop .gov>> Jared, (b_l(5_l ____________________ I just spoke to Secretary Shulkin and he ... l(bl(5l If so, let me know and I'll make time this week . ___. I Scott Scott Blackburn Acting CIO & Executive-in-Charge, Department of Veterans Affairs Office of Informat ion & Technology VA-18-0298-B-000555 Page 1893 of 23Ys of 5 871 Document ID: 0.7.1705.485095 Blackburn , Scott R. ,..... EOP/WHO To: who.eop .gov> Cc: Bee: Subject: RE: [EXTERNAL] RE: interoperabil ity Date: Mon Mar 05 2018 16:14:49 EST Attachments: ________ L..._ _______ ,...., Available anytime now . Just standing by whenever Jared is ready . Sent with Good (www.good .com) IEOP/WHO From: l(bl(5l Sent: Monday, March 05, 2018 10:55 :04 AM To : Blackburn , Scott R. Cc: Berkowitz , Avrahm J. EOP/WHO; l~ (b_ l<6_l -----~ Subject: [EXTERNA L] RE: interoperability Scott - Jared arrives around 10pm ton ight so it might be better to have cal l. Would anyt ime between 3 and 5 work? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Sunda y , March 4 , 2018 11 :35 AM 6 6 ===========~~ ~!.!..!..!.:::..:..:::~:..::c::.!..:..... ____ ~ To: l; ~ Subj ect: RE: interope rability Hi l(b)(6) I can make that time wo rk if we do a phone call. I leave for Las Vegas tonigh t so I will already be there by that time . Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas) , but I VA-18-0298-B-000556 Page 1894 of 23~ 6 of 871 could also do it there. Let me know. Scott (202) 430 -9139 I EOP/WHO ._l (b-l(5_l ________ From: l(bl(5l Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn , Scott R. (b_ l(6_l _____ Cc: Berkowitz, Avrahm J. EOP/WHO; l._ Subj ect: [EXTERNA L] RE: interoperability _,~who .eop.gov] __. Hi Scott, I apo logize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference. Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mai lto:Scott.Blackburn@va.gov] Sent: Wednesday, February 28, 20 18 9:15 PM who.eop .gov> To: Kushner, Jared C. EOP/WHQ(bl(6l who.eo . ov>; Liddell, Chr isto Cc: Berkowitz, Avrahm J. EOP/WHO (bl(6l l(bl(6l @who.eop.gov> ;,_ (b_l(6_l _____________ Subject: RE : interoperability ..J=va.gov> Great. We will find time . From: Kushner, Jared C. EOP/W HOl(bl(5l @who.eop .gov] Sent: Wednesday , February 28, 2018 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability (b) (5) From: Blackburn, Scott R. [mailto:Scot t.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM VA-18-0298-B-000557 Page 1895 of 23Ys of 7 871 To: Kushner, Jared C . EOP/WHO (bl( 5l who.eop .gov> who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO (bl( 5l Subject: interope rabi lity Jared, I just spoke to Secretary Shu lkin and he (b)( 5l If so, let me know and 1'~11 -m_a_k_e_t-im - e-th_i_s_w_e_e_k__--------------~ l(bH5> I Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000558 Page 1896 of 23Ys of 8 871 Document ID: 0.7.1705. 1489544 From: ,..._--------.-~ To: '--------~ EOP/W HO @who .eop.gov> Berkowitz, Avrahm J. EOP/W HO l(bJ(5l @ who.eop.gov>; Blackburn, Scott R. Cc: Bee: Subject: Date: Attachments: [EXTERNAL ] RE: interoperabili ty Mon Mar 05 2018 12:06:04 EST That is no prob lem ! From JbJ(5l @va.gov] Sent: Monda y , Ma rch 5, 2018 12:05 Pf)4 To: l(bJ(5l EOP/W HO f l(BJ ~who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO ~ who.eop.gov>; Blackburn, Scott R. Subject: RE: interoperability Importance: High I I would it be possible for Mr. Kushner to call Scott after 3:30 PM EST? He will be wrapping up Hi l(bJ(5l speaking at HIMSS before that and may be still taking audience questions at 3PM. Thanks so much! Moblie: l~ (b_ J5(_l ---~ I From: l(b)(BJ EOP/WHO .... l(b_l(5_l ________ Sent: Monday, March 05, 2018 8:29 AM To: Blackburn, Scott R. _____ Cc: Berkowitz, Avrahm J . EOP/WH ~ who.eop .gov>; (b)(6l I l(b) (6) I __ '------------~ Subject: RE: interoperability Of course. Anytime in that window works for me (although the later in that window the better as I have an event here at HiMSS ending right at 3pm ET). Jared can call me at (202) 430-9139. I From: l(b){B) EOP/WHO ._l (b_l(B _l _______ Sent: Monday, March 05 , 2018 10:55 AM To: Blackburn, Scott R. 5 Cc: Berkowitz , Avrahm J . EOP/WHO; l...,, (b= )( _l -----~ Subject: [EXTERNAL] RE: interoperability ____. @who .eop.gov] Scott - Jared arrive s around 10pm tonight so it might be better to have call. Would anytime between 3 and 5 work? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Sunda y, March 4, 2018 11 :35 A ~,,....--------. 5 To: l(bH6l EOP/WHO !::: (b=l(=l -------.-~ ~!.!::::.;~~ -:..::c:: o..:..: v>:...._ ___ Cc: Berkowitz, Avrahm J . EOP/WH ~ who.eop .gov>; (b)(5l I l(b) (6) I _, '--------------' Subject: RE : interoperability Hi l(b)(6) I can make that time work if we do a phone ca ll. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas), but I cou ld also do it there. Let me know . Scott (202) 430-9139 VA-18-0298-B-000560 Page 1898 of 23~ 0 of 871 From: l(bl<5l IEOP/WHO ..... l(b_l(5_l --------Sent: Sunday , March 04, 20 18 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; l._ (b_l(5_i _____ Subject: [EXTERNAL] RE: interoperab ility ~ who.eop.gov ] ___, Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference. Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Wednesday, February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHO (bl(6l who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO (bl(6l who.eo . ov>? Liddell Christo her P. EOP/WHO l(bl(6l @who.eop .gov> ;._ (b_J(5_l _____________ __.@va.gov> Subject: RE: interoperability Great. We will find time . 5 l@who.eop .gov] From: Kushner , Jared C. EOP/W Hdb l( l Sent: Wednesday , February 28, 2018 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability (b)(5) From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner , Jared C. EOP/WHO i(bl(5l l@who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO ~ who.eop .gov> Subject: interoperabi lity Jared , VA-18-0298-B-000561 Page 1899 of 23~ 1 of 871 I just spoke to Secretary Shulkin and he (bl< 5l If so, let me know and l'.ll_ _m_a_k_e_t-im -e - th_i_ s _w_e_e_k________________ l(bl(5l I __, Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000562 Page 1900 of 23~ 2 of 871 Document ID: 0.7.1705. 1489535 l To: l Berkowitz, Avrahm J. EOP/W HO Cc: l ; Blackburn , Scott R. Bee: Subject: RE: interoperabi lity Date: Mon Mar 05 2018 12:05: 16 EST Attachments: Hi1 6 6 Cc: Berkowitz, Avrahm J. EOP/WHQ ;!(bJ(l I l(b)(6) I -----------~ Subject: RE: interoperability Of course. Anytime in that window wo rks for me (although the later in that window the bette r as I have an event here at HiMSS ending right at 3pm ET). Jared can call me at (202) 430-9139. VA-18-0298-B-000563 Page 190 1 of 23 ~ 3 of 871 I From: l(bJ(BJ EOP/WHO _l (b_J(B _J--------~ Sent: Monday, March 05 , 2018 10:55 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; ._l ____ Cc: Berkowitz, Avrahm J. EOP/WHO ~ who.eop .gov>; _(b_J6(_l _________ l(b)(6) Subject: RE: interoperability I I _, ___, Hi l(b)(6) I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas), but I could also do it there. Let me know. Scott (202) 430-9139 From:!(bJ(5J IEOP/WHO ._l (b_J(B _J--------~ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. 5 Cc: Berkowitz, Avrahm J. EOP/WHO ;l_ (b_ J(_l _____ Subject: [EXTERNAL] RE: interoperability @who .eop.gov] _ Hi Scott, VA-18-0298-B-000564 Page 1902 of 23~ 4 of 871 I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference. Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Wednesday, February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHQ Cc: Berkowitz, Avrahm J. EOP/WHO {bl{6l who.eo . ov>; Liddell, Christo her P. EOP/WHO 6l l ; (b)(6l @va.gov> Subject: RE: interoperability Great. We will find time . 5 From: Kushner , Jared C. EOP/WHo j Cc: Berkowitz, Avrahm J. EOP/WHO (b)(5l who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he (b)(5l 5l i To: Blackburn, Scott R. Berkowitz,Avrahm J. EOP/WHO Cc: 5 ) ~ who.eop.gov>; l Bee: Subject: [EXTERNAL] RE: interoperability Date: Mon Mar 05 2018 11 :29:23 EST Attachments: Great he will speak with you soon! From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 11 :14 AM 6 EOP/WHO~ "" 6 Cc: Berkowitz, Avrahm J. EOP/WHO ~ who .eop .gov>; (bl(l l(b)(6) I '-------------' Subject: RE: interoperability I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas), but I cou ld also do it there. Let me know. Scott (202) 430-9139 IEOP/WHO ..... l(b_l(5_l ________ From: l(b)(Gl Sent: Sunday, March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J . EOP/WHO ; r l(Gl Subject: [EXTERNAL] RE : interoperab"'" il-ity-----~ ....., @who .eop.gov] Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vega s to speak at the HiMMs conference. Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va .gov] Sent: Wednesday, February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHO (bl(5l who.eop .gov> Cc: Berkowitz, Avrahm J . EOP/WHO (bl(6l who .eo . ov>? Liddell Christo her P. EOP/WHO l(bl<6l ka)who.eop.gov> ; (bl(5l va.gov> Subject: RE: interoperability Great. We will find time . VA-18-0298-B-000568 Page 1906 of 23~ 8 of 871 5 From: Kushner , Jared C. EOP/WHO l Cc: Berkowitz, Avrahm J. EOP/WHO (bl<6l who.eop .gov> Subject: interoperabi lity Jared , I just spoke to Secretary Shulk in and he ,..... To: l(b)(6) ~ EOP/WHO l(b)( 5l who.eop .gov> Berkowitz, Avrahm J. EOP/WHO Cc: ~ who .eop .gov> ; 1(0 )( 5) l Bee: Subject: RE: interoperability Date: Mon Mar05201811:13:58 EST Attachments: Of course . Anytime in that window works for me (although the later in that window the better as I have an event here at HiMSS ending right at 3pm ET). Jared can call me at (202) 430-9139. From: 1(0 H6l I EOP/WHO ._l'?_ )(G -) ________ Sent: Monday , March 05, 2018 10:55 AM To : Blackburn , Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ;l~(0_H6_l _____ ~ Subje ct: [EXTERNAL] RE: interoperability _.@who .eop .gov] Scott - Jared arrives around 10pm tonight so it might be better to have call. Would anytime between 3 and 5 work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Sunday , March 4, 2018 11 :35 AM 5) To: j(o)( IEOP/WHQ r::(0""" H5::l --------, Cc: Berkowitz, Avrahm J. EOP/WHO ~ who.eop .gov>; l(b)(6) I who .eo . ov> (b)( 5 l ~----------~ Subject: RE: interoperability I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there VA-18-0298-B-000570 Page 1908 of 23fil.oof 871 by that time. Not sure when Jared gets in (or if he would even have time when in Las Vegas), but I could also do it there. Let me know. Scott (202) 430-9139 5 From:i(bl(5l IEOP/WHO ~l 6l Cc: Berkowitz , Avrahm J. EOP/WHO (bH who.eo . ov>; Liddell Christo her P. EOP/WHO 5 l(bl(l l@who.eop .gov> ; (bl(5l va.gov> Subject: RE: interoperability Great. We will find time . 5 From: Kushner , Jared C. EOP/WHO l(bl Cc: Berkowitz, Avrahm J. EOP/WHQ(bl(5> who.eop.gov> Subject: interoperability Jared , I just spoke to Secretary Shulkin and he (bl(5> l(bH If so, let me know and l',,.,. ll _m_a...,.. k_e....,. t,.... im_e_t.,..,.. h..,.. is- w - ee...., k- .---------------' 5> I Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000572 Page 1910 of 23fil, 2 of 871 Document ID: 0.7.1705.484828 Blackburn , Scott R. l(b)(6) EOP/W HO To: 6 l(b)( l @who.eop .gov> Berkowitz, Avrahm J. EOP/W HO Cc: ~ who .eop .gov> ;l._ (0_ l(5_l _____ ___. ; <0l<6l 1<0)(6) l@va.gov> ._ __________ I _. Subject: RE: interoperability Hi l(b)(6) VA-18-0298-B-000573 Page 1911 of 23fil, 3 of 871 I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he would even have time when in Las Vegas), but I cou ld also do it there. Let me know. Scott (202) 430-9139 I 5 EOP/WHO ._l 'b_l' _l ________ From: l(b)(5) Sent: Sunday , March 04 , 2018 11 :30 AM To : Blackburn, Scott R. 5 __. Cc: Berkowitz, Avrahm J. EOP/WHO; 'b-)( _l _____ Subject: [EXTERNAL] RE: interoperability ..... @who .eop .gov] l..... Hi Scott , I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference . Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Wednesday , February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHQ(b )(5l who.eop.gov > 6 Cc: Berkowitz, Avrahm J . EOP/WH (bl; Liddell, Christopher P. EOP/WHO l; (b)(6) va.gov > Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO ! Cc: Berkowitz, Avrahm J. EOP/WHO (bl(5 l who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he (bl<5l If so, let me know and 1'~11 -m_a_k_e_t-im - e- th-is_ w_e-ek- .-------------~ l(bl{5l I Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000575 Page 1913 of 23fil, 5 of 871 Document ID: 0.7.1705.1489325 l(b)(6) EOP/WHO From: !(bl(6l @who.eop.gov> To: Blackburn, Scott R. Berkowitz, Avrahm J. EOP/WHO Cc: ~ who .eop.gov> J(bl(6> l Bee: Subject: [EXTERNAL] RE: interoperability Date: Mon Mar 05 2018 10:55:04 EST Attachments: I Scott - Jared arrives around 10pm ton ight so it might be better to have call. Would anyt ime between 3 and 5 work? From: Blackburn, Scott R. [mai lto:Scott.Blackburn@va.gov] Sent: Sunda y, March 4, 2018 11 :35 AM To:l(bl(5> EOP/WHO ~,b-l(6->------~ who .eop.gov> 5 Cc: Berkowitz, Avrahm J. EOP/WHQ(b l( > who.eop .gov>; l(bl(6> !(bl(6> @va.gov> ___________ I ....., Subject: RE : interoperability I can make that time work if we do a phone ca ll. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he would even have time when in Las Vegas) , but I cou ld also do it there. Let me know. Scott (202) 430-9139 I From: l(bl(5> EOP/WHO ._l 'b_>5,_>________ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; ..... l'b_>5,_>_____ ....., @who .eop.gov] _ VA-18-0298-B-000576 Page 1914 of 23fil, 6 of 871 Subject: [EXTERNAL] RE: interoperability Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference . Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Wednesday , February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHO (bl(6l who.eop .gov> Cc: Berkowitz , Avrahm J. EOP/WH (bl(6l who.eo . ov>; Liddell, Christo her P. EOP/WHO l(bl(5l @who .eop.gov>; (bl(5l va.gov> Subject: RE: interoperability Great. We will find time . l@who.eop.gov] From: Kushne r, Jared C. EOP/WHO !(bl(5l Sent: Wednesday, February 28, 2018 7:56 AM To : Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability (b)(5) From: Blackburn , Scott R. [mailto :Scott.Blackb urn@va.gov] Sent: Monday , February 26, 2018 5:05 PM who.eop .gov> To : Kushner, Jared C. EOP/WHQ(bl(5l Cc: Berkowitz, Avrahm J. EOP/WHO (bl(5l who.eop .gov> Subject: interoperability Jared, (b_H5_l ____________________ I just spoke to Secretary Shulkin and he .... 5l l(bH If so, let me know and I'll make time this week. ......, I VA-18-0298-B-000577 Page 1915 of 23fil, 7 of 871 Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000578 Page 1916 of 23 5~8 of 871 Document ID: 0.7.1705.484798 i(b) (6) ..JEOP/WHO From: !(bJ(6l @who.eop.gov> Blackburn, Scott R. Berkowitz, Avrahm J. EOP/WHO Cc: ~ who .eop.gov>; ~l (b_l(6_l --,------,--....,.......,~ ; (bl(5l l(b){ 6l @va .gov> ~----------~ Subject: RE: interoperability Hi l(b)(6) I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time. Not sure when Jared gets in (or if he would even have time when in Las Vegas) , but I could also do it there. Let me know. Scott (202) 430-9139 5 I 5 From: l(bHl EOP/WHO ~l (b-l(_l --------~ Sent: Sunday , March 04, 2018 11:30 AM To: Blackburn, Scott R. (R)wh o.eop.gov ] VA-18-0298-B-000579 Page 1917 of 23fil, 9 of 871 5 Cc: Berkowitz, Avrahm J. EOP/WHO; ~' To: Kushner, Jared C. EOP/WHQ(bJ(5l 5 Cc: Berkowitz, Avrahm J. EOP/WHO (bH l who.ea . ov>; Liddell, Christo her P. EOP/WHO 6l l ; (bJ (5l va.gov> Subject: RE : interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO l(bl(5l @who.eop .gov] Sent: Wednesday , February 28, 2018 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J . EOP/WHO ; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability (b)(5) From: Blackburn, Scott R. [mailto :Scott.Blackburn@va .gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner, Jared C. EOP/WHO (bl(6l who.eop .gov> Cc: Berkowitz, Avrahm J . EOP/W L..:.C....: _ who .eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he (bl(5l l(bl(5l If so, let me know and l'h11 -,-m_a....,. k_e_,t.,.. im - e--,.,th..,. is_ w_e-ek.-.-------------~ I VA-18-0298-B-000580 Page 19 18 of 23Ysoof 871 Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-B-000581 Page 1919 of 23 5~1 of 871 Document ID: 0.7.1705. 1763070 From: Blackburn , Scott R. EOP/W HO To: ........... _______ ....,,, {bJ(6J @who.eop .gov> Berkowitz, Avrahm J. EOP/W HO Cc: ~ who .eop.gov> ;l Bee: RE: interoperabi lity Subject: Sun Mar 04 2018 11 :34:52 EST Date: Attachments: I can make that time work if we do a phone call. I leave for Las Vegas tonight so I will already be there by that time . Not sure when Jared gets in (or if he wou ld even have time when in Las Vegas) , but I could also do it there. Let me know. Scott (202) 430-9139 5 From: i Cc: Berkowitz , Avrahm J. EOP/WHO (bl(6l who.eo . ov>; Liddell, Christo her P. EOP/WHO i ; (bl(6l va.gov> VA-18-0298-B-000582 Page 1920 of 23Ys of 2 871 Subject: RE: interoperability Great. We will find time . From: Kushner, Jared C. EOP/WHO i To: Kushner , Jared C. EOP/WHQ( bJ(5l who .eop.gov > Cc: Berkowitz, Avrahm J. EOP/WH (bJ(5l Subject: interoperabi lity Jared , I just spoke to Secretary Shu lkin and he (bl(5l l (b)(6) EOP/WHO To: (bJ(6l who.eop.gov> Berkowitz, Avrahm J. EOP/WHO Cc: ~ who.eop.gov>; l~ (b_ l(6_> --,------,--..,.......,.~ From: !(bl(6> Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; l~ (b_ l(6_> -----~ Subject: [EXTERNAL] RE: interoperability _______ _.. @who.eop.gov] Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference . Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. (mailto:Scott.Blackburn@va.gov] Sent: Wednesday, February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHQ(bl(5> who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHQ(bl(5l who.eop.gov>; Liddell, Christopher P. EOP/WHO VA-18-0298-B-000584 Page 1923 of 23Ys of 4 871 5 5 l(bl;l.... Great. We will find time. From: Kushner, Jared C. EOP/WHo j 6 Cc: Berkowitz, Avrahm J. EOP/WHO (bl Subject: interoperability Jared, (b_H5_l ____________________ I just spok e to Secretary Shu lkin and he .... 5 If so, let me know and I'll make time this week . i Blackburn, Scott R. Berkowitz, Avrahm J. EOP/W HO Cc: 5l 5l l; l Bee: Subject: [EXTERNAL ] RE: interoperabili ty Date: Sun Mar 04 2018 11 :30:23 EST Attachments: Hi Scott, I apologize for the delay. It might be best for you to speak with Jared about this before he heads to Las Vegas to speak at the HiMMs conference . Would tomorrow afternoon around 3pm work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Wednesday , February 28, 20 18 9:15 PM 5 l who.eop .gov> To: Kushner, Jared C. EOP/WHQ; Liddell, Christo her P. EOP/WHO 5l i ; Subject: RE: interoperability Great. We will find time . From: Kushner, Jared C. EOP/W HOl who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO< bl(5l Subject: interope rabi lity Jared, I just spoke to Secretary Shu lkin and he (bl(5l If so, let me know and 1'~ 11_m_a_k_e_t-im- e- th-is_ w_e_e_k _ --------------~ l Blackburn, Scott R. Berkowitz, Avrahm J. EOP/W HO Cc: ~ who .eop.gov>; ~l To: Kushner, Jared C. EOP/WH (bl(5l Cc: Berkowitz , Avrahm J. EOP/WHO (bl(6l who.eo . ov>; Liddell, Christo 5 5 l ; ._ Great. We will find time . @who.eop .gov] From: Kushner, Jared C. EOP/W HO l To: Kushner , Jared C. EOP/WH (bl (5l 6 who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO (bl( l Subject: interoperability Jared, I just spoke to Secretary Shulkin and he (bl( 5l If so, let me know and l!-,., 'll_m _a ....., k_e_t,.,... im _e ___,., th...,. is_ w_e_e,,_ k.------------------' i !(b)(6l l; Windom, John H. Cc: Bee: Subject: FW: interoperability Date: Wed Feb 28 2018 21:15:40 EST Attachments: Lets discuss briefly tomorrow. From: Kushner, Jared C. EOP/WHO l(bl(5l @who.eop .gov] Sent: Wednesday , February 28, 20 18 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; Liddell , Christopher P. EOP/WHO Subject: [EXTERN AL] RE: interoperability (b)(S) From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner , Jared C. EOP/WH (bl(5l who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO (bl(5l who.eop .gov> Subject: interoperabi lity Jared, (b_l(5_> ____________________ I just spoke to Secretary Shulkin and he._ l(bl(Sl !If so, let me know and I'll make time this week . ___, Scott Scott Blackburn VA-18-0298-B-000590 Page 1930 of 23~ 0 of 871 Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000591 Page 193 1 of 23 5~1 of 871 Document ID: 0.7.1705. 176 1819 Blackburn , Scott R. Kushner , Jared C. EOP/W HO To: l(bl<5l @who .eop .gov> Berkowitz, Avrahm J. EOP/W HO Cc: (bl<5l who .eo . ov>? Liddell , Christopher P. EOP/WHO (bl{6l who .eop.gov> ;._l (b_l<5_l _____ ____. Bee: RE: interoperabi lity Subject: Wed Feb 28 2018 21:15:19 EST Date: Attachments: Great. We will find time . @who.eop .gov] From: Kushner , Jared C. EOP/W HO l Cc: Berkowitz, Avrahm J. EOP/WHO (bl{6l who .eop .gov > Subject: interoperabi lity Jared , 5 I j ust spoke to Secretary Shu lkin and he .... (b_l<_l --------------------~ l(bl<5l If so, let me know and I'll make time this week . I Scott VA-18-0298-B-000592 Page 1932 of 23~ 2 of 871 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000593 Page 1933 of 23 5~3 of 871 Document ID: 0.7.1705.478730 Blackburn, Scott R. Kushner, Jared C. EOP/W HO To: l(bl(6 l @who.eop .gov> Berkowitz, Avrahm J. EOP/W HO Cc: (bl(6l who .eop.gov>; Liddell , Christopher P. EOP/WHO (bl(6l who.eop.gov> ;f,-l (b~l<5~l ~--------' To: Kushner, Jared C. EOP/WHo< bl(5l 5 Cc: Berkowitz, Avrahm J. EOP/WHO (bl Subject: interoperabi lity Jared, I just spoke to Secretary Shu lkin and he(bl(5l ~---------------------~ l To: Windom, John H. ; Short, John (VACO) ; Zenooz , Ashwini Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 21 :08:07 EST Attachments: From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Wednesday , February 28, 20 18 4 :53 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(bl<5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4 :36 PM, Blackburn, Scott R. wrote : Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition. Our new Cerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Cerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cerner without any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review VA-18-0298-B-000596 Page 1936 of 23~ 6 of 871 flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report . The med duplication is configured similarly to test and parameters will determine how the system acts . Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking , dupes , dose range checks , and interactions are checked at time of ordering. As an aside , while the DoD Gerner implementation has been far from perfect this is one area where it has been very successfu l; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented . Stream lined SOAP notes . Yes , the VA/Gerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To: 'Bruce Moskowitz' @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren 't going to let you get tar and feathered! Again, we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott VA-18-0298-B-000597 Page 1937 of 23~ 7 of 871 From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Wednesday , February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; 1p;l(bl(5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertent ly create vendor lock); we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Current ly 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one examp le of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. VA-18-0298-B-000598 Page 1938 of 23~ 8 of 871 DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott @mac.com] From: Bruce Moskowitz l(bl(5l Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apo logize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. (b_ J(5_l _____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l,.._ _,@mac.com> wrote: To clarify further it states the ir commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. (b_J(5_l _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l ~l @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud VA-18-0298-B-000599 Page 1939 of 23~ 9 of 871 Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovation s. #3) Below is the IP language that we negotiated. l(bl(5l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. VA-18-0298-B-000600 Page 1940 of 231ioof 871 Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model , share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g ., ingestion and record APls) with both international and national standards designating organizations. However , current language does not requ ire access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables , definitions , and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " VA-18-0298-B-000601 Page 194 1 of 23 8~1 of 871 Concur with Cerner edit, negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000602 Page 1942 of 23 8~2 of 871 Document ID: 0.7.1705.478101 Bruce Moskowitz From: @mac.com> Blackburn, Scott R. DJS ; Marc Sherman !(bl(6l @gmail.com>; O'Rourke, Peter M. ; I (bl( 5l frenchangel59.com>; l(bl( 6l l@gmail.com (bl (6l gmail.com> !(bl( 5> To: Cc: Bee: Subject: Date: Attachments: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Wed Feb 28 2018 16:53:27 EST Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4:36 PM, Blackburn, Scott R. wrote : Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition . Our new Gerner EHR platform includes Enterprise Dragon Nuance. VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework . The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line. Even if they are not exactly named the same the result s review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of VA-18-0298-B-000603 Page 1943 of 2s1i 3 of 871 after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report . The med duplication is configured similarly to test and parameters will determine how the system acts. Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering. As an aside, while the DoD Gerner implementation has been far from perfect this is one area where it has been very successful ; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at the ir initial three sites that have been implemented . Streamlined SOAP notes . Yes , the VA/Gerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To : 'Bruce Moskowitz' 5 J @gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP;l'bJC Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren 't going to let you get tar and feathered! Again , we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott 5 J l@mac.com] From: Bruce Moskowitz i wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provide r or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA , we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. VA-18-0298-B-000605 Page 1945 of 23 8~5 of 871 Scott From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; l(b){GJ @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l(b ...._J5<_i _____ ~l@mac.com> wrote: To clarify further it states their commercia l cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. ...._ l<6_l _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: VA-18-0298-B-000606 Page 1946 of 231i6 of 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP language that we negotiated. l(bJ(5l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls . Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000607 Page 194 7 of 231i7 of 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . VA-18-0298-B-000608 Page 1948 of 23e~sof 871 -Scott VA-18-0298-B-000609 Page 1949 of 23 8~9 of 871 Document ID: 0.7.1705.380899 From: Bruce Moskowitz @mac.com> Blackburn, Scott R. DJS ; Marc Sherman l; O'Rourke, Peter M. ; IP (bJ(6l frenchangel59.com>; l l(bJ(6l To: Cc: Bee: Subject: Date: Attachments: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Wed Feb 28 2018 16:53:27 EST Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4 :36 PM, Blackburn, Scott R. wrote : Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition . Our new Gerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework . The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line. Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of VA-18-0298-B-000610 Page 1950 of 231~oof 871 after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report . The med duplication is configured similarly to test and parameters will determine how the system acts. Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering. As an aside, while the DoD Gerner implementation has been far from perfect this is one area where it has been very successful ; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at the ir initial three sites that have been implemented . Streamlined SOAP notes . Yes , the VA/Gerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To : 'Bruce Moskowitz' 5 l !@gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP;l(bl< Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren 't going to let you get tar and feathered! Again , we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott @mac.com] From: Bruce Moskowitz l(bl(5l Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; 1pJ bH5l Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000611 Page 1951 of2 31~ 1 ofB? 1 Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provide r or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA , we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. VA-18-0298-B-000612 Page 1952 of 23 8~2 of 871 Scott From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; i wrote: To clarify further it states their commercia l cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. (b_l<5_l ______ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l @ma c.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: VA-18-0298-B-000613 Page 1953 of 231~ of 3 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP language that we negotiated. 0 5 j< l( l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls . Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000614 Page 1954 of 231~ 4 of 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . VA-18-0298-B-000615 Page 1955 of 23 8~5 of 871 -Scott VA-18-0298-B-000616 Page 1956 of 23 8~6 of 871 Document ID: 0.7.1705.1761558 From: Blackburn, Scott R. To: Bruce Moskowitz l(bl(6> @mac .com> Cc: DJS ; Marc Sherman l(b)(6l @gmail.com>; O'Rourke, Peter M. ; IP (bl(5l frenchangel59.com> Jbl(6l @gmail.com (b)(6l gmail.com> Bee: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Feb 28 2018 16:36:15 EST Date: Attachments: Bruce - as promised here is more inform ation on what we will have to address the other 4 issues you mentioned. I still owe you device registry. Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition . Our new Gerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be ava ilable on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report. The med duplication is configured similarly to test and parameters will determine how the system acts . Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering. As an aside , while the DoD Gerner implementation has been far from perfect this is one area where it has been very VA-18-0298-B-000617 Page 1957 of 231~ 7 of 871 successful; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented . Streamlined SOAP notes. Yes , the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To: 'Bruce Moskowitz' <5l @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; 1p;l(bl Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren't going to let you get tar and feathered! Again, we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott From: Bruce Moskowitz l wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into th is this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... ***** **** The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system . ********* Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ********* Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with . We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ********* DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team . This will help not just Veterans , but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott VA-18-0298-B-000619 Page 1959 of 23 8~9 of 871 From: Bruce Moskowitz l(b)(GJ @mac.com] Sent: Tuesday, February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl{5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 _____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ._l _. @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to VA-18-0298-B-000620 Page 1960 of 231~o of 871 help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... ********* The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ********* In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. l VA-18-0298-B-000622 Page 1962 of 23 8~2 of 871 Page 1963 of of Em Document ID: 0.7.1705.478092 From: Blackburn, Scott R. To: Bruce Moskowitz l(bl(5> @mac .com> DJS ; Marc Sherman !(bl(6l @gmail.com>; O'Rourke, Peter M. ; I (bl(5l frenchangel59.com>; l(bl(5l @gmail.com (bl(6l gmail.com> Bee: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Feb 28 2018 16:36:15 EST Date: Attachments: Bruce - as promised here is more inform ation on what we will have to address the other 4 issues you mentioned. I still owe you device registry. Let me know if this makes sense or not. Also happy to get you on the phone directly with my experts. - Scott Voice Recognition . Our new Gerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Gerner will port over the voice prints so the clinicians that use it today w ill be able to use it tomorrow in Gerner without any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data , from any source, be ava ilable on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report. The med duplication is configured similarly to test and parameters will determine how the system acts . Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch those. For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering. As an aside , while the DoD Gerner implementation has been far from perfect this is one area where it has been very VA-18-0298-B-000624 Page 1964 of 231~ 4 of 871 successful; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented . Streamlined SOAP notes. Yes , the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:30 PM To: 'Bruce Moskowitz' 5 l @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; IP: l(bH Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Bruce - we certainly aren't going to let you get tar and feathered! Again, we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott From: Bruce Moskowitz l(bl<5l @mac.com] Sent: Wednesday , February 28, 20181 :13 PM To : Blackburn, Scott R. 6l Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP: l(bl< @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: VA-18-0298-B-000625 Page 1965 of 231~ 5 of 871 Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into th is this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provide r or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system . Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA , we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA , not VA). Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with . We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team . This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott VA-18-0298-B-000626 Page 1966 of 23 8~6 of 871 From: Bruce Moskowitz l(bl(5l @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(bl(5 l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 l(b_l(_i ______ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz .... @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz !~(b_ J( _l -----~l @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to VA-18-0298-B-000627 Page 196 7 of 231~ 7 of 871 help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. l VA-18-0298-B-000629 Page 1969 of 23 8~9 of 871 Page 197'0 of 23??0 of Em Document ID: 0.7.1705.1201812 Short, John (VAGO) Blackburn, Scott R. Cc: Windom , John H. ; Zenooz, Ashwini Bee: Subject: RE: Open API - it is CLOUD + languge + Rasu ... Update All 4 Answers Date: Wed Feb 28 2018 15: 19:37 EST Attachments: 1. Voice Recognition? The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework . The Clinician can use the dictation and other features with voice recognition . 2. How will all entered lab data , from any source, be available on a graph? Graphs are generally available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together . 2. Can Cerner 's system catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact? Yes . All tests are configured to have a time where and alert is issued based on parameters we configure and can flex by venue. Over utilization is generally avoided with real time alerting but we would have to use some mechanism to monitor , via report , usually . The med duplication is configured similarly to test and parameters determine how the system acts. Tall man lettering reduces errors in look alike , sound alike meds, and finally in instances we identify unique instances of errors we can configure rules to catch those. For meds all allergy checking , dupes , dose range checks , and interactions are checked at time of ordering. **Also, at DoD Gerner has already prevented over 15,000 duplicate test at the three sites. 3. Does Gerner have streamlined SOAP notes? Yes. These are provided and will be further configured under VA direction to meet VA clinician needs. VA-18-0298-B-000631 Page 197 1 of 23e~ 1 of 871 From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:33 PM To: Windom, John H.; Short , John (VACO); Zenooz , Ashwini Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. @mac.com] From: Bruce Moskowit~(bl(6l Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP: l(bl(5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... VA-18-0298-B-000632 Page 1972 of 231~ of 2 871 ******** The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VNCerner system. ******** Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ******** Gerner does have a partnership with AWS (which is why we high lighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ******** DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott @mac.com] From: Bruce Moskowitz l(b)(G) Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b){GJ Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 (b_l<_l _____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ,_l ___. @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud VA-18-0298-B-000633 Page 1973 of 231~ of 3 871 Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz -l(b_l(5_l _____ ~l@mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM , Blackburn , Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... ******** The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire remote hosted customer base. ******** In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. l(b)(5l (b){5) VA-18-0298-B-000634 Page 1974 of 231~ 4 of 871 Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties , increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in VA-18-0298-B-000635 Page 1975 of 23e~ 5 of 871 accessing the data model, includ ing producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits cons istent with intent of recommendation . -Scott VA-18-0298-B-000636 Page 1976 of 23e~ 6 of 871 Document ID: 0.7.1705.478032 Short, John (VAGO) Blackburn, Scott R. Windom , John H. Cc: ; Zenooz, Ashwini Bee: RE: Open API - it is CLOUD + languge + Rasu ... Update All 4 Answers Subject: Wed Feb 28 2018 15:19:37 EST Date: Attachments: 1. Voice Recognition? The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework . The Clinician can use the dictation and other features with voice recognition. 2. How will all entered lab data , from any source, be available on a graph? Graphs are generally available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line. Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together . 2. Can Cerner 's system catching test duplication , over utilization and medication duplication/errors at time of ordering instead of after the fact? Yes . All tests are configured to have a time where and alert is issued based on parameters we configure and can flex by venue. Over utilization is generally avoided with real time alerting but we would have to use some mechanism to monitor , via report , usually . The med duplication is configured similarly to test and parameters determine how the system acts. Tall man lettering reduces errors in look alike , sound alike meds, and finally in instances we identify unique instances of errors we can configure rules to catch those. For meds all allergy checking , dupes , dose range checks , and interactions are checked at time of ordering. **Also, at DoD Gerner has already prevented over 15,000 duplicate test at the three sites. 3. Does Gerner have streamlined SOAP notes? VA-18-0298-B-000637 Page 1977 of 23S~? of 871 Yes. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn, Scott R. Sent: Wednesday, February 28, 2018 2:33 PM To: Windom, John H.; Short, John (VACO); Zenooz, Ashwini Subject: FW: [EXTERNAL] Re: Open AP I - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. @mac.com] From: Bruce Moskowitz l(b)( 5) Sent: Wednesday, February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(b)( 5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and VA-18-0298-B-000638 Page 1978 of 231~sof 871 absolutely do not want to inadvertently create vendor lock); we've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back. A few things I lea rned this morn ing ... The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. Currently 3 cloud providers meet the Government security requirements -AWS, Azure/Microsoft and CSRA. The re are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this . I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uni form. Thanks again for the feedback and support. We are going to make sure this is crysta l clear. Scott From: Bruce Moskowitz l(b){G) @mac.com] Sent: Tue sday, February 27 , 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP ;l(bl<5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. (b_H6_l _______ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ._l @ma c.co m> wrote: VA-18-0298-B-000639 Page 1979 of 231~ 9 of 871 To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. <_bJ<5_i _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz !,_ _, @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP language that we negotiated. l VA-18-0298-B-000642 Page 1982 of 23e~2 of 871 Document ID: 0.7.1705.1201307 From: Short, John (VACO) Blackburn, Scott R. Windom , John H. ; Zenooz, Ashwini Bee: Subject: RE: Open API - it is CLOUD + languge + Rasu ... Update Date: Wed Feb 28 2018 15:04: 15 EST Attachments: Two additional answers below . From: Short, John (VACO) Sent: Wednesday , February 28, 20 18 2:54 PM To: Blackburn, Scott R. Cc: Windom , John H.; Zenooz, Ashwini Subject: RE: Open API - it is CLOUD + languge + Rasu I hadn't seen these other questions until now. See below for one answer. I am working the others as well. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:33 PM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. @ma c.com ] From: Bruce Moskowitz l(bl(5l Sent: Wednesday, February 28, 2018 1:13 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(bl(5l VA-18-0298-B-000643 Page 1983 of 2s1i3 of 871 Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition **The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Gerner w ill port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework. The Clinician can use the dictation and other features with voice recognition. All entering lab data on a graph from any source **Every lab has different reference ranges so graphing together can cause patient safety concerns. However , trending patterns can be built with alerts based off different lab source data. Catching test dupl ication , over ut ilization and medication duplication/errors the fact at time of ordering not after **Yes Gerner does this . At DoD Gerner has already prevented over 15,000 duplicate test at the three sites. Yes , at point of RX order Gerner will indicate if a duplicate RX is about to be ordered . Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... ******** The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. ***** *** Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now . Again , the goal here is to VA-18-0298-B-000644 Page 1984 of 23e~4 of 871 create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ******** Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ******** DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support . We are going to make sure this is crystal clear . Scott @mac.com] From : Bruce Moskowitz l(b)(5) Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M. ; 1p;l(bH5 l Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l (b_H_l _____ ~ @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000645 Page 198 5 of 231isof 871 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz !~ wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . ******** The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ******** In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated . l{bJ{sJ (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate VA-18-0298-B-000646 Page 1986 of 231i6 of 871 shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperab ility Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties. Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files . Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperabi lity by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate , extend, and share that know ledge with clinica l partners . This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report exp lain the steps involved in accessing the data model , including producing an examp le data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, VA-18-0298-B-000647 Page 1987 of 23e~ 7 of 871 order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000648 Page 1988 of 23e~sof 871 Document ID: 0.7.1705.478019 From: Short, John (VACO) To: Blackburn, Scott R. Windom , John H. Cc: ; Zenooz, Ashwini Bee: RE: Open API - it is CLOUD + langug e + Rasu ... Update Subject: Wed Feb 28 2018 15:04:15 EST Date: Attachments: Two add itional answers below . From: Short, John (VACO) Sent: Wednesday, February 28, 2018 2:54 PM To: Blackburn, Scott R. Cc: Windom , John H.; Zenooz, Ashwini Subject: RE: Open API - it is CLOUD + languge + Rasu I hadn 't seen these other questions until now. See below for one answer. I am working the others as well. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 2:33 PM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. 5 (b_l( _>_______ From: Bruce Moskowit zl.... __,@mac .com] VA-18-0298-B-000649 Page 1989 of of 231i 9 871 Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. 6l @gmail.com Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP;l(bl< Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition **The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Cerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cerner without any rework. The Clinician can use the dictation and other features with voice recognition. All entering lab data on a graph from any source **Every lab has different reference ranges so graphing together can cause patient safety concerns. However , trending patterns can be built with alerts based off different lab source data. Catching test duplication, over utilization and medication duplication/errors at time of ordering not after the fact **Yes Cerner does this. At DoD Cerner has already prevented over 15,000 duplicate test at the three sites. Yes, at point of RX order Cerner will indicate if a duplicate RX is about to be ordered. Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018, at 12:52 PM, Blackburn, Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back. A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VNCerner system. VA-18-0298-B-000650 Page 1990 of 231~oof 871 Currently 3 cloud providers meet the Government security requirements -AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with . We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott @mac.com] From: Bruce Moskowitz l(bl(5l Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl{6l Subje ct: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad VA-18-0298-B-000651 Page 1991 of 231~ 1 of 871 Bruce Moskowitz M.D. (b_)(6_l ______ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . 5 l #3) Below is the IP language that we negotiated . l(b)( (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface, and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls . VA-18-0298-B-000652 Page 1992 of 231~ of 2 871 Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files . Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: VA-18-0298-B-000653 Page 1993 of 23e~3 of 871 Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000654 Page 1994 of 23e~4 of 871 Document ID: 0.7.1705.478012 From: Blackburn, Scott R. To: Windom, John H. ; Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 15:00:34 EST Attachments: Help me, help you!!! @mac.com] From: Bruce Moskowitz l(b){G) Sent: Wednesday , February 28, 20 18 2:56 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)C6l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu One last thing so you are not talked on an additional fee . They need to have In the contract language to incorporate a device registry that the VA is working on Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 2:32 PM, Blackburn , Scott R. wrote : Bruce - we certainly aren't going to let you get tar and feathered! Again , we really appreciate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are top ics you've brought up in past and we were definitely listening. I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott VA-18-0298-B-000655 Page 1995 of 231~ 5 of 871 From: Bruce Moskowitz l(bl(5l @mac.com ] Sent: Wednesday, February 28, 20 18 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognition All entering lab data on a graph from any source Catching test duplication, over utilization and medication duplication/errors at time of ordering not after the fact Stream lined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 20 18, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertent ly create vendor lock); we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). VA-18-0298-B-000656 Page 1996 of 231~ 6 of 871 Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott @mac.com] From: Bruce Moskowitz l(b)(GJ Sent: Tuesday , February 27, 2018 9:29 PM To : Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; IP; l(bl<6l Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apo logize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. ...._J5< _l ______ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l(b @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000657 Page 1997 of 231~ 7 of 871 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms . Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP lanauaae that we neaotiated. 1 VA-18-0298-B-000660 Page 2000 of 23e~o of 871 Document ID: 0.7.1705.807828 From: Bruce Moskowitz l(b)(GJ @mac .com> Blackburn , Scott R. DJS ; Marc Sherman !(b)(6l @gmail.com>; O'Rourke, Peter M. ; IP 6l (b)( G) frenchangel59.com>; l(b)( @gmail.com Bee: Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Date: Wed Feb 28 2018 14:56:19 EST Attachments: One last thing so you are not talked on an additional fee. They need to have In the contract language to incorporate a device registry that the VA is working on Sent from my iPad Bruce Moskow itz M.D. On Feb 28, 2018, at 2:32 PM, Blackburn, Scott R. wrote: Bruce - we certainly aren't going to let you get tar and feathered! Again, we really appreciate all the support you've given us. On these other 4, I'll get you answers on these ASAP. I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiat ion. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott l(b_J(5_J~~~~~~~___. @mac.com] From: Bruce Moskowitz .... Sent: Wednesday , February 28, 20 18 1:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP;l(b)(G) l@gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000661 Page 2001 of 231i 1 of 871 Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this th is more thi s morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morn ing ... ********* The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or app lications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. ***** **** Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA , not VA) . ********* Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one examp le of the open cou ld environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ********* DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear . VA-18-0298-B-000662 Page 2002 of 23e~ 2 of 871 Scott 5 From: Bruce Moskowitz l(bl< @mac.com] ) Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl< l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l wrote: To clarify further it states their commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone VA-18-0298-B-000663 Page 2003 of 2s1i 3 of 871 On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use inv itation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technica l lead ... ********* The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's ent ire remote hosted custo mer base. ********* In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. l(bl<5l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperab ility Pane l findings is as follows , Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000664 Page 2004 of 231i 4 of 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Gerner edit , negotiated inclusion at no additional cost. VA-18-0298-B-000665 Page 2005 of 23e~ 5 of 871 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000666 Page 2006 of 23e~ 6 of 871 Document ID: 0.7.1705.478007 From: Bruce Moskowitz !(bl(5> @mac .com> To: Blackburn, Scott R. DJS ; Marc Sherman l(b)(6l @gmail.com>; O'Rourke, Peter M. ; IP(bl(6l frenchangel59.com>; 6> l(bl(5l @gmail.com (bH gmail.com> Bee: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Subject: Wed Feb 28 2018 14:56:19 EST Date: Attachments : One last thing so you are not talked on an additional fee . They need to have In the contract language to incorporate a device registry that the VA is working on Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 2:32 PM, Blackburn , Scott R. wrote : Bruce - we certainly aren 't going to let you get tar and feathered! Again , we really apprec iate all the support you 've given us. On these other 4, I'll get you answers on these ASAP . I know these are topics you've brought up in past and we were definitely listening . I've been hammering the team to make sure we incorporate all this feedback into the negotiat ion . Let me send you the specifics where we have landed to make sure that we got them right. Stand by .. . Scott @mac.com] From: Bruce Moskowitz l(bl(5l Sent: Wednesday , February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000667 Page 2007 of 231i 7 of 871 Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incred ibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 c loud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one examp le of the open cou ld environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear. VA-18-0298-B-000668 Page 2008 of 23e~s of 871 Scott From: Bruce Moskowitz l(b)(Bl @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz .... l(b-l( _l _____ __, @mac.com> wrote: To clarify further it states their commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz l(b ...._ l(5_l _____ __. @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone VA-18-0298-B-000669 Page 2009 of 231ig of 871 On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5l #3) Below is the IP language that we negotiated. i VA-18-0298-B-000672 Page 2012 of 23 8~2 of 871 Document ID: 0.7.1705.1200897 From: Short, John (VACO) Blackburn, Scott R. Windom , John H. ; Zenooz, Ashwini Bee: Subject: RE: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 14:53:37 EST Attachments: I hadn't seen these other questions until now. See below for one answer. I am working the others as well. From: Blackburn, Scott R. Sent: Wednesday, February 28, 20 18 2:33 PM To : Windom, John H.; Short, John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. @mac.com] From: Bruce Moskowitz l(b)(G) Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: !(b)(6) @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: VA-18-0298-B-000673 Page 2013 of 231~ of 3 871 Voice Recognition **The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework. The Clinician can use the dictation and other features with voice recognition. All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this th is more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morning ... ******** The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. ***** *** Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA , not VA). ******** Gerner does have a partnership with AWS (which is why we highl ighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ******** DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans , but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott VA-18-0298-B-000674 Page 20 14 of 23 8~4 of 871 From: Bruce Moskowitz !(bl(5l @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke , Peter M.; 1pJ bHl l@gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018 , at 9:20 PM, Bruce Moskowitz .... l(b_l(5_l _____ __.l @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz .... l(b_l(5_l _____ ~ @mac .com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: VA-18-0298-B-000675 Page 2015 of 231~ of 5 871 #1) Rasu is all in as far as starting to help right away . I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . ******** The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ******** In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP lanauaae that we neaotiated. i<0 l<5l (b)(5) Of importance : Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the quest ion on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2) -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outs ide of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model , share data for analytics VA-18-0298-B-000676 Page 2016 of 231~ of 6 871 freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners . This fosters rapid adoption from industry best practices , e.g ., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in access ing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism . Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000677 Page 2017 of 23 8~7 of 871 VA-18-0298-B-000678 Page 2018 of 23e~s of 871 Document ID: 0.7.1705.478006 From: Short, John (VACO) To: Blackburn, Scott R. Windom , John H. Cc: ; Zenooz, Ashwini Bee: RE: Open API - it is CLOUD + langug e + Rasu Subject: Wed Feb 28 2018 14:53:37 EST Date: Attachments: I hadn't seen these other questions until now. See below for one answer. I am working the others as well. From: Blackburn, Scott R. Sent: Wednesday, February 28, 20 18 2:33 PM To: Windom, John H.; Short , John (VACO) ; Zenooz , Ashwini Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. 5 ) l@mac.com] From: Bruce Moskowitz l(b)( Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(bl< l @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: VA-18-0298-B-000679 Page 2019 of 231~ of 9 871 Voice Recognition **The EHRM platform includes Enterprise Dragon Nuance. VHA already deployed the enterprise version which maintains people voice print and the Clinical Staff say it works very well. Gerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Gerner without any rework. The Clinician can use the dictation and other features with voice recognition. All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 20 18, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we 've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. Currently 3 cloud providers meet the Government security requirements -AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again, the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one examp le of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to the ir specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembe rs still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. VA-18-0298-B-000680 Page 2020 of 23e~o of 871 Scott From: Bruce Moskowit zl'bl<5l @mac.com] Sent: Tuesday, February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apo logize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 'b_H6_l _____ On Feb 27, 2018 , at 9:20 PM, Bruce Moskowitz ~l ~ @mac.com> wrote: To clarify further it states their commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. l'b_l<5_i _____ On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz .... __,@mac.com> wrote: Th is is a prob lem it should say open cloud to all entit ies not commerc ial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: VA-18-0298-B-000681 Page 202 1 of 231i 1 of 871 #1) Rasu is all in as far as starting to help right away . I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Was hington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The APls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerne r and Amazon announced that they wou ld be working together in cooperation to acce lerate HealthCare Innovations. 5 #3) Below is the IP lanquaqe that we neqotiated. ! VA-18-0298-B-000684 Page 2024 of 23 8~4 of 871 Document ID: 0.7.1705.477904 From: Blackburn, Scott R. To: Windom, John H. ; Short, John (VACO) ; Zenooz, Ashwini Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 14:32:54 EST Attachments: Where did we land on the 4 topics below? I want to make sure they understand that you guys did a hell of a job so we have a warm and fuzzy that we are getting the best deal for Veterans. From: Bruce Moskowitz l(bl(5> @mac.com] Sent: Wednesday, February 28, 20 18 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5> l@gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five CIO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: Voice Recognition All entering lab data on a graph from any source Catching test duplication , over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000685 Page 2025 of 231i 5 of 871 On Feb 28, 2018, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provide r or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this . I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear . Scott From: Bruce Moskowitz l(b)(BJ @mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(bl{5l l@gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad VA-18-0298-B-000686 Page 2026 of 231i 6 of 871 Bruce Moskowitz M.D. .... _J<5_i _____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 5 wrote : This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead .. . The Open AP ls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to acce lerate HealthCare Innovations. VA-18-0298-B-000687 Page 2027 of 231i 7 of 871 #3) Below is the IP language that we negotiated . l VA-18-0298-B-000689 Page 2029 of 23 8~9 of 871 Document ID: 0.7.1705.477899 From: Blackburn, Scott R. To: Bruce Moskowitz l(bl<6l @mac .com> Cc: DJS ; Marc Sherman (bl{6l gma il.com>; O'Rourke, Peter M. ; 93af-o 'ro urke, p>; IP~fr @gmail.com i wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don 't anticipate any push back . A few things I learned this morning .. . The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear . Scott VA-18-0298-B-000691 Page 2031 of 23e~ 1 of 871 From: Bruce Moskowitz !(0 l(5l @mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(0 H6 l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apo logize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 0 5 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l(.... _l( _l _____ __.@mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Work ing on Sent from my iPad Bruce Moskowitz M.D . 0 5 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ._l ( _l( _l _____ ___. l@mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitat ion travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to VA-18-0298-B-000692 Page 2032 of 231i 2 of 871 help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. !(bl(5l (b)(5) Of importance : Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA . Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties. Panelists acknowledged this recommendation is a stretch goal. VA-18-0298-B-000693 Page 2033 of 231i 3 of 871 RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files . Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners . This fosters rapid adoption from industry best practices , e.g ., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4 .1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies ." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000694 Page 2034 of 23e~4 of 871 Page 2035 of 23%35 of 8T1 Document ID: 0.7.1705.807713 Bruce Moskowitz From: !(bl(6> @mac .com> To: Blackburn, Scott R. Cc: DJS ; Marc Sherman !(bl(6l @gmail.com>; O'Rourke, Peter M. ; IP ~ frenchangel59.com>; l(bl(6l @gmail.com 6 @gmail.com> l(bl(l Bee: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Subject: Wed Feb 28 2018 13:13:19 EST Date: Attachments : Thank you my five CIO's had looked forward to tar and feather ing me if the cloud is not done correctly! The other issues are : Voice Recognition All entering lab data on a graph from any source Catching test dupl ication , over utilization and medication duplication /error s at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into th is th is more this morning . What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... ********* The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system . ********* Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including VA-18-0298-B-000696 Page 2042 of 231i 6 of 871 Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now . Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ********* Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ***** **** DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans , but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crysta l clear. Scott From: Bruce Moskowitz l(bJ(GJ @mac.com] Sent: Tuesday, February 27, 2018 9:29 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; l wrote: To clarify further it states their commercia l cloud instead a commerc ial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad VA-18-0298-B-000697 Page 2043 of 2s1i 7 of 871 Bruce Moskowitz M.D. ...._l<5_l _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... ********* The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ***** **** In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 #3) Below is the IP language that we negotiated . l VA-18-0298-B-000700 Page 2046 of 23f ~o of 871 Document ID: 0.7.1705.1761200 From: Blackburn, Scott R. To: Bruce Moskowitz l(bl(6l @mac .com> DJS ; Marc Sherman l(bl(6l @gmail.com>; O'Rourke, Peter M. ; IP (bl(6l frenchangel59.com>; (bl(5l gmail.com 6 (bl( l gmail.com> Bee: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Feb 28 2018 12:52:20 EST Date: Attachments: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock); we 've also gone back this mornign to confi rm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... ********* The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or app lications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. ********* Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). ********* Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open cou ld env ironm ents they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. ********" DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans , but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott VA-18-0298-B-000701 Page 2052 of 23WJ of 1 871 From: Bruce Moskowitz l(b)(GJ @ma c.com ] Sent: Tue sday, February 27, 2018 9:29 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: l(b){Gl Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 5 l(b_l<_l _____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz .... __.@mac.com> wrote: To clarify further it states their commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. (b_H5_l _____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ._l __.l?mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innov ation committee (so we will all be at VA-18-0298-B-000702 Page 2053 of 23WJ of 2 871 HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... ********* The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ********* In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. l(b) (5) #3) Below is the IP lanauaae that we neaotiated. I (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownersh ip when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA . Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . VA-18-0298-B-000703 Page 2054 of 23WJ of 3 871 Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers . Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documen tation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4 .1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demons trating how much of the data is computable ; provide cost estimates for outside parties to access the data via this mechani sm. Gerner Concur , with requested change : Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets , etc ., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partner s. This fosters rapid adoption from industry best practices , e.g., clinical professional societies ." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000704 Page 2055 of 23 7~4 of 871 VA-18-0298-B-000705 Page 2056 of 23 7~5 of 871 Document ID: 0.7.1705.477552 Blackburn, Scott R. Bruce Moskowitz To: j(bJ(6J @mac.com> Cc: DJS ; Marc Sherman (bl(6l gmail.com>; O'Rourke, Peter M. ; IP(bl(6l frenchangel59.com>; l(bl(5l l@gmail.com (bl(6l gmail.com> Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Wed Feb 28 2018 12:52:20 EST Date: Attachments: Bruce - this is incredibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertently create vendor lock) ; we 've also gone back this mornign to confirm with Gerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back . A few things I learned this morning ... The contract does NOT lock us in to Amazon Web Services (AWS) . Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. Currently 3 cloud providers meet the Government security requirements - AWS , Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again , the goal here is to create open environment as long as the provider meets certain standards (these standards are dictated by GSA, not VA). Gerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPEN and not proprietary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but servicemembers still in uniform . Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott VA-18-0298-B-000706 Page 2057 of 23WJ of 6 871 From: Bruce Moskowit zl' bl(5l @mac.com] Sent: Tuesday, February 27, 2018 9:29 PM To: Blackburn, Scott R. 5 l@gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: l wrote: To clarify further it states their commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at VA-18-0298-B-000707 Page 2058 of 23WJ of 7 871 HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . 5 #3) Below is the IP language that we negotiated. l(bl< l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownersh ip when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA . Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . VA-18-0298-B-000708 Page 2059 of 23WJ of 8 871 Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers . Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documen tation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4 .1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demons trating how much of the data is computable ; provide cost estimates for outside parties to access the data via this mechani sm. Gerner Concur , with requested change : Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules, order sets , etc ., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partner s. This fosters rapid adoption from industry best practices , e.g., clinical professional societies ." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000709 Page 2060 of 23 7~9 of 871 VA-18-0298-B-000710 Page 2061 of 23f~o of 871 Document ID: 0.7.1705.1200607 From: Windom, John H. To: Short, John (VACO) ; Blackburn , Scott R. Cc: Bee: Subject: RE: RE :: Open API - it is CLOUD+ languge + Rasu Date: Wed Feb 28 2018 12:26:20 EST Attachments: Concur . Jw Sent with Good (www.good .com) From: Short , John (VACO) Sent: Wednesday , February 28, 20 18 9:24 :15 AM To : Blackburn, Scott R. Cc: Windom , John H. Subject: RE:: Open API - it is CLOUD+ languge + Rasu Validated by Cerne r. Cerner 's Open API interfaces are hosted in a high ly sca lable cloud environment. In the case of Cerner 's proposed services for VA, the AP ls will be accessible by any app lication and from any cloud environment that meets the requis ite security and privacy requirements to protect Veteran data . A lso , there have been public announcements about Cerner and Amazon 's Cloud, but that is just one examp le of the open c loud environments that Cerner is working with . Cerner interface s with many public and private clouds in the US and abroad. From: Blackburn, Scott R. Sent: Wednesday , February 28, 2018 6:04 AM To: Windom , John H.; Short , John (VACO) VA-18-0298-B-000711 Page 2062 of 23 7~1 of 871 Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Ok Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday, February 28, 2018 5:38 :57 AM To: Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sir None of what I read is hard . However , I cannot meet until after pentagon session . Metroing to the pentagon this morning . Vr John Sent with Good (www .good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To : Blackburn, Scott R. ; Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:05 PM To : Short, John (VACO); W indom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure . I should be in the office around 7am. We can also ride over together . Sent with Good (www.good .com) VA-18-0298-B-000712 Page 2063 of 23 7~2 of 871 From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward. Sent with Good (www.good .com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn , Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regard less of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To: Short, John (VACO); Windom , John H. Subject: FW: [EXTERNAL] Re: Open AP I - it is CLOUD+ languge + Rasu React ions? Sent with Good (www.good .com) VA-18-0298-B-000713 Page 2064 of 23 7~3 of 871 From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . 5 #3) Below is the IP lanauaae that we neaotiated . l(oJ(l (0)(5) VA-18-0298-B-000714 Page 206 5 of 231A 4 of 871 Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers . Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this VA-18-0298-B-000715 Page 2066 of 23 7~5 of 871 mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000716 Page 2067 of 23 7~6 of 871 Document ID: 0.7.1705.1200808 Short, John (VACO) Blackburn, Scott R. Cc: Windom , John H. Bee: Subject: RE:: Open API - it is CLOUD+ languge + Rasu Date: Wed Feb 28 2018 12:24:15 EST Attachments: , Validated by Gerner. Cerner's Open API interfaces are hosted in a high ly sca lable cloud environment. In the case of Cerner 's proposed services for VA , the APls will be accessible by any app lication and from any cloud environment that meets the requisite security and privacy requirements to protect Veteran data . A lso, there have been pub lic annou ncements about Gerner and Amazon 's Cloud, but that is just one examp le of the open c loud environments that Gerner is working with . Gerner interfaces with many public and private clouds in the US and abroad. From: Blackburn, Scott R. Sent: Wednesday, February 28, 20 18 6:04 AM To: Windom, John H.; Short , John (VACO) Subject: RE : [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Ok Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday, February 28, 2018 5:38:57 AM To: Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000717 Page 2068 of 23 7~7 of 871 Sir None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 7:04:56 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tue sday, February 27, 2018 10:05 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + langug e + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000718 Page 2069 of 23 7~8 of 871 Let's talk in AM. I want to get this right so we can close and move forward. Sent with Good (www.good .com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To : Short, John (VACO); Windom , John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Reactions? Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a prob lem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone VA-18-0298-B-000719 Page 2070 of 23 7~9 of 871 On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... * The Open APls that VA has access to from Cerner reside in their Comme rcial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. * In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 l VA-18-0298-B-000722 Page 2073 of 23 7~2 of 871 Document ID: 0.7.1705.477326 Short, John (VACO) Blackburn, Scott R. Windom , John H. Cc: Bee: Subject: RE:: Open API - it is CLOUD+ languge + Rasu Date: Wed Feb 28 2018 12:24: 15 EST Attachments: 18 Validated by Gerner. Cerner's Open API interfaces are hosted in a highly sca lable cloud environment. In the case of Cerner 's proposed services for VA , the APls will be accessible by any application and from any cloud environmen t that meets the requisite secur ity and privacy requirements to protect Veteran data . Also , there have been public announcements about Gerner and Amazon 's Cloud, but that is just one examp le of the open cloud environm ents that Gerner is working with . Gerner interfaces with many public and private clouds in the US and abroad. From: Blackburn, Scott R. Sent: Wednesday, February 28, 2018 6:04 AM To: Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Ok Sent with Good (www.good .com) From: Windom, John H. Sent: Wednesday, February 28, 2018 5:38 :57 AM To: Short, John (VACO); Blackburn, Scott R. VA-18-0298-B-000723 Page 2074 of 23 7~3 of 871 Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sir None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 7:04:56 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tuesday, February 27, 2018 10:05 PM To : Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am . We can also ride over together . Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To : Blackburn , Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO . From: Blackburn, Scott R. Sent: Tuesday, February 27, 2018 10:02 PM To: Short, John (VACO); Windom , John H. VA-18-0298-B-000724 Page 2075 of 23 7~4 of 871 Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connect ion as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regard less of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone VA-18-0298-B-000725 Page 2076 of 23 7~5 of 871 On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something , he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's ent ire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovation s. #3) Below is the IP lanquaqe that we neqotiated. l VA-18-0298-B-000728 Page 2079 of 23 7~8 of 871 Document ID: 0.7.1705.476959 From: Kushner, Jared C. EOP/WHO l(bl(6> @who .eop.gov> Blackburn, Scott R. Berkowitz, Avrahm J. EOP/WHO Cc: (bl(6l who .eo . ov>? Liddell , Christopher P. EOP/WHO (bl(6> who.eop.gov> Bee: Subject: [EXTERNAL ] RE: interoperabili ty Date: Wed Feb 28 2018 07:56: 11 EST Attachments: (b)(5) From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday , February 26, 2018 5:05 PM To : Kushner , Jared C. EOP/WHQ(bl(6l who.eop .gov > Cc: Berkowitz, Avrahm J. EOP/WHO (bl(6> who.eop .gov> Subject: interoperabi lity Jared, I just spoke to Secretary Shulkin and he (bl(5> l(bl(5> If so, let me know and l!--:--: 'll_m _a _k,_e_t"'" im _e _,.., th..,. is_ w_e_e..k.---------------' I Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-B-000729 Page 2080 of 23~ 9 of 871 Document ID: 0.7.1705.1199378 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 06:32:50 EST Attachments: I'm on the Metro and should meet you between 0700 & 0715 Warmest regards! Respectfully, John A. Short (SES), Doctoral Candidate, MBA-ISM , MSIS, CNSS 4011 /4012, FEMA PDS Executive Dire ctor, Information Technology Systems Modernization CTO, EHRM PEO VA Office: 202 461-9299 Cell: (b)(GJ ----,-,=-----' john.short@va.gov john.a.short10.civ@mail.mil From: Blackburn, Scott R. Sent: Wednesday, February 28, 2018 6:04:04 AM To : Windom, John H.; Short, John (VACO) Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Ok Sent with Good (www.good.com) From: Windom, John H. Sent: Wednesday , February 28, 2018 5:38:57 AM To: Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sir VA-18-0298-B-000730 Page 2081 of 23'% 0 of 871 None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www .good .com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 7:04:56 PM To : Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:05 PM To: Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27 , 2018 10:03:32 PM To : Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000731 Page 2082 of 23 7~1 of 871 Let's talk in AM. I want to get this right so we can close and move forward. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements . Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However , regardless of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn , Scott R. wrote: VA-18-0298-B-000732 Page 2083 of 23 7~2 of 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 #3) Below is the IP language that we negotiated. l(bH) (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownersh ip when third parties consume Cerner terminology through open APls . Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2) -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000733 Pa ge 2084 of 231/h of 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties. Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Gerner edit , negotiated inclusion at no additional cost. VA-18-0298-B-000734 Page 208 5 of 23 7~4 of 871 Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000735 Page 2086 of 23 7~5 of 871 Document ID: 0.7.1705.476902 From: Blackburn, Scott R. To: Windom, John H. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL ] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 06:04:04 EST Attachments: Ok Sent with Good (www.good.com) From: Windom , John H. Sent: Wednesday , February 28, 20 18 5:38:57 AM To: Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Sir None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www .good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! VA-18-0298-B-000736 Page 2087 of 23 7~6 of 871 From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:05 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO . From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:02 PM To: Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good.com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a VA-18-0298-B-000737 Page 2088 of 23 7~7 of 871 presence there. However, regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn, Scott R. Sent: Tuesday, February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday, February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTE RNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's ent ire remote hosted customer base. VA-18-0298-B-000738 Page 2089 of 23 7~8 of 871 In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP lanauaae that we neaotiated. l(bl(5l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner 's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows , Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. VA-18-0298-B-000739 Page 2090 of 23~ 9 of 871 Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tab les, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as termino logies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinica l content assets such as termino logies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinica l partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000740 Page 209 1 of 23f~o of 871 Document ID: 0.7.1705.1199355 From: Blackburn , Scott R. To: Windom, John H. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 06:04:04 EST Attachments: Ok Sent with Good (www.good .com) From: Windom , John H. Sent: Wednesday , February 28, 2018 5:38:57 AM To : Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sir None of what I read is hard . However , I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! VA-18-0298-B-000741 Page 2092 of 23 7~1 of 871 From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:05 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday, February 27, 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tue sday, February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + langug e + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regardless of what cloud provider someone is using they can connect to our Cerner platform. VA-18-0298-B-000742 Page 2093 of 23 7~2 of 871 From: Blackburn, Scott R. Sent: Tuesday, February 27 , 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open AP I - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open AP ls that VA has access to from Gerner reside in their Commercial Cloud environment. This env ironment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they wou ld be working together in cooperation to acce lerate HealthCare Innovations. VA-18-0298-B-000743 Page 2094 of 23 7~3 of 871 5 #3) Below is the IP lanauaae that we neaotiated. l(bl( l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface, and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive serv ice to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g. , ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables , definitions, and examples of fully populated Veteran data files. Provide documentation VA-18-0298-B-000744 Page 2095 of 231fa of 4 871 or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4 .1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decis ion support rules , order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000745 Page 2096 of 23 7~5 of 871 Document ID: 0.7.1705. 1474 197 From: Windom, John H. To: Short, John (VACO) ; Blackburn , Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re : Open AP I - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 05:38:57 EST Attachments: Sir None of what I read is hard. However, I cannot meet until after pentagon session . Metroing to the pentagon this morning . Vr John Sent with Good (www .good .com) From : Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To : Blackburn, Scott R.; Windom, John H. Subj ect: RE: [EXTERNAL] Re : Open AP I - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:05 PM To : Short, John (VACO); Windom , John H. Subject: RE: [EXTERNA L] Re: Open AP I - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www .good .com) VA-18-0298-B-000746 Page 2097 of 23 7~6 of 871 From: Short, John (VACO) Sent: Tuesday, February 27 , 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO . From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To : Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements . Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there . However , regard less of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open AP I - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good .com) VA-18-0298-B-000747 Page 2098 of 23 7~7 of 871 From: Bruce Moskowitz Sent: Tuesday, February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP lanquaqe that we neqotiated. l VA-18-0298-B-000750 Page 2101 of 23f~ o of 871 Document ID: 0.7.1705.476900 From: Windom, John H. To: Short, John (VACO) ; Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 05:38:57 EST Attachments: Sir None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To : Blackburn , Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:05 PM To : Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good .com) VA-18-0298-B-000751 Page 2102 of 23 7~1 of 871 From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However , regardless of what cloud provider someone is using they can connect to our Gerner platform . From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? VA-18-0298-B-000752 Page 2103 of 23 7~2 of 871 Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engag ing right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base . In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . 5 #3) Below is the IP lanauaae that we neaotiated. l(bl( l (b)(5) VA-18-0298-B-000753 Page 2104 of 23W; of 3 871 Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls . Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties. Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of VA-18-0298-B-000754 Page 2105 of 23 7~4 of 871 the data is compu table; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4 .1: "n) The Contractor shall support Knowledge Interoperabi lity by support ing the extension of clinical content assets such as termino logies, clinical dec ision support rules , order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controll ing nationa l standard . Th is includes the ability to curate, extend, and share that know ledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur w ith Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000755 Page 2106 of 23 7~5 of 871 Document ID: 0.7.1705.476896 From: DJS To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:24:26 EST Attachments: Thanks You were great today Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 7:22:11 PM To: DJS; O'Rourke , Peter M. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu I'm just checking a few facts and will respond to Bruce in the morning. I want to make sure I get it right. But I think we are all set. We do not have "it must be Amazon" but rather that is who they have partnered with as their cloud provider to start. I will clarify that. It is open to any cloud provider that meets the government security requirements (FISMA High). Right now only Amazon, Azure (Microsoft) and CSRA have that certification but others (eg VirtuStream by Dell) will eventually. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 9:28:56 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl< l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care VA-18-0298-B-000756 Page 2107 of 23W; of 6 871 iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ,_l (b_l<5_i _____ _. @mac.com> wrote: To clarify further it states the ir commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 5 wrote: This is a prob lem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open AP ls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base . In a recent press release Cerner and Amazon announced that they wou ld be working together in cooperation to accelerate HealthCare Innovations . VA-18-0298-B-000757 Page 2108 of 231/$7 of 871 #3) Below is the IP lanquaqe that we neqotiated. i VA-18-0298-B-000759 Page 2110 of 23 7~9 of 871 Document ID: 0.7.1705.1761076 From: Blackburn, Scott R. To: DJS ; O'Rourke, Peter M. Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Tue Feb 27 2018 22:22:11 EST Date: Attachments: I'm just checking a few facts and will respond to Bruce in the morning. I want to make sure I get it right. But I think we are all set. We do not have "it must be Amazon" but rather that is who they have partnered with as their cloud provider to start. I will clarify that. It is open to any cloud provider that meets the government secu rity requirements (FISMA High). Right now only Amazon, Azure (Microsoft) and CSRA have that certification but others (eg VirtuStream by Dell) will eventually. Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 9:28:56 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(bl(5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. 0 6 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ,...l ( _H_' _____ _. @mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on VA-18-0298-B-000760 Page 211 1 of 23'% 0 of 871 Sent from my iPad Bruce Moskowitz M.D. wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us . He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to acce lerate HealthCare Inno vations. 5 > #3) Below is the IP lanauaae that we neaotiated . l< (b)(5) VA-18-0298-B-000761 Page 2112 of 23~ 1 of 871 Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers . Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this VA-18-0298-B-000762 Page 2113 of 23 7~2 of 871 mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000763 Page 2114 of 23 7~3 of 871 Document ID: 0.7.1705.476895 From: Blackburn, Scott R. To: DJS ; O'Rourke , Peter M. Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:22:11 EST Attachments: I'm just checking a few facts and will respond to Bruce in the morning. I want to make sure I get it right. But I think we are all set. We do not have "it must be Amazon" but rather that is who they have partnered wit h as their cloud provider to start. I will clarify that. It is open to any cloud provider that meets the government security requ irements (F ISMA High). Right now only Amazon, Azure (Microsoft) and CSRA have that certification but others (eg VirtuStream by Dell) wi ll eventua lly. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 9:28:56 PM To : Blackburn, Scott R. 5 Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; 1p r l( l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apo logize for the word ing instead of the ir commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskow itz M.D. 5 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l (b-l( _l _____ ~ @mac.com> wrote: To clarify further it states the ir commercia l cloud instead a commerc ial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all VA-18-0298-B-000764 Page 2115 of 23~ 4 of 871 Working on Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms . Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base . In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP lanquaqe that we neqotiated. i VA-18-0298-B-000767 Page 2118 of 23 7~7 of 871 Document ID: 0.7.1705.1198618 From: Short, John (VACO) To: Blackburn , Scott R. ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:04:56 EST Attachments: Roger that! From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:05 PM To : Short , John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Sure. I should be in the office around 7am. We can also ride over together . Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 10:03:32 PM To : Blackburn , Scott R.; Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:02 PM To: Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-B-000768 Page 2119 of 23 7~8 of 871 Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn , Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regardless of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To: Short, John (VACO); Windom , John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: VA-18-0298-B-000769 Page 2120 of 23 7~9 of 871 #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Was hington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The APls are cloud based . Here is the response from our Technical lead .. . * The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. * In a recent press release Gerner and Amazon announced that they wou ld be working together in coope ration to acce lerate HealthCare Innovations. #3) Below is the IP lanquaqe that we neqotiated . i VA-18-0298-B-000772 Page 2123 of 23 7~2 of 871 Document ID: 0.7.1705.1761074 From: Blackburn , Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:04:38 EST Attachments: Sure. I should be in the office around 7am . We can also ride over together . Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tue sday, February 27, 2018 10:03:32 PM To: Blackburn, Scott R. ; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + langug e + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward . Sent with Good (www.good.com) VA-18-0298-B-000773 Page 2124 of 23 7~3 of 871 From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regardless of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To : Blackburn , Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. VA-18-0298-B-000774 Page 2125 of 23f ~4 of 871 #2) The AP ls are cloud based. Here is the response from our Technical lead .. . The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to acce lerate HealthCare Innovations. l(b)(5) #3) Below is the IP language that we negotiated. 1 (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their AP I is used to connect to the Cerner interface , and there wi ll be no derivative Contractor IP ownership when third parties consume Cerne r terminology through open APls . Regarding the quest ion on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows , Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model , share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data ana lytics . VA-18-0298-B-000775 Page 2126 of 231!7 of 5 871 Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Gerner edit, negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000776 Page 2 127 of 23 7~6 of 871 Document ID: 0.7.1705.476894 From: Blackburn, Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:04:38 EST Attachments: Sure. I should be in the office around 7am. We can also ride over together. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:03:32 PM To: Blackburn , Scott R. ; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM . I want to get this right so we can close and move forward . Sent with Good (www.good.com) VA-18-0298-B-000777 Page 2129 of 23 7~7 of 871 From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However , regardless of what cloud provider someone is using they can connect to our Gerner platform. From: Blackburn, Scott R. Sent: Tuesday, February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday, February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right VA-18-0298-B-000778 Page 2130 of 23 7~8 of 871 away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP lanauaae that we neaotiated. 0 5 1( l( > (0)(5) Of importance : Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls . Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway, that is adopt ing an outside-in , value-to -business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . VA-18-0298-B-000779 Page 2131 of 231!7 of 9 871 Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data ana lytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls} with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tab les, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling nationa l standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Concur with Gerner edit, negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000780 Page 2132 of 23f ~oof 871 Page 2133 of 23}?1 of Em Document ID: 0.7.1705.1198602 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:03:32 EST Attachments: Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 10:02 PM To: Short, John (VACO); Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Let's talk in AM. I want to get this right so we can close and move forward. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements . Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there . However , regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. VA-18-0298-B-000782 Page 2134 of 23 7~2 of 871 Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskowitz Sent: Tuesday , February 27, 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. * * In a recent press release Cerner and Amazon announced that they would be working together in coope ration to accelerate HealthCare Innovations . #3) Below is the IP lanquaqe that we neqotiated. l(b) (S) (b) (S) VA-18-0298-B-000783 Page 2135 of 231/s of 3 871 I''"'' Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally , Cerner's response and the final negotiation language on sharing their data mode l as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model , share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tab les, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by VA-18-0298-B-000784 Page 2136 of 231/s of 4 871 supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000785 Page 2137 of 23 7~5 of 871 Document ID: 0.7.1705.476892 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open AP I - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:03:32 EST Attachments: Do you want to meet before we go to the Pentagon? Transpo leaves at 0730 from VACO . From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 10:02 PM To: Short, John (VACO); Windom , John H. Subject: RE: [EXTERNAL] Re: Open AP I - it is CLOUD + languge + Rasu Let's talk in AM . I want to get this right so we can close and move forward . Sent with Good (www.good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connect ion as long as it meets the security requirements. Gerner is operat ing their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However , regard less of what cloud provider someone is using they can connect to our Gerner platform . From: Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM VA-18-0298-B-000786 Page 2138 of 23 7~6 of 871 To: Short, John (VACO); Windom , John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www .good .com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is will ing to start engag ing right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3 Below is the IP Ian ua e that we ne otiated. <0 l<5l (b)(5) VA-18-0298-B-000787 Pa ge 2139 of 231/h of 871 (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface, and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls . Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway, that is adopt ing an outside-in , value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperab ility Panel findings is as follows, Gerner agreed to suggested addit ion of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations . However , current language does not require access to the EHRM data model , supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " VA-18-0298-B-000788 Page 2140 of 231/sa of 871 Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g ., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000789 Page 2141 of 23 7~9 of 871 Document ID: 0.7.1705.476882 From: Blackburn, Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Date: Tue Feb 27 2018 22:02:24 EST Attachments: Let's talk in AM. I want to get this right so we can close and move forward. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tuesday , February 27, 2018 10:00:49 PM To: Blackburn , Scott R. ; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu It is open to any Cloud or non-cloud connection as long as it meets the security requirements. Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However, regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To : Short, John (VACO); Windom , John H. Subject: FW: [EXTERNAL] Re: Open AP I - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) VA-18-0298-B-000790 Page 2142 of 23f ~oof 871 From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP language that we negotiated . 5 l(b)( ) (b)(5) VA-18-0298-B-000791 Page 2143 of 23Wi of 1 871 Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers . Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this VA-18-0298-B-000792 Page 2144 of 23 7~2 of 871 mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000793 Page 2145 of 23 7~3 of 871 Document ID: 0.7.1705.1198593 From: Blackburn , Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:02:24 EST Attachments: Let's talk in AM . I want to get this right so we can close and move forward. Sent with Good (www.good.com) From: Short, John (VACO) Sent: Tue sday, February 27, 2018 10:00:49 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE : [EXTERNAL] Re : Open API - it is CLOUD + langug e + Rasu It is open to any Cloud or non-cloud connection as long as it meets the secu rity requirements . Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there. However , regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 9:15 PM To: Short, John (VACO); Windom, John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Reactions? Sent with Good (www.good.com) VA-18-0298-B-000794 Page 2146 of 23 7~4 of 871 From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation comm ittee (so we will all be at HiMSS together next week) . However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to acce lerate HealthCare Innovations. 5 #3) Below is the IP language that we negotiated . l(bl( l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. VA-18-0298-B-000795 Page 2147 of 23"% of 5 871 Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: VA-18-0298-B-000796 Page 2 148 of 23 7~6 of 871 Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000797 Page 2149 of 23 7~7 of 871 Document ID: 0.7.1705.1198586 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:00:49 EST Attachments: It is open to any Cloud or non-cloud connection as long as it meets the security requirements . Cerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there . However , regardless of what cloud provider someone is using they can connect to our Cerner platform. From: Blackburn , Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To : Short, John (VACO); W indom , John H. Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good.com) From: Bruce Moskow itz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn , Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : VA-18-0298-B-000798 Page 2150 of 23 7~8 of 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. * * In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 #3) Below is the IP lanauaae that we neaotiated. l VA-18-0298-B-000801 Page 2153 of 23 8~1 of 871 Document ID: 0.7.1705.476878 From: Short, John (VACO) To: Blackburn, Scott R. ; Windom, John H. Cc: Bee: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Subject: Tue Feb 27 2018 22:00:49 EST Date: Attachments: It is open to any Cloud or non-cloud connection as long as it meets the security requirements . Gerner is operating their own Commercial Cloud and are in talks with multiple Cloud providers to have a presence there . However , regardless of what cloud provider someone is using they can connect to our Gerner platform . From : Blackburn, Scott R. Sent: Tuesday , February 27 , 2018 9:15 PM To : Short, John (VACO); Windom , John H. Subje ct: FW: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Reactions? Sent with Good (www.good .com) From: Bruce Moskow itz Sent: Tuesday , February 27 , 2018 8:20:26 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M. Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone VA-18-0298-B-000802 Page 2154 of 23 8~2 of 871 On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5l #3) Below is the IP language that we negotiated. i VA-18-0298-B-000805 Page 2157 of 23 8~5 of 871 Document ID: 0.7.1705.1761060 From: Blackburn, Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 21 :33:02 EST Attachments: Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 9:28:56 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: l(bl{5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz .... l(b_l<6_l _____ ___. @ . mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 6 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_l<_l _____ __.l @mac.com> wrote: VA-18-0298-B-000806 Page 2158 of 231i 6 of 871 This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead .. . The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . #3) Below is the IP lanQuaQethat we neQotiated. l VA-18-0298-B-000809 Page 2161 of 23 8~9 of 871 Document ID: 0.7.1705.476873 From: Blackburn, Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: FW: [EXTERNAL] Re: Open API - it is CLOUD + langug e + Rasu Subject: Date: Tue Feb 27 2018 21 :33:02 EST Attachments: Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday, February 27, 2018 9:28:56 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; i wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-B-000810 Page 2162 of 231~o of 871 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz l(b ...._l<5_l _____ ----J @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms . Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu 's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead ... The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . l(b)(5 ) #3) Below is the IP lanquaqe that we neqotiated . I (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. VA-18-0298-B-000811 Page 2163 of 231~ of 1 871 Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model, tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate , extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur, with requested change: VA-18-0298-B-000812 Page 2164 of 23 8~2 of 871 Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that know ledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Cerner edit, negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000813 Page 2165 of 23 8~3 of 871 Document ID: 0.7.1705.807346 Bruce Moskow itz From: l To: Blackburn, Scott R. Cc: DJS ; Marc Sherman l; O'Rourke, Peter M. ; IP (bJ(6J frenchange l59.com> l Bee: Subject: [EXTERNAL ] Re: Open AP I - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 21 :28:56 EST Attachments: Apo logize for the word ing instead of the ir commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 20 18, at 9:20 PM, Bruce Moskowitz ~l wrote: To clarify further it states the ir commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not j ust amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 20 18, at 8:20 PM, Bruce Moskowitz ~l wrote: Th is is a prob lem it should say open cloud to all entit ies not commerc ial cloud Second it should be open platfo rm and not jus t Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 20 18, at 6:09 PM, Blackburn, Scott R. wrote : VA-18-0298-B-000814 Page 2166 of 231~ of 4 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him . He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for somet hing, he will find a way to do it (and we will use inv itation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technica l lead .. . ********* The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's ent ire remote hosted custo mer base. ********* In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. . o l(b)(5) #3) Below Is the IP language that we negotiated. 1 (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperab ility Pane l findings is as follows , Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000815 Page 2167 of 231~ of 5 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Gerner edit , negotiated inclusion at no additional cost. VA-18-0298-B-000816 Page 2 168 of 23 8~6 of 871 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000817 Page 2169 of 23 8~7 of 871 Document ID: 0.7.1705.476529 Bruce Moskowitz From: l(bJ(5l @mac.com> To: Blackburn, Scott R. Cc: DJS ; Marc Sherman l(bJ(6J @gmail.com >; O'Rourke, Peter M. ; I (bJ( l frenchangel59.com>; 5 l(bJ< l gmail.com (bJ(6l gmail.com> Bee: Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 21 :28:56 EST Attachments: Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 20 18, at 9:20 PM, Bruce Moskowitz ~l (b_H5_l ______ ~~m ac.com> wrote: To clarify further it states the ir commercial cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not ju st amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~l (b_H_l _____ ~l @mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : VA-18-0298-B-000818 Page 2170 of 231~ of 8 871 David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 #3) Below is the IP language that we negotiated. l(bl< l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: VA-18-0298-B-000819 Page 2171 of 231~ of 9 871 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Gerner edit , negotiated inclusion at no additional cost. VA-18-0298-B-000820 Page 2172 of 23 8~0 of 871 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000821 Page 2173 of 23 8~1 of 871 Document ID: 0.7.1705.1761054 From: Blackburn , Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: FW : [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 21 :22 :02 EST Attachments: Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 9:20:07 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP:l(bl< l l@gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018 , at 8:20 PM , Bruce Moskowitz .... l(b_l<5_l _____ __.l@mac .com> wrote : This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: VA-18-0298-B-000822 Page 2174 of 231~ of 2 871 #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based . Here is the response from our Technical lead .. . The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the IP lanauaae that we neaotiated . (b){5) l (b)(5) Of importance : Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others , see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2) -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway , that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model , share data for analytics VA-18-0298-B-000823 Page 2175 of 231~ of 3 871 freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics . Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model , underpinning terminology model , tables , definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable. " Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets , etc. This includes the ability to curate, extend , and share that knowledge with clinical partners . This fosters rapid adoption from industry best practices , e.g ., clinical professional societies. " Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in access ing the data model , including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism . Gerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate , extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Concur with Gerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000824 Page 2 176 of 23 8~4 of 871 VA-18-0298-B-000825 Page 2177 of 23 8~5 of 871 Document ID: 0.7.1705.476524 From: Blackburn, Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: FW: [EXTERNAL] Re: Open API - it is CLOUD + langug e + Rasu Subject: Tue Feb 27 2018 21 :22:02 EST Date: Attachments: Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday, February 27, 2018 9:20:07 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;i(bl(5l @gmail.com Subject: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu To clarify further it states the ir commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: VA-18-0298-B-000826 Page 2178 of 231~ of 6 871 #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Was hington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The APls are cloud based . Here is the response from our Technical lead .. . The Open AP ls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Gerner and Amazon announced that they wou ld be working together in coope ration to acce lerate HealthCare Innovations. 5 #3) Below is the IP lanquaqe that we neqotiated . i VA-18-0298-B-000829 Page 2181 of 23 8~9 of 871 Document ID: 0.7.1705.807334 From: Bruce Moskow itz l Blackburn, Scott R. DJS ; Marc Sherman l; O'Rourke, Peter M. ; IP (bl(5l frenchange l59.com>; l (bl(6l Bee: [EXTERNAL ] Re: Open AP I - it is CLOUD + languge + Rasu Subject: Tue Feb 27 2018 21 :20:07 EST Date: Attachments: To clarify further it states the ir commercia l cloud instead a commercia l cloud Open to all entities and of equal importance an open platform to all not just amazon Sent from my iPad Bruce Moskowitz M.D. 5 On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz ~l wrote: This is a prob lem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018 , at 6:09 PM, Blackburn , Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation comm ittee (so we w ill all be at HiMSS toget her next week). However if he needs to come to Was hington this week for something, he wi ll find a way to do it (and we will use invitat ion travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead .. . VA-18-0298-B-000830 Page 2182 of 231~o of 871 ********* The Open APls that VA has access to from Gerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. ********* In a recent press release Gerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 5 #3) Below is the IP language that we negotiated. l(bl( l (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Gerner interface , and there will be no derivative Contractor IP ownership when third parties consume Gerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner 's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Gerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating VA-18-0298-B-000831 Page 2183 of 231~ of 1 871 organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperabi lity by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinica l partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report exp lain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperabi lity by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that know ledge with clinical partners. This fosters rapid adoption from industry best practices, e.g ., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000832 Page 2184 of 23 8~2 of 871 Document ID: 0.7.1705.476518 From: Bruce Moskowitz 5 @mac.com> Blackburn, Scott R. DJS ; Marc Sherman !(b)(6l @gmail.com>; O'Rourke, Peter M. ; IP (bl( 6l frenchangel59.com>; 5 l(bH > !@gmail.com (bl( 6l gmail.com> l(bl( l To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Tue Feb 27 2018 21 :20:07 EST To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon Sent from my iPad Bruce Moskowitz M.D. 6 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz l(b .... _l( _>_____ __,l?mac.com> wrote: This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn 't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The AP ls are cloud based. Here is the response from our Technical lead ... VA-18-0298-B-000833 Page 2185 of 231~ of 3 871 The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner 's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . l(b)(5) #3) Below is the IP lanauaae that we neaotiated. I (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface , and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner 's response and the final negotiation language on sharing their data model as a result of the Interoperab ility Panel findings is as follows, Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties . Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points (e.g., ingestion and record APls) with both international and national standards designating VA-18-0298-B-000834 Page 2186 of 231~ of 4 871 organizations. However, current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperabi lity by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinica l partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report exp lain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur, with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperabi lity by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. , to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that know ledge with clinical partners. This fosters rapid adoption from industry best practices, e.g ., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-B-000835 Page 2187 of 23 8~5 of 871 Document ID: 0.7.1705. 1198347 From: Blackburn , Scott R. To: Short, John (VACO) ; Windom, John H. Cc: Bee: Subject: FW: [EXTERNAL] Re: Open API - it is CLO UD + languge + Rasu Tue Feb 27 2018 21 :15:09 EST Date: Attachments: Reactions? Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Tuesday , February 27 , 2018 8:20:26 PM To : Blackburn , Scott R. Cc: DJS ; Marc Sherman ; O'Rourke , Peter M. Subject: [EXTERNA L] Re: Open API - it is CLOUD + languge + Rasu This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon Sent from my iPhone On Feb 27, 20 18, at 6:09 PM, Blackburn, Scott R. wrote : David/Bruce/Marc - here are a few updates: #1) Rasu is all in as far as starting to help right away . I just got off the phone with him. He has UPMC comm itments rest of this week and is Chairman of HiMSS Innovation comm ittee (so we will all be at HiMSS together next week) . However if he needs to come to Was hington this week for something, he will find a way to do it (and we will use invitat ion travel to pay for it). He is willing to start engag ing right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help . I've attached Rasu's CV in case you need it. VA-18-0298-B-000836 Page 2192 of 23 8~6 of 871 #2) The AP ls are cloud based. Here is the response from our Technical lead ... The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire remote hosted customer base. In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. l(b)(5) #3) Below is the IP language that we negotiated. I (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to connect to the Cerner interface, and there will be no derivative Contractor IP ownership when third parties consume Cerner terminology through open APls. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more responsive service to the Veteran, VA is making a deliberate shift towards becoming a standards[MJT2] -based API driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platform API Gateway, that is adopting an outside-in, value-to-business driven approach to create APl's that are managed as products to be consumed by developers within and outside of VA. Finally, Cerner's response and the final negotiation language on sharing their data model as a result of the Interoperability Panel findings is as follows , Cerner agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Cerner will provide the VA with access to the data model, share data for analytics freely to 3rd parties, increase the amount of computable data exchanged with 3rd parties. Panelists acknowledged this recommendation is a stretch goal. RFP Section 5.8 address the support to business intelligence and data analytics. Section 5.10.4.1 supports the sharing of Contractor proprietary information/data model extension points VA-18-0298-B-000837 Page 2193 of 231~ of 7 871 (e.g., ingestion and record APls) with both international and national standards designating organizations. However , current language does not require access to the EHRM data model, supporting understanding of and therefore increase the exchange of computable data with community care providers. Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tables, definitions, and examples of fully populated Veteran data files. Provide documentation or software that is used for quality checks and that illustrate what data elements are computable." Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc. This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies." Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules, order sets, etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices , e.g ., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-B-000838 Page 2194 of 23 8~8 of 871 Document ID: 0.7.1705.473591-000003 Owner: Blackburn, Scott R. Filename: EHRM _ National Interoperability Cooperative Commitment (NIC2) - DRAFT_2 .... pptx Last Modified: Mon Feb 26 16:02:56 CST 2018 VA-18-0298-B-000839 Page 2223 of 23 8~9 of 871 National Interoperability Cooperative Commitment (NIC2) : VA's Open APIStandards Acceleration We commit to communicate veteran data via open, standardsbased APIs, for veteran and clinician designated applications, and "bulk"access to Veteran's Choice Act partners. o ExposeMoreHealthData:We intend to map our respectivehealth data to industrystandards,includingthe current and forthcomingversionsof the FHIR APIover the next 18months, to reciprocateon the VA'smakingavailableFHIR resourcesas mutuallyagreed viaa standards accelerationcollaborativethat will be made freelyavailablefor anyone to use or share; o Establish''ModelEHRAgreements'': We, in collaborationwiththe VA,intend to workwithour EHRvendorsto expose more FHIRAPis,and to reach mutual agreement on how to map proprietaryAPisto FHIRresources in a manner that allowsus the rightto reuse artifacts,tools,and services to lower APImapping costs for any interested providersthat signa future VAled model agreement; o StartwithHighPriorityResources: We intend to make the "commonclinical data set" availableto developersservingveterans, clinicians,and partners responsiblefor coordinatingpatient care, and willworkon an initialslate of additionalFHIRresources, includingscheduling,questionnaire(forthe suicide preventionApp(s))clinicalnotes, reports, and patient encounters. G VA-18-0298-B-000840 National Interoperability Cooperative Commitment (NIC2): VA's Open APIStandards Acceleration Continued: Special Note. This collaborative will work to reach agreement with a VAled model on Innovations Priorities and IP rules associated with any custom extensions between an EHRvendor's proprietary API and the associated FHIRresource similar to what is called for by the SMARTHealth IT organization. "Custom SMARTon FHIRExtension to a Proprietary API: Should a vendor neglect to provide SMARTon FHIRnatively, the client has the right to provide a custom extension to the vendor's APLThe ownership of the IP for the custom extension is negotiable between the client and the vendor , but the ownership of the app using the custom extension belongs to its author." Cooperative Commitment Members: G VA-18-0298-B-000841 Document ID: 0.7.1705.550638 From: Windom, John H. 6l l(bl( l; Clancy, Carolyn ; VHA USH Meeting Requests ; Vojta, Christopher L. ; Mock, Teresa J. ; Blackburn, Scott R. ; ,(b 5 (bl( l ; I.(b...a., l(6,..... l -----. 5 (fydibohf23spdlt)/cn= rec ipients/cn=vh (bl(6l Isaac, Char lyn Bee: RE: Friday's DEPSEC Weekly Mtg re: Cerner Update Subject: Thu Feb 22 2018 12:25:01 EST Date: EHRM _ TAC _Summary _ lnteroperability Study (02142018) .pptx Attachments: VA EHRM Interoperab ility Pane l Jan 2018 - Append ix C Matrix - FINAL Adju ....docx Please see attached read aheads. I wi ll bring hardcopies. Vr John John H . W indom, Senior Executive Service (SES) Program Executive for Electron ic Hea lth Record Modernizat ion (PEO EHRM) Special Adv iso r to the Under Secretary fo r Health 8 11 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windo m@va.gov Office: (202) 46 1-5820 VA-18-0298-B-000842 Page 2229 of 231i 2 of 871 Mobile :-l(b_ J(G _l ---~ 5 Executive Assistant: -l To: Wallace, Patricia ; Clancy, Carolyn Cc: j To: Clancy, Carolyn ; Blackburn , Scott R. Cc: Bee: Topic Area 2 Project Subject: Fri Feb 16 2018 13:19:13 EST Date: Attachments: Good Afternoon , I have received a request by Mr. Moskowitz for a meeting to discuss the Topic Area 2 project. He specifically requested that this call is for VA/VHA participants only (no commercia l partner). His stated purpose is to "understand if the project will solve the problems brought up on the initial call." Because of the comp lexity of schedules, I will proceed with coordinating time on calendars including those of Drew Mykelgard and myself. Scott, if there are others to be included please let me know . I will look for background information to refresh our memories on the discussions of last June and get to you in advance. Please give me a call if you have questions. 202 407 1521. Patti VA-18-0298-B-000845 Page 2256 of 23 8~5 of 871 Document ID: 0.7.1705.452558 Blackburn , Scott R. To: GtJCaro,le~(CMS/OA) l(b)(BJ cms .hhs .gov> Cc: Bee: Subject: MITRE report on VA interoperabili ty Date: Thu Feb 08 2018 21 :31 :34 EST Attachments: VA EHRM Interoperability Review Report Executive Summary Jan 2018 FINAL .PDF VA EHRM Interoperab ility Review Report Jan 2018 FINAL.PDF In case I've haven 't sent you already . Please keep close hold . VA-18-0298-B-000846 Page 2258 of 231i 6 of 871 Document ID: 0.7.1705. 1422636 From: Cox, Tim (VACO) To: Blackburn, Scott R. Cc: Bee: Subject: RE: Report and Executive Summary Date: Thu Feb 08 2018 13:04:02 EST Attachments: Thank you Timothy A. Cox, MS Acting Director, IT Strategic Communication Office of Information and Technology Department of Veterans Affairs https ://vaww .oit. va .govI 202-461-9417 (Office) l(b)(GJ !(Mobi le) From: Blackburn, Scott R. Sent: Thursday, February 08, 2018 12:53 PM To: Cox, Tim (VACO) Subject: FW: Report and Executive Summary From: W indom, John H. Se r Ibmsdav Febwarv 01, 2018 2:48 PM To:(b)(GJ hsaac, Cha rlyn Cc: Bowman, Thomas; Devine, Daniel C.; Blackburn, Scott R. Subject: FW: Report and Executive Summary Ladies, VA-18-0298-B-000847 Pag e 2316 of 231i 7 of 871 Super closehold on this MITRE interoperability report. Mr. Blackburn is sending to the Secretary this afternoon but I know this will be the primary topic of discussion with the DEPSEC at my meeting with him tomorrow. Thank you. Please print a copy of each for the DEPSEC. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John .Windom@va .gov Office: (202) 461-5820 5 Mobile : .... l(b_H_l ____ ...., 5 Executive Assistant: .... l(b-l( _l ________ l....----~ 5 (b_J( _l (R)va .gov __.~ Appointments and Scheduling Office: (202) 461-6618 From: Schnitzer , Jay J l(b)(G) l@mitre .org] Sent: Thursday , February 01, 2018 2:33 PM To: Blackburn, Scott R.; Windom, John H. Subject: [EXTERNAL] Report and Executive Summary Hi Scott and John, On behalf of MITRE, as per our agreement, I am pleased to send you two documents attached: 1.The final version of the VA EHRM Interoperability Report, and VA-18-0298-B-000848 Page 2317 of 231ia of 871 2.The fina l version of the Executive Summary of the VA EHRM Interoperabili ty Review Report. Thank you. Best , Jay Jay J. Schnitzer , M.D., Ph.D. V ice President , Chief Technology Officer (CTO) The MITRE Corporation 202 Burlington Road I Bedford , MA I 01730 -1420 Office : (781) 271-6988 Mobile :~l (b_l(6_> ----~ 6 Email :~r_ H_> -~ ~ mitre .org VA-18-0298-B-000849 Page 2318 of 231i 9 of 871 Document ID: 0.7.1705.389968 From: Selnick , Darin S. EOP/WHO i Sandoval, Camilo J . Cc: Ira iaoawski Drew C. EOP/WHO 5 i Bee: Subject: [EXTERNAL] FW: Summary comments to 300 Pages Report - Electronic Health Record Modernization Date: Tue Mar 20 2018 12:39:36 CDT Attachments: image002 .png Cam Can you answer Andrew question. Darin Darin Selnick Veteran Affairs Advisor White House Domestic Policy Council l..... Ce11 Subject: FW: Summary comments to 300 Pages Report - Electronic Health Record Modernization So whats the status of this? From: 1pl who.eop.gov> Cc: Salvi, Mary E. EOP/WHO (bJ(5l Subject: [EXTERNAL] Summary comments to 300 Pages Report - Electron ic Health Record Modernization =::---------,_ _ VA-18-0298-B-000850 850 of 871 Document ID: 0.7.1705.389968-000001 5 Owner : Seln ick, Darin S. EOP/WHO ~l VA-18-0298-B-000851 851 of 871 imAdd?p thePweo rafr\gato e~ect lon1.0 of the "Performan ce Work Statemen t for the VA 1 ElectronicHealth RecordModernization System",Version 1.7,between what is currently the first paragraph and the second paragraph. This project has been awarded via the public interest exception in FAR 6.302-7. The goal of this accelerated award Is to deliver a modernizedsystemin the best interests of Veterans. their healthcare,and the providers that care for them both insidethe VA and tn commercialcare settings. ? ? This award contemplates the provision of services by Carner. Corporation, and accordinglythese documentsreferenceCerner Corporationand?its software and services. However, the Government may determinethat in some cases a differentsource of software and/or services wlll best support the public's interest in areas such as qualityof care, patien1engagement, operationalefficiency, or interoperabilityto fulfill the goals of Electronic Health Record Modemization, the VeteransoChoiceprogram, or other reasonas the Governmentmay decide. The Governmentmay requireperformanceof part or anof this awardby an alternativesource in any such case. This may Include,for example, delivery of software or services by any contractor within the Government's competitive rangefor the Departmentof Defense?sDHMSM as providedin the Government,s February 1.9, 2015 notice. VA-18-0298-B-000852 852 of 871 Document ID: 0.7.1705.823668 Blackburn , Scott R. DJS ; Windom , John H. ; Zenooz, Ashwini ; Short, John (VACO) ; Bruce Moskowitz 6 ~ mac .com> ; Marc Sherman l(bl< l @gmail.com> 1 ~------/o=va/ou=exchange Cc: '-------------' administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: EHR calls tomorrow night Subject: Mon Mar 19 2018 21 :55:27 CDT Date: Attachments: 5 We will start at 7:30pm tomorrow night. Dial in is:l.... To: Windom, John H. ; (bl(5l group (fydibohf23spdlt)/cn=recipients/cn =j(bl(6l Zenooz, Ashwini Cc: Bee: Subject: FW: White House Electronic Health Records Interoperabili ty Listening Session Invitation Date: Mon Dec 11 2017 19:00:41 CST Attachments: I From: Byrne, Jim (OGC) Sent: Monday, December 11, 2017 6:54 PM To: Blackburn, Scott R. Subject: FW: [EXTERNAL] FW: White House Electronic Health Records Interoperab ility Listening Session Invitation Sent with Good (www.good .com) 5 From: l(bl< l IEOP/WHO Sent: Monday, December 11, 2017 1:39:38 PM To: Byrne, Jim (OGC) Subject: [EXTERNAL] FW: White House Electronic Health Records Interoperability Listening Sess ion Invitation External Participants 1 Kyle Armbrester VA-18-0298-B-000854 854 of 871 Chief Product Officer Athena health 2 Christine Bechte l Coordinator "Get My Health Data" Campaign 3 Ricky Bloombfield Apple 4 Ed Cantwell CEO Center for Healthcare Interoperability 5 Aneesh Chopra Only Conclusion 6 John Doerr Chairman Kleiner Perkins Caufield Byers 7 VA-18-0298-B-000855 855 of 871 Cynthia Fisher Patients Rights Advocate 8 Marc Harrison CEO lntermountain Healthcare 9 Ryan Howells Principal Leavitt Partners 10 Dr. Stan Huff Senior Medical lnformaticist lntermountain Health Care 11 John Kansky President & CEO Indiana Health Information Exchange 12 Chris Klomp CEO VA-18-0298-B-000856 856 of 871 Collective Medical Technologies 13 Bob Kocher Partner Venrock 14 Josh Mandel Health Lead Verily, Google 15 Ken Mand i Boston Children's Hospital 16 Farzard Mostashari CEO Adelade and former National Coordinator for Health IT 17 Frank Opelka 18 Dr. Marc VA-18-0298-B-000857 857 of 871 Overhage CMIO Cerner 19 Ryan Panchadsaram Kleiner Perkins Caufield Byers 20 Mike Polcari VP & Chief Architect 23andme 21 Dan Rodrigues CEO Karee 22 Josh Rosenthal Co-Founder Rowdmap 23 Mariann Yeager CEO Sequo ia Project VA-18-0298-B-000858 858 of 871 Government Part icipants 1 Jared Kushner 2 Seema Verma 3 Chris Liddell 4 Matt Lira 5 Andrew Bremberg 6 Kristen Honey Only to 1 PM and 4 PM 7 Dr. Don VA-18-0298-B-000859 859 of 871 Rucker 8 Joel Minton 9 Scott Blackburn Acting CIO 10 Adam Boehler 11 Eric Hagan Acting Secretary of HHS, Only to 4 PM session 12 Ricci Mulligan Acting Principal Deputy Assistant Secretary 13 John Windom Program Executive for Electronic Health Record Modernization 14 Shannon VA-18-0298-B-000860 860 of 871 Sartin USDS CMS 15 Lynn Bird EMR General Council Representative 16 Kelly Cleary Deputy Genera l Counsel and Chief Legal Officer , CMS 1:00-1 :15 PM Introductory Remarks by Jared Kushner and Seema Verma Laying out the Vision Indian Treaty Room, Room 474 1:15-2 :15PM Introduct ions from Participants and Discussion of Vision Indian Treaty Room , Room 474 2:15 - 3:45 PM Working Group Sessions Secretary of War Rooms Group 1: Government 's role : What actions can CMS/ONC/HHS take to encourage interoperability (e.g., definition of meaningful use, information blocking, etc.)? What timeframe is realistic based on these actions and how can we accelerate that timeframe? Group 2: Technica l standards and authentication: What is needed for full industry support, alignment , and adoption? What approaches /technologies can we use to verify identit ies (e.g. , fingerp rint scanning)? Will this vary by vendor or provider? VA-18-0298-B-000861 86 1 of 87 1 Group 3: Patient and physician engagement: How do we focus the solution to encourage participation (e.g., campaign around demand) and overcome obstacles, and address any issues such as HIPAA compliance? Group 4: Public/private partnership: How do we encourage private sector innovation? Can the government help to jump start with claims or other data? Who do we need to have on board, and how do we best engage with the broadest possible group? 3:45 - 4:00 PM Break 4:00- 4:15 PM Remarks from Acting Secretary Eric Hargan Eisenhower Executive Office Building, Room 350 4:15- 5:00PM Summary of Discussion and Next Steps Eisenhower Executive Office Building, Room 350 VA-18-0298-B-000862 862 of 871 Document ID: 0.7.1705.391045 From: Byrne , Jim (OGC) To: Blackburn , Scott R. Cc: Bee: Subject: FW: [EXTERNAL] FW: White House Electronic Health Records Interoperability Listening Session Invitation Date: Mon Dec 11 2017 18:53:38 CST Attachments: Sent with Good (www.good.com) I From: l(bl(5l EOP/WHO Sent: Monday, December 11, 20171:39:38 PM To: Byrne, J im (OGC) Subject: [EXTERNAL] FW: White House Electronic Health Records Interoperability Listening Sess ion Invitat ion External Participants 1 Kyle Armbrester Chief Product Officer Athena health 2 Christine Bechtel Coordinator "Get My Health Data" Campaign VA-18-0298-B-000863 863 of 871 3 Ricky Bloombfield Apple 4 Ed Cantwell CEO Center for Healthcare Interoperability 5 Aneesh Chopra Only Conclusion 6 John Doerr Chairman Kleiner Perkins Caufield Byers 7 Cynthia Fisher Patients Rights Advocate 8 Marc Harrison VA-18-0298-B-000864 864 of 871 CEO lntermountain Healthcare 9 Ryan Howells Principal Leavitt Partners 10 Dr. Stan Huff Senior Medical lnformaticist lntermountain Hea lth Care 11 John Kansky President & CEO Indiana Health Information Exchange 12 Chris Klomp CEO Collective Medical Technologies 13 Bob Kocher Partner Venrock 14 VA-18-0298-B-000865 865 of 871 Josh Mandel Health Lead Verily, Google 15 Ken Mandi Boston Children's Hospital 16 Farzard Mostashari CEO Adelade and former National Coordinator for Health IT 17 Frank Opelka 18 Dr. Marc Overhage CMIO Gerner 19 Ryan Panchadsaram VA-18-0298-B-000866 866 of 871 Kleiner Perkins Caufield Byers 20 Mike Polcari VP & Chief Architect 23andme 21 Dan Rodrigues CEO Kareo 22 Josh Rosenthal Co-Founder Rowdmap 23 Mariann Yeager CEO Sequo ia Project Government Participants 1 Jared Kushner 2 VA-18-0298-B-000867 867 of 871 Seema Verma 3 Chris Liddell 4 Matt Lira 5 Andrew Bremberg 6 Kristen Honey Only to 1 PM and 4 PM 7 Dr . Don Rucker 8 Joel Minton 9 VA-18-0298-B-000868 868 of 871 Scott Blackburn Acting CIO 10 Adam Boehler 11 Eric Hagan Acting Secretary of HHS, Only to 4 PM session 12 Ricci Mulligan Acting Principal Deputy Ass istant Secretary 13 John Windom Program Executive for Electronic Health Record Modern ization 14 Shannon Sartin USDS CMS 15 Lynn Bird EMR General Council Representative 16 VA-18-0298-B-000869 869 of 871 Kelly Cleary Deputy General Counsel and Chief Legal Officer, CMS 1:00-1:15 PM Introductory Remarks by Jared Kushner and Seema Verma Laying out the Vision Indian Treaty Room, Room 474 1:15-2 :15PM Introduct ions from Participants and Discussion of Vision Indian Treaty Room , Room 474 2:15- 3:45 PM Working Group Sessions Secretary of War Rooms Group 1: Government's role: What actions can CMS/ONC/HHS take to encourage interoperability (e.g., definition of meaningful use, information blocking, etc.)? What timeframe is realistic based on these actions and how can we accelerate that timeframe? Group 2: Technical standards and authentication: What is needed for full industry support, alignment, and adoption? What approaches/technologies can we use to verify identities (e.g ., fingerprint scanning)? Will this vary by vendor or provider? Group 3: Patient and physician engagement: How do we focus the solution to encourage participation (e.g ., campaign around demand) and overcome obstacles, and address any issues such as HIPAA compliance? Group 4: Public/private partnership: How do we encourage private sector innovation? Can the government help to jump start with claims or other data? Who do we need to have on board, and how do we best engage with the broadest possible group? 3:45 - 4:00 PM Break VA-18-0298-B-000870 870 of 871 4:00- 4:15 PM Remarks from Acting Secretary Eric Hargan Eisenhower Executive Office Building , Room 350 4 :15- 5:00PM Summary of Discussion and Next Steps Eisenhower Executive Office Building, Room 350 VA-18-0298-B-000871 871 of 871